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Sequera-Arquelladas S, Hidalgo-Tenorio C, López-Cortés L, Gutiérrez A, Santos J, Téllez F, Omar M, Ferra-Murcia S, Fernández E, Javier R, García-Vallecillos C, Pasquau J. DOLAMA 200: Effectiveness and Safety of a Dual Therapy with Dolutegravir Plus Lamivudine in Treatment-Experienced HIV-1 Infected Real World Participants in Spain. Viruses 2024; 16:259. [PMID: 38400035 PMCID: PMC10893067 DOI: 10.3390/v16020259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/14/2024] [Accepted: 02/01/2024] [Indexed: 02/25/2024] Open
Abstract
The continuous pharmacological advances in antiretroviral treatment (ART) and the increasing understanding of HIV drug resistance has led to a change in the paradigm of ART optimization in the setting of the viral suppression of treatment-experienced patients with the emerging evidence of the effectiveness and safety of dual therapies. The aim of this study is to determine the antiviral efficacy and safety of switching to Dolutegravir + Lamivudine in people living with HIV, and to analyze the rate of patients with virologic failure (VF). A total of 200 patients were included with a median age of 51 years, 189 cells/µL of nadir CD4+, 13 years on ART and four previous ART regimens. Among the 168 patients who completed a follow-up at 48 weeks, a total of five VFs occurred, resulting in a 2.98% (5/168) VF rate. The results of the intention-to-treat analysis were a VF rate of 2.54% (5/197), and the rate of patients/year with viral suppression was 98.3% (298/303) in the observed data analysis. We observed a significant improvement in mean CD4 lymphocytes, the CD4/CD8 ratio and lipid profiles. The optimization of ART to DTG plus 3TC is a cost-effective switch option for treatment-experienced HIV patients, and also improves their lipid profiles.
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Affiliation(s)
- Sergio Sequera-Arquelladas
- Unit of Infectious Diseases, Instituto de Investigación Biosanitario de Granada (IBS-Granada), Virgen de las Nieves University Hospital, 18014 Granada, Spain; (C.H.-T.); (R.J.); (C.G.-V.); (J.P.)
| | - Carmen Hidalgo-Tenorio
- Unit of Infectious Diseases, Instituto de Investigación Biosanitario de Granada (IBS-Granada), Virgen de las Nieves University Hospital, 18014 Granada, Spain; (C.H.-T.); (R.J.); (C.G.-V.); (J.P.)
| | - Luis López-Cortés
- Department of Infectious Diseases, Virgen del Rocio University Hospitals, 41013 Seville, Spain; (L.L.-C.); (A.G.)
| | - Alicia Gutiérrez
- Department of Infectious Diseases, Virgen del Rocio University Hospitals, 41013 Seville, Spain; (L.L.-C.); (A.G.)
| | - Jesús Santos
- IBIMA Plataforma BIONAND, Unit of Infectious Diseases, Virgen de la Victoria University Hospital, 29010 Málaga, Spain;
| | - Francisco Téllez
- Unit of Infectious Diseases, Puerto Real Universitary Hospital, 11510 Cádiz, Spain;
| | - Mohamed Omar
- Unit of Infectious Diseases, Hospital Complex of Jaen, 23007 Jaén, Spain;
| | - Sergio Ferra-Murcia
- Unit of Infectious Diseases, Hospital Torrecárdenas Hospital, 04009 Almería, Spain;
| | - Elisa Fernández
- Internal medicine Service, Hospital Poniente, 04700 Almería, Spain;
| | - Rosario Javier
- Unit of Infectious Diseases, Instituto de Investigación Biosanitario de Granada (IBS-Granada), Virgen de las Nieves University Hospital, 18014 Granada, Spain; (C.H.-T.); (R.J.); (C.G.-V.); (J.P.)
| | - Coral García-Vallecillos
- Unit of Infectious Diseases, Instituto de Investigación Biosanitario de Granada (IBS-Granada), Virgen de las Nieves University Hospital, 18014 Granada, Spain; (C.H.-T.); (R.J.); (C.G.-V.); (J.P.)
| | - Juan Pasquau
- Unit of Infectious Diseases, Instituto de Investigación Biosanitario de Granada (IBS-Granada), Virgen de las Nieves University Hospital, 18014 Granada, Spain; (C.H.-T.); (R.J.); (C.G.-V.); (J.P.)
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Kabra M, Barber TJ, Allavena C, Marcelin AG, Di Giambenedetto S, Pasquau J, Gianotti N, Llibre JM, Rial-Crestelo D, De Miguel-Buckley R, Blick G, Turner M, Harrison C, Wynne T, Verdier G, Parry CM, Jones B, Okoli C, Donovan C, Priest J, Letang E. Virologic Response to Dolutegravir Plus Lamivudine in People With Suppressed Human Immunodeficiency Virus Type 1 and Historical M184V/I: A Systematic Literature Review and Meta-analysis. Open Forum Infect Dis 2023; 10:ofad526. [PMID: 38033982 PMCID: PMC10686367 DOI: 10.1093/ofid/ofad526] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Indexed: 12/02/2023] Open
Abstract
Background To investigate the impact of the M184V/I mutation on virologic response to dolutegravir plus lamivudine (DTG + 3TC) in suppressed-switch populations, a meta-analysis was performed using virologic outcomes from people with human immunodeficiency virus type 1 (PWH) with and without M184V/I before DTG + 3TC switch in real-world studies identified via systematic literature review. Sensitivity analyses were performed using data from PWH with M184V/I in interventional studies identified via targeted literature review. Methods Single-arm meta-analyses using common- and random-effects models were used to estimate proportions of PWH with virologic failure (VF) among real-world populations with and without M184V/I and interventional study participants with M184V/I at 24, 48, and 96 weeks. Results Literature reviews identified 5 real-world studies from 3907 publications and 51 abstracts meeting inclusion criteria and 5 interventional studies from 1789 publications and 3 abstracts. All time points had low VF incidence in PWH with M184V/I (real-world: 1.43%-3.81%; interventional: 0.00%) and without (real-world: 0.73%-2.37%). Meta-analysis-estimated proportions (95% confidence interval) with VF were low at weeks 24, 48, and 96, respectively, for PWH with M184V/I (real-world: 0.01 [.00-.04], 0.03 [.01-.06], and 0.04 [.01-.07]; interventional: 0.00 [.00-.02], 0.00 [.00-.01], and 0.00 [.00-.03]) and without (real-world: 0.00 [.00-.02], 0.02 [.01-.04], and 0.02 [.00-.05]). One real-world study (n = 712) reported treatment-emergent M184V at VF in 1 of 652 (0.15%) PWH without prior M184V/I. Conclusions Results suggest that prior M184V/I has minimal impact on virologic suppression after switching to DTG + 3TC and provide reassurance when considering switching regimens in virologically suppressed PWH with incomplete treatment history or limited treatment options.
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Affiliation(s)
| | - Tristan J Barber
- Ian Charleson Day Centre, Royal Free London National Health Service Foundation Trust, London, United Kingdom
- Institute for Global Health, University College London, London, United Kingdom
| | - Clotilde Allavena
- Department of Infectious and Tropical Diseases, Centre Hospitalier Universitaire Hôtel-Dieu, Nantes, France
| | - Anne-Geneviève Marcelin
- Sorbonne Université, Inserm, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Assistance Publique–Hôpitaux de Paris, Laboratoire de Virologie, Hôpital Pitié-Salpêtrière, Paris, France
| | - Simona Di Giambenedetto
- Laboratory and Infectious Diseases Sciences, Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico and Department of Safety and Bioethics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Juan Pasquau
- Unit of Infectious Diseases, Virgen de las Nieves University Hospital, Granada, Spain
| | - Nicola Gianotti
- Infectious Diseases Unit, Istituto di Ricovero e Cura a Carattere Scientifico Ospedale San Raffaele, Milan, Italy
| | - Josep M Llibre
- Infectious Diseases Division and Fight Infections Foundation, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | - David Rial-Crestelo
- HIV Unit, Hospital Universitario 12 de Octubre, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain
| | - Rosa De Miguel-Buckley
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain
- Infectious Diseases Unit, Hospital Universitario La Paz, Madrid, Spain
| | - Gary Blick
- Health Care Advocates International, Stratford, Connecticut, USA
| | | | | | | | | | | | - Bryn Jones
- ViiV Healthcare, Brentford, United Kingdom
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Hidalgo-Tenorio C, Sadyrbaeva-Dolgova S, Enríquez-Gómez A, Muñoz P, Plata-Ciezar A, Miró JM, Alarcón A, Martínez-Marcos FJ, Loeches B, Escrihuela-Vidal F, Vinuesa D, Herrero C, Boix-Palop L, Del Mar Arenas M, Vázquez EG, de Las Revillas FA, Pasquau J. EN-DALBACEN 2.0 Cohort: real-life study of dalbavancin as sequential/consolidation therapy in patients with infective endocarditis due to Gram-positive cocci. Int J Antimicrob Agents 2023; 62:106918. [PMID: 37442488 DOI: 10.1016/j.ijantimicag.2023.106918] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 06/26/2023] [Accepted: 07/04/2023] [Indexed: 07/15/2023]
Abstract
OBJECTIVES Infective endocarditis (IE) has high mortality and morbidity and requires long hospital stays to deliver the antibiotic treatment recommended in clinical practice guidelines. We aimed to analyse the health outcomes of the use of dalbavancin (DBV) in the consolidation treatment of IEs caused by Gram-positive cocci and to perform a pharmacoeconomic study. MATERIALS AND METHODS This observational, retrospective, Spanish multicentre study in patients with IE who received DBV as part of antibiotic treatment in consolidation phase were followed for at least 12 months. The study was approved by the Provincial Committee of the coordinating centre. RESULTS The study included 124 subjects, 70.2% male, with a mean age of 67.4 years and median Charlson index of 4 (interquartile range: 2.5-6). Criteria for definite IE were met by 91.1%. Coagulase-negative staphylococci (38.8%), Staphylococcus aureus (22.6%), Enterococcus faecalis (19.4%), and Streptococcus Spp. (9.7%) were isolated more frequently, all susceptible to vancomycin. Before DVB administration, 91.2% had undergone surgery; 60.5% had received a second regimen for 24.5 d (16.6-56); and 20.2% had received a third regimen for 14.5 d (12-19.5). DBV was administered to facilitate discharge in 95.2% of cases. At 12 months, the effectiveness was of 95.9%, and there was 0.8% loss to follow-up, 0.8% IE-related death, and 3.2% relapse. Adverse events were recorded in 3.2%. The hospital stay was reduced by 14 d, and there was a mean savings of 5548.57 €/patient vs. conventional treatments. CONCLUSION DBV is highly effective, safe, and cost-effective as consolidation therapy in patients with IE by Gram-positive cocci, with few adverse events.
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Affiliation(s)
- Carmen Hidalgo-Tenorio
- Hospital Universitario Virgen de las Nieves, Instituto de Investigación Biosanitario de Granada, Granada, Spain.
| | - Svetlana Sadyrbaeva-Dolgova
- Hospital Universitario Virgen de las Nieves, Instituto de Investigación Biosanitario de Granada, Granada, Spain
| | - Andrés Enríquez-Gómez
- Hospital Universitario Virgen Macarena, Instituto de Biomedicina de Sevilla / Departamento de Medicina, Universidad de Sevilla / CSIC, Centro de Investigación Biomédica en Red en Enfermedades Infecciosas, Sevilla, Spain
| | - Patricia Muñoz
- Hospital General Universitario Gregorio Marañón. Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain
| | | | - Jose Maria Miró
- Hospital Universitario Clinic-IDIBAPS, Departamento de Medicina, Universidad de Barcelona, Barcelona, Spain
| | - Arístides Alarcón
- Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla / Departamento de Medicina, Universidad de Sevilla / CSIC, Sevilla Investigación Biomédica en Red en Enfermedades Infecciosas, Sevilla, Spain
| | | | | | | | - David Vinuesa
- Hospital Universitario San Cecilio, Instituto de Investigación Biosanitario de Granada, Granada, Spain
| | | | | | | | | | | | - J Pasquau
- Hospital Universitario Virgen de las Nieves, Instituto de Investigación Biosanitario de Granada, Granada, Spain
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Candel FJ, Barreiro P, Salavert M, Cabello A, Fernández-Ruiz M, Pérez-Segura P, San Román J, Berenguer J, Córdoba R, Delgado R, España PP, Gómez-Centurión IA, González Del Castillo JM, Heili SB, Martínez-Peromingo FJ, Menéndez R, Moreno S, Pablos JL, Pasquau J, Piñana JL, On Behalf Of The Modus Investigators Adenda. Expert Consensus: Main Risk Factors for Poor Prognosis in COVID-19 and the Implications for Targeted Measures against SARS-CoV-2. Viruses 2023; 15:1449. [PMID: 37515137 PMCID: PMC10383267 DOI: 10.3390/v15071449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 06/17/2023] [Accepted: 06/23/2023] [Indexed: 07/30/2023] Open
Abstract
The clinical evolution of patients infected with the Severe Acute Respiratory Coronavirus type 2 (SARS-CoV-2) depends on the complex interplay between viral and host factors. The evolution to less aggressive but better-transmitted viral variants, and the presence of immune memory responses in a growing number of vaccinated and/or virus-exposed individuals, has caused the pandemic to slowly wane in virulence. However, there are still patients with risk factors or comorbidities that put them at risk of poor outcomes in the event of having the coronavirus infectious disease 2019 (COVID-19). Among the different treatment options for patients with COVID-19, virus-targeted measures include antiviral drugs or monoclonal antibodies that may be provided in the early days of infection. The present expert consensus is based on a review of all the literature published between 1 July 2021 and 15 February 2022 that was carried out to establish the characteristics of patients, in terms of presence of risk factors or comorbidities, that may make them candidates for receiving any of the virus-targeted measures available in order to prevent a fatal outcome, such as severe disease or death. A total of 119 studies were included from the review of the literature and 159 were from the additional independent review carried out by the panelists a posteriori. Conditions found related to strong recommendation of the use of virus-targeted measures in the first days of COVID-19 were age above 80 years, or above 65 years with another risk factor; antineoplastic chemotherapy or active malignancy; HIV infection with CD4+ cell counts < 200/mm3; and treatment with anti-CD20 immunosuppressive drugs. There is also a strong recommendation against using the studied interventions in HIV-infected patients with a CD4+ nadir <200/mm3 or treatment with other immunosuppressants. Indications of therapies against SARS-CoV-2, regardless of vaccination status or history of infection, may still exist for some populations, even after COVID-19 has been declared to no longer be a global health emergency by the WHO.
