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Martínez de Victoria-Carazo J, García-Ceberino PM, de Salazar-González A, Faro-Míguez N, Fuentes-López A, Viñuela-González L, Palomares-Rodríguez J, Valero-Ubierna C, Ruíz-Villaverde R, García-García F, Hernández-Quero J, Ruíz-Sancho AL. Mpox Infection and Sexually Transmitted Infections: A Cross-Sectional Study from a Secondary Hospital in the May-September 2022 International Outbreak. AIDS Res Hum Retroviruses 2023; 39:604-609. [PMID: 37450341 DOI: 10.1089/aid.2023.0016] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/15/2023] Open
Abstract
The aims of this study were to describe the characteristics of patients infected by mpox in our setting, to determine the prevalence of mpox in samples that are classically used for diagnosing sexually transmitted infections (STIs) such as anal, urethral, pharyngeal, and urine, and to assess the prevalence of coinfection with STIs in the same samples. A cross-sectional study was conducted, collecting all confirmed cases of mpox between June and July 2022 using polymerase chain reaction. Sociodemographic data, HIV and other STI status, and prevalence of mpox and STIs in urethral, anal, pharyngeal, or urine samples were collected. Data from 22 patients were extracted, all of whom were men who have sex with men (MSM) and 54.5% were previously HIV positive. The median age was 43 years. All the skin samples were positive for mpox, followed by anal samples (n = 10, 45.5%). Mpox was isolated in 2 or more samples simultaneously in 12 (54%) cases. Nine (41%) patients were positive for an STI and four of them had more than one STIs (18.2%). Human mpox has been epidemiologically significant among MSM. Mpox should be investigated not only in skin lesions but also in samples classically used for STIs. Mpox, such as other STIs, shares ways of transmission and coinfection may be underdiagnosed.
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Affiliation(s)
| | | | | | - Naya Faro-Míguez
- Infectious Diseases Service, Hospital Universitario Clínico San Cecilio, Granada, Spain
| | - Ana Fuentes-López
- Microbiology Service, Hospital Universitario Clínico San Cecilio, Granada, Spain
| | | | | | - Carmen Valero-Ubierna
- Preventive Medicine and Public Health Service, Hospital Universitario Clínico San Cecilio, Granada, Spain
| | | | | | - José Hernández-Quero
- Infectious Diseases Service, Hospital Universitario Clínico San Cecilio, Granada, Spain
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Santos JR, Casadellà M, Noguera-Julian M, Micán-Rivera R, Domingo P, Antela A, Portilla J, Sanz J, Montero-Alonso M, Navarro J, Masiá M, Valcarce-Pardeiro N, Ocampo A, Pérez-Martínez L, García-Vallecillos C, Vivancos MJ, Imaz A, Iribarren JA, Hernández-Quero J, Villar-García J, Barrufet P, Paredes R. Effectiveness and safety of integrase strand transfer inhibitors in Spain: a prospective real-world study. Front Cell Infect Microbiol 2023; 13:1187999. [PMID: 37434782 PMCID: PMC10331300 DOI: 10.3389/fcimb.2023.1187999] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 05/30/2023] [Indexed: 07/13/2023] Open
Abstract
Introduction Second-generation integrase strand transfer inhibitors (INSTIs) are preferred treatment options worldwide, and dolutegravir (DTG) is the treatment of choice in resource-limited settings. Nevertheless, in some resource-limited settings, these drugs are not always available. An analysis of the experience with the use of INSTIs in unselected adults living with HIV may be of help to make therapeutic decisions when second-generation INSTIs are not available. This study aimed to evaluate the real-life effectiveness and safety of dolutegravir (DTG), elvitegravir/cobicistat (EVG/c), and raltegravir (RAL) in a large Spanish cohort of HIV-1-infected patients. Methods Real-world study of adults living with HIV who initiated integrase INSTIs DTG, EVG/c, and RAL-based regimens in three settings (ART-naïve patients, ART-switching, and ART-salvage patients). The primary endpoint was the median time to treatment discontinuation after INSTI-based regimen initiation. Proportion of patients experiencing virological failure (VF) (defined as two consecutive viral loads (VL) ≥200 copies/mL at 24 weeks or as a single determination of VL ≥1,000 copies/mL while receiving DTG, EVG/c or RAL, and at least 3 months after INSTI initiation) and time to VF were also evaluated. Results Virological effectiveness of EVG/c- and RAL-based regimens was similar to that of DTG when given as first-line and salvage therapy. Treatment switching for reasons other than virological failure was more frequent in subjects receiving EVG/c and, in particular, RAL. Naïve patients with CD4+ nadir <100 cells/μL were more likely to develop VF, particularly if they initiated RAL or EVG/c. In the ART switching population, initiation of RAL and EVG/c was associated with both VF and INSTI discontinuation. There were no differences in the time to VF and INSTI discontinuation between DTG, EVG/c and RAL. Immunological parameters improved in the three groups and for the three drugs assessed. Safety and tolerability were consistent with expected safety profiles. Discussion Whereas second-generation INSTIs are preferred treatment options worldwide, and DTG is one of the treatment of choices in resource-limited settings, first-generation INSTIs may still provide high virological and immunological effectiveness when DTG is not available.
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Affiliation(s)
- José Ramón Santos
- Fight Infections Foundation, Service of Infectious Diseases, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | | | | | - Pere Domingo
- Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Antonio Antela
- Infectious Diseases Unit, Santiago de Compostela Clinical University Hospital, Santiago de Compostela, Spain
| | - Joaquin Portilla
- Department of Internal Medicine, Hospital General Universitario Dr. Balmis de Alicante, Alicante, Spain
| | - Jesús Sanz
- Department of Infectious Diseases, University Hospital de La Princesa, Madrid, Spain
| | - Marta Montero-Alonso
- Infectious Diseases Unit, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Jordi Navarro
- Infectious Diseases Department, Hospital Universitari Vall d’Hebron, Barcelona, Spain
| | - Mar Masiá
- Infectious Diseases Unit, Elche University General Hospital, Elche, Spain
- Centro de Investigaciones Biomédicas en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | | | | | - Laura Pérez-Martínez
- Department of Infectious Diseases, Biomedical Research Center of La Rioja (CIBIR), Logroño, Spain
| | | | - María Jesús Vivancos
- Centro de Investigaciones Biomédicas en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Department of Infectious Diseases and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Ramón y Cajal Hospital, Madrid, Spain
| | - Arkaitz Imaz
- HIV and STI Unit, Infectious Diseases Department, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, Spain
| | - José Antonio Iribarren
- Department of Infectious Diseases, Donostia University Hospital, Instituto de Investigación Sanitaria BioDonostia, Universidad del País Vasco, San Sebastián, Spain
| | | | - Judit Villar-García
- Infectious Diseases Department, Hospital del Mar - Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain
| | - Pilar Barrufet
- Infectious Diseases Unit, Mataró Hospital, Mataró, Spain
| | - Roger Paredes
- Fight Infections Foundation, Service of Infectious Diseases, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- IrsiCaixa AIDS Research Institute, Badalona, Spain
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3
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Gil-Rodríguez J, Martos-Ruiz M, Benavente-Fernández A, Aranda-Laserna P, Montero-Alonso MÁ, Peregrina-Rivas JA, Fernández-Reyes D, Martínez de Victoria-Carazo J, Guirao-Arrabal E, Hernández-Quero J. Lung ultrasound score severity cut-off points in COVID-19 pneumonia. A systematic review and validating cohort. Med Clin (Engl Ed) 2023; 160:531-539. [PMID: 37337552 PMCID: PMC10273011 DOI: 10.1016/j.medcle.2023.01.023] [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] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 01/06/2023] [Indexed: 06/21/2023]
Abstract
Objectives Our purpose was to establish different cut-off points based on the lung ultrasound score (LUS) to classify COVID-19 pneumonia severity. Methods Initially, we conducted a systematic review among previously proposed LUS cut-off points. Then, these results were validated by a single-centre prospective cohort study of adult patients with confirmed SARS-CoV-2 infection. Studied variables were poor outcome (ventilation support, intensive care unit admission or 28-days mortality) and 28-days mortality. Results From 510 articles, 11 articles were included. Among the cut-off points proposed in the articles included, only the LUS > 15 cut-off point could be validated for its original endpoint, demonstrating also the strongest relation with poor outcome (odds ratio [OR] = 3.636, confidence interval [CI] 1.411-9.374). Regarding our cohort, 127 patients were admitted. In these patients, LUS was statistically associated with poor outcome (OR = 1.303, CI 1.137-1.493), and with 28-days mortality (OR = 1.024, CI 1.006-1.042). LUS > 15 showed the best diagnostic performance when choosing a single cut-off point in our cohort (area under the curve 0.650). LUS ≤ 7 showed high sensitivity to rule out poor outcome (0.89, CI 0.695-0.955), while LUS > 20 revealed high specificity to predict poor outcome (0.86, CI 0.776-0.917). Conclusions LUS is a good predictor of poor outcome and 28-days mortality in COVID-19. LUS ≤ 7 cut-off point is associated with mild pneumonia, LUS 8-20 with moderate pneumonia and ≥20 with severe pneumonia. If a single cut-off point were used, LUS > 15 would be the point which better discriminates mild from severe disease.
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Affiliation(s)
- Jaime Gil-Rodríguez
- Internal Medicine Unit, San Cecilio University Hospital, Avenida del Conocimiento s/n, 18016 Granada, Spain
| | - Michel Martos-Ruiz
- Internal Medicine Unit, San Cecilio University Hospital, Avenida del Conocimiento s/n, 18016 Granada, Spain
| | | | - Pablo Aranda-Laserna
- Internal Medicine Unit, San Cecilio University Hospital, Avenida del Conocimiento s/n, 18016 Granada, Spain
| | - Miguel Ángel Montero-Alonso
- Department of Statistics and Operational Research, University of Granada, Avenida de la Investigación n° 11, 18071 Granada, Spain
| | | | - Daniel Fernández-Reyes
- Internal Medicine Unit, San Cecilio University Hospital, Avenida del Conocimiento s/n, 18016 Granada, Spain
| | | | - Emilio Guirao-Arrabal
- Infectious Diseases Unit, San Cecilio University Hospital, Avenida del Conocimiento s/n, 18016 Granada, Spain
| | - José Hernández-Quero
- Infectious Diseases Unit, San Cecilio University Hospital, Avenida del Conocimiento s/n, 18016 Granada, Spain
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Rodríguez-Hernández MÁ, Carneros D, Núñez-Núñez M, Coca R, Baena R, López-Ruiz GM, Cano-Serrano ME, Martínez-Tellería A, Fuentes-López A, Praena-Fernandez JM, Garbers C, Hernández-Quero J, García F, Rose-John S, Bustos M. Identification of IL-6 Signalling Components as Predictors of Severity and Outcome in COVID-19. Front Immunol 2022; 13:891456. [PMID: 35634332 PMCID: PMC9137400 DOI: 10.3389/fimmu.2022.891456] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [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: 03/07/2022] [Accepted: 04/11/2022] [Indexed: 11/13/2022] Open
Abstract
IL-6 is one of the major mediators of the hyper-inflammatory responses with complex biological functions as it can signal via different modes of action. IL-6 by classical signalling has anti-inflammatory and antibacterial activities, while trans-signalling mediates pro-inflammatory effects. The net biological effect of IL-6 is established by multiple factors beyond its absolute concentration. Here, we assess the relationship between IL-6 signalling variables [IL-6, soluble IL-6R (sIL-6R) and soluble gp130 (sgp130)] and outcomes in a cohort of 366 COVID-19 patients. The potential trans-signalling was evaluated by a ratio between the pro-inflammatory binary IL-6:sIL-6R complex and the inactive ternary IL-6:sIL-6R:sgp130 complex (binary/ternary complex) and the fold molar excess of sgp130 over sIL-6R (FME). Our data provide new evidence that high levels of IL-6, sIL-6R, sgp130, binary/ternary complex ratio, and low FME are independent predictors of COVID-19 severity in survivor patients (without death), and the combination of IL-6 + sIL-6R + sgp130 exhibited the most robust classification capacity. Conversely, in a subgroup of patients with a very poor prognosis, we found that high levels of IL-6 and low levels of sIL-6R, sgp130, and binary/ternary complex ratio were predictors of death. In this context, the highest predictive capacity corresponded to the combined analysis of IL-6 + FME + lymphopenia + creatinine. Herein, we present IL-6 signalling variables as a helpful tool for the early identification and stratification of patients with clear implications for treatment and clinical decision-making.
