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Viñuela L, de Salazar A, Fuentes A, Serrano-Conde E, Falces-Romero I, Pinto A, Portilla I, Masiá M, Peraire J, Gómez-Sirvent JL, Sanchiz M, Iborra A, Baza B, Aguilera A, Olalla J, Espinosa N, Iribarren JA, Martínez-Velasco M, Imaz A, Montero M, Rivero M, Suarez-García I, Maciá MD, Galán JC, Perez-Elias MJ, García-Fraile LJ, Moreno C, Garcia F. Transmitted drug resistance to antiretroviral drugs in Spain during the period 2019-2021. J Med Virol 2023; 95:e29287. [PMID: 38084763 DOI: 10.1002/jmv.29287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 10/17/2023] [Accepted: 11/18/2023] [Indexed: 12/18/2023]
Abstract
To evaluate the prevalence of transmitted drug resistance (TDR) to nucleoside and nonnucleoside reverse transcriptase inhibitors (NRTI, NNRTI), protease inhibitors (PI), and integrase strand transfer inhibitors (INSTI) in Spain during the period 2019-2021, as well as to evaluate transmitted clinically relevant resistance (TCRR) to antiretroviral drugs. Reverse transcriptase (RT), protease (Pro), and Integrase (IN) sequences from 1824 PLWH (people living with HIV) were studied. To evaluate TDR we investigated the prevalence of surveillance drug resistance mutations (SDRM). To evaluate TCRR (any resistance level ≥ 3), and for HIV subtyping we used the Stanford v.9.4.1 HIVDB Algorithm and an in-depth phylogenetic analysis. The prevalence of NRTI SDRMs was 3.8% (95% CI, 2.8%-4.6%), 6.1% (95% CI, 5.0%-7.3%) for NNRTI, 0.9% (95% CI, 0.5%-1.4%) for PI, and 0.2% (95% CI, 0.0%-0.9%) for INSTI. The prevalence of TCRR to NRTI was 2.1% (95% CI, 1.5%-2.9%), 11.8% for NNRTI, (95% CI, 10.3%-13.5%), 0.2% (95% CI, 0.1%-0.6%) for PI, and 2.5% (95% CI, 1.5%-4.1%) for INSTI. Most of the patients were infected by subtype B (79.8%), while the majority of non-Bs were CRF02_AG (n = 109, 6%). The prevalence of INSTI and PI resistance in Spain during the period 2019-2021 is low, while NRTI resistance is moderate, and NNRTI resistance is the highest. Our results support the use of integrase inhibitors as first-line treatment in Spain. Our findings highlight the importance of ongoing surveillance of TDR to antiretroviral drugs in PLWH particularly with regard to first-line antiretroviral therapy.
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Affiliation(s)
- Laura Viñuela
- Clinical Microbiology Unit, Hospital Universitario Clínico San Cecilio, Granada, Spain
- Instituto de Investigación Ibs, Granada, Spain
- Ciber de Enfermedades Infecciosas, CIBERINFEC, ISCIII, Madrid, Spain
| | - Adolfo de Salazar
- Clinical Microbiology Unit, Hospital Universitario Clínico San Cecilio, Granada, Spain
- Instituto de Investigación Ibs, Granada, Spain
- Ciber de Enfermedades Infecciosas, CIBERINFEC, ISCIII, Madrid, Spain
| | - Ana Fuentes
- Clinical Microbiology Unit, Hospital Universitario Clínico San Cecilio, Granada, Spain
- Instituto de Investigación Ibs, Granada, Spain
- Ciber de Enfermedades Infecciosas, CIBERINFEC, ISCIII, Madrid, Spain
| | - Esther Serrano-Conde
- Clinical Microbiology Unit, Hospital Universitario Clínico San Cecilio, Granada, Spain
| | | | - Adriana Pinto
- Infectious Diseases Unit, Hospital 12 de Octubre, Madrid, Spain
| | - Irene Portilla
- Infectious Diseases Unit, Hospital General Universitario de Alicante, Alicante, Spain
| | - Mar Masiá
- Ciber de Enfermedades Infecciosas, CIBERINFEC, ISCIII, Madrid, Spain
- Infectious Diseases Unit, Hospital General Universitario de Elche, Elche, Spain
| | - Joaquim Peraire
- Ciber de Enfermedades Infecciosas, CIBERINFEC, ISCIII, Madrid, Spain
- Infectious Diseases Unit, Hospital Universitari de Tarragona Joan XXIII, IISPV, Universitat Rovira i Virgili, Tarragona, Spain
| | - Juan Luis Gómez-Sirvent
- Infectious Diseases Unit, Hospital Universitario de Canarias, Las Palmas de Gran Canaria, Spain
| | - Marta Sanchiz
- Infectious Diseases Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Asunción Iborra
- Clinical Microbiology Unit, Hospital Virgen de la Arrixaca, Murcia, Spain
| | - Begoña Baza
- Centro Sanitario Sandoval, Hospital Clínico San Carlos, Madrid, Spain
- Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain
- Instituto de Medicina de Laboratorio (IML), Madrid, Spain
| | - Antonio Aguilera
- Clinical Microbiology Unit, Complejo Hospitalario Universitario de Santiago, Santiago, Spain
| | - Julián Olalla
- Infectious Diseases Unit, Hospital Costa del Sol, Marbella, Spain
| | - Nuria Espinosa
- Infectious Diseases Unit, Hospital Virgen del Rocío, Seville, Spain
| | | | | | - Arkaitz Imaz
- Infectious Diseases Unit, Hospital Universitario de Bellvitge, Barcelona, Spain
| | - Marta Montero
- Infectious Diseases Unit, Hospital Universitario La Fe, Valencia, Spain
| | - María Rivero
- Infectious Diseases Unit, Hospital de Navarra, Pamplona, Spain
| | | | | | - Juan Carlos Galán
- Infectious Diseases Unit, Hospital Ramón y Cajal, Madrid, Spain
- Ciber de Epidemiologia y Salud Publica, CIBERESP, Madrid, Spain
- Insituto Ramón y Cajal de Investigación Sanitaria (IRYSCIS), Madrid, Spain
| | - Maria Jesus Perez-Elias
- Ciber de Enfermedades Infecciosas, CIBERINFEC, ISCIII, Madrid, Spain
- Infectious Diseases Unit, Hospital Ramón y Cajal, Madrid, Spain
| | | | - Cristina Moreno
- Ciber de Enfermedades Infecciosas, CIBERINFEC, ISCIII, Madrid, Spain
- Instituto de Salud Carlos III, Madrid, Spain
| | - Federico Garcia
- Clinical Microbiology Unit, Hospital Universitario Clínico San Cecilio, Granada, Spain
- Instituto de Investigación Ibs, Granada, Spain
- Ciber de Enfermedades Infecciosas, CIBERINFEC, ISCIII, Madrid, Spain
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2
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Benavent E, Kortajarena X, Sobrino-Diaz B, Gasch O, Rodríguez-Pardo D, Escudero-Sanchez R, Bahamonde A, Rodriguez-Montserrat D, García-País MJ, Del Toro López MD, Sorli L, Nodar A, Vilchez HH, Muñez E, Iribarren JA, Ariza J, Murillo O. Vertebral osteomyelitis after spine instrumentation surgery: risk factors and management. J Hosp Infect 2023; 140:102-109. [PMID: 37482096 DOI: 10.1016/j.jhin.2023.07.008] [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] [Received: 05/07/2023] [Revised: 06/30/2023] [Accepted: 07/06/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND Vertebral osteomyelitis after spine instrumentation surgery (pVOM) is a rare complication. Most cases of infection occur early after surgery that involve skin and soft tissue and can be managed with debridement, antibiotics, and implant retention (DAIR). AIM To identify pVOM risk factors and evaluate management strategies. METHODS From a multicentre cohort of deep infection after spine instrumentation (IASI) cases (2010-2016), pVOM cases were compared with those without vertebral involvement. Early and late infections were defined (<60 days and >60 days after surgery, respectively). Multivariate analysis was used to explore risk factors. FINDINGS Among 410 IASI cases, 19 (4.6%) presented with pVOM, ranging from 2% (7/347) in early to 19.1% (12/63) in late IASIs. After multivariate analysis, age (adjusted odds ratio (aOR): 1.10; 95% confidence interval (CI): 1.03-1.18), interbody fusion (aOR: 6.96; 95% CI: 2-24.18) and coagulase-negative staphylococci (CoNS) infection (aOR: 3.83; 95% CI: 1.01-14.53) remained independent risk factors for pVOM. Cases with pVOM had worse prognoses than those without (failure rate; 26.3% vs 10.8%; P = 0.038). Material removal was the preferred strategy (57.9%), mainly in early cases, without better outcomes (failure rate; 33.3% vs 50% compared with DAIR). Late cases managed with removal had greater success compared with DAIR (failure rate; 0% vs 40%; P = 0.067). CONCLUSION Risk factors for pVOM are old age, use of interbody fusion devices and CoNS aetiology. Although the diagnosis leads to a worse prognosis, material withdrawn should be reserved for late cases or when spinal fusion is achieved.
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Affiliation(s)
- E Benavent
- Infectious Diseases Department, Hospital Universitari de Bellvitge, IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain; Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Spain
| | - X Kortajarena
- Infectious Diseases Department, Hospital Universitario Donostia, Gipuzkoa, Spain
| | - B Sobrino-Diaz
- Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Spain; Department of Infectious Diseases, Hospital Regional Universitario Málaga - Instituto de investigacion biomedica de Málaga (IBIMA), Málaga, Spain
| | - O Gasch
- Infectious Diseases Department, Hospital Parc Tauli de Sabadell, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - D Rodríguez-Pardo
- Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Spain; Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - R Escudero-Sanchez
- Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Spain; Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain; Infectious Disease Department, University Hospital Ramón y Cajal, Madrid, Spain
| | - A Bahamonde
- Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Spain; Department of Internal Medicine-Infectious Diseases, Hospital Universitario del Bierzo, León, Spain
| | - D Rodriguez-Montserrat
- Orthopedic Surgery Department, Germans Trias i Pujol University Hospital, Badalona, Spain
| | - M J García-País
- Infectious Disease Unit and Microbiology Departments, Hospital Universitario Lucus Augusti, Lugo, Spain
| | - M D Del Toro López
- Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Spain; Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain; Division of Infectious Diseases and Microbiology, University Hospital Virgen Macarena, Seville, Spain; Biomedicine Institute of Sevilla/Department of Medicine, University of Seville/CSIC, Seville, Spain
| | - L Sorli
- Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Spain; Infectious Diseases Department, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona (UAB), CEXS-Universitat Pompeu Fabra, Barcelona, Spain
| | - A Nodar
- Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Spain; Infectious Diseases Unit, Internal Medicine Department and Instituto de Investigación Biomédica Galicia Sur, Hospital Álvaro Cunqueiro, Vigo, Spain
| | - H H Vilchez
- Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Spain; Infectious Diseases Unit, Internal Medicine Department, Hospital Universitari Son Espases, Fundació Institut d'Investigació Sanitària Illes Balears (IdISBa), Palma de Mallorca, Spain
| | - E Muñez
- Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Spain; Infectious Diseases Unit, Internal Medicine Department, Universitary Hospital Puerta de Hierro-Majadahonda - Research Institute Puerta de Hierro-Segovia de Arana (IDPHISA), Madrid, Spain
| | - J A Iribarren
- Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Spain; Infectious Diseases Department, Hospital Universitario Donostia, Gipuzkoa, Spain; Biodonostia Health Research Institute, Gipuzkoa, Spain
| | - J Ariza
- Infectious Diseases Department, Hospital Universitari de Bellvitge, IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain; Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Spain; Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - O Murillo
- Infectious Diseases Department, Hospital Universitari de Bellvitge, IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain; Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Spain; Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain.
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Martínez-Sanz J, Díaz-Álvarez J, Rosas M, Ron R, Iribarren JA, Bernal E, Gutiérrez F, Ruiz Sancho A, Cabello N, Olalla J, Moreno S, Serrano-Villar S. Expanding HIV clinical monitoring: the role of CD4, CD8, and CD4/CD8 ratio in predicting non-AIDS events. EBioMedicine 2023; 95:104773. [PMID: 37639938 PMCID: PMC10474064 DOI: 10.1016/j.ebiom.2023.104773] [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] [Received: 04/25/2023] [Revised: 08/10/2023] [Accepted: 08/10/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND While a low CD4/CD8 ratio during HIV treatment correlates with immunosenescence, its value in identifying patients at an increased risk for clinical events remains unclear. METHODS We analyzed data from the CoRIS cohort to determine whether CD4 count, CD8 count, and CD4/CD8 ratio at year two of antiretroviral therapy (ART) could predict the risk of serious non-AIDS events (SNAEs) during the next five years. These included major adverse cardiovascular events, non-AIDS-defining malignancies, and non-accidental deaths. We used pooled logistic regression with inverse probability weighting to estimate the survival curves and cumulative risk of clinical events. FINDINGS The study included 4625 participants, 83% male, of whom 200 (4.3%) experienced an SNAE during the follow-up period. A CD4/CD8 ratio <0.3 predicted an increased risk of SNAEs during the next five years (OR 1.63, 95% CI 1.03-2.58). The effect was stronger at a CD4/CD8 ratio cut-off of <0.2 (OR 3.09, 95% CI 1.57-6.07). Additionally, low CD4 count at cut-offs of <500 cells/μL predicted an increased risk of clinical events. Among participants with a CD4 count ≥500 cells/μL, a CD8 count ≥1500 cells/μL or a CD4/CD8 ratio <0.4 predicted increased SNAE risk. INTERPRETATION Our results support the use of the CD4/CD8 ratio and CD8 count as predictors of clinical progression. Patients with CD4/CD8 ratio <0.3 or CD8 count ≥1500/μL, regardless of their CD4 count, may benefit from closer monitoring and targeted preventive interventions. FUNDING This work was supported by CIBER (CB 2021), Instituto de Salud Carlos III, Ministerio de Ciencia e Innovación and Unión Europea-NextGenerationEU; by the Spanish AIDS Research Network (RIS) RD16/0025/0001 project as part of the Plan Nacional R + D + I, and cofinanced by Instituto de Salud Carlos III (ISCIII)- Subdirección General de Evaluación y el Fondo Europeo de Desarrollo Regional (FEDER), ISCIII projects PI18/00154, PI21/00141, and ERDF, "A way to make Europe", ICI20/00058.
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Affiliation(s)
- Javier Martínez-Sanz
- Department of Infectious Diseases, Hospital Ramón y Cajal, IRYCIS, Madrid, Spain; CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain.
| | - Jorge Díaz-Álvarez
- Department of Infectious Diseases, Hospital Ramón y Cajal, IRYCIS, Madrid, Spain; CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Marta Rosas
- Department of Infectious Diseases, Hospital Ramón y Cajal, IRYCIS, Madrid, Spain; CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Raquel Ron
- Department of Infectious Diseases, Hospital Ramón y Cajal, IRYCIS, Madrid, Spain; CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - José Antonio Iribarren
- Hospital Universitario Donostia, Instituto de Investigación BioDonostia, San Sebastián, Spain
| | - Enrique Bernal
- Hospital General Universitario Reina Sofía, Murcia, Spain
| | - Félix Gutiérrez
- Hospital General Universitario de Elche & Universidad Miguel Hernández, Alicante, Spain; CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Noemi Cabello
- Hospital Universitario Clínico San Carlos, Madrid, Spain
| | | | - Santiago Moreno
- Department of Infectious Diseases, Hospital Ramón y Cajal, IRYCIS, Madrid, Spain; University of Alcalá, Madrid, Spain; CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Sergio Serrano-Villar
- Department of Infectious Diseases, Hospital Ramón y Cajal, IRYCIS, Madrid, Spain; CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
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4
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Izquierdo R, Rava M, Moreno-García E, Blanco JR, Asensi V, Cervero M, Curran A, Rubio R, Iribarren JA, Jarrín I. HIV medical care interruption among people living with HIV in Spain, 2004-2020. AIDS 2023; 37:1277-1284. [PMID: 36939068 DOI: 10.1097/qad.0000000000003552] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
OBJECTIVE We estimated the incidence rate of HIV medical care interruption (MCI) and its evolution over a 16-year-period, and identified associated risk factors among HIV-positive individuals from the Cohort of the Spanish AIDS Research Network in 2004-2020. DESIGN We included antiretroviral-naive individuals aged at least 18 years at enrolment, recruited between January 1, 2004, and August 30, 2019, and followed-up until November 30, 2020. METHODS Individuals with any time interval of at least 15 months between two visits were defined as having a MCI. We calculated the incidence rate (IR) of having at least one MCI and used multivariable Poisson regression models to identify associated risk factors. RESULTS Of 15 274 individuals, 5481 (35.9%) had at least one MCI. Of those, 2536 (46.3%) returned to HIV care after MCI and 3753 (68.5%) were lost to follow-up at the end of the study period. The incidence rate (IR) of MCI was 7.2/100 person-years (py) [95% confidence interval (CI): 7.0-7.4]. The annual IR gradually decreased from 20.5/100 py (95% CI: 16.4-25.6) in 2004 to 4.9/100 py (95% CI: 4.4-5.5) in 2014, a slight increase was observed between 2015 and 2018, reaching 9.3/100 py (95% CI: 8.6-10.2) in 2019. Risk factors for MCI included younger age, lower educational level, having contracted HIV infection through injecting drug use or heterosexual intercourse, having been born outside of Spain, and CD4 + cell count >200 cell/μl, viral load <100 000 and co-infection with hepatitis C virus at enrolment. CONCLUSIONS Around a third of individuals had at least one MCI during the follow-up. Identified predictors of MCI can help health workers to target and support most vulnerable individuals.
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Affiliation(s)
- Rebeca Izquierdo
- National Center for Epidemiology, Instituto de Salud Carlos III
- Centre of Biomedical Research for Infectious Diseases (CIBERINFEC), Madrid
| | - Marta Rava
- National Center for Epidemiology, Instituto de Salud Carlos III
- Centre of Biomedical Research for Infectious Diseases (CIBERINFEC), Madrid
| | | | | | - Víctor Asensi
- Infectious Diseases - HIV Unit, Internal Medicine, Hospital Universitario Central de Asturias, Oviedo University School of Medicine, Translational Research in Infective Pathology Lab, ISPA-FINBA
| | - Miguel Cervero
- Internal Medicine Department, Hospital Universitario Severo Ochoa, Leganés
| | - Adrian Curran
- Infectious Diseases Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Barcelona
| | - Rafael Rubio
- HIV Unit, Internal Medicine Department, Biomedical Research Institute Imas12, Hospital Universitario 12 de Octubre. Medicine Department. Universidad Complutense de Madrid, Madrid
| | - José Antonio Iribarren
- Department of Infectious Diseases, Donostia University Hospital, IIS Biodonostia, San Sebastián, Spain
| | - Inmaculada Jarrín
- National Center for Epidemiology, Instituto de Salud Carlos III
- Centre of Biomedical Research for Infectious Diseases (CIBERINFEC), Madrid
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5
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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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6
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Buzón-Martín L, Dueñas Gutierrez C, Iribarren JA, de los Santos I, Santiago ADD, Morán-Rodríguez MÁ, Pousada G, Rico CG, García EM, Ferreira E, Gómez AI, gómez CM, Barquero JG, Egido Murciano MV, Troya J. 1262. Dolutegravir Plus 3TC In Antiretroviral Experienced Adults: Immunovirological Outcomes In a Multicenter Retrospective Cohort In Spain. Open Forum Infect Dis 2022. [PMCID: PMC9752996 DOI: 10.1093/ofid/ofac492.1093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Dolutegravir-based dual therapies for treating people living with HIV (PLHIV) are strategies strongly recommended in several practice guidelines. The safety and efficacy combination of Dolutegravir (DTG) plus 3TC as a switching strategy in virologically suppressed patients was demonstrated in the TANGO study. Wide multicenter real life data supporting this treatment is needed. The aim of the current study was to describe the efficacy in terms of immunovirological outcomes in patients treated with this antiretroviral combination. Methods From November 1st 2020 to August 1st 2021, data from 1062 PLHIV collected from 13 Spanish institutions were recorded in a multicenter, retrospective study; After discarding cases in which relevant variables were missing, finally 694 cases underwent statistical analysis. Inclusion criteria were age >18 years, and to receive treatment with DTG/3TC as a switch strategy. Immunovirological impact of this strategy ( CD4+, CD8+ and CD4+/CD8+ cell count, as well as HIV plasma viral load through weeks 24, 48 and 96 of follow up) was evaluated using multivariable mixed models where the individual was considered as a random effect. Sex and age were added as demographic covariables. Results 78% of patients were men, 16% had been previously diagnosed of AIDS. Mean age was 48 years old. Mean CD4 T cell count nadir was 300 cell/ml (160-480). We found a significant increase in CD4+ counts at 24, 48 and 96 weeks after switching drug strategy. We also detected a small increase in the CD4+/CD8+ count rate at 48 and 96 weeks. No significant change was found in CD8+ count. No differences were found on behalf of sex, between backbone drugs (73% switched from a TDF/FTC backbone and 26.9% from ABC/3TC) or amongst the different third agents used (62% switched from integrase inhibitors). We identified a strong and negative effect of having AIDS in the CD4+ count. However, this effect did not interact with the effect of switching drug strategies. CD4, CD8 and CD4/CD8 after switch at 24, 48 and 96w
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![]() Conclusion PLHIV who, being virologically suppressed, switched to dual therapy based on DTG/3TC, experienced a statistically significant increase of CD4+ T cell count at weeks 24, 48 and 96, as well as an increase in CD4/CD8 T cell ratio, as well as high efficacy in terms of viral replication suppression, independently of the stage of HIV infection. Disclosures Luis Buzón-Martín, MD, ViiV, GILEAD, Jannsen, MSD: Lecture fees Carlos Dueñas Gutierrez, MD, ViIV, GILEAD, Jannsen, MSD: Lecture fees Jesús Troya, Staff, ViiV, GILEAD, Jannsen, MSD: Lecture fees.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Eva Ferreira
- Hospital General de Segovia, Segovia, Castilla y Leon, Spain
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7
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Del Amo J, Polo R, Moreno S, Martínez E, Cabello A, Iribarren JA, Curran A, Macías J, Montero M, Dueñas C, Mariño AI, de la Cámara SP, Díaz A, Arribas JR, Jarrín I, Hernán MA. Tenofovir disoproxil fumarate/emtricitabine and severity of coronavirus disease 2019 in people with HIV infection. AIDS 2022; 36:2171-2179. [PMID: 36382436 PMCID: PMC9673178 DOI: 10.1097/qad.0000000000003372] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Effective, safe, and affordable antivirals are needed for coronavirus disease 2019 (COVID-19). Several lines of research suggest that tenofovir may be effective against COVID-19, but no large-scale human studies with appropriate adjustment for comorbidities have been conducted. METHODS We studied HIV-positive individuals on antiretroviral therapy (ART) in 2020 at 69 HIV clinics in Spain. We collected data on sociodemographics, ART, CD4+ cell count, HIV-RNA viral-load, comorbidities and the following outcomes: laboratory-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, COVID-19 hospitalization, intensive care unit (ICU) admission and death. We compared the 48-week risks for individuals receiving tenofovir disoproxil fumarate (TDF)/emtricitabine (FTC), tenofovir alafenamide (TAF)/FTC, abacavir (ABC)/lamivudine (3TC), and other regimes. All estimates were adjusted for clinical and sociodemographic characteristics via inverse probability weighting. RESULTS Of 51 558 eligible individuals, 39.6% were on TAF/FTC, 11.9% on TDF/FTC, 26.6% on ABC/3TC, 21.8% on other regimes. There were 2402 documented SARS-CoV-2 infections (425 hospitalizations, 45 ICU admissions, 37 deaths). Compared with TAF/FTC, the estimated risk ratios (RR) (95% confidence interval) of hospitalization were 0.66 (0.43, 0.91) for TDF/FTC and 1.29 (1.02, 1.58) for ABC/3TC, the RRs of ICU admission were 0.28 (0.11, 0.90) for TDF/FTC and 1.39 (0.70, 2.80) for ABC/3TC, and the RRs of death were 0.37 (0.23, 1.90) for TDF/FTC and 2.02 (0.88-6.12) for ABC/3TC. The corresponding RRs of hospitalization for TDF/FTC were 0.49 (0.24, 0.81) in individuals ≥50 years and 1.15 (0.59, 1.93) in younger individuals. DISCUSSION Compared with other antiretrovirals, TDF/FTC lowers COVID-19 severity among HIV-positive individuals with virological control. This protective effect may be restricted to individuals aged 50 years and older.