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Affiliation(s)
- Francisco Javier Candel
- Clinical Microbiology & Infectious Diseases, Transplant Coordination, Hospital Clínico Universitario San Carlos, 28040 Madrid, Spain
| | - Pablo Barreiro
- Regional Public Health Laboratory, Infectious Diseases, Internal Medicine, Hospital General Universitario La Paz, 28055 Madrid, Spain
- Department of Medical Specialities and Public Health, Universidad Rey Juan Carlos, 28922 Madrid, Spain
| | - Miguel Salavert
- Infectious Diseases, Internal Medicine, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain
| | - Alfonso Cabello
- Internal Medicine, Hospital Universitario Fundación Jiménez Díaz, 28040 Madrid, Spain
| | - Mario Fernández-Ruiz
- Unit of Infectious Diseases, Hospital Universitario "12 de Octubre", Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III (ISCIII), 28041 Madrid, Spain
| | - Pedro Pérez-Segura
- Medical Oncology, Hospital Clínico Universitario San Carlos, 28040 Madrid, Spain
| | - Jesús San Román
- Department of Medical Specialities and Public Health, Universidad Rey Juan Carlos, 28922 Madrid, Spain
| | - Juan Berenguer
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), 28007 Madrid, Spain
| | - Raúl Córdoba
- Haematology and Haemotherapy, Hospital Universitario Fundación Jiménez Díaz, 28040 Madrid, Spain
| | - Rafael Delgado
- Clinical Microbiology, Hospital Universitario "12 de Octubre", Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), 28041 Madrid, Spain
| | - Pedro Pablo España
- Pneumology, Hospital Universitario de Galdakao-Usansolo, 48960 Vizcaya, Spain
| | | | | | - Sarah Béatrice Heili
- Intermediate Respiratory Care Unit, Hospital Universitario Fundación Jiménez Díaz, 28040 Madrid, Spain
| | - Francisco Javier Martínez-Peromingo
- Department of Medical Specialities and Public Health, Universidad Rey Juan Carlos, 28922 Madrid, Spain
- Geriatrics, Hospital Universitario Rey Juan Carlos, 28933 Madrid, Spain
| | - Rosario Menéndez
- Pneumology, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain
| | - Santiago Moreno
- Infectious Diseases, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain
| | - José Luís Pablos
- Rheumatology, Hospital Universitario "12 de Octubre", Instituto de Investigación Sanitaria Hospital "12 de Octubre" (imas12), 28041 Madrid, Spain
| | - Juan Pasquau
- Infectious Diseases, Hospital Universitario Virgen de las Nieves, 18014 Granada, Spain
| | - José Luis Piñana
- Haematology and Haemotherapy, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain
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Hidalgo-Tenorio C, Sadyrbaeva S, Enríquez-Gómez A, Muñoz P, Plata Ciezar A, Miró Meda J, Alarcón A, Martínez Marcos F, Loheches B, Eschiruela-Vidal F, Vinuesa D, Herrero C, Badia Martí C, Arenas M, García Vázquez E, Fariñas M, Pasquau J. COHORTE EN-DALBACEN 2.0: DALBAVANCINA COMO TRATAMIENTO ANTIBIÓTICO DE CONSOLIDACIÓN DE EI POR COCOS GRAM POSITIVOS. Cirugía Cardiovascular 2023. [DOI: 10.1016/j.circv.2022.12.020] [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: 02/15/2023] Open
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Morata L, Aguado JM, Salavert M, Pasquau J, Míguez E, Muñoz P, Rosselló I, Almirante B. Dalbavancin in clinical practice in Spain: a 2 year retrospective study. JAC Antimicrob Resist 2022; 4:dlac120. [PMID: 36570687 PMCID: PMC9777743 DOI: 10.1093/jacamr/dlac120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 11/08/2022] [Indexed: 12/24/2022] Open
Abstract
Objectives Dalbavancin is approved for the treatment of acute bacterial skin and skin-structure infections (ABSSSIs) in adults. Its unique pharmacokinetic properties allow daily dosing to be avoided. The objective was to describe the sociodemographic and clinical characteristics of patients treated with dalbavancin in Spain, and to evaluate its effectiveness and safety in real-world settings. Patients and methods This non-interventional, retrospective, observational and multicentre study included patients who received at least one dose between 2018 and 2019 in seven Spanish hospitals. Results In total, 187 patients were included. The most common comorbidities were cardiovascular disease (27.4%) and diabetes mellitus (23.5%). Dalbavancin was used to treat osteoarticular infections (28.3%), ABSSSIs (22.5%), cardiovascular infections (20.9%) and catheter-related infections (18.2%). The most prevalent pathogens were Staphylococcus aureus (34.2%), CoNS (32.6%), and enterococci (12.8%). The main reason for use was early hospital discharge (65.8%). Most patients were treated with 1500 mg in a single dose (35.3%) and the median duration of treatment was 2 weeks. The treatment was clinically successful in 91.4% of cases. Six patients (3.2%) reported adverse events. Physicians agreed on the potential reduction of hospitalization days (85.3%). A subanalysis of patient characteristics and type of pathogen showed similar results in terms of efficacy and safety. Conclusions Dalbavancin seems to be effective and safe as second-line treatment in severe Gram-positive infections. It improves treatment adherence and allows outpatient management. Furthermore, the effectiveness and safety profile are maintained against diverse microorganisms in Gram-positive infections and regardless of the patients' comorbidities at baseline, or age.
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Affiliation(s)
- Laura Morata
- Service of Infectious Diseases, Hospital Clínic Barcelona, Calle de Villarroel, 170, Spain
| | - José María Aguado
- Infectious Diseases Unit, Hospital Universitario 12 de Octubre, Avenida de Córdoba, s/n, Spain
| | - Miguel Salavert
- Infectious Diseases Unit, Hospital Universitari i Politècnic La Fe, Avinguda de Fernando Abril Martorell, 106, Spain
| | - Juan Pasquau
- Department of Infectious Diseases, Hospital Universitario Virgen de las Nieves, Avenida de las Fuerzas Armadas, 2, Spain
| | - Enrique Míguez
- Division of Infectious Diseases, Hospital Universitario A Coruña, As Xubias 84, A Coruña 15006, Spain
| | - Patricia Muñoz
- Department of Medical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Calle del Dr. Esquerdo, 46, Spain
| | - Irantzu Rosselló
- Medical Department, Angelini Pharma España, Calle Antonio Machado, 78-80, Edificio Australia—3a planta, Viladecans 08840, Spain
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Hidalgo-Tenorio C, Pasquau J, Vinuesa D, Ferra S, Terrón A, SanJoaquín I, Payeras A, Martínez OJ, López-Ruz MÁ, Omar M, de la Torre-Lima J, López-Lirola A, Palomares J, Blanco JR, Montero M, García-Vallecillos C. DOLAVI Real-Life Study of Dolutegravir Plus Lamivudine in Naive HIV-1 Patients (48 Weeks). Viruses 2022; 14:v14030524. [PMID: 35336931 PMCID: PMC8951045 DOI: 10.3390/v14030524] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/28/2022] [Accepted: 03/02/2022] [Indexed: 12/28/2022] Open
Abstract
Brief: Real-world data in naïve HIV-1 patients demonstrate that dolutegravir plus lamivudine in a multiple tablet regimen is effective, safe, and satisfactory; it causes moderately increasing weight and abdominal circumference and is administrable on a test-and-treat strategy. Background: Our objectives were to determine the real-life effectiveness and safety of DT with dolutegravir (50 mg/QD) plus lamivudine (300 mg/QD) in a multiple-tablet regimen (MTR) in naïve PLHIV followed up for 48 weeks and to evaluate the compliance and satisfaction of patients. Material and methods: An open, single-arm, multicenter, non-randomized clinical trial from May 2019 through September 2020 with a 48-week follow-up. Results: The study included 88 PLHIV patients (87.5% male) with a mean age of 35.9 years; 76.1% were MSM patients. The mean baseline CD4 was 516.4 cells/uL, with a viral load (VL) of 4.49 log10, and 11.4% were in the AIDS stage. DT started within 7 days of first specialist consultation in all patients and the same day in 84.1%; 3.4% had baseline resistance mutations (K103N, V106I + E138A, and V108I); 12.5% were lost to follow-up. At week 48, 86.3% had VL < 50 cop/uL by intention-to-treat analysis and 98.7% by per-protocol (PP) analysis. Virological failure (VF) was recorded in 1.1%, with no resistance mutation. One blip was detected in 5.2% without VF. Three reported anxiety, dizziness, and cephalgia, respectively, at week 4 and one reported insomnia at week 24; none reported adverse events at week 48. The mean weight was 4 kg higher at 48 weeks (p = 0.0001) and abdominal circumference 3 cm larger at 24 weeks (p = 0.022). No forgetfulness occurred in 98.7% of patients. Patient satisfaction was 90/100 at 4, 24, and 48 weeks. Conclusion: Real-world data demonstrate that dolutegravir plus lamivudine in MTR is effective, safe, and satisfactory, moderately increasing weight and abdominal circumference and administrable on a test-and-treat strategy.
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Affiliation(s)
- Carmen Hidalgo-Tenorio
- Unit of Infectious Diseases, Virgen de las Nieves University Hospital, 18014 Granada, Spain; (J.P.); (M.Á.L.-R.); (C.G.-V.)
- Correspondence:
| | - Juan Pasquau
- Unit of Infectious Diseases, Virgen de las Nieves University Hospital, 18014 Granada, Spain; (J.P.); (M.Á.L.-R.); (C.G.-V.)
| | - David Vinuesa
- Unit of Infectious Diseases, University Hospital San Cecilio, 18016 Granada, Spain;
| | - Sergio Ferra
- Unit of Infectious Diseases, Torrecárdenas University Hospital, 04009 Almería, Spain;
| | - Alberto Terrón
- Unit of Infectious Diseases, Hospital de Jerez, 11407 Jerez de la Frontera, Spain;
| | - Isabel SanJoaquín
- Unit of Infectious Diseases, Hospital Lozano Blesa, 50009 Zaragoza, Spain;
| | - Antoni Payeras
- Internal Medicine Service, Hospital Son Llatzer, 07198 Palma, Spain;
| | | | - Miguel Ángel López-Ruz
- Unit of Infectious Diseases, Virgen de las Nieves University Hospital, 18014 Granada, Spain; (J.P.); (M.Á.L.-R.); (C.G.-V.)
| | - Mohamed Omar
- Unit of Infectious Diseases, Hospital Complex of Jaén, 23007 Jaén, Spain;
| | | | - Ana López-Lirola
- Unit of Infectious Diseases, University Hospital Canarias, 38320 San Cristóbal de La Laguna, Spain;
| | - Jesús Palomares
- Internal Medicine Service, Hospital Santa Ana, 18600 Motril, Spain;
| | - José Ramón Blanco
- Unit of Infectious Diseases, Hospital San Pedro, 26006 Logroño, Spain;
| | - Marta Montero
- Service of Infectious Diseases, Hospital de La Fe, 46026 València, Spain;
| | - Coral García-Vallecillos
- Unit of Infectious Diseases, Virgen de las Nieves University Hospital, 18014 Granada, Spain; (J.P.); (M.Á.L.-R.); (C.G.-V.)
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Mensa J, Barberán J, Ferrer R, Borges M, Rascado P, Maseda E, Oliver A, Marco F, Adalia R, Aguilar G, Estella A, León López R, Robles Marcos MS, González de Molina FJ, Serrano García R, Salavert M, Fernández Gómez J, Poliakova Y, Pasquau J, Azanza JR, Bou Arévalo G, LLinares Mondéjar P, Cardinal-Fernández P, Soriano A. Recommendations for antibiotic selection for severe nosocomial infections. Rev Esp Quimioter 2021; 34:511-524. [PMID: 34693705 PMCID: PMC8638841 DOI: 10.37201/req/126.2021] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Severe infection and its evolution to sepsis are becoming more prevalent every day and are among the leading causes of critical illness and mortality. Proper management is crucial to improve prognosis. This document addresses three essential points that have a significant impact on this objective: a) early recognition of patients with sepsis criteria, b) identification of those patients who suffer from an infection and have a high risk of progressing to sepsis, and c) adequate selection and optimization of the initial antimicrobial treatment.
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Affiliation(s)
| | - J Barberán
- José Barberán, Servicio de Medicina Interna - Enfermedades Infecciosas. Hospital Universitario HM Montepríncipe. Universidad San Pablo CEU. Spain.
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9
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Casadellà M, Santos JR, Noguera-Julian M, Micán-Rivera R, Domingo P, Antela A, Portilla J, Sanz J, Montero-Alonso M, Navarro J, Masiá M, Valcarce-Pardeiro N, Ocampo A, Pérez-Martínez L, Pasquau J, Vivancos MJ, Imaz A, Carmona-Oyaga P, Muñoz-Medina L, Villar-García J, Barrufet P, Paredes R. Primary resistance to integrase strand transfer inhibitors in Spain using ultrasensitive HIV-1 genotyping. J Antimicrob Chemother 2021; 75:3517-3524. [PMID: 32929472 DOI: 10.1093/jac/dkaa349] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 07/03/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Transmission of resistance mutations to integrase strand transfer inhibitors (INSTIs) in HIV-infected patients may compromise the efficacy of first-line antiretroviral regimens currently recommended worldwide. Continued surveillance of transmitted drug resistance (TDR) is thus warranted. OBJECTIVES We evaluated the rates and effects on virological outcomes of TDR in a 96 week prospective multicentre cohort study of ART-naive HIV-1-infected subjects initiating INSTI-based ART in Spain between April 2015 and December 2016. METHODS Pre-ART plasma samples were genotyped for integrase, protease and reverse transcriptase resistance using Sanger population sequencing or MiSeq™ using a ≥ 20% mutant sensitivity cut-off. Those present at 1%-19% of the virus population were considered to be low-frequency variants. RESULTS From a total of 214 available samples, 173 (80.8%), 210 (98.1%) and 214 (100.0%) were successfully amplified for integrase, reverse transcriptase and protease genes, respectively. Using a Sanger-like cut-off, the overall prevalence of any TDR, INSTI-, NRTI-, NNRTI- and protease inhibitor (PI)-associated mutations was 13.1%, 1.7%, 3.8%, 7.1% and 0.9%, respectively. Only three (1.7%) subjects had INSTI TDR (R263K, E138K and G163R), while minority variants with integrase TDR were detected in 9.6% of subjects. There were no virological failures during 96 weeks of follow-up in subjects harbouring TDR as majority variants. CONCLUSIONS Transmitted INSTI resistance remains rare in Spain and, to date, is not associated with virological failure to first-line INSTI-based regimens.
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Affiliation(s)
- M Casadellà
- IrsiCaixa AIDS Research Institute, Badalona, Catalonia, Spain
| | - J R Santos
- Lluita contra la SIDA Foundation, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | | | - P Domingo
- Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - A Antela
- Infectious Diseases Unit, Santiago de Compostela Clinical University Hospital, Santiago de Compostela, Spain
| | - J Portilla
- Hospital General Universitario de Alicante, Alicante, Spain
| | - J Sanz
- University Hospital de La Princesa, Madrid, Spain
| | - M Montero-Alonso
- Infectious Diseases Unit, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - J Navarro
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - M Masiá
- Infectious Diseases Unit, Elche University General Hospital, Elche, Spain
| | | | - A Ocampo
- HIV Unit, Hospital Álvaro Cunqueiro, Vigo, Spain
| | - L Pérez-Martínez
- Infectious Diseases Area, Hospital San Pedro-CIBIR, Logroño, Spain
| | - J Pasquau
- University Hospital Virgen de las Nieves, Granada, Spain
| | - M J Vivancos
- Infectious Diseases Unit, Ramón y Cajal Hospital, Madrid, Spain
| | - A Imaz
- HIV and STI Unit, Infectious Diseases Department, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), Hospitalet de Llobregat, Spain
| | - P Carmona-Oyaga
- Infectious Diseases Unit, Donostia University Hospital, San Sebastián, Spain
| | | | - J Villar-García
- Infectious Diseases Department, Hospital del Mar - IMIM, Barcelona, Spain
| | - P Barrufet
- Infectious Diseases Unit, Mataró Hospital, Mataró, Spain
| | - R Paredes
- IrsiCaixa AIDS Research Institute, Badalona, Catalonia, Spain.,Lluita contra la SIDA Foundation, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
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10
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Pujol M, Miró JM, Shaw E, Aguado JM, San-Juan R, Puig-Asensio M, Pigrau C, Calbo E, Montejo M, Rodriguez-Álvarez R, Garcia-Pais MJ, Pintado V, Escudero-Sánchez R, Lopez-Contreras J, Morata L, Montero M, Andrés M, Pasquau J, Arenas MDM, Padilla B, Murillas J, Jover-Sáenz A, López-Cortes LE, García-Pardo G, Gasch O, Videla S, Hereu P, Tebé C, Pallarès N, Sanllorente M, Domínguez MÁ, Càmara J, Ferrer A, Padullés A, Cuervo G, Carratalà J. Daptomycin Plus Fosfomycin Versus Daptomycin Alone for Methicillin-resistant Staphylococcus aureus Bacteremia and Endocarditis: A Randomized Clinical Trial. Clin Infect Dis 2021; 72:1517-1525. [PMID: 32725216 PMCID: PMC8096235 DOI: 10.1093/cid/ciaa1081] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 07/27/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND We aimed to determine whether daptomycin plus fosfomycin provides higher treatment success than daptomycin alone for methicillin-resistant Staphylococcus aureus (MRSA) bacteremia and endocarditis. METHODS A randomized (1:1) phase 3 superiority, open-label, and parallel group clinical trial of adult inpatients with MRSA bacteremia was conducted at 18 Spanish hospitals. Patients were randomly assigned to receive either 10 mg/kg of daptomycin intravenously daily plus 2 g of fosfomycin intravenously every 6 hours, or 10 mg/kg of daptomycin intravenously daily. Primary endpoint was treatment success 6 weeks after the end of therapy. RESULTS Of 167 patients randomized, 155 completed the trial and were assessed for the primary endpoint. Treatment success at 6 weeks after the end of therapy was achieved in 40 of 74 patients who received daptomycin plus fosfomycin and in 34 of 81 patients who were given daptomycin alone (54.1% vs 42.0%; relative risk, 1.29 [95% confidence interval, .93-1.8]; P = .135). At 6 weeks, daptomycin plus fosfomycin was associated with lower microbiologic failure (0 vs 9 patients; P = .003) and lower complicated bacteremia (16.2% vs 32.1%; P = .022). Adverse events leading to treatment discontinuation occurred in 13 of 74 patients (17.6%) receiving daptomycin plus fosfomycin, and in 4 of 81 patients (4.9%) receiving daptomycin alone (P = .018). CONCLUSIONS Daptomycin plus fosfomycin provided 12% higher rate of treatment success than daptomycin alone, but this difference did not reach statistical significance. This antibiotic combination prevented microbiological failure and complicated bacteremia, but it was more often associated with adverse events. CLINICAL TRIALS REGISTRATION NCT01898338.
