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Casamitjà MT, Ventura N, Mantas S, Sunyer J, Mallolas J, Bou A, Parreño R, Turró O. The implementation of health promotion on health professionals practice and public policy managers. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab165.144] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Reorientation in interventions aimed at implementing Health Promotion (HP) on health professionals and public policy managers is a key issue on the political agenda. It is crucial to know which factors influence the process of implementing HP between both fields. The aim of this study was to identify barriers, facilitators and proposals for the implementation of HP and to know which were the differences and similarities between health professionals and public policy managers.
Methods
A qualitative study was carried out to determine which were the barriers, facilitators and recommendations for the implementation of HP programmes. Between March 2017 -December 2018 six focus groups, purposively selected, were formed (32 women & 20 men). The study was completed with three semi-structured interviews to public policy managers of our area between January 2020-February 2020. Theorical saturation was reached and validity of the study was ensured by triangulation.
Results
Globally, health professionals and public policy managers identified shortage of global actions, lack of coordination between different health agents and the complexity of social determinants in the implementation of HP as the main barriers. Common facilitators were belief in the effectiveness of social prescription and the tasks related to HP and the existence of new professionals oriented towards the individual and their assets in health. Greater intersectoral relationship with a vision of health in all policies, redistribution of public resources and increase in social prescription were the most valued proposals.
Conclusions
Prioritize HP strategies in the agenda of all professionals. Health in all policies from all health agents and from interdisciplinary work. Identify and deepen in the study of these factors to develop new proposals for the implementation of HP.
Key messages
Greater intersectoral relationship is needed. Prioritize HP strategies in the agenda of all professionals.
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Affiliation(s)
- MT Casamitjà
- Health Promotion, Official College of Medicine, Girona, Spain
- Health Promotion, Group of Professionals for Health Promotion, Girona, Spain
| | - N Ventura
- Health Promotion, Official College of Nursing, Girona, Spain
- Health Promotion, Group of Professionals for Health Promotion, Girona, Spain
| | - S Mantas
- Health Promotion, Official College of Psychologist, Girona, Spain
- Health Promotion, Group of Professionals for Health Promotion, Girona, Spain
| | - J Sunyer
- Health Promotion, Official College of Veterinary, Girona, Spain
- Health Promotion, Group of Professionals for Health Promotion, Girona, Spain
| | - J Mallolas
- Health Promotion, Official College of Pharmacists, Girona, Spain
- Health Promotion, Group of Professionals for Health Promotion, Girona, Spain
| | - A Bou
- Health Promotion, Official College of Medicine, Girona, Spain
- Health Promotion, Group of Professionals for Health Promotion, Girona, Spain
| | - R Parreño
- Health Promotion, Official College of Nursing, Girona, Spain
- Health Promotion, Group of Professionals for Health Promotion, Girona, Spain
| | - O Turró
- Health Promotion, Official College of Psychologist, Girona, Spain
- Health Promotion, Group of Professionals for Health Promotion, Girona, Spain
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Perello R, Vergara A, Monclus E, Jimenez S, Montero M, Saubi N, Moreno A, Eto Y, Inciarte A, Mallolas J, Martínez E, Marcos MA. Cytomegalovirus infection in HIV-infected patients in the era of combination antiretroviral therapy. BMC Infect Dis 2019; 19:1030. [PMID: 31801482 PMCID: PMC6894188 DOI: 10.1186/s12879-019-4643-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 11/20/2019] [Indexed: 12/20/2022] Open
Abstract
Background Cytomegalovirus infection dramatically decreased with the introduction of antiretroviral therapy. Whether incidence, clinical characteristics and prognosis of cytomegalovirus in HIV infected patients, has changed over time is. scarcely known. Methods Retrospective single-center study. Patients included in this study were all HIV infected patients that went to our center for any disease, and were diagnosed with cytomegalovirus, during the period 2004–2015. epidemiological, clinical and laboratory patients variables were collected in a clinical database. Clinical characteristics, incidence of cytomegalovirus and predictors of mortality during the study were assessed. Results were considered statistically significant when p < 0.05. All statistical analyses were calculated by SPSS version 20.0 (Chicago, IL,USA). Results Fifty-six cases of cytomegalovirus infection, in HIV infected patients were identified during the study period (incidence rate-1.7 cases per 1000 persons/year). The most frequent presentation was systemic illness in 43% of cases. Of note,no patients presented with ophthalmic manifestations. The 30-days mortality was 18%. Predictors of mortality were, in the univariate analysis, admission to the intensive care unit OR 32.4 (3.65–287.06) p = 0.0001, and mechanic ventilation 84 OR (8.27–853.12) p = 0.0001, and ART OR 4.1 (0.97–17.31) p = 0.044. These variables were assessed by multivariate analysis, and only mechanical ventilation was statistically significant (p < 0.05) Conclusion Incidence of cytomegalovirus infection was higher than described in the antiretroviral therapy era. Clinical presentation has changed. Mechanic ventilation predicted mortality.
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Affiliation(s)
- R Perello
- Servicio de Urgencias, Hospital Clínic, Barcelona, Spain.
| | - A Vergara
- Servicio de Microbiología, CDB, Hospital Clínic, Barcelona, Spain
| | - E Monclus
- Servicio de Urgencias, Hospital Clínic, Barcelona, Spain
| | - S Jimenez
- Servicio de Urgencias, Hospital Clínic, Barcelona, Spain
| | - M Montero
- Servicio de Urgencias, Hospital Clínic, Barcelona, Spain
| | - N Saubi
- Servicio de Enfermedades Infecciosas, Hospital Clínic, Barcelona, Spain
| | - A Moreno
- Servicio de Microbiología, CDB, Hospital Clínic, Barcelona, Spain
| | - Y Eto
- Servicio de Enfermedades Infecciosas, Hospital Clínic, Barcelona, Spain
| | - A Inciarte
- Servicio de Enfermedades Infecciosas, Hospital Clínic, Barcelona, Spain
| | - J Mallolas
- Servicio de Enfermedades Infecciosas, Hospital Clínic, Barcelona, Spain
| | - E Martínez
- Servicio de Enfermedades Infecciosas, Hospital Clínic, Barcelona, Spain
| | - M A Marcos
- Servicio de Microbiología, CDB, Hospital Clínic, Barcelona, Spain
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Inciarte A, Leal L, González E, León A, Lucero C, Mallolas J, Torres B, Laguno M, Rojas J, Martínez-Rebollar M, González-Cordón A, Cruceta A, Arnaiz JA, Gatell JM, García F. Tenofovir disoproxil fumarate/emtricitabine plus ritonavir-boosted lopinavir or cobicistat-boosted elvitegravir as a single-tablet regimen for HIV post-exposure prophylaxis. J Antimicrob Chemother 2018; 72:2857-2861. [PMID: 29091217 DOI: 10.1093/jac/dkx246] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Accepted: 06/22/2017] [Indexed: 02/07/2023] Open
Abstract
Objectives To assess HIV-1 post-exposure prophylaxis (PEP) non-completion at day 28, comparing ritonavir-boosted lopinavir versus cobicistat-boosted elvitegravir as a single-tablet regimen (STR), using tenofovir disoproxil fumarate/emtricitabine with both of these therapies. Methods A prospective, open, randomized clinical trial was performed. Individuals attending the emergency room due to potential sexual exposure to HIV and who met criteria for PEP were randomized 1:3 into two groups receiving either 400/100 mg of lopinavir/ritonavir (n = 38) or 150/150 mg of elvitegravir/cobicistat (n = 119), with both groups also receiving 245/200 mg of tenofovir disoproxil fumarate/emtricitabine. Five follow-up visits were scheduled at days 1, 10, 28, 90 and 180. The primary endpoint was PEP non-completion at day 28. Secondary endpoints were adherence, adverse effects and rate of seroconversions. Clinical trials.gov number: NCT08431173. Results Median age was 32 years and 95% were males. PEP non-completion at day 28 was 36% (n = 57), with a trend to be higher in the lopinavir/ritonavir arm [lopinavir/ritonavir 47% (n = 18) versus elvitegravir/cobicistat 33% (n = 39), P = 0.10]. We performed a modified ITT analysis including only those patients who attended on day 1. PEP non-completion in this subgroup was higher in the lopinavir/ritonavir arm than in the elvitegravir/cobicistat arm (33% versus 15%, respectively, P = 0.04). Poor adherence was significantly higher in the lopinavir/ritonavir arm versus the elvitegravir/cobicistat arm (47% versus 9%, respectively, P < 0.0001). Adverse events were reported by 73 patients (59%), and were significantly more common in the lopinavir/ritonavir arm (90% versus 49%, P = 0.0001). A seroconversion was observed in the elvitegravir/cobicistat arm in a patient with multiple exposures before and after PEP. Conclusions A higher PEP non-completion, poor adherence and adverse events were observed in patients allocated to the lopinavir/ritonavir arm, suggesting that STR elvitegravir/cobicistat is a well-tolerated antiretroviral for PEP.
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Affiliation(s)
- A Inciarte
- Infectious Diseases Unit, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - L Leal
- Infectious Diseases Unit, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - E González
- Infectious Diseases Unit, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - A León
- Infectious Diseases Unit, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - C Lucero
- Infectious Diseases Unit, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - J Mallolas
- Infectious Diseases Unit, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - B Torres
- Infectious Diseases Unit, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - M Laguno
- Infectious Diseases Unit, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - J Rojas
- Infectious Diseases Unit, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - M Martínez-Rebollar
- Infectious Diseases Unit, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - A González-Cordón
- Infectious Diseases Unit, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - A Cruceta
- Infectious Diseases Unit, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - J A Arnaiz
- Infectious Diseases Unit, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - J M Gatell
- Infectious Diseases Unit, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - F García
- Infectious Diseases Unit, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
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González-Cordón A, Doménech M, Camafort M, Martínez-Rebollar M, Torres B, Laguno M, Rojas J, Loncà M, Blanco JL, Mallolas J, Gatell JM, de Lazzari E, Martínez E. Subclinical cardiovascular disease in patients starting contemporary protease inhibitors. HIV Med 2018; 19:497-503. [PMID: 29745457 DOI: 10.1111/hiv.12619] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aim of the study was to assess changes in and factors associated with anatomical [carotid artery intima-media thickness (CIMT)] and functional (arterial stiffness) markers of subclinical cardiovascular disease progression in antiretroviral-naïve patients starting triple combination antiretroviral therapy containing contemporary protease inhibitors. METHODS This was a planned substudy of the ATADAR (Metabolic Effects of Atazanavir/Ritonavir Versus Darunavir/Ritonavir in Combination With Tenofovir/Emtricitabine in naïve HIV-1 Infected Patients) clinical trial (ClinicalTrials.gov identifier NCT01274780). ATADAR is a multicentre, randomized, open-label clinical trial comparing the effects of ritonavir-boosted atazanavir and darunavir, both with tenofovir/emtricitabine, in antiretroviral-naïve HIV-infected patients. Common CIMT and aortic augmentation index (AIx@75) were measured at baseline and after 12 months of follow-up. Antiretroviral treatment, traditional cardiovascular risk factors and HIV-related factors were assessed as potential predictors of CIMT and Aix@75 changes using linear regression analysis. RESULTS Thirty-three patients were included in this pilot study. While CIMT significantly increased in the pooled population [median (interquartile range (IQR)) 68 (-13, 128) μm; P = 0.0511], AIx@75 did not [median (IQR) 1 (-6, 5)%; P = 0.8964]. Patients on darunavir showed a trend to faster CIMT progression than those on atazanavir [median change (IQR) 117 (-2, 143) vs. -6 (-58, 89) μm, respectively; P = 0.0917]. However, after adjustment in the multivariate analysis, a higher baseline Framingham score was the only factor associated with CIMT progression (coefficient 16.02; 95% confidence interval -1.04, 33.08; P = 0.064). AIx@75 change was not associated with any baseline factor. CONCLUSIONS CIMT was a more sensitive marker of subclinical vascular disease progression than arterial stiffness in antiretroviral-naïve patients starting antiretroviral therapy with contemporary protease inhibitors. Classical risk factors but not antiretroviral therapy were associated with faster CIMT progression.