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Affiliation(s)
- María Ángeles Rodríguez-Hernández
- Area of Liver, Digestive and Inflammatory Diseases, Institute of Biomedicine of Seville (IBIS), Spanish National Research Council (CSIC) - University of Seville (US) - Virgen del Rocio University Hospital (HUVR), Seville, Spain
- *Correspondence: María Ángeles Rodríguez-Hernández, ; Matilde Bustos,
| | - David Carneros
- Area of Liver, Digestive and Inflammatory Diseases, Institute of Biomedicine of Seville (IBIS), Spanish National Research Council (CSIC) - University of Seville (US) - Virgen del Rocio University Hospital (HUVR), Seville, Spain
| | - María Núñez-Núñez
- Department of Pharmacy, San Cecilio University Hospital, Granada, Spain
- Infectious Disease Unit, San Cecilio University Hospital, Granada, Spain
- Biosanitary Research Institute of Granada (ibs.Granada), Granada, Spain
| | - Ramón Coca
- Department of Clinical Analysis, Virgen de las Nieves University Hospital, Granada, Spain
| | - Rosario Baena
- Department of Pharmaceutical Technology and Chemistry, University of Navarra, Pamplona, Spain
| | - Gema M. López-Ruiz
- Area of Liver, Digestive and Inflammatory Diseases, Institute of Biomedicine of Seville (IBIS), Spanish National Research Council (CSIC) - University of Seville (US) - Virgen del Rocio University Hospital (HUVR), Seville, Spain
| | | | | | - Ana Fuentes-López
- Department of Microbiology, San Cecilio University Hospital, Granada, Spain
| | | | - Christoph Garbers
- Department of Pathology, Medical Faculty, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
| | | | - Federico García
- Biosanitary Research Institute of Granada (ibs.Granada), Granada, Spain
- Department of Microbiology, San Cecilio University Hospital, Granada, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), ISCIII, Madrid, Spain
| | | | - Matilde Bustos
- Area of Liver, Digestive and Inflammatory Diseases, Institute of Biomedicine of Seville (IBIS), Spanish National Research Council (CSIC) - University of Seville (US) - Virgen del Rocio University Hospital (HUVR), Seville, Spain
- *Correspondence: María Ángeles Rodríguez-Hernández, ; Matilde Bustos,
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5
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Peregrina-Rivas JA, Guirao-Arrabal E, Ramos-Pleguezuelos FM, Hernández-Quero J. Erythema nodosum: An uncommon manifestation of Rickettsiosis. Enferm Infecc Microbiol Clin (Engl Ed) 2022; 40:151-152. [PMID: 35249676 DOI: 10.1016/j.eimce.2021.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 01/20/2021] [Indexed: 06/14/2023]
Affiliation(s)
| | - Emilio Guirao-Arrabal
- Unidad de Enfermedades Infecciosas, Hospital Universitario San Cecilio, Granada, Spain.
| | | | - José Hernández-Quero
- Unidad de Enfermedades Infecciosas, Hospital Universitario San Cecilio, Granada, Spain
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6
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Howe AY, Rodrigo C, Cunningham E, Douglas MW, Dietz J, Grebely J, Popping S, Sfalcin JA, Parczewski M, Sarrazin C, de Salazar A, Fuentes A, Sayan M, Quer J, Kjellin M, Kileng H, Mor O, Lennerstrand J, Fourati S, di Maio VC, Chulanov V, Pawlotsky JM, Harrigan PR, Ceccherini-Silberstein F, Garcia F, Martinello M, Matthews G, Fernando FF, Esteban JI, Müllhaupt B, Wiesch JSZ, Buggisch P, Neumann-Haefelin C, Berg T, Berg CP, Schattenberg JM, Moreno C, Stauber R, Lloyd A, Dore G, Applegate T, Ignacio J, Garcia-Cehic D, Gregori J, Rodriguez-Frias F, Rando A, Angelico M, Andreoni M, Babudieri S, Bertoli A, Cento V, Coppola N, Craxì A, Paolucci S, Parruti G, Pasquazzi C, Perno CF, Teti E, Vironet C, Lannergård A, Duberg AS, Aleman S, Gutteberg T, Soulier A, Gourgeon A, Chevaliez S, Pol S, Carrat F, Salmon D, Kaiser R, Knopes E, Gomes P, de Kneght R, Rijnders B, Poljak M, Lunar M, Usubillaga R, Seguin C, Tay E, Wilson C, Wang DS, George J, Kok J, Pérez AB, Chueca N, García-Deltoro M, Martínez-Sapiña AM, Lara-Pérez MM, García-Bujalance S, Aldámiz-Echevarría T, Vera-Méndez FJ, Pineda JA, Casado M, Pascasio JM, Salmerón J, Alados-Arboledas JC, Poyato A, Téllez F, Rivero-Juárez A, Merino D, Vivancos-Gallego MJ, Rosales-Zábal JM, Ocete MD, Simón MÁ, Rincón P, Reus S, De la Iglesia A, García-Arata I, Jiménez M, Jiménez F, Hernández-Quero J, Galera C, Balghata MO, Primo J, Masiá M, Espinosa N, Delgado M, von-Wichmann MÁ, Collado A, Santos J, Mínguez C, Díaz-Flores F, Fernández E, Bernal E, De Juan J, Antón JJ, Vélez M, Aguilera A, Navarro D, Arenas JI, Fernández C, Espinosa MD, Ríos MJ, Alonso R, Hidalgo C, Hernández R, Téllez MJ, Rodríguez FJ, Antequera P, Delgado C, Martín P, Crespo J, Becerril B, Pérez O, García-Herola A, Montero J, Freyre C, Grau C, Cabezas J, Jimenez M, Rodriguez MAM, Quilez C, Pardo MR, Muñoz-Medina L, Figueruela B. Characteristics of hepatitis C virus resistance in an international cohort after a decade of direct-acting antivirals. JHEP Rep 2022; 4:100462. [PMID: 35434589 PMCID: PMC9010635 DOI: 10.1016/j.jhepr.2022.100462] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 02/05/2022] [Indexed: 10/24/2022] Open
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7
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García-Ceberino PM, Guirao-Arrabal E, Ferrer Amate F, Hernández-Quero J. Fatal sepsis months after bladder instillations with Mycobacterium bovis in patient with SARS-CoV-2 infection. Rev Esp Quimioter 2021; 34:684-681. [PMID: 34753280 PMCID: PMC8638762 DOI: 10.37201/req/095.2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- P M García-Ceberino
- Pedro Manuel García Ceberino, Internal Medicine Unit. Hospital Universitario Clínico San Cecilio. Av/ Investigación s/n. (18016). Granada, Spain.
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8
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Carrero A, Berenguer J, Hontañón V, Guardiola JM, Navarro J, von Wichmann MA, Téllez MJ, Quereda C, Santos I, Sanz J, Galindo MJ, Hernández-Quero J, Jiménez-Sousa MA, Pérez-Latorre L, Bellón JM, Resino S, Esteban H, Martínez E, González-García J. Effects of Hepatitis C Virus (HCV) Eradication on Bone Mineral Density in Human Immunodeficiency Virus/HCV-Coinfected Patients. Clin Infect Dis 2021; 73:e2026-e2033. [PMID: 32930720 DOI: 10.1093/cid/ciaa1396] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 09/11/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Little is known about the effects of eradication of hepatitis C virus (HCV) on bone mineral density (BMD) and biomarkers of bone remodeling in human immunodeficiency virus (HIV)/HCV-coinfected patients. METHODS We prospectively assessed standardized BMD (sBMD) at the lumbar spine and femoral neck, World Health Organization BMD categories at both sites, and plasma concentrations of soluble receptor activator of NF-κβ ligand (sRANKL), and osteoprotegerin (OPG) at baseline (the date of initiation of anti-HCV therapy) and at 96 weeks. RESULTS A total of 238 patients were included. The median age was 49.5 years, 76.5% were males, 48.3% had cirrhosis, 98.3% were on antiretroviral therapy, median CD4+ cell count was 527 cells/μL, and 86.6% had HIV-1 RNA <50 copies/mL. The prevalence of osteoporosis at baseline at the lumbar spine (LS) and femoral neck (FN) was 17.6% and 7.2%, respectively. Anti-HCV therapy comprised pegylated interferon (peg-IFN) and ribavirin (RBV) plus 1 direct-acting antiviral in 53.4%, peg-IFN/RBV in 34.5%, and sofosbuvir/RBV in 12.2%. A total of 145 (60.9%) patients achieved sustained virologic response (SVR). No significant effect of SVR was observed on sBMD for the interaction between time and SVR either in the LS (P = .801) or the FN (P = .911). Likewise, no significant effect of SVR was observed in plasma levels of sRANKL (P = .205), OPG (P = .249), or sRANKL/OPG ratio (P = .123) for the interaction between time and SVR. No significant correlation was found between fibrosis by transient elastography, and LS and FN sBMD, at baseline and week 96. CONCLUSIONS SVR was not associated with significant changes in BMD nor biomarkers of bone remodeling in HIV/HCV-coinfected persons.
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Affiliation(s)
- Ana Carrero
- Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Juan Berenguer
- Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Víctor Hontañón
- Hospital Universitario La Paz, Madrid, Spain.,Instituto de Investigación Sanitaria La Paz, Madrid, Spain
| | | | - Jordi Navarro
- Hospital Universitari Vall d'Hebrón, Barcelona, Spain
| | | | | | | | | | - José Sanz
- Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Spain
| | | | | | - María A Jiménez-Sousa
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Leire Pérez-Latorre
- Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - José M Bellón
- Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Salvador Resino
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | | | | | - Juan González-García
- Hospital Universitario La Paz, Madrid, Spain.,Instituto de Investigación Sanitaria La Paz, Madrid, Spain
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Guirao-Arrabal E, Muñoz-Medina L, Anguita-Santos F, Vinuesa-García D, Hernández-Quero J. Empirical treatment with doxycycline of fever of intermediate duration. Eur J Clin Microbiol Infect Dis 2021; 40:2047-2050. [PMID: 34327567 PMCID: PMC8321886 DOI: 10.1007/s10096-021-04322-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 07/20/2021] [Indexed: 10/31/2022]
Affiliation(s)
- Emilio Guirao-Arrabal
- Infectious Disease Unit, Hospital Universitario San Cecilio, Avenida de la Investigación s/n. 18014, Granada, Spain.
| | - Leopoldo Muñoz-Medina
- Infectious Disease Unit, Hospital Universitario San Cecilio, Avenida de la Investigación s/n. 18014, Granada, Spain
| | - Francisco Anguita-Santos
- Infectious Disease Unit, Hospital Universitario San Cecilio, Avenida de la Investigación s/n. 18014, Granada, Spain
| | - David Vinuesa-García
- Infectious Disease Unit, Hospital Universitario San Cecilio, Avenida de la Investigación s/n. 18014, Granada, Spain
| | - José Hernández-Quero
- Infectious Disease Unit, Hospital Universitario San Cecilio, Avenida de la Investigación s/n. 18014, Granada, Spain
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10
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Pérez-Latorre L, Berenguer J, Micán R, Montero M, Cifuentes C, Puig T, Sanz J, Ferrero OL, De La Fuente B, Rodríguez C, Reus S, Hernández-Quero J, Gaspar G, Pérez-Martínez L, García C, Force L, Veloso S, De Miguel M, Jarrín I, González-García J. HIV/HBV coinfection: temporal trends and patient characteristics, Spain, 2002 to 2018. ACTA ACUST UNITED AC 2021; 26. [PMID: 34169818 PMCID: PMC8229377 DOI: 10.2807/1560-7917.es.2021.26.25.2000236] [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] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background Recent and reliable estimates on the prevalence of coinfection with human immunodeficiency virus (HIV) and hepatitis B virus (HBV) in Europe are lacking. Aim Leveraged on a study designed to assess HIV/HCV coinfection prevalence, we assessed the prevalence of HIV/HBV coinfection in Spain in 2018 and compared the results with five similar studies performed since 2002. Methods This cross-sectional prevalence study was carried out in 43 centres, and patients were selected using simple random sampling. The reference population comprised 40,322 patients and the sample size were 1,690 patients. Results The prevalence of HIV/HBV coinfection in Spain at the end of 2018 was 3.2%. The prevalence in 2002, 2009, 2015, 2016 and 2017 was 4.9%, 3.4%, 3%, 3.9% and 3%, respectively. Among the HIV/HBV-coinfected patients identified in 2018, 16.7% had cirrhosis according to transient elastography and 26.3% tested positive for antibodies against hepatitis D virus. All HIV/HBV-coinfected patients were receiving drugs with activity against HBV, and 97% of those tested for HBV DNA had an HBV DNA load < 80 IU/mL. Conclusions The prevalence of HIV/HBV coinfection in Spain remained stable at around 3% for a decade. Our data could facilitate the design of national programmes to control HBV infection and help identify areas of patient management that need improvement.