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Affiliation(s)
- Miquel Pujol
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Institut Investigacions Biomèdiques de Bellvitge, University of Barcelona, Barcelona, Spain
| | - José-María Miró
- Department of Infectious Diseases, Hospital Clinic, Institut d’Investigacions Biomèdiques Agust Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Evelyn Shaw
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Institut Investigacions Biomèdiques de Bellvitge, University of Barcelona, Barcelona, Spain
| | - Jose-María Aguado
- Department of Infectious Diseases, Hospital Universitario 12 Octubre, Instituto de Investigación Hospital 12 de Octubre, Universidad Complutense, Madrid, Spain
| | - Rafael San-Juan
- Department of Infectious Diseases, Hospital Universitario 12 Octubre, Instituto de Investigación Hospital 12 de Octubre, Universidad Complutense, Madrid, Spain
| | - Mireia Puig-Asensio
- Department of Infectious Diseases, Hospital Vall d’Hebron, Vall d’Hebron Institut de Recerca, Barcelona, Spain
| | - Carles Pigrau
- Department of Infectious Diseases, Hospital Vall d’Hebron, Vall d’Hebron Institut de Recerca, Barcelona, Spain
| | - Esther Calbo
- Infectious Diseases Unit, Hospital Universitari Mútua de Terrassa, Fundació Docència i Recerca Mútua de Terrassa, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Miguel Montejo
- Department of Infectious Diseases, Hospital Universitario Cruces, Biocruces Bizkaia, Bilbao, Spain
| | - Regino Rodriguez-Álvarez
- Department of Infectious Diseases, Hospital Universitario Cruces, Biocruces Bizkaia, Bilbao, Spain
| | - María-Jose Garcia-Pais
- Infectious Diseases Unit, Hospital Lucus Augusti, Instituto de Investigación Sanitaria de Santiago de Compostela, Lugo, Spain
| | - Vicente Pintado
- Department of Infectious Diseases, Hospital Universitario Ramon y Cajal, Instituto Ramon y Cajal de Investigación Sanitaria, Madrid, Spain
| | - Rosa Escudero-Sánchez
- Department of Infectious Diseases, Hospital Universitario Ramon y Cajal, Instituto Ramon y Cajal de Investigación Sanitaria, Madrid, Spain
| | - Joaquín Lopez-Contreras
- Department of Infectious Diseases, Hospital Universitari de Sant Pau, Institut d’Investigació Biomèdica de Sant Pau, Barcelona, Spain
| | - Laura Morata
- Department of Infectious Diseases, Hospital Clinic, Institut d’Investigacions Biomèdiques Agust Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Milagros Montero
- Department of Infectious Diseases, Hospital del Mar, Institut de Recerca Hospital del Mar, Barcelona, Spain
| | - Marta Andrés
- Infectious Disease Unit, Consorci Sanitari de Terrassa, Terrassa, Spain
| | - Juan Pasquau
- Department of Infectious Diseases, Hospital Universitario Virgen de las Nieves, Instituto de Investigación Sanitaria Granada, Granada, Spain
| | - María-del-Mar Arenas
- Department of Infectious Diseases, Hospital Universitario Virgen de las Nieves, Instituto de Investigación Sanitaria Granada, Granada, Spain
| | - Belén Padilla
- Department of Clinical Microbiology and Infectious Diseases, Hospital Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Javier Murillas
- Department of Internal Medicine, Hospital Universitari Son Espases, Fundació Institut d’Investigació Sanitària Illes Balears, Mallorca, Spain
| | - Alfredo Jover-Sáenz
- Territorial Unit of Nosocomial Infection, Hospital Universitari Arnau de Vilanova, Institut de Recerca Biomèdica de Lleida, Lleida, Spain
| | - Luis-Eduardo López-Cortes
- Department of Infectious Diseases, Hospital Universitario Virgen Macarena, Instituto de Biomedicina de Sevilla, Sevilla, Spain
| | - Graciano García-Pardo
- Department of Internal Medicine, Hospital Universitari Joan XXIII, Universitat Rovira i Virgili, Tarragona, Spain
| | - Oriol Gasch
- Department of Infectious Diseases, Consorci Sanitari Hospital Parc Taulí, Fundació Institut d’Investigació i Innovació Parc Taulí, Sabadell, Spain
| | - Sebastian Videla
- Department of Clinical Pharmacology, Institut Investigacions Biomèdiques de Bellvitge, Clinical Research and Clinical Trials Unit, Plataforma Spanish Clinical Research Network, Barcelona, Spain
| | - Pilar Hereu
- Department of Clinical Pharmacology, Institut Investigacions Biomèdiques de Bellvitge, Clinical Research and Clinical Trials Unit, Plataforma Spanish Clinical Research Network, Barcelona, Spain
| | - Cristian Tebé
- Biostatistics Unit, Institut Investigacions Biomèdiques de Bellvitge, L’Hospitalet Llobregat, L’Hospitalet del Llobregat, Spain
| | - Natalia Pallarès
- Biostatistics Unit, Institut Investigacions Biomèdiques de Bellvitge, L’Hospitalet Llobregat, L’Hospitalet del Llobregat, Spain
| | - Mireia Sanllorente
- Department of Clinical Pharmacology, Institut Investigacions Biomèdiques de Bellvitge, Clinical Research and Clinical Trials Unit, Plataforma Spanish Clinical Research Network, Barcelona, Spain
| | - María-Ángeles Domínguez
- Department of Microbiology and Parasitology, Hospital Universitari de Bellvitge, Institut Investigacions Biomèdiques de Bellvitge, University of Barcelona, Barcelona, Spain
| | - Jordi Càmara
- Department of Microbiology and Parasitology, Hospital Universitari de Bellvitge, Institut Investigacions Biomèdiques de Bellvitge, University of Barcelona, Barcelona, Spain
| | - Anna Ferrer
- Department of Pharmacy, Hospital Universitari de Bellvitge, Institut Investigacions Biomèdiques de Bellvitge, University of Barcelona, Barcelona, Spain
| | - Ariadna Padullés
- Department of Pharmacy, Hospital Universitari de Bellvitge, Institut Investigacions Biomèdiques de Bellvitge, University of Barcelona, Barcelona, Spain
| | - Guillermo Cuervo
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Institut Investigacions Biomèdiques de Bellvitge, University of Barcelona, Barcelona, Spain
| | - Jordi Carratalà
- Department of Infectious Diseases, Hospital Universitari de Bellvitge, Institut Investigacions Biomèdiques de Bellvitge, University of Barcelona, Barcelona, Spain
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11
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Arnaíz de Las Revillas F, Sousa D, Ardunay C, García-Vidal C, Montejo M, Rodríguez-Álvarez R, Pasquau J, Bouza E, Oteo JA, Balseiro C, Méndez C, Lwoff N, Llinares P, Fariñas MC. Healthcare-associated pneumonia: a prospective study in Spain. Rev Esp Quimioter 2020; 33:358-368. [PMID: 32693555 PMCID: PMC7528418 DOI: 10.37201/req/067.2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective The aim of the study was to describe the epidemiological characteristics and factors related to outcome in Streptococcus pneumoniae and methicillin-resistant Staphylococcus aureus (MRSA) healthcare-associated pneumonia (HCAP). Patients and method A 3-year prospective observational epidemiological case study of HCAP was conducted in seven Spanish hospitals. Microbiological and patient characteristics and outcomes were collected and classified by causative pathogen into 4 categories: “S. pneumoniae”, “MRSA”, “Others” and “Unknown”. Patients were followed up 30 days after discharge. Results A total of 258 (84.6%) patients were enrolled (170 were men [65.9%]). Mean age was 72.4 years ± 15 years (95% CI [70.54-74.25]). The etiology of pneumonia was identified in 73 cases (28.3%):S. pneumoniae in 35 patients (13.6%), MRSA in 8 (3.1%), and other microorganisms in 30 patients (11.6%). Significant differences in rates of chronic obstructive pulmonary disease (p < 0.05), previous antibiotic treatment (p < 0.05), other chronic respiratory diseases, inhaled corticosteroids (p < 0.01), and lymphoma (p < 0.05) were observed among the four groups. Patients with MRSA pneumonia had received more previous antibiotic treatment (87.5%). Thirty-three (12.8%) patients died during hospitalisation; death in 27 (81.2%) was related to pneumonia. Conclusions The etiology of HCAP was identified in only one quarter of patients, with S. pneumoniae being the most prevalent microorganism. Patients with chronic respiratory diseases more frequently presented HCAP due to MRSA than to S. pneumoniae. Death at hospital discharge was related in most cases to pneumonia.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - M C Fariñas
- María Carmen Fariñas. Infectious Diseases Unit, Hospital Universitario Marqués de Valdecilla, Av. Valdecilla, 25, 39008 Santander, Cantabria, Spain.
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12
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Hidalgo-Tenorio C, Gil-Anguita C, López Ruz MA, Omar M, López-Hidalgo J, Pasquau J. ART is key to clearing oncogenic HPV genotypes (HR-HPV) in anal mucosa of HIV-positive MSM. PLoS One 2019; 14:e0224183. [PMID: 31648254 PMCID: PMC6813028 DOI: 10.1371/journal.pone.0224183] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 10/06/2019] [Indexed: 12/23/2022] Open
Abstract
Background Anal squamous cell carcinoma (ASCC) is one of the most frequent non-AIDS-defining neoplasias in HIV patients, mainly in MSM, and it has been associated with chronic infection with high-risk human papilloma virus (HR-HPV). Our main objective was to determine HR-HPV clearance and acquisition rates and related factors and their relationship with the incidence of HSILs and ASCC in anal mucosa of HIV+ MSM. Patients and methods The study included consecutive HIV-infected MSM between May 2010 and December 2018. Data were gathered at baseline and annually on their sexual behavior, CD4 and CD8 levels, plasma HIV viral load, and results of anal cytology, HPV PCR, and high-resolution anoscopy. Results Out of the 405 patients studied, 34.9% of patients cleared oncogenic genotypes (IQR: 37–69) within 49 months, and 42.9% acquired new genotypes within 36 months (IQR:12–60). In multivariate analysis, clearance was only significantly influenced by the duration of antiretroviral therapy (ART) (OR: 1.016, 95% CI 1.003–1.030). The incidence of HSILs was 30.86/1,000 patient-years and that of ASCC was 81.22/100,000 patient-years; these incidences were not influenced by the acquisition (acquired: 14.9% vs. non-acquired: 10.4%; p = 0.238) or clearance (cleared 11.4% vs. non-cleared: 13.2%; p = 0.662) rates of these viruses. Conclusions The duration of ART appears to positively affect oncogenic genotype clearance in the anal mucosa of HIV+ MSM, although this clearance does not affect the incidence of HSILs or ASCC. The reduction in HSIL+ rate observed in our patients may be attributable to the bundle of measures adopted at our center.
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Affiliation(s)
- Carmen Hidalgo-Tenorio
- Department of Infectious Diseases; “Virgen de las Nieves” University Hospital, Granada, Spain
- * E-mail:
| | - Concepción Gil-Anguita
- Department of Infectious Diseases; “Virgen de las Nieves” University Hospital, Granada, Spain
| | - Miguel Angel López Ruz
- Department of Infectious Diseases; “Virgen de las Nieves” University Hospital, Granada, Spain
| | - Mohamed Omar
- Unit of Infectious Diseases, Jaen “Hospital Complex”, Spain
| | - Javier López-Hidalgo
- Pathology Department; “Virgen de las Nieves” University Hospital, Granada, Spain
| | - Juan Pasquau
- Department of Infectious Diseases; “Virgen de las Nieves” University Hospital, Granada, Spain
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13
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Hidalgo-Tenorio C, Vinuesa D, Plata A, Martin Dávila P, Iftimie S, Sequera S, Loeches B, Lopez-Cortés LE, Fariñas MC, Fernández-Roldan C, Javier-Martinez R, Muñoz P, Arenas-Miras MDM, Martínez-Marcos FJ, Miró JM, Herrero C, Bereciartua E, De Jesus SE, Pasquau J. DALBACEN cohort: dalbavancin as consolidation therapy in patients with endocarditis and/or bloodstream infection produced by gram-positive cocci. Ann Clin Microbiol Antimicrob 2019; 18:30. [PMID: 31629409 PMCID: PMC6800500 DOI: 10.1186/s12941-019-0329-6] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 10/09/2019] [Indexed: 12/27/2022] Open
Abstract
Objectives To analyse the effectiveness of dalbavancin (DBV) in clinical practice as consolidation therapy in patients with bloodstream infection (BSI) and/or infective endocarditis (IE) produced by gram-positive cocci (GPC), as well as its safety and pharmacoeconomic impact. Methods A multicentre, observational and retrospective study was conducted of hospitalised patients with IE and/or BSI produced by GPC who received at least one dose of DBV. Clinical response was assessed during hospitalization, at 3 months and at 1 year. Results Eighty-three patients with median age of 73 years were enrolled; 73.5% were male; 59.04% had BSI and 49.04% IE (44.04% prosthetic valve IE, 32.4% native IE, 23.5% pacemaker lead). The most frequently isolated microorganism was Staphylococcus aureus in BSI (49%) and coagulase-negative staphylococci in IE (44.1%). All patients with IE were clinically cured in hospital; at 12 months, there was 2.9% loss to follow-up, 8.8% mortality unrelated to IE, and 2.9% therapeutic failure rate. The percentage effectiveness of DBV to treat IE was 96.7%. The clinical cure rate for BSI was 100% during hospital stay and at 3 months; there were no recurrences or deaths during the follow-up. No patient discontinued treatment for adverse events. The saving in hospital stay was 636 days for BSI (315,424.20€) and 557 days for IE (283,187.45€). Conclusions DBV is an effective consolidation antibiotic therapy in clinically stabilized patients with IE and/or BSI. It proved to be a cost-effective treatment, reducing the hospital stay, thanks to the pharmacokinetic/pharmacodynamic profile of this drug.
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Affiliation(s)
- Carmen Hidalgo-Tenorio
- Department of Infectious Diseases, Hospital Universitario Virgen de las Nieves, Av. de las Fuerzas Armadas no 2, 18014, Granada, Spain.
| | | | | | | | | | - Sergio Sequera
- Department of Infectious Diseases, Hospital Universitario Virgen de las Nieves, Av. de las Fuerzas Armadas no 2, 18014, Granada, Spain
| | | | | | | | - Concepción Fernández-Roldan
- Department of Infectious Diseases, Hospital Universitario Virgen de las Nieves, Av. de las Fuerzas Armadas no 2, 18014, Granada, Spain
| | - Rosario Javier-Martinez
- Department of Infectious Diseases, Hospital Universitario Virgen de las Nieves, Av. de las Fuerzas Armadas no 2, 18014, Granada, Spain
| | | | | | | | | | | | | | - Samantha E De Jesus
- Department of Infectious Diseases, Hospital Universitario Virgen de las Nieves, Av. de las Fuerzas Armadas no 2, 18014, Granada, Spain
| | - Juan Pasquau
- Department of Infectious Diseases, Hospital Universitario Virgen de las Nieves, Av. de las Fuerzas Armadas no 2, 18014, Granada, Spain
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14
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Pérez-Valero I, Pasquau J, Rubio R, Rivero A, Santos J, Sanz J, Mariño A, Crespo M, Hernández-Quero J, Iribarren JA, Gutiérrez F, Terrón A, Esteban H, Pérez-Molina JA. Neurocognitive safety after 96 weeks on dual therapy with atazanavir/ritonavir plus lamivudine: results of the neurocognitive substudy of the SALT randomized clinical trial. J Antimicrob Chemother 2019; 73:2444-2451. [PMID: 29897573 DOI: 10.1093/jac/dky212] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 05/09/2018] [Indexed: 01/03/2023] Open
Abstract
Background Concerns have been voiced over the capacity of deintensification strategies to preserve neurocognitive function and prevent neurocognitive impairment. Methods We present the 96 week results of a neurocognitive substudy nested within the SALT clinical trial: a randomized, open-label, non-inferiority trial that compares whether atazanavir/ritonavir + lamivudine is non-inferior to atazanavir/ritonavir + two NRTIs in HIV-suppressed patients on stable triple therapy. A global deficit score (GDS) for five neurocognitive tasks was used to assess neurocognitive function. Changes in neurocognitive function (GDS value) were determined at weeks 48 and 96. The effect of atazanavir/ritonavir + lamivudine, adjusted for significant confounders, on the change in neurocognitive function was determined using analysis of covariance (ANCOVA) at week 96. Results The per-protocol analysis included 92 participants (47 atazanavir/ritonavir + lamivudine and 45 atazanavir/ritonavir + two NRTIs). All baseline characteristics were comparable in both groups. At weeks 48 and 96, changes in GDS [week 48, atazanavir/ritonavir + lamivudine -0.3 (95% CI -0.5 to -0.1) versus atazanavir/ritonavir + two NRTIs -0.2 (95% CI -0.4 to 0.0), P = 0.39; week 96, atazanavir/ritonavir + lamivudine -0.3 (95% CI -0.5 to -0.1) versus atazanavir/ritonavir + two NRTIs -0.2 (95% CI -0.4 to -0.1); P = 0.471] were similar. This absence of differences was also observed in all cognitive tasks. Atazanavir/ritonavir + lamivudine did not impact the change in neurocognitive function at week 96; the adjusted effect of atazanavir/ritonavir + lamivudine on GDS change, considering atazanavir/ritonavir + two NRTIs as a reference, was 0.01 (95% CI -0.18 to 0.21) (P = 0.90). Conclusions Neurocognitive function remained stable after 96 weeks, both in the atazanavir/ritonavir + lamivudine and in the atazanavir/ritonavir + two NRTIs arms, provided HIV remained suppressed.