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Affiliation(s)
- Julia Del Amo
- Division of HIV, STI, Hepatitis and Tuberculosis. Ministry of Health, Madrid
- CIBER de Enfermedades Infecciosas
| | - Rosa Polo
- Division of HIV, STI, Hepatitis and Tuberculosis. Ministry of Health, Madrid
| | - Santiago Moreno
- CIBER de Enfermedades Infecciosas
- University Hospital Ramón y Cajal Madrid
- HIV Network of Excellence
| | - Esteban Martínez
- CIBER de Enfermedades Infecciosas
- HIV Network of Excellence
- University Hospital Clinic, Barcelona
| | - Alfonso Cabello
- HIV Network of Excellence
- University Hospital La Concepción, Fundación Jiménez Díaz, Madrid
| | | | - Adria Curran
- HIV Network of Excellence
- University Hospital, Vall D'Hebron, Barcelona
| | - Juan Macías
- HIV Network of Excellence
- University Hospital Virgen de Valme, Seville
| | - Marta Montero
- HIV Network of Excellence
- University Hospital La Fe, Valencia
| | | | - Ana I Mariño
- HIV Network of Excellence
- University Hospital El Ferrol
| | | | - Asuncion Díaz
- CIBER de Enfermedades Infecciosas
- HIV Network of Excellence
- National Center for Epidemiology, Institute of Health Carlos III
| | - José Ramón Arribas
- CIBER de Enfermedades Infecciosas
- HIV Network of Excellence
- University Hospital La Paz, IdiPAZ Madrid, Spain
| | - Inma Jarrín
- CIBER de Enfermedades Infecciosas
- HIV Network of Excellence
- National Center for Epidemiology, Institute of Health Carlos III
| | - Miguel A Hernán
- CAUSALab
- Departments of Epidemiology and Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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8
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Ruiz-Algueró M, Alejos B, García Yubero C, Riera Jaume M, Antonio Iribarren J, Asensi V, Pasquau F, Galera CE, Pascual-Carrasco M, Muñoz A, Jarrín I, Suárez-García I, Moreno S, Jarrín I, Dalmau D, Navarro ML, González MI, Blanco JL, Garcia F, Rubio R, Iribarren JA, Gutiérrez F, Vidal F, Berenguer J, González J, Alejos B, Hernando V, Moreno C, Iniesta C, Garcia Sousa LM, Perez NS, Muñoz-Fernández MÁ, García-Merino IM, Fernández IC, Rico CG, de la Fuente JG, Concejo PP, Portilla J, Merino E, Reus S, Boix V, Giner L, Gadea C, Portilla I, Pampliega M, Díez M, Rodríguez JC, Sánchez-Payá J, Gómez JL, Hernández J, Alemán MR, del Mar Alonso M, Inmaculada Hernández M, Díaz-Flores F, García D, Pelazas R, Lirola AL, Moreno JS, Caso AA, Hernández Gutiérrez C, Novella Mena M, Rubio R, Pulido F, Bisbal O, Hernando A, Domínguez L, Crestelo DR, Bermejo L, Santacreu M, Antonio Iribarren J, Arrizabalaga J, Aramburu MJ, Camino X, Rodríguez-Arrondo F, von Wichmann MÁ, Tomé LP, Goenaga MÁ, Bustinduy MJ, Azkune H, Ibarguren M, Lizardi A, Kortajarena X, Gutiérrez F, Masiá M, Padilla S, Navarro A, Montolio F, Robledano C, Gregori Colomé J, Adsuar A, Pascual R, Fernández M, García E, García JA, Barber X, Muga R, Sanvisens A, Fuster D, Berenguer J, de Quirós JCLB, Gutiérrez I, Ramírez M, Padilla B, Gijón P, Aldamiz-Echevarría T, Tejerina F, José Parras F, Balsalobre P, Diez C, Latorre LP, Vidal F, Peraire J, Viladés C, Veloso S, Vargas M, López-Dupla M, Olona M, Rull A, Rodríguez-Gallego E, Alba V, Montero Alonso M, López Aldeguer J, Blanes Juliá M, Tasias Pitarch M, Hernández IC, Calabuig Muñoz E, Cuéllar Tovar S, Salavert Lletí M, Navarro JF, González-Garcia J, Arnalich F, Arribas JR, de la Serna JIB, Castro JM, Escosa L, Herranz P, Hontañón V, García-Bujalance S, López-Hortelano MG, González-Baeza A, Martín-Carbonero ML, Mayoral M, Mellado MJ, Micán RE, Montejano R, Luisa Montes M, Moreno V, Pérez-Valero I, Rodés B, Sainz T, Sendagorta E, Stella Alcáriz N, Valencia E, Ramón Blanco J, Antonio Oteo J, Ibarra V, Metola L, Sanz M, Pérez-Martínez L, Arazo P, Sampériz G, Dalmau D, Jaén A, Sanmartí M, Cairó M, Martinez-Lacasa J, Velli P, Font R, Xercavins M, Alonso N, Repáraz J, de Alda MGR, de León Cano MT, de Galarreta BPR, Segura F, José Amengual M, Navarro G, Sala M, Cervantes M, Pineda V, Calzado S, Navarro M, de los Santos I, Sanz Sanz J, Aparicio AS, Sarriá Cepeda C, Garcia-Fraile Fraile L, Martín Gayo E, Moreno S, Luis Casado J, Dronda F, Moreno A, Jesús Pérez Elías M, Gómez Ayerbe C, Gutiérrez C, Madrid N, del Campo Terrón S, Martí P, Ansa U, Serrano S, Jesús Vivancos M, Cano A, García AA, Bravo Urbieta J, Muñoz Á, Jose Alcaraz M, Villalba MDC, García F, Hernández J, Peña A, Muñoz L, Casas P, Alvarez M, Chueca N, Vinuesa D, Martinez-Montes C, Romero JD, Rodríguez C, Puerta T, Carlos Carrió J, Vera M, Ballesteros J, Ayerdi O, Antela A, Losada E, Riera M, Peñaranda M, Leyes M, Ribas MA, Campins AA, Vidal C, Fanjul F, Murillas J, Homar F, Santos J, Ayerbe CG, Viciana I, Palacios R, González CM, Viciana P, Espinosa N, López-Cortés LF, Podzamczer D, Ferrer E, Imaz A, Tiraboschi J, Silva A, Saumoy M, Ribera E, Curran A, Olalla J, del Arco A, de la torre J, Prada JL, de Lomas Guerrero JMG, Stachowski JP, Martínez OJ, Vera FJ, Martínez L, García J, Alcaraz B, Jimeno A, Iglesias AC, Souto BP, de Cea AM, Muñoz J, Zubero MZ, Baraia-Etxaburu JM, Ugarte SI, Beneitez OLF, de Munain JL, López MMC, de la Peña M, Lopez M, Galera C, Albendin H, Pérez A, Iborra A, Moreno A, Merlos MA, Vidal A, Amador C, Pasquau F, Ena J, Benito C, Fenoll V, Anguita CG, Rabasa JTA, Suárez-García I, Malmierca E, González-Ruano P, Rodrigo DM, Seco MPR, Vidal MAG, de Zarraga MA, Pérez VE, Molina MJT, García JV, Moreno JPS, Górgolas M, Cabello A, Álvarez B, Prieto L, Sanz Moreno J, Arranz Caso A, Gutiérrez CH, Novella Mena M, Galindo Puerto MJ, Fernando Vilalta R, Ferrer Ribera A, Román AR, Brieva Herrero MT, Juárez AR, López PL, Sánchez IM, Martínez JP, Jiménez MC, Perea RT, Ruiz-Capillas JJJ, Pineda JA. Use of Generic Antiretroviral Drugs and Single-Tablet Regimen De-Simplification for the Treatment of HIV Infection in Spain. AIDS Res Hum Retroviruses 2022; 38:433-440. [PMID: 35357907 DOI: 10.1089/aid.2021.0122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The present study sought to describe the use of generic drugs and single-tablet regimen (STR) de-simplification for the treatment of human immunodeficiency virus (HIV) infection among 41 hospitals from the cohort of the Spanish HIV/AIDS Research Network (CoRIS). In June 2018, we collected information on when generic antiretroviral drugs (ARVs) were introduced in the different hospitals, how the decisions to use them were made, and how the information was provided to the patients. Most of the nine available generic ARVs in Spain by June 2018 had been introduced in at least 85% of the participating hospitals, except for zidovudine (AZT)/lamivudine (3TC) and AZT. The time difference between the effective marketing date of each generic ARV and its first dispensing date in the hospitals was much shorter for the more recently approved generic ARV since the year 2017. However, only up to 20% of the hospitals de-simplified efavirenz (EFV)/tenofovir disoproxil (TDF)/emtricitabine (FTC), dolutegravir (DTG)/abacavir (ABC)/3TC, and rilpivirine (RPV)/TDF/FTC (to generic EFV+TDF/FTC, DTG+generic ABC/3TC, and RPV+generic TDF/FTC, respectively), whereas the generic STR EFV/TDF/FTC was introduced in 87.8% of the centers. The median times between the date of effective marketing of generic TDF/FTC and the date of de-simplification of EFV/TDF/FTC and RPV/TDF/FTC were 723 [interquartile range (IQR): 369-1,119] and 234 (IQR: 142-264) days, respectively; this time was 155 (IQR: 28-287) days for de-simplification of DTG/ABC/3TC. In conclusion, despite the widespread use of generic ARVs, STRs de-simplification was only undertaken in <20% of the hospitals. There was wide variability in the timing of the introduction of each generic ARV after they were available in the market.
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Affiliation(s)
- Marta Ruiz-Algueró
- National Center for Epidemiology, Institute of Health Carlos, Madrid, Spain
- CIBER de Enfermedades Infecciosas, Institute of Health CArlos III, Madrid, Spain
| | - Belén Alejos
- National Center for Epidemiology, Institute of Health Carlos, Madrid, Spain
| | | | | | - José Antonio Iribarren
- Servicio de Enfermedades Infecciosas, Hospital Universitario Donostia, Instituto de Investigación BioDonostia, San Sebastián, Spain
| | - Víctor Asensi
- Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | | | - Mario Pascual-Carrasco
- CIBER de Enfermedades Infecciosas, Institute of Health CArlos III, Madrid, Spain
- Unidad de Investigación en Telemedicina y Salud Digital (UITes), Instituto de Salud Carlos III, Madrid, Spain
| | - Adolfo Muñoz
- CIBER de Enfermedades Infecciosas, Institute of Health CArlos III, Madrid, Spain
- Unidad de Investigación en Telemedicina y Salud Digital (UITes), Instituto de Salud Carlos III, Madrid, Spain
| | - Inmaculada Jarrín
- National Center for Epidemiology, Institute of Health Carlos, Madrid, Spain
- CIBER de Enfermedades Infecciosas, Institute of Health CArlos III, Madrid, Spain
| | - Inés Suárez-García
- CIBER de Enfermedades Infecciosas, Institute of Health CArlos III, Madrid, Spain
- Infectious Diseases Unit, Department of Internal Medicine, Hospital Universitario Infanta Sofía, Madrid, Spain
- Facultad de Ciencias Biomédicas, Universidad Europea de Madrid, Madrid, Spain
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Domínguez-Domínguez L, Rava M, Bisbal O, Lopez-Cortés L, Portilla J, Podzamczer D, Olalla J, Fuster D, Rubio R, Jarrín I, Iribarren JA, Moreno S. Low CD4/CD8 ratio is associated with increased morbidity and mortality in late and non-late presenters: results from a multicentre cohort study, 2004–2018. BMC Infect Dis 2022; 22:379. [PMID: 35428209 PMCID: PMC9013070 DOI: 10.1186/s12879-022-07352-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 04/05/2022] [Indexed: 11/10/2022] Open
Abstract
Background To study whether the association between the CD4/CD8 ratio variation over time and the development of clinical outcomes vary in late presenters (CD4 count < 350/µL or AIDS event at enrolment) or advanced presenters (CD4 count < 200/µL or AIDS event at enrolment). Methods We included ART-naïve adults from the Cohort of the Spanish HIV/AIDS Research Network (CoRIS) enrolled between January 2004 up to November 2018 and with at least 6 months of follow-up. We used extended Cox proportional hazard models to estimate the hazard ratios (HRs) for the association between CD4/CD8 ratio over time and a composite endpoint of the occurrence of the first AIDS event, first serious non-AIDS event or overall mortality occurring from 6 months after enrolment. HRs in non-late, late and advanced presenters were obtained by including an interaction term between late presentation status and CD4/CD8 ratio over time. Results Of 10,018 participants, 55.6% were late presenters and 26.5% were advanced presenters. Compared with CD4/CD8 ratio > 0.4, CD4/CD8 ratio ≤ 0.4 over time was associated with an increased risk of experiencing the composite endpoint in non-late (HR 1.90; 95%CI 1.48, 2.43), late (HR 1.94; 1.46, 2.57) and advanced presenters (HR 1.72; 1.26, 2.34). Similarly, CD4/CD8 ratio ≤ 0.4 over time was associated with a higher risk of developing an AIDS event (HR 3.31; 2.23, 4.93 in non-late; HR 2.75; 1.78, 4.27 in late and HR 2.25; 1.34, 3.76 in advanced presenters) or serious non-AIDS event (HR 1.39; 0.96, 2.02 in non-late, HR 1.62; 1.10, 2.40 in late and HR 1.49; 0.97, 2.29 in advanced presenters) as well as with a higher risk of overall mortality (HR 1.49; 0.92, 2.41 in non-late, HR 1.80; 1.04, 3.11 in late and HR 1.61; 0.92, 2.83 in advanced presenters) compared to CD4/CD8 > 0.4, regardless of the late presentation status. Conclusions A low CD4/CD8 measured over time is associated with increased risk of morbidity and mortality in people living with HIV independently of their late presentation status. These data support the prognostic role of CD4/CD8 over time and can help defining a subgroup of patients who need closer monitoring to avoid comorbidities. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07352-z.
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Serrano-Villar S, López-Huertas MR, Jiménez D, Galera C, Martínez-Sanz J, Moreno E, Muriel A, Gutiérrez F, Busca C, Portilla J, Bisbal O, Iribarren JA, Tejerina F, de Los Santos I, Moreno S. Long-Term Changes of Inflammatory Biomarkers in Individuals on Suppressive Three-Drug or Two-Drug Antiretroviral Regimens. Front Immunol 2022; 13:848630. [PMID: 35359950 PMCID: PMC8964183 DOI: 10.3389/fimmu.2022.848630] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 02/11/2022] [Indexed: 11/30/2022] Open
Abstract
Background Because inflammation is associated with mortality and has been linked to HIV transcription in lymphoid tissues during ART, it is necessary to address the long-term effects of switching 3-drug (3DR) to 2-drug regimens (2DR) on inflammation. Methods Nested study in the Spanish AIDS Research Network. We selected PWH ART-naive initiating 3DR who achieved viral suppression in the first 48 weeks and either remained on 3DR or switched to 2DR (3TC+bPI; 3TC+DTG; DTG+RPV). We assessed the trajectories on inflammatory markers during ART using multivariate piecewise mixed models. Results We analyzed 619 plasma samples from 148 patients (3DR, N=90; 2DR, N=58), the median follow-up was 4.6 (IQR 3.2-6.2) years. There were no significant differences in baseline characteristics between groups. After adjusting for potential confounders, patients with 3DR experienced a slow decline of IL6, hs-CRP, sCD14, sCD163, and D-dimer over time. In contrast, compared to 3DR, switching to 2DR was associated with increases in IL-6 (p=0.001), hs-CRP (p=0.003), and D-dimer (p=0.001) after year 3 from virologic suppression. 2DR was associated with a higher risk of hs-CRP quartile increase (aOR 3.3, 95%CI 1.1-10) and D-dimer quartile increase (aOR 3.7, 95%CI 1.1-13). The adjusted biomarker trajectories did not reveal a distinct pattern according to the type of 2DR used (bPI vs DTG). Conclusions In this study in virally suppressed individuals, maintaining 3DR was associated with a more favorable long-term inflammatory profile than switching to 2DR. The potential clinical implications of these findings on the development of non-AIDS events deserve further investigation.
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Affiliation(s)
- Sergio Serrano-Villar
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, Facultad de Medicina, Universidad de Alcalá, Instituto de Investivestigación Ramón y Cajal (IRYCIS), Madrid, Spain.,CIBER de Enfermedades Infecciosas CIBER-Infec, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Daniel Jiménez
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, Facultad de Medicina, Universidad de Alcalá, Instituto de Investivestigación Ramón y Cajal (IRYCIS), Madrid, Spain.,CIBER de Enfermedades Infecciosas CIBER-Infec, Instituto de Salud Carlos III, Madrid, Spain
| | - Carlos Galera
- HIV Unit, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Javier Martínez-Sanz
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, Facultad de Medicina, Universidad de Alcalá, Instituto de Investivestigación Ramón y Cajal (IRYCIS), Madrid, Spain.,CIBER de Enfermedades Infecciosas CIBER-Infec, Instituto de Salud Carlos III, Madrid, Spain
| | - Elena Moreno
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, Facultad de Medicina, Universidad de Alcalá, Instituto de Investivestigación Ramón y Cajal (IRYCIS), Madrid, Spain.,CIBER de Enfermedades Infecciosas CIBER-Infec, Instituto de Salud Carlos III, Madrid, Spain
| | - Alfonso Muriel
- Biostatistics Unit, Hospital Universitario Ramón y Cajal, Facultad de Medicina, Universidad de Alcalá, IRYCIS, Madrid, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Félix Gutiérrez
- CIBER de Enfermedades Infecciosas CIBER-Infec, Instituto de Salud Carlos III, Madrid, Spain.,Hospital General Universitario de Elche and Universidad Miguel Hernández, Alicante, Spain
| | - Carmen Busca
- CIBER de Enfermedades Infecciosas CIBER-Infec, Instituto de Salud Carlos III, Madrid, Spain.,HIV Unit, Hospital Universitario La Paz, Madrid, Spain
| | - Joaquín Portilla
- Department of Internal Medicine, Hospital General Universitario de Alicante, Alicante, Spain
| | - Otilia Bisbal
- HIV Unit, Hospital Universitario Doce de Octubre, Madrid, Spain
| | | | | | | | - Santiago Moreno
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, Facultad de Medicina, Universidad de Alcalá, Instituto de Investivestigación Ramón y Cajal (IRYCIS), Madrid, Spain.,CIBER de Enfermedades Infecciosas CIBER-Infec, Instituto de Salud Carlos III, Madrid, Spain
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Carrasco I, Tarancon-Diez L, Vázquez-Alejo E, Jiménez de Ory S, Sainz T, Apilanez M, Epalza C, Guillén S, Tomás Ramos J, Díez C, Bernardino JI, Iribarren JA, Zamora A, Muñoz-Fernández MÁ, Navarro ML. Innate and adaptive abnormalities in youth with vertically acquired HIV through a multicentre cohort in Spain. J Int AIDS Soc 2021; 24:e25804. [PMID: 34672108 PMCID: PMC8528666 DOI: 10.1002/jia2.25804] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 07/29/2021] [Indexed: 12/25/2022] Open
Abstract
Introduction Immune abnormalities have been described among youth with vertically acquired HIV (YWVH) despite antiretroviral treatment (ART). The CD4/CD8 ratio could be a useful prognostic marker. We assess immune activation and senescence in a cohort of YWVH in comparison to youth without vertically acquired HIV. Methods YWVH under suppressive ART were included and compared to a group of HIV‐negative donors (HD) matched by age and sex, from September 2019 to September 2020. Subset distribution and expression of activation, maturation, senescence and exhaustion markers on T and NK cells were studied on peripheral blood mononuclear cells by multiparametric flow cytometry. Results Thirty‐two YWVH (median age: 24.4 years (interquartile range: 22.5 to 28.3 years)) were included. Among YWVH, CD4‐ and CD8‐T cells showed high levels of activation (HLA‐DR/CD38), IL‐7 receptor expression (CD127) and exhaustion (TIM‐3). Regarding NK cells, YWVH showed increased levels of activation and exhaustion markers compared to HD. Strong inverted correlations were observed between T‐cell activation (HLA‐DR/CD38), senescence (CD57) and exhaustion (TIGIT, PD‐1) levels with the CD4/CD8 ratio among YWVH. HLA‐DR, CD69, NKG2D and NKG2A expression levels on NK cells also correlated with the CD4/CD8 ratio. Age at ART initiation was directly associated with higher frequency of CD16high NK‐cell subsets, exhaustion T‐cell levels (CD57, TIM3) and NK cells activation levels. Conclusions Immunological changes associated with vertically acquired HIV, characterized by increased activation and exhaustion levels in innate and adaptive immune components, are only partially restored by ART. The CD4/CD8 ratio can be a useful marker of disease progression for routine clinical practice.