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Affiliation(s)
| | - Juan Berenguer
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | | | | | - Teresa Puig
- Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - José Sanz
- Hospital Príncipe de Asturias, Alcalá de Henares, Spain
| | | | | | | | - Sergio Reus
- Hospital General Universitario de Alicante, Alicante, Spain
| | | | | | | | - Coral García
- Hospital Universitario Virgen de las Nieves, Granada, Spain
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- The members of the GeSIDA 8514 Study Group have been listed under Investigators
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Aomar-Millán IF, Salvatierra J, Torres-Parejo Ú, Faro-Miguez N, Callejas-Rubio JL, Ceballos-Torres Á, Cruces-Moreno MT, Gómez-Jiménez FJ, Hernández-Quero J, Anguita-Santos F. Anakinra after treatment with corticosteroids alone or with tocilizumab in patients with severe COVID-19 pneumonia and moderate hyperinflammation. A retrospective cohort study. Intern Emerg Med 2021; 16:843-852. [PMID: 33400157 PMCID: PMC7782569 DOI: 10.1007/s11739-020-02600-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 12/02/2020] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Little evidence appears to exist for the use of anakinra, a recombinant interleukin-1 receptor antagonist, after non-response to treatment with corticosteroids alone or combined with tocilizumab in patients with severe COVID-19 pneumonia and moderate hyperinflammatory state. PATIENTS AND METHODS A retrospective observational cohort study was carried out involving 143 patients with severe COVID-19 pneumonia and moderate hyperinflammation. They received standard therapy along with pulses of methylprednisolone (group 1) or methylprednisolone plus tocilizumab (group 2), with the possibility of receiving anakinra (group 3) according to protocol. The aim of this study was to assess the role of anakinra in the clinical course (death, admission to the intensive care ward) during the first 60 days after the first corticosteroid pulse. Clinical, laboratory, and imaging characteristics as well as infectious complications were also analyzed. RESULTS 74 patients (51.7%) in group 1, 59 (41.3%) patients in group 2, and 10 patients (7%) in group 3 were included. 8 patients (10.8%) in group 1 died, 6 (10.2%) in group 2, and 0 (0%) in group 3. After adjustment for age and clinical severity indices, treatment with anakinra was associated with a reduced risk of mortality (adjusted hazard ratio 0.518, 95% CI 0.265-0.910; p = 0.0437). Patients in group 3 had a lower mean CD4 count after 3 days of treatment. No patients in this group presented infectious complications. CONCLUSIONS In patients with moderate hyperinflammatory state associated with severe COVID-19 pneumonia, treatment with anakinra after non-response to corticosteroids or corticosteroids plus tocilizumab therapy may be an option for the management of these patients and may improve their prognosis.
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Affiliation(s)
- Ismael Francisco Aomar-Millán
- Department of Internal Medicine, San Cecilio University Hospital, Hospital Universitario San Cecilio, Avda. del Conocimiento s/n, 18016, Granada, Spain.
| | - Juan Salvatierra
- Department of Rheumatology, San Cecilio University Hospital, Granada, Spain
| | - Úrsula Torres-Parejo
- Department of Statistics and Operational Research, University of Granada, Granada, Spain
| | - Naya Faro-Miguez
- Department of Infectious Diseases, San Cecilio University Hospital, Granada, Spain
| | - José Luis Callejas-Rubio
- Department of Internal Medicine, San Cecilio University Hospital, Hospital Universitario San Cecilio, Avda. del Conocimiento s/n, 18016, Granada, Spain
| | - Ángel Ceballos-Torres
- Department of Internal Medicine, San Cecilio University Hospital, Hospital Universitario San Cecilio, Avda. del Conocimiento s/n, 18016, Granada, Spain
| | | | - Francisco Javier Gómez-Jiménez
- Department of Internal Medicine, San Cecilio University Hospital, Hospital Universitario San Cecilio, Avda. del Conocimiento s/n, 18016, Granada, Spain
| | - José Hernández-Quero
- Department of Infectious Diseases, San Cecilio University Hospital, Granada, Spain
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12
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Aomar-Millán IF, Salvatierra J, Hernández-Quero J. Anakinra after treatment with corticosteroids alone or with tocilizumab in patients with severe COVID‑19 pneumonia and moderate hyperinflammation. A retrospective cohort study: reply. Intern Emerg Med 2021; 16:1105-1106. [PMID: 33694056 PMCID: PMC7945597 DOI: 10.1007/s11739-021-02690-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 02/25/2021] [Indexed: 11/15/2022]
Affiliation(s)
- Ismael Francisco Aomar-Millán
- Department of Internal Medicine, San Cecilio University Hospital, Avda. del Conocimiento s/n, 18016, Granada, Spain.
| | - Juan Salvatierra
- Department of Rheumatology, San Cecilio University Hospital, Granada, Spain
| | - José Hernández-Quero
- Department of Infectious Diseases, San Cecilio University Hospital, Granada, Spain
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13
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Salvatierra J, Aomar-Millán IF, Hernández-Quero J. Interleukin-1 and interleukin-6 inhibition in patients with COVID-19 and hyperinflammation. Lancet Rheumatol 2021; 3:e248. [PMID: 33782671 PMCID: PMC7990485 DOI: 10.1016/s2665-9913(21)00064-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Juan Salvatierra
- Department of Rheumatology, San Cecilio University Hospital, Granada, Spain
| | | | - José Hernández-Quero
- Department of Infectious Diseases, San Cecilio University Hospital, Granada, Spain
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Peregrina-Rivas JA, Guirao-Arrabal E, Ramos-Pleguezuelos FM, Hernández-Quero J. Erythema nodosum: An uncommon manifestation of Rickettsiosis. Enferm Infecc Microbiol Clin 2021; 40:S0213-005X(21)00031-8. [PMID: 33622497 DOI: 10.1016/j.eimc.2021.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 01/18/2021] [Accepted: 01/20/2021] [Indexed: 11/20/2022]
Affiliation(s)
| | - Emilio Guirao-Arrabal
- Unidad de Enfermedades Infecciosas, Hospital Universitario San Cecilio, Granada, Spain.
| | | | - José Hernández-Quero
- Unidad de Enfermedades Infecciosas, Hospital Universitario San Cecilio, Granada, Spain
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15
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Badiola J, Muñoz-Medina L, Callejas JL, Delgado-García A, Jurado M, Hernández-Quero J. Hemophagocytic lymphohistiocytosis associated with Leishmania: A hidden passenger in endemic areas. Enferm Infecc Microbiol Clin 2020; 39:188-191. [PMID: 32473845 DOI: 10.1016/j.eimc.2020.04.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 04/13/2020] [Accepted: 04/19/2020] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Hemophagocytic lymphohistiocytosis (HLH) is an aggressive and life-threatening syndrome characterized by excessive immune activation. We analyzed the presentation, diagnosis and prognosis of our cohort of HLH-Leishmania cases. METHODS We studied HLH cases in patients over 14 years of age in the province of Granada (Spain), from January 2008 to November 2019. RESULTS In this study, Leishmania was the predominant trigger of adult HLH in our region. There were no differences in the clinical-analytical presentation between HLH triggered by Leishmania and those initiated by a different cause. RT-PCR was the best tool to identify Leishmania as the trigger of HLH, given that the other microbiological tests showed low sensitivity to detect the parasite in our HLH-Leishmania cases. CONCLUSION A comprehensive search for Leishmania is mandatory in HLH cases. Based on our findings, we propose that RT-PCR for Leishmania in bone marrow samples must be included in HLH differential diagnostic protocols.
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Affiliation(s)
- Jon Badiola
- Department of Hematology and Hemotherapy, Hospital Universitario Virgen de las Nieves, Granada, Spain.
| | - Leopoldo Muñoz-Medina
- Department of Infectious Disease, Hospital Universitario San Cecilio, Granada, Spain
| | - José Luis Callejas
- Department of Autoimmune Diseases, Hospital Universitario San Cecilio, Granada, Spain
| | - Alicia Delgado-García
- Department of Hematology and Hemotherapy, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Manuel Jurado
- Department of Hematology and Hemotherapy, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - José Hernández-Quero
- Department of Infectious Disease, Hospital Universitario San Cecilio, Granada, Spain
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16
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Guirao-Arrabal E, González LM, García-Fogeda JL, Miralles-Adell C, Sánchez-Moreno G, Chueca N, Anguita-Santos F, Muñoz-Medina L, Vinuesa-García D, Hernández-Quero J, Montero E. Imported babesiosis caused by Babesia microti-A case report. Ticks Tick Borne Dis 2020; 11:101435. [PMID: 32249191 DOI: 10.1016/j.ttbdis.2020.101435] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 03/05/2020] [Accepted: 03/26/2020] [Indexed: 12/22/2022]
Affiliation(s)
- Emilio Guirao-Arrabal
- Infectious Diseases Unit, Hospital Universitario San Cecilio, Avenida de la Investigación, s/n, 18016, Granada, Spain.
| | - Luis Miguel González
- Parasitology Reference and Research Laboratory, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Ctra. Majadahonda-Pozuelo Km 2, 28220, Majadahonda, Madrid, Spain.
| | - José Luís García-Fogeda
- Infectious Diseases Unit, Hospital Universitario San Cecilio, Avenida de la Investigación, s/n, 18016, Granada, Spain.
| | - Claudia Miralles-Adell
- Laboratory Unit, Hospital Universitario San Cecilio, Avenida de la Investigación, s/n, 18016 Granada, Spain.
| | - Guacimara Sánchez-Moreno
- Hematology Unit, Hospital Universitario San Cecilio, Avenida de la Investigación, s/n, 18016 Granada, Spain.
| | - Natalia Chueca
- Hematology Unit, Hospital Universitario San Cecilio, Avenida de la Investigación, s/n, 18016 Granada, Spain.
| | - Francisco Anguita-Santos
- Infectious Diseases Unit, Hospital Universitario San Cecilio, Avenida de la Investigación, s/n, 18016, Granada, Spain.
| | - Leopoldo Muñoz-Medina
- Infectious Diseases Unit, Hospital Universitario San Cecilio, Avenida de la Investigación, s/n, 18016, Granada, Spain.
| | - David Vinuesa-García
- Infectious Diseases Unit, Hospital Universitario San Cecilio, Avenida de la Investigación, s/n, 18016, Granada, Spain.
| | - José Hernández-Quero
- Infectious Diseases Unit, Hospital Universitario San Cecilio, Avenida de la Investigación, s/n, 18016, Granada, Spain.
| | - Estrella Montero
- Parasitology Reference and Research Laboratory, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Ctra. Majadahonda-Pozuelo Km 2, 28220, Majadahonda, Madrid, Spain.
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Pérez AB, Chueca N, Macías J, Pineda JA, Salmerón J, Rivero-Juárez A, Hidalgo-Tenorio C, Espinosa MD, Téllez F, Von-Wichmann MÁ, Omar M, Santos J, Hernández-Quero J, Antón JJ, Collado A, Lozano AB, García-Deltoro M, Casado M, Pascasio JM, Selfa A, Rosales JM, De la Iglesia A, Arenas JI, García-Bujalance S, Ríos MJ, Bernal E, Martínez O, García-Herola A, Vélez M, Rincón P, García F. Prevalence of resistance associated substitutions and efficacy of baseline resistance-guided chronic hepatitis C treatment in Spain from the GEHEP-004 cohort. PLoS One 2019; 14:e0221231. [PMID: 31469856 PMCID: PMC6716636 DOI: 10.1371/journal.pone.0221231] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 04/20/2019] [Accepted: 08/01/2019] [Indexed: 12/11/2022] Open
Abstract
Treatment guidelines differ in their recommendation to determine baseline resistance associated substitutions (RAS) before starting a first-line treatment with direct-acting antivirals (DAAs). Here we analyze the efficacy of DAA treatment with baseline RAS information. We conducted a prospective study involving 23 centers collaborating in the GEHEP-004 DAA resistance cohort. Baseline NS5A and NS3 RASs were studied by Sanger sequencing. After issuing a comprehensive resistance report, the treating physician decided the therapy, duration and ribavirin use. Sustained virological response (SVR12) data are available in 275 patients. Baseline NS5A RAS prevalence was between 4.3% and 26.8% according to genotype, and NS3 RASs prevalence (GT1a) was 6.3%. Overall, SVR12 was 97.8%. Amongst HCV-GT1a patients, 75.0% had >800,000 IU/ml and most of those that started grazoprevir/elbasvir were treated for 12 weeks. In genotype 3, NS5A Y93H was detected in 9 patients. 42.8% of the HCV-GT3 patients that started sofosbuvir/velpatasvir included ribavirin, although only 14.7% carried Y93H. The efficacy of baseline resistance-guided treatment in our cohort has been high across the most prevalent HCV genotypes in Spain. The duration of the grazoprevir/elbasvir treatment adhered mostly to AASLD/IDSA recommendations. In cirrhotic patients infected with GT-3 there has been a high use of ribavirin.