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Affiliation(s)
- A González-Cordón
- Infectious Diseases Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - M Doménech
- Cardiovascular, Nutrition and Aging Group, Hypertension and Vascular Risk Unit, Department of Internal Medicine, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - M Camafort
- Hypertension and Vascular Risk Unit, Department of Internal Medicine, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain
- CIBEROBN, Instituto de Salud Carlos III, Madrid, Spain
| | - M Martínez-Rebollar
- Infectious Diseases Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - B Torres
- Infectious Diseases Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - M Laguno
- Infectious Diseases Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - J Rojas
- Infectious Diseases Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - M Loncà
- Infectious Diseases Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - J L Blanco
- Infectious Diseases Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - J Mallolas
- Infectious Diseases Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - J M Gatell
- Infectious Diseases Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - E de Lazzari
- Infectious Diseases Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - E Martínez
- Infectious Diseases Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain
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Camon S, Quiros C, Saubi N, Moreno A, Marcos MA, Eto Y, Rofael S, Monclus E, Brown J, McHugh TD, Mallolas J, Perello R. Full blood count values as a predictor of poor outcome of pneumonia among HIV-infected patients. BMC Infect Dis 2018; 18:189. [PMID: 29673334 PMCID: PMC5909258 DOI: 10.1186/s12879-018-3090-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 04/10/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND To evaluate the predictive value of analytical markers of full blood count that can be assessed in the emergency department for HIV infected patients, with community-acquired pneumonia (CAP). METHODS Prospective 3-year study including all HIV-infected patients that went to our emergency department with respiratory clinical infection, more than 24-h earlier they were diagnosed with CAP and required admission. We assessed the different values of the first blood count performed on the patient as follows; total white blood cells (WBC), neutrophils, lymphocytes (LYM), basophils, eosinophils (EOS), red blood cells (RBC), hemoglobin, hematocrit, mean corpuscular volume, mean corpuscular hemoglobin concentration, mean corpuscular hemoglobin, red blood cell distribution width (RDW), platelets (PLT), mean platelet volume, and platelet distribution width (PDW). The primary outcome measure was 30-day mortality and the secondary, admission to an intensive care unit (ICU). The predictive power of the variables was determined by statistical calculation. RESULTS One hundred sixty HIV-infected patients with pneumonia were identified. The mean age was 42 (11) years, 99 (62%) were male, 79 (49%) had ART. The main route of HIV transmission was through parenteral administration of drugs. Streptococcus pneumonia was the most frequently identified etiologic agent of CAP The univariate analysis showed that the values of PLT (p < 0.009), EOS (p < 0.033), RDW (p < 0.033) and PDW (p < 0.09) were predictor of mortality, but after the logistic regression analysis, no variable was shown as an independent predictor of mortality. On the other hand, higher RDW (OR = 1.2, 95% CI 1.1-1.4, p = 0.013) and a lower number of LYM (OR 2.2, 95% CI 1.1-2.2; p = 0.035) were revealed as independent predictors of admission to ICU. CONCLUSION Red blood cell distribution and lymphocytes were the most useful predictors of disease severity identifying HIV infected patients with CAP who required ICU admission.
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Affiliation(s)
- S. Camon
- Servicio de Urgencias, Hospital Clínic, Barcelona, Spain
| | - C. Quiros
- Servicio de Urgencias, Hospital Clínic, Barcelona, Spain
| | - N. Saubi
- Servicio de Enfermedades Infecciosas, Hospital Clínic, Barcelona, Spain
| | - A. Moreno
- Servicio de Enfermedades Infecciosas, Hospital Clínic, Barcelona, Spain
| | - M. A. Marcos
- Servicio de Microbiología, Hospital Clínic, Barcelona, Spain
| | - Y. Eto
- Servicio de Enfermedades Infecciosas, Hospital Clínic, Barcelona, Spain
| | - S. Rofael
- Microbiology department, UCL, Royal Free Hospital, London, UK
| | - E. Monclus
- Servicio de Urgencias, Hospital Clínic, Barcelona, Spain
| | - J. Brown
- Pneumology department, Royal Free Hospital, London, UK
| | - T. D. McHugh
- Pneumology department, Royal Free Hospital, London, UK
| | - J. Mallolas
- Servicio de Enfermedades Infecciosas, Hospital Clínic, Barcelona, Spain
| | - R. Perello
- Servicio de Urgencias, Hospital Clínic, Barcelona, Spain
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Nicolás D, Esteve A, Cuadros A, Campbell CNJ, Tural C, Podzamczer D, Murillas J, Homar F, Segura F, Force L, Vilaró J, Masabeu À, Garcia I, Mercadal J, Montoliu A, Ferrer E, Riera M, Cifuentes C, Ambrosioni J, Navarro G, Manzardo C, Clotet B, Gatell JM, Casabona J, Miró JM, Murillas J, Manzardo C, Masabeu A, Mercadal J, Cifuentes C, Dalmau D, Domingo P, Falcó V, Curran A, Agustí C, Montoliu A, Pérez I, Curto J, Gargoulas F, Gómez A, Rubia JC, Zamora L, Blanco JL, Garcia-Alcaide F, Martínez E, Mallolas J, Llibre JM, Sirera G, Romeu J, Jou A, Negredo E, Saumoy M, Imaz A, Bolao F, Cabellos C, Peña C, DiYacovo S, Van Den Eynde E, Sala M, Cervantes M, Amengual MJ, Navarro M, Segura V, Barrufet P, Molina J, Alvaro M, Payeras T, Gracia Mateo M, Fernández J. Safe Reduction in CD4 Cell Count Monitoring in Stable, Virally Suppressed Patients With HIV Infection or HIV/Hepatitis C Virus Coinfection. Clin Infect Dis 2016; 62:1578-1585. [PMID: 27126346 DOI: 10.1093/cid/ciw157] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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: 11/13/2015] [Accepted: 03/09/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND It has been suggested that routine CD4 cell count monitoring in human immunodeficiency virus (HIV)-monoinfected patients with suppressed viral loads and CD4 cell counts >300 cell/μL could be reduced to annual. HIV/hepatitis C virus (HCV) coinfection is frequent, but evidence supporting similar reductions in CD4 cell count monitoring is lacking for this population. We determined whether CD4 cell count monitoring could be reduced in monoinfected and coinfected patients by estimating the probability of maintaining CD4 cell counts ≥200 cells/µL during continuous HIV suppression. METHODS The PISCIS Cohort study included data from 14 539 patients aged ≥16 years from 10 hospitals in Catalonia and 2 in the Balearic Islands (Spain) since January 1998. All patients who had at least one period of 6 months of continuous HIV suppression were included in this analysis. Cumulative probabilities with 95% confidence intervals were calculated using the Kaplan-Meier estimator stratified by the initial CD4 cell count at the period of continuous suppression initiation. RESULTS A total of 8695 patients were included. CD4 cell counts fell to <200 cells/µL in 7.4% patients, and the proportion was lower in patients with an initial count >350 cells/µL (1.8%) and higher in those with an initial count of 200-249 cells/µL (23.1%). CD4 cell counts fell to <200 cells/µL in 5.7% of monoinfected and 11.1% of coinfected patients. Of monoinfected patients with an initial CD4 cell count of 300-349 cells/µL, 95.6% maintained counts ≥200 cells/µL. In the coinfected group with the same initial count, this rate was lower, but 97.6% of coinfected patients with initial counts >350 cells/µL maintained counts ≥200 cells/µL. CONCLUSIONS From our data, it can be inferred that CD4 cell count monitoring can be safely performed annually in HIV-monoinfected patients with CD4 cell counts >300 cells/µL and HIV/HCV-coinfected patients with counts >350 cells/µL.
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Affiliation(s)
- David Nicolás
- Hospital Clinic-Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona
| | - Anna Esteve
- Centre for Epidemiological Studies on HIV/STI in Catalonia - ASPC, CIBER Epidemiologia y Salud Publica
| | | | - Colin N J Campbell
- Centre for Epidemiological Studies on HIV/STI in Catalonia - ASPC, CIBER Epidemiologia y Salud Publica
| | - Cristina Tural
- Fundació Lluita Contra la Sida, Fundacio Irsicaixa, Hospital Universitari Germans Trias i Pujol
| | - Daniel Podzamczer
- Hospital Universitari de Bellvitge-Bellvitge Institute for Biomedical Research, Hospitalet de Llobregat
| | | | | | - Ferrán Segura
- Corporació Sanitària i Universitària Parc Taulí, Universitat Autónoma de Barcelona
| | | | | | | | | | | | - Alexandra Montoliu
- Centre for Epidemiological Studies on HIV/STI in Catalonia - ASPC, CIBER Epidemiologia y Salud Publica
| | - Elena Ferrer
- Hospital Universitari de Bellvitge-Bellvitge Institute for Biomedical Research, Hospitalet de Llobregat
| | | | | | - Juan Ambrosioni
- Hospital Clinic-Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona
| | - Gemma Navarro
- Corporació Sanitària i Universitària Parc Taulí, Universitat Autónoma de Barcelona
| | - Christian Manzardo
- Hospital Clinic-Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona
| | - Bonaventura Clotet
- Hospital Universitari de Bellvitge-Bellvitge Institute for Biomedical Research, Hospitalet de Llobregat
| | - Josep M Gatell
- Hospital Clinic-Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona
| | - Jordi Casabona
- Centre for Epidemiological Studies on HIV/STI in Catalonia - ASPC, CIBER Epidemiologia y Salud Publica
| | - José M Miró
- Hospital Clinic-Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona
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Crespo M, Navarro J, Martinez-Rebollar M, Podzamczer D, Domingo P, Mallolas J, Saumoy M, Mateo GM, Curran A, Gatell J, Ribera E. Improvement of BMD after Switching from Lopinavir/R Plus Two Nucleos(T)ide Reverse Transcriptase Inhibitors to Lopinavir/R Plus Lamivudine: OLE-LIP Substudy. HIV Clin Trials 2016; 17:89-95. [PMID: 27125363 DOI: 10.1080/15284336.2016.1149929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To compare 48-week changes in bone mineral density (BMD) and body fat distribution between patients continuing lopinavir/ritonavir and two NRTIs and those switching to lopinavir/ritonavir and lamivudine. METHODS Substudy of a randomized, open-label, multicenter OLE study was carried out. Adult HIV-infected patients with <50 copies/mL for ≥6 months were randomized (1:1) to continue lopinavir/ritonavir and two NRTIs or switching to lopinavir/ritonavir and lamivudine. Dual-energy X-ray absorptiometry (DXA) was performed at baseline and after 48 weeks to measure bone composition and body fat distribution in both the groups. RESULTS Forty-one patients (dual-therapy, n = 23; triple-therapy, n = 18) of 239, who received at least one dose of study medication, completed the study: median age, 42 years, 71% male, 73% Caucasian. At week 48, total BMD increased by 1.04% (95% CI, 0.06 to 2.01%) among patients switching to dual-therapy, whereas no significant changes occurred in patients maintaining triple-therapy. Dual-therapy and older age were independently associated with total BMD increase. Among patients discontinuing tenofovir-DF, a significant increase was seen in total BMD (1.43; 95% CI, -0.04 to 2.91) and total hip (1.33%; 95% CI, 0.44 to 2.22%). A non-statistically significant decrease in femoral and spinal BMD was observed in patients who discontinued abacavir and in those continuing triple-therapy. Regarding fat distribution, no significant changes were seen in both the treatment groups. DISCUSSION BMD increased following switching to lopinavir/ritonavir plus lamivudine in HIV-infected patients on suppressive triple-therapy with lopinavir/ritonavir and two NRTIs including tenofovir-DF.