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Affiliation(s)
| | - Juan Pasquau
- Hospital Virgen de las Nieves, Internal Medicine, Granada, Spain
| | - Rafael Rubio
- H.U. Doce de Octubre, Internal Medicine, Madrid, Spain
| | | | - José Santos
- Hospital Virgen de la Victoria, Internal Medicine, Malaga, Spain
| | - Jesus Sanz
- Hospital de Alcala de Henares, Internal Medicine, Alcala de Henares, Spain
| | - Ana Mariño
- Hospital Arquitecto Marcide, Internal Medicine, O Ferrol, Spain
| | - Manel Crespo
- Hospital Vall d'Hebron, Internal Medicine, Barcelona, Spain
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Podzamczer D, Rozas N, Domingo P, Miralles C, den Eynde EV, Romero A, Deig E, Knobel H, Pasquau J, Antela A, Clotet B, Geijo P, de Castro ER, Casado MA, Muñoz A, Casado A, For The Pro-Str Study Group. Real World Patient-reported Outcomes in HIV-infected Adults Switching to EVIPLERA®, Because of a Previous Intolerance to cART. PRO-STR Study. Curr HIV Res 2019; 16:425-435. [PMID: 30760189 PMCID: PMC6700757 DOI: 10.2174/1570162x17666190212163518] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 02/07/2019] [Accepted: 02/11/2019] [Indexed: 12/29/2022]
Abstract
Background: To investigate the impact of switching from stable Combined Antiretroviral Therapy (cART) to single-tablet regimen (RPV/FTC/TDF=EVIPLERA®/COMPLERA®) on patient-reported outcomes in HIV-infected adults who cannot tolerate previous cART, in a real-world setting. Methods: PRO-STR is a 48-week observational, prospective, multicenter study. Presence and magnitude of symptoms (main endpoint), health-related quality-of-life (HRQoL), adherence, satisfaction with treatment and patient preferences were assessed. Results: Three hundred patients with 48-week follow-up, who switched to EVIPLERA® (mean age: 46.6 years; male: 74.0%; 74.7% switched from a non-nucleoside reverse-transcriptase-inhibitor, 25.3% from a protease inhibitor + ritonavir) were included. There was no statistical difference in median CD4+ cell count (baseline: 678.5 cells/mm3; 48-week: 683.0 cells/mm3) neither in virological suppression (≤50 copies/mL) (baseline: 98.3%; 48-week: 95.3%). The most frequent reasons for switching were neuropsychiatric (62.3%), gastrointestinal (19.3%) and biochemical/metabolic (19.3%) events. Only 7.7% of patients permanently discontinued therapy. At 48-week, all outcomes showed an improvement compared to baseline. Overall, there was a significant decrease (p-value≤0.05) in number and magnitude of symptoms, while HRQoL, satisfaction and adherence improved significantly. Most patients prefered EVIPLERA® than previous cART. According to the type of intolerance, HRQoL was improved, but only significantly in patients with neuropsychiatric and gastrointestinal symptoms. Adherence improved significantly in patients with metabolic disturbances and satisfaction with EVIPLERA® was higher in the three groups. Conclusion: Switching to EVIPLERA® from non-nucleoside reverse-transcriptase-inhibitor or protease inhibitor-based regimens due to toxicity, improved the presence/magnitude of symptoms, HRQoL, and preference with treatment. EVIPLERA® maintained a virological response, CD4+ cell count and maintained or improved adherence.
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Affiliation(s)
- D Podzamczer
- Hospital Universitari de Bellvitge, Barcelona, Spain
| | - N Rozas
- Hospital Universitari de Bellvitge, Barcelona, Spain
| | - P Domingo
- Hospital de la Santa Creu y Sant Pau, Barcelona, Spain
| | - C Miralles
- Hospital Xeral de Vigo, Pontevedra, Spain
| | | | - A Romero
- Hospital de Especialidades de Puerto Real, Cadiz, Spain
| | - E Deig
- Hospital General de Granollers, Barcelona, Spain
| | - H Knobel
- Hospital del Mar, Barcelona, Spain
| | - J Pasquau
- Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - A Antela
- Complejo Hospitalario Universitario de Santiago, A Coruna, Spain
| | - B Clotet
- Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | - P Geijo
- Hospital Virgen de la Luz, Cuenca, Spain
| | | | - M A Casado
- Pharmacoeconomics & Outcomes Research Iberia, Madrid, Spain
| | - A Muñoz
- Pharmacoeconomics & Outcomes Research Iberia, Madrid, Spain
| | - A Casado
- Pharmacoeconomics & Outcomes Research Iberia, Madrid, Spain
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Hidalgo-Tenorio C, Cortés LL, Gutiérrez A, Santos J, Omar M, Gálvez C, Sequera S, Jesús SED, Téllez F, Fernández E, García C, Pasquau J. DOLAMA study: Effectiveness, safety and pharmacoeconomic analysis of dual therapy with dolutegravir and lamivudine in virologically suppressed HIV-1 patients. Medicine (Baltimore) 2019; 98:e16813. [PMID: 31393412 PMCID: PMC6708975 DOI: 10.1097/md.0000000000016813] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Dolutegravir (DTG) has shown effectiveness in combination with rilpivirine in with experience of antiretroviral therapy (ART) and with 3TC in naïve patients (GEMINI trial). The main objectives of this real-life study were to analyze the effectiveness and safety of 3TC plus DTG in virologically suppressed HIV-1 patients and to conduct a pharmacoeconomic analysis.We conducted an observational, retrospective and multicenter study of HIV+ patients pretreated for at least 6 months with ART that was then simplified to 3TC + DTG for any reason. We gathered data on viral loads (VLs) during exposure to the DT, calculating the rate with VL < 50 copies/mL at week 48, and on associated adverse effects.The 177 HIV+ patients were collected, 77.4% male, with average age of 48.5 years and mean count of 252.2cell/μL CD4+ nadir lymphocytes; 96.6% had VL < 50 copies/mL and 674 cells/μL CD4+ lymphocytes. Median time since HIV diagnosis was 15 years, and median ART duration was 13 years, and 34.5% of patients were on mono- or dual-therapy before the switch. At week 48, 82.4% of patients had VL < 50 cop/μL using an intention-to-treat (ITT) analysis, 89.6% according to mITT, and 96.7% according to Per-Protocol analysis. 3.3% patients had virological failure (VF). These effectiveness data and costs were compared with those for 2 reference triple therapies (DTG/ABC/3TC and EVG/cobi/FTC/TAF) in a cost minimization analysis, showing cost savings with administration of DTG+3TC (2741 &OV0556;/year vs DTG/ABC/3TC and 4164 &OV0556;/year vs EVG/cobi/FTC/TAF) and in a cost-effectiveness analysis, finding the DT to be the most cost-effective approach (ICER = -548 vs DTG/ABC/3TC and ICER = -4,627&OV0556; vs EVG/cobi/FTC/TAF)The combination of 3TC with DTG appears to be a safe and effective option for the simplification of ART in pretreated and virologically stable HIV-positive patients, being cost-effective and offering the same effectiveness as the triple therapy it replaces.
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Affiliation(s)
| | - Luis López Cortés
- Department of Infectious Diseases, Virgen del Rocio University Hospitals, Seville
| | - Alicia Gutiérrez
- Department of Infectious Diseases, Virgen del Rocio University Hospitals, Seville
| | - Jesús Santos
- Unit of Infectious Diseases, Virgen de las Victoria University Hospital, Málaga
| | - Mohamed Omar
- Unit of Infectious Diseases, Hospital Complex of Jaen
| | - Carmen Gálvez
- Unit of Infectious Diseases, Hospital Torrecárdenas Hospital, Almería
| | - Sergio Sequera
- Unit of Infectious Diseases, Virgen de las Nieves University Hospital, Granada
| | | | - Franciso Téllez
- Unit of Infectious Diseases, University Hospital Puerto Real, Cádiz
| | - Elisa Fernández
- Internal medicine Service, Hospital Poniente, Almería, Spain
| | - Coral García
- Unit of Infectious Diseases, Virgen de las Nieves University Hospital, Granada
| | - Juan Pasquau
- Unit of Infectious Diseases, Virgen de las Nieves University Hospital, Granada
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Candel FJ, Mensa J, Pasquau J, González del Castillo J. La crisis de los antibióticos: de la prescripción empírica a la dirigida. Enferm Infecc Microbiol Clin 2019; 37:214-215. [DOI: 10.1016/j.eimc.2018.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 08/31/2018] [Indexed: 10/28/2022]
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18
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Pasquau J, de Jesus SE, Arazo P, Crusells MJ, Ríos MJ, Lozano F, de la Torre J, Galindo MJ, Carmena J, Santos J, Tornero C, Verdejo G, Samperiz G, Palacios Z, Hidalgo-Tenorio C. Effectiveness and safety of dual therapy with rilpivirine and boosted darunavir in treatment-experienced patients with advanced HIV infection: a preliminary 24 week analysis (RIDAR study). BMC Infect Dis 2019; 19:207. [PMID: 30819101 PMCID: PMC6396540 DOI: 10.1186/s12879-019-3817-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 02/13/2019] [Indexed: 01/01/2023] Open
Abstract
Background The objective was to analyze the effectiveness and safety of dual therapy with rilpivirine plus boosted-darunavir (RPV + bDRV) in real-life patients. Methods Observational, retrospective, multi-center study in HIV+ patients who had received RPV + bDRV for 24 weeks to optimize/simplify their previous antiretroviral treatment. We determined the percentage of patients without virologic failure (2 consecutive viral loads > 50 copies/mL) at 24 weeks of treatment. Results The study included 161 patients from 15 hospitals with median age of 49 years; 29.3% had previous AIDS stage and median CD4+ lymphocyte nadir of 170 cells/uL. They had been diagnosed with HIV for a median of 17 years and had received 14 years of ART, with five previous treatment combinations, and 36.6% had a history of virological failure. The reasons for the switch were simplification/optimization (49.7%), toxicity/intolerance (17.4%), or inadequate effectiveness of previous ART (10.6%). Baseline VL of 50–1000 copies/mL was recorded in 25.5% of the patients. In the“intention-to-treat” analysis at 24 weeks, 87.6% of 161 patients continued the study treatment without virologic failure criteria. In the “on treatment” analysis (excluding patients who discontinued treatment with dual therapy for any reason other than virologic failure) the efficacy was 94.6% (141/149 patients). Conclusions Dual therapy with RPV + DRVb proved to be effective and safe in patients with advanced HIV infection, long exposure to ART, low CD4 nadir, previous virologic failure, and/or history of ineffective ART.
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Affiliation(s)
- Juan Pasquau
- Hospital Universitario Virgen de las Nieves, Granada, Spain.
| | | | | | | | | | | | | | | | - Jorge Carmena
- Hospital Universitario Doctor Peset, Valencia, Spain
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Pujol M, Miro JM, Shaw E, Aguado JM, Garrido RSJ, Puig M, Pigrau C, Calbo E, Montejo JM, Rodriguez R, Garcia-Pais MJ, Pintado V, Escudero R, Lopez-Contreras J, Morata L, Montero M, Andres M, Pasquau J, Padilla B, Murillas J, Jover A, Lopez-Cortes LE, Garcia-Pardo G, Gasch O, Videla S, Tebe C, Pallares N, Hereu P, Sanllorente M, Dominguez MA, Camara J, Padulles A, Carratala J. LB3. Daptomycin Plus Fosfomycin vs. Daptomycin Monotherapy for Methicillin-Resistant Staphylococcus aureus Bacteremia: A Multicenter, Randomized, Clinical Trial. Open Forum Infect Dis 2018. [PMCID: PMC6253582 DOI: 10.1093/ofid/ofy229.2177] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Daptomycin plus fosfomycin combination has demonstrated synergistic and bactericidal effect in animal models of methicillin-resistant Staphylococcus aureus bacteremia (MRSAB), but there is lack of data in humans.
Method
A randomized (1:1), open-label, clinical trial involving adults with MRSAB was conducted at 18 medical centers in Spain. Patients were assigned to receive daptomycin, 10 mg/kg IV daily plus fosfomycin, 2 g IV/6 hour (combination therapy) or to receive daptomycin 10 mg/kg/24 h IV (monotherapy) during 10 up to 14 days for uncomplicated bacteremia and 28 up to 42 days for complicated bacteremia. The primary efficacy endpoints were: (a) treatment success at Test-of-Cure visit (ToC: 6 weeks after end of therapy) and (b) treatment success at 7 days (defined as alive at day 7 and clearance of bacteremia without relapse from 8 to 90 days after randomization), according with the proposed primary endpoints for use in clinical trials in bloodstream infections in adults.
Result
Between December 2013 and November 2017, 674 patients with MRSAB were evaluated and 155 patients were randomized: 74 received combination therapy and 81 monotherapy. In intention-to-treat analysis, (a) at ToC visit successful outcome was achieved in 40 of 74 patients (54,1%) who received combination therapy as compared with 34 of 81 patients (42%) who were given monotherapy (54.1% vs. 42.0%; absolute difference, 12.1%; 95% confidence interval, 0%-27.0%); (b) at 7 days after starting the therapy: a successful outcome was achieved in 69 of 74 patients who received combination therapy as compared with 62 out of 81 patients who received monotherapy (93.2% vs. 76.5%; absolute difference, 16.7%; 95% confidence interval, 5.4%–27.7%). Combination therapy was associated with lower rates of microbiologic failure than monotherapy at ToC visit (0 vs. 9 patients, P = 0.009). Combination therapy, as compared with daptomycin monotherapy, was associated with a nonsignificantly higher rate of adverse events due to study medication leading to treatment failure and discontinuation of therapy: 6/74 (8.1%) vs. 3/81 (3.7%) (P = 0.31).
Conclusion
The combination of daptomycin plus fosfomycin was more effective than daptomycin alone for treating MRSAB (NCT01898338).
Disclosures
All authors: No reported disclosures.
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Affiliation(s)
- Miquel Pujol
- Infectious Diseases Department, Hospital de Bellvitge, L’Hospitalet llobregat, Spain
| | | | - Evelyn Shaw
- Hospital de Bellvitge, L’Hospitalet llobregat, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Cristian Tebe
- Institut d’Investigacions Biomèdiques de Bellvitge (IDIBELL), L’Hospitalet llobregat, Spain
| | - Natalia Pallares
- Institud d’Investigacions Biomèdiques de Bellvitge (IDIBELL), L’Hospitalet llobregat, Spain
| | - Pilar Hereu
- Hospital de Bellvitge, L’Hospitalet llobregat, Spain
| | | | | | - Jordi Camara
- Hospital de Bellvitge, L’Hospitalet llobregat, Spain
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López-Ruz MA, López-Zúñiga MA, Gonzalvo MC, Sampedro A, Pasquau J, Hidalgo C, Rosario J, Castilla JA. Effect of monotherapy with darunavir/cobicistat on viral load and semen quality of HIV-1 patients. PLoS One 2018; 13:e0196257. [PMID: 29689065 PMCID: PMC5915275 DOI: 10.1371/journal.pone.0196257] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 04/09/2018] [Indexed: 11/28/2022] Open
Abstract
Many patients previously using darunavir/ritonavir (DRV/r) (800/100mg) have switched to darunavir/cobicistat (DRV/C) (800/150 mg) either as part of triple therapy (ART) or as monotherapy with DRV (mDRV). The latter approach continues to be used in some countries for patients receiving long-term treatment. However, to date, the behaviour of DRV/C in the seminal compartment has not been analysed. This study explores how the combination behaves in monotherapy, with respect to the control of viral load and seminal quality. To this end, we studied 20 patients who were treated with mDRV/C after previous treatment with mDRV/r for at least 24 weeks. A viral load control in seminal plasma similar to that published in the literature was observed after 24 weeks of treatment with mDRV/C (viral load positivity in 20% of patients). Similarly, semen quality was confirmed (70% normozoospermic) in patients treated with this formulation, as has previously been reported for ART and mDRV/r. The DRV levels measured in seminal plasma were above EC50, regardless of whether the seminal viral load was positive or negative. We conclude that this mDRV/C co-formulation behaves like mDRV/r in seminal plasma in terms of viral load control and semen quality.