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Affiliation(s)
- Ana Belén Pérez
- Clinical Microbiology Unit, University Hospital Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, Spain
| | - Natalia Chueca
- Clinical Microbiology Unit, University Hospital San Cecilio, Instituto de Investigacion Ibs. Granada, Granada, Spain
| | - Juan Macías
- Infectious Diseases Unit, University Hospital Nuestra Señora de Valme, Sevilla, Spain
| | - Juan Antonio Pineda
- Infectious Diseases Unit, University Hospital Nuestra Señora de Valme, Sevilla, Spain
| | - Javier Salmerón
- Hepatology Unit, University Hospital San Cecilio Granada, Instituto de Investigación Ibs. CIBERehd, Granada, Spain
| | - Antonio Rivero-Juárez
- Infectious Diseases Unit, University Hospital Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba, Córdoba, Spain
| | | | | | - Francisco Téllez
- Infectious Diseases Unit, Hospital Puerto Real, Puerto Real, Cádiz, Spain
| | | | - Mohamed Omar
- Infectious Diseases Unit, Complejo Hospitalario de Jaén, Jáen, Spain
| | - Jesús Santos
- Infectious Diseases Unit, University Hospital Virgen de la Victoria, Málaga, Spain
| | | | | | - Antonio Collado
- Infectious Diseases Unit, Complejo Hospitalario Torrecárdenas, Almería, Spain
| | - Ana Belén Lozano
- Infectious Diseases Unit, Hospital de Poniente, El Ejido, Almería, Spain
| | | | - Marta Casado
- Hepatology Unit, Complejo Hospitalario Torrecárdenas, Almería, Spain
| | | | - Aida Selfa
- Hepatology Unit, Hospital Comarcal Santa Ana, Motril Granada, Spain
| | | | | | | | | | - María José Ríos
- Infectious Diseases Unit, University Hospital Virgen Macarena, Seville, Spain
| | - Enrique Bernal
- Infectious Diseases Unit, Hospital General Reina Sofía, Murcia, Spain
| | - Onofre Martínez
- Infectious Diseases Unit, University Hospital Santa Lucía, Cartagena, Spain
| | | | - Mónica Vélez
- Infectious Diseases Unit, Hospital General de La Palma, La Palma, Spain
| | - Pilar Rincón
- Infectious Diseases Unit, University Hospital Nuestra Señora de Valme, Sevilla, Spain
| | - Federico García
- Clinical Microbiology Unit, University Hospital San Cecilio, Instituto de Investigacion Ibs. Granada, Granada, Spain
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Núñez-Núñez M, Casas-Hidalgo I, García-Fumero R, Vallejo-Rodríguez I, Anguita-Santos F, Hernández-Quero J, Cabeza-Barrera J, Ruiz-Sancho A. Dalbavancin is a novel antimicrobial against Gram-positive pathogens: clinical experience beyond labelled indications. Eur J Hosp Pharm 2018; 27:310-312. [PMID: 32839266 DOI: 10.1136/ejhpharm-2018-001711] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 10/22/2018] [Accepted: 10/30/2018] [Indexed: 11/03/2022] Open
Abstract
Very limited labelled indications have been approved for the newer antimicrobials. Data on the clinical uses, efficacy and safety of dalbavancin are scarce, thus here we sought to describe our clinical experience. 16-month observational prospective study was performed. 19 (86%) were used under off-label indications. 10 (46%) for osteoarticular infections, 5 (23%) bloodstream infections and 3 (14%) endocarditis. To highlight, one patient received dalbavancin as long-term suppressive therapy. Most frequent use reasons were promptly hospital discharge, 11 (65%), and the presence of resistant organisms involving limited treatment options, 5 (23%). Successful outcome was observed in >95% of the patients and only 1 (4.5%) adverse event was reported. Further evidence beyond labelled indications is urgently needed. Despite the limitations, dalbavancin appears to be a safe and efficient option for adult patients who have tried and/or failed other therapies due to multidrug-resistant Gram-positive organisms.
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Affiliation(s)
- María Núñez-Núñez
- Department of Pharmacy, University Hospital San Cecilio, Granada, Andalucía, Spain.,Department of Infectious Diseases, University Hospital San Cecilio, Granada, Andalucía, Spain
| | | | - Ricardo García-Fumero
- Department of Pharmacy, University Hospital Virgen de las Nieves, Granada, Andalucía, Spain
| | | | | | - José Hernández-Quero
- Department of Infectious Diseases, University Hospital San Cecilio, Granada, Andalucía, Spain
| | - José Cabeza-Barrera
- Department of Pharmacy, University Hospital San Cecilio, Granada, Andalucía, Spain
| | - Andrés Ruiz-Sancho
- Department of Infectious Diseases, University Hospital San Cecilio, Granada, Andalucía, Spain
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Pasquau J, Hidalgo-Tenorio C, Montes ML, Romero-Palacios A, Vergas J, Sanjoaquín I, Hernández-Quero J, Aguirrebengoa K, Orihuela F, Imaz A, Ríos-Villegas MJ, Flores J, Fariñas MC, Vázquez P, Galindo MJ, García-Mercé I, Lozano F, de los Santos I, de Jesus SE, García-Vallecillos C. High quality of life, treatment tolerability, safety and efficacy in HIV patients switching from triple therapy to lopinavir/ritonavir monotherapy: A randomized clinical trial. PLoS One 2018; 13:e0195068. [PMID: 29649309 PMCID: PMC5896909 DOI: 10.1371/journal.pone.0195068] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 03/15/2018] [Indexed: 01/03/2023] Open
Abstract
Trial design The QoLKAMON study evaluated quality of life, efficacy and treatment safety in HIV patients receiving lopinavir/ritonavir in monotherapy (MT) versus continuing combined antiretroviral triple treatment with a boosted protease inhibitor (TT). Methods This was a 24-week, open-label, multicentre study in virologically-suppressed HIV-infected participants (N = 225) with a 2:1 randomization: 146 patients who switched to MT were compared with 79 patients who remained on a TT regimen. The primary endpoint was change in patient-reported outcomes in quality of life as measured by the MOS-HIV and EQ-5D questionnaires. Secondary endpoints included treatment adherence, patient satisfaction, incidence of adverse events and differences in plasma HIV-1 RNA viral load (VL) and CD4 cell counts. Results Baseline quality of life, measured with the MOS-HIV score, was very good (overall score of 83 ± 10.5 in the MT arm and 82.3 ± 11.3 in the TT arm) and suffered no change during the study in any of the arms (at week 24, 83.5 ± 12.2 in MT arm and 81.9 ± 12.7 in TT arm), without statistically significant differences when compared. In regards to adherence to therapy and patient satisfaction, some aspects (number of doses forgotten in the last week and satisfaction of treatment measured with the CESTA score, dimension 1) improved significantly with MT. There were also no differences in the incidence and severity of adverse events, even though 22.8% of those in the MT arm switched their treatment when they were included in the study. Moreover, there was also no significant difference between the immunological and virological evolution of MT and TT. In the MT arm, the VL was always undetectable in 83% of patients (vs 90.7% in the TT arm) and there were only 6.7% of virological failures with VL > 50 copies/mL (vs 2.3% in the TT arm), without resistance mutations and with resuppression of VL after switching back to TT. Conclusions In a new clinical trial, monotherapy as a treatment simplification strategy in HIV-1 infected patients with sustained viral suppression has demonstrated quality of life, safety and efficacy profiles comparable to those of conventional triple therapy regimens.
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Affiliation(s)
- Juan Pasquau
- Hospital Universitario Virgen de las Nieves, Infectious Diseases, Granada, Spain
- * E-mail:
| | | | - María Luisa Montes
- Hospital Universitario de La Paz, Internal Medicine HIV Unit, Madrid, Spain
| | | | - Jorge Vergas
- Hospital Clínico San Carlos, Infectious Diseases, Granada, Spain
| | - Isabel Sanjoaquín
- Hospital Clínico Universitario Lozano Blesa, Infectious Diseases, Zaragoza, Spain
| | | | | | - Francisco Orihuela
- Hospital Regional Universitario de Málaga, Infectious Diseases, Málaga, Spain
| | - Arkaitz Imaz
- Hospital Universitario de Bellvitge, Infectious Diseases, Barcelona, Spain
| | - María José Ríos-Villegas
- Hospital Universitario Virgen Macarena, Infectious Diseases and Clinical Microbiology, Seville, Spain
| | - Juan Flores
- Hospital Arnau de Vilanova, Infectious Diseases, Valencia, Spain
| | - María Carmen Fariñas
- Hospital Universitario Marqués de Valdecilla, Infectious Diseases, Santander, Spain
| | - Pilar Vázquez
- Hospital Universitario Juan Canalejo, Infectious Diseases, La Coruña, Spain
| | - María José Galindo
- Hospital Clínico Universitario de Valencia, Infectious Diseases, Valencia, Spain
| | | | - Fernando Lozano
- Hospital Universitario Nuestra Señora de Valme, Infectious Diseases, Seville, Spain
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20
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Berenguer J, Jarrín I, Pérez-Latorre L, Hontañón V, Vivancos MJ, Navarro J, Téllez MJ, Guardiola JM, Iribarren JA, Rivero-Juárez A, Márquez M, Artero A, Morano L, Santos I, Moreno J, Fariñas MC, Galindo MJ, Hernando MA, Montero M, Cifuentes C, Domingo P, Sanz J, Domíngez L, Ferrero OL, De la Fuente B, Rodríguez C, Reus S, Hernández-Quero J, Gaspar G, Pérez-Martínez L, García C, Force L, Veloso S, Losa JE, Vilaró J, Bernal E, Arponen S, Ortí AJ, Chocarro Á, Teira R, Alonso G, Silvariño R, Vegas A, Geijo P, Bisbe J, Esteban H, González-García J. Human Immunodeficiency Virus/Hepatits C Virus Coinfection in Spain: Elimination Is Feasible, but the Burden of Residual Cirrhosis Will Be Significant. Open Forum Infect Dis 2018; 5:ofx258. [PMID: 29354658 PMCID: PMC5767960 DOI: 10.1093/ofid/ofx258] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [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: 09/05/2017] [Accepted: 12/19/2017] [Indexed: 12/13/2022] Open
Abstract
Background We assessed the prevalence of antibodies against hepatitis C virus (HCV-Abs) and active HCV infection in patients infected with human immunodeficiency virus (HIV) in Spain in 2016 and compared the results with those of similar studies performed in 2002, 2009, and 2015. Methods The study was performed in 43 centers during October-November 2016. The sample was estimated for an accuracy of 2% and selected by proportional allocation and simple random sampling. During 2016, criteria for therapy based on direct-acting antiviral agents (DAA) were at least significant liver fibrosis, severe extrahepatic manifestations of HCV, and high risk of HCV transmissibility. Results The reference population and the sample size were 38904 and 1588 patients, respectively. The prevalence of HCV-Abs in 2002, 2009, 2015, and 2016 was 60.8%, 50.2%, 37.7%, and 34.6%, respectively (P trend <.001, from 2002 to 2015). The prevalence of active HCV in 2002, 2009, 2015, and 2016 was 54.0%, 34.0%, 22.1%, and 11.7%, respectively (P trend <.001). The anti-HCV treatment uptake in 2002, 2009, 2015, and 2016 was 23.0%, 48.0%, 59.3%, and 74.7%, respectively (P trend <.001). In 2016, HCV-related cirrhosis was present in 7.6% of all HIV-infected individuals, 15.0% of patients with active HCV, and 31.5% of patients who cleared HCV after anti-HCV therapy. Conclusions Our findings suggest that with universal access to DAA-based therapy and continued efforts in prevention and screening, it will be possible to eliminate active HCV among HIV-infected individuals in Spain in the short term. However, the burden of HCV-related cirrhosis will continue to be significant among HIV-infected individuals.
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Affiliation(s)
- Juan Berenguer
- Hospital General Universitario Gregorio Marañón/Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | | | - Leire Pérez-Latorre
- Hospital General Universitario Gregorio Marañón/Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Víctor Hontañón
- Hospital Universitario La Paz/Instituto de Investigación Sanitaria La Paz, Madrid, Spain
| | | | | | | | | | | | - Antonio Rivero-Juárez
- Hospital Universitario Reina Sofia/Instituto Maimónides de Investigación Biomédica de Córdoba, Spain
| | | | | | - Luis Morano
- Hospital Universitario Álvaro Cunqueiro, Vigo, Spain
| | | | | | - María C Fariñas
- Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | | | - María A Hernando
- Universidad Europea/Instituto de Investigación Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | | | - Pere Domingo
- Hospital Universitario Arnau de Vilanova, Lleida, Spain
| | - José Sanz
- Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Spain
| | - Lourdes Domíngez
- Hospital Universitario 12 de Octubre/ Instituto de Investigación Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Sari Arponen
- Hospital Universitario de Torrejón, Torrejón de Ardoz, Spain
| | | | | | | | | | | | - Ana Vegas
- Hospital Infanta Elena, Valdemoro, Spain
| | | | | | | | - Juan González-García
- Hospital Universitario La Paz/Instituto de Investigación Sanitaria La Paz, Madrid, Spain
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Poveda E, Hernández-Quero J, Pérez-Elías MJ, Ribas MA, Martínez-Madrid OJ, Flores J, Navarro J, Gutiérrez F, García-Deltoro M, Imaz A, Ocampo A, Artero A, Blanco F, Bernal E, Pasquau J, Mínguez-Gallego C, Pérez N, Aiestaran A, García F, Paredes R. Genotypic tropism testing of proviral DNA to guide maraviroc initiation in aviraemic subjects: 48-week analysis of results from the PROTEST study. HIV Med 2016; 18:482-489. [PMID: 28035758 DOI: 10.1111/hiv.12479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2016] [Indexed: 12/28/2022]
Abstract
OBJECTIVES Maraviroc (MVC) is a suitable drug for aviraemic subjects on antiretroviral treatment (ART) developing toxicity. Its prescription requires prior tropism testing. It is unknown if proviral DNA genotypic tropism testing is reliable for guiding MVC initiation in aviraemic subjects, so this study was carried out to address this issue. METHODS PROTEST was a phase 4, prospective, single-arm clinical trial carried out in 24 HIV care centres in Spain. MVC-naïve HIV-1-infected patients with HIV-1 RNA < 50 copies/mL on stable ART during the previous 6 months who required an ART change because of toxicity and who had R5 HIV, as determined by proviral DNA genotypic tropism testing, initiated MVC with two nucleoside reverse transcriptase inhibitors (NRTIs) and were followed for 48 weeks. Virological failure was defined as two consecutive viral load measurements > 50 copies/mL. RESULTS Tropism results were available for 141 of 175 (80.6%) subjects screened: 60% had R5 and 85% of these (n = 74) were finally included in the study. Previous ART included protease inhibitors (PIs) in 62% of subjects, nonnucleoside reverse transcriptase inhibitors (NNRTIs) in 36%, and integrase inhibitors (INIs) in 2%. Main reasons for treatment change were dyslipidaemia (42%), gastrointestinal symptoms (22%) and liver toxicity (15%). MVC was given alongside tenofovir (TDF)/emtricitabine (FTC) (54%) and abacavir (ABC)/lamivudine (3TC) (40%) in most patients. Eighty-four per cent of patients maintained a viral load < 50 copies/mL to week 48, whereas 16% discontinued treatment: two withdrew informed consent, one had an R5 to X4 shift between screening and baseline, one was lost to follow-up, one developed an adverse event (rash), two died from non-study-related causes, and five developed protocol-defined virological failure. CONCLUSIONS Initiation of MVC plus two NRTIs in aviraemic subjects based on genotypic tropism testing of proviral HIV-1 DNA is associated with low rates of virological failure for up to 1 year.