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Affiliation(s)
- M Crespo
- a Hospital Universitari Vall d'Hebrón , Autonomous University of Barcelona , Barcelona , Spain.,b Vall d'Hebron Research Institute , Barcelona , Spain
| | - J Navarro
- a Hospital Universitari Vall d'Hebrón , Autonomous University of Barcelona , Barcelona , Spain.,b Vall d'Hebron Research Institute , Barcelona , Spain
| | | | - D Podzamczer
- d Hospital Universitario de Bellvitge , Barcelona , Spain
| | - P Domingo
- e Hospital de la Santa Creu i Sant Pau , Barcelona , Spain
| | - J Mallolas
- c Hospital Clínic/IDIBAPS , University of Barcelona , Barcelona , Spain
| | - M Saumoy
- d Hospital Universitario de Bellvitge , Barcelona , Spain
| | - G M Mateo
- e Hospital de la Santa Creu i Sant Pau , Barcelona , Spain
| | - A Curran
- a Hospital Universitari Vall d'Hebrón , Autonomous University of Barcelona , Barcelona , Spain
| | - J Gatell
- c Hospital Clínic/IDIBAPS , University of Barcelona , Barcelona , Spain
| | - E Ribera
- a Hospital Universitari Vall d'Hebrón , Autonomous University of Barcelona , Barcelona , Spain
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Mallolas J, Gatell JM, Miró JM, Marco F, Bisbe J, Jiménez de Anta MT, Soriano E. Analysis of prognostic factors in 274 consecutive episodes of Pseudomonas aeruginosa bacteremia. Antibiot Chemother (1971) 2015; 44:106-14. [PMID: 1801628 DOI: 10.1159/000420305] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- J Mallolas
- Infectious Diseases, Unit Hospital Clinic, Faculty of Medicine, Barcelona, Spain
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Berenguer J, Zamora FX, Aldámiz-Echevarría T, Von Wichmann MA, Crespo M, López-Aldeguer J, Carrero A, Montes M, Quereda C, Téllez MJ, Galindo MJ, Sanz J, Santos I, Guardiola JM, Barros C, Ortega E, Pulido F, Rubio R, Mallolas J, Tural C, Jusdado JJ, Pérez G, Díez C, Álvarez-Pellicer J, Esteban H, Bellón JM, González-García J, Miralles P, Cosín J, López J, Padilla B, Parras F, Carrero A, Aldamiz-Echevarría T, Tejerina F, Gutiérrez I, Ramírez M, Carretero S, Bellón J, Berenguer J, Alvarez-Pellicer J, Rodríguez E, Arribas J, Montes M, Bernardino I, Pascual J, Zamora F, Peña J, Arnalich F, Díaz M, González-García J, Bustinduy M, Iribarren J, Rodríguez-Arrondo F, Von-Wichmann M, Blanes M, Cuellar S, Lacruz J, Montero M, Salavert M, López-Aldeguer J, Callau P, Miró J, Gatell J, Mallolas J, Ferrer A, Galindo M, Van den Eynde E, Pérez M, Ribera E, Crespo M, Vergas J, Téllez M, Casado J, Dronda F, Moreno A, Pérez-Elías M, Sanfrutos M, Moreno S, Quereda C, Jou A, Tural C, Arranz A, Casas E, de Miguel J, Schroeder S, Sanz J, Condés E, Barros C, Sanz J, Santos I, Hernando A, Rodríguez V, Rubio R, Pulido F, Domingo P, Guardiola J, Ortiz L, Ortega E, Torres R, Cervero M, Jusdado J, Rodríguez-Zapata M, Pérez G, Gaspar G, Barquilla E, Ramírez M, Moyano B, Aznar E, Esteban H. Comparison of the Prognostic Value of Liver Biopsy and FIB-4 Index in Patients Coinfected With HIV and Hepatitis C Virus. Clin Infect Dis 2014; 60:950-8. [DOI: 10.1093/cid/ciu939] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
- Juan Berenguer
- Hospital General Universitario Gregorio Marañón
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM)
| | - Francisco X. Zamora
- Hospital Universitario La Paz
- Instituto de Investigación Sanitaria La Paz (IdiPAZ), Madrid
| | - Teresa Aldámiz-Echevarría
- Hospital General Universitario Gregorio Marañón
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM)
| | | | | | | | - Ana Carrero
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM)
| | - Marisa Montes
- Hospital Universitario La Paz
- Instituto de Investigación Sanitaria La Paz (IdiPAZ), Madrid
| | | | | | | | - José Sanz
- Hospital Universitario Príncipe de Asturias, Alcalá de Henares
| | | | | | | | | | - Federico Pulido
- Hospital Universitario 12 de Octubre
- Instituto de Investigación Hospital 12 de Octubre
(i+12), Madrid
| | - Rafael Rubio
- Hospital Universitario 12 de Octubre
- Instituto de Investigación Hospital 12 de Octubre
(i+12), Madrid
| | | | | | | | | | - Cristina Díez
- Hospital General Universitario Gregorio Marañón
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM)
| | - Julio Álvarez-Pellicer
- Hospital Universitario La Paz
- Instituto de Investigación Sanitaria La Paz (IdiPAZ), Madrid
| | | | - José M. Bellón
- Hospital General Universitario Gregorio Marañón
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM)
| | - Juan González-García
- Hospital Universitario La Paz
- Instituto de Investigación Sanitaria La Paz (IdiPAZ), Madrid
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Camós S, Gubern C, Sobrado M, Rodríguez R, Romera V, Moro M, Lizasoain I, Serena J, Mallolas J, Castellanos M. The high-mobility group I-Y transcription factor is involved in cerebral ischemia and modulates the expression of angiogenic proteins. Neuroscience 2014; 269:112-30. [DOI: 10.1016/j.neuroscience.2014.03.036] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Revised: 03/07/2014] [Accepted: 03/18/2014] [Indexed: 12/24/2022]
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Gubern C, Camós S, Hurtado O, Rodríguez R, Romera VG, Sobrado M, Cañadas R, Moro MA, Lizasoain I, Serena J, Mallolas J, Castellanos M. Characterization of Gcf2/Lrrfip1 in experimental cerebral ischemia and its role as a modulator of Akt, mTOR and β-catenin signaling pathways. Neuroscience 2014; 268:48-65. [PMID: 24637094 DOI: 10.1016/j.neuroscience.2014.02.051] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2013] [Revised: 02/03/2014] [Accepted: 02/27/2014] [Indexed: 01/27/2023]
Abstract
Leucine-rich repeat in Flightless-1 interaction protein 1 (Lrrfip1) is an up-regulated protein after cerebral ischemia whose precise role in the brain both in healthy and ischemic conditions is unclear. Different Lrrfip1 isoforms with distinct roles have been reported in human and mouse species. The present study aimed to analyze the Lrrfip1 transcriptional variants expressed in rat cortex, to characterize their expression patterns and subcellular location after ischemia, and to define their putative role in the brain. Five transcripts were identified and three of them (Lrrfip1, CRA_g and CRA_a' (Fli-I leucine-rich repeat associated protein 1 - Flap-1)) were analyzed by quantitative real-time polymerase chain reaction (qPCR). All the transcripts were up-regulated and showed differential expression patterns after in vivo and in vitro ischemia models. The main isoform, Lrrfip1, was found to be up-regulated from the acute to the late phases of ischemia in the cytoplasm of neurons and astrocytes of the peri-infarct area. This study demonstrates that Lrrfip1 activates β-catenin, Akt, and mammalian target of rapamycin (mTOR) proteins in astrocytes and positively regulates the expression of the excitatory amino acid transporter subtype 2 (GLT-1). Our findings point to Lrrfip1 as a key brain protein that regulates pro-survival pathways and proteins and encourages further studies to elucidate its role in cerebral ischemia as a potential target to prevent brain damage and promote functional recovery after stroke.
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Affiliation(s)
- C Gubern
- Grup de Recerca Cerebrovascular, Servei de Neurologia, Institut d'Investigació Biomèdica de Girona (IdIBGi) Dr. Josep Trueta, Hospital Universitari de Girona Dr. Josep Trueta, Avenida de França s/n, 17007 Girona, Spain.
| | - S Camós
- Grup de Recerca Cerebrovascular, Servei de Neurologia, Institut d'Investigació Biomèdica de Girona (IdIBGi) Dr. Josep Trueta, Hospital Universitari de Girona Dr. Josep Trueta, Avenida de França s/n, 17007 Girona, Spain
| | - O Hurtado
- Unidad de Investigación Neurovascular, Departamento de Farmacología, Facultad de Medicina, Universidad Complutense, Avenida Complutense s/n, 28040 Madrid, Spain
| | - R Rodríguez
- Grup de Recerca Cerebrovascular, Servei de Neurologia, Institut d'Investigació Biomèdica de Girona (IdIBGi) Dr. Josep Trueta, Hospital Universitari de Girona Dr. Josep Trueta, Avenida de França s/n, 17007 Girona, Spain
| | - V G Romera
- Unidad de Investigación Neurovascular, Departamento de Farmacología, Facultad de Medicina, Universidad Complutense, Avenida Complutense s/n, 28040 Madrid, Spain
| | - M Sobrado
- Unidad de Investigación Neurovascular, Departamento de Farmacología, Facultad de Medicina, Universidad Complutense, Avenida Complutense s/n, 28040 Madrid, Spain
| | - R Cañadas
- Unidad de Investigación Neurovascular, Departamento de Farmacología, Facultad de Medicina, Universidad Complutense, Avenida Complutense s/n, 28040 Madrid, Spain
| | - M A Moro
- Unidad de Investigación Neurovascular, Departamento de Farmacología, Facultad de Medicina, Universidad Complutense, Avenida Complutense s/n, 28040 Madrid, Spain
| | - I Lizasoain
- Unidad de Investigación Neurovascular, Departamento de Farmacología, Facultad de Medicina, Universidad Complutense, Avenida Complutense s/n, 28040 Madrid, Spain
| | - J Serena
- Grup de Recerca Cerebrovascular, Servei de Neurologia, Institut d'Investigació Biomèdica de Girona (IdIBGi) Dr. Josep Trueta, Hospital Universitari de Girona Dr. Josep Trueta, Avenida de França s/n, 17007 Girona, Spain
| | - J Mallolas
- Grup de Recerca Cerebrovascular, Servei de Neurologia, Institut d'Investigació Biomèdica de Girona (IdIBGi) Dr. Josep Trueta, Hospital Universitari de Girona Dr. Josep Trueta, Avenida de França s/n, 17007 Girona, Spain.
| | - M Castellanos
- Grup de Recerca Cerebrovascular, Servei de Neurologia, Institut d'Investigació Biomèdica de Girona (IdIBGi) Dr. Josep Trueta, Hospital Universitari de Girona Dr. Josep Trueta, Avenida de França s/n, 17007 Girona, Spain
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Lopez-Aldeguer J, Antela A, Mallolas J, Caloto MT, Montanyà I. CP-022 Cost-efficacy model of the introduction of emtricitabine/rilpivirine/tenofovir vs. the combination of tenofovir/emtricitabine + generic efavirenz in Spanish clinical practice. Eur J Hosp Pharm 2014. [DOI: 10.1136/ejhpharm-2013-000436.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Cobos-Trigueros N, Rinaudo M, Solé M, Castro P, Pumarol J, Hernández C, Fernández S, Nicolás JM, Mallolas J, Vila J, Morata L, Gatell JM, Soriano A, Mensa J, Martínez JA. Acquisition of resistant microorganisms and infections in HIV-infected patients admitted to the ICU. Eur J Clin Microbiol Infect Dis 2013; 33:611-20. [DOI: 10.1007/s10096-013-1995-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2013] [Accepted: 10/07/2013] [Indexed: 11/29/2022]
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Podzamczer D, Tiraboschi JM, Mallolas J, Curto J, Cárdenes MA, Casas E, Castro A, Echevarría S, Leal M, Lopez Bernaldo de Quirós JC, Moreno S, Puig T, Ribera E, Villalonga C, Gómez-Sirvent JL, García-Henarejos JA, Lopez-Aldeguer J, Barrufet P, Force L, Santos I, Sanz J. Long-term benefits of nevirapine-containing regimens: multicenter study with 506 patients, followed-up a median of 9 years. Curr HIV Res 2012; 10:513-20. [PMID: 22716109 DOI: 10.2174/157016212802429820] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Revised: 04/29/2012] [Accepted: 06/11/2012] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate long-term outcomes in patients maintaining a nevirapine (NVP)-based regimen. METHODS Retrospective, multicenter, cohort study including patients currently receiving an NVP regimen that had been started at least 5 years previously. Demographic, clinical, and analytical variables were recorded. RESULTS Median follow-up was 8.9 (5.7-11.3) years. Baseline characteristics: 74% men, 47 years old, 36% drug users, 40% AIDS, 40% HCV+, 51.4% detectable HIV-1 viral load, CD4 count 395 (4-1,421)/μL, 19% CD4 < 200/μL, 27% ALT grade 1-2, 36% AST grade 1-2. Thirty percent ART-naive, 83%received NVP associated with 2 nucleoside analogues during the study period, and 17% a protease inhibitor. A significant improvement was observed in general health status markers, including hemoglobin, platelets, and albumin, regardless of HCV coinfection. CD4 cell gain was +218 and +322/μL after 6 and 9 years, respectively (+321 and +391 in naive patients). Triglycerides significantly decreased in pretreated patients, whereas the percentage of patients with HDLc < 1.03 mmol/L and LDL-c > 3.37 mmol/L significantly decreased in a subsample with available values. A significant decrease in transaminases, alkaline phosphatase, and Fib4 score was observed, mainly in HCV+ and ARV-naive patients. CONCLUSIONS In patients who tolerate NVP therapy, (even those with HCV coinfection), long term benefits may be significant in terms of a progressive improvement in general health status markers and CD4 response, a favorable lipid profile, and good liver tolerability.