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Affiliation(s)
- Itzíar Carrasco
- Infectious Diseases in Paediatric Population, Gregorio Marañón Research Institute (IiSGM) and University Hospital, Madrid, Spain.,Universidad Complutense de Madrid, Madrid, Spain
| | - Laura Tarancon-Diez
- Immunology Section, Inmuno-Biology Molecular Laboratory, Gregorio Marañón University General Hospital (HGUGM), Gregorio Marañón Health Research Institute (IiSGM), Spanish HIV HGM BioBank, Madrid, Spain
| | - Elena Vázquez-Alejo
- Immunology Section, Inmuno-Biology Molecular Laboratory, Gregorio Marañón University General Hospital (HGUGM), Gregorio Marañón Health Research Institute (IiSGM), Spanish HIV HGM BioBank, Madrid, Spain
| | - Santiago Jiménez de Ory
- Infectious Diseases in Paediatric Population, Gregorio Marañón Research Institute (IiSGM) and University Hospital, Madrid, Spain
| | - Talía Sainz
- Department of Paediatrics, La Paz Research Institute (IdiPAZ) and University Hospital, Madrid, Spain
| | - Miren Apilanez
- Department of Paediatrics, Donostia University Hospital, País Vasco, Spain
| | - Cristina Epalza
- Department of Paediatrics, 12 de Octubre University Hospital, Madrid, Spain
| | - Sara Guillén
- Department of Paediatrics, Getafe University Hospital, Madrid, Spain
| | - José Tomás Ramos
- Department of Paediatrics, Clínico San Carlos University Hospital, Madrid, Spain
| | - Cristina Díez
- Department Infectious Diseases, Gregorio Marañón Research Institute and University Hospital, Madrid, Spain
| | - Jose Ignacio Bernardino
- Department of Infectious Diseases, La Paz Research Institute (IdiPAZ) and University Hospital, Madrid, Spain
| | | | - Angielys Zamora
- Biochemistry Section, Gregorio Marañón University Hospital, Madrid, Spain
| | - María Ángeles Muñoz-Fernández
- Immunology Section, Inmuno-Biology Molecular Laboratory, Gregorio Marañón University General Hospital (HGUGM), Gregorio Marañón Health Research Institute (IiSGM), Spanish HIV HGM BioBank, Madrid, Spain
| | - María Luisa Navarro
- Infectious Diseases in Paediatric Population, Gregorio Marañón Research Institute (IiSGM) and University Hospital, Madrid, Spain.,Universidad Complutense de Madrid, Madrid, Spain
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- Infectious Diseases in Paediatric Population, Gregorio Marañón Research Institute (IiSGM) and University Hospital, Madrid, Spain
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12
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Mancheño-Losa M, Lora-Tamayo J, Fernández-Sampedro M, Rodríguez-Pardo D, Muñoz-Mahamud E, Soldevila L, Palou M, Barbero JM, Del Toro MD, Iribarren JA, Sobrino B, Rico-Nieto A, Guío-Carrión L, Gómez L, Escudero-Sánchez R, García-País MJ, Jover-Sáenz A, Praena J, Baraia-Etxaburu JM, Auñón Á, Múñez-Rubio E, Murillo O. Prognosis of unexpected positive intraoperative cultures in arthroplasty revision: A large multicenter cohort. J Infect 2021; 83:542-549. [PMID: 34509512 DOI: 10.1016/j.jinf.2021.09.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 08/14/2021] [Accepted: 09/03/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND The positive-intraoperative-cultures-type prosthetic joint infection (PIOC-PJI) is considered when surgical cultures yield microorganisms in presumed aseptic arthroplasty revisions. Herein we assess the risk factors for failure in the largest cohort of PIOC-PJI patients reported to date. METHODS A retrospective, observational, multicenter study was performed during 2007-2017. Surgeries leading to diagnose PIOC-PJI included only one-stage procedures with either complete or partial prosthesis revision. Failure was defined as recurrence caused by the same microorganism. RESULTS 203 cases were included (age 72 years, 52% females). Coagulase-negative staphylococci (n = 125, 62%) was the main etiology, but some episodes were caused by virulent bacteria (n = 51, 25%). Prosthesis complete and partial revision was performed in 93 (46%) and 110 (54%) cases, respectively. After a median of 3.4 years, failure occurred in 17 episodes (8.4%, 95%CI 5.3-13.1). Partial revision was an independent predictor of failure (HR 3.63; 95%CI 1.03-12.8), adjusted for gram-negative bacilli (GNB) infection (HR 2.68; 95%CI 0.91-7.89) and chronic renal impairment (HR 2.40; 95%CI 0.90-6.44). Treatment with biofilm-active antibiotics (rifampin/fluoroquinolones) had a favorable impact on infections caused by staphylococci and GNB. CONCLUSION Overall prognosis of PIOC-PJI is good, but close follow-up is required in cases of partial revision and in infections caused by GNB.
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Affiliation(s)
- Mikel Mancheño-Losa
- Department of Internal Medicine, Hospital Universitario 12 de Octubre, Instituto de Investigación Biomédica "imas12" Hospital 12 de Octubre, Av. de Córdoba s/n, Madrid, Spain; Bone and Joint Infection Study Group of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Spain
| | - Jaime Lora-Tamayo
- Department of Internal Medicine, Hospital Universitario 12 de Octubre, Instituto de Investigación Biomédica "imas12" Hospital 12 de Octubre, Av. de Córdoba s/n, Madrid, Spain; Spanish Network for the Study of Infectious Diseases / Red Española de Investigación en Patología Infecciosa (REIPI), Spain; Bone and Joint Infection Study Group of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Spain; CIBER de Enfermedades Infecciosas, Instuto de Salud Carlos III, Madrid.
| | - Marta Fernández-Sampedro
- Department of Infectious Diseases, Hospital Universitario Marqués de Valdecilla, Santander, Spain; Bone and Joint Infection Study Group of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Spain
| | - Dolors Rodríguez-Pardo
- Department of Infectious Diseases, Vall d'Hebron Hospital Universitari, Barcelona, Spain; Spanish Network for the Study of Infectious Diseases / Red Española de Investigación en Patología Infecciosa (REIPI), Spain; Bone and Joint Infection Study Group of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Spain
| | - Ernesto Muñoz-Mahamud
- Department of Orthopedics and Trauma Surgery, Hospital Clinic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Laura Soldevila
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain; Bone and Joint Infection Study Group of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Spain
| | - Mariona Palou
- Department of Infectious Diseases, Hospital Universitari Parc Taulí, Sabadell, Spain; Bone and Joint Infection Study Group of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Spain
| | - José María Barbero
- Department of Internal Medicine, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Spain; Bone and Joint Infection Study Group of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Spain
| | - María Dolores Del Toro
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Hospital Universitario Virgen Macarena, University of Seville, Institute of Biomedicine of Seville (IBiS), Spain; Bone and Joint Infection Study Group of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Spain
| | - José Antonio Iribarren
- Department of Infectious Diseases, Hospital Universitario Donostia, IIS BioDonostia, San Sebastián, Spain; Bone and Joint Infection Study Group of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Spain
| | - Beatriz Sobrino
- Department of Infectious Diseases, Hospital Regional Universitario de Málaga, Málaga, Spain; Bone and Joint Infection Study Group of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Spain
| | - Alicia Rico-Nieto
- Department of Infectious Diseases, Hospital Universitario La Paz, Madrid, Spain; Bone and Joint Infection Study Group of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Spain
| | - Laura Guío-Carrión
- Department of Infectious Diseases, Hospital Universitario Cruces, Barakaldo, Spain; Bone and Joint Infection Study Group of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Spain
| | - Lucía Gómez
- Department of Infectious Diseases, Hospital Universitari Mútua Terrassa, Terrassa, Spain; Bone and Joint Infection Study Group of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Spain
| | - Rosa Escudero-Sánchez
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, Madrid, Spain; Spanish Network for the Study of Infectious Diseases / Red Española de Investigación en Patología Infecciosa (REIPI), Spain; Bone and Joint Infection Study Group of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Spain
| | - María José García-País
- Department of Infectious Diseases, Hospital Universitario Lucus Augusti, Lugo, Spain; Bone and Joint Infection Study Group of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Spain
| | - Alfredo Jover-Sáenz
- Department of Infectious Diseases, Hospital Universitari Arnau de Vilanova, Lleida, Spain; Bone and Joint Infection Study Group of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Spain
| | - Julia Praena
- Department of Infectious Diseases, Hospital Universitario Virgen del Rocío, Sevilla, Spain; Bone and Joint Infection Study Group of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Spain
| | - Josu Miren Baraia-Etxaburu
- Department of Infectious Diseases, Hospital Universitario de Basurto, Bilbao, Spain; Bone and Joint Infection Study Group of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Spain
| | - Álvaro Auñón
- Department of Orthopedics and Trauma Surgery, Hospital Universitario Fundación Jiménez-Díaz, Madrid, Spain; CIBER de Enfermedades Infecciosas, Instuto de Salud Carlos III, Madrid
| | - Elena Múñez-Rubio
- Department of Infectious Diseases, Hospital Universitario Puerta de Hierro, Madrid, Spain; Bone and Joint Infection Study Group of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Spain
| | - Oscar Murillo
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain; Spanish Network for the Study of Infectious Diseases / Red Española de Investigación en Patología Infecciosa (REIPI), Spain; Bone and Joint Infection Study Group of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Spain; CIBER de Enfermedades Infecciosas, Instuto de Salud Carlos III, Madrid
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13
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Muñoz Hornero C, Muriel A, Montero M, Iribarren JA, Masía M, Muñoz L, Sampériz G, Navarro G, Moreno S, Pérez-Elías MJ. Differences in epidemiology and mortality between men and women with HIV infection in the CoRIS cohort from 2004 to 2014. ACTA ACUST UNITED AC 2021; 39:372-382. [PMID: 34373227 DOI: 10.1016/j.eimce.2021.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 05/19/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION This study sought to analyse differences in epidemiology and survival between women and men living with HIV (WLHIV and MLHIV) in the CoRIS cohort and the course of their disease over a 10-year period. METHODS Variables of interest between WLHIV and MLHIV were compared. A trend analysis was performed using the Mantel-Haenszel test. Kaplan-Meier survival curves and a Cox regression analysis were used to study survival. RESULTS A total of 10,469 people were enrolled; of them, 1,742 (16.6%) were women. At the time of enrolment in the cohort, WLHIV, compared to MLHIV, had higher rates of transmission due to intravenous drug use (IDU), hepatitis C virus (HCV) coinfection, AIDS-stage disease and foreign origin. They also had a worse immunovirological status and a lower educational level. These differences were maintained in the trend study. Regarding age, the women included in the cohort were older whereas the men were younger. In the comparative analysis between women according to place of origin, we found that the group of Spanish WLHIV featured older women with higher rates of IDU transmission and HCV coinfection, whereas the group of WLHIV born outside of Spain featured women with higher rates of syphilis infection. There were no major differences in relation to other characteristics such as educational level or disease status. Although sex was not a determinant of survival, conditions more prevalent in women were determinants of survival. CONCLUSIONS HIV-infected women presented at diagnosis with certain epidemiological and HIV-associated characteristics that made them more vulnerable. These trends became more marked or did not improve during the years of observation.
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Affiliation(s)
| | - Alfonso Muriel
- Unidad de Bioestadística Clínica, Hospital Ramón y Cajal, YRICIS, CIBERESP, Madrid, Spain
| | - Marta Montero
- Servicio de Enfermedades Infecciosas, Hospital La Fe, Valencia, Spain
| | - José Antonio Iribarren
- Servicio de Enfermedades Infecciosas, Hospital Universitario Donostia, San Sebastián, Spain
| | - Mar Masía
- Servicio de Enfermedades Infecciosas, Hospital de Elche, Elche, Alicante, Spain
| | - Leopoldo Muñoz
- Servicio de Enfermedades Infecciosas, Hospital San Cecilio, Granada, Spain
| | - Gloria Sampériz
- Servicio de Enfermedades Infecciosas, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Gemma Navarro
- Servicio de Enfermedades Infecciosas, Hospital Parc Taulí, Sabadell, Barcelona, Spain
| | - Santiago Moreno
- Servicio de Enfermedades Infecciosas, Hospital Ramón y Cajal, Madrid, Spain
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14
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Rodríguez-Pardo D, Del Toro MD, Guío-Carrión L, Escudero-Sánchez R, Fernández-Sampedro M, García-Viejo MÁ, Velasco-Arribas M, Soldevila-Boixader L, Femenias M, Iribarren JA, Pulido-Garcia MDC, Navarro MD, Lung M, Corona PS, Almirante B, Pigrau C. Role of asymptomatic bacteriuria on early periprosthetic joint infection after hip hemiarthroplasty. BARIFER randomized clinical trial. Eur J Clin Microbiol Infect Dis 2021; 40:2411-2419. [PMID: 33864153 DOI: 10.1007/s10096-021-04241-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 03/30/2021] [Indexed: 12/30/2022]
Abstract
PURPOSE To evaluate preoperative asymptomatic bacteriuria (ASB) treatment to reduce early-periprosthetic joint infections (early-PJIs) after hip hemiarthroplasty (HHA) for fracture. METHODS Open-label, multicenter RCT comparing fosfomycin-trometamol versus no intervention with a parallel follow-up cohort without ASB. PRIMARY OUTCOME early-PJI after HHA. RESULTS Five hundred ninety-four patients enrolled (mean age 84.3); 152(25%) with ASB (77 treated with fosfomycin-trometamol/75 controls) and 442(75%) without. Despite the study closed without the intended sample size, ASB was not predictive of early-PJI (OR: 1.06 [95%CI: 0.33-3.38]), and its treatment did not modify early-PJI incidence (OR: 1.03 [95%CI: 0.15-7.10]). CONCLUSIONS Neither preoperative ASB nor its treatment appears to be risk factors of early-PJI after HHA. ClinicalTrials.gov Identifier: Eudra CT 2016-001108-47.
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Affiliation(s)
- Dolors Rodríguez-Pardo
- Infectious Diseases Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain. .,Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0003), Instituto de Salud Carlos III, Madrid, Spain. .,Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Madrid, Spain.
| | - María Dolores Del Toro
- Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0003), Instituto de Salud Carlos III, Madrid, Spain.,Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Madrid, Spain.,Infectious Diseases Unit, Hospital Universitario Virgen Macarena, Departamento de Medicina, Universidad de Sevilla, Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain
| | - Laura Guío-Carrión
- Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0003), Instituto de Salud Carlos III, Madrid, Spain.,Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Madrid, Spain.,Infectious Diseases Department, Hospital Universitario Cruces, Barakaldo, Vizcaya, Spain
| | - Rosa Escudero-Sánchez
- Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Madrid, Spain.,Infectious Diseases Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Marta Fernández-Sampedro
- Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0003), Instituto de Salud Carlos III, Madrid, Spain.,Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Madrid, Spain.,Infectious Diseases Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Miguel Ángel García-Viejo
- Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Madrid, Spain.,Internal Medicine Department, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - María Velasco-Arribas
- Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Madrid, Spain.,Internal Medicine Department (Infectious Diseases Division), Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Laura Soldevila-Boixader
- Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Madrid, Spain.,Infectious Diseases Department, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Magdalena Femenias
- Orthopedic Surgery Department, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - José Antonio Iribarren
- Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Madrid, Spain.,Infectious Diseases Department, Hospital Universitario Donostia IIS Biodonostia, San Sebastián, Spain
| | | | - María Dolores Navarro
- Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0003), Instituto de Salud Carlos III, Madrid, Spain.,Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Madrid, Spain.,Infectious Diseases Unit, Hospital Universitario Virgen Macarena, Departamento de Medicina, Universidad de Sevilla, Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain
| | - Mayli Lung
- Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0003), Instituto de Salud Carlos III, Madrid, Spain.,Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Madrid, Spain.,Microbiology Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Pablo S Corona
- Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0003), Instituto de Salud Carlos III, Madrid, Spain.,Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Madrid, Spain.,Septic and Reconstructive Surgery Unit, Orthopedic Surgery Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Benito Almirante
- Infectious Diseases Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain.,Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0003), Instituto de Salud Carlos III, Madrid, Spain.,Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Madrid, Spain
| | - Carles Pigrau
- Infectious Diseases Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain.,Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0003), Instituto de Salud Carlos III, Madrid, Spain.,Study Group on Osteoarticular Infections of the Spanish Society of Clinical Microbiology and Infectious Diseases (GEIO-SEIMC), Madrid, Spain
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15
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Bouza E, Cobo J, Rodríguez-Hernández MJ, Salavert M, Horcajada JP, Iribarren JA, Obi E, Lozano V, Maratia S, Cuesta M, Uría E, Limón E. Economic burden of recurrent Clostridioides difficile infection in adults admitted to Spanish hospitals. A multicentre retrospective observational study. Rev Esp Quimioter 2021; 34:126-135. [PMID: 33618513 PMCID: PMC8019457 DOI: 10.37201/req/135.2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 12/09/2020] [Accepted: 01/07/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Clostridioides difficile infection (CDI) is associated with increased hospital stays and mortality and a high likelihood of rehospitalization, leading to increased health resource use and costs. The objective was to estimate the economic burden of recurrent CDI (rCDI). METHODS Observational, retrospective study carried out in six hospitals. Adults aged ≥18 years with ≥1 confirmed diagnosis (primary or secondary) of rCDI between January 2010 and May 2018 were included. rCDI-related resource use included days of hospital stay (emergency room, ward, isolation and ICU), tests and treatments. For patients with primary diagnosis of rCDI, the complete hospital stay was attributed to rCDI. When diagnosis of rCDI was secondary, hospital stay attributed to rCDI was estimated using 1:1 propensity score matching as the difference in hospital stay compared to controls. Controls were hospitalizations without CDI recorded in the Spanish National Hospital Discharge Database. The cost was calculated by multiplying the natural resource units by the unit cost. Costs (euros) were updated to 2019. RESULTS We included 282 rCDI episodes (188 as primary diagnosis): 66.31% of patients were aged ≥65 years and 57.80% were female. The mean hospital stay (SD) was 17.18 (23.27) days: 86.17% of rCDI episodes were isolated for a mean (SD) of 10.30 (9.97) days. The total mean cost (95%-CI) per episode was €10,877 (9,499-12,777), of which the hospital stay accounted for 92.56. CONCLUSIONS There is high cost and resource use associated with rCDI, highlighting the importance of preventing rCDI to the Spanish National Health System.
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Affiliation(s)
| | | | | | | | | | | | | | - V Lozano
- Virginia Lozano, Merck Sharp-Dohme, Calle de Josefa Valcárcel, 38, 28027, Madrid, Spain.
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16
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Pérez-Jacoiste Asín MA, Bisbal O, Iribarren JA, Pérez-Rivilla A, Mican R, Dronda F, González-Domenech CM, Vinuesa-García D, Macías J, Lumbreras C, Moreno S, Rubio R. Cryptococcal infection in HIV-infected patients with CD4 + T-cell counts under 100/μL diagnosed in a high-income country: a multicentre cohort study. Clin Microbiol Infect 2020; 27:1171.e1-1171.e7. [PMID: 33069858 DOI: 10.1016/j.cmi.2020.09.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 09/27/2020] [Accepted: 09/28/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The World Health Organization recommends routinely screening HIV-infected patients with CD4+ T-cell counts <100/μL for cryptococcal infection to prevent cryptococcal meningitis (CM), based on studies in Sub-Saharan Africa where the prevalence of positive cryptococcal antigen (CrAg+) is ≥ 3% in this subgroup. Data about such prevalence in Spain are unavailable and rare in other European countries. Thus, the Spanish AIDS Study Group guidelines do not recommend routinely screening. We aim to determine the prevalence and outcomes of cryptococcal infection in this subgroup of patients in Spain. METHODS We determined CrAg using a lateral flow assay in banked plasma from participants in the cohort of the Spanish AIDS Research Network. Eligible patients had CD4+ T-cell counts ≤100/μL at the time of plasma collection and a follow-up >4 weeks, unless they died. RESULTS We included 576 patients from June 2004 to December 2017. Of these, 43 were CrAg+ for an overall prevalence of 7.5%. There were no differences depending on birthplace. The CrAg+ was independently associated with a higher mortality at eight weeks (hazard ratio (HR) 5.36, 95% confidence interval (CI) 1.46-19.56) and 6 months (HR 3.12, 95% CI 1.19-8.21). CM was reported in 10 of the 43 CrAg+ patients. There were no cases among negatives. Five patients had CM when the plasma was collected and five developed it during the follow-up. The number of subjects needed to screen to anticipate the diagnosis of one CM case was 114. CONCLUSIONS The CrAg+ prevalence among HIV-infected patients with CD4+ T-cell counts ≤100/μL diagnosed in Spain, both immigrants and native-born Spanish, is >7%. Consequently, the Spanish AIDS Study Group guidelines have to be updated and recommend routine screening for cryptococcal infection in these patients. Future studies should explore whether this recommendation could be firmly applied to other European populations.