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Affiliation(s)
- E Poveda
- Instituto de Investigación Biomédica de A Coruña (INIBIC)-Complejo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain
| | | | | | - M A Ribas
- Hospital Son Espases, Palma de Mallorca, Spain
| | | | - J Flores
- Hospital Arnau de Vilanova, Valencia, Spain
| | - J Navarro
- Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - F Gutiérrez
- Hospital Universitario de Elche, Elche, Spain
| | | | - A Imaz
- Hospital Universitari de Bellvitge, Barcelona, Spain
| | - A Ocampo
- Hospital Xeral de Vigo, Vigo, Spain
| | - A Artero
- Hospital Universitario Dr. Peset, Valencia
| | - F Blanco
- Hospital Carlos III, Madrid, Spain
| | - E Bernal
- Hospital Reina Sofía, Murcia, Spain
| | - J Pasquau
- Hospital Virgen de la Nieves, Granada, Spain
| | | | - N Pérez
- Universitat Politécnica de Catalunya, Barcelona, Spain
| | - A Aiestaran
- Universitat Politécnica de Catalunya, Barcelona, Spain
| | - F García
- Hospital Universitario San Cecilio, Granada, Spain
| | - R Paredes
- HIV Unit and irsiCaixa AIDS Research Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
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Lozano-Alonso S, Linares-Palomino JP, Vera-Arroyo B, Bravo-Molina A, Hernández-Quero J, Ros-Díe E. Evaluación de la capacidad de difusión tisular de antibióticos en isquemia de miembros inferiores. Enferm Infecc Microbiol Clin 2016; 34:477-83. [DOI: 10.1016/j.eimc.2015.10.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 10/06/2015] [Accepted: 10/13/2015] [Indexed: 11/27/2022]
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Blanco JR, Jarrin I, Pérez-Elías MJ, Gutiérrez F, Hernández-Quero J, Portilla J, Dalmau D, Moreno S, Hernando V. Combined effect of sex and age in response to antiretroviral therapy in HIV-infected patients. Antivir Ther 2016; 22:21-29. [PMID: 27467968 DOI: 10.3851/imp3071] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Gender-specific data on the management of HIV infection are scarce. Further, an increase in the proportion of new HIV diagnoses in older persons has been observed. Using data from the CoRIS cohort, we compared immunovirological responses and survival in HIV-infected men and women who started their first combination antiretroviral therapy (cART) when aged < /≥50 years. METHODS We used multivariable logistic, linear and Cox regression, adjusting for potential confounders and including an interaction between age and sex, to assess differences in immunovirological responses and mortality, respectively. RESULTS At 96 weeks, among subjects <50 years, women were less likely than men to achieve virological response (VR; adjusted OR [aOR] 0.77, 95% CI 0.60, 0.99) and among women, older individuals were more likely to achieve VR than the younger ones (aOR 1.96; 95% CI 1.15, 3.34). Initiating cART at ≥50 years was associated with lower increases in CD4+ T-cell count both in men (-65.8; 95% CI -91.3, -40.3) and women (-37.7; 95% CI -79.7, 4.4) and women showed higher increases than men in both subjects aged <50 (21.8; 95% CI -1.9, 45.5) and ≥50 years at cART initiation (49.9; 95% CI 19.9, 79.9). A higher risk of death in men ≥50 was observed (adjusted hazard ratio [aHR] 2.69; 95% CI 1.73, 4.21), but not in women (aHR 1.49; 95% CI 0.70, 1.14). Women experienced lower mortality than men <50 (0.66; 95% CI 0.41, 1.07) and in those ≥50 (0.37; 95% CI 0.14, 0.93). CONCLUSIONS Sex and age at cART initiation have a noticeable association with both virological and immunological responses and mortality. Age ≥50 is associated with poorer immunological response and higher mortality but this effect is less pronounced in women than in men.
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Affiliation(s)
| | - Inma Jarrin
- Red de Investigación en SIDA, Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain.,CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | | | - Félix Gutiérrez
- Hospital General de Elche & Universidad Miguel Hernández, Alicante, Spain
| | | | | | - David Dalmau
- Hospital Universitari MutuaTerrasa, Terrasa, Spain
| | | | - Victoria Hernando
- Red de Investigación en SIDA, Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain.,CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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Morales-García C, Parra-Ruiz J, Sánchez-Martínez JA, Delgado-Martín AE, Amzouz-Amzouz A, Hernández-Quero J. Concomitant tuberculosis and lung cancer diagnosed by bronchoscopy. Int J Tuberc Lung Dis 2016; 19:1027-32. [PMID: 26260819 DOI: 10.5588/ijtld.14.0578] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING South Granada Health Area (SGHA), Spain. OBJECTIVE To describe the characteristics of concomitant tuberculosis (TB) and lung cancer cases. DESIGN A total of 319 TB cases diagnosed between January 2003 and December 2010 were evaluated and identified using a prospective database. During this period, samples of bronchial secretions were obtained from all patients who underwent fibreoptic bronchoscopy (FBS) as part of a TB screening programme. A descriptive study was conducted. RESULTS Concomitant TB and lung cancer were diagnosed in 15 cases (4.7% of total TB cases). The most common radiographic finding was atelectasis (53.3%), and the most common histological type was epidermoid carcinoma (60%). Lung cancer stage was advanced (III-IV) in 60% of the cases. CONCLUSION The association between TB and lung cancer found in the SGHA after implementing a TB screening programme was higher than in other studies. This suggests that it would be advisable to perform acid-fast bacilli smear and mycobacterial culture of bronchial aspirates in all patients with presumed lung cancer, particularly in high TB prevalence areas.
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Affiliation(s)
- C Morales-García
- Department of Pulmonology, Virgen de las Nieves University Hospital, Granada, Spain
| | - J Parra-Ruiz
- Department of Infectious Diseases, San Cecilio University Hospital, Granada, Spain
| | | | | | - A Amzouz-Amzouz
- Department of Pulmonology, Virgen de las Nieves University Hospital, Granada, Spain
| | - J Hernández-Quero
- Department of Infectious Diseases, San Cecilio University Hospital, Granada, Spain
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Neukam K, Espinosa N, Collado A, Delgado-Fernández M, Jiménez-Aguilar P, Rivero-Juárez A, Hontañón-Antoñana V, Gómez-Berrocal A, Ruiz-Morales J, Merino D, Carrero A, Téllez F, Ríos MJ, Hernández-Quero J, de Lagarde-Sebastián M, Pérez-Camacho I, Vera-Méndez F, Macías J, Pineda JA. Hepatic Safety of Rilpivirine/Emtricitabine/Tenofovir Disoproxil Fumarate Fixed-Dose Single-Tablet Regimen in HIV-Infected Patients with Active Hepatitis C Virus Infection: The hEPAtic Study. PLoS One 2016; 11:e0155842. [PMID: 27195797 PMCID: PMC4873169 DOI: 10.1371/journal.pone.0155842] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 05/05/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES The aim of this study was to evaluate the frequency of transaminase elevations (TE) and total bilirubin elevations (TBE) during the first year of therapy with a single tablet regimen including RPV/FTC/TDF (EPA) in HIV/hepatitis C virus (HCV)-coinfected subjects in clinical practice. METHODS In a retrospective analysis, HIV/HCV-coinfected subjects who started EPA at 17 centres throughout Spain were included as cases. Subjects who started an antiretroviral therapy (ART) other than EPA during the study period at the same hospitals were randomly selected as controls in a 1:2 ratio. Primary outcome variables were grade (G) 3-4 TE and G4 TBE. RESULTS Of the 519 subjects included, 173 individuals started EPA. Nine (5.2%) subjects of the EPA group and 49 (14.2%) controls were naïve to ART. The median (Q1-Q3) follow-up was 11.2 (9.7-13.9) months. TE was observed in 2 [1.2%; 95% confidence interval (CI): 0.14%-4.1%] subjects receiving EPA and 11 (3.2%; 95%CI: 1.6%-5.6%) controls (p = 0.136), all events were G3. No patient discontinued ART due to TE. One (0.6%; 95%CI: 0.01%-3.1%) subject on EPA and 8 (2.3%; 95%CI: 1%-4.5%) subjects in the control group developed TBE (p = 0.141), without developing any other hepatic event during follow-up. Three (2.3%) subjects with cirrhosis versus 10 (3.1%) without cirrhosis showed G3-4 TE (p = 0.451). CONCLUSION The frequency of severe liver toxicity in HIV/HCV-coinfected subjects receiving EPA under real-life conditions is very low, TE were generally mild and did not lead to drug discontinuation. All these data suggest that EPA can be safely used in this particular subpopulation.
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Affiliation(s)
- Karin Neukam
- Unit of Infectious Diseases and Microbiology, Hospital Universitario de Valme, Seville, Spain
- * E-mail:
| | - Nuria Espinosa
- Service of Infectious Diseases, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Antonio Collado
- Unit of Infectious Diseases, Hospital Torrecárdenas, Almeria, Spain
| | | | | | - Antonio Rivero-Juárez
- Unit of Infectious Diseases, Hospital Universitario Reina Sofía, Instituto de Investigación Biomédica de Córdoba (IMIBIC), Cordoba, Spain
| | | | - Ana Gómez-Berrocal
- Service of Internal/Infectious Medicine, Hospital Universitario de la Princesa, Madrid, Spain
| | - Josefa Ruiz-Morales
- Unit of Infectious Diseases, Hospital Universitario Virgen de la Victoria, Malaga, Spain
| | - Dolores Merino
- Unit of Infectious Diseases, Complejo Hospitalario de Huelva, Huelva, Spain
| | - Ana Carrero
- Unit of Infectious Diseases/HIV, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Francisco Téllez
- Unit of Infectious Diseases, Hospital La Línea, AGS Campo de Gibraltar, La Linea de la Concepcion, Spain
| | - María José Ríos
- Unit of Infectious Diseases, Hospital Virgen Macarena, Seville, Spain
| | | | | | | | | | - Juan Macías
- Unit of Infectious Diseases and Microbiology, Hospital Universitario de Valme, Seville, Spain
| | - Juan A. Pineda
- Unit of Infectious Diseases and Microbiology, Hospital Universitario de Valme, Seville, Spain
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Bermúdez MDLP, Araújo LFD, Reyes AO, Hernández-Quero J, Teva I. Analysis of cognitive variables and sexual risk behaviors among infected and HIV-uninfected people from Spain. AIDS Care 2016; 28:890-7. [PMID: 26981840 DOI: 10.1080/09540121.2016.1161163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 02/02/2023]
Abstract
The wider availability of anti-retroviral treatment has brought about an improvement in the immunological situation of human immunodeficiency virus (HIV)-positive individuals, which in turn has led to significant reductions in AIDS-related morbidity and mortality and better quality of life for patients. However, the rate of diagnosis of new cases of HIV among the adult population is on the increase due to high-risk sexual behavior practices, particularly not using condoms, sexual relations with a large number of partners and starting sexual relations at a younger age, with unplanned pregnancies and sexually transmitted infections (STIs), including HIV. For this reason, public health managers have invested considerable effort in recent years in creating STI and HIV prevention programs. Yet, in spite of the implementation of measures for reducing the rates of infection, few studies have been published in Spain comparing individuals living with HIV with the general population about cognitive variables and the link between these variables and high-risk sexual behavior. The objective was to compare a group of individuals living with HIV with another group from the general population in terms of cognitive variables (knowledge about STIs and HIV, concern about STI/HIV and pregnancy, self-efficacy to refuse sexual relations and resilience) and sexual behavior. The sample consisted of 318 adults, 159 were from the general population and 159 were individuals living with HIV. Individuals living with HIV had higher scores for concern about HIV/AIDS, STIs, pregnancy and knowledge of STI/HIV compared with the general population. We concluded that uninfected people who had low and high level of concern about HIV/AIDS began having anal sex at a younger age than those with a medium level of concern. Overall, results indicate that the concern about HIV/AIDS should be addressed in preventive health interventions to minimize the risks of sexual behavior.