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Affiliation(s)
- D Podzamczer
- HIV Unit, Infectious Disease Service, Hospital Universitari de Bellvitge, c/Feixa Llarga s/n. L'Hospitalet de Llobregat, 08907 Barcelona, Spain.
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Calvo-Sánchez M, Perelló R, Pérez I, Mateo MG, Junyent M, Laguno M, Blanco JL, Martínez-Rebollar M, Sánchez M, Mallolas J, Gatell JM, Domingo P, Martínez E. Differences between HIV-infected and uninfected adults in the contributions of smoking, diabetes and hypertension to acute coronary syndrome: two parallel case-control studies. HIV Med 2012; 14:40-8. [PMID: 23088307 DOI: 10.1111/j.1468-1293.2012.01057.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2012] [Indexed: 01/19/2023]
Abstract
OBJECTIVES The aim of the study was to assess the separate contributions of smoking, diabetes and hypertension to acute coronary syndrome (ACS) in HIV-infected adults relative to uninfected adults. METHODS Two parallel case-control studies were carried out. In the first study, HIV-positive adults diagnosed with ACS between 1997 and 2009 (HIV+/ACS) were matched for age, gender and known duration of HIV infection with HIV-positive adults without ACS (HIV+/noACS), each individual in the HIV+/ACS group being matched with three individuals in the HIV+/noACS group. In the second study, each individual in the HIV+/ACS group in the first study was matched for age, gender and calendar date of ACS diagnosis with three HIV-negative individuals diagnosed with ACS between 1997 and 2009 (HIV-/ACS). Each individual in the HIV-/ACS group was then matched for age and gender with an HIV-negative adult without ACS (HIV-/noACS). After matching, the ratio of numbers of individuals in the HIV+/ACS, HIV+/noACS, HIV-/ACS and HIV-/noACS groups was therefore 1 : 3 : 3 : 3, respectively. We performed logistic regression analyses to identify risk factors for ACS in each case-control study and calculated population attributable risks (PARs) for smoking, diabetes and hypertension in HIV-positive and HIV-negative individuals. RESULTS There were 57 subjects in the HIV+/ACS group, 173 in the HIV+/noACS group, 168 in the HIV-/ACS group, and 171 in the HIV-/noACS group. Independent risk factors for ACS were smoking [odds ratio (OR) 4.091; 95% confidence interval (CI) 2.086-8.438; P < 0.0001] and a family history of cardiovascular disease (OR 7.676; 95% CI 1.976-32.168; P = 0.0003) in HIV-positive subjects, and smoking (OR 4.310; 95% CI 2.425-7.853; P < 0.0001), diabetes (OR 5.778; 95% CI 2.393-15.422; P = 0.0002) and hypertension (OR 6.589; 95% CI 3.554-12.700; P < 0.0001) in HIV-negative subjects. PARs for smoking, diabetes and hypertension were 54.35 and 30.58, 6.57 and 17.24, and 9.07 and 38.81% in HIV-positive and HIV-negative individuals, respectively. CONCLUSIONS The contribution of smoking to ACS in HIV-positive adults was generally greater than the contributions of diabetes and hypertension, and was almost twice as high as that in HIV-negative adults. Development of effective smoking cessation strategies should be prioritized to prevent cardiovascular disease in HIV-positive adults.
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Affiliation(s)
- M Calvo-Sánchez
- Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain.
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Perelló R, Calvo M, Miró O, Castañeda M, Saubí N, Camón S, Foix A, Gatell JM, Masotti M, Mallolas J, Sánchez M, Martinez E. Clinical presentation of acute coronary syndrome in HIV infected adults: a retrospective analysis of a prospectively collected cohort. Eur J Intern Med 2011; 22:485-8. [PMID: 21925057 DOI: 10.1016/j.ejim.2011.02.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2010] [Revised: 02/06/2011] [Accepted: 02/21/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To compare clinical presentation and short-term prognosis of acute coronary syndrome (ACS) in HIV-infected and uninfected adults. DESIGN Retrospective analysis of a prospectively collected cohort. METHODS HIV-infected patients with myocardial infarction or unstable angina were identified by clinical history and specific characteristics of HIV infection were consecutively registered. Surviving patients were followed for at least one month after discharge. Risk factors for cardiovascular disease, clinical symptoms at admission, type of ACS, delivery of care, and factors associated with prognosis were compared between HIV-infected and uninfected adults. RESULTS Among 627 patients included, 44 (7%) were HIV-infected patients. HIV-infected patients were younger, more frequently men, and had higher prevalence of cardiovascular risk factors than uninfected patients. HIV-infected patients persisted frequently with less pain at Emergency Department (ED) (34% vs 82%, P<0.001) and complained of dyspnea (2% vs 15%, P<0.05) persisted in respect to HIV-uninfected patients. ST-elevation myocardial infarction was the most frequent ACS in HIV-infected patients (59% vs 24%) whereas non-ST-elevation myocardial infarction (23% vs 38%) and unstable angina (18% vs 38%) were the predominant ones in uninfected patients (P<0.001). Catheterism was performed more commonly in HIV-infected patients (75% vs 62%, P<0.01) and similarly admitted in the coronary care unit (38% vs 41%, P=0.81). The evolution was similar in both groups. When HIV-infected patients were matched by age and sex with a subgroup of 88 HIV-uninfected patients, most of the differences disappeared. CONCLUSIONS HIV-infected adults presenting with ACS are younger and have fewer symptoms than uninfected. Despite having a more established disease, short-term prognosis is similar.
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Affiliation(s)
- R Perelló
- Emergency Department, Barcelona, Spain.
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Berenguer J, von Wichmann MA, Quereda C, Miralles P, Mallolas J, Lopez-Aldeguer J, Alvarez-Pellicer J, De Miguel J, Crespo M, Guardiola JM, Tellez MJ, Galindo MJ, Arponen S, Barquilla E, Bellon JM, Gonzalez-Garcia J, Miralles P, Cosin J, Lopez JC, Padilla B, Sanchez Conde M, Bellon JM, Gutierrez I, Ramirez M, Carretero S, Aldamiz-Echevarria T, Tejerina F, Berenguer J, Alvarez-Pellicer J, Rodriguez E, Arribas JR, Montes ML, Bernardino I, Pascual JF, Zamora F, Pena JM, Arnalich F, Gonzalez-Garcia J, Bustinduy MJ, Iribarren JA, Rodriguez-Arrondo F, Von-Wichmann MA, Blanes M, Cuellar S, Lacruz J, Montero M, Salavert M, Lopez-Aldeguer J, Callau P, Miro JM, Gatell JM, Mallolas J, Ferrer A, Galindo MJ, Van den Eynde E, Perez M, Ribera E, Crespo M, Vergas J, Tellez MJ, Casado JL, Dronda F, Moreno A, Perez-Elias MJ, Sanfrutos MA, Moreno S, Quereda C, Jou A, Tural C, Arranz A, Casas E, de Miguel J, Schroeder S, Sanz J, Condes E, Barros C, Sanz J, Santos I, Hernando A, Rodriguez V, Rubio R, Pulido F, Domingo P, Guardiola JM, Ortiz L, Ortega E, Torres L:R, Cervero M, Jusdado JJ, Montes ML, Perez G, Gaspar G, Barquilla E, Mahillo B, Moyano B, Cotarelo M, Aznar E, Esteban H. Effect of accompanying antiretroviral drugs on virological response to pegylated interferon and ribavirin in patients co-infected with HIV and hepatitis C virus. J Antimicrob Chemother 2011; 66:2843-9. [DOI: 10.1093/jac/dkr362] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Lejeune M, Miro JM, De Lazzari E, Garcia F, Claramonte X, Martinez E, Ribera E, Arrizabalaga J, Arribas JR, Domingo P, Ferrer E, Plana M, Valls ME, Podzamczer D, Pumarola T, Jacquet A, Mallolas J, Gatell JM, Gallart T. Restoration of T Cell Responses to Toxoplasma gondii after Successful Combined Antiretroviral Therapy in Patients with AIDS with Previous Toxoplasmic Encephalitis. Clin Infect Dis 2011; 52:662-70. [DOI: 10.1093/cid/ciq197] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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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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Oyagüez I, Casado MA, Cotarelo M, Ramírez-Arellano A, Mallolas J. Fe de errores de«Impacto presupuestario de una combinación a dosis fija de efavirenz-emtricitabina-tenofovir para tratamiento de pacientes infectados por el virus de la inmunodeficiencia humana tipo 1». Farm Hosp 2010; 34:S1130-6343(10)00184-4. [PMID: 20696608 DOI: 10.1016/j.farma.2010.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2010] [Accepted: 07/08/2010] [Indexed: 10/19/2022] Open
Affiliation(s)
- I Oyagüez
- Pharmacoeconomics & Outcomes Research Iberia, Madrid, España
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Berenguer J, González-García J, López-Aldeguer J, Von-Wichmann MA, Quereda C, Hernando A, Sanz J, Tural C, Ortega E, Mallolas J, Santos I, Miralles P, Montes ML, Bellón JM, Esteban H. Pegylated interferon {alpha}2a plus ribavirin versus pegylated interferon {alpha}2b plus ribavirin for the treatment of chronic hepatitis C in HIV-infected patients. J Antimicrob Chemother 2009; 63:1256-63. [PMID: 19363085 DOI: 10.1093/jac/dkp106] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES The two currently available types of pegylated interferon (peg-IFN) used to treat hepatitis C have different pharmacokinetic properties. It is unclear how these differences affect response to therapy. We compared the effectiveness and safety of peg-IFN-alpha2a and peg-IFN-alpha2b, both with ribavirin, against chronic hepatitis C virus (HCV) infection in HIV-infected patients. METHODS From the GESIDA HIV/HCV cohort, we analysed patients treated with peg-IFN-alpha2a (n = 315) or peg-IFN-alpha2b (n = 242). The primary endpoint was a sustained virological response (SVR). RESULTS Both groups were well matched in baseline characteristics except for a higher frequency of injection drug users in the peg-IFN-alpha2b group than in the peg-IFN-alpha2a group (85% versus 76%; P = 0.01) and a higher frequency of bridging fibrosis and cirrhosis (F3-F4) in the peg-IFN-alpha2b group than in the peg-IFN-alpha2a group (42% versus 33%; P = 0.04). End-of-treatment response was significantly lower among patients treated with peg-IFN-alpha2b [40% versus 52%; odds ratio (OR), 1.63; 95% confidence interval (95% CI), 1.16-2.29; P < 0.01]. However, no significant differences were found in SVR between patients treated with peg-IFN-alpha2b and those treated with peg-IFN-alpha2a (31% versus 33%; OR, 1.09; 95% CI, 0.75-1.59; P = 0.655). Therapy was interrupted due to adverse events in 33 (14%) patients treated with peg-IFN-alpha2b and 47 (15%) patients treated with peg-IFN-alpha2a. CONCLUSIONS No differences in effectiveness and safety were found between peg-IFN-alpha2b and peg-IFN-alpha2a for the treatment of chronic HCV infection in HIV-infected patients.
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Laguno M, Cifuentes C, Murillas J, Veloso S, Larrousse M, Payeras A, Bonet L, Vidal F, Milinkovic A, Bassa A, Villalonga C, Pérez I, Tural C, Martínez-Rebollar M, Calvo M, Blanco JL, Martínez E, Sánchez-Tapias JM, Gatell JM, Mallolas J. Randomized trial comparing pegylated interferon alpha-2b versus pegylated interferon alpha-2a, both plus ribavirin, to treat chronic hepatitis C in human immunodeficiency virus patients. Hepatology 2009; 49:22-31. [PMID: 19085908 DOI: 10.1002/hep.22598] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
UNLABELLED Although two pegylated interferons (Peg-IFN) are available to treat chronic hepatitis C virus (HCV) infection, no head-to-head comparative studies have been published. We aim to compare the efficacy and safety of PEG IFN alfa-2b (PEG 2b) versus PEG IFN alfa-2a (PEG 2a), plus ribavirin (RBV). A prospective, randomized, multi-center, open-label clinical trial including 182 human immunodeficiency virus (HIV)-hepatitis C virus (HCV) patients naïve for HCV therapy was performed. Patients were assigned to PEG 2b (80-150 mug/week; n = 96) or PEG 2a (180 mug/week; n = 86), plus RBV (800-1200 mg/day) for 48 weeks. The primary endpoint was sustained virological response (SVR: negative HCV-RNA 24 weeks after completion of treatment). At baseline, both groups were well balanced: 73% male; 63% HCV genotype 1 or [corrected] 4; 29% had fibrosis index of 3 or greater. The overall SVR was 44% (42% PEG 2b versus 46% PEG 2a, P = 0.65). Among genotypes 1 or [corrected] 4, SVRs were 28% versus 32% (P = 0.67) and 62% versus 71% (P = 0.6) in genotypes 2 or [corrected] 3 for PEG 2b and PEG 2a, respectively. Early virological response (EVR; >or=2 log reduction from baseline or negative HCV-RNA at week 12) was 70% in the PEG 2b group and 80% in the PEG 2a group (P = 0.13), reaching a positive predictive value of SVR of 64% and a negative predictive value of 100% in both arms. Side effects were present in 96% of patients but led to treatment discontinuation in 10% of patients (8% on PEG 2b and 13% on PEG 2a, P = 0.47). CONCLUSION In patients with HIV, HCV therapy with PEG 2b or PEG 2a plus RBV had no significant differences in efficacy and safety.