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Affiliation(s)
- María Asunción Pérez-Jacoiste Asín
- Department of Internal Medicine, Hospital Universitario 12 de Octubre, Instituto de Investigación Hospital 12 de Octubre (imas12), Madrid, Spain.
| | - Otilia Bisbal
- HIV Unit, Department of Internal Medicine, Hospital Universitario 12 de Octubre, Instituto de Investigación Hospital 12 de Octubre (imas12), Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain
| | - José Antonio Iribarren
- Department of Infectious Diseases, Hospital Universitario Donostia, Instituto BioDonostia, San Sebastián, Spain
| | | | - Rafael Mican
- HIV Unit, Department of Internal Medicine, Hospital Universitario La Paz, Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
| | - Fernando Dronda
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Universidad de Alcalá, Madrid, Spain
| | - Carmen María González-Domenech
- Biomedical Research Institute of Malaga, Clinical Microbiology and Infectious Diseases Unit, Hospital Virgen de la Victoria, Málaga, Spain
| | | | - Juan Macías
- Department of Infectious Diseases, Hospital Nuestra Señora de Valme, Sevilla, Spain
| | - Carlos Lumbreras
- Department of Internal Medicine, Hospital Universitario 12 de Octubre, Instituto de Investigación Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Santiago Moreno
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Universidad de Alcalá, Madrid, Spain
| | - Rafael Rubio
- HIV Unit, Department of Internal Medicine, Hospital Universitario 12 de Octubre, Instituto de Investigación Hospital 12 de Octubre (imas12), Department of Medicine, School of Medicine, Universidad Complutense, Madrid, Spain
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Suárez-García I, Moreno C, Ruiz-Algueró M, Pérez-Elías MJ, Navarro M, Díez Martínez M, Viciana P, Pérez-Martínez L, Górgolas M, Amador C, de Zárraga MA, Jarrín I, Moreno S, Jarrín I, Dalmau D, Navarro ML, González MI, Garcia F, Poveda E, Iribarren JA, Gutiérrez F, Rubio R, Vidal F, Berenguer J, González J, Muñoz-Fernández MÁ, Jarrin I, Alejos B, Moreno C, Iniesta C, Sousa LMG, Perez NS, Rava M, Muñoz-Fernández MÁ, Fernández IC, Merino E, García G, Portilla I, Agea I, Portilla J, Sánchez-Payá J, Rodríguez JC, Gimeno L, Giner L, Díez M, Carreres M, Reus S, Boix V, Torrús D, Lirola AL, García D, Díaz-Flores F, Gómez JL, del Mar Alonso M, Pelazas R, Hernández J, Alemán MR, Hernández MI, Asensi V, Valle E, Carmenado MER, Secades TSZ, Is LP, Rubio R, Pulido F, Bisbal O, Hernando A, Domínguez L, Crestelo DR, Bermejo L, Santacreu M, Iribarren JA, Arrizabalaga J, Aramburu MJ, Camino X, Rodríguez-Arrondo F, von Wichmann MÁ, Tomé LP, Goenaga MÁ, Bustinduy MJ, Azkune H, Ibarguren M, Lizardi A, Kortajarena X, Oyaga MPC, Igartua MU, Gutiérrez F, Masiá M, Padilla S, Navarro A, Montolio F, Robledano C, Colomé JG, Adsuar A, Pascual R, Fernández M, García E, García JA, Barber X, Muga R, Sanvisens A, Fuster D, Berenguer J, de Quirós JCLB, Gutiérrez I, Ramírez M, Padilla B, Gijón P, Aldamiz-Echevarría T, Tejerina F, Parras FJ, Balsalobre P, Diez C, Latorre LP, Fanciulli C, Vidal F, Peraire J, Viladés C, Veloso S, Vargas M, Olona M, Rull A, Rodríguez-Gallego E, Alba V, Castellanos AJ, López-Dupla M, Alonso MM, Aldeguer JL, Juliá MB, Pitarch MT, Hernández IC, Muñoz EC, Tovar SC, Lletí MS, Navarro JF, González-Garcia J, Arnalich F, Arribas JR, de la Serna JIB, Castro JM, Escosa L, Herranz P, Hontañón V, García-Bujalance S, López-Hortelano MG, González-Baeza A, Martín-Carbonero ML, Mayoral M, Mellado MJ, Micán RE, Montejano R, Montes ML, Moreno V, Pérez-Valero I, Rodés B, Sainz T, Sendagorta E, Alcáriz NS, Valencia E, Blanco JR, Oteo JA, Ibarra V, Metola L, Sanz M, Pérez-Martínez L, Arazo P, Sampériz G, Dalmau D, Jaén A, Sanmartí M, Cairó M, Martinez-Lacasa J, Velli P, Font R, Xercavins M, Alonso N, Marcotegui MR, Repáraz J, de Alda MGR, de León Cano MT, de Galarreta BPR, Amengual MJ, Navarro G, Garcia MC, Isbert SC, Vilasaro MN, de los Santos I, Sanz JS, Aparicio AS, Cepeda CS, Fraile LGF, Gayo EM, Moreno S, Osorio JLC, Nuñez FD, Zamora AM, Elías MJP, Gutiérrez C, Madrid N, del Campo Terrón S, Villar SS, Gallego MJV, Sanz JM, Urroz UA, Velasco T, Bernal E, Sanchez AC, García AA, Urbieta JB, Perez AM, Alcaraz MJ, del Carmen Villalba M, García F, Quero JH, Medina LM, Alvarez M, Chueca N, García DV, Martinez-Montes C, Beltran CG, de Salazar Gonzalerz A, Lopez AF, Utrilla MR, Del Romero J, Rodríguez C, Puerta T, Carrió JC, Vera M, Ballesteros J, Ayerdi O, Antela A, Losada E, Riera M, Peñaranda M, Leyes M, Ribas MA, Campins AA, Vidal C, Fanjul F, Murillas J, Homar F, Santos J, Ayerbe CG, Viciana I, Palacios R, López CP, Gonzalez-Domenec CM, Viciana P, Espinosa N, López-Cortés LF, Podzamczer D, Imaz A, Tiraboschi J, Silva A, Saumoy M, Prieto P, Ribera E, Curran A, Sierra JO, Stachowski JP, del Arco A, de la torre J, Prada JL, de Lomas Guerrero JMG, Martínez OJ, Vera FJ, Martínez L, García J, Alcaraz B, Jimeno A, Iglesias AC, Souto BP, de Cea AM, Muñoz J, Zubero MZ, Baraia-Etxaburu JM, Ugarte SI, Beneitez OLF, de Munain JL, López MMC, de la Peña M, Lopez M, Azkarreta IL, Galera C, Albendin H, Pérez A, Iborra A, Moreno A, Merlos MA, Vidal A, Meca M, Amador C, Pasquau F, Ena J, Benito C, Fenoll V, Anguita CG, Rabasa JTA, Suárez-García I, Malmierca E, González-Ruano P, Rodrigo DM, Seco MPR, Mohamed-Balghata MO, Vidal MAG, de Zarraga MA, Pérez VE, Molina MJT, García JV, Moreno JPS, Górgolas M, Cabello A, Álvarez B, Prieto L, Moreno JS, Caso AA, Gutiérrez CH, Mena MN, Puerto MJG, Vilalta RF, Ribera AF, Román AR, Juárez AR, López PL, Sánchez IM, Casas MF, Espejo AC, Jiménez MC, Perea RT, Pineda JA, Mayo PR, Sanchez JM, Gutierrez NM, Real LM, Gomez AC, Fuertes MF, Gonzalez-Serna A, Poveda E, Pérez A, Crespo M, Morano L, Miralles C, Ocampo A, Pousada G. Effectiveness of the combination elvitegravir/cobicistat/tenofovir/emtricitabine (EVG/COB/TFV/FTC) plus darunavir among treatment-experienced patients in clinical practice: a multicentre cohort study. AIDS Res Ther 2020; 17:45. [PMID: 32690099 PMCID: PMC7372769 DOI: 10.1186/s12981-020-00302-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 07/13/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study was to investigate the effectiveness and tolerability of the combination elvitegravir/cobicistat/tenofovir/emtricitabine plus darunavir (EVG/COB/TFV/FTC + DRV) in treatment-experienced patients from the cohort of the Spanish HIV/AIDS Research Network (CoRIS). METHODS Treatment-experienced patients starting treatment with EVG/COB/TFV/FTC + DRV during the years 2014-2018 and with more than 24 weeks of follow-up were included. TFV could be administered either as tenofovir disoproxil fumarate or tenofovir alafenamide. We evaluated virological response, defined as viral load (VL) < 50 copies/ml and < 200 copies/ml at 24 and 48 weeks after starting this regimen, stratified by baseline VL (< 50 or ≥ 50 copies/ml at the start of the regimen). RESULTS We included 39 patients (12.8% women). At baseline, 10 (25.6%) patients had VL < 50 copies/ml and 29 (74.4%) had ≥ 50 copies/ml. Among patients with baseline VL < 50 copies/ml, 85.7% and 80.0% had VL < 50 copies/ml at 24 and 48 weeks, respectively, and 100% had VL < 200 copies/ml at 24 and 48 weeks. Among patients with baseline VL ≥ 50 copies/ml, 42.3% and 40.9% had VL < 50 copies/ml and 69.2% and 68.2% had VL < 200 copies/ml at 24 and 48 weeks. During the first 48 weeks, no patients changed their treatment due to toxicity, and 4 patients (all with baseline VL ≥ 50 copies/ml) changed due to virological failure. CONCLUSIONS EVG/COB/TFV/FTC + DRV was well tolerated and effective in treatment-experienced patients with undetectable viral load as a simplification strategy, allowing once-daily, two-pill regimen with three antiretroviral drug classes. Effectiveness was low in patients with detectable viral loads.
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Muñoz Hornero C, Muriel A, Montero M, Iribarren JA, Masía M, Muñoz L, Sampériz G, Navarro G, Moreno S, Pérez-Elías MJ. Differences in epidemiology and mortality between men and women with HIV infection in the CoRIS cohort from 2004 to 2014. Enferm Infecc Microbiol Clin 2020; 39:S0213-005X(20)30220-2. [PMID: 32680794 DOI: 10.1016/j.eimc.2020.05.021] [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: 03/02/2020] [Revised: 05/14/2020] [Accepted: 05/19/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION This study sought to analyse differences in epidemiology and survival between women and men living with HIV in the CoRIS cohort and the course of their disease over a 10-year period. METHODS Variables of interest between women living with HIV and men living with HIV were compared. A trend analysis was performed using the Mantel-Haenszel test. Kaplan-Meier survival curves and a Cox regression analysis were used to study survival. RESULTS A total of 10,469 people were enrolled; of them, 1,742 (16.6%) were women. At the time of enrolment in the cohort, women living with HIV, compared to men living with HIV, had higher rates of transmission due to intravenous drug use (IDU), hepatitisC virus (HCV) coinfection, AIDS-stage disease and foreign origin. They also had a worse immunovirological status and a lower educational level. These differences were maintained in the trend study. Regarding age, the women included in the cohort were older whereas the men were younger. In the comparative analysis between women according to place of origin, we found that the group of Spanish women living with HIV featured older women with higher rates of IDU transmission and HCV coinfection, whereas the group of women living with HIV born outside of Spain featured women with higher rates of syphilis infection. There were no major differences in relation to other characteristics such as educational level or disease status. Although sex was not a determinant of survival, conditions more prevalent in women were determinants of survival. CONCLUSIONS HIV-infected women presented at diagnosis with certain epidemiological and HIV-associated characteristics that made them more vulnerable. These trends became more marked or did not improve during the years of observation.
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Affiliation(s)
| | - Alfonso Muriel
- Unidad de Bioestadística Clínica, Hospital Ramón y Cajal. YRICIS. CIBERESP, Madrid, España
| | - Marta Montero
- Servicio de Enfermedades Infecciosas, Hospital La Fe, Valencia, España
| | - José Antonio Iribarren
- Servicio de Enfermedades Infecciosas, Hospital Universitario Donostia, San Sebastián, España
| | - Mar Masía
- Servicio de Enfermedades Infecciosas, Hospital de Elche, Elche, Alicante, España
| | - Leopoldo Muñoz
- Servicio de Enfermedades Infecciosas, Hospital San Cecilio, Granada, España
| | - Gloria Sampériz
- Servicio de Enfermedades Infecciosas, Hospital Universitario Miguel Servet, Zaragoza, España
| | - Gemma Navarro
- Servicio de Enfermedades Infecciosas, Hospital Parc Taulí, Sabadell, Barcelona, España
| | - Santiago Moreno
- Servicio de Enfermedades Infecciosas, Hospital Ramón y Cajal, Madrid, España
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Escudero-Sanchez R, Senneville E, Digumber M, Soriano A, Del Toro MD, Bahamonde A, Del Pozo JL, Guio L, Murillo O, Rico A, García-País MJ, Rodríguez-Pardo D, Iribarren JA, Fernández M, Benito N, Fresco G, Muriel A, Ariza J, Cobo J. Suppressive antibiotic therapy in prosthetic joint infections: a multicentre cohort study. Clin Microbiol Infect 2020; 26:499-505. [PMID: 31539638 DOI: 10.1016/j.cmi.2019.09.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [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: 05/09/2019] [Revised: 09/01/2019] [Accepted: 09/07/2019] [Indexed: 02/08/2023]
Abstract
OBJECTIVES The aim was to describe the effectiveness of suppressive antibiotic treatment (SAT) in routine clinical practice when used in situations in which removal of a prosthetic implant is considered essential for the eradication of an infection, and it cannot be performed. METHODS This was a descriptive retrospective and multicentre cohort study of prosthetic joint infection (PJI) cases managed with SAT. SAT was considered to have failed if a fistula appeared or persisted, if debridement was necessary, if the prosthesis was removed due to persistence of the infection or if uncontrolled symptoms were present. RESULTS In total, 302 patients were analysed. Two hundred and three of these patients (67.2%) received monotherapy. The most commonly used drugs were tetracyclines (39.7% of patients) (120/302) and cotrimoxazole (35.4% of patients) (107/302). SAT was considered successful in 58.6% (177/302) of the patients (median time administered, 36.5 months; IQR 20.75-59.25). Infection was controlled in 50% of patients at 5 years according to Kaplan-Meier analysis. Resistance development was documented in 15 of 65 (23.1%) of the microbiologically documented cases. SAT failure was associated with age <70 years (sub-hazard ratio (SHR) 1.61, 95% CI 1.1-2.33), aetiology other than Gram-positive cocci (SHR 1.56, 95% CI 1.09-2.27) and location of the prosthesis in the upper limb (SHR 2.4, 95% CI 1.5-3.84). SAT suspension was necessary due to adverse effects in 17 of 302 patients (5.6%). CONCLUSIONS SAT offers acceptable results for patients with PJI when surgical treatment is not performed or when it fails to eradicate the infection.
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Affiliation(s)
| | - E Senneville
- Centre Hospitalier Gustave Dron, Tourcoing, France
| | - M Digumber
- Centre Hospitalier Gustave Dron, Tourcoing, France
| | | | | | | | | | - L Guio
- Hospital Cruces, Vizcaya, Spain
| | - O Murillo
- Hospital Bellvitge, Barcelona, Spain
| | - A Rico
- Hospital Universitario La Paz, Madrid, Spain
| | | | | | | | | | - N Benito
- Hospital Santa Creu I Sant Pau, Barcelona, Spain
| | - G Fresco
- Hospital Ramón y Cajal, IRYCIS, Madrid, Spain
| | - A Muriel
- Hospital Ramón y Cajal, IRYCIS, CIBER, Madrid, Spain
| | - J Ariza
- Hospital Bellvitge, Barcelona, Spain
| | - J Cobo
- Hospital Ramón y Cajal, IRYCIS, Madrid, Spain
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Lathouwers E, Wong EY, Brown K, Baugh B, Ghys A, Jezorwski J, Mohsine EG, Van Landuyt E, Opsomer M, De Meyer S, De Wit S, Florence E, Vandekerckhove L, Vandercam B, Brunetta J, Klein M, Murphy D, Rachlis A, Walmsley S, Ajana F, Cotte L, Girard PM, Katlama C, Molina JM, Poizot-Martin I, Raffi F, Rey D, Reynes J, Teicher E, Yazdanpanah Y, Arastéh K, Bickel M, Bogner J, Esser S, Faetkenheuer G, Jessen H, Kern W, Rockstroh J, Spinner C, Stellbrink HJ, Stoehr A, Antinori A, Castelli F, Chirianni A, De Luca A, Di Biagio A, Galli M, Lazzarin A, Maggiolo F, Maserati R, Mussini C, Garlicki A, Gasiorowski J, Halota W, Horban A, Parczewski M, Piekarska A, Belonosova E, Chernova O, Dushkina N, Kulagin V, Ryamova E, Shuldyakov A, Sizova N, Tsybakova O, Voronin E, Yakovlev A, Antela A, Arribas JR, Berenguer J, Casado J, Estrada V, Galindo MJ, Garcia Del Toro M, Gatell JM, Gorgolas M, Gutierrez F, Gutierrez MDM, Negredo E, Pineda JA, Podzamczer D, Portilla Sogorb J, Rivero A, Rubio R, Viciana P, De Los Santos I, Clarke A, Gazzard BG, Johnson MA, Orkin C, Reeves I, Waters L, Benson P, Bhatti L, Bredeek F, Crofoot G, Cunningham D, DeJesus E, Eron J, Felizarta F, Franco R, Gallant J, Hagins D, Henry K, Jayaweera D, Lucasti C, Martorell C, McDonald C, McGowan J, Mills A, Morales-Ramirez J, Prelutsky D, Ramgopal M, Rashbaum B, Ruane P, Slim J, Wilkin A, deVente J, De Wit S, Florence E, Moutschen M, Van Wijngaerden E, Vandekerckhove L, Vandercam B, Brunetta J, Conway B, Klein M, Murphy D, Rachlis A, Shafran S, Walmsley S, Ajana F, Cotte L, Girard PM, Katlama C, Molina JM, Poizot-Martin I, Raffi F, Rey D, Reynes J, Teicher E, Yazdanpanah Y, Gasiorowski J, Halota W, Horban A, Piekarska A, Witor A, Arribas JR, Perez-Valero I, Berenguer J, Casado J, Gatell JM, Gutierrez F, Galindo MJ, Gutierrez MDM, Iribarren JA, Knobel H, Negredo E, Pineda JA, Podzamczer D, Portilla Sogorb J, Pulido F, Ricart C, Rivero A, Santos Gil I, Blaxhult A, Flamholc L, Gisslèn M, Thalme A, Fehr J, Rauch A, Stoeckle M, Clarke A, Gazzard BG, Johnson MA, Orkin C, Post F, Ustianowski A, Waters L, Bailey J, Benson P, Bhatti L, Brar I, Bredeek UF, Brinson C, Crofoot G, Cunningham D, DeJesus E, Dietz C, Dretler R, Eron J, Felizarta F, Fichtenbaum C, Gallant J, Gathe J, Hagins D, Henn S, Henry KW, Huhn G, Jain M, Lucasti C, Martorell C, McDonald C, Mills A, Morales-Ramirez J, Mounzer K, Nahass R, Olivet H, Osiyemi O, Prelutsky D, Ramgopal M, Rashbaum B, Richmond G, Ruane P, Scarsella A, Scribner A, Shalit P, Shamblaw D, Slim J, Tashima K, Voskuhl G, Ward D, Wilkin A, de Vente J. Week 48 Resistance Analyses of the Once-Daily, Single-Tablet Regimen Darunavir/Cobicistat/Emtricitabine/Tenofovir Alafenamide (D/C/F/TAF) in Adults Living with HIV-1 from the Phase III Randomized AMBER and EMERALD Trials. AIDS Res Hum Retroviruses 2020; 36:48-57. [PMID: 31516033 PMCID: PMC6944133 DOI: 10.1089/aid.2019.0111] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Darunavir/cobicistat/emtricitabine/tenofovir alafenamide (D/C/F/TAF) 800/150/200/10 mg is being investigated in two Phase III trials, AMBER (NCT02431247; treatment-naive adults) and EMERALD (NCT02269917; treatment-experienced, virologically suppressed adults). Week 48 AMBER and EMERALD resistance analyses are presented. Postbaseline samples for genotyping/phenotyping were analyzed from protocol-defined virologic failures (PDVFs) with viral load (VL) ≥400 copies/mL at failure/later time points. Post hoc analyses were deep sequencing in AMBER, and HIV-1 proviral DNA from baseline samples (VL <50 copies/mL) in EMERALD. Through week 48 across both studies, no darunavir, primary PI, or tenofovir resistance-associated mutations (RAMs) were observed in HIV-1 viruses of 1,125 participants receiving D/C/F/TAF or 629 receiving boosted darunavir plus emtricitabine/tenofovir-disoproxil-fumarate. In AMBER, the nucleos(t)ide analog reverse transcriptase inhibitor (N(t)RTI) RAM M184I/V was identified in HIV-1 of one participant during D/C/F/TAF treatment. M184V was detected pretreatment as a minority variant (9%). In EMERALD, in participants with prior VF and genoarchive data (N = 140; 98 D/C/F/TAF and 42 control), 4% had viruses with darunavir RAMs, 38% with emtricitabine RAMs, mainly at position 184 (41% not fully susceptible to emtricitabine), 4% with tenofovir RAMs, and 21% ≥ 3 thymidine analog-associated mutations (24% not fully susceptible to tenofovir) detected at screening. All achieved VL <50 copies/mL at week 48 or prior discontinuation. D/C/F/TAF has a high genetic barrier to resistance; no darunavir, primary PI, or tenofovir RAMs were observed through 48 weeks in AMBER and EMERALD. Only one postbaseline M184I/V RAM was observed in HIV-1 of an AMBER participant. In EMERALD, baseline archived RAMs to darunavir, emtricitabine, and tenofovir in participants with prior VF did not preclude virologic response.
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Affiliation(s)
| | - Eric Y Wong
- Janssen Scientific Affairs, LLC, Titusville, New Jersey
| | | | - Bryan Baugh
- Janssen Research & Development LLC, Raritan, New Jersey
| | - Anne Ghys
- Janssen Pharmaceutica NV, Beerse, Belgium
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Pérez-Valero I, Pasquau J, Rubio R, Rivero A, Santos J, Sanz J, Mariño A, Crespo M, Hernández-Quero J, Iribarren JA, Gutiérrez F, Terrón A, Esteban H, Pérez-Molina JA. Neurocognitive safety after 96 weeks on dual therapy with atazanavir/ritonavir plus lamivudine: results of the neurocognitive substudy of the SALT randomized clinical trial. J Antimicrob Chemother 2019; 73:2444-2451. [PMID: 29897573 DOI: 10.1093/jac/dky212] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 05/09/2018] [Indexed: 01/03/2023] Open
Abstract
Background Concerns have been voiced over the capacity of deintensification strategies to preserve neurocognitive function and prevent neurocognitive impairment. Methods We present the 96 week results of a neurocognitive substudy nested within the SALT clinical trial: a randomized, open-label, non-inferiority trial that compares whether atazanavir/ritonavir + lamivudine is non-inferior to atazanavir/ritonavir + two NRTIs in HIV-suppressed patients on stable triple therapy. A global deficit score (GDS) for five neurocognitive tasks was used to assess neurocognitive function. Changes in neurocognitive function (GDS value) were determined at weeks 48 and 96. The effect of atazanavir/ritonavir + lamivudine, adjusted for significant confounders, on the change in neurocognitive function was determined using analysis of covariance (ANCOVA) at week 96. Results The per-protocol analysis included 92 participants (47 atazanavir/ritonavir + lamivudine and 45 atazanavir/ritonavir + two NRTIs). All baseline characteristics were comparable in both groups. At weeks 48 and 96, changes in GDS [week 48, atazanavir/ritonavir + lamivudine -0.3 (95% CI -0.5 to -0.1) versus atazanavir/ritonavir + two NRTIs -0.2 (95% CI -0.4 to 0.0), P = 0.39; week 96, atazanavir/ritonavir + lamivudine -0.3 (95% CI -0.5 to -0.1) versus atazanavir/ritonavir + two NRTIs -0.2 (95% CI -0.4 to -0.1); P = 0.471] were similar. This absence of differences was also observed in all cognitive tasks. Atazanavir/ritonavir + lamivudine did not impact the change in neurocognitive function at week 96; the adjusted effect of atazanavir/ritonavir + lamivudine on GDS change, considering atazanavir/ritonavir + two NRTIs as a reference, was 0.01 (95% CI -0.18 to 0.21) (P = 0.90). Conclusions Neurocognitive function remained stable after 96 weeks, both in the atazanavir/ritonavir + lamivudine and in the atazanavir/ritonavir + two NRTIs arms, provided HIV remained suppressed.