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Affiliation(s)
- María de la Paz Bermúdez
- a Mind Brain and Behavior (Spanish acronym CIMCYC) Research Center, University of Granada , Granada , Spain
| | | | - Antonio Ortega Reyes
- a Mind Brain and Behavior (Spanish acronym CIMCYC) Research Center, University of Granada , Granada , Spain
| | - José Hernández-Quero
- c Faculty of Medicine , San Cecilio University Hospital, University of Granada , Granada , Spain
| | - Inmaculada Teva
- a Mind Brain and Behavior (Spanish acronym CIMCYC) Research Center, University of Granada , Granada , Spain
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Bravo-Molina A, Linares-Palomino JP, Lozano-Alonso S, Asensio-García R, Ros-Díe E, Hernández-Quero J. Influence of wound scores and microbiology on the outcome of the diabetic foot syndrome. J Diabetes Complications 2016; 30:329-34. [PMID: 26644145 DOI: 10.1016/j.jdiacomp.2015.11.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [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: 08/23/2015] [Revised: 10/27/2015] [Accepted: 11/01/2015] [Indexed: 01/22/2023]
Abstract
AIMS To establish if the microbiology and the TEXAS, PEDIS and Wagner wound classifications of the diabetic foot syndrome (DFS) predict amputation. METHODS Prospective cohort study of 250 patients with DFS from 2009 to 2013. Tissue samples for culture were obtained and wound classification scores were recorded at admission. RESULTS Infection was monomicrobial in 131 patients (52%). Staphylococcus aureus was the most frequent pathogen (76 patients, 30%); being methicillin-resistant S. aureus in 26% (20/76) Escherichia coli and Enterobacter faecalis were 2nd and 3rd most frequent pathogens. Two hundred nine patients (85%) needed amputation being major in 25 patients (10%). The three wound scales associated minor amputation but did not predict this outcome. Predictors of minor amputation in the multivariate analysis were the presence of osteomyelitis, the location of the wound in the forefoot and of major amputation elevated C reactive proteine (CRP) levels. A low ankle-brachial index (ABI) predicted major amputation in the follow-up. Overall, 74% of gram-positives were sensitive to quinolones and 98% to vancomycin and 90% of gram-negatives to cefotaxime and 95% to carbapenems. CONCLUSIONS The presence of osteomyelitis and the location of the wound in the forefoot predict minor amputation and elevated CRP levels predict major amputation. In the follow-up a low ABI predicts major amputation.
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Affiliation(s)
| | | | - Silvia Lozano-Alonso
- Angiology and Vascular Surgery Unit, San Cecilio University Hospital, Granada, Spain
| | | | - Eduardo Ros-Díe
- Angiology and Vascular Surgery Unit, San Cecilio University Hospital, Granada, Spain
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Palacios R, Pérez-Hernández IA, Martínez MA, Mayorga ML, González-Domenech CM, Omar M, Olalla J, Romero A, Romero JM, Pérez-Camacho I, Hernández-Quero J, Santos J. Efficacy and safety of switching to abacavir/lamivudine (ABC/3TC) plus rilpivirine (RPV) in virologically suppressed HIV-infected patients on HAART. Eur J Clin Microbiol Infect Dis 2016; 35:815-9. [PMID: 26879392 DOI: 10.1007/s10096-016-2602-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 02/01/2016] [Indexed: 11/25/2022]
Abstract
We analysed the efficacy and safety of switching from a regimen based on nonnucleoside reverse transcriptase inhibitors (NNRTI) or integrase inhibitors (INI) to ABC/3TC + RPV in virologically suppressed HIV-infected patients. This multicentre, retrospective study comprised asymptomatic HIV-infected patients who switched from 2 NRTI + NNRTI or 2 NRTI + INI to ABC/3TC + RPV between February 2013 and December 2013; all had undetectable HIV viral load prior to switching. Efficacy and safety, and changes in lipids and cardiovascular risk (CVR) were analysed at 48 weeks. Of 85 patients (74.1 % men, mean age 49.5 years), 83 (97.6 %) switched from a regimen based on NNRTI (EFV 74, RPV 5, ETV 2, NVP 2), and 45 (53 %) switched from TDF/FTC to ABC/3TC. The main reasons for switching were toxicity (58.8 %) and convenience (29.4 %). At 48 weeks, 78 (91.8 %) patients continued taking the same regimen; efficacy was 88 % by intention to treat, and 96 % by per protocol. Two patients were lost to follow-up and five ceased the new regimen (4 due to adverse effects and 1 virologic failure). Mean CD4 cell counts increased (744 vs. 885 cells/μL; p = 0.0001), and there were mean decreases in fasting total cholesterol (-15.9 mg/dL; p < 0.0001) and LDL-cholesterol (-11.0 mg/dL; p < 0.004), with no changes in HDL-cholesterol, triglycerides, total cholesterol:HDL-cholesterol ratio, and CVR. ABC/3TC + RPV is effective and safe in virologically-suppressed patients on antiretroviral therapy (ART). Forty-eight weeks after switching the lipid profile improved with decreases in total and LDL cholesterol.
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Affiliation(s)
- R Palacios
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain.
- UGC Enfermedades Infecciosas, Hospital Clínico Universitario Virgen de la Victoria, 29010, Málaga, Spain.
| | - I A Pérez-Hernández
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
- UGC Enfermedades Infecciosas, Hospital Clínico Universitario Virgen de la Victoria, 29010, Málaga, Spain
| | - M A Martínez
- Hospital Universitario de San Cecilio de Granada, Granada, Spain
| | - M L Mayorga
- Hospital Regional Universitario Carlos Haya, Málaga, Spain
| | | | - M Omar
- Hospital Universitario Ciudad de Jaén, Jaén, Spain
| | - J Olalla
- Hospital Costa del Sol, Marbella, Spain
| | - A Romero
- Hospital Universitario de Puerto Real, Cádiz, Spain
| | | | | | | | - J Santos
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
- UGC Enfermedades Infecciosas, Hospital Clínico Universitario Virgen de la Victoria, 29010, Málaga, Spain
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López-Cortés LF, Castaño MA, López-Ruz MA, Rios-Villegas MJ, Hernández-Quero J, Merino D, Jiménez-Aguilar P, Marquez-Solero M, Terrón-Pernía A, Tellez-Pérez F, Viciana P, Orihuela-Cañadas F, Palacios-Baena Z, Vinuesa-Garcia D, Fajardo-Pico JM, Romero-Palacios A, Ojeda-Burgos G, Pasquau-Liaño J. Effectiveness of Ritonavir-Boosted Protease Inhibitor Monotherapy in Clinical Practice Even with Previous Virological Failures to Protease Inhibitor-Based Regimens. PLoS One 2016; 11:e0148924. [PMID: 26872331 PMCID: PMC4752289 DOI: 10.1371/journal.pone.0148924] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [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: 05/21/2015] [Accepted: 01/19/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Significant controversy still exists about ritonavir-boosted protease inhibitor monotherapy (mtPI/rtv) as a simplification strategy that is used up to now to treat patients that have not experienced previous virological failure (VF) while on protease inhibitor (PI) -based regimens. We have evaluated the effectiveness of two mtPI/rtv regimens in an actual clinical practice setting, including patients that had experienced previous VF with PI-based regimens. METHODS This retrospective study analyzed 1060 HIV-infected patients with undetectable viremia that were switched to lopinavir/ritonavir or darunavir/ritonavir monotherapy. In cases in which the patient had previously experienced VF while on a PI-based regimen, the lack of major HIV protease resistance mutations to lopinavir or darunavir, respectively, was mandatory. The primary endpoint of this study was the percentage of participants with virological suppression after 96 weeks according to intention-to-treat analysis (non-complete/missing = failure). RESULTS A total of 1060 patients were analyzed, including 205 with previous VF while on PI-based regimens, 90 of whom were on complex therapies due to extensive resistance. The rates of treatment effectiveness (intention-to-treat analysis) and virological efficacy (on-treatment analysis) at week 96 were 79.3% (CI95, 76.8-81.8) and 91.5% (CI95, 89.6-93.4), respectively. No relationships were found between VF and earlier VF while on PI-based regimens, the presence of major or minor protease resistance mutations, the previous time on viral suppression, CD4+ T-cell nadir, and HCV-coinfection. Genotypic resistance tests were available in 49 out of the 74 patients with VFs and only four patients presented new major protease resistance mutations. CONCLUSION Switching to mtPI/rtv achieves sustained virological control in most patients, even in those with previous VF on PI-based regimens as long as no major resistance mutations are present for the administered drug.
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Affiliation(s)
- Luis F. López-Cortés
- Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, Spain
| | | | | | | | | | | | | | | | | | | | - Pompeyo Viciana
- Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Sevilla, Spain
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Parra D, Peña-Monje A, Coronado-Álvarez NM, Hernández-Quero J, Parra-Ruiz J. In vitro efficacy of daptomycin and teicoplanin combined with ethanol, clarithromycin or gentamicin as catheter lock solutions. BMC Microbiol 2015; 15:245. [PMID: 26518881 PMCID: PMC4628264 DOI: 10.1186/s12866-015-0585-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 03/24/2015] [Accepted: 10/23/2015] [Indexed: 11/10/2022] Open
Abstract
Background Despite widespread use, optimum choice of antimicrobial agents, concentrations, combinations and exposure times have not been determined for antibiotic lock technique (ALT). Our objective was to evaluate the efficacy of different antibiotic combinations using an in vitro model of catheter-related infection. Daptomycin (DAP) 5 mg/mL, teicoplanin (TEC) 5 mg/mL, both alone and combined with gentamicin (GM) 2.5 mg/mL, clarythromycin (CLA) 5 mg/mL or ethanol 35 % were evaluated against four clinical strains of methicillin resistant coagulase negative staphylococci. Lock solutions were renewed every 24 h. Results After 72 h catheters were reincubated with culture media to investigate bacterial regrowth. All antibiotic combinations resulted in significant reductions (p < 0.05) of Log(10) cfu/mL at 72 h for both organisms compared with controls. DAP resulted in significant reductions of Log(10) for all organism versus TEC (p = 0.001). Only DAP reached the limit of detection at 72 h, however did not prevent regrowth after 24 h of ALT removal. DAP + Ethanol and TEC + ethanol eradicated biofilm at 72 h, but only DAP + ethanol (against all strains) and DAP + CLA (against two strains) prevented regrowth at 24 h after ALT removal. Conclusions Based on these data, ALT with DAP + ethanol and DAP + CLA should be explored in clinical trials.
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Affiliation(s)
- Diego Parra
- Laboratorio de Investigación Antimicrobiana, Hospital Universitario San Cecilio. Instituto de Investigación Biosanitaria de Granada, 18012, Granada, Spain.
| | - Alejandro Peña-Monje
- Servicio de Microbiología, Hospital Universitario San Cecilio, 18012, Granada, Spain.
| | - Nieves María Coronado-Álvarez
- Laboratorio de Investigación Antimicrobiana, Hospital Universitario San Cecilio. Instituto de Investigación Biosanitaria de Granada, 18012, Granada, Spain.
| | - José Hernández-Quero
- Laboratorio de Investigación Antimicrobiana, Hospital Universitario San Cecilio. Instituto de Investigación Biosanitaria de Granada, 18012, Granada, Spain. .,Servicio de Enfermedades Infecciosas, Hospital Universitario San Cecilio. Instituto de Investigación Biosanitaria de Granada, Avda Dr. Olóriz 16, 18012, Granada, Spain.
| | - Jorge Parra-Ruiz
- Laboratorio de Investigación Antimicrobiana, Hospital Universitario San Cecilio. Instituto de Investigación Biosanitaria de Granada, 18012, Granada, Spain. .,Servicio de Enfermedades Infecciosas, Hospital Universitario San Cecilio. Instituto de Investigación Biosanitaria de Granada, Avda Dr. Olóriz 16, 18012, Granada, Spain.
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Unciti-Broceta JD, Arias JL, Maceira J, Soriano M, Ortiz-González M, Hernández-Quero J, Muñóz-Torres M, de Koning HP, Magez S, Garcia-Salcedo JA. Specific Cell Targeting Therapy Bypasses Drug Resistance Mechanisms in African Trypanosomiasis. PLoS Pathog 2015; 11:e1004942. [PMID: 26110623 PMCID: PMC4482409 DOI: 10.1371/journal.ppat.1004942] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 05/08/2015] [Indexed: 01/01/2023] Open
Abstract
African trypanosomiasis is a deadly neglected disease caused by the extracellular parasite Trypanosoma brucei. Current therapies are characterized by high drug toxicity and increasing drug resistance mainly associated with loss-of-function mutations in the transporters involved in drug import. The introduction of new antiparasitic drugs into therapeutic use is a slow and expensive process. In contrast, specific targeting of existing drugs could represent a more rapid and cost-effective approach for neglected disease treatment, impacting through reduced systemic toxicity and circumventing resistance acquired through impaired compound uptake. We have generated nanoparticles of chitosan loaded with the trypanocidal drug pentamidine and coated by a single domain nanobody that specifically targets the surface of African trypanosomes. Once loaded into this nanocarrier, pentamidine enters trypanosomes through endocytosis instead of via classical cell surface transporters. The curative dose of pentamidine-loaded nanobody-chitosan nanoparticles was 100-fold lower than pentamidine alone in a murine model of acute African trypanosomiasis. Crucially, this new formulation displayed undiminished in vitro and in vivo activity against a trypanosome cell line resistant to pentamidine as a result of mutations in the surface transporter aquaglyceroporin 2. We conclude that this new drug delivery system increases drug efficacy and has the ability to overcome resistance to some anti-protozoal drugs.