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Leon A, Martinez E, Milinkovic A, Mora B, Mallolas J, Blanco JL, Larrousse M, Laguno M, Gallart T, Plana M, Gatell JM, Garcia F. Influence of repeated cycles of structured therapy interruption on the rate of recovery of CD4+ T cells after highly active antiretroviral therapy resumption. J Antimicrob Chemother 2008; 63:184-8. [DOI: 10.1093/jac/dkn461] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Martin M, Del Cacho E, Codina C, Tuset M, De Lazzari E, Mallolas J, Miró JM, Gatell J, Ribas J. Relationship between adherence level, type of the antiretroviral regimen, and plasma HIV type 1 RNA viral load: a prospective cohort study. AIDS Res Hum Retroviruses 2008; 24:1263-8. [PMID: 18834323 DOI: 10.1089/aid.2008.0141] [Citation(s) in RCA: 118] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The relationship between adherence, antiretroviral regimen, and viral load (VL) suppression was assessed through a 1 year prospective follow-up study among 1142 HIV-infected patient. Patients on antiretroviral therapy who attended to the pharmacy during a 6-month period were considered eligible. Those included in the final analysis were patients who had been taking the same antiretroviral therapy for > or =6 months since their inclusion. The cohort included patients taking first line therapy (n = 243) and antiretroviral-experienced patients (n = 899). Naive patients who were included had to have reached undetectable VL at enrollment. Antiretroviral-experienced patients with detectable VL determinations in the previous 6 months were excluded. Adherence was measured by means of announced pill counts and dispensation pharmacy records. Of patients, 58% were taking NNRTI, 31.4% boosted PI, and 10.6% unboosted PI-based regimens. Overall, the relative risk of virologic failure was 9.0 (95% CI 4.0-20.1) in patients with adherence 80-89.9%, 45.6 (95% CI 19.9-104.5) with adherence 70-79.9%, and 77.3 (95% CI 34.2-174.9) with adherence <70%, compared with adherence of > or =90%. The risk of virologic failure in patients with adherence <90% taking unboosted PI was 2.5 times higher than the group taking boosted PI (95% CI 1.2-5.3). There were no statistical differences in patients taking boosted PI and those who were taking NNRTI. Less than 95% of adherence is associated with high virologic success. For patients taking NNRTI- or boosted PI-based regimens with adherence rates of 80%, the failure rate is <10%. These data do not affect the goal of achieving the highest level of adherence possible.
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Affiliation(s)
- M. Martin
- Pharmacy Department, Hospital Clinic, 08036 Barcelona, Spain
| | - E. Del Cacho
- Pharmacy Department, Hospital Clinic, 08036 Barcelona, Spain
| | - C. Codina
- Pharmacy Department, Hospital Clinic, 08036 Barcelona, Spain
| | - M. Tuset
- Pharmacy Department, Hospital Clinic, 08036 Barcelona, Spain
| | - E. De Lazzari
- Epidemiology and Biostatistics Department, Hospital Clinic, 08036 Barcelona, Spain
| | - J. Mallolas
- Infectious Diseases Department, Hospital Clinic, 08036 Barcelona, Spain
| | - J.-M. Miró
- Infectious Diseases Department, Hospital Clinic, 08036 Barcelona, Spain
| | - J.M. Gatell
- Infectious Diseases Department, Hospital Clinic, 08036 Barcelona, Spain
| | - J. Ribas
- Pharmacy Department, Hospital Clinic, 08036 Barcelona, Spain
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De Lazzari E, León A, Arnaiz JA, Martinez E, Knobel H, Negredo E, Clotet B, Montaner J, Storfer S, Asenjo MA, Mallolas J, Miró JM, Gatell JM. Hepatotoxicity of nevirapine in virologically suppressed patients according to gender and CD4 cell counts. HIV Med 2008; 9:221-6. [DOI: 10.1111/j.1468-1293.2008.00552.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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26
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Mallolas J, Podzamczer D, Domingo P, Echeverría P, Ribera E, Gutierrez F, Knobel H, Cosín J, Ferrer E, Arranz JA, Roca V, Pich J, de Lazzari E, Gatell JM. Efficacy and safety of switching from lopinavir/r to atazanavir/r in suppressed patients receiving a LPV/r-containing HAART: ATAZIP 96-week results. J Int AIDS Soc 2008. [DOI: 10.1186/1758-2652-11-s1-p53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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27
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Martínez E, Milinkovic A, Buira E, de Lazzari E, León A, Larrousse M, Loncá M, Laguno M, Blanco JL, Mallolas J, García F, Miró JM, Gatell JM. Incidence and causes of death in HIV-infected persons receiving highly active antiretroviral therapy compared with estimates for the general population of similar age and from the same geographical area. HIV Med 2007; 8:251-8. [PMID: 17461853 DOI: 10.1111/j.1468-1293.2007.00468.x] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.2] [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: 11/26/2022]
Abstract
BACKGROUND Since the introduction of highly active antiretroviral therapy (HAART), the incidence of death in HIV-infected patients has dramatically decreased, and causes of death other than those related to HIV infection have increased, although it is unclear how these parameters compare with those in the age-matched general population living in the same geographical region. METHODS Consecutive HIV-infected adults who were prescribed HAART in our hospital were prospectively followed from January 1997 to December 2004 or until death, loss to follow-up or discontinuation of HAART. Estimations of the annual incidence and causes of death in the general population of similar age in Catalonia per calendar year in the study period were obtained and compared with those in the HIV-infected cohort. RESULTS There were 235 deaths among the 4471 patients on HAART (5%). The incidence of mortality decreased over time in HIV-infected patients (P<0.001; chi(2) test for trend), although it has remained approximately five times higher than that for the age-matched general population. AIDS-related events were the most common cause of death (n=95; 40%), although they significantly decreased over time (P<0.001; chi(2) test for trend), whereas liver diseases (P<0.001; chi(2) test for trend) and non-AIDS-defining infections (P=0.008; chi(2) test for trend) significantly increased over time. Infections in general (33 times higher), liver diseases (11 times higher) and non-Hodgkin lymphoma (5 times higher) were overrepresented as causes of death in the HIV-infected cohort compared with the age-matched general population. CONCLUSIONS Non-AIDS-defining infectious diseases, liver diseases, and non-Hodgkin lymphoma represent specific targets for efforts to further decrease mortality in HIV-infected patients receiving HAART.
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Affiliation(s)
- E Martínez
- Infectious Diseases Unit, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clínic Universitari, Barcelona, Spain.
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Mallolas J, Sarasa M, Nomdedeu M, Soriano A, López-Púa Y, Blanco JL, Martínez E, Gatell JM. Pharmacokinetic interaction between rifampicin and ritonavir-boosted atazanavir in HIV-infected patients. HIV Med 2007; 8:131-4. [PMID: 17352770 DOI: 10.1111/j.1468-1293.2007.00442.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [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: 11/28/2022]
Abstract
BACKGROUND Tuberculosis (TB) is a common opportunistic infection among HIV-infected people, and rifampicin is an important drug for the treatment of TB. However, administration of rifampicin in combination with antiretroviral therapy, particularly protease inhibitors, is difficult because of drug-drug interactions. METHODS We have performed a prospective study in three HIV-infected patients with TB treated with a rifampicin-containing regimen (rifampicin 600 mg per day) and antiretroviral therapy including only nucleoside reverse transcriptase inhibitors (NRTIs) plus atazanavir 300 mg once a day (qd) and ritonavir 100 mg qd, to evaluate whether the inducing effect of rifampicin on the drug-metabolizing enzyme cytochrome P450 (CYP) 3A4 could be overcome by the inhibitory effect of ritonavir. A complete pharmacokinetic evaluation of the steady-state concentrations of atazanavir and ritonavir was performed. RESULTS In all three cases, more than 50% of the time the atazanavir level was below the minimum recommended trough plasma level (150 ng/mL according to current pharmacokinetic guidelines) to inhibit HIV wild-type replication. CONCLUSION These results strongly indicate that the administration of rifampicin with a combination of atazanavir 300 mg qd plus ritonavir 100 mg qd must be avoided because subtherapeutic concentrations of atazanavir are produced.
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Affiliation(s)
- J Mallolas
- Infectious Diseases, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain.
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29
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Mallolas J, Blanco JL, Pich J, Arnaiz JA, Peña JM, Dalmau D, de Lazzari E, Ochoa A, Vidal F, Ribas MA, Segura F, Pedrol E, Flores J, Cruceta A, Varea S, Miró JM, Martínez E, Gatell JM. A randomized trial comparing the efficacy and tolerability of two HAART strategies at two years in antiretroviral naive patients. Rev Clin Esp 2007; 207:427-32. [PMID: 17915162 DOI: 10.1157/13109831] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [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: 11/21/2022]
Abstract
BACKGROUND The use of HAART combining 2 nucleoside analogues reverse transcriptase inhibitors (NRTIs) plus one protease inhibitor (PI) or 2 NRTIs + 1 non-nucleoside reverse transcriptase inhibitor (NNRTI) has shown comparable efficacy. The study was designed to compare long term (2 years) effectiveness of two antiretroviral (ARV) treatment strategies in patients not previously treated: starting with a nelfinavir based HAART switching to nevirapine in case of failure or side effects or the reverse sequence. METHODS This multicenter, randomized, open label clinical trial enrolled ARV-naïve HIV patients with CD4 counts below 500 cells/mm3. They were randomly assigned to start ddI + d4T + nelfinavir (switching to ZDV + 3TC + NEV in case of failure or toxicity) (PI-NEV arm) or ddI + d4T + nevirapine, switching to ZDV + 3TC + NFV in case of failure or toxicity (NEV-PI arm). The primary study endpoint was the Kaplan-Meier estimates of the time to failure after switching to second regimen if necessary (considering failure as two consecutive plasma HIV-1 RNA determinations above 200 copies/mL, death, a new category C event or toxicity leading to treatment discontinuation of the second regimen) after a minimum follow-up of two years. RESULTS A total of 137 patients were evaluable (67 and 70 in the PI-NEV and NEV-PI arms respectively). Baseline characteristics did not differ among groups. Kaplan-Meier estimates of time to failure did not show differences between the two arms neither in the on-treatment (OT) analysis (log rank test, p = 0.81) nor in the intent-to-treat (ITT) analysis (p = 0.58). At 24 months, the estimated proportion of patients free of failure were 72% and 66% respectively in the PI-NEV and NEV-PI arms OT analysis (p = 0.54) and 73% and 64% in the PI-NEV and NEV-PI arms in the ITT analysis (p = 0.49). The difference in the median in CD4+ lymphocyte count at 24 months was not significantly different in the two groups: 393 and 307 CD4 cells/mm3 in the PI-NEV and NEV-PI arms respectively (p = 0.167). The incidence of adverse events (AEs) in the two arms was very similar: 50 (75%) in the PI-NEV and 54 (70%) in the NEV-PI group, as it was for grade 3-4 AEs leading to drug switching. CONCLUSION At two years both treatments strategies (PI-NEV vs NEV-PI) had a high and comparable efficacy and were generally well tolerated.
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Affiliation(s)
- J Mallolas
- Infectious Diseases Service, Hospital Clinic, Barcelona, Spain.