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Affiliation(s)
- Miguel A. López-Ruz
- Unidad de Enfermedades Infecciosas, Hospital Universitario Virgen de las Nieves, Granada, Spain
- Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Granada, España
| | | | - María Carmen Gonzalvo
- Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Granada, España
- Unidad de Reproducción, UGC Laboratorio Clínico y UGC Obstetricia y Ginecología, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Antonio Sampedro
- Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Granada, España
- UGC Microbiología, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Juan Pasquau
- Unidad de Enfermedades Infecciosas, Hospital Universitario Virgen de las Nieves, Granada, Spain
- Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Granada, España
| | - Carmen Hidalgo
- Unidad de Enfermedades Infecciosas, Hospital Universitario Virgen de las Nieves, Granada, Spain
- Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Granada, España
| | - Javier Rosario
- Unidad de Enfermedades Infecciosas, Hospital Universitario Virgen de las Nieves, Granada, Spain
- Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Granada, España
| | - Jose Antonio Castilla
- Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Granada, España
- Unidad de Reproducción, UGC Laboratorio Clínico y UGC Obstetricia y Ginecología, Hospital Universitario Virgen de las Nieves, Granada, Spain
- Dpto. Anatomía y Embriología Humana, Facultad Medicina, Universidad de Granada, Granada, Spain
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Pasquau J, Hidalgo-Tenorio C, Montes ML, Romero-Palacios A, Vergas J, Sanjoaquín I, Hernández-Quero J, Aguirrebengoa K, Orihuela F, Imaz A, Ríos-Villegas MJ, Flores J, Fariñas MC, Vázquez P, Galindo MJ, García-Mercé I, Lozano F, de los Santos I, de Jesus SE, García-Vallecillos C. High quality of life, treatment tolerability, safety and efficacy in HIV patients switching from triple therapy to lopinavir/ritonavir monotherapy: A randomized clinical trial. PLoS One 2018; 13:e0195068. [PMID: 29649309 PMCID: PMC5896909 DOI: 10.1371/journal.pone.0195068] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 03/15/2018] [Indexed: 01/03/2023] Open
Abstract
Trial design The QoLKAMON study evaluated quality of life, efficacy and treatment safety in HIV patients receiving lopinavir/ritonavir in monotherapy (MT) versus continuing combined antiretroviral triple treatment with a boosted protease inhibitor (TT). Methods This was a 24-week, open-label, multicentre study in virologically-suppressed HIV-infected participants (N = 225) with a 2:1 randomization: 146 patients who switched to MT were compared with 79 patients who remained on a TT regimen. The primary endpoint was change in patient-reported outcomes in quality of life as measured by the MOS-HIV and EQ-5D questionnaires. Secondary endpoints included treatment adherence, patient satisfaction, incidence of adverse events and differences in plasma HIV-1 RNA viral load (VL) and CD4 cell counts. Results Baseline quality of life, measured with the MOS-HIV score, was very good (overall score of 83 ± 10.5 in the MT arm and 82.3 ± 11.3 in the TT arm) and suffered no change during the study in any of the arms (at week 24, 83.5 ± 12.2 in MT arm and 81.9 ± 12.7 in TT arm), without statistically significant differences when compared. In regards to adherence to therapy and patient satisfaction, some aspects (number of doses forgotten in the last week and satisfaction of treatment measured with the CESTA score, dimension 1) improved significantly with MT. There were also no differences in the incidence and severity of adverse events, even though 22.8% of those in the MT arm switched their treatment when they were included in the study. Moreover, there was also no significant difference between the immunological and virological evolution of MT and TT. In the MT arm, the VL was always undetectable in 83% of patients (vs 90.7% in the TT arm) and there were only 6.7% of virological failures with VL > 50 copies/mL (vs 2.3% in the TT arm), without resistance mutations and with resuppression of VL after switching back to TT. Conclusions In a new clinical trial, monotherapy as a treatment simplification strategy in HIV-1 infected patients with sustained viral suppression has demonstrated quality of life, safety and efficacy profiles comparable to those of conventional triple therapy regimens.
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Affiliation(s)
- Juan Pasquau
- Hospital Universitario Virgen de las Nieves, Infectious Diseases, Granada, Spain
- * E-mail:
| | | | - María Luisa Montes
- Hospital Universitario de La Paz, Internal Medicine HIV Unit, Madrid, Spain
| | | | - Jorge Vergas
- Hospital Clínico San Carlos, Infectious Diseases, Granada, Spain
| | - Isabel Sanjoaquín
- Hospital Clínico Universitario Lozano Blesa, Infectious Diseases, Zaragoza, Spain
| | | | | | - Francisco Orihuela
- Hospital Regional Universitario de Málaga, Infectious Diseases, Málaga, Spain
| | - Arkaitz Imaz
- Hospital Universitario de Bellvitge, Infectious Diseases, Barcelona, Spain
| | - María José Ríos-Villegas
- Hospital Universitario Virgen Macarena, Infectious Diseases and Clinical Microbiology, Seville, Spain
| | - Juan Flores
- Hospital Arnau de Vilanova, Infectious Diseases, Valencia, Spain
| | - María Carmen Fariñas
- Hospital Universitario Marqués de Valdecilla, Infectious Diseases, Santander, Spain
| | - Pilar Vázquez
- Hospital Universitario Juan Canalejo, Infectious Diseases, La Coruña, Spain
| | - María José Galindo
- Hospital Clínico Universitario de Valencia, Infectious Diseases, Valencia, Spain
| | | | - Fernando Lozano
- Hospital Universitario Nuestra Señora de Valme, Infectious Diseases, Seville, Spain
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Mensa J, Barberán J, Soriano A, Llinares P, Marco F, Cantón R, Bou G, del Castillo JG, Maseda E, Azanza JR, Pasquau J, García-Vidal C, Reguera JM, Sousa D, Gómez J, Montejo M, Borges M, Torres A, Alvarez-Lerma F, Salavert M, Zaragoza R, Oliver A. Antibiotic selection in the treatment of acute invasive infections by Pseudomonas aeruginosa: Guidelines by the Spanish Society of Chemotherapy. Rev Esp Quimioter 2018; 31:78-100. [PMID: 29480677 PMCID: PMC6159363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Pseudomonas aeruginosa is characterized by a notable intrinsic resistance to antibiotics, mainly mediated by the expression of inducible chromosomic β-lactamases and the production of constitutive or inducible efflux pumps. Apart from this intrinsic resistance, P. aeruginosa possess an extraordinary ability to develop resistance to nearly all available antimicrobials through selection of mutations. The progressive increase in resistance rates in P. aeruginosa has led to the emergence of strains which, based on their degree of resistance to common antibiotics, have been defined as multidrug resistant, extended-resistant and panresistant strains. These strains are increasingly disseminated worldwide, progressively complicating the treatment of P. aeruginosa infections. In this scenario, the objective of the present guidelines was to review and update published evidence for the treatment of patients with acute, invasive and severe infections caused by P. aeruginosa. To this end, mechanisms of intrinsic resistance, factors favoring development of resistance during antibiotic exposure, prevalence of resistance in Spain, classical and recently appeared new antibiotics active against P. aeruginosa, pharmacodynamic principles predicting efficacy, clinical experience with monotherapy and combination therapy, and principles for antibiotic treatment were reviewed to elaborate recommendations by the panel of experts for empirical and directed treatment of P. aeruginosa invasive infections.
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Affiliation(s)
- José Mensa
- Servicio de Enfermedades Infecciosas, Hospital Clinic, Barcelona, Spain
| | - José Barberán
- Servicio de Medicina Enfermedades infecciosas, Hospital Universitario HM Montepríncipe, Universidad San Pablo CEU. Madrid, Spain
| | - Alex Soriano
- Servicio de Enfermedades Infecciosas, Hospital Clinic, Barcelona, Spain
| | - Pedro Llinares
- Unidad de Enfermedades Infecciosas, Complejo Hospitalario Universitario A Coruña, Spain
| | - Francesc Marco
- Servicio de Microbiología, Hospital Clinic, Barcelona, Spain
| | - Rafael Cantón
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS). Madrid, Spain
| | - German Bou
- Servicio de Microbiología, Complejo Hospitalario Universitario A Coruña, Spain
| | | | - Emilio Maseda
- Servicio de Anestesiología, Hospital Universitario La Paz, Madrid, Spain
| | - José Ramón Azanza
- Servicio de Farmacología, Clínica Universitaria de Navarra, Pamplona, Spain
| | - Juan Pasquau
- Servicio de Enfermedades Infecciosas, Hospital Universitario Virgen de la Nieves, Granada, Spain
| | | | - José María Reguera
- Servicio de Enfermedades Infecciosas, Hospital Universitario Carlos Haya, Málaga, Spain
| | - Dolores Sousa
- Unidad de Enfermedades Infecciosas, Complejo Hospitalario Universitario A Coruña, Spain
| | - Joaquín Gómez
- Servicio de Enfermedades Infecciosas, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Miguel Montejo
- Servicio de Enfermedades Infecciosas, Hospital Universitario Cruces, Bilbao, Spain
| | - Marcio Borges
- Servicio de Medicina Intensiva, Hospital Son Llátzer, Palma de Mallorca, Spain
| | - Antonio Torres
- Departamento de Neumología, Hospital Clinic, Barcelona, Spain
| | | | - Miguel Salavert
- Unidad de Enfermedades Infecciosas. Hospital Univeristario la Fe, Valencia, Spain
| | - Rafael Zaragoza
- Servicio de Medicina Intensiva, Hospital Universitario Dr. Peset, Valencia, Spain
| | - Antonio Oliver
- Servicio de Microbiología, Hospital Universitari Son Espases, Instituto de Investigación Sanitaria Illes Balears (idISBa), Palma de Mallorca, Spain
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Hidalgo-Tenorio C, Elisabeth de Jesus S, Fernández-Roldán C, Javier R, Pasquau J. Dalbavancina como tratamiento antibiótico de pacientes con endocarditis y/o bacteriemia por cocos grampositivos, en la práctica clínica habitual. Cirugía Cardiovascular 2018. [DOI: 10.1016/j.circv.2017.12.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Pérez-Parra S, Chueca N, Álvarez M, Pasquau J, Omar M, Collado A, Vinuesa D, Lozano AB, Yebra G, García F. High prevalence and diversity of HIV-1 non-B genetic forms due to immigration in southern Spain: A phylogeographic approach. PLoS One 2017; 12:e0186928. [PMID: 29084239 PMCID: PMC5662216 DOI: 10.1371/journal.pone.0186928] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 10/10/2017] [Indexed: 11/18/2022] Open
Abstract
Phylogenetic studies are a valuable tool to understand viral transmission patterns and the role of immigration in HIV-1 spread. We analyzed the spatio-temporal relationship of different HIV-1 non-B subtype variants over time using phylogenetic analysis techniques. We collected 693 pol (PR+RT) sequences that were sampled from 2005 to 2012 from naïve patients in different hospitals in southern Spain. We used REGA v3.0 to classify them into subtypes and recombinant forms, which were confirmed by phylogenetic analysis through maximum likelihood (ML) using RAxML. For the main HIV-1 non-B variants, publicly available, genetically similar sequences were sought using HIV-BLAST. The presence of HIV-1 lineages circulating in our study population was established using ML and Bayesian inference (BEAST v1.7.5) and transmission networks were identified. We detected 165 (23.4%) patients infected with HIV-1 non-B variants: 104 (63%) with recombinant viruses in pol: CRF02_AG (71, 43%), CRF14_BG (8, 4.8%), CRF06_cpx (5, 3%) and nine other recombinant forms (11, 6.7%) and unique recombinants (9, 5.5%). The rest (61, 37%) were infected with non-recombinant subtypes: A1 (30, 18.2%), C (7, [4.2%]), D (3, [1.8%]), F1 (9, 5.5%) and G (12, 7.3%). Most patients infected with HIV-1 non-B variants were men (63%, p < 0.001) aged over 35 (73.5%, p < 0.001), heterosexuals (92.2%, p < 0.001), from Africa (59.5%, p < 0.001) and living in the El Ejido area (62.4%, p<0.001). We found lineages of epidemiological relevance (mainly within Subtype A1), imported primarily through female sex workers from East Europe. We detected 11 transmission clusters of HIV-1 non-B Subtypes, which included patients born in Spain in half of them. We present the phylogenetic profiles of the HIV-1 non-B variants detected in southern Spain, and explore their putative geographical origins. Our data reveals a high HIV-1 genetic diversity likely due to the import of viral lineages that circulate in other countries. The highly immigrated El Ejido area acts as a gateway through which different subtypes are introduced into other regions, hence the importance of setting up epidemiological control measures to prevent future outbreaks.
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Affiliation(s)
- Santiago Pérez-Parra
- Servicio de Microbiología Clínica, Hospital Universitario San Cecilio, Campus de la Salud e Instituto de Investigación IBS, Granada, Spain
| | - Natalia Chueca
- Servicio de Microbiología Clínica, Hospital Universitario San Cecilio, Campus de la Salud e Instituto de Investigación IBS, Granada, Spain
| | - Marta Álvarez
- Servicio de Microbiología Clínica, Hospital Universitario San Cecilio, Campus de la Salud e Instituto de Investigación IBS, Granada, Spain
| | - Juan Pasquau
- Servicio de Infecciosas, Hospital Virgen de las Nieves, Granada, Spain
| | - Mohamed Omar
- Servicio de Infecciosas, Hospital Ciudad de Jaén, Jaén, Spain
| | - Antonio Collado
- Servicio de Medicina Interna, Hospital de Torrecárdenas, Almería, Spain
| | - David Vinuesa
- Servicio de Infecciosas, Hospital Universitario San Cecilio, Granada, Spain
| | | | - Gonzalo Yebra
- The Roslin Institute, University of Edinburgh, Edinburgh, the United Kingdom
| | - Federico García
- Servicio de Microbiología Clínica, Hospital Universitario San Cecilio, Campus de la Salud e Instituto de Investigación IBS, Granada, Spain
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Hidalgo-Tenorio C, Gil-Anguita C, Ramírez-Taboada J, Esquivias J, López-Ruz MA, Balgahata OM, Javier-Martinez R, Pasquau J. Risk factors for infection by oncogenic human papillomaviruses in HIV-positive MSM patients in the ART era (2010-2016). Medicine (Baltimore) 2017; 96:e8109. [PMID: 28953633 PMCID: PMC5626276 DOI: 10.1097/md.0000000000008109] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Squamous cell carcinoma of anus (SCCA) is one of the most frequent non-AIDS-defining diseases in HIV patients, mainly in men who have sex with men (MSM), and it is associated with human papillomavirus (HPV) infection.To determine the prevalence of high-risk HPV (HR-HPV) genotypes, premalignant lesions (HSIL) and SCCA in a cohort of HIV-positive MSM; to study the distribution of HPV genotypes according to anal histology results; and to analyze risk factors for this infection.This prospective single-center study was conducted between May 2010 and September 2016. At the study visit, cotton swabs were used to collect anal samples for cytology study in ThinPrep Pap Test liquid medium (Thin Prep Processor 2000, Hologic Corp, USA), and for HPV PCR (Linear Array HPV Genotyping Test). After, high-resolution anoscopy (HRA) (Zeiss 150 fc) was carried out. Logistic regression analysis was performed to identify risk factors for HR-HPV infection.The study included 319 patients, with mean age of 36.7 years; HR-HPV was detected in 81.3%. The prevalence of HSIL was 13.5% and SCCA was 0.3%. With regard to the distribution of HPV genotypes according to histology results, HPV 16 was the most frequent genotype in normal anal mucosa (26.7%), in LSILs (36.9%), and in HSILs (38%). In multivariate analysis, CD4 nadir < 200 cells/μL was the factor associated with infection by HR-HPV (OR 3.66, 95% CI 1.05%-12.75%).HIV-positive MSM showed a high prevalence of HSIL+ lesions and of infection by oncogenic HPV, which appears to be favored by a deficient immune system. HPV 16 was the most frequently isolated genotype in anal mucosa, regardless of lesion type.