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Affiliation(s)
- Juan D. Unciti-Broceta
- Unidad de Enfermedades Infecciosas y Microbiología, Instituto de Investigación Biosanitaria ibs.GRANADA, Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain
- Instituto de Parasitología y Biomedicina “López-Neyra” (IPBLN-CSIC), PTS Granada, Armilla, Spain
- Centro Pfizer-Universidad de Granada-Junta de Andalucía de Genómica e Investigación Oncológica (GENYO), PTS Granada, Granada, Spain
| | - José L. Arias
- Departamento de Farmacia y Tecnología Farmacéutica, Facultad de Farmacia, Universidad de Granada, Granada, Spain
| | - José Maceira
- Unidad de Enfermedades Infecciosas y Microbiología, Instituto de Investigación Biosanitaria ibs.GRANADA, Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain
- Instituto de Parasitología y Biomedicina “López-Neyra” (IPBLN-CSIC), PTS Granada, Armilla, Spain
- Centro Pfizer-Universidad de Granada-Junta de Andalucía de Genómica e Investigación Oncológica (GENYO), PTS Granada, Granada, Spain
| | - Miguel Soriano
- Centro Pfizer-Universidad de Granada-Junta de Andalucía de Genómica e Investigación Oncológica (GENYO), PTS Granada, Granada, Spain
- Departamento de Agronomía, Universidad de Almería, Almería, Spain
| | - Matilde Ortiz-González
- Unidad de Enfermedades Infecciosas y Microbiología, Instituto de Investigación Biosanitaria ibs.GRANADA, Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain
- Centro Pfizer-Universidad de Granada-Junta de Andalucía de Genómica e Investigación Oncológica (GENYO), PTS Granada, Granada, Spain
| | - José Hernández-Quero
- Unidad de Enfermedades Infecciosas y Microbiología, Instituto de Investigación Biosanitaria ibs.GRANADA, Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain
| | - Manuel Muñóz-Torres
- Unidad de Metabolismo Óseo, Instituto de Investigación Biosanitaria ibs.GRANADA, Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain
| | - Harry P. de Koning
- Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Stefan Magez
- Unit of Cellular and Molecular Immunology, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Structural Biology, VIB, Vrije Universiteit Brussel, Brussels, Belgium
| | - José A. Garcia-Salcedo
- Unidad de Enfermedades Infecciosas y Microbiología, Instituto de Investigación Biosanitaria ibs.GRANADA, Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain
- Instituto de Parasitología y Biomedicina “López-Neyra” (IPBLN-CSIC), PTS Granada, Armilla, Spain
- Centro Pfizer-Universidad de Granada-Junta de Andalucía de Genómica e Investigación Oncológica (GENYO), PTS Granada, Granada, Spain
- * E-mail:
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Parra-Ruiz J, Ramos V, Dueñas C, Coronado-Álvarez NM, Cabo-Magadán R, Portillo-Tuñón V, Vinuesa D, Muñoz-Medina L, Hernández-Quero J. Rational application of adenosine deaminase activity in cerebrospinal fluid for the diagnosis of tuberculous meningitis. Infection 2015; 43:531-5. [PMID: 25869821 DOI: 10.1007/s15010-015-0777-7] [Citation(s) in RCA: 9] [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: 01/09/2015] [Accepted: 04/03/2015] [Indexed: 01/22/2023]
Abstract
PURPOSE Tuberculous meningitis (TBM) is one of the most serious and difficult to diagnose manifestations of TB. An ADA value >9.5 IU/L has great sensitivity and specificity. However, all available studies have been conducted in areas of high endemicity, so we sought to determine the accuracy of ADA in a low endemicity area. METHODS This retrospective study included 190 patients (105 men) who had ADA tested in CSF for some reason. Patients were classified as probable/certain TBM or non-TBM based on clinical and Thwaite's criteria. Optimal ADA cutoff was established by ROC curves and a predictive algorithm based on ADA and other CSF biochemical parameters was generated. RESULTS Eleven patients were classified as probable/certain TBM. In a low endemicity area, the best ADA cutoff was 11.5 IU/L with 91 % sensitivity and 77.7 % specificity. We also developed a predictive algorithm based on the combination of ADA (>11.5 IU/L), glucose (<65 mg/dL) and leukocytes (≥13.5 cell/mm(3)) with increased accuracy (Se: 91 % Sp: 88 %). CONCLUSIONS Optimal ADA cutoff value in areas of low TB endemicity is higher than previously reported. Our algorithm is more accurate than ADA activity alone with better sensitivity and specificity than previously reported algorithms.
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Affiliation(s)
- Jorge Parra-Ruiz
- Servicio de Enfermedades Infecciosas, Hospital Universitario San Cecilio, Avda Dr. Olóriz 16, 18012, Granada, Spain.
- Laboratorio de Investigación Anti Microbiana, Hospital Universitario San Cecilio, Granada, Spain.
| | - V Ramos
- Servicio de Enfermedades Infecciosas, Hospital Universitario San Cecilio, Avda Dr. Olóriz 16, 18012, Granada, Spain
| | - C Dueñas
- Servicio de Medicina Interna, Complejo Asistencial Universitario de Burgos, Burgos, Spain
| | - N M Coronado-Álvarez
- Laboratorio de Investigación Anti Microbiana, Hospital Universitario San Cecilio, Granada, Spain
- Unidad de Gestión Clínica de Laboratorio, Hospital Universitario San Cecilio, Granada, Spain
| | - R Cabo-Magadán
- Servicio de Medicina Interna, Complejo Asistencial Universitario de Burgos, Burgos, Spain
| | - V Portillo-Tuñón
- Servicio de Medicina Interna, Complejo Asistencial Universitario de Burgos, Burgos, Spain
| | - D Vinuesa
- Servicio de Enfermedades Infecciosas, Hospital Universitario San Cecilio, Avda Dr. Olóriz 16, 18012, Granada, Spain
| | - L Muñoz-Medina
- Servicio de Enfermedades Infecciosas, Hospital Universitario San Cecilio, Avda Dr. Olóriz 16, 18012, Granada, Spain
| | - J Hernández-Quero
- Servicio de Enfermedades Infecciosas, Hospital Universitario San Cecilio, Avda Dr. Olóriz 16, 18012, Granada, Spain
- Laboratorio de Investigación Anti Microbiana, Hospital Universitario San Cecilio, Granada, Spain
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Arias JL, Unciti-Broceta JD, Maceira J, Del Castillo T, Hernández-Quero J, Magez S, Soriano M, García-Salcedo JA. Nanobody conjugated PLGA nanoparticles for active targeting of African Trypanosomiasis. J Control Release 2014; 197:190-8. [PMID: 25445702 DOI: 10.1016/j.jconrel.2014.11.002] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 10/31/2014] [Accepted: 11/03/2014] [Indexed: 11/25/2022]
Abstract
Targeted delivery of therapeutics is an alternative approach for the selective treatment of infectious diseases. The surface of African trypanosomes, the causative agents of African trypanosomiasis, is covered by a surface coat consisting of a single variant surface glycoprotein, termed VSG. This coat is recycled by endocytosis at a very high speed, making the trypanosome surface an excellent target for the delivery of trypanocidal drugs. Here, we report the design of a drug nanocarrier based on poly ethylen glycol (PEG) covalently attached (PEGylated) to poly(D,L-lactide-co-glycolide acid) (PLGA) to generate PEGylated PLGA nanoparticles. This nanocarrier was coupled to a single domain heavy chain antibody fragment (nanobody) that specifically recognizes the surface of the protozoan pathogen Trypanosoma brucei. Nanoparticles were loaded with pentamidine, the first-line drug for T. b. gambiense acute infection. An in vitro effectiveness assay showed a 7-fold decrease in the half-inhibitory concentration (IC50) of the formulation relative to free drug. Furthermore, in vivo therapy using a murine model of African trypanosomiasis demonstrated that the formulation cured all infected mice at a 10-fold lower dose than the minimal full curative dose of free pentamidine and 60% of mice at a 100-fold lower dose. This nanocarrier has been designed with components approved for use in humans and loaded with a drug that is currently in use to treat the disease. Moreover, this flexible nanobody-based system can be adapted to load any compound, opening a range of new potential therapies with application to other diseases.
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Affiliation(s)
- José L Arias
- Departamento de Farmacia y Tecnología Farmacéutica, Facultad de Farmacia, Universidad de Granada, Granada, Spain
| | - Juan D Unciti-Broceta
- Unidad de Enfermedades Infecciosas y Microbiología, Instituto de Investigación Biosanitaria ibs.GRANADA, Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain; Instituto de Parasitología y Biomedicina "López-Neyra" (IPBLN-CSIC), PTS Granada, Armilla, Spain; GENYO, Centro de Genómica e Investigación Oncológica: Pfizer/Universidad de Granada/Junta de Andalucía, PTS Granada, Granada, Spain
| | - José Maceira
- Unidad de Enfermedades Infecciosas y Microbiología, Instituto de Investigación Biosanitaria ibs.GRANADA, Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain; Instituto de Parasitología y Biomedicina "López-Neyra" (IPBLN-CSIC), PTS Granada, Armilla, Spain; GENYO, Centro de Genómica e Investigación Oncológica: Pfizer/Universidad de Granada/Junta de Andalucía, PTS Granada, Granada, Spain
| | - Teresa Del Castillo
- Unidad de Enfermedades Infecciosas y Microbiología, Instituto de Investigación Biosanitaria ibs.GRANADA, Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain; Instituto de Parasitología y Biomedicina "López-Neyra" (IPBLN-CSIC), PTS Granada, Armilla, Spain; GENYO, Centro de Genómica e Investigación Oncológica: Pfizer/Universidad de Granada/Junta de Andalucía, PTS Granada, Granada, Spain
| | - José Hernández-Quero
- Unidad de Enfermedades Infecciosas y Microbiología, Instituto de Investigación Biosanitaria ibs.GRANADA, Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain
| | - Stefan Magez
- Unit of Cellular and Molecular Immunology, Vrije Universiteit Brussel, Brussels, Belgium; Department of Structural Biology, VIB, Vrije Universiteit Brussel, Brussels, Belgium
| | - Miguel Soriano
- GENYO, Centro de Genómica e Investigación Oncológica: Pfizer/Universidad de Granada/Junta de Andalucía, PTS Granada, Granada, Spain; Departamento de Agronomía, Universidad de Almería, Almería, Spain
| | - José A García-Salcedo
- Unidad de Enfermedades Infecciosas y Microbiología, Instituto de Investigación Biosanitaria ibs.GRANADA, Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain; Instituto de Parasitología y Biomedicina "López-Neyra" (IPBLN-CSIC), PTS Granada, Armilla, Spain; GENYO, Centro de Genómica e Investigación Oncológica: Pfizer/Universidad de Granada/Junta de Andalucía, PTS Granada, Granada, Spain.
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Parra-Ruiz J, Sanjuán C, Muñoz-Medina L, Vinuesa D, Martínez-Pérez MA, Hernández-Quero J. Letter: accuracy of liver stiffness measurement - a comparison of two different FibroScan devices. Aliment Pharmacol Ther 2014; 39:1434-5. [PMID: 24849157 DOI: 10.1111/apt.12762] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Affiliation(s)
- J Parra-Ruiz
- Servicio de Enfermedades Infecciosas, Hospital Universitario San Cecilio, Granada, Spain.