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Affiliation(s)
| | - Juan Pasquau
- Hospital Virgen de las Nieves, Internal Medicine, Granada, Spain
| | - Rafael Rubio
- H.U. Doce de Octubre, Internal Medicine, Madrid, Spain
| | | | - José Santos
- Hospital Virgen de la Victoria, Internal Medicine, Malaga, Spain
| | - Jesus Sanz
- Hospital de Alcala de Henares, Internal Medicine, Alcala de Henares, Spain
| | - Ana Mariño
- Hospital Arquitecto Marcide, Internal Medicine, O Ferrol, Spain
| | - Manel Crespo
- Hospital Vall d'Hebron, Internal Medicine, Barcelona, Spain
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Alejos B, Suárez-García I, Bisbal O, Iribarren JA, Asensi V, Górgolas M, Muga R, Moreno S, Jarrín I. Choice of the initial antiretroviral treatment for HIV-positive individuals in the era of integrase inhibitors. PLoS One 2019; 14:e0221598. [PMID: 31449566 PMCID: PMC6709901 DOI: 10.1371/journal.pone.0221598] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 08/10/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND We aimed to describe the most frequently prescribed initial antiretroviral therapy (ART) regimens in recent years in HIV-positive persons in the Cohort of the Spanish HIV/AIDS Research Network (CoRIS) and to investigate factors associated with the choice of each regimen. METHODS We analyzed initial ART regimens prescribed in adults participating in CoRIS from 2014 to 2017. Only regimens prescribed in >5% of patients were considered. We used multivariable multinomial regression to estimate Relative Risk Ratios (RRRs) for the association between sociodemographic and clinical characteristics and the choice of the initial regimen. RESULTS Among 2874 participants, abacavir(ABC)/lamivudine(3TC)/dolutegavir(DTG) was the most frequently prescribed regimen (32.1%), followed by tenofovir disoproxil fumarate (TDF)/emtricitabine (FTC)/elvitegravir(EVG)/cobicistat(COBI) (14.9%), TDF/FTC/rilpivirine (RPV) (14.0%), tenofovir alafenamide (TAF)/FTC/EVG/COBI (13.7%), TDF/FTC+DTG (10.0%), TDF/FTC+darunavir/ritonavir or darunavir/cobicistat (bDRV) (9.8%) and TDF/FTC+raltegravir (RAL) (5.6%). Compared with ABC/3TC/DTG, starting TDF/FTC/RPV was less likely in patients with CD4<200 cells/μL and HIV-RNA>100.000 copies/mL. TDF/FTC+DTG was more frequent in those with CD4<200 cells/μL and HIV-RNA>100.000 copies/mL. TDF/FTC+RAL and TDF/FTC+bDRV were also more frequent among patients with CD4<200 cells//μL and with transmission categories other than men who have sex with men. Compared with ABC/3TC/DTG, the prescription of other initial ART regimens decreased from 2014-2015 to 2016-2017 with the exception of TDF/FTC+DTG. Differences in the choice of the initial ART regimen were observed by hospitals' location. CONCLUSIONS The choice of initial ART regimens is consistent with Spanish guidelines' recommendations, but is also clearly influenced by physician's perception based on patient's clinical and sociodemographic variables and by the prescribing hospital location.
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Affiliation(s)
- Belén Alejos
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain
- * E-mail: (BA); (ISG)
| | - Inés Suárez-García
- Infectious Diseases Unit, Department of Internal Medicine, Hospital Universitario Infanta Sofia, Madrid, Spain
- Universidad Europea, Madrid, Spain
- * E-mail: (BA); (ISG)
| | - Otilia Bisbal
- Hospital Universitario Doce de Octubre, Madrid, Spain
| | | | - Víctor Asensi
- Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Miguel Górgolas
- Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Roberto Muga
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | - Inma Jarrín
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain
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Armiñanzas C, Fariñas-Alvarez C, Zarauza J, Muñoz P, González Ramallo V, Martínez Sellés M, Miró Meda JM, Pericás JM, Goenaga MÁ, Ojeda Burgos G, Rodríguez Álvarez R, Castelo Corral L, Gálvez-Acebal J, Martínez Marcos FJ, Fariñas MC, Fernández Sánchez F, Noureddine M, Rosas G, de la Torre Lima J, Aramendi J, Bereciartua E, Blanco MJ, Blanco R, Boado MV, Campaña Lázaro M, Crespo A, Goikoetxea J, Iruretagoyena JR, Irurzun Zuazabal J, López-Soria L, Montejo M, Nieto J, Rodrigo D, Rodríguez D, Rodríguez R, Vitoria Y, Voces R, García López MV, Georgieva RI, Ojeda G, Rodríguez Bailón I, Ruiz Morales J, Cuende AM, Echeverría T, Fuerte A, Gaminde E, Goenaga MÁ, Idígoras P, Iribarren JA, Izaguirre Yarza A, Kortajarena Urkola X, Reviejo C, Carrasco R, Climent V, Llamas P, Merino E, Plazas J, Reus S, Álvarez N, Bravo-Ferrer JM, Castelo L, Cuenca J, Llinares P, Miguez Rey E, Rodríguez Mayo M, Sánchez E, Sousa Regueiro D, Martínez FJ, Alonso MDM, Castro B, García Rosado D, Durán MDC, Miguel Gómez MA, Lacalzada J, Nassar I, Plata Ciezar A, Reguera Iglesias JM, Asensi Álvarez V, Costas C, de la Hera J, Fernández Suárez J, Iglesias Fraile L, León Arguero V, López Menéndez J, Mencia Bajo P, Morales C, Moreno Torrico A, Palomo C, Paya Martínez B, Rodríguez Esteban Á, Rodríguez García R, Telenti Asensio M, Almela M, Ambrosioni J, Azqueta M, Brunet M, Bodro M, Cartañá R, Falces C, Fita G, Fuster D, García de la Mària C, Hernández-Meneses M, Llopis Pérez J, Marco F, Miró JM, Moreno A, Nicolás D, Ninot S, Quintana E, Paré C, Pereda D, Pericás JM, Pomar JL, Ramírez J, Rovira I, Sandoval E, Sitges M, Soy D, Téllez A, Tolosana JM, Vidal B, Vila J, Adán I, Bermejo J, Bouza E, Celemín D, Cuerpo Caballero G, Delgado Montero A, Fernández Cruz A, García Mansilla A, García Leoni ME, González Ramallo V, Kestler Hernández M, Hualde AM, Marín M, Martínez-Sellés M, Menárguez MC, Muñoz P, Rincón C, Rodríguez-Abella H, Rodríguez-Créixems M, Pinilla B, Pinto Á, Valerio M, Vázquez P, Verde Moreno E, Antorrena I, Loeches B, Martín Quirós A, Moreno M, Ramírez U, Rial Bastón V, Romero M, Saldaña A, Agüero Balbín J, Amado C, Armiñanzas Castillo C, Arnaiz García A, Cobo Belaustegui M, Fariñas MC, Fariñas-Álvarez C, Gómez Izquierdo R, García I, González-Rico C, Gutiérrez-Cuadra M, Gutiérrez Díez J, Pajarón M, Parra JA, Sarralde A, Teira R, Zarauza J, Domínguez F, García Pavía P, González J, Orden B, Ramos A, Centella T, Hermida JM, Moya JL, Martín-Dávila P, Navas E, Oliva E, Del Río A, Ruiz S, Hidalgo Tenorio C, Almendro Delia M, Araji O, Barquero JM, Calvo Jambrina R, de Cueto M, Gálvez Acebal J, Méndez I, Morales I, López-Cortés LE, de Alarcón A, García E, Haro JL, Lepe JA, López F, Luque R, Alonso LJ, Azcárate P, Azcona Gutiérrez JM, Blanco JR, García-Álvarez L, Oteo JA, Sanz M, de Benito N, Gurguí M, Pacho C, Pericas R, Pons G, Álvarez M, Fernández AL, Martínez A, Prieto A, Regueiro B, Tijeira E, Vega M, Canut Blasco A, Cordo Mollar J, Gainzarain Arana JC, García Uriarte O, Martín López A, Ortiz de Zárate Z, Urturi Matos JA, García Domínguez G, Sánchez-Porto A, Arribas Leal JM, García Vázquez E, Hernández Torres A, Blázquez A, de la Morena Valenzuela G, Alonso Á, Aramburu J, Calvo FE, Moreno Rodríguez A, Tarabini-Castellani P, Heredero Gálvez E, Maicas Bellido C, Largo Pau J, Sepúlveda MA, Toledano Sierra P, Iqbal-Mirza SZ, Cascales Alcolea E, Egea Serrano P, Hernández Roca JJ, Keituqwa Yañez I, Peláez Ballesta A, Soriano V, Moreno Escobar E, Peña Monje A, Sánchez Cabrera V, Vinuesa García D, Arrizabalaga Asenjo M, Cifuentes Luna C, Núñez Morcillo J, Pérez Seco MC, Villoslada Gelabert A, Aured Guallar C, Fernández Abad N, García Mangas P, Matamala Adell M, Palacián Ruiz MP, Porres JC, Alcaraz Vidal B, Cobos Trigueros N, Del Amor Espín MJ, Giner Caro JA, Jiménez Sánchez R, Jimeno Almazán A, Ortín Freire A, Viqueira González M, Pericás Ramis P, Ribas Blanco MÁ, Ruiz de Gopegui Bordes E, Vidal Bonet L, Bellón Munera MC, Escribano Garaizabal E, Tercero Martínez A, Segura Luque JC. Role of age and comorbidities in mortality of patients with infective endocarditis. Eur J Intern Med 2019; 64:63-71. [PMID: 30904433 DOI: 10.1016/j.ejim.2019.03.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [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: 12/29/2018] [Revised: 02/22/2019] [Accepted: 03/05/2019] [Indexed: 02/08/2023]
Abstract
PURPOSE The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. METHODS Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015.Patients were stratified into three age groups:<65 years,65 to 80 years,and ≥ 80 years.The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk. RESULTS A total of 3120 patients with IE (1327 < 65 years;1291 65-80 years;502 ≥ 80 years) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients ≥80 years who underwent surgery were significantly lower compared with other age groups (14.3%,65 years; 20.5%,65-79 years; 31.3%,≥80 years). In-hospital mortality was lower in the <65-year group (20.3%,<65 years;30.1%,65-79 years;34.7%,≥80 years;p < 0.001) as well as 1-year mortality (3.2%, <65 years; 5.5%, 65-80 years;7.6%,≥80 years; p = 0.003).Independent predictors of mortality were age ≥ 80 years (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32-3.34), CCI ≥ 3 (HR:1.62; 95% CI:1.39-1.88),and non-performed surgery (HR:1.64;95% CI:11.16-1.58).When the three age groups were compared,the AUROC curve for CCI was significantly larger for patients aged <65 years(p < 0.001) for both in-hospital and 1-year mortality. CONCLUSION There were no differences in the clinical presentation of IE between the groups. Age ≥ 80 years, high comorbidity (measured by CCI),and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the <65-year group.
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Affiliation(s)
- Carlos Armiñanzas
- Infectious Diseases Unit, Hospital Universitario Marqués de Valdecilla, University of Cantabria, IDIVAL, Santander, Spain.
| | - Concepción Fariñas-Alvarez
- Division of Health Care Quality, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain.
| | - Jesús Zarauza
- Hospital Universitario Marqués de Valdecilla, Santander, Spain.
| | - Patricia Muñoz
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Facultad de Medicina, Universidad Complutense de Madrid, Spain.
| | - Víctor González Ramallo
- Servicio de Medicina Interna, Hospitalización a Domicilio, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - Manuel Martínez Sellés
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Universidad Europea, Universidad Complutense, Madrid, Spain.
| | - José Mª Miró Meda
- Servicio de Enfermedades Infecciosas, Hospital Clinic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain.
| | - Juan Manuel Pericás
- Servicio de Enfermedades Infecciosas, Hospital Clinic de Barcelona-IDIBAPS. Barcelona, Spain.
| | - Miguel Ángel Goenaga
- Servicio de Enfermedades Infecciosas, Hospital Universitario Donosti, San Sebastián, Spain
| | - Guillermo Ojeda Burgos
- Servicio de Medicina Interna, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Regino Rodríguez Álvarez
- Unidad de Enfermedades Infecciosas, Hospital Universitario de Cruces, Bilbao, Universidad del País Vasco, País Vasco, Spain.
| | - Laura Castelo Corral
- Servicio de Enfermedades Infecciosas, Complejo Hospitalario A Coruña, A Coruña, Spain
| | - Juan Gálvez-Acebal
- JUnidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena Instituto de Biomedicina de Sevilla, IBIS, Universidad de Sevilla, Sevilla, Spain.
| | | | - Maria Carmen Fariñas
- Maria Carmen Fariñas, Infectious Diseases Unit, Hospital Universitario Marqués de Valdecilla, IDIVAL, University of Cantabria, Santander, Spain.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ana María Cuende
- Hospital Universitario Donostia-Policlínica Gipuzkoa, San Sebastián, Spain
| | - Tomás Echeverría
- Hospital Universitario Donostia-Policlínica Gipuzkoa, San Sebastián, Spain
| | - Ana Fuerte
- Hospital Universitario Donostia-Policlínica Gipuzkoa, San Sebastián, Spain
| | - Eduardo Gaminde
- Hospital Universitario Donostia-Policlínica Gipuzkoa, San Sebastián, Spain
| | | | - Pedro Idígoras
- Hospital Universitario Donostia-Policlínica Gipuzkoa, San Sebastián, Spain
| | | | | | | | - Carlos Reviejo
- Hospital Universitario Donostia-Policlínica Gipuzkoa, San Sebastián, Spain
| | | | | | | | | | - Joaquín Plazas
- Hospital General Universitario de Alicante, Alicante, Spain
| | - Sergio Reus
- Hospital General Universitario de Alicante, Alicante, Spain
| | - Nemesio Álvarez
- Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
| | | | - Laura Castelo
- Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - José Cuenca
- Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - Pedro Llinares
- Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
| | | | | | - Efrén Sánchez
- Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | - Carlos Costas
- Hospital Universitario Central Asturias, Oviedo, Spain
| | | | | | | | | | | | | | | | | | - Carmen Palomo
- Hospital Universitario Central Asturias, Oviedo, Spain
| | | | | | | | | | - Manuel Almela
- Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - Juan Ambrosioni
- Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - Manuel Azqueta
- Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - Mercè Brunet
- Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - Marta Bodro
- Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - Ramón Cartañá
- Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - Carlos Falces
- Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - Guillermina Fita
- Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - David Fuster
- Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | | | | | | | - Francesc Marco
- Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - José M Miró
- Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - Asunción Moreno
- Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - David Nicolás
- Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - Salvador Ninot
- Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - Eduardo Quintana
- Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - Carlos Paré
- Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - Daniel Pereda
- Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - Juan M Pericás
- Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - José L Pomar
- Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - José Ramírez
- Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - Irene Rovira
- Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - Elena Sandoval
- Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - Marta Sitges
- Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - Dolors Soy
- Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - Adrián Téllez
- Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - José M Tolosana
- Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - Bárbara Vidal
- Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - Jordi Vila
- Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain
| | - Iván Adán
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Javier Bermejo
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Emilio Bouza
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Daniel Celemín
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | | | | | | | | | | | | | | | - Mercedes Marín
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | | | - Patricia Muñoz
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Cristina Rincón
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | | | - Blanca Pinilla
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Ángel Pinto
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Pilar Vázquez
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | | | | | | | - Mar Moreno
- Hospital Universitario La Paz, Madrid, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | - Iván García
- Universitario Marqués de Valdecilla, Santander, Spain
| | | | | | | | | | | | | | - Ramón Teira
- Universitario Marqués de Valdecilla, Santander, Spain
| | - Jesús Zarauza
- Universitario Marqués de Valdecilla, Santander, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | - Soledad Ruiz
- Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | | | - Omar Araji
- Hospital Universitario Virgen Macarena, Sevilla, Spain
| | | | | | | | | | - Irene Méndez
- Hospital Universitario Virgen Macarena, Sevilla, Spain
| | | | | | | | - Emilio García
- Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | | | | | | | - Rafael Luque
- Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | | | | | | | | | | | | | | | | | - Mercé Gurguí
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Roser Pericas
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Guillem Pons
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - M Álvarez
- Complejo Hospitalario Universitario de Santiago de Compostela, A Coruña, Spain
| | - A L Fernández
- Complejo Hospitalario Universitario de Santiago de Compostela, A Coruña, Spain
| | - Amparo Martínez
- Complejo Hospitalario Universitario de Santiago de Compostela, A Coruña, Spain
| | - A Prieto
- Complejo Hospitalario Universitario de Santiago de Compostela, A Coruña, Spain
| | - Benito Regueiro
- Complejo Hospitalario Universitario de Santiago de Compostela, A Coruña, Spain
| | - E Tijeira
- Complejo Hospitalario Universitario de Santiago de Compostela, A Coruña, Spain
| | - Marino Vega
- Complejo Hospitalario Universitario de Santiago de Compostela, A Coruña, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | - Ana Blázquez
- Hospital Clínico Universitario Virgen de la Arrixaca Murcia, Spain
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24
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Medrano LM, Gutiérrez-Rivas M, Blanco J, García M, Jiménez-Sousa MA, Pacheco YM, Montero M, Iribarren JA, Bernal E, Martínez OJ, Benito JM, Rallón N, Resino S. Mitochondrial haplogroup H is related to CD4+ T cell recovery in HIV infected patients starting combination antiretroviral therapy. J Transl Med 2018; 16:343. [PMID: 30522500 PMCID: PMC6282399 DOI: 10.1186/s12967-018-1717-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 12/02/2018] [Indexed: 12/20/2022] Open
Abstract
Background The mitochondrial DNA (mtDNA) seems to influence in a large number of diseases, including HIV infection. Moreover, there is a substantial inter-individual variability in the CD4+ recovery in HIV-infected patients on combination antiretroviral therapy (cART). Our study aimed to analyze the association between mtDNA haplogroups and CD4+ recovery in HIV-infected patients on cART. Methods This is a retrospective study of 324 naïve cART patients with CD4+ < 200 cells/mm3, who were followed-up during 24 months after initiating cART. All patients had undetectable HIV viral load during the follow-up. Besides, we included 141 healthy controls. MtDNA genotyping was performed by using Sequenom’s MassARRAY platform. The primary outcome variable was the slope of CD4+ recovery. Patients were stratified into two groups by the median slope value of CD4+ (9.65 CD4+ cells/mm3/month). Logistic regression analyses were performed to calculate the odds of CD4+ recovery according to mtDNA haplogroups. Results Our study included European HIV-infected patients within the N macro-cluster. The baseline values of CD4+ T-cells were similar between groups of patients stratified by the P50th of the slope of CD4+ T-cells recovery. Patients in the low CD4+ T-cells recovery group were older (p = 0.001), but this variable was included in the multivariate models. When we analyzed the frequencies of mtDNA haplogroups, no significant differences between HIV-infected individuals and healthy controls were found. We did not find any significant association between mtDNA haplogroups and the slope of CD4+ T-cells recovery by linear regression analysis. However, Patients carrying haplogroup H had a higher odds of having a better CD4+ recovery (> 9.65 CD4+ cells/mm3/month) than patients without haplogroup H (p = 0.032). The adjusted logistic regression showed that patients carrying haplogroup H had a higher likelihood of achieving a CD4+ recovery > 9.65 CD4+ cells/mm3/month [adjusted odds ratio (aOR) = 1.75 (95% CI = 1.04; 2.95); p = 0.035]. Conclusions European mitochondrial haplogroup H was associated with the improved CD4+ recovery in HIV-infected patients starting cART with CD4+ < 200 cells/mm3. Electronic supplementary material The online version of this article (10.1186/s12967-018-1717-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Luz M Medrano
- Unidad de Infección Viral e Inmunidad, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Carretera Majadahonda-Pozuelo, Km 2.2, 28220, Majadahonda, Madrid, Spain
| | - Mónica Gutiérrez-Rivas
- Unidad de Infección Viral e Inmunidad, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Carretera Majadahonda-Pozuelo, Km 2.2, 28220, Majadahonda, Madrid, Spain
| | - Julià Blanco
- Institut de Recerca de la Sida IrsiCaixa-HIVACAT, Badalona, Barcelona, Spain.,Institut d'investigació en Ciènces de la Salut Germans Trias i Pujol, Universitat Autónoma de Barcelona, Badalona, Barcelona, Spain
| | - Marcial García
- Instituto de Investigación Sanitaria-Fundación Jiménez Díaz, Universidad Autónoma de Madrid (IIS-FJD, UAM), Av. Reyes Católicos, 2, 28040, Madrid, Spain.,Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, Spain
| | - María A Jiménez-Sousa
- Unidad de Infección Viral e Inmunidad, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Carretera Majadahonda-Pozuelo, Km 2.2, 28220, Majadahonda, Madrid, Spain
| | - Yolanda M Pacheco
- Laboratorio de Immunobiología, Instituto de Biomedicina de Sevilla (IBiS), Seville, Spain.,UGC Clinical Laboratories, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Marta Montero
- Hospital Universitario y Politécnico de La Fe, Valencia, Spain
| | | | - Enrique Bernal
- Hospital General Universitario Reina Sofía, Murcia, Spain
| | | | - José M Benito
- Instituto de Investigación Sanitaria-Fundación Jiménez Díaz, Universidad Autónoma de Madrid (IIS-FJD, UAM), Av. Reyes Católicos, 2, 28040, Madrid, Spain. .,Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, Spain.
| | - Norma Rallón
- Instituto de Investigación Sanitaria-Fundación Jiménez Díaz, Universidad Autónoma de Madrid (IIS-FJD, UAM), Av. Reyes Católicos, 2, 28040, Madrid, Spain.,Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, Spain
| | - Salvador Resino
- Unidad de Infección Viral e Inmunidad, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Carretera Majadahonda-Pozuelo, Km 2.2, 28220, Majadahonda, Madrid, Spain.
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25
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Lora-Tamayo J, Senneville É, Ribera A, Bernard L, Dupon M, Zeller V, Li HK, Arvieux C, Clauss M, Uçkay I, Vigante D, Ferry T, Iribarren JA, Peel TN, Sendi P, Miksic NG, Rodríguez-Pardo D, Del Toro MD, Fernández-Sampedro M, Dapunt U, Huotari K, Davis JS, Palomino J, Neut D, Clark BM, Gottlieb T, Trebše R, Soriano A, Bahamonde A, Guío L, Rico A, Salles MJC, Pais MJG, Benito N, Riera M, Gómez L, Aboltins CA, Esteban J, Horcajada JP, O'Connell K, Ferrari M, Skaliczki G, Juan RS, Cobo J, Sánchez-Somolinos M, Ramos A, Giannitsioti E, Jover-Sáenz A, Baraia-Etxaburu JM, Barbero JM, Choong PFM, Asseray N, Ansart S, Moal GL, Zimmerli W, Ariza J. The Not-So-Good Prognosis of Streptococcal Periprosthetic Joint Infection Managed by Implant Retention: The Results of a Large Multicenter Study. Clin Infect Dis 2017; 64:1742-1752. [PMID: 28369296 DOI: 10.1093/cid/cix227] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [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: 11/28/2016] [Accepted: 03/14/2017] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND. Streptococci are not an infrequent cause of periprosthetic joint infection (PJI). Management by debridement, antibiotics, and implant retention (DAIR) is thought to produce a good prognosis, but little is known about the real likelihood of success. METHODS. A retrospective, observational, multicenter, international study was performed during 2003-2012. Eligible patients had a streptococcal PJI that was managed with DAIR. The primary endpoint was failure, defined as death related to infection, relapse/persistence of infection, or the need for salvage therapy. RESULTS. Overall, 462 cases were included (median age 72 years, 50% men). The most frequent species was Streptococcus agalactiae (34%), and 52% of all cases were hematogenous. Antibiotic treatment was primarily using β-lactams, and 37% of patients received rifampin. Outcomes were evaluable in 444 patients: failure occurred in 187 (42.1%; 95% confidence interval, 37.5%-46.7%) after a median of 62 days from debridement; patients without failure were followed up for a median of 802 days. Independent predictors (hazard ratios) of failure were rheumatoid arthritis (2.36), late post-surgical infection (2.20), and bacteremia (1.69). Independent predictors of success were exchange of removable components (0.60), early use of rifampin (0.98 per day of treatment within the first 30 days), and long treatments (≥21 days) with β-lactams, either as monotherapy (0.48) or in combination with rifampin (0.34). CONCLUSIONS. This is the largest series to our knowledge of streptococcal PJI managed by DAIR, showing a worse prognosis than previously reported. The beneficial effects of exchanging the removable components and of β-lactams are confirmed and maybe also a potential benefit from adding rifampin.