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Affiliation(s)
| | | | | | - Javier Esquivias
- Department of Pathology, Virgen de las Nieves University Hospital, Granada
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Hidalgo-Tenorio C, Ramírez-Taboada J, Gil-Anguita C, Esquivias J, Omar-Mohamed-Balgahata M, SamPedro A, Lopez-Ruz M, Pasquau J. Safety and immunogenicity of the quadrivalent human papillomavirus (qHPV) vaccine in HIV-positive Spanish men who have sex with men (MSM). AIDS Res Ther 2017; 14:34. [PMID: 28720147 PMCID: PMC5516305 DOI: 10.1186/s12981-017-0160-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 07/11/2017] [Indexed: 01/05/2023] Open
Abstract
Background Safety and immunogenicity of the quadrivalent human papillomavirus (qHPV) vaccine were evaluated in HIV-positive Spanish MSM. The prevalence of High Squamous Intraepithelial Lesions (HSIL) and genotypes of high-risk human papillomavirus (HR-HPV) were also determined, as well as risk factors associated with the presence of HR-HPV in anal mucosa. Methods This is a randomised, double blind, placebo-controlled trial of the quadrivalent HPV (qHPV) vaccine. The study enrolled from May 2012 to May 2014. Vaccine and placebo were administered at 0, 2 and 6 months (V1, V2, V3 clinical visits). Vaccine antibody titres were evaluated at 7 months. Cytology (Thin Prep® Pap Test), HPV PCR genotyping (Linear Array HPV Genotyping Test), and high-resolution anoscopy (Zeiss 150 fc© colposcope) were performed at V1. Results Patients (n = 162; mean age 37.9 years) were screened for inclusion; 14.2% had HSIL, 73.1% HR-HPV and 4.5% simultaneous infection with HPV16 and 18. Study participants (n = 129) were randomized to qHPV vaccine or placebo. The most common adverse event was injection-site pain predominating in the placebo group [the first dose (83.6% vs. 56.1%; p = 0.0001]; the second dose (87.8% vs. 98.4%; p = 0.0001); the third dose (67.7% vs. 91.9%; p = 0.0001). The vaccine did not influence either the viral load of HIV or the levels of CD4. Of those vaccinated, 76% had antibodies to HPV vs. 30.2% of those receiving placebo (p = 0.0001). In the multivariate analysis, Older age was associated with lower HR-HPV infection (RR 0.97; 95% CI 0.96–0.99), and risk factor were viral load of HIV >200 copies/µL (RR 1.42 95% CI 1.17–1.73) and early commencement of sexual activity (RR 1.35; 95% CI 1.001–1.811). Conclusions This trial showed significantly higher anti-HR-HPV antibody titres in vaccinated individuals than in unvaccinated controls. There were no serious adverse events attributable to the vaccine. In our cohort, 1 of every 7 patients had HSIL and the prevalence of combined infection by genotypes 16 and 18 was low. This suggests that patients could benefit from receiving qHPV vaccine. Older age was the main protective factor against HR-HPV infection, and non-suppressed HIV viremia was a risk factor. Clinical trial registration: ISRCTN14732216 (http://www.isrctn.com/ISRCTN14732216).
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Ribera E, Martínez-Sesmero JM, Sánchez-Rubio J, Rubio R, Pasquau J, Poveda JL, Pérez-Mitru A, Roldán C, Hernández-Novoa B. Economic impact of optimising antiretroviral treatment in human immunodeficiency virus-infected adults with suppressed viral load in Spain, by implementing the grade A-1 evidence recommendations of the 2015 GESIDA/National AIDS Plan. Enferm Infecc Microbiol Clin 2017; 36:157-164. [PMID: 28109551 DOI: 10.1016/j.eimc.2016.11.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 11/05/2016] [Accepted: 11/27/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The objective of this study is to estimate the economic impact associated with the optimisation of triple antiretroviral treatment (ART) in patients with undetectable viral load according to the recommendations from the GeSIDA/PNS (2015) Consensus and their applicability in the Spanish clinical practice. METHODS A pharmacoeconomic model was developed based on data from a National Hospital Prescription Survey on ART (2014) and the A-I evidence recommendations for the optimisation of ART from the GeSIDA/PNS (2015) consensus. The optimisation model took into account the willingness to optimise a particular regimen and other assumptions, and the results were validated by an expert panel in HIV infection (Infectious Disease Specialists and Hospital Pharmacists). The analysis was conducted from the NHS perspective, considering the annual wholesale price and accounting for deductions stated in the RD-Law 8/2010 and the VAT. RESULTS The expert panel selected six optimisation strategies, and estimated that 10,863 (13.4%) of the 80,859 patients in Spain currently on triple ART, would be candidates to optimise their ART, leading to savings of €15.9M/year (2.4% of total triple ART drug cost). The most feasible strategies (>40% of patients candidates for optimisation, n=4,556) would be optimisations to ATV/r+3TC therapy. These would produce savings between €653 and €4,797 per patient per year depending on baseline triple ART. CONCLUSION Implementation of the main optimisation strategies recommended in the GeSIDA/PNS (2015) Consensus into Spanish clinical practice would lead to considerable savings, especially those based in dual therapy with ATV/r+3TC, thus contributing to the control of pharmaceutical expenditure and NHS sustainability.
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Affiliation(s)
- Esteban Ribera
- Servicio de Enfermedades Infecciosas, Hospital Universitari Vall d'Hebron, Barcelona, España.
| | | | | | - Rafael Rubio
- Unidad de Infección VIH, Hospital Universitario 12 de Octubre, Madrid, España
| | - Juan Pasquau
- Sección de Enfermedades Infecciosas, Hospital Universitario Virgen de las Nieves, Granada, España
| | - José Luis Poveda
- Servicio de Farmacia, Hospital Universitari i Politècnic La Fe de Valencia, Valencia, España
| | | | - Celia Roldán
- Departamento Médico, Bristol-Myers Squibb, Madrid, España
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Poveda E, Hernández-Quero J, Pérez-Elías MJ, Ribas MA, Martínez-Madrid OJ, Flores J, Navarro J, Gutiérrez F, García-Deltoro M, Imaz A, Ocampo A, Artero A, Blanco F, Bernal E, Pasquau J, Mínguez-Gallego C, Pérez N, Aiestaran A, García F, Paredes R. Genotypic tropism testing of proviral DNA to guide maraviroc initiation in aviraemic subjects: 48-week analysis of results from the PROTEST study. HIV Med 2016; 18:482-489. [PMID: 28035758 DOI: 10.1111/hiv.12479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2016] [Indexed: 12/28/2022]
Abstract
OBJECTIVES Maraviroc (MVC) is a suitable drug for aviraemic subjects on antiretroviral treatment (ART) developing toxicity. Its prescription requires prior tropism testing. It is unknown if proviral DNA genotypic tropism testing is reliable for guiding MVC initiation in aviraemic subjects, so this study was carried out to address this issue. METHODS PROTEST was a phase 4, prospective, single-arm clinical trial carried out in 24 HIV care centres in Spain. MVC-naïve HIV-1-infected patients with HIV-1 RNA < 50 copies/mL on stable ART during the previous 6 months who required an ART change because of toxicity and who had R5 HIV, as determined by proviral DNA genotypic tropism testing, initiated MVC with two nucleoside reverse transcriptase inhibitors (NRTIs) and were followed for 48 weeks. Virological failure was defined as two consecutive viral load measurements > 50 copies/mL. RESULTS Tropism results were available for 141 of 175 (80.6%) subjects screened: 60% had R5 and 85% of these (n = 74) were finally included in the study. Previous ART included protease inhibitors (PIs) in 62% of subjects, nonnucleoside reverse transcriptase inhibitors (NNRTIs) in 36%, and integrase inhibitors (INIs) in 2%. Main reasons for treatment change were dyslipidaemia (42%), gastrointestinal symptoms (22%) and liver toxicity (15%). MVC was given alongside tenofovir (TDF)/emtricitabine (FTC) (54%) and abacavir (ABC)/lamivudine (3TC) (40%) in most patients. Eighty-four per cent of patients maintained a viral load < 50 copies/mL to week 48, whereas 16% discontinued treatment: two withdrew informed consent, one had an R5 to X4 shift between screening and baseline, one was lost to follow-up, one developed an adverse event (rash), two died from non-study-related causes, and five developed protocol-defined virological failure. CONCLUSIONS Initiation of MVC plus two NRTIs in aviraemic subjects based on genotypic tropism testing of proviral HIV-1 DNA is associated with low rates of virological failure for up to 1 year.
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Affiliation(s)
- E Poveda
- Instituto de Investigación Biomédica de A Coruña (INIBIC)-Complejo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain
| | | | | | - M A Ribas
- Hospital Son Espases, Palma de Mallorca, Spain
| | | | - J Flores
- Hospital Arnau de Vilanova, Valencia, Spain
| | - J Navarro
- Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - F Gutiérrez
- Hospital Universitario de Elche, Elche, Spain
| | | | - A Imaz
- Hospital Universitari de Bellvitge, Barcelona, Spain
| | - A Ocampo
- Hospital Xeral de Vigo, Vigo, Spain
| | - A Artero
- Hospital Universitario Dr. Peset, Valencia
| | - F Blanco
- Hospital Carlos III, Madrid, Spain
| | - E Bernal
- Hospital Reina Sofía, Murcia, Spain
| | - J Pasquau
- Hospital Virgen de la Nieves, Granada, Spain
| | | | - N Pérez
- Universitat Politécnica de Catalunya, Barcelona, Spain
| | - A Aiestaran
- Universitat Politécnica de Catalunya, Barcelona, Spain
| | - F García
- Hospital Universitario San Cecilio, Granada, Spain
| | - R Paredes
- HIV Unit and irsiCaixa AIDS Research Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
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Pérez-Parra S, Chueca N, Álvarez M, Pasquau J, Omar M, Collado A, Vinuesa D, Lozano AB, Yebra G, García F. Phylodynamic and Phylogeographic Profiles of Subtype B HIV-1 Epidemics in South Spain. PLoS One 2016; 11:e0168099. [PMID: 28002469 PMCID: PMC5176287 DOI: 10.1371/journal.pone.0168099] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 11/23/2016] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Since 1982, HIV-1 epidemics have evolved to different scenarios in terms of transmission routes, subtype distribution and characteristics of transmission clusters. We investigated the evolutionary history of HIV-1 subtype B in south Spain. PATIENTS & METHODS We studied all newly diagnosed HIV-1 subtype B patients in East Andalusia during the 2005-2012 period. For the analysis, we used the reverse transcriptase and protease sequences from baseline resistance, and the Trugene® HIV Genotyping kit (Siemens, Barcelona, Spain). Subtyping was done with REGA v3.0. The maximum likelihood trees constructed with RAxML were used to study HIV-1 clustering. Phylogeographic and phylodynamic profiles were studied by Bayesian inference methods with BEAST v1.7.5 and SPREAD v1.0.6. RESULTS Of the 493 patients infected with HIV-1 subtype B, 234 grouped into 55 clusters, most of which were small (44 clusters ≤ 5 patients, 31 with 2 patients, 13 with 3). The rest (133/234) were grouped into 11 clusters with ≥ 5 patients, and most (82%, 109/133) were men who have sex with men (MSM) grouped into 8 clusters. The association with clusters was more frequent in Spanish (p = 0.02) men (p< 0.001), MSM (p<0.001) younger than 35 years (p = 0.001) and with a CD4+ T-cell count above 350 cells/ul (p<0.001). We estimated the date of HIV-1 subtype B regional epidemic diversification around 1970 (95% CI: 1965-1987), with an evolutionary rate of 2.4 (95%CI: 1.7-3.1) x 10-3 substitutions/site/year. Most clusters originated in the 1990s in MSMs. We observed exponential subtype B HIV-1 growth in 1980-1990 and 2005-2008. The most significant migration routes for subtype B went from inland cities to seaside locations. CONCLUSIONS We provide the first data on the phylodynamic and phylogeographic profiles of HIV-1 subtype B in south Spain. Our findings of transmission clustering among MSMs should alert healthcare managers to enhance preventive measures in this risk group in order to prevent future outbreaks.
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Affiliation(s)
- Santiago Pérez-Parra
- Servicio de Microbiología Clínica, Hospital Universitario San Cecilio, Complejo Hospitalario e Instituto de Investigación IBS, Granada, Spain
| | - Natalia Chueca
- Servicio de Microbiología Clínica, Hospital Universitario San Cecilio, Complejo Hospitalario e Instituto de Investigación IBS, Granada, Spain
| | - Marta Álvarez
- Servicio de Microbiología Clínica, Hospital Universitario San Cecilio, Complejo Hospitalario e Instituto de Investigación IBS, Granada, Spain
| | - Juan Pasquau
- Servicio de Infecciosas, Hospital Virgen de las Nieves, Granada, Spain
| | - Mohamed Omar
- Servicio de Infecciosas, Hospital Ciudad de Jaén, Jaén, Spain
| | - Antonio Collado
- Servicio de Medicina Interna, Hospital de Torrecárdenas, Almería, Spain
| | - David Vinuesa
- Servicio de Infecciosas, Hospital Universitario San Cecilio, Granada, Spain
| | - Ana B. Lozano
- Servicio de Infecciosas, Hospital de Poniente, Almería, Spain
| | - Gonzalo Yebra
- Institute of Evolutionary Biology, University of Edinburgh, Edinburgh, United Kingdom
| | - Federico García
- Servicio de Microbiología Clínica, Hospital Universitario San Cecilio, Complejo Hospitalario e Instituto de Investigación IBS, Granada, Spain
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Perez-Molina JA, Rubio R, Rivero A, Pasquau J, Suárez-Lozano I, Riera M, Estébanez M, Palacios R, Sanz-Moreno J, Troya J, Mariño A, Antela A, Navarro J, Esteban H, Moreno S. Simplification to dual therapy (atazanavir/ritonavir + lamivudine) versus standard triple therapy [atazanavir/ritonavir + two nucleos(t)ides] in virologically stable patients on antiretroviral therapy: 96 week results from an open-label, non-inferiority, randomized clinical trial (SALT study). J Antimicrob Chemother 2016; 72:246-253. [DOI: 10.1093/jac/dkw379] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 08/02/2016] [Accepted: 08/10/2016] [Indexed: 11/13/2022] Open
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Pasquau J, Sadyrbaeva S, De Jesús SE, Hidalgo-Tenorio C. [The role of antimicrobial stewardship programs in the control of bacterial resistance]. Rev Esp Quimioter 2016; 29 Suppl 1:47-51. [PMID: 27608314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
In order to improve infection prognosis and reduce the existing microbial resistance problem (a challenge similar to that of climate change), a higher implication of the Administration, an increased level of social awareness and the development of specific corporate networks, including the pharmaceutical industry, is needed. However, we must first consolidate Antimicrobial Stewardship Programmes with experts who seek to improve antibiotic therapy effectivity in severe infections and to reduce global antibiotic exposure.
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Affiliation(s)
- J Pasquau
- Juan Pasquau, Unidad de Enfermedades Infecciosas. Hospital Virgen de las Nieves. Complejo Hospitalario Universitario de Granada, Spain.
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Lopez-Ruz MA, Navas P, López-Zúñiga MA, Gonzalvo MC, Sampedro A, Pasquau J, Hidalgo-Tenorio C, Javier R, Castilla JA. Effect of Monotherapy with Darunavir/Ritonavir on Viral Load in Seminal Fluid, and Quality Parameters of Semen in HIV-1-Positive Patients. PLoS One 2016; 11:e0159305. [PMID: 27442068 PMCID: PMC4956273 DOI: 10.1371/journal.pone.0159305] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 06/30/2016] [Indexed: 01/05/2023] Open
Abstract
Patients with human immunodeficiency virus type 1 (HIV-1) who receive antiretroviral therapy (ART) often achieve increased survival and improved quality of life. In this respect, monotherapy with darunavir/ritonavir (mDRV/r) can be a useful treatment strategy. This prospective study analyses the effect of mDRV/r on sperm quality and viral load in a group of 28 patients who had previously been given conventional ART and who had recorded a viral load <20 copies/mL for at least six months. These patients were given mDRV/r at a dose of 800/100 mg for 48 weeks. At baseline (V0), CD4, CD8, FSH, LH and testosterone levels were measured, together with HIV-1 viral load in plasma and semen. In addition, seminal fluid quality was studied before mDRV/r treatment was prescribed. At week 48 (V1), HIV-1 viral load in plasma and semen and the quality of the seminal fluid were again measured. The results obtained indicate that at V0, 10% of the patients with ART had a positive viral load in seminal fluid (>20 copies/ml), and that at V1, after mDRV/r treatment, this figure had fallen to 3%. The quality of seminal fluid was close to normal in 57% of patients at V0 and in 62% at V1. We conclude that, similar to ART, mDRV/r maintains HIV-1 viral load in most patients, and that there is no worsening in seminal fluid quality.