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Genebat M, Vera F, Hernández-Quero J, Domingo P, Guardiola JM, Martínez-Madrid O, Martínez L, de la Llana FG, Sánchez-Villegas J, Álvarez H, Mariño A, Lluch JF, Martínez-Pérez MA, Marín J, Ruiz-Mateos E, Leal M. Efficacy and tolerability after 24weeks of treatment with telaprevir, pegylated interferon and ribavirin in cirrhotic HIV–HCV coinfected subjects. Antiviral Res 2014; 104:59-61. [DOI: 10.1016/j.antiviral.2014.01.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 01/14/2014] [Accepted: 01/23/2014] [Indexed: 01/18/2023]
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Gálvez-López R, Peña-Monje A, Antelo-Lorenzo R, Guardia-Olmedo J, Moliz J, Hernández-Quero J, Parra-Ruiz J. Elution kinetics, antimicrobial activity, and mechanical properties of 11 different antibiotic loaded acrylic bone cement. Diagn Microbiol Infect Dis 2014; 78:70-4. [DOI: 10.1016/j.diagmicrobio.2013.09.014] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Revised: 08/04/2013] [Accepted: 09/22/2013] [Indexed: 01/28/2023]
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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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Masiá M, Padilla S, Álvarez D, López JC, Santos I, Soriano V, Hernández-Quero J, Santos J, Tural C, del Amo J, Gutiérrez F. Risk, predictors, and mortality associated with non-AIDS events in newly diagnosed HIV-infected patients: role of antiretroviral therapy. AIDS 2013; 27:181-9. [PMID: 23018442 DOI: 10.1097/qad.0b013e32835a1156] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We aimed to characterize non-AIDS events (NAEs) occurring in newly diagnosed HIV-infected patients in a contemporary cohort. METHODS The Cohort of the AIDS Research Network (CoRIS) is a prospective, multicenter cohort of HIV-infected adults antiretroviral naive at entry, established in 2004. We evaluated the incidence of and the mortality due to NAEs and AIDS events through October 2010. Poisson regression was used to investigate factors associated with a higher incidence of NAEs. RESULTS Overall, 5185 patients (13.306 person-years of follow-up), median age (interquartile range) 36 (29-43) years, participated in the study. A total of 86.5% patients had been diagnosed in 2004 or later. The incidence rate of NAEs was 28.93 per 1000 person-years [95% confidence interval (CI) 26.15-32.07], and of AIDS-defining events 25.23 per 1000 person-years (95% CI 22.60-28.16). The most common NAEs were psychiatric, hepatic, malignant, renal, and cardiovascular related. After adjustment, age, higher HIV-viral load, and lower CD4 cell count at cohort entry were associated with the occurrence of NAEs, whereas likelihood significantly decreased with sexual transmission and higher educational level. Additionally, antiretroviral therapy was inversely associated with the development of some NAEs, specifically of psychiatric [incidence rate ratio (95% CI) 0.54 (0.30-0.96)] and renal-related [incidence rate ratio (95% CI) 0.31 (0.13-0.72)] events. One hundred and seventy-three (3.33%) patients died during the study period. NAEs contributed to 28.9% of all deaths, with an incidence rate (95% CI) of 3.75 (2.84-4.94) per 1000 person-years. CONCLUSION In patients newly diagnosed with HIV infection, NAEs are a significant cause of morbidity and mortality. Our results suggest a protective effect of antiretroviral therapy in the occurrence of NAEs, in particular of psychiatric and renal-related events.
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Parra-Ruiz J, Hernández-Quero J. [Pharmacodynamic and pharmacokinetic evaluation of respiratory fluoroquinolones. Guideline to selection of the most appropriate fluoroquinolone]. Rev Esp Quimioter 2012; 25:245-251. [PMID: 23303254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Since its approval, fluoroquinolones have become one of the most prescribed antibacterial agents. Because of its widespread use, serious concerns about the emergence of resistance in Streptococcus pneumoniae, Pseudomonas spp, and entrobacteriaceae, has arisen, especially because of cross-resistance between fluoroquinolones. Huge efforts has been done to identify pharmacokinetic (PK) parameters like maximum serum concentration (Cmax), area under the curve of serum concentrations (AUC) and pharmacodynamic (PD) parameters like the minimum inhibitory concentration (MIC) or the mutant prevention concentration (MPC), to optimize the use of the new fluoroquinolones, especially against these difficult to treat microorganisms. The new fluoroquinolones commercially available in Spain, levofloxacin and moxifloxacin, have significant differences in their PK (Cmax, half-life, volume of distribution, etc), PD (MIC, MPC,) and in their PK/PD parameters (AUC/MIC; AUC/MPC) that allow clinicians to establish clear preference for the utilization of one of them. Proper use of these new fluoroquinolones according to these PK/PD parameters will result in better management of respiratory infections with a reduction in the emergence of resistance. Based on data reviewed in this paper moxifloxacin use, with best PK/PD characteristics, should be preferred over levofloxacin. Should levofloxacin be used, alternative dosing strategies would be recommended to avoid selection of resistant variants.
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Affiliation(s)
- Jorge Parra-Ruiz
- Servicio de Enfermedades Infecciosas, Hospital Universitario San Cecilio, Granada, Spain.
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Abstract
Serious Gram-positive bacterial infections are a major cause of morbidity and mortality among older adults and can pose a significant challenge to clinicians. Although more than 50% of patients treated with daptomycin are > 65 years old, there are few data evaluating the efficacy and safety of daptomcyn in this population. Analysis of data from patients > 65 years old included in the Cubicin Outcomes Registry and Experience (CORE), a multicenter, retrospective registry designed to collect post-marketing clinical data on patients who received daptomycin, and in its European version, the EUCORE, showed similar rates of efficacy and safety in this population to those in younger patients, suggesting that daptomycin is also a valuable option in older patients with serious Gram-positive infections.
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Affiliation(s)
- Jorge Parra-Ruiz
- Unidad de Enfermedades Infecciosas, Unidad de Gestión Clínica de Medicina Interna y Enfermedades Infecciosas, Hospital Universitario San Cecilio, Granada, España
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Poveda E, Paredes R, Moreno S, Alcamí J, Córdoba J, Delgado R, Gutiérrez F, Llibre JM, García Deltoro M, Hernández-Quero J, Pulido F, Iribarren JA, García F. Update on clinical and methodological recommendations for genotypic determination of HIV tropism to guide the usage of CCR5 antagonists. AIDS Rev 2012; 14:208-217. [PMID: 22833064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The genotypic determination of HIV tropism to guide the use of maraviroc, the first CCR5 antagonist with specific antiviral activity against CCR5 (R5)-tropic HIV variants, has been widespread in the last two years. Retrospective analyses from maraviroc clinical trials (MOTIVATE and MERIT) demonstrated that specific genotypic tools and the phenotypic assay TrofileTM are comparable in predicting virologic response to maraviroc. Moreover, recent studies performed in cohorts of patients outside clinical trials have reported overall rates of virologic response to maraviroc up to 82% in patients harboring HIV R5-tropic variants according to genotypic tools. Specific technical requirements as well as recommendations for proper HIV tropism determination in the clinical setting have been improving, according to new data reported in several studies related with this issue. This review updates clinical and methodological recommendations for genotypic determination of HIV tropism to guide therapeutic decisions using CCR5 antagonists, considering the most recently reported data.
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Affiliation(s)
- Eva Poveda
- Infectious Diseases Department, Hospital Carlos III, Madrid, Spain.
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Parra-Ruiz J, Dueñas-Gutiérrez C, Tomás-Jiménez C, Linares-Palomino JP, Garrido-Gomez J, Hernández-Quero J. Safety analysis of high dose (>6 mg/kg/day) daptomycin in patients with concomitant statin therapy. Eur J Clin Microbiol Infect Dis 2011; 31:1771-4. [DOI: 10.1007/s10096-011-1500-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Accepted: 11/16/2011] [Indexed: 01/21/2023]
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43
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Parra-Ruiz J, Peña-Monje A, Tomás-Jiménez C, Pomares-Mora J, Hernández-Quero J. Eficacia y seguridad de daptomicina en dosis elevadas (≥ 8mg/kg/día). Enferm Infecc Microbiol Clin 2011; 29:425-7. [DOI: 10.1016/j.eimc.2011.02.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2010] [Revised: 02/19/2011] [Accepted: 02/23/2011] [Indexed: 11/30/2022]
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Garcia F, Alvarez M, Fox Z, Garcia-Diaz A, Guillot V, Johnson M, Chueca N, Phillips A, Hernández-Quero J, Geretti AM. Predicting antiretroviral drug resistance from the latest or the cumulative genotype. Antivir Ther 2011; 16:373-82. [DOI: 10.3851/imp1753] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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45
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Parra-Ruiz J, Tomas-Jiménez C, Muñoz-Medina L, Hernández-Quero J. Bacteriemia persistente por Staphylococcus aureus resistente a meticilina. El resultado de un tratamiento inadecuado. Enferm Infecc Microbiol Clin 2009; 27:372-3. [DOI: 10.1016/j.eimc.2008.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2008] [Accepted: 12/04/2008] [Indexed: 11/25/2022]
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46
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Chueca N, Garrido C, Alvarez M, Poveda E, de Dios Luna J, Zahonero N, Hernández-Quero J, Soriano V, Maroto C, de Mendoza C, García F. Improvement in the determination of HIV-1 tropism using the V3 gene sequence and a combination of bioinformatic tools. J Med Virol 2009; 81:763-7. [PMID: 19319937 DOI: 10.1002/jmv.21425] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Natalia Chueca
- Microbiology Department, Hospital Universitario San Cecilio, Granada, Spain
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47
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Arias-Santiago S, Arrabal-Polo MA, Hernández-Quero J, Naranjo-Sintes R. Multiple cutaneous ulcerations: secondary syphilis in an HIV-positive patient. Int J Infect Dis 2009; 13:e337. [PMID: 19230735 DOI: 10.1016/j.ijid.2008.12.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2008] [Accepted: 12/04/2008] [Indexed: 11/18/2022] Open
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48
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Parra-Ruiz J, Alvarez M, Chueca N, Peña A, Pasquau J, López-Ruz MA, Maroto MDC, Hernández-Quero J, García F. [Genotypic resistance in HIV-1-infected patients with persistent low-level viremia]. Enferm Infecc Microbiol Clin 2009; 27:75-80. [PMID: 19254638 DOI: 10.1016/j.eimc.2008.02.007] [Citation(s) in RCA: 11] [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: 11/16/2007] [Accepted: 02/25/2008] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Highly active antiretroviral therapy (HAART) in HIV patients is considered successful when plasma viral load (VL) reaches < 50 copies/ml. However, many patients have a persistent VL of 50 to 1000 copies/ml, and treatment guidelines do not recommend genotypic resistance testing at these levels because of poor performance. The aim of this study was to evaluate the usefulness of a concentration technique for HIV-1 sequencing in samples with < 1000 copies/ml, and determine the virological consequences of HAART treatment changes guided by resistance testing in this scenario. METHODS Observational study performed in 51 patients with plasma VL between 50 and 1000 copies/m; 27 patients had these levels for at least 12 consecutive months. Prior to RNA extraction, virions were concentrated from 3-ml plasma samples and then genotyped following standard procedures. RESULTS Forty-seven of the 51 samples were successfully sequenced, resulting in a sensitivity of 92%. Among these 47 patients, 27 showed a persistent viral load of 50-1000 copies/ml for 12 months, and 20 patients achieved undetectable viral load following the genotype-guided HAART change (intention-to-treat analysis: NC = F; 20 of 27 [74.1%]; on-treatment analysis: 20 of 23 [86.9%]). CONCLUSIONS We report a simple method for genotype sequencing in patients with persistent low-level viremia that allowed a modification of the HAART regimen leading to undetectable plasma viremia.
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Affiliation(s)
- Jorge Parra-Ruiz
- Unidad de Enfermedades Infecciosas, Hospital Universitario San Cecilio, Granada, España
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Bernabeu-Wittel M, García Morillo S, Ollero M, Hernández-Quero J, González de la Puente M, Montero Pérez-Barquero M, Díez F, García-Alegría J, Pujol E, Sanromán C, Cuello J. El Plan Estratégico para el desarrollo de la Medicina Interna en Andalucía. Rev Clin Esp 2008; 208:295-301. [DOI: 10.1157/13123189] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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50
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Gutiérrez F, Padilla S, Masiá M, Iribarren JA, Moreno S, Viciana P, Hernández-Quero J, Alemán R, Vidal F, Salavert M, Blanco JR, Leal M, Dronda F, Perez Hoyos S, del Amo J. Patients' characteristics and clinical implications of suboptimal CD4 T-cell gains after 1 year of successful antiretroviral therapy. Curr HIV Res 2008; 6:100-7. [PMID: 18336257 DOI: 10.2174/157016208783885038] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
To describe characteristics and prognosis of patients with suboptimal immunological response to combined antiretroviral therapy (CART). Using data from a multicenter cohort study, we selected patients who initiated CART and showed suboptimal CD4-T cell response (defined as <50 cells/L increase) after 1 year of therapy, despite sustained virological suppression. Characteristics of those patients were compared with subjects who showed optimal immunological response. Of 650 patients with virological suppression, 108 (16.6%) showed suboptimal CD4-T cell response. Independent predictors of suboptimal response were previous injection drug use (OR, 1.85; 95% CI, 1.12-2.98) and age at CART initiation (OR, 1.04 per year increase; 95%CI, 1.01-1.06). Hepatitis C virus coinfection was not associated with impaired immunological response. As compared with patients with optimal immunological response, those with suboptimal response had a higher mortality rate (3.22 versus 0.71 per 100 person-years; p=.001), but a similar rate of new AIDS-defining events. In patients with sustained virological suppression with CART, previous injection drug use, but not hepatitis C virus coinfection, and older age at initiation of therapy were associated with suboptimal CD4 T-cell responses. Patients with suboptimal response had a higher mortality over time, mainly due to diseases other than AIDS-defining events.
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Affiliation(s)
- Félix Gutiérrez
- Unidad de Enfermedades Infecciosas, Hospital General Universitario de Elche, Universidad Miguel Hernández, Alicante, Spain.
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