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Affiliation(s)
- Jaime Lora-Tamayo
- Unit of Infectious Diseases, Department of Internal Medicine, Hospital Universitario 12 de Octubre, Instituto de Investigación Hospital 12 de Octubre, Madrid, Spain
- Red Española de Investigación en Patología Infecciosa (REIPI)
| | - Éric Senneville
- Department of Infectious Diseases, Gustave Dron Hospital of Tourcoing, France
| | - Alba Ribera
- Red Española de Investigación en Patología Infecciosa (REIPI)
- Department of Infectious Diseases, Hospital Universitario de Bellvitge, IDIBELL, Barcelona, Spain
- Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford, United Kingdom
| | - Louis Bernard
- Department of Infectious Diseases, Hôpital Universitaire Bretonneau, Tours, France
- Centre de Référence pour les Infections Ostéo-Articulaires Complexes du Grand Ouest (CRIOGO)
| | - Michel Dupon
- Centre correspondant de prise en charge des Infections Ostéo-articulaires Complexes du Grand Sud-Ouest, CHU Bordeaux
| | - Valérie Zeller
- Centre de Référence des Infections Ostéo-Articulaires Complexes, Groupe Hospitalier Diaconesses Croix Saint Simon, Paris, and
| | - Ho Kwong Li
- Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford, United Kingdom
| | - Cédric Arvieux
- Centre de Référence pour les Infections Ostéo-Articulaires Complexes du Grand Ouest (CRIOGO)
- Department of Infectious Diseases, Rennes University Hospital, Rennes, France
| | - Martin Clauss
- Interdisciplinary Septic Surgical Unit, Kantonsspital Baselland, Liestal
| | - Ilker Uçkay
- Department of Infectious Diseases, Hôpitaux Universitaires Genève, Switzerland
| | - Dace Vigante
- Hospital of Traumatology and Orthopedics, Riga, Latvia
| | - Tristan Ferry
- Department of Infectious and Tropical Diseases, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, France
| | - José Antonio Iribarren
- Department of Infectious Diseases, Hospital Universitario Donostia, San Sebastián, Spain
| | - Trisha N Peel
- Department of Infectious Diseases, Saint Vincent's Public Hospital, Melbourne, Victoria, Australia
| | - Parham Sendi
- Department of Infectious Diseases, University Hospital of Bern, Switzerland
| | - Nina Gorišek Miksic
- Infectious Diseases Department, University Clinical Center, Maribor, Slovenia
| | - Dolors Rodríguez-Pardo
- Red Española de Investigación en Patología Infecciosa (REIPI)
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona
| | - María Dolores Del Toro
- Red Española de Investigación en Patología Infecciosa (REIPI)
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Institute of Biomedicine of Seville (Ibis), University of Seville, University Hospitals Virgen Macarena y Virgen del Rocío, and
| | - Marta Fernández-Sampedro
- Red Española de Investigación en Patología Infecciosa (REIPI)
- Department of Infectious Diseases, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Ulrike Dapunt
- Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Germany
| | | | - Joshua S Davis
- Department of Infectious Diseases, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Julián Palomino
- Red Española de Investigación en Patología Infecciosa (REIPI)
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Institute of Biomedicine of Seville (Ibis), University of Seville, University Hospitals Virgen Macarena y Virgen del Rocío, and
| | - Danielle Neut
- Departments of Orthopedic Surgery and Biomedical Engineering, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Benjamin M Clark
- Department of Infectious Diseases, Fiona Stanley Hospital, Western Australia
| | - Thomas Gottlieb
- Department of Microbiology and Infectious Diseases, Concord Hospital, New South Wales, Australia
| | - Rihard Trebše
- Service for Bone Infections, Valdoltra Orthopaedic Hospital, Ankaran, Slovenia
| | - Alex Soriano
- Red Española de Investigación en Patología Infecciosa (REIPI)
- Department of Infectious Diseases, Hospital Clínic, Barcelona, Spain
- ESCMID Study Group for Implant-Associated Infections (ESGIAI)
| | | | - Laura Guío
- Red Española de Investigación en Patología Infecciosa (REIPI)
- Unit of Infectious Diseases, Hospital de Cruces, Barakaldo, and
| | - Alicia Rico
- Unit of Infectious Diseases, Department of Internal Medicine, Hospital Universitario La Paz, Madrid, Spain
| | - Mauro J C Salles
- Unit of Infectious Diseases, Department of Internal Medicine, Santa Casa de Misericórdia de São Paulo, Brazil
| | - M José G Pais
- Unit of Infectious Diseases, Department of Internal Medicine, Hospital Universitario Lucus Augusti, Lugo, Spain
| | - Natividad Benito
- Red Española de Investigación en Patología Infecciosa (REIPI)
- Unit of Infectious Diseases, Hospital Universitari de la Santa Creu I Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona
| | - Melchor Riera
- Red Española de Investigación en Patología Infecciosa (REIPI)
- Department of Internal Medicine, Hospital Son Espases, Palma de Mallorca, and
| | - Lucía Gómez
- Unit of Infectious Diseases, Hospital Universitari Mútua de Terrassa, Spain
| | - Craig A Aboltins
- Department of Infectious Diseases, Northern Health, Victoria and University of Melbourne, Northern Clinical School, Australia
| | - Jaime Esteban
- Department of Clinical Microbiology, IIS-Fundación Jiménez Díaz, Madrid
| | | | - Karina O'Connell
- Department of Clinical Microbiology, Beaumont Hospital, Dublin, Ireland
| | - Matteo Ferrari
- Department of Orthopedics and Rehabilitation, Humanitas Research Hospital, Milano, Italy
| | - Gábor Skaliczki
- Department of Orthopedics, OrhopediClinic, Semmelweis University, Budapest, Hungary
| | - Rafael San Juan
- Unit of Infectious Diseases, Department of Internal Medicine, Hospital Universitario 12 de Octubre, Instituto de Investigación Hospital 12 de Octubre, Madrid, Spain
- Red Española de Investigación en Patología Infecciosa (REIPI)
| | - Javier Cobo
- Red Española de Investigación en Patología Infecciosa (REIPI)
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, IRYCIS
| | - Mar Sánchez-Somolinos
- Red Española de Investigación en Patología Infecciosa (REIPI)
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, and
| | - Antonio Ramos
- Unit of Infectious Diseases, Department of Internal Medicine, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Efthymia Giannitsioti
- Department of Infectious Diseases, 4th Department of Internal Medicine, NKUA, ATTIKON University General Hospital, Athens, Greece
| | - Alfredo Jover-Sáenz
- Department of Infectious Diseases, Hospital Universitari Arnau de Vilanova, Lleida
| | | | - José María Barbero
- Department of Internal Medicine, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Spain
| | - Peter F M Choong
- University of Melbourne, Departments of Surgery and Orthopaedic, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - Nathalie Asseray
- Centre de Référence pour les Infections Ostéo-Articulaires Complexes du Grand Ouest (CRIOGO)
- Department of Infectious Diseases, Hôpital Universitaire Hôtel Dieu, Nantes
| | - Séverine Ansart
- Centre de Référence pour les Infections Ostéo-Articulaires Complexes du Grand Ouest (CRIOGO)
- Department of Infectious Diseases, Hôpital Universitaire La Cavale Blanche, Brest, and
| | - Gwenäel Le Moal
- Centre de Référence pour les Infections Ostéo-Articulaires Complexes du Grand Ouest (CRIOGO)
- Department of Infectious Diseases, Hôpital Universitaire La Miletrie, Poitiers, France
| | - Werner Zimmerli
- Interdisciplinary Septic Surgical Unit, Kantonsspital Baselland, Liestal
| | - Javier Ariza
- Red Española de Investigación en Patología Infecciosa (REIPI)
- Department of Infectious Diseases, Hospital Universitario de Bellvitge, IDIBELL, Barcelona, Spain
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Lora-Tamayo J, Euba G, Cobo J, Horcajada JP, Soriano A, Sandoval E, Pigrau C, Benito N, Falgueras L, Palomino J, Del Toro MD, Jover-Sáenz A, Iribarren JA, Sánchez-Somolinos M, Ramos A, Fernández-Sampedro M, Riera M, Baraia-Etxaburu JM, Ariza J. Short- versus long-duration levofloxacin plus rifampicin for acute staphylococcal prosthetic joint infection managed with implant retention: a randomised clinical trial. Int J Antimicrob Agents 2016; 48:310-6. [PMID: 27524103 DOI: 10.1016/j.ijantimicag.2016.05.021] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [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: 03/14/2016] [Revised: 05/04/2016] [Accepted: 05/28/2016] [Indexed: 02/08/2023]
Abstract
Levofloxacin plus rifampicin (L+R) is the treatment of choice for acute staphylococcal prosthetic joint infection (PJI) managed with debridement and implant retention (DAIR). Long courses have been empirically recommended, but some studies have suggested that shorter treatments could be as effective. Our aim was to prove that a short treatment schedule was non-inferior to the standard long schedule. An open-label, multicentre, randomised clinical trial (RCT) was performed. Patients with an early post-surgical or haematogenous staphylococcal PJI, managed with DAIR and initiated on L+R were randomised to receive 8 weeks of treatment (short schedule) versus a long schedule (3 months or 6 months for hip or knee prostheses, respectively). The primary endpoint was cure rate. From 175 eligible patients, 63 were included (52% women; median age, 72 years): 33 patients (52%) received the long schedule and 30 (48%) received the short schedule. There were no differences between the two groups except for a higher rate of polymicrobial infection in the long-schedule group (27% vs. 7%; P = 0.031). Median follow-up was 540 days. In the intention-to-treat analysis, cure rates were 58% and 73% in patients receiving the long and short schedules, respectively (difference -15.7%, 95% CI -39.2% to 7.8%). Forty-four patients (70%) were evaluable per-protocol: cure rates were 95.0% and 91.7% for the long and short schedules, respectively (difference 3.3%, 95% CI -11.7% to 18.3%). This is the first RCT suggesting that 8 weeks of L+R could be non-inferior to longer standard treatments for acute staphylococcal PJI managed with DAIR.
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Affiliation(s)
- Jaime Lora-Tamayo
- Unidad de Enfermedades Infecciosas, Hospital Universitario 12 de Octubre, Instituto de Investigación Hospital 12 de Octubre "i+12", Madrid, Spain.
| | - Gorane Euba
- Servicio de Enfermedades Infecciosas, Hospital Universitario de Bellvitge, Barcelona, Spain
| | - Javier Cobo
- Servicio de Enfermedades Infecciosas, IRYCIS, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Juan Pablo Horcajada
- Servicio de Enfermedades Infecciosas, Hospital del Mar, IMIM, CEXS-UPF, Barcelona, Spain
| | - Alex Soriano
- Servicio de Enfermedades Infecciosas, Hospital Clínic i Provincial, IDIBAPS, Barcelona, Spain
| | - Enrique Sandoval
- Servicio de Traumatología, Fundación Jiménez Díaz, Madrid, Spain
| | - Carles Pigrau
- Servicio de Enfermedades Infecciosas, Hospital Universitario Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Natividad Benito
- Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Luis Falgueras
- Servicio de Enfermedades Infecciosas, Corporació Sanitària Parc Taulí, Sabadell, Spain
| | - Julián Palomino
- Servicio de Enfermedades Infecciosas, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - María Dolores Del Toro
- Unidad Clínica Intercentros de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospitales Universitarios Virgen Macarena y Virgen del Rocío, Seville, Spain
| | - Alfredo Jover-Sáenz
- Unidad Funcional de Infección Nosocomial y Servicio de Medicina Interna, Hospital Universitario Arnau de Vilanova, Lleida, Spain
| | - José Antonio Iribarren
- Servicio de Enfermedades Infecciosas, Hospital Universitario Donostia, San Sebastián, Spain
| | - Mar Sánchez-Somolinos
- Servicio de Microbiología y Enfermedades Infecciosas, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Antonio Ramos
- Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Marta Fernández-Sampedro
- Servicio de Enfermedades Infecciosas, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Melchor Riera
- Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | | | - Javier Ariza
- Servicio de Enfermedades Infecciosas, Hospital Universitario de Bellvitge, Barcelona, Spain
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27
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Rivero A, Pérez-Molina JA, Blasco AJ, Arribas JR, Crespo M, Domingo P, Estrada V, Iribarren JA, Knobel H, Lázaro P, López-Aldeguer J, Lozano F, Moreno S, Palacios R, Pineda JA, Pulido F, Rubio R, de la Torre J, Tuset M, Gatell JM. Costs and cost-efficacy analysis of the 2016 GESIDA/Spanish AIDS National Plan recommended guidelines for initial antiretroviral therapy in HIV-infected adults. Enferm Infecc Microbiol Clin 2016; 35:88-99. [PMID: 27459919 DOI: 10.1016/j.eimc.2016.06.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 04/20/2016] [Revised: 06/14/2016] [Accepted: 06/14/2016] [Indexed: 11/16/2022]
Abstract
INTRODUCTION GESIDA and the AIDS National Plan panel of experts suggest preferred (PR), alternative (AR), and other regimens (OR) for antiretroviral treatment (ART) as initial therapy in HIV-infected patients for the year 2016. The objective of this study is to evaluate the costs and the efficacy of initiating treatment with these regimens. METHODS Economic assessment of costs and efficiency (cost/efficacy) based on decision tree analyses. Efficacy was defined as the probability of reporting a viral load <50copies/mL at week 48 in an intention-to-treat analysis. Cost of initiating treatment with an ART regimen was defined as the costs of ART and its consequences (adverse effects, changes of ART regimen, and drug resistance studies) during the first 48 weeks. The payer perspective (National Health System) was applied, only taking into account differential direct costs: ART (official prices), management of adverse effects, studies of resistance, and HLA B*5701 testing. The setting is Spain and the costs correspond to those of 2016. A sensitivity deterministic analysis was conducted, building three scenarios for each regimen: base case, most favourable, and least favourable. RESULTS In the base case scenario, the cost of initiating treatment ranges from 4663 Euros for 3TC+LPV/r (OR) to 10,894 Euros for TDF/FTC+RAL (PR). The efficacy varies from 0.66 for ABC/3TC+ATV/r (AR) and ABC/3TC+LPV/r (OR), to 0.89 for TDF/FTC+DTG (PR) and TDF/FTC/EVG/COBI (AR). The efficiency, in terms of cost/efficacy, ranges from 5280 to 12,836 Euros per responder at 48 weeks, for 3TC+LPV/r (OR), and RAL+DRV/r (OR), respectively. CONCLUSION Despite the overall most efficient regimen being 3TC+LPV/r (OR), among the PR and AR, the most efficient regimen was ABC/3TC/DTG (PR). Among the AR regimes, the most efficient was TDF/FTC/RPV.
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Affiliation(s)
- Antonio Rivero
- Unidad de Gestión Clínica de Enfermedades Infecciosas, Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba, Córdoba, Spain
| | | | | | - José Ramón Arribas
- Servicio de Medicina Interna, Unidad de VIH, IdiPAZ, Hospital Universitario La Paz, Madrid, Spain
| | - Manuel Crespo
- Hospital Universitari Vall d'Hebron, Vall d'Hebron Institute of Research (VHIR), Barcelona, Spain
| | - Pere Domingo
- Hospitals Universitaris Arnau de Vilanova & Santa María, Universitat de Lleida, Institut de Recerca Biomèdica (IRB) de Lleida, Lieida, Spain
| | - Vicente Estrada
- Hospital Clínico San Carlos, IdISSC; Universidad Complutense, Madrid, Spain
| | - José Antonio Iribarren
- Servicio de Enfermedades Infecciosas, Hospital Universitario Donostia, San Sebastián, Spain
| | - Hernando Knobel
- Servicio de Enfermedades Infecciosas, Hospital del Mar, Barcelona, Spain
| | | | - José López-Aldeguer
- Servicio de Medicina Interna y Unidad de Enfermedades Infecciosas, Hospital Universitario La Fe, Valencia, Spain
| | - Fernando Lozano
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario de Valme, Sevilla, Spain
| | - Santiago Moreno
- Servicio de Enfermedades Infecciosas, Hospital Ramón y Cajal, Universidad de Alcalá de Henares, Instituto de Investigación Sanitaria Ramón y Cajal (IRYCIS), Alcalá de Henares, Madrid, Spain
| | - Rosario Palacios
- Unidad de Enfermedades Infecciosas, Hospital Virgen de la Victoria, Málaga, Spain
| | - Juan Antonio Pineda
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario de Valme, Sevilla, Spain
| | - Federico Pulido
- Unidad VIH, i+12, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Rafael Rubio
- Unidad VIH, i+12, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Javier de la Torre
- Grupo de Enfermedades Infecciosas de la Unidad de Medicina Interna, Hospital Costa del Sol, Marbella, Málaga, Spain
| | | | - Josep M Gatell
- Servicio de Enfermedades Infecciosas, Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain
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Suárez-García I, Sobrino-Vegas P, Dalmau D, Rubio R, Iribarren JA, Blanco JR, Gutierrez F, Montero Alonso M, Bernal E, Vinuesa García D, Del Amo J. Clinical outcomes of patients infected with HIV through use of injected drugs compared to patients infected through sexual transmission: late presentation, delayed anti-retroviral treatment and higher mortality. Addiction 2016; 111:1235-45. [PMID: 26890155 DOI: 10.1111/add.13348] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2015] [Revised: 11/30/2015] [Accepted: 02/08/2016] [Indexed: 11/30/2022]
Abstract
AIMS To compare patients who acquired HIV infection through use of injected drugs (HIV-IDU) with patients who acquired HIV by sexual transmission (HIV-ST) in terms of late presentation (LP), delay in anti-retroviral treatment (ART) initiation, virological and immunological response to ART, mortality and progression to AIDS. DESIGN Prospective multi-centre cohort study of HIV-infected subjects naive to ART at entry (Cohort of the Spanish HIV Research Network: CoRIS). SETTING Thirty-one centres from the Spanish public health-care system. PARTICIPANTS A total of 9355 patients were included (1064 HIV-IDU and 8291 HIV-ST) during 2004-13. MEASUREMENTS We compared LP (defined as presentation for care with a CD4 cell count < 350/μl and/or AIDS-defining illness), delayed ART initiation (defined as initiating treatment more than 6 months after the date when treatment was indicated by the guidelines, or not initiating treatment at all when it was indicated), virological and immunological response to ART (defined as viral load < 50 HIV-1 RNA copies/ml and a CD4 count increase of at least 100 cells/μl, respectively, after 1 year of treatment), mortality and progression to AIDS in HIV-IDU and HIV-ST. FINDINGS Compared with HIV-ST, HIV-IDU had higher risk of LP [odds ratio (OR) = 1.76; 95% confidence interval (CI) = 1.41-2.18], delayed ART initiation (OR 1.87; 95% CI = 1.46-2.40) and higher mortality [hazard ratio (HR) = 1.43; 95% CI = 1.03-2.01] and risk of progression to AIDS [subhazard ratio (SHR) = 1.68; 95% CI = 1.29-2.18]. Virological suppression due to ART was lower in HIV-IDU than in patients with HIV-ST only among patients without hepatitis C virus (HCV) infection [adjusted OR (aOR) = 0.59; 95% CI = 0.36-0.95]; among patients with HCV infection, virological suppression due to ART did not show significant differences between HIV-IDU and HIV-ST. There were no significant differences in immunological response after adjusting by HCV (aOR = 0.74; 95% CI = 0.52-1.06). CONCLUSIONS In Spain, patients who acquire HIV infection through use of injected drugs appear to have a higher risk of late presentation, delayed initiation of anti-retroviral treatment and progression to AIDS and death than patients who acquire HIV by sexual transmission.
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Affiliation(s)
- Inés Suárez-García
- Infectious Diseases Unit, Department of Internal Medicine, Hospital Universitario Infanta Sofía, Madrid, Spain
| | - Paz Sobrino-Vegas
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain
| | - David Dalmau
- Hospital Universitari Mutua Terrassa, Terrassa, Spain
| | - Rafael Rubio
- Unidad Infección VIH, Hospital Universitario Doce de Octubre, Madrid, Spain
| | | | - José Ramón Blanco
- Department of Infectious Diseases, Hospital San Pedro-CIBIR, Logroño, Spain
| | - Félix Gutierrez
- Infectious Diseases Unit, Hospital General de Elche and Universidad Miguel Hernández, Alicante, Spain
| | - Marta Montero Alonso
- Department of Infectious Diseases, Hospital Universitario La Fe, Valencia, Spain
| | | | - David Vinuesa García
- Unidad de Gestion Clínica de Microbiología y Enfermedades Infecciosas, Hospital Clínico San Cecilio, Granada, Spain
| | - Julia Del Amo
- Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain
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Iribarren JA, Rubio R, Aguirrebengoa K, Arribas JR, Baraia-Etxaburu J, Gutiérrez F, Lopez Bernaldo de Quirós JC, Losa JE, Miró JM, Moreno S, Pérez Molina J, Podzamczer D, Pulido F, Riera M, Rivero A, Sanz Moreno J, Amador C, Antela A, Arazo P, Arrizabalaga J, Bachiller P, Barros C, Berenguer J, Caylá J, Domingo P, Estrada V, Knobel H, Locutura J, López Aldeguer J, Llibre JM, Lozano F, Mallolas J, Malmierca E, Miralles C, Miralles P, Muñoz A, Ocampo A, Olalla J, Pérez I, Pérez Elías MJ, Pérez Arellano JL, Portilla J, Ribera E, Rodríguez F, Santín M, Sanz Sanz J, Téllez MJ, Torralba M, Valencia E, Von Wichmann MA. Executive summary: Prevention and treatment of opportunistic infections and other coinfections in HIV-infected patients: May 2015. Enferm Infecc Microbiol Clin 2016; 34:517-23. [PMID: 27056581 DOI: 10.1016/j.eimc.2016.02.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 02/15/2016] [Accepted: 02/16/2016] [Indexed: 11/19/2022]
Abstract
Opportunistic infections continue to be a cause of morbidity and mortality in HIV-infected patients. They often arise because of severe immunosuppression resulting from poor adherence to antiretroviral therapy, failure of antiretroviral therapy, or unawareness of HIV infection by patients whose first clinical manifestation of AIDS is an opportunistic infection. The present article is an executive summary of the document that updates the previous recommendations on the prevention and treatment of opportunistic infections in HIV-infected patients, namely, infections by parasites, fungi, viruses, mycobacteria, and bacteria, as well as imported infections. The article also addresses immune reconstitution inflammatory syndrome. This document is intended for all professionals who work in clinical practice in the field of HIV infection.