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30
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León A, Martinez E, Sarasa M, López Y, Mallolas J, De Lazzari E, Laguno M, Milincovic A, Blanco JL, Larrousse M, Lonca M, Gatell JM. Impact of steady-state lopinavir plasma levels on plasma lipids and body composition after 24 weeks of lopinavir/ritonavir-containing therapy free of thymidine analogues. J Antimicrob Chemother 2007; 60:824-30. [PMID: 17712031 DOI: 10.1093/jac/dkm285] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [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: 11/13/2022] Open
Abstract
OBJECTIVES To study the impact of lopinavir/ritonavir-containing therapy on plasma lipids and body fat of HIV-infected adults and to assess whether lopinavir plasma levels at steady state are correlated with plasma lipids and body fat after 24 weeks. METHODS Patients had their antiretroviral therapy switched to an antiretroviral regimen containing lopinavir/ritonavir plus one or two non-thymidine analogues. Body composition was assessed by dual energy X-ray absorptiometry at baseline and at week 24 and an intensive pharmacokinetic (PK) 12 h profile was performed at week 2. RESULTS Twenty-six patients were included. Plasma triglycerides (from 206 mg/dL to 261 mg/dL, P = 0.09) and total cholesterol (from 201 to 206 mg/dL, P = 0.03) increased from baseline to week 24. There was a significant rise in total fat (from 10.9 to 11.9 kg, P = 0.02) and limb fat (from 3.8 to 4.4 kg, P = 0.02) from baseline to week 24. We did not find any correlation between PK lopinavir levels and changes over time for triglycerides, cholesterol or body fat composition. CONCLUSIONS There was an increase in plasma triglycerides and total cholesterol levels and a gain in both total and limb fat at 24 weeks, but these changes were not correlated with lopinavir plasma levels.
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Affiliation(s)
- A León
- Infectious Diseases Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain.
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31
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Mallolas J, Blanco J, Labarga P, Vergara A, Ocampo A, Sarasa M, Arnedo M, López-Púa Y, García J, Juega J, Guelar A, Terrón A, Dalmau D, García I, Zárraga M, Martínez E, Carné X, Pumarola T, Escayola R, Gatell J. Inhibitory quotient as a prognostic factor of response to a salvage antiretroviral therapy containing ritonavir-boosted saquinavir. The CIVSA Study. HIV Med 2007; 8:226-33. [PMID: 17461850 DOI: 10.1111/j.1468-1293.2007.00464.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [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: 11/28/2022]
Abstract
BACKGROUND The addition of a low dose of ritonavir to protease inhibitors (PIs) has become a widespread strategy to improve PI pharmacokinetics. As resistance is a major barrier to long-term suppression, in salvage therapy genotype and/or phenotype scoring is currently used to predict the response. We evaluated the relationship between the saquinavir (SQV) inhibitory quotient (IQ) (virtual and genotypic) and virological response. METHODS Eligible patients were on a PI-containing highly active antiretroviral therapy (HAART) regimen excluding SQV and had a viral load >5000 HIV-1 RNA copies/mL. The PI was switched to SQV/ritonavir (RTV) 1000/100 mg twice a day (bid) and the same two backbone nucleoside reverse transcriptase inhibitors (NRTIs) were maintained at least until week 4, when the resistance test results became available. Genotype and virtual phenotype were determined at baseline, while the SQV trough plasma concentration was determined at week 4. RESULTS Fifty-three patients were included in the study. Mean baseline viral load and CD4 count were 137,693 copies/mL and 263 cells/microL, respectively, the mean number of previous PIs was 2.3 and the mean number of protease gene mutations (PGMs) was 4.1. Using an on-treatment analysis, at week 16 the mean increase in CD4 count was 70.9 cells/microL, viral load was <200 copies/mL in 17 out of 37 patients (45.9%), and 30 out of 45 patients (66.7%) were considered virological responders (VRs) (viral load <200 copies/mL or viral load declined > or =1 log(10) at week 16). Median virtual phenotype was 1.3 (0.6-6.9). Baseline differences were detected between VR and non-VR populations: the mean numbers of PGMs were 3.2 and 5.8 (P<0.05), the mean numbers of SQV-associated mutations were 2 and 3.8 (P<0.05), and the mean CD4 counts were 365.9 and 184.3 cells/microL (P<0.05), respectively. Mean SQV trough concentrations at week 4 were 1.1 and 1.0 microg/mL (not significant), and mean virtual IQs were 0.7 and 0.1 (P<0.01), respectively. Multivariate analysis showed that baseline PGMs >5 or SQV-associated mutations>5, virtual phenotype, baseline viral load >50,000 copies/mL, and virtual IQ <0.5, but not genotypic IQ, were the variables independently associated with non-VR. CONCLUSION In heavily pretreated patients, the use of SQV virtual IQ or alternatively virtual phenotype, as well as PGMs, is a useful tool for the prediction of virological response.
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Lizasoain I, Cárdenas A, Hurtado O, Romera C, Mallolas J, Lorenzo P, Castillo J, Moro MA. Targets of cytoprotection in acute ischemic stroke: present and future. Cerebrovasc Dis 2006; 21 Suppl 2:1-8. [PMID: 16651809 DOI: 10.1159/000091698] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [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: 11/19/2022] Open
Abstract
Although the management of stroke has improved remarkably over the last decade due mainly to the advent of thrombolysis, most neuroprotective agents, although successful in animal studies, have failed in humans. Our increasing knowledge concerning the ischemic cascade is leading to a considerable development of pharmacological tools suggesting that each step of this cascade might be a target for cytoprotection. Glutamate has long been recognized to play key roles in the pathophysiology of ischemia. However, although some trials are still ongoing, the results from several completed trials with drugs interfering with the glutamatergic pathway have been disappointing. Regarding the inhibition of glutamate release as a possible target for cytoprotection, it might be afforded either by decreasing glutamate efflux or by increasing glutamate uptake. In this context, it has been shown that glutamate transport is the primary and only mechanism for maintaining extracellular glutamate concentrations below excitotoxic levels. This transport is executed by the five high-affinity, sodium-dependent plasma membrane glutamate transporters. Among them, the transporter EAAT2 is responsible for up to 90% of all glutamate transport. We will discuss the effect of different neuroprotective tools (membrane stabilizers or endogenous neuroprotection) affecting glutamate efflux and/or expression of EAAT2. We will also describe the finding of a novel polymorphism in the EAAT2 promoter region which could be responsible for differences in both gene function and regulation under pathological conditions such as cerebral ischemia, and which might well account for the failure of glutamate antagonists in the clinical practice. These results may possess important therapeutic implications in the management of patients at risk of ischemic events, since it has been demonstrated that those patients with progressing stroke have higher plasma concentrations of glutamate which remain elevated up to 24 h when compared to the levels in patients without neurological deterioration.
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Affiliation(s)
- I Lizasoain
- Departamento de Farmacología, Facultad de Medicina, Universidad Complutense de Madrid, Spain.
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Blanco JL, Biglia A, Martinez E, Sánchez M, de Lazzari E, Leon A, Milinkovic A, Larrousse M, Lonca M, Laguno M, Mallolas J, Gatell JM. Intrathoracic fat in HIV-infected patients. HIV Med 2006; 7:213-7. [PMID: 16630033 DOI: 10.1111/j.1468-1293.2006.00361.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The impact of HIV infection or antiretroviral therapy on the intrathoracic fat compartment is unknown. METHODS Consecutive clinically stable HIV-infected adult patients, irrespective of exposure to antiretroviral therapy, and non-HIV-infected healthy volunteers, both without clinical evidence of body fat changes consistent with lipodystrophy and adjusted for age, gender and body mass index, were recruited for this study. Thoracic and abdominal fat was assessed by computed tomography and compared between patients and controls. RESULTS There were nine women (33%) and 18 men (67%) in each group. Nineteen patients (70%) had been taking antiretrovirals for a median of 8 months (interquartile range: 6-11). Among the HIV-infected patients, intrathoracic fat (median; interquartile range) did not differ significantly between treated (6.7 cm(2); 4.5-8.3 cm(2)) and untreated (6.9 cm(2); 5.7-10.9 cm(2)) individuals (P=0.288). However, intrathoracic fat content (median; interquartile range) was higher in HIV-infected patients (6.8 cm(2); 5.6-10.5 cm(2)) than in controls (5.6 cm(2); 3.9-6.7 cm(2)) (P=0.025). Intrathoracic fat was positively correlated with intra-abdominal fat both in patients (rho=0.6, P=0.002) and in controls (rho=0.7, P=0.004). CONCLUSION In HIV-infected adults without clinical evidence of lipodystrophy, intrathoracic fat content was higher than in healthy persons and positively correlated with intra-abdominal fat content.
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Affiliation(s)
- J L Blanco
- Infectious Diseases Unit, Hospital Clinic-Institut d'Investigaciones Biomediques August Pi i Sunyer, University of Barcelona, Barcelona, Spain.
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Pulido F, Ribera E, Moreno S, Muñoz A, Podzamczer D, del Pozo MA, Rivero A, Rodríguez F, Sanjoaquín I, Teira R, Viciana P, Villalonga C, Antela A, Carmena J, Ena J, Gonzalez E, Kindelán JM, Mallolas J, Márquez M, Martínez E. Once-daily antiretroviral therapy: Spanish Consensus Statement. J Antimicrob Chemother 2005; 56:808-18. [PMID: 16150862 DOI: 10.1093/jac/dki320] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [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: 11/13/2022] Open
Abstract
BACKGROUND Administration of antiretroviral therapy (ART) once daily is creating extraordinary interest among the members of the scientific community and also among those who receive the therapy. However, in clinical practice, some doubts remain about its use. OBJECTIVES This document examines the characteristics and possibilities of treatment administered once daily. METHODS Consensus of 248 Spanish experts in the field. RESULTS Once-daily dosing is considered an added value which could favour adherence and, therefore, efficacy, as well as the quality of life of certain patients, however, the objective of adequate adherence in the long term is often difficult to achieve regardless of the treatment used. In theory, any patient can receive once-daily therapy, although some patients could particularly benefit from it, e.g. those with unfavourable social or personal circumstances, including drug users, patients whose treatment must be supervised, patients receiving multiple medications, or those who need rescue therapy after multiple treatment failures. At present, it is possible to design once-daily ART using some of the combinations of drugs considered as first-choice in national and international recommendations for antiretroviral therapy, but the options are still limited. The marketing of new drugs with this characteristic could allow us to increase the number and types of patient who can benefit from once-daily regimens, including those patients who need rescue therapy. CONCLUSIONS Once-daily ART is a good alternative to regimens administered several times each day when a potent combination of active drugs is available.
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Affiliation(s)
- F Pulido
- Hospital Universitario 12 de Octubre, 28041 Madrid, Spain.
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Bäuerle J, Laguno M, Mauss S, Mallolas J, Murillas J, Miquel R, Schmutz G, Setzer B, Gatell JM, Walker UA. Mitochondrial DNA depletion in liver tissue of patients infected with hepatitis C virus: contributing effect of HIV infection? HIV Med 2005; 6:135-9. [PMID: 15807720 DOI: 10.1111/j.1468-1293.2005.00276.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [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: 12/23/2022]
Abstract
OBJECTIVES It has been suggested that chronic hepatitis C virus (HCV) infection depletes mitochondrial DNA (mtDNA) in the liver. Because decreased mtDNA levels were also found in humans infected with HIV, we investigated whether HIV may have aggravated hepatic mtDNA depletion in individuals with HCV infection. METHODS In this cross-sectional study, liver biopsies were performed in a total of 40 individuals prior to any antiviral therapy. The individuals were recruited from the Hospital Clinic, Barcelona and the HIV Centre, Dusseldorf. Seventeen patients were negative for HIV and HCV and were biopsied for liver enzyme elevation of unknown cause (controls), 14 individuals had chronic HCV but no HIV infection, and nine subjects were coinfected with both viruses. mtDNA and liver histology were centrally assessed. RESULTS The groups did not differ with respect to age, gender, liver function tests and HCV viral load, where applicable. mtDNA levels were decreased by 19% in the HCV-monoinfected group (P=0.03) and by 27% in the HIV/HCV-coinfected subjects (P=0.02) compared to controls. The mtDNA content, however, did not differ between individuals with HCV monoinfection and HCV/HIV coinfection (P=0.75). The degrees of liver fibrosis, inflammatory activity or steatosis did not correlate with mtDNA content. CONCLUSIONS Liver mtDNA content is reduced in both HCV-monoinfected and HIV/HCV-coinfected patients. Under the limitations of our study, we could demonstrate only a slight trend towards more pronounced mtDNA depletion in HIV/HCV-coinfected subjects.