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Affiliation(s)
- Miguel A. Lopez-Ruz
- Unidad de Enfermedades Infecciosas, Hospital Virgen de las Nieves, Complejo Hospitalario Universitario Granada, Instituto de Investigación Biosanitaria de Granada (IIBG), Granada, Spain
- * E-mail:
| | - Purificación Navas
- Unidad Reproducción, UGC Laboratorio Clínico y UGC Obstetricia y Ginecología, Complejo Hospitalario Universitario Granada, Instituto de Investigación Biosanitaria de Granada (IIBG), Granada, Spain
- Dpto. Anatomía y Embriología Humana, Programa del Doctorado de Biomedicina Regenerativa, Universidad de Granada, Granada, Spain
| | - Miguel A. López-Zúñiga
- Unidad de Enfermedades Infecciosas, Hospital Virgen de las Nieves, Complejo Hospitalario Universitario Granada, Instituto de Investigación Biosanitaria de Granada (IIBG), Granada, Spain
| | - María Carmen Gonzalvo
- Unidad Reproducción, UGC Laboratorio Clínico y UGC Obstetricia y Ginecología, Complejo Hospitalario Universitario Granada, Instituto de Investigación Biosanitaria de Granada (IIBG), Granada, Spain
| | - Antonio Sampedro
- Unidad de Microbiología, Hospital Virgen de las Nieves, Complejo Hospitalario Universitario Granada, Instituto de Investigación Biosanitaria de Granada (IIBG), Granada, Spain
| | - Juan Pasquau
- Unidad de Enfermedades Infecciosas, Hospital Virgen de las Nieves, Complejo Hospitalario Universitario Granada, Instituto de Investigación Biosanitaria de Granada (IIBG), Granada, Spain
| | - Carmen Hidalgo-Tenorio
- Unidad de Enfermedades Infecciosas, Hospital Virgen de las Nieves, Complejo Hospitalario Universitario Granada, Instituto de Investigación Biosanitaria de Granada (IIBG), Granada, Spain
| | - Rosario Javier
- Unidad de Enfermedades Infecciosas, Hospital Virgen de las Nieves, Complejo Hospitalario Universitario Granada, Instituto de Investigación Biosanitaria de Granada (IIBG), Granada, Spain
| | - José A. Castilla
- Unidad Reproducción, UGC Laboratorio Clínico y UGC Obstetricia y Ginecología, Complejo Hospitalario Universitario Granada, Instituto de Investigación Biosanitaria de Granada (IIBG), Granada, Spain
- Dpto. Anatomía y Embriología Humana, Programa del Doctorado de Biomedicina Regenerativa, Universidad de Granada, Granada, Spain
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Pasquau J, Hidalgo-Tenorio C. Nuke-Sparing Regimens for the Long-Term Care of HIV Infection. AIDS Rev 2015; 17:220-230. [PMID: 26679853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
With the efficacy of antiretroviral therapy already guaranteed for all practical purposes, the main objective in the management of HIV-positive patients has moved to reduce and prevent potential long-term toxicities. Nucleos(t)ide-sparing regimens could enable the best to address this issue, with a wide range of current options that may allow adaptation to distinct patient populations. Monotherapy with boosted darunavir and lopinavir has been safely prescribed as maintenance therapy to stable patients on stable antiretroviral therapy without nadir CD4 count < 200/mm³, low-level baseline viremia, prolonged viral suppression, and without prior virologic failure. In the presence of all these requirements, dual therapy with lamivudine plus boosted lopinavir or atazanavir has been shown to be equivalent to standard triple therapy. Other nucleoside-sparing dual therapies, especially using raltegravir combined with boosted darunavir or lopinavir and etravirine or rilpivirine in combination with boosted darunavir, have performed well as simplification strategies or rescue interventions in a wide spectrum of patients as long as drug resistance was absent. With current economical constrains, nuke-sparing regimens have attained a degree of maturity that makes it possible to anticipate that they will play an important role in the optimization of antiretroviral therapy in the near future.
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Affiliation(s)
- Juan Pasquau
- Infectious Doseases Unit, Virgen de las Nieves University Hospital, Complejo Hospitalario, Granada, Spain
| | - Carmen Hidalgo-Tenorio
- Infectious Doseases Unit, Virgen de las Nieves University Hospital, Complejo Hospitalario, Granada, Spain
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Pasquau J, Matesanz M. [Duration of antimicrobial therapy]. Rev Esp Quimioter 2015; 28 Suppl 1:30-33. [PMID: 26365731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The management of infectious diseases is always complex, not only because of its high incidence and mortality, but the difficulty of designing effective treatments that minimize the development of bacterial resistance in the clinical setting. One of the most important options is the reduction of exposure to antibiotic treatment, optimizing by desescalation and shortening the duration of therapy.
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Affiliation(s)
- Juan Pasquau
- Juan Pasquau Liaño, Unidad de Enfermedades Infecciosas. Hospital Virgen de las Nieves, Granada, Spain.
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Blanco JR, Arroyo-Manzano D, Rojas-Liévano JF, Crespo M, Bravo I, Pasquau J, Garcia Del Toro M, Herrero C, Rivero A, Moreno S, Llibre JM. The efficacy and safety of maraviroc addition to a stable antiretroviral regimen in subjects with suppressed plasma HIV-RNA is not influenced by age. AIDS Res Hum Retroviruses 2015; 31:893-7. [PMID: 26059859 DOI: 10.1089/aid.2015.0016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
There are few data about the immunovirological efficacy, safety/tolerability, and durability of maraviroc (MVC) addition to aging patients on suppressive antiretroviral therapy (cART) and undetectable viral load (<50 copies/ml). The aging population is underrepresented in most HIV clinical trials. This study included 80 patients aged ≥50 years and 161 aged <50 years and showed that after 48 weeks of treatment, there was no between-group differences in the median increase of CD4(+) T cells or the virological suppression rate. Safety and tolerability were also comparable. In multivariable analysis, the effect of age was not modified and was independent of the response to MVC. An immunological recovery of ≥100 CD4(+) T cells was significantly less common in those with a longer HIV history (≥15 years) (OR 0.43; p=0.016) or having <200/mm(3) CD4(+) T cells at MVC initiation (OR 0.27; p=0.004). Meanwhile, achieving a CD4/CD8 ratio ≥0.5 at week 48 was less likely in those with CD4(+) T cell counts <200 at MVC initiation (OR 0.09; p<0.0001) or with a previous AIDS event (OR 0.43; p=0.028). In summary, the immunovirological efficacy, safety/tolerability, and durability of MVC addition in patients virologically suppressed were independent of the patient's age at treatment onset.
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Affiliation(s)
| | | | | | - Manuel Crespo
- Hospital Universitari Vall d'Hebrón, Barcelona, Spain
| | - Isa Bravo
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Juan Pasquau
- Hospital Universitario Virgen de las Nieves, Granada, Spain
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Perez-Molina JA, Rubio R, Rivero A, Pasquau J, Suárez-Lozano I, Riera M, Estébanez M, Santos J, Sanz-Moreno J, Troya J, Mariño A, Antela A, Navarro J, Navarro J, Esteban H, Moreno S. Dual treatment with atazanavir-ritonavir plus lamivudine versus triple treatment with atazanavir-ritonavir plus two nucleos(t)ides in virologically stable patients with HIV-1 (SALT): 48 week results from a randomised, open-label, non-inferiority trial. Lancet Infect Dis 2015; 15:775-84. [PMID: 26062881 DOI: 10.1016/s1473-3099(15)00097-3] [Citation(s) in RCA: 98] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 03/18/2015] [Accepted: 03/20/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Problems associated with lifelong antiretroviral therapy, such as need for strict adherence, drug-related toxic effects, difficulties with treatment schedules, and cost, mean that simplification strategies should be sought. We aimed to explore the efficacy and safety of dual treatment with atazanavir-ritonavir plus lamivudine as an option to switch to from standard combination antiretroviral therapy in patients with an HIV-1 infection who are virologically suppressed. METHODS In this randomised, open-label, non-inferiority trial, we recruited patients aged 18 years and older with chronic HIV-1 infection and no previous treatment failure or resistance, and with HIV-1 RNA of less than 50 copies per mL for at least 6 months, negative hepatitis B virus surface antigen, and good general health, from 30 hospitals in Spain. Exclusion criteria were switch in antiretroviral therapy during the previous 4 months, previous virological failure, pregnancy or breastfeeding, Gilbert's syndrome, use of contraindicated drugs, grade 4 laboratory abnormalities, and previous intolerance to any of the study drugs. We randomly assigned patients (1:1; stratified by active hepatitis C virus infection and previous treatment; computer-generated random number sequence) to dual treatment with oral atazanavir (300 mg once daily) and ritonavir (100 mg once daily) plus lamivudine (300 mg once daily) or triple treatment with oral atazanavir (300 mg once daily) and ritonavir (100 mg once daily) plus two nucleos(t)ide reverse transcriptase inhibitors at the discretion of the investigators. The primary endpoint was virological response, defined as HIV-1 RNA of less than 50 copies per mL at week 48, in the per-protocol population, with a non-inferiority margin of 12%. We included patients who received at least one dose of the study drug in the safety analysis. This study is registered at ClinicalTrials.gov, number NCT01307488. FINDINGS Between Sept 29, 2011, and May 2, 2013, we randomly assigned 286 patients (143 [50%] to each group). At week 48 in the per-protocol population, 112 (84%) of 133 patients had virological response in the dual-treatment group versus 105 (78%) of 135 in the triple-treatment group (difference 6% [95% CI -5 to 16%), showing non-inferiority at the prespecified level. 14 (5%) patients developed severe adverse events (dual treatment six [4%]; triple treatment eight [6%]), none of which we deemed related to the study drug. Grade 3-4 adverse events were similar between groups (dual treatment 77 [55%] of 140; triple treatment 78 [55%] of 141). Treatment discontinuations were less frequent in the dual-treatment group (three [2%]) than in the triple-treatment group (ten [7%]; p=0·047). INTERPRETATION In our trial, dual treatment was effective, safe, and non-inferior to triple treatment in patients with an HIV-1 infection who are virologically suppressed who switch antiretroviral therapy because of toxic effects, intolerance, or simplification. This combination has the potential to suppress some of the long-term toxic effects associated with nucleos(t)ide reverse transcriptase inhibitors, preserve future treatment options, and reduce the cost of antiretroviral therapy. FUNDING Bristol Myers-Squibb and Fundación SEIMC-GESIDA.
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Affiliation(s)
- José A Perez-Molina
- Infectious Diseases Department, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain.
| | - Rafael Rubio
- HIV Clinic, Hospital Universitario Doce de Octubre, Madrid, Spain
| | - Antonio Rivero
- Infectious Diseases Unit, Hospital Universitario Reina Sofia, Instituto Maimónides de Investigación Biomédica de Córdoba, Córdoba, Spain
| | - Juan Pasquau
- Infectious Diseases Unit, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Ignacio Suárez-Lozano
- Infectious Diseases Unit, Complejo Hospitalario Universitario de Huelva, Huelva, Spain
| | - Melcior Riera
- Infectious Diseases Unit, Hospital Son Espases, Mallorca, Spain
| | - Miriam Estébanez
- Internal Medicine Department, Hospital Universitario La Paz, Instituto de Investigation Sanitaria del Hospital Universitario La Paz, Madrid, Spain
| | - Jesús Santos
- Infectious Diseases Clinical Management Unit, Hospital Virgen de la Victoria, Málaga, Spain
| | - José Sanz-Moreno
- Infectious Diseases Unit, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Spain
| | - Jesús Troya
- Internal Medicine Department, Hospital Infanta Leonor, Madrid, Spain
| | - Ana Mariño
- Infectious Diseases Unit, Internal Medicine Department, Complejo Hospitalario Universitario de Ferrol, Ferrol, Spain
| | - Antonio Antela
- Infectious Diseases Unit, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain
| | | | - José Navarro
- Infectious Diseases Department, Hospital Universitari Vall d'Hebrón, Barcelona, Spain
| | - Herminia Esteban
- Fundación Spanish Society of Infectious Diseases and Clinical Microbiology-Fundación SEIMC-GESIDA, Madrid, Spain
| | - Santiago Moreno
- Infectious Diseases Department, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain
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Llibre JM, Rivero A, Rojas JF, Garcia Del Toro M, Herrero C, Arroyo D, Pineda JA, Pasquau J, Masiá M, Crespo M, Blanco JR, Moreno S. Safety, efficacy and indications of prescription of maraviroc in clinical practice: Factors associated with clinical outcomes. Antiviral Res 2015; 120:79-84. [PMID: 25977241 DOI: 10.1016/j.antiviral.2015.05.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 04/29/2015] [Accepted: 05/05/2015] [Indexed: 11/18/2022]
Abstract
Maraviroc is approved for treatment-experienced HIV+ adults in twice-daily administration. Limited data are available on safety, efficacy and use in routine clinical practice, outside of restrictive clinical trials. This retrospective multicenter (27 centers) study included 667 subjects starting a regimen with maraviroc. The primary endpoint was plasma HIV-RNA <50copies/mL and CD4(+) cell count change at 48 and 96weeks (FDA snapshot analysis). 94.4% had CCR5 tropism (58.3% Trofile™, 29.2% population genotype, and 12% genotyping proviral DNA). Half of the subjects received the drug in scenarios or dosages outside the initial approval. Maraviroc was prescribed for salvage in 346 (51.9%) individuals, as a switch strategy due to toxicity in 135 (38.7%), for immune discordance in 75 (11.2%), and for simplification in 48 (7.2%). After salvage therapy, 223 (64.5%) subjects had HIV-RNA <50copies/mL at 48weeks, and 178 (51.4%) at 96weeks. Darunavir/r was included in 224 (64.7%) subjects and associated with higher rates of virological and immunologic efficacy (p<0.001). In multivariate analysis MSM (OR 2.25; 95%CI 1.29-3.94) and baseline HIV-RNA <100,000copies/mL (OR 1.96; 1.06-3.70) were associated with virological suppression. An increase in CD4(+) counts was seen at 48 and 96weeks in subjects with immune discordance (p<0.001). Maraviroc was used once-daily in 142 (21.3%) subjects overall, and 68 (57.4%) in switch/simplification. No new safety signals were identified. Besides in salvage regimens, maraviroc was frequently used in switch due to toxicity, simplification, and immune discordance. The efficacy in salvage in clinical practice was higher than in phase III clinical trials, likely due to availability of new active drugs in the regimen. These results increase our understanding of the efficacy, safety, and conditions of prescription of maraviroc beyond the initial registrational trials and the early manufacturer pharmacovigilance programs.
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Affiliation(s)
- Josep M Llibre
- HIV Unit and "Lluita contra la SIDA" Foundation, Hospital Universitari Germans Trias i Pujol, Badalona, Universitat Autònoma de Barcelona, Spain.
| | | | | | | | - Cristina Herrero
- HIV Unit and "Lluita contra la SIDA" Foundation, Hospital Universitari Germans Trias i Pujol, Badalona, Universitat Autònoma de Barcelona, Spain
| | - David Arroyo
- Clinical Biostatistics Unit, Hospital Ramón y Cajal, CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | | | - Juan Pasquau
- Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Mar Masiá
- Hospital Universitario de Elche, Spain
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Sadyrbaeva S, Aznarte Padial P, Hidalgo Tenorio C, Pasquau J, Salazar Bravo M. PS-053 Analysis of the use of fidaxomicin in a tertiary university hospital. Eur J Hosp Pharm 2015. [DOI: 10.1136/ejhpharm-2015-000639.378] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Shaw E, Miró JM, Puig-Asensio M, Pigrau C, Barcenilla F, Murillas J, Garcia-Pardo G, Espejo E, Padilla B, Garcia-Reyne A, Pasquau J, Rodriguez-Baño J, López-Contreras J, Montero M, de la Calle C, Pintado V, Calbo E, Gasch O, Montejo M, Salavert M, Garcia-Pais MJ, Carratalà J, Pujol M. Daptomycin plus fosfomycin versus daptomycin monotherapy in treating MRSA: protocol of a multicentre, randomised, phase III trial. BMJ Open 2015; 5:e006723. [PMID: 25762232 PMCID: PMC4360784 DOI: 10.1136/bmjopen-2014-006723] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Despite the availability of new antibiotics such as daptomycin, methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia continues to be associated with high clinical failure rates. Combination therapy has been proposed as an alternative to improve outcomes but there is a lack of clinical studies. The study aims to demonstrate that combination of daptomycin plus fosfomycin achieves higher clinical success rates in the treatment of MRSA bacteraemia than daptomycin alone. METHODS AND ANALYSIS A multicentre open-label, randomised phase III study. Adult patients hospitalised with MRSA bacteraemia will be randomly assigned (1:1) to group 1: daptomycin 10 mg/kg/24 h intravenous; or group 2: daptomycin 10 mg/kg/24 h intravenous plus fosfomycin 2 gr/6 g intravenous. The main outcome will be treatment response at week 6 after stopping therapy (test-of-cure (TOC) visit). This is a composite variable with two values: Treatment success: resolution of clinical signs and symptoms (clinical success) and negative blood cultures (microbiological success) at the TOC visit. Treatment failure: if any of the following conditions apply: (1) lack of clinical improvement at 72 h or more after starting therapy; (2) persistent bacteraemia (positive blood cultures on day 7); (3) therapy is discontinued early due to adverse effects or for some other reason based on clinical judgement; (4) relapse of MRSA bacteraemia before the TOC visit; (5) death for any reason before the TOC visit. Assuming a 60% cure rate with daptomycin and a 20% difference in cure rates between the two groups, 103 patients will be needed for each group (α:0.05, ß: 0.2). Statistical analysis will be based on intention to treat, as well as per protocol and safety analysis. ETHICS AND DISSEMINATION The protocol was approved by the Spanish Medicines and Healthcare Products Regulatory Agency (AEMPS). The sponsor commits itself to publishing the data in first quartile peer-review journals within 12 months of the completion of the study. TRIAL REGISTRATION NUMBER NCT01898338.