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Iribarren JA, Rubio R, Aguirrebengoa K, Arribas JR, Baraia-Etxaburu J, Gutiérrez F, Lopez Bernaldo de Quirós JC, Losa JE, Miró JM, Moreno S, Pérez Molina J, Podzamczer D, Pulido F, Riera M, Rivero A, Sanz Moreno J, Amador C, Antela A, Arazo P, Arrizabalaga J, Bachiller P, Barros C, Berenguer J, Caylá J, Domingo P, Estrada V, Knobel H, Locutura J, López Aldeguer J, Llibre JM, Lozano F, Mallolas J, Malmierca E, Miralles C, Miralles P, Muñoz A, Ocampo A, Olalla J, Pérez I, Pérez Elías MJ, Pérez Arellano JL, Portilla J, Ribera E, Rodríguez F, Santín M, Sanz Sanz J, Téllez MJ, Torralba M, Valencia E, Von Wichmann MA. Prevention and treatment of opportunistic infections and other coinfections in HIV-infected patients: May 2015. Enferm Infecc Microbiol Clin 2016; 34:516.e1-516.e18. [PMID: 26976381 DOI: 10.1016/j.eimc.2016.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 02/04/2016] [Indexed: 01/04/2023]
Abstract
Despite the huge advance that antiretroviral therapy represents for the prognosis of infection by the human immunodeficiency virus (HIV), opportunistic infections (OIs) continue to be a cause of morbidity and mortality in HIV-infected patients. OIs often arise because of severe immunosuppression resulting from poor adherence to antiretroviral therapy, failure of antiretroviral therapy, or unawareness of HIV infection by patients whose first clinical manifestation of AIDS is an OI. The present article updates our previous guidelines on the prevention and treatment of various OIs in HIV-infected patients, namely, infections by parasites, fungi, viruses, mycobacteria, and bacteria, as well as imported infections. The article also addresses immune reconstitution inflammatory syndrome.
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Hofstra LM, Sauvageot N, Albert J, Alexiev I, Garcia F, Struck D, Van de Vijver DAMC, Åsjö B, Beshkov D, Coughlan S, Descamps D, Griskevicius A, Hamouda O, Horban A, Van Kasteren M, Kolupajeva T, Kostrikis LG, Liitsola K, Linka M, Mor O, Nielsen C, Otelea D, Paraskevis D, Paredes R, Poljak M, Puchhammer-Stöckl E, Sönnerborg A, Staneková D, Stanojevic M, Van Laethem K, Zazzi M, Zidovec Lepej S, Boucher CAB, Schmit JC, Wensing AMJ, Puchhammer-Stockl E, Sarcletti M, Schmied B, Geit M, Balluch G, Vandamme AM, Vercauteren J, Derdelinckx I, Sasse A, Bogaert M, Ceunen H, De Roo A, De Wit S, Echahidi F, Fransen K, Goffard JC, Goubau P, Goudeseune E, Yombi JC, Lacor P, Liesnard C, Moutschen M, Pierard D, Rens R, Schrooten Y, Vaira D, Vandekerckhove LPR, Van den Heuvel A, Van Der Gucht B, Van Ranst M, Van Wijngaerden E, Vandercam B, Vekemans M, Verhofstede C, Clumeck N, Van Laethem K, Beshkov D, Alexiev I, Lepej SZ, Begovac J, Kostrikis L, Demetriades I, Kousiappa I, Demetriou V, Hezka J, Linka M, Maly M, Machala L, Nielsen C, Jørgensen LB, Gerstoft J, Mathiesen L, Pedersen C, Nielsen H, Laursen A, Kvinesdal B, Liitsola K, Ristola M, Suni J, Sutinen J, Descamps D, Assoumou L, Castor G, Grude M, Flandre P, Storto A, Hamouda O, Kücherer C, Berg T, Braun P, Poggensee G, Däumer M, Eberle J, Heiken H, Kaiser R, Knechten H, Korn K, Müller H, Neifer S, Schmidt B, Walter H, Gunsenheimer-Bartmeyer B, Harrer T, Paraskevis D, Hatzakis A, Zavitsanou A, Vassilakis A, Lazanas M, Chini M, Lioni A, Sakka V, Kourkounti S, Paparizos V, Antoniadou A, Papadopoulos A, Poulakou G, Katsarolis I, Protopapas K, Chryssos G, Drimis S, Gargalianos P, Xylomenos G, Lourida G, Psichogiou M, Daikos GL, Sipsas NV, Kontos A, Gamaletsou MN, Koratzanis G, Sambatakou H, Mariolis H, Skoutelis A, Papastamopoulos V, Georgiou O, Panagopoulos P, Maltezos E, Coughlan S, De Gascun C, Byrne C, Duffy M, Bergin C, Reidy D, Farrell G, Lambert J, O'Connor E, Rochford A, Low J, Coakely P, O'Dea S, Hall W, Mor O, Levi I, Chemtob D, Grossman Z, Zazzi M, de Luca A, Balotta C, Riva C, Mussini C, Caramma I, Capetti A, Colombo MC, Rossi C, Prati F, Tramuto F, Vitale F, Ciccozzi M, Angarano G, Rezza G, Kolupajeva T, Vasins O, Griskevicius A, Lipnickiene V, Schmit JC, Struck D, Sauvageot N, Hemmer R, Arendt V, Michaux C, Staub T, Sequin-Devaux C, Wensing AMJ, Boucher CAB, van de Vijver DAMC, van Kessel A, van Bentum PHM, Brinkman K, Connell BJ, van der Ende ME, Hoepelman IM, van Kasteren M, Kuipers M, Langebeek N, Richter C, Santegoets RMWJ, Schrijnders-Gudde L, Schuurman R, van de Ven BJM, Åsjö B, Kran AMB, Ormaasen V, Aavitsland P, Horban A, Stanczak JJ, Stanczak GP, Firlag-Burkacka E, Wiercinska-Drapalo A, Jablonowska E, Maolepsza E, Leszczyszyn-Pynka M, Szata W, Camacho R, Palma C, Borges F, Paixão T, Duque V, Araújo F, Otelea D, Paraschiv S, Tudor AM, Cernat R, Chiriac C, Dumitrescu F, Prisecariu LJ, Stanojevic M, Jevtovic D, Salemovic D, Stanekova D, Habekova M, Chabadová Z, Drobkova T, Bukovinova P, Shunnar A, Truska P, Poljak M, Lunar M, Babic D, Tomazic J, Vidmar L, Vovko T, Karner P, Garcia F, Paredes R, Monge S, Moreno S, Del Amo J, Asensi V, Sirvent JL, de Mendoza C, Delgado R, Gutiérrez F, Berenguer J, Garcia-Bujalance S, Stella N, de Los Santos I, Blanco JR, Dalmau D, Rivero M, Segura F, Elías MJP, Alvarez M, Chueca N, Rodríguez-Martín C, Vidal C, Palomares JC, Viciana I, Viciana P, Cordoba J, Aguilera A, Domingo P, Galindo MJ, Miralles C, Del Pozo MA, Ribera E, Iribarren JA, Ruiz L, de la Torre J, Vidal F, Clotet B, Albert J, Heidarian A, Aperia-Peipke K, Axelsson M, Mild M, Karlsson A, Sönnerborg A, Thalme A, Navér L, Bratt G, Karlsson A, Blaxhult A, Gisslén M, Svennerholm B, Bergbrant I, Björkman P, Säll C, Mellgren Å, Lindholm A, Kuylenstierna N, Montelius R, Azimi F, Johansson B, Carlsson M, Johansson E, Ljungberg B, Ekvall H, Strand A, Mäkitalo S, Öberg S, Holmblad P, Höfer M, Holmberg H, Josefson P, Ryding U. Transmission of HIV Drug Resistance and the Predicted Effect on Current First-line Regimens in Europe. Clin Infect Dis 2015; 62:655-663. [PMID: 26620652 PMCID: PMC4741360 DOI: 10.1093/cid/civ963] [Citation(s) in RCA: 118] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 11/06/2015] [Indexed: 11/13/2022] Open
Abstract
Transmitted human immunodeficiency virus drug resistance in Europe is stable at around 8%. The impact of baseline mutation patterns on susceptibility to antiretroviral drugs should be addressed using clinical guidelines. The impact on baseline susceptibility is largest for nonnucleoside reverse transcriptase inhibitors. Background. Numerous studies have shown that baseline drug resistance patterns may influence the outcome of antiretroviral therapy. Therefore, guidelines recommend drug resistance testing to guide the choice of initial regimen. In addition to optimizing individual patient management, these baseline resistance data enable transmitted drug resistance (TDR) to be surveyed for public health purposes. The SPREAD program systematically collects data to gain insight into TDR occurring in Europe since 2001. Methods. Demographic, clinical, and virological data from 4140 antiretroviral-naive human immunodeficiency virus (HIV)–infected individuals from 26 countries who were newly diagnosed between 2008 and 2010 were analyzed. Evidence of TDR was defined using the WHO list for surveillance of drug resistance mutations. Prevalence of TDR was assessed over time by comparing the results to SPREAD data from 2002 to 2007. Baseline susceptibility to antiretroviral drugs was predicted using the Stanford HIVdb program version 7.0. Results. The overall prevalence of TDR did not change significantly over time and was 8.3% (95% confidence interval, 7.2%–9.5%) in 2008–2010. The most frequent indicators of TDR were nucleoside reverse transcriptase inhibitor (NRTI) mutations (4.5%), followed by nonnucleoside reverse transcriptase inhibitor (NNRTI) mutations (2.9%) and protease inhibitor mutations (2.0%). Baseline mutations were most predictive of reduced susceptibility to initial NNRTI-based regimens: 4.5% and 6.5% of patient isolates were predicted to have resistance to regimens containing efavirenz or rilpivirine, respectively, independent of current NRTI backbones. Conclusions. Although TDR was highest for NRTIs, the impact of baseline drug resistance patterns on susceptibility was largest for NNRTIs. The prevalence of TDR assessed by epidemiological surveys does not clearly indicate to what degree susceptibility to different drug classes is affected.
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Affiliation(s)
- L Marije Hofstra
- Luxembourg Institute of Health, Luxembourg.,Department of Virology, University Medical Center Utrecht, The Netherlands
| | | | - Jan Albert
- Karolinska Institute, Solna.,Karolinska University Hospital, Stockholm, Sweden
| | - Ivailo Alexiev
- National Center of Infectious and Parasitic Diseases, Sofia, Bulgaria
| | - Federico Garcia
- Complejo Hospitalario Universitario de Granada, Instituto de Investigación IBS Granada; on behalf of Cohorte de Adultos de la Red de Investigación en SIDA, Spain
| | | | | | | | - Danail Beshkov
- National Center of Infectious and Parasitic Diseases, Sofia, Bulgaria
| | | | - Diane Descamps
- AP-HP Groupe hospitalier Bichat-Claude Bernard, IAME INSERM UMR 1137, Université Paris Diderot Sorbonne Paris Cité, Paris, France
| | | | | | | | | | | | | | - Kirsi Liitsola
- Department of Infectious Diseases, National Institute for Health and Welfare, Helsinki, Finland
| | - Marek Linka
- National Reference Laboratory for HIV/AIDS, National Institute of Public Health, Prague, Czech Republic
| | - Orna Mor
- National HIV Reference Laboratory, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | | | - Dan Otelea
- National Institute for Infectious Diseases "Prof. dr. Matei Bals", Bucharest, Romania
| | | | | | - Mario Poljak
- Faculty of Medicine, Slovenian HIV/AIDS Reference Centre, University of Ljubljana, Slovenia
| | | | - Anders Sönnerborg
- Karolinska Institute, Solna.,Karolinska University Hospital, Stockholm, Sweden
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Santos JR, Blanco JL, Masiá M, Gutiérrez F, Pérez-Elías MJ, Iribarren JA, Force L, Antela A, Knobel H, Salavert M, López Bernaldo De Quirós JC, Pino M, Paredes R, Clotet B. Virological failure to raltegravir in Spain: incidence, prevalence and clinical consequences. J Antimicrob Chemother 2015; 70:3087-95. [PMID: 26490727 DOI: 10.1093/jac/dkv205] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 06/18/2015] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The objective of this study was to evaluate the incidence, prevalence and clinical consequences of virological failure (VF) to raltegravir-based regimens in Spain. METHODS A multicentre, retrospective, observational study was performed in 10 tertiary hospitals (January 2006 to June 2013). The study included HIV-1-infected patients with loss of virological suppression (LVS; two consecutive HIV-1 RNA ≥50 copies/mL) while receiving raltegravir. VF and low-level viraemia (LLV) were defined as two consecutive HIV-1 RNA ≥200 copies/mL and 50 to <200 copies/mL, respectively. Integrase strand-transfer inhibitor resistance was investigated at LVS. During the 48 weeks following LVS, recorded data included clinical characteristics, treatment discontinuations, AIDS-associated events and deaths. Effectiveness of therapy following LVS was evaluated by ITT and PP. Multivariate regression was used to assess predictors of efficacy. RESULTS Of the 15 009 HIV-infected patients in participating centres, 2782 (18.5%) had received raltegravir-based regimens. Of those, 192 (6.9%), 125 (4.5%) and 67 (2.4%) experienced LVS, VF and LLV, respectively. The incidence of VF was 1.8 (95% CI, 1.5-2.1) per 100 patients/year. The prevalence of VF was 4.5% (95% CI, 3.8%-5.3%). Integrase-associated mutations were found in 78.8% of patients with integrase genotyping results available. High-level resistance to dolutegravir was not observed. Salvage therapy failed in 34.1% of patients; progression to AIDS/death occurred in 8.3% during the first year following LVS. The latter was associated with intravenous drug use, time on raltegravir and lower CD4+ count nadir in patients who started raltegravir-based treatments as salvage regimens. CONCLUSIONS VF with raltegravir is infrequent, but often associated with major clinical complications in treatment-experienced patients.
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Affiliation(s)
- José Ramón Santos
- Lluita contra la SIDA Foundation, Germans Trias i Pujol University Hospital, Barcelona, Spain Universitat Autònoma de Barcelona, Barcelona, Spain
| | - José Luis Blanco
- Hospital Clinic de Barcelona, University of Barcelona, IDIBAPS, Barcelona, Spain
| | - Mar Masiá
- Infectious Diseases Unit, Elche University General Hospital, Elche, Spain Miguel Hernández University, Elche, Spain
| | - Félix Gutiérrez
- Infectious Diseases Unit, Elche University General Hospital, Elche, Spain Miguel Hernández University, Elche, Spain
| | | | | | - Lluis Force
- Infectious Diseases Unit, Mataró Hospital, Mataró, Spain
| | - Antonio Antela
- Infectious Diseases Unit, University Hospital, Santiago de Compostela, Spain
| | - Hernando Knobel
- Service of Infectious Diseases, Hospital del Mar, IMIM (Hospital del Mar Research Institute), Barcelona, Spain
| | - Miguel Salavert
- Infectious Diseases Unit, La Fe University and Polytechnic Hospital, Valencia, Spain
| | | | - María Pino
- IrsiCaixa AIDS Research Institute, Barcelona, Spain
| | - Roger Paredes
- Lluita contra la SIDA Foundation, Germans Trias i Pujol University Hospital, Barcelona, Spain IrsiCaixa AIDS Research Institute, Barcelona, Spain Universitat de Vic-Universitat Central de Catalunya, Vic, Spain
| | - Bonaventura Clotet
- Lluita contra la SIDA Foundation, Germans Trias i Pujol University Hospital, Barcelona, Spain Universitat Autònoma de Barcelona, Barcelona, Spain IrsiCaixa AIDS Research Institute, Barcelona, Spain Universitat de Vic-Universitat Central de Catalunya, Vic, Spain
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Pacheco YM, Jarrin I, Rosado I, Campins AA, Berenguer J, Iribarren JA, Rivero M, Muñoz-Medina L, Bernal-Morell E, Gutiérrez F, Leal M. Increased risk of non-AIDS-related events in HIV subjects with persistent low CD4 counts despite cART in the CoRIS cohort. Antiviral Res 2015; 117:69-74. [PMID: 25766861 DOI: 10.1016/j.antiviral.2015.03.002] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [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: 12/05/2014] [Revised: 02/18/2015] [Accepted: 03/02/2015] [Indexed: 10/23/2022]
Abstract
The aim was to analyze clinical complications in HIV-infected subjects who persistently maintain low CD4 levels despite virological response to cART in the Spanish CoRIS cohort. The main inclusion criteria were CD4 counts <200cells/mm(3) at cART-initiation and at least 2years under cART achieving a viral load <500copies/mL. Those patients with CD4 counts <250cells/mm(3) 2years after cART were classified as the Low-CD4 group, and clinical events were collected from this time-point. Poisson regression models were used to calculate incidence rate ratios of death, AIDS-defining events, serious non-AIDS-defining events (NAE) and of each specific NAE category (non-AIDS-defining malignancies (non-ADM), cardiovascular, kidney- and liver-related events). Of 9667 patients in the cohort, a total of 1128 met the criteria and 287 (25.4%) were classified in the Low-CD4 group. A higher risk of death (aIRR: 4.71; 95% CI: 1.88-11.82; p-value=0.001) and of non-ADM were observed in this group (aIRR: 2.23; 95% CI: 1.07-4.63; p=0.03). Our results stress the need to control accelerated aging in this population to counter their increased risk of non-AIDS-defining diseases, particularly cancer, and are consistent with the concept that clinical complications are potentially affected by genetics and lifestyle.
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Affiliation(s)
- Y M Pacheco
- Laboratory of Immunovirology, Clinic Unit of Infectious Diseases, Microbiology and Preventive Medicine, Institute of Biomedicine of Seville, IBiS, Virgen del Rocío University Hospital/CSIC/University of Seville, Seville 41013, Spain.
| | - I Jarrin
- Institute of Health Carlos III, Madrid, Spain
| | - I Rosado
- Laboratory of Immunovirology, Clinic Unit of Infectious Diseases, Microbiology and Preventive Medicine, Institute of Biomedicine of Seville, IBiS, Virgen del Rocío University Hospital/CSIC/University of Seville, Seville 41013, Spain
| | - A A Campins
- Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - J Berenguer
- Infectious Diseases/HIV Unit, Gregorio Marañón General University Hospital, Madrid, Spain
| | - J A Iribarren
- Hospital Universitario de Donostia, San Sebastián, Spain
| | - M Rivero
- Navarra Hospital, Pamplona, Spain
| | - L Muñoz-Medina
- Unidad de Enfermedades Infecciosas, Hospital Universitario San Cecilio, Granada, Spain
| | - E Bernal-Morell
- Servicio de Enfermedades Infecciosas, Hospital General Universitario Reina Sofia, Madrid, Spain
| | - F Gutiérrez
- Infectious Diseases Unit, Hospital General Universitario de Elche, Clinical Medicine Department, Universidad Miguel Hernández, Alicante, Spain
| | - M Leal
- Laboratory of Immunovirology, Clinic Unit of Infectious Diseases, Microbiology and Preventive Medicine, Institute of Biomedicine of Seville, IBiS, Virgen del Rocío University Hospital/CSIC/University of Seville, Seville 41013, Spain
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Monge S, Diez M, Pulido F, Iribarren JA, Campins AA, Arazo P, Montero M, Miro JM, Moreno S, Del Amo J. Tuberculosis in a cohort of HIV-positive patients: epidemiology, clinical practice and treatment outcomes. Int J Tuberc Lung Dis 2015; 18:700-8. [PMID: 24903942 DOI: 10.5588/ijtld.13.0778] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To describe tuberculosis (TB) incidence, risk factors, clinical presentation, disease management and outcomes in human immunodeficiency virus (HIV) infected patients from the CoRIS cohort, Spain, 2004-2010. DESIGN Open multicentre cohort of antiretroviral treatment (ART) naïve patients at entry. Incidence and risk factors were evaluated using multivariate Poisson regression. RESULTS Among 6811 patients, 271 were eligible for the study and 198 for the estimation of the incidence rate; TB incidence ranged from 12.1 to 14.1/1000 person-years. TB was associated with low education level (rate ratio [RR] 2.65, 95%CI 1.73-4.07), being sub-Saharan African (RR 3.14, 95%CI 1.81-5.45), heterosexual (RR 2.01, 95%CI 1.22-3.29) or an injecting drug user (RR 2.11, 95%CI 1.20-3.69), not undergoing ART (RR 3.33, 95%CI 2.22-4.76), CD4 <200 cells/mm(3) (RR 5.20, 95%CI 3.25-8.33) and log-viral load of 4-5 (RR 5.44, 95%CI 3.28-9.02) or >5 (RR 13.10, 95%CI 8.27-20.76). Overall, 87% were new cases and 13% were previously treated cases; 175 (65%) were bacteriologically confirmed. Drug susceptibility testing was performed in 146 (83%) patients: resistance to first-line drugs was 11.1% in new and 36.4% in previously treated cases. Standard anti-tuberculosis treatment with four or three drugs was prescribed in respectively 55% and 36% of cases. Treatment default was 11%, and was higher among previously treated cases; 80% received ART during anti-tuberculosis treatment, 80% of new and 50% of previously treated cases were cured or completed treatment, and 18 (6.6%) died. CONCLUSION TB incidence in HIV-infected patients remains high. Interventions should include early HIV diagnosis and access to ART, enhanced bacteriological confirmation, wider use of four-drug regimens and reduction in treatment default.
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Affiliation(s)
- S Monge
- Red de Investigación en Sida, Centro Nacional de Epidemiología, CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
| | - M Diez
- Aacute;rea de Vigilancia Epidemiológica del VIH/SIDA y Comportamientos de Riesgo, Plan Nacional sobre el SIDA, Ministerio de Sanidad, Servicios Sociales e Igualdad/Centro Nacional de Epidemiología, Instituto de Salud Carlos III and CIBERESP Madrid, Spain
| | - F Pulido
- Hospital Universitario 12 de Octubre, Madrid, Spain
| | - J A Iribarren
- Hospital Universitario de Donostia, San Sebastián, Spain
| | - A A Campins
- Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - P Arazo
- Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - M Montero
- El Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - J M Miro
- Hospital Clinic Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - S Moreno
- Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - J Del Amo
- Red de Investigación en Sida, Centro Nacional de Epidemiología, CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
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Estrada V, Bernardino JI, Masiá M, Iribarren JA, Ortega A, Lozano F, Miralles C, Olalla J, Santos J, Elías MJP, Domingo P, Cruz AF. Cardiovascular risk factors and lifetime risk estimation in HIV-infected patients under antiretroviral treatment in Spain. HIV Clin Trials 2015; 16:57-65. [PMID: 25874992 DOI: 10.1179/1528433614z.0000000008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND AND OBJECTIVES Cardiovascular disease is a major concern in HIV-infected patients. Lifetime risk estimations use the risk of developing it over the course of remaining lifetime, and are useful in communicating this risk to young patients. We aim to describe the prevalence of cardiovascular risk factors among a representative sample of HIV-infected subjects under antiretroviral therapy in Spain, and to estimate their lifetime risk of cardiovascular disease. METHODS Cross-sectional survey about cardiovascular risk factors in 10 HIV units across Spain. Lifetime risk assessed according to Barry was classified in two major categories: low and high lifetime risk. RESULTS We included 895 subjects, 72% men, median age 45.7 years; median CD4 lymphocyte count 598 cells/μl, median time since HIV diagnosis 11 years, median time on antiretroviral treatment 6.3 years, 87% had undetectable HIV viral load. Tobacco smoking was the most frequent risk factor (54%), followed by dyslipidemia (48.6%) and hypertension (38.6%). Estimated 10-year coronary risk (Framingham/Regicor Risk Score) risk was low ( < 5%) in 78% of the patients, and intermediate (5-10%) in 20%. Lifetime risk estimation showed a high risk profile for 71.4% of the population studied, which was associated with increasing age, prolonged antiretroviral therapy and patient's place of origin. CONCLUSIONS Modifiable cardiovascular risk factors in this population are very common. There are significant disparities between the low 10-year risk estimated with the Framingham/Regicor score and the higher lifetime risk in HIV patients on antiretroviral therapy. A more aggressive management of modifiable cardiovascular risk factors in these patients seems advisable.