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Affiliation(s)
- J Bäuerle
- Department of Clinical Immunology, Medizinische Universitätsklinik, Freiburg, Germany
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Badía X, Podzamczer D, Moral I, Roset M, Arnaiz JA, Loncà M, Casiró A, Rosón B, Gatell JM, Grinberg N, Puentes T, Furst MJL, Julio Méndez S, Lupo S, Suárez C, Agostini M, Cassetti I, Bologna R, Salud H, Cahn P, Patterson P, Krolewiecki A, David DO, Luna N, Cruceta A, Pich J, Varea S, Carné X, Mallolas J, Clotet B, Romeu J, Cruz L, Arrizabalaga J, Iribarren JA, Rodríguez F, Von Wichmann MA, Jimeno B, Pulido F, Rubio R, Flores J, González-Lahoz J, Rodríguez-Rosado R, Núñez M. Health-Related Quality of Life in HIV Patients Switching to Twice-Daily Indinavir/Ritonavir Regimen or Continuing with Three-Times-Daily Indinavir-Based Therapy. Antivir Ther 2004. [DOI: 10.1177/135965350400900615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective To evaluate health-related quality of life (HRQoL) changes in patients treated with indinavir three-times daily after switching to a twice-daily indinavir/ritonavir regimen or continuing with the same regimen. Methods Patients on HAART including indinavir three-times-daily with undetectable viral load were randomly assigned to continue with this therapy or to change to a twice-daily indinavir/ritonavir (800/100 mg) regimen. The Medical Outcomes Study HIV Health Survey (MOS-HIV) questionnaire was used as the HRQoL measure. Results A total of 118 patients participated in the study, of which 59 (50%) were randomly assigned to continue with the three-times-daily regimen. Patients had a mean age of 39 years and 80% of them were male. At baseline, subjects included in the three-times-daily group presented a significantly greater number of symptoms than subjects in the twice-daily group, but no statistically significant differences were observed in MOS-HIV scores between the groups. In the intention-to-treat (ITT) analysis, a reduction in HRQoL scores was observed in both groups, which was greater in the twice-daily group. In the per protocol analysis, reduction of HRQoL was minimal. Conclusions A HRQoL deterioration, greater in the twice-daily group, was observed in this study in the ITT analysis, while HRQoL remained stable in both groups in patients who continued with and tolerated the allocated regimen.
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Affiliation(s)
| | - Xavier Badía
- Department of Clinical Epidemiology and Public Health, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- HO Statistics & Modelling, Health Outcomes Research Group, Barcelona, Spain
| | | | - Irene Moral
- HO Statistics & Modelling, Health Outcomes Research Group, Barcelona, Spain
| | - Montse Roset
- HO Statistics & Modelling, Health Outcomes Research Group, Barcelona, Spain
| | | | | | | | - Beatriz Rosón
- Hospital Universitario de Bellvitge, Barcelona, Spain
| | | | - N Grinberg
- Hospital Alvarez, Buenos Aires, Argentina
| | | | | | | | - S Lupo
- Centro Caici, Rosario, Argentina
| | - C Suárez
- Centro Caici, Rosario, Argentina
| | | | | | | | | | - P Cahn
- Fundación Huésped, Buenos Aires, Argentina
| | | | | | - DO David
- Hospital Rawson, Córdoba, Argentina
| | - N Luna
- Hospital Rawson, Córdoba, Argentina
| | | | - J Pich
- Hospital Clinic, Barcelona, Spain
| | - S Varea
- Hospital Clinic, Barcelona, Spain
| | - X Carné
- Hospital Clinic, Barcelona, Spain
| | | | - B Clotet
- Hospital Germans Trias i Pujol, Badalona, Spain
| | - J Romeu
- Hospital Germans Trias i Pujol, Badalona, Spain
| | - L Cruz
- Hospital Germans Trias i Pujol, Badalona, Spain
| | | | - JA Iribarren
- Hospital Ntra Sra de Aranzazu, San Sebastián, Spain
| | - F Rodríguez
- Hospital Ntra Sra de Aranzazu, San Sebastián, Spain
| | | | - B Jimeno
- Hospital Ntra Sra de Aranzazu, San Sebastián, Spain
| | - F Pulido
- Hospital 12 de Octubre, Madrid, Spain
| | - R Rubio
- Hospital 12 de Octubre, Madrid, Spain
| | - J Flores
- Hospital Arnau de Vilanova, Valencia, Spain
| | | | | | - M Núñez
- Hospital Carlos III, Madrid, Spain
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37
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Soriano V, Miró JM, García-Samaniego J, Torre-Cisneros J, Núñez M, del Romero J, Martín-Carbonero L, Castilla J, Iribarren JA, Quereda C, Santín M, González J, Arribas JR, Santos I, Hernández-Quero J, Ortega E, Asensi V, del Pozo MA, Berenguer J, Tural C, Clotet B, Leal M, Mallolas J, Sánchez-Tapias JM, Moreno S, Gatell JM, Téllez MJ, Rubio R, Ledesma E, Domingo P, Barreiro P, Pedreira J, Romero M, González-Lahoz J, Lissen E. Consensus conference on chronic viral hepatitis and HIV infection: updated Spanish recommendations. J Viral Hepat 2004; 11:2-17. [PMID: 14738553 DOI: 10.1046/j.1365-2893.2003.00491.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Chronic hepatitis B and C represent a leading cause of morbidity and mortality among human immunodeficiency virus (HIV)-infected patients worldwide. New treatment options against both hepatitis B (HBV) and C (HCV) viruses have prompted us to update previous recommendations for the management of coinfected individuals. Fifteen topics (nine related to HCV, five to HBV and one to both viruses) were selected for this purpose. A panel of Spanish experts in the field was invited to review these areas and propose specific recommendations, which were scored according to the Infectious Disease Society of America (IDSA) grading system. These guidelines represent a comprehensive and updated overview on the management of hepatitis B and C in HIV-infected patients.
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Affiliation(s)
- V Soriano
- Service of Infectious Diseases, Hospital Carlos III, Madrid, Spain.
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Rodriguez-Revenga L, Badenas C, Sánchez A, Mallolas J, Carrió A, Pedrinaci S, Barrionuevo JL, Milà M. Cryptic chromosomal rearrangement screening in 30 patients with mental retardation and dysmorphic features. Clin Genet 2003; 65:17-23. [PMID: 15032970 DOI: 10.1111/j..2004.00167.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [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: 11/28/2022]
Abstract
Mental retardation affects 1-3% of the general population, and the genetic causes in many cases are unknown. Cytogenetically undetected chromosomal imbalances have been indicated as an explanation. Nowadays, due to the development of molecular cytogenetic techniques, it is possible to identify cryptic rearrangements involving the ends of chromosomes. We report a screening using chromosome-specific telomere fluorescence in-situ hybridization (FISH) probes, in a group of 30 patients with a well-characterized phenotype including mental retardation, dysmorphic features, and a normal karyotype. Among them, two subtelomeric rearrangements have been detected and characterized. One of them is a de novo deletion of 1p36, which has been previously described as a new contiguous gene syndrome. The second is an unbalanced product of a cryptic translocation involving chromosomes 1 and 13, which results in a partial 1q trisomy and partial 13q monosomy. These findings highlight, the importance of searching for cryptic subtelomeric rearrangements in non-syndromic mentally retarded patients.
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Affiliation(s)
- L Rodriguez-Revenga
- IDIBAPS (Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer), Hospital Clínic, Barcelona, Spain
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Rifé M, Badenas C, Mallolas J, Jiménez L, Cervera R, Maya A, Glover G, Rivera F, Milà M. Incidence of Fragile X in 5,000 Consecutive Newborn Males. ACTA ACUST UNITED AC 2003; 7:339-43. [PMID: 15000813 DOI: 10.1089/109065703322783725] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.2] [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: 11/12/2022]
Abstract
Fragile X syndrome (FXS) is the commonest cause of inherited mental retardation in males. Even though this affirmation is repeated in virtually all papers referring to FXS, the precise frequency of this syndrome in the general population is unknown. We present a general population screening analyzing an anonymous series of 5,000 consecutive newborn males from the neonatal screening program of the population of Catalonia in Spain. The aim of the study is to determine the incidence of FXS via a simple and economical methodology based on the nonamplification of the fragment containing the CGG repeats of the FRAXA locus in the samples carrying alleles over 52 repeats. From the initial 5,000 samples, 4,920 were in the normal range, 15 gave rise to bands with more than 52 repeats (11 corresponded to intermediate alleles and four premutated alleles). After further studies, two samples were considered to be carriers of full mutations. According to these results, the incidence of FXS affected newborn males is 1 in 2,466, and 1 in 1,233 males is a carrier of the premutation. We can deduce that 1 in 8,333 is an affected female with clinical manifestations and 1 in 411 will be a premutation carrier woman. Upon reviewing the literature, there seems to be variability in the frequencies found by the different groups. Therefore, given that our study is limited to the Catalan population in Spain, these results should be taken as valid for the Catalan region and should only be extrapolated to other populations with caution.
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Affiliation(s)
- M Rifé
- Servei de Genètica. Centre de Diagnòstic Biòmedic, Hospital Clínic and IDIBAPS (Institut d'Investigacions Biomèdiques Agustí Pi I Sunyer), Barcelona, Spain
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40
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Katlama C, Gazzard B, Mallolas J, Schürmann D, Moroni M, Demonty N, Antoun Z, Gordon D. Comparison of metabolic abnormalities 48 weeks after switching from highly active antiretroviral therapy containing a non-nucleoside reverse transcriptase inhibitor to Trizivir versus continued highly active antiretroviral therapy. AIDS 2003; 17:1855-6. [PMID: 12891074 DOI: 10.1097/00002030-200308150-00017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Forty patients participating in the TRIZAL study were treated with a non-nucleoside reverse transcriptase inhibitor (NNRTI)-containing regimen before being randomly assigned either to continue their baseline therapy or to switch to a triple nucleoside regimen. No difference was observed in treatment efficacy between the two groups, and total cholesterol was observed to improve significantly in the switch group. Switch maintenance may be an appropriate strategy in patients treated with an NNRTI.
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Affiliation(s)
- C Katlama
- Pitie-Salpetriere Hospital, Paris, France
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41
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Berenguer J, Miralles P, Arrizabalaga J, Ribera E, Dronda F, Baraia-Etxaburu J, Domingo P, Márquez M, Rodriguez-Arrondo FJ, Laguna F, Rubio R, Lacruz Rodrigo J, Mallolas J, de Miguel V. Clinical course and prognostic factors of progressive multifocal leukoencephalopathy in patients treated with highly active antiretroviral therapy. Clin Infect Dis 2003; 36:1047-52. [PMID: 12684918 DOI: 10.1086/374048] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2002] [Accepted: 12/25/2002] [Indexed: 11/03/2022] Open
Abstract
We analyzed survival rates, neurologic function, and prognostic factors for 118 consecutive patients with acquired immunodeficiency syndrome-associated progressive multifocal leukoencephalopathy (PML) treated with highly active antiretroviral therapy (HAART) in 11 hospitals throughout Spain. Seventy-five patients (63.6%) remained alive for a median of 114 weeks (2.2 years) after diagnosis of PML. Neurologic function of the survivors was categorized as cure or improvement in 33, stabilization or worsening in 40, and unknown in 2. The baseline CD4+ cell count was the only variable found with prognostic significance. The odds ratio of death was 2.71 (95% confidence interval, 1.19-6.15) for patients with CD4+ cell counts of <100 cells/microL, compared with patients who had CD4+ cell counts of > or =100 cells/microL. One-third of patients with PML died despite receipt of HAART; neurologic function improved in approximately one-half of the survivors. A CD4+ cell count of <100 cells/microL was associated with higher mortality.
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Affiliation(s)
- Juan Berenguer
- Infectious Diseases Service of Hospital Gregorio Marañón, 28007, Madrid, Spain.
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Katlama C, Fenske S, Gazzard B, Lazzarin A, Clumeck N, Mallolas J, Lafeuillade A, Mamet JP, Beauvais L. TRIZAL study: switching from successful HAART to Trizivir (abacavir-lamivudine-zidovudine combination tablet): 48 weeks efficacy, safety and adherence results. HIV Med 2003; 4:79-86. [PMID: 12702127 DOI: 10.1046/j.1468-1293.2003.00139.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess the antiviral efficacy, safety, and adherence in subjects who switched to Trizivir following long-term HIV-1 RNA suppression. STUDY DESIGN A randomized, open-label, multicentre, 48-week comparative study in subjects who have received two nucleoside reverse transcriptase inhibitors plus a protease inhibitor or an nonnucleoside reverse transcriptase inhibitor or three nucleoside reverse transcriptase inhibitors for at least 6 months, with a history of undetectable plasma HIV-1 RNA since initiation of therapy and plasma viral load of < 50 HIV-1 RNA copies/mL at screening. METHODS Subjects were randomized 1:1 to continue their current treatment or to switch to a simplified treatment with Trizivir administered twice daily. Assessments included plasma HIV-1 RNA, lymphocyte counts, clinical laboratory evaluations, adverse events, and adherence to treatment (obtained via subject self-report). Treatment failure was defined as a plasma viral load of >/= 400 HIV-1 RNA copies/mL on two consecutive occasions or premature discontinuation of randomized treatment. RESULTS At week 48, the proportion of treatment failures in Trizivir arm (23/106, 22%) was noninferior to that observed in continued arm (23/103, 22%) with a treatment difference stratified by prior ART of 1.2%[-10.1; 12.5]. Incidence of adverse events was similar in both treatment groups. The incidence of possible hypersensitivity reaction in the Trizivir trade mark arm was 10%. Significant reductions in cholesterol and triglyceride plasma levels were observed in the Trizivir arm (P < 0.001 and P = 0.006, respectively). CONCLUSION Switching to Trizivir offers a potent and simplified regimen with equivalent efficacy and significant improvement in lipid abnormalities compared to continued triple therapy.