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Affiliation(s)
- E Shaw
- Hospital Universitari de Bellvitge-IDIBELL, Hospitalet de Llobregat, Barcelona, Spain
| | - J M Miró
- Hospital Universitari Clínic-IDIBAPS, Barcelona, Spain
| | | | - C Pigrau
- Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - F Barcenilla
- Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - J Murillas
- Hospital Universitari Son Espases, Mallorca, Spain
| | | | - E Espejo
- Hospital Universitari de Terrassa, Terrassa, Barcelona, Spain
| | - B Padilla
- Hospital Universitario Gregorio Marañon, Madrid, Spain
| | | | - J Pasquau
- Hospital Universitario Virgen de las Nieves, Granada, Spain
| | | | | | - M Montero
- Hospital Universitari Parc de Salut Mar, Barcelona, Spain
| | - C de la Calle
- Hospital Universitari Clínic-IDIBAPS, Barcelona, Spain
| | - V Pintado
- Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - E Calbo
- Hospital Universitari Mutúa de Terrassa, Barcelona, Spain
| | - O Gasch
- Corporació Sanitaria Parc Taulí, Sabadell, Barcelona, Spain
| | - M Montejo
- Hospital Universitario de Cruces, Barakaldo, Spain
| | - M Salavert
- Hospital Universitari i Politècnic la Fe, Valencia, Spain
| | | | - J Carratalà
- Hospital Universitari de Bellvitge-IDIBELL, Hospitalet de Llobregat, Barcelona, Spain
| | - M Pujol
- Hospital Universitari de Bellvitge-IDIBELL, Hospitalet de Llobregat, Barcelona, Spain
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Sadyrbaeva S, Aznarte Padial P, Hidalgo Tenorio C, Pasquau J. PS-051 The impact of an antimicrobial stewardship program on prescriptions of ertapanem in a tertiary hospital. Eur J Hosp Pharm 2015. [DOI: 10.1136/ejhpharm-2015-000639.376] [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: 11/04/2022] Open
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Pérez-Parra S, Chueca-Porcuna N, Álvarez-Estevez M, Pasquau J, Omar M, Collado A, Vinuesa D, Lozano AB, García-García F. [Study of human immunodeficiency virus transmission chains in Andalusia: analysis from baseline antiretroviral resistance sequences]. Enferm Infecc Microbiol Clin 2015; 33:603-8. [PMID: 25648468 DOI: 10.1016/j.eimc.2014.11.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 11/19/2014] [Accepted: 11/24/2014] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND OBJECTIVE Protease and reverse transcriptase HIV-1 sequences provide useful information for patient clinical management, as well as information on resistance to antiretrovirals. The aim of this study is to evaluate transmission events, transmitted drug resistance, and to georeference subtypes among newly diagnosed patients referred to our center. METHODS A study was conducted on 693 patients diagnosed between 2005 and 2012 in Southern Spain. Protease and reverse transcriptase sequences were obtained for resistance to cART analysis with Trugene(®) HIV Genotyping Kit (Siemens, NAD). MEGA 5.2, Neighbor-Joining, ArcGIS and REGA were used for subsequent analysis. RESULTS The results showed 298 patients clustered into 77 different transmission events. Most of the clusters were formed by pairs (n=49), of men having sex with men (n=26), Spanish (n=37), and below 45 years of age (73.5%). Urban areas from Granada, and the coastal areas of Almeria and Granada showed the greatest subtype heterogeneity. Five clusters were formed by more than 10 patients, and 15 clusters had transmitted drug resistance. CONCLUSIONS The study data demonstrate how the phylogenetic characterization of transmission clusters is a powerful tool to monitor the spread of HIV, and may contribute to design correct preventive measures to minimize it.
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Affiliation(s)
- Santiago Pérez-Parra
- Servicio de Microbiología Clínica, Hospital Universitario San Cecilio, Complejo Hospitalario e Instituto de Investigación IBS, Granada, España.
| | - Natalia Chueca-Porcuna
- Servicio de Microbiología Clínica, Hospital Universitario San Cecilio, Complejo Hospitalario e Instituto de Investigación IBS, Granada, España
| | - Marta Álvarez-Estevez
- Servicio de Microbiología Clínica, Hospital Universitario San Cecilio, Complejo Hospitalario e Instituto de Investigación IBS, Granada, España
| | - Juan Pasquau
- Servicio de Infecciosas, Hospital Virgen de las Nieves, Granada, España
| | - Mohamed Omar
- Servicio de Infecciosas, Hospital Ciudad de Jaén, Jaén, España
| | - Antonio Collado
- Servicio de Medicina Interna, Hospital de Torrecárdenas, Almería, España
| | - David Vinuesa
- Servicio de Infecciosas, Hospital Universitario San Cecilio, Granada, España
| | | | - Federico García-García
- Servicio de Microbiología Clínica, Hospital Universitario San Cecilio, Complejo Hospitalario e Instituto de Investigación IBS, Granada, España
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Pedrol E, Viciana P, Arranz A, Pasquau J, Deig E, Tasias M. [Reasons for antiretroviral treatment change in HIV+ patients in Spain in 2010-2011. SWITCH AUDIT Study]. Rev Esp Quimioter 2014; 27:93-97. [PMID: 24940888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Survey in 349 HIV infected subjects in 19 Spanish Hospitals in 2010-2011, to assess the reasons for antiretroviral treatment change. Simplification was the most frequent reason for change (37%), followed by toxicity (30%) and treatment failure (21%). There were statistically significant differences according to treatment line and transmission category. In conclusion, in many patients treatment is changed in order to obtain the benefits of a regimen easier to follow.
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Affiliation(s)
- Enric Pedrol
- Enric Pedrol Clotet, Unitat VIH. Servei de Medicina Interna, Hospital de Sant Pau i Santa Tecla, Rambla Vella, 14, Tarragona-43003, Spain.
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Aznarte P, Sadyrbaeva S, Martínez-Casanova N, García-Rodríguez J, Pasquau J, Hidalgo-Tenorio C. DI-011 Evaluation of the use of levofloxacin and moxifloxacin in the treatment of pneumonia. Eur J Hosp Pharm 2014. [DOI: 10.1136/ejhpharm-2013-000436.182] [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: 11/04/2022] Open
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Macías J, Recio E, Márquez M, García C, Jiménez P, Merino D, Muñoz L, Pasquau J, Ojeda G, Bancalero P, Chueca N, Pineda JA. Efficacy and safety of once-daily maraviroc plus ritonavir-boosted darunavir in pretreated HIV-infected patients in a real-life setting. HIV Med 2014; 15:417-24. [DOI: 10.1111/hiv.12129] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2013] [Indexed: 11/27/2022]
Affiliation(s)
- J Macías
- Unit of Infectious Diseases and Microbiology; Hospital Universitario de Valme; Seville Spain
- Instituto de Biomedicina de Sevilla (IBiS); Seville Spain
| | - E Recio
- Unit of Infectious Diseases and Microbiology; Hospital Universitario de Valme; Seville Spain
- Instituto de Biomedicina de Sevilla (IBiS); Seville Spain
| | - M Márquez
- Unit of Infectious Diseases; Hospital Virgen de la Victoria; Malaga Spain
| | - C García
- Unit of Infectious Diseases; Hospital Jerez de la Frontera; Cadiz Spain
| | - P Jiménez
- Unit of Infectious Diseases; Hospital Universitario Puerto Real; Cadiz Spain
| | - D Merino
- Unit of Infectious Diseases; Complejo Hospitalario de Huelva; Huelva Spain
| | - L Muñoz
- Unit of Infectious Diseases; Hospital Universitario San Cecilio; Granada Spain
| | - J Pasquau
- Unit of Infectious Diseases; Hospital Universitario Virgen de las Nieves; Granada Spain
| | - G Ojeda
- Unit of Infectious Diseases; Hospital Virgen de la Victoria; Malaga Spain
| | - P Bancalero
- Unit of Infectious Diseases; Hospital Jerez de la Frontera; Cadiz Spain
| | - N Chueca
- Department of Microbiology; Hospital Universitario San Cecilio; Granada Spain
| | - JA Pineda
- Unit of Infectious Diseases and Microbiology; Hospital Universitario de Valme; Seville Spain
- Instituto de Biomedicina de Sevilla (IBiS); Seville Spain
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Molina I, Carmen del Gonzalvo M, Clavero A, Ángel López-Ruz M, Mozas J, Pasquau J, Sampedro A, Martínez L, Castilla JA. Assisted reproductive technology and obstetric outcome in couples when the male partner has a chronic viral disease. Int J Fertil Steril 2014; 7:291-300. [PMID: 24520499 PMCID: PMC3901182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Accepted: 02/26/2013] [Indexed: 11/10/2022]
Abstract
BACKGROUND Assisted reproductive technology (ART) with washed semen can achieve pregnancy with minimal risk of horizontal and vertical transmission of chronic viral diseases (CVD) such as human immunodeficiency virus (HIV), hepati- tis C virus (HCV) and hepatitis B virus (HBV) among serodiscordant couples. How- ever, few studies have been made of the use made by these couples of ARTs or of the obstetric results achieved. MATERIALS AND METHODS In this retrospective study, 93 men who were seropositive for HIV, HCV or HBV and who underwent assisted reproduction treatment at our centre (Hospital Universitario Virgen de las Nieves, Granada, Spain) were included. Washed semen was tested to detect viral particles. Non-infected women were tested before and after each treatment, as were the neonates at birth and after three months. RESULTS A total of 62 sperm samples were washed, and none were positive for the detec- tion of viral molecules. Semen samples from 34 HBV positive males were not washed since the female partner had immunity to hepatitis B. In total, 38 clinical pregnancies were achieved (22% per cycle and 40.9% per couple) out of 173 cycles initiated, and 28 births were achieved (16.2% per cycle and 30.1% per couple), producing 34 live births. The rate of multiple pregnancies was 21.4%. Obstetric and neonatal results were similar in the groups of couples studied. At follow-up, no seroconversion was detected in the women or neonates. CONCLUSION Sperm washing and intracytoplasmic sperm injection are shown to be a safe and effective option for reducing the risk of transmission or super infection in serodiscordant or concordant couples who wish to have a child. Pregnancies ob- tained by ART in couples when the male is CVD infected achieve good obstetric and neonatal results.
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Affiliation(s)
- Irene Molina
- Human Reproduction Unit, Clinical Management Unit for Obstetrics and Gynaecology, Virgen de las Nieves
University Hospital, Granada Institute for Healthcare Research, Granada, Spain,
* Corresponding Address:
U. Reproducción, UGC de Obstetricia y
GinecologíaHospital Universitario Virgen de las NievesInstituto de Investigación Biosanitaria de Granada (IIBG)GranadaSpain
| | - María Carmen del Gonzalvo
- Human Reproduction Unit, Clinical Management Unit for Obstetrics and Gynaecology, Virgen de las Nieves
University Hospital, Granada Institute for Healthcare Research, Granada, Spain
| | - Ana Clavero
- Human Reproduction Unit, Clinical Management Unit for Obstetrics and Gynaecology, Virgen de las Nieves
University Hospital, Granada Institute for Healthcare Research, Granada, Spain
| | - Miguel Ángel López-Ruz
- Infectious Disease Unit, Internal Medicine Service, Virgen de las Nieves University Hospital, Granada, Spain
| | - Juan Mozas
- Human Reproduction Unit, Clinical Management Unit for Obstetrics and Gynaecology, Virgen de las Nieves
University Hospital, Granada Institute for Healthcare Research, Granada, Spain
| | - Juan Pasquau
- Infectious Disease Unit, Internal Medicine Service, Virgen de las Nieves University Hospital, Granada, Spain
| | - Antonio Sampedro
- Microbiology Service, Virgen de las Nieves University Hospital, Granada, Spain
| | - Luis Martínez
- Human Reproduction Unit, Clinical Management Unit for Obstetrics and Gynaecology, Virgen de las Nieves
University Hospital, Granada Institute for Healthcare Research, Granada, Spain
| | - José Antonio Castilla
- Human Reproduction Unit, Clinical Management Unit for Obstetrics and Gynaecology, Virgen de las Nieves
University Hospital, Granada Institute for Healthcare Research, Granada, Spain
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Calbo E, Álvarez-Rocha L, Gudiol F, Pasquau J. A review of the factors influencing antimicrobial prescribing. Enferm Infecc Microbiol Clin 2013; 31 Suppl 4:12-5. [DOI: 10.1016/s0213-005x(13)70127-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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López-Cortés LE, Del Toro MD, Gálvez-Acebal J, Bereciartua-Bastarrica E, Fariñas MC, Sanz-Franco M, Natera C, Corzo JE, Lomas JM, Pasquau J, Del Arco A, Martínez MP, Romero A, Muniain MA, de Cueto M, Pascual A, Rodríguez-Baño J. Impact of an evidence-based bundle intervention in the quality-of-care management and outcome of Staphylococcus aureus bacteremia. Clin Infect Dis 2013; 57:1225-33. [PMID: 23929889 DOI: 10.1093/cid/cit499] [Citation(s) in RCA: 166] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Staphylococcus aureus bacteremia (SAB) is associated with significant morbidity and mortality. Several aspects of clinical management have been shown to have significant impact on prognosis. The objective of the study was to identify evidence-based quality-of-care indicators (QCIs) for the management of SAB, and to evaluate the impact of a QCI-based bundle on the management and prognosis of SAB. METHODS A systematic review of the literature to identify QCIs in the management of SAB was performed. Then, the impact of a bundle including selected QCIs was evaluated in a quasi-experimental study in 12 tertiary Spanish hospitals. The main and secondary outcome variables were adherence to QCIs and mortality. Specific structured individualized written recommendations on 6 selected evidence-based QCIs for the management of SAB were provided. RESULTS A total of 287 and 221 patients were included in the preintervention and intervention periods, respectively. After controlling for potential confounders, the intervention was independently associated with improved adherence to follow-up blood cultures (odds ratio [OR], 2.83; 95% confidence interval [CI], 1.78-4.49), early source control (OR, 4.56; 95% CI, 2.12-9.79), early intravenous cloxacillin for methicillin-susceptible isolates (OR, 1.79; 95% CI, 1.15-2.78), and appropriate duration of therapy (OR, 2.13; 95% CI, 1.24-3.64). The intervention was independently associated with a decrease in 14-day and 30-day mortality (OR, 0.47; 95% CI, .26-.85 and OR, 0.56; 95% CI, .34-.93, respectively). CONCLUSIONS A bundle orientated to improving adherence to evidence-based QCIs improved the management of patients with SAB and was associated with reduced mortality.
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Affiliation(s)
- Luis E López-Cortés
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Sevilla
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Aznarte P, Hidalgo C, Ferrit M, Martínez N, Pasquau J. GRP-151 Program Interventions to Optimise the Duration of Antibiotic Treatment. Eur J Hosp Pharm 2013. [DOI: 10.1136/ejhpharm-2013-000276.151] [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: 11/04/2022] Open
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Mensa J, Soriano A, Llinares P, Barberán J, Montejo M, Salavert M, Alvarez-Rocha L, Maseda E, Moreno A, Pasquau J, Gómez J, Parra J, Candel F, Azanza JR, García JE, Marco F, Soy D, Grau S, Arias J, Fortún J, de Alarcón CA, Picazo J. [Guidelines for antimicrobial treatment of the infection by Staphylococcus aureus]. Rev Esp Quimioter 2013; 26 Suppl 1:1-84. [PMID: 23824510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- José Mensa
- Departamento de Enfermedades Infecciosas, Hospital Clínic de Barcelona, C/Villarroel 170, 08036 Barcelona, Spain.
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Pasquau J, Gostkorzewicz J, Ledesma F, Anceau A, Hill A, Moecklinghoff C. Budget impact analysis of switching to darunavir/ritonavir monotherapy for HIV-infected people in Spain. Appl Health Econ Health Policy 2012; 10:139-141. [PMID: 22293019 DOI: 10.2165/11598380-000000000-00000] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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