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Rodríguez-Pardo D, Pigrau C, Lora-Tamayo J, Soriano A, del Toro MD, Cobo J, Palomino J, Euba G, Riera M, Sánchez-Somolinos M, Benito N, Fernández-Sampedro M, Sorli L, Guio L, Iribarren JA, Baraia-Etxaburu JM, Ramos A, Bahamonde A, Flores-Sánchez X, Corona PS, Ariza J. Gram-negative prosthetic joint infection: outcome of a debridement, antibiotics and implant retention approach. A large multicentre study. Clin Microbiol Infect 2014; 20:O911-9. [PMID: 24766536 DOI: 10.1111/1469-0691.12649] [Citation(s) in RCA: 137] [Impact Index Per Article: 13.7] [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: 02/02/2014] [Revised: 04/07/2014] [Accepted: 04/18/2014] [Indexed: 02/05/2023]
Abstract
We aim to evaluate the epidemiology and outcome of gram-negative prosthetic joint infection (GN-PJI) treated with debridement, antibiotics and implant retention (DAIR), identify factors predictive of failure, and determine the impact of ciprofloxacin use on prognosis. We performed a retrospective, multicentre, observational study of GN-PJI diagnosed from 2003 through to 2010 in 16 Spanish hospitals. We define failure as persistence or reappearance of the inflammatory joint signs during follow-up, leading to unplanned surgery or repeat debridement>30 days from the index surgery related death, or suppressive antimicrobial therapy. Parameters predicting failure were analysed with a Cox regression model. A total of 242 patients (33% men; median age 76 years, interquartile range (IQR) 68-81) with 242 episodes of GN-PJI were studied. The implants included 150 (62%) hip, 85 (35%) knee, five (2%) shoulder and two (1%) elbow prostheses. There were 189 (78%) acute infections. Causative microorganisms were Enterobacteriaceae in 78%, Pseudomonas spp. in 20%, and other gram-negative bacilli in 2%. Overall, 19% of isolates were ciprofloxacin resistant. DAIR was used in 174 (72%) cases, with an overall success rate of 68%, which increased to 79% after a median of 25 months' follow-up in ciprofloxacin-susceptible GN-PJIs treated with ciprofloxacin. Ciprofloxacin treatment exhibited an independent protective effect (adjusted hazard ratio (aHR) 0.23; 95% CI, 0.13-0.40; p<0.001), whereas chronic renal impairment predicted failure (aHR, 2.56; 95% CI, 1.14-5.77; p 0.0232). Our results confirm a 79% success rate in ciprofloxacin-susceptible GN-PJI treated with debridement, ciprofloxacin and implant retention. New therapeutic strategies are needed for ciprofloxacin-resistant PJI.
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Affiliation(s)
- D Rodríguez-Pardo
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
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Monge S, Díez M, Alvarez M, Guillot V, Iribarren JA, Palacios R, Delgado R, Jaén A, Blanco JR, Domingo P, Portilla J, Pérez Elías MJ, Garcia F. Use of cohort data to estimate national prevalence of transmitted drug resistance to antiretroviral drugs in Spain (2007-2012). Clin Microbiol Infect 2014; 21:105.e1-5. [PMID: 25636937 DOI: 10.1016/j.cmi.2014.08.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [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: 04/29/2014] [Revised: 08/01/2014] [Accepted: 08/02/2014] [Indexed: 10/24/2022]
Abstract
Prevalence of transmitted drug resistance (pTDR) to antiretroviral drugs in Spain (2007-2012) was estimated using the CoRIS cohort, adjusting its territorial distribution and transmission route to the reference population from the Spanish Information System on New human immunodeficiency virus diagnoses. A total of 2702 patients from ten autonomous communities and with naive FASTA sequence within 6 months of human immunodeficiency virus diagnosis were selected. Weighted pTDR, estimated using the inverse probability of selection in the sample by autonomous communities and transmission group, was 8.12% (95% CI 6.44-9.80), not significantly different from unweighted pTDR. We illustrate how proportional weighting can maximize representativeness of cohort-based data, and its value to monitor pTDR at country level.
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Affiliation(s)
- S Monge
- Red de Investigación en Sida, Centro Nacional de Epidemiología, Instituto de Salud Carlos III, CIBERESP, Madrid, Spain.
| | - M Díez
- Área de Vigilancia Epidemiológica del VIH/sida y Comportamientos de Riesgo, Plan Nacional sobre el Sida, Ministerio de Sanidad, Servicios Sociales e Igualdad/Centro Nacional de Epidemiología, Instituto de Salud Carlos III, CIBERESP, Madrid, Spain
| | - M Alvarez
- Instituto de Investigación Biosanitaria ibs GRANADA, Hospitales Universitarios de Granada, Spain
| | - V Guillot
- Instituto de Investigación Biosanitaria ibs GRANADA, Hospitales Universitarios de Granada, Spain
| | - J A Iribarren
- Hospital Universitario Donostia, San Sebastián, Spain
| | - R Palacios
- Hospital Universitario Virgen de la Victoria, Malaga, Spain
| | - R Delgado
- Hospital Universitario 12 de Octubre, Madrid, Spain
| | - A Jaén
- Hospital Universitario Mutua de Terrassa, Barcelona, Spain
| | - J R Blanco
- Hospital San Pedro-CIBIR, Logroño, Spain
| | - P Domingo
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - J Portilla
- Hospital General Universitario de Alicante, Alicante, Spain
| | | | - F Garcia
- Instituto de Investigación Biosanitaria ibs GRANADA, Hospitales Universitarios de Granada, Spain
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Polo Rodríguez R, Muñoz Galligo E, Iribarren JA, Domingo Pedrol P, Leyes García M, Maiques Montesinos V, Miralles Martín P, Noguera Julian A, Ocampo Hernandez A, Peres Bares ML, López Rojano M, Suy Franch A, Viñuela Beneitez MC, González Tomé MI. Executive summary of the Consensus Statement on monitoring HIV: pregnancy, birth, and prevention of mother-to-child transmission. Enferm Infecc Microbiol Clin 2014; 32:311-9. [PMID: 24582834 DOI: 10.1016/j.eimc.2013.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 12/02/2013] [Indexed: 11/26/2022]
Abstract
The main objective in the management of HIV-infected pregnant women is prevention of mother-to-child transmission; therefore, it is essential to provide universal antiretroviral treatment, regardless of CD4 count. All pregnant women must receive adequate information and undergo HIV serology testing at the first visit. If the serological status is unknown at the time of delivery, or in the immediate postpartum, HIV serology testing has to be performed as soon as possible. In this document, recommendations are made regarding the health of the mother and from the perspective of minimizing mother-to-child transmission.
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Suárez-García I, Sobrino-Vegas P, Tejada A, Viciana P, Ribas MA, Iribarren JA, Díaz Menéndez M, Rivero M, Arazo P, del Amo J, Moreno S. Compliance with national guidelines for HIV treatment and its association with mortality and treatment outcome: a study in a Spanish cohort. HIV Med 2013; 15:86-97. [DOI: 10.1111/hiv.12078] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2013] [Indexed: 11/29/2022]
Affiliation(s)
- I Suárez-García
- Infectious Diseases Unit; Infanta Sofía Hospital; Madrid Spain
| | | | - A Tejada
- Ramón y Cajal Hospital; Madrid Spain
| | - P Viciana
- Virgen del Rocío Hospital; Sevilla Spain
| | - MA Ribas
- Son Espases Hospital; Palma de Mallorca; Spain
| | | | | | - M Rivero
- Navarra Hospital; Pamplona Spain
| | - P Arazo
- Miguel Servet Hospital; Zaragoza Spain
| | - J del Amo
- National Epidemiology Center; Madrid Spain
| | - S Moreno
- Ramón y Cajal Hospital; Madrid Spain
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40
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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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Pérez-Elías MJ, Muriel A, Moreno A, Martinez-Colubi M, Iribarren JA, Masiá M, Blanco JR, Palacios R, del Romero J, Pérez DG, Hernando V. Relevant gender differences in epidemiological profile, exposure to first antiretroviral regimen and survival in the Spanish AIDS Research Network. Antivir Ther 2013; 19:375-85. [DOI: 10.3851/imp2714] [Citation(s) in RCA: 6] [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] [Accepted: 11/04/2013] [Indexed: 10/25/2022]
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Lora-Tamayo J, Murillo O, Iribarren JA, Soriano A, Sánchez-Somolinos M, Baraia-Etxaburu JM, Rico A, Palomino J, Rodríguez-Pardo D, Horcajada JP, Benito N, Bahamonde A, Granados A, del Toro MD, Cobo J, Riera M, Ramos A, Jover-Sáenz A, Ariza J. A large multicenter study of methicillin-susceptible and methicillin-resistant Staphylococcus aureus prosthetic joint infections managed with implant retention. Clin Infect Dis 2013; 56:182-94. [PMID: 22942204 DOI: 10.1093/cid/cis746] [Citation(s) in RCA: 258] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Several series predicting the prognosis of staphylococcal prosthetic joint infection (PJI) managed with debridement, antibiotics, and implant retention (DAIR) have been published, but some of their conclusions are controversial. At present, little is known regarding the efficacy of the different antibiotics that are used or their ability to eliminate methicillin-resistant S. aureus (MRSA) infection. METHODS This was a retrospective, multicenter, observational study of cases of PJI by S. aureus that were managed with DAIR (2003-2010). Cases were classified as failures when infection persistence/relapse, death, need for salvage therapy, or prosthesis removal occurred. The parameters that predicted failure were analyzed with logistic and Cox regression. RESULTS Out of 345 episodes (41% men, 73 years), 81 episodes were caused by MRSA. Fifty-two were hematogenous, with poorer prognoses, and 88% were caused by methicillin-susceptible S. aureus (MSSA). Antibiotics were used for a median of 93 days, with similar use of rifampin-based combinations in MSSA- and MRSA-PJI. Failure occurred in 45% of episodes, often early after debridement. The median survival time was 1257 days. There were no overall prognostic differences between MSSA- and MRSA-PJI, but there was a higher incidence of MRSA-PJI treatment failure during the period of treatment (HR 2.34), while there was a higher incidence of MSSA-PJI treatment failure after therapy. Rifampin-based combinations exhibited an independent protective effect. Other independent predictors of outcome were polymicrobial, inflammatory, and bacteremic infections requiring more than 1 debridement, immunosuppressive therapy, and the exchange of removable components of the prosthesis. CONCLUSIONS This is the largest series of PJI by S. aureus managed with DAIR reported to date. The success rate was 55%. The use of rifampin may have contributed to homogenizing MSSA and MRSA prognoses, although the specific rifampin combinations may have had different efficacies.
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Affiliation(s)
- Jaime Lora-Tamayo
- Infectious Diseases, Hospital Universitario Bellvitge, IDIBELL, Universidad de Barcelona, Barcelona, Spain.
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Monge S, Alejos B, Dronda F, Del Romero J, Iribarren JA, Pulido F, Rubio R, Miró JM, Gutierrez F, Del Amo J. Inequalities in HIV disease management and progression in migrants from Latin America and sub-Saharan Africa living in Spain. HIV Med 2012; 14:273-83. [DOI: 10.1111/hiv.12001] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2012] [Indexed: 11/29/2022]
Affiliation(s)
- S Monge
- AIDS Research Network; National Centre of Epidemiology; Carlos III Health Institute; Madrid; Spain
| | - B Alejos
- AIDS Research Network; National Centre of Epidemiology; Carlos III Health Institute; Madrid; Spain
| | - F Dronda
- Ramón y Cajal University Hospital; Madrid; Spain
| | | | | | - F Pulido
- 12 de Octubre University Hospital; Madrid; Spain
| | - R Rubio
- 12 de Octubre University Hospital; Madrid; Spain
| | - JM Miró
- Hospital Clinic - IDIBAPS; University of Barcelona; Barcelona; Spain
| | | | - J Del Amo
- AIDS Research Network; National Centre of Epidemiology; Carlos III Health Institute; Madrid; Spain
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Betancor G, Garriga C, Puertas MC, Nevot M, Anta L, Blanco JL, Pérez-Elías MJ, de Mendoza C, Martínez MA, Martinez-Picado J, Menéndez-Arias L, Iribarren JA, Caballero E, Ribera E, Llibre JM, Clotet B, Jaén A, Dalmau D, Gatel JM, Peraire J, Vidal F, Vidal C, Riera M, Córdoba J, López Aldeguer J, Galindo MJ, Gutiérrez F, Álvarez M, García F, Pérez-Romero P, Viciana P, Leal M, Palomares JC, Pineda JA, Viciana I, Santos J, Rodríguez P, Gómez Sirvent JL, Gutiérrez C, Moreno S, Pérez-Olmeda M, Alcamí J, Rodríguez C, del Romero J, Cañizares A, Pedreira J, Miralles C, Ocampo A, Morano L, Aguilera A, Garrido C, Manuzza G, Poveda E, Soriano V. Clinical, virological and biochemical evidence supporting the association of HIV-1 reverse transcriptase polymorphism R284K and thymidine analogue resistance mutations M41L, L210W and T215Y in patients failing tenofovir/emtricitabine therapy. Retrovirology 2012; 9:68. [PMID: 22889300 PMCID: PMC3468358 DOI: 10.1186/1742-4690-9-68] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Accepted: 07/26/2012] [Indexed: 11/10/2022] Open
Abstract
Background Thymidine analogue resistance mutations (TAMs) selected under treatment with nucleoside analogues generate two distinct genotypic profiles in the HIV-1 reverse transcriptase (RT): (i) TAM1: M41L, L210W and T215Y, and (ii) TAM2: D67N, K70R and K219E/Q, and sometimes T215F. Secondary mutations, including thumb subdomain polymorphisms (e.g. R284K) have been identified in association with TAMs. We have identified mutational clusters associated with virological failure during salvage therapy with tenofovir/emtricitabine-based regimens. In this context, we have studied the role of R284K as a secondary mutation associated with mutations of the TAM1 complex. Results The cross-sectional study carried out with >200 HIV-1 genotypes showed that virological failure to tenofovir/emtricitabine was strongly associated with the presence of M184V (P < 10-10) and TAMs (P < 10-3), while K65R was relatively uncommon in previously-treated patients failing antiretroviral therapy. Clusters of mutations were identified, and among them, the TAM1 complex showed the highest correlation coefficients. Covariation of TAM1 mutations and V118I, V179I, M184V and R284K was observed. Virological studies showed that the combination of R284K with TAM1 mutations confers a fitness advantage in the presence of zidovudine or tenofovir. Studies with recombinant HIV-1 RTs showed that when associated with TAM1 mutations, R284K had a minimal impact on zidovudine or tenofovir inhibition, and in their ability to excise the inhibitors from blocked DNA primers. However, the mutant RT M41L/L210W/T215Y/R284K showed an increased catalytic rate for nucleotide incorporation and a higher RNase H activity in comparison with WT and mutant M41L/L210W/T215Y RTs. These effects were consistent with its enhanced chain-terminated primer rescue on DNA/DNA template-primers, but not on RNA/DNA complexes, and can explain the higher fitness of HIV-1 having TAM1/R284K mutations. Conclusions Our study shows the association of R284K and TAM1 mutations in individuals failing therapy with tenofovir/emtricitabine, and unveils a novel mechanism by which secondary mutations are selected in the context of drug-resistance mutations.
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Affiliation(s)
- Gilberto Betancor
- Centro de Biología Molecular "Severo Ochoa", Consejo Superior de Investigaciones Científicas & Universidad Autónoma de Madrid, Madrid, Spain
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Imaz A, Olmo M, Peñaranda M, Gutiérrez F, Romeu J, Larrousse M, Domingo P, Oteo JA, Curto J, Vilallonga C, Masiá M, López-Aldeguer J, Iribarren JA, Podzamczer D. Short-term and long-term clinical and immunological consequences of stopping antiretroviral therapy in HIV-infected patients with preserved immune function. Antivir Ther 2012; 18:125-30. [PMID: 22805174 DOI: 10.3851/imp2249] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND The aim of this study was to assess the short-term and long-term consequences of stopping antiretroviral therapy (ART) in patients with preserved immune function. METHODS This was a randomized 144-week follow-up CD4⁺ T-cell-count-guided treatment-interruption trial. HIV-1-infected adults with plasma HIV-1 RNA<50 copies/ml, CD4⁺ T-cell count >500 cells/μl and nadir CD4⁺ T-cell count >100 cells/μl were randomized to continuous treatment (CT) or treatment interruption (TI) until CD4⁺ T-cell count decreased to <350 cells/μl. The primary end points were AIDS-defining illnesses, death, CD4⁺ T-cell count <200 cells/μl, or virological failure after restarting ART. RESULTS A total of 106 patients were included, 50 in the CT arm and 56 in the TI arm. A trend to a higher rate of primary end points was observed in the TI group (26.8% versus 14%, difference 12.8%, 95% CI -2.3, 27.8; P=0.105). In addition, 10 patients presented clinical events related with HIV rebound, including 8 cases of thrombocytopaenia. The CD4⁺ T-cell count significantly decreased in the TI group (even in patients with persistently high CD4⁺ T-cell counts and no clinical events) versus the CT group (median change -408 cells/μl versus -21.5 cells/μl; P<0.001), whereas a significant increase in CD8⁺ T-cell count was observed (256 cells/μl versus -59 cells/μl; P<0.001). The time to ART re-initiation was significantly associated with nadir and baseline CD4⁺ T-cell counts. CONCLUSIONS Discontinuation of ART in patients with preserved immune function is followed by significant immunological impairment even in those with no clinical events, and may be associated with an increased risk of HIV-related complications. Hence, patients who stop ART voluntarily should be closely monitored, regardless of their CD4⁺ T-cell count.
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Affiliation(s)
- Arkaitz Imaz
- HIV Unit, Infectious Diseases Service, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
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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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Azkune H, Ibarguren M, Camino X, Iribarren JA. [Prevention of HIV transmission (vertical, occupational and non-occupational)]. Enferm Infecc Microbiol Clin 2011; 29:615-25. [PMID: 21816514 DOI: 10.1016/j.eimc.2011.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2011] [Accepted: 05/18/2011] [Indexed: 10/17/2022]
Abstract
In these almost thirty years since the epidemic of HIV infection strategies have been developed to decrease the transmission risk when a non-infected person comes into contact with HIV. One of the key landmarks was the use zidovudine was shown to reduce the risk of HIV infection by vertical transmission from 25% to 8% when given from the second trimester of pregnancy, during partum and for several weeks in the newborn. These strategies have been subsequently perfected until achieving vertical transmission rates less than 1%. Almost at the same time, strategies have been developed in an attempt to reduce the risk of transmission of infection after occupational accidents and, in the last few years prophylaxis after non-occupational exposure has been a field of particular concern. Even in this past year several experiments on pre-exposure prophylaxis have been published, which are generating an intense debate on is applicability. In this article, we analyse the state of the art in the prevention of vertical transmission and occupational and non-occupational prophylaxis, from a perspective of applying this in the developed world. We also review the published data on pre-exposure prophylaxis.
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Affiliation(s)
- Harkaitz Azkune
- Unidad de Enfermedades Infecciosas, Hospital Donostia, San Sebastián, España
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Macías J, Mallolas J, López-Cortés LF, Cartón JA, Domingo P, Moreno S, Iribarren JA, Neukam K, Rodrigo A, Jiménez-Expósito MJ, Pineda JA. Liver safety of two nucleoside analogs plus efavirenz, nevirapine or a ritonavir-boosted protease inhibitor in HIV/HCV-coinfected drug-naïve patients. J Int AIDS Soc 2010. [PMCID: PMC3113099 DOI: 10.1186/1758-2652-13-s4-p91] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Blanco JR, Caro AM, Pérez-Cachafeiro S, Gutiérrez F, Iribarren JA, González-García J, Ferrando-Martínez S, Navarro G, Moreno S. HIV infection and aging. AIDS Rev 2010; 12:218-230. [PMID: 21179186] [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: 05/30/2023]
Abstract
The median age of HIV-infected patients is increasing all over the world. Age has a significant impact on some aspects of HIV-infection when compared to younger patients. Diagnostic delay and late presentation are more frequent in older patients because some of the initial symptoms are masked by age and because older people are not considered to be a risk group for HIV infection. Despite the clinical, immunological, and virologic benefits of HAART, most studies suggest that older patients have a poorer immunological and clinical response to HAART than younger patients, despite a similar virologic response. Other problems include the frequent presence of comorbid conditions and medications that can affect the efficacy and safety of HAART as well as its pharmacokinetics and pharmacodynamics. Because no guidelines recommend a specific HAART regimen for older people, specific clinical trials and pharmacological studies should be designed to optimize HAART in these patients.
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Fernández-García A, Pérez-Álvarez L, Cuevas MT, Delgado E, Muñoz-Nieto M, Cilla G, Iribarren JA, Pinilla M, Ocampo A, Miralles C, Pérez-Castro S, González-Galeano M, de Castro RO, Trigo M, García V, Sánchez AM, Thomson MM. Identification of a new HIV type 1 circulating BF intersubtype recombinant form (CRF47_BF) in Spain. AIDS Res Hum Retroviruses 2010; 26:827-32. [PMID: 20618102 DOI: 10.1089/aid.2009.0311] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
We report the identification of a new HIV-1 circulating recombinant form (CRF47_BF) derived from subtypes B and F. It was initially identified in protease-reverse transcriptase sequences from nine individuals from three separate regions of Spain who acquired HIV-1 infection via sexual contact. All nine sequences formed a strongly supported phylogenetic cluster, branching apart from all known CRFs, and in bootscan analyses were BF mosaics with two coincident breakpoints. Two epidemiologically unlinked viruses were sequenced in near full-length genomes, which exhibited identical mosaic structures, with 16 intersubtype breakpoints in a genome predominantly of subtype B. Subtype F segments of the new CRF failed to cluster with any of the near full-length genome subtype F sequences available in public databases. Recent dates of HIV-1 diagnoses and short genetic distances suggest a recent origin of this CRF. This is the tenth reported CRF_BF, the first apparently having originated outside of South America.
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Affiliation(s)
| | - Lucía Pérez-Álvarez
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - María Teresa Cuevas
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Elena Delgado
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Mercedes Muñoz-Nieto
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Gustavo Cilla
- Complejo Hospitalario Donostia, San Sebastián, Guipúzcoa, Spain
| | | | - Milagros Pinilla
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Antonio Ocampo
- Complejo Hospitalario Universitario Xeral Cies, Vigo, Pontevedra, Spain
| | - Celia Miralles
- Complejo Hospitalario Universitario Xeral Cies, Vigo, Pontevedra, Spain
| | | | - María González-Galeano
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | | | - Matilde Trigo
- Complejo Hospitalario Provincial de Pontevedra, Pontevedra, Spain
| | - Valentina García
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Ana M. Sánchez
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Michael M. Thomson
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
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