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Affiliation(s)
- C Katlama
- Hôpital Pitié-Sâlpetrière, Paris, France.
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43
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Tortajada C, Pérez-Cuevas B, Moreno A, Martínez E, Mallolas J, García F, Valls E, Miró JM, De Lazzari E, Gatell JM. Highly active antiretroviral therapy (HAART) modifies the incidence and outcome of visceral leishmaniasis in HIV-infected patients. J Acquir Immune Defic Syndr 2002; 30:364-6. [PMID: 12131576 DOI: 10.1097/00126334-200207010-00015] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Rifé M, Mallolas J, Badenas C, Tazón B, Miguélez MR, Pàmpols T, Sànchez A, Milà M. Pilot study for the neonatal screening of fragile X syndrome. Prenat Diagn 2002; 22:459-62. [PMID: 12116303 DOI: 10.1002/pd.346] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [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: 11/07/2022]
Abstract
Fragile X syndrome (SFX) is the commonest form of inherited mental retardation. Due to the highly variable phenotype clinical diagnosis is complicated. In nearly all cases, the disorder is caused by expansion of a CGG-repeat in the 5'-untranslated region of the FMR1 (fragile X mental retardation-1) gene. We have evaluated the feasibility, efficiency and costs of two methodologies in order to develop a simple test to screen large populations: PCR and fragile X mental retardation-1 protein (FMRP) immunodetection. We studied 100 newborn males using PCR and immunodetection (26.91 Euro). All but one amplified the CGG repeat of the FMR1 gene within the normal size range. The sample that failed to amplify showed only 28% of FMRP expression by immunodetection study; both results indicated an affected male. A further 100 males were studied only by polymerase chain reaction (PCR) (7.8 Euro); all of them amplified within the normal size range. Both methodologies, PCR and immunodetection, are feasible for screening large populations, PCR being the most suitable, economical and less time-consuming. However, it is advisable to keep slides for immunodetection when PCR fails or the external control shows no amplification. Early detection of SFX-affected individuals would represent a great benefit for their maximum social integration, due to appropriate treatment and early stimulation and would permit a cascade screening in their pedigree.
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Affiliation(s)
- M Rifé
- Genetics Service, Hospital Clínic, Barcelona, Spain
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45
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Mallolas J, Vilaseca MA, Pavia C, Lambruschini N, Cambra FJ, Campistol J, Gómez D, Carrió A, Estivill X, Milà M. Large de novo deletion in chromosome 12 affecting the PAH, IGF1, ASCL1, and TRA1 genes. J Mol Med (Berl) 2002; 78:721-4. [PMID: 11434725 DOI: 10.1007/s001090000160] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [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: 10/27/2022]
Abstract
Phenylketonuria is one of the most common genetic diseases in humans, affecting 1 in 10,000 whites. Deletions are generally uncommon in genes in which no long highly homologous segments are present, and in phenylalanine hydroxylase (PAH) deficiency they represent only 5% of cases. We present the case of a girl affected by classical phenylketonuria who has been screened for mutations in the PAH gene. During the molecular study a large de novo deletion has detected in 12qter, including PAH, and the genes for insulin-like growth factor 1 (IGF1), human achaete-scute homolog 1 (ASCL1), and tumor rejection antigen (TRA1). The patient showed phenylketonuria, short stature, and pathological electro-oculography results in both eyes, with high affectation of the relative electrogenesis of the photoreceptor-pigment epithelium complex. She had previously been misdiagnosed as homozygous for the IVS8nt-7A-G mutation, instead of heterozygous for a mutation and a de novo deletion. As a result incorrect genetic counseling had been given. The deletion of the PAH, IGF1, and ASCL1 genes could explain the patient's phenotype corresponding to a contiguous gene syndrome. We stress the relevance of polymorphic marker haplotype analysis and the importance of family study in genetic recessive diseases, such as phenylketonuria, to avoid incorrect diagnosis and genetic counseling.
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Affiliation(s)
- J Mallolas
- Servei Genètica, Hospital Clínic, Barcelona, Spain
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46
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Saras-Nacenta M, López-Púa Y, Lípez-Cortés LF, Mallolas J, Gatell JM, Carné X. Determination of efavirenz in human plasma by high-performance liquid chromatography with ultraviolet detection. J Chromatogr B Biomed Sci Appl 2001; 763:53-9. [PMID: 11710583 DOI: 10.1016/s0378-4347(01)00357-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Efavirenz is a non-nucleoside reverse transcriptase inhibitor for the treatment of the HIV infection. A simple, high-performance liquid chromatographic method has been developed and validated for the quantitative determination of efavirenz in human plasma. The method involved solid-phase extraction of the drug and the internal standard (L-737,354) from 300 microl of human plasma. The analysis was via UV detection at 250 nm using a reversed-phase C8 analytical column and a isocratic mobile phase consisting of phosphate buffer (pH 5.75)-acetonitrile that resolved the drug and internal standard from endogenous matrix components and potential coadministered drugs. Within- and between-day precisions were less than 8.6% for all quality control samples. The lower limit of quantification was 0.1 microg/ml. Recovery of efavirenz from human plasma was greater than 83%. This validated assay is being used in pharmacokinetic studies with efavirenz.
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Affiliation(s)
- M Saras-Nacenta
- Clinical Pharmacology Service (UASP, Unitat d'Avaluació, Suport i Prevenció), Hospital Clinic, Barcelona, Spain.
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47
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Milà M, Mallolas J. [Fragile X syndrome: premature ovarian failure. Preimplantation and preconception genetic diagnosis]. Rev Neurol 2001; 33 Suppl 1:S20-3. [PMID: 12447814] [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: 02/27/2023]
Abstract
Although it is generally accepted that women who are carriers of the premutation of the fragile X syndrome (FXS) show no pathological clinical features, several studies have shown that they have a higher incidence of premature failure of their ovaries (early menopause) than the general population. However, when women who are carriers of the complete mutation are studied, no relation is seen between the two conditions. All women who are carriers of the premutation of the FMR1 gene should be informed that they have a greater possibility than the general population (10-15 times) of having an early menopause. Pre-implantation genetic diagnosis (PGD) is a technique used in diagnosis, based on genetic analysis of an embryo obtained by in vitro fertilization (IVF) and subsequently transferred to genetically healthy viable embryos. Preconception genetic diagnosis is based on the genetic study of an ovule before fertilization and subsequent IVF of healthy ovules. The methodology is similar in both cases. Genetic study of FXS is especially difficult because of the large number of CGG repetitions in affected. Often indirect diagnosis has to be made. Both diagnoses have a series of evident advantages over prenatal diagnosis. There is no pregnancy present so the stress and emotional trauma of VIP (voluntary interruption of pregnancy) is avoided. However, it should be pointed out that there are technical drawbacks regarding genetic analysis and the need to resort to IVF in fertile couples.
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Affiliation(s)
- M Milà
- Servicio de Genética, Hospital Clínico, Barcelona, Spain.
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48
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Podzamczer D, Ramón Arribas J, Mallolas J, María Peña J, Pulido F. [Treatment of opportunistic infections among adult and adolescent patients infected with the human immunodeficiency virus in the era of highly active anti-retroviral therapy]. Enferm Infecc Microbiol Clin 2001; 19:376-92. [PMID: 11602139 DOI: 10.1016/s0213-005x(01)72670-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- D Podzamczer
- Ciutat Sanitària i Universitària de Bellvitge, Barcelona, Spain.
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Martínez E, Arnedo M, Giner V, Gil C, Caballero M, Alós L, García F, Holtzer C, Mallolas J, Miró JM, Pumarola T, Gatell JM. Lymphoid tissue viral burden and duration of viral suppression in plasma. AIDS 2001; 15:1477-82. [PMID: 11504979 DOI: 10.1097/00002030-200108170-00004] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [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: 11/26/2022]
Abstract
OBJECTIVES To assess virological response in lymphoid tissue and its impact on the durability of response in plasma in HIV-1-infected persons who achieved sustained suppression of plasma viraemia with different antiretroviral regimens. METHODS Consecutive patients on first-line antiretroviral therapy were included if they had a plasma HIV-1 RNA viraemia < 20 copies/ml within the last 6 months and tonsillar tissue accessible for biopsy. First-line therapy contained two nucleoside analogues: alone (2NRTI group, n = 3); plus a HIV-1 protease inhibitor (PI group, n = 11) or plus nevirapine (NVP group; n = 16). Patients were followed until virus was detectable in plasma, they changed therapy or were lost to follow-up. RESULTS Tonsillar HIV-1 RNA could be detected (> 100 copies/mg) in 10 patients: one in the PI group (9%), six (38%) in the NVP group and in all three patients in the 2NRTI group. Primary resistance mutations could be detected in only 2 of these 10 patients. After a median of 9 months after the biopsies, viral suppression in plasma had failed in 6 of these 10 patients whereas failure had only occurred in 1 out of 20 with initially undetectable viral load in lymphoid tissue (P = 0.01; log rank test). CONCLUSIONS In patients with sustained viral suppression in plasma, triple therapy including a HIV-1 protease inhibitor was more potent than triple therapy containing nevirapine or dual therapy with nucleoside analogues to reduce viral burden in lymphoid tissue. A worse response in lymphoid tissue could not be explained by local selection of resistance and was associated with a less durable virological response in plasma.
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Affiliation(s)
- E Martínez
- Unit of Infectious Diseases, Clinical Institute of Infectious Diseases and Immunology IDIBAPS-Hospital Clínic Universitari, Barcelona, Spain
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50
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Blanch J, Martínez E, Rousaud A, Blanco JL, García-Viejo MA, Peri JM, Mallolas J, De Lazzari E, De Pablo J, Gatell JM. Preliminary data of a prospective study on neuropsychiatric side effects after initiation of efavirenz. J Acquir Immune Defic Syndr 2001; 27:336-43. [PMID: 11468421 DOI: 10.1097/00126334-200108010-00003] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [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: 11/26/2022]
Abstract
OBJECTIVE To assess baseline variables able to predict neuropsychiatric side effects (NPSEs) associated with the initiation of an efavirenz (EFV)-containing regimen in HIV-1-infected patients. DESIGN Open-label, prospective, observational study. METHODS Consecutive HIV-1-infected outpatients in whom EFV was prescribed underwent a psychiatric interview. At baseline and at 2, 4, and 12 weeks, patients completed the Symptoms Check List-90-Revised (SCL-90-R), the Medical Outcome Study for HIV-positive patients (MOS-HIV), and a standardized questionnaire concerning potential NPSEs. RESULTS Preliminary data showed that discontinuation of EFV because of NPSEs occurred in 4 of 31 patients (13%). Patients who completed the follow-up showed a decrease in SCL-90-R total score (p =.004) and in several subscales such as Interpersonal Sensitivity (p =.009), Depression (p =.001), and Anxiety (p =.040), whereas no changes in MOS-HIV were observed. Having fewer years of education (p =.006), having fewer baseline central nervous symptoms (p =.000), reporting better baseline physical status (p =.013), and having higher baseline scores in the Heath Transition subscale of the MOS-HIV (p =.000) and in the Somatization subscale of the SCL-90-R (p =.002) were associated with more NPSEs. CONCLUSION Patients maintained on EFV showed a decrease in psychologic distress related to self-image, depression, and anxiety, without any effect on quality of life. Patients with a lower level of education, those who feel physically and psychologically better at baseline than in the past, and those who suffer from more distress as a result of physical complaints may be at greater risk of reporting more NPSEs after EFV initiation.
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Affiliation(s)
- J Blanch
- Clinical Institute of Psychiatry and Psychology, Institut De Investigacions Biomédiques August Pi i Sunyer (IDIBAPS), Fundació Clinic per a la Recerca Biomédica, Hospital Clínic Universitari de Barcelona, Spain.
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