Treatment of COVID-19 with convalescent plasma in patients with humoral immunodeficiency - Three consecutive cases and review of the literature

Patients lacking humoral response have been suggested to develop a less severe COVID-19, but there are some reports with a prolonged, relapsing or deadly course. From April 2020, there is growing evidence on the benefits of COVID-19 convalescent plasma (CCP) for patients with humoral immunodeficiency. Most of them had a congenital primary immunodeficiency or were on treatment with anti CD20 antibodies. We report on three patients treated in our hospital and review thirty-one more cases described in the literature. All patients but three resolved clinical picture with CCP. A dose from 200 to 800ml was enough in most cases. Antibody levels after transfusion were negative or low, suggesting consumption of them in SARS-CoV-2 neutralization. These patients have a protracted clinical course shortened after CCP. CCP could be helpful for patients with humoral immunodeficiency. It avoid relapses and chronification. CCP should be transfused as early as possible in patients with COVID-19 and humoral immunodeficiency.

Treatment of COVID-19 with convalescent plasma in patients with humoral immunodeficiency - Three consecutive cases and review of the literature

Patients lacking humoral response have been suggested to develop a less severe COVID-19, but there are some reports with a prolonged, relapsing or deadly course. From April 2020, there is growing evidence on the benefits of COVID-19 convalescent plasma (CCP) for patients with humoral immunodeficiency. Most of them had a congenital primary immunodeficiency or were on treatment with anti CD20 antibodies. We report on three patients treated in our hospital and review thirty-one more cases described in the literature. All patients but three resolved clinical picture with CCP. A dose from 200 to 800ml was enough in most cases. Antibody levels after transfusion were negative or low, suggesting consumption of them in SARS-CoV-2 neutralization. These patients have a protracted clinical course shortened after CCP. CCP could be helpful for patients with humoral immunodeficiency. It avoid relapses and chronification. CCP should be transfused as early as possible in patients with COVID-19 and humoral immunodeficiency.

THU0460 PHYSICAL FITNESS AND QUALITY OF LIFE IN WOMEN WITH FIBROMYALGIA: LONGITUDINAL ANALYSES FROM THE AL-ÁNDALUS PROJECT

Background:

Optimizing the highly deteriorated quality of life (QoL) of patients with fibromyalgia is one of the main goals in the management of the disease1. Physical fitness has been identified as a powerful marker of health that is positively related to QoL in this population2, although previous evidence is mainly based on cross-sectional data.

Objectives:

This study aimed to examine the longitudinal associations (2- and 5-year follow-up) between physical fitness and QoL in women with fibromyalgia.

Methods:

In this prospective cohort study, women diagnosed with fibromyalgia (age: 51.3±7.6 years) with completed data were included at baseline (n=441), at 2-year follow-up (n=220) and at 5-year follow-up (n=227). The Senior Fitness Tests battery was used to assess physical fitness components and a standardized global fitness index was calculated. The eight dimensions plus the two physical and mental component summaries of the Short-Form health survey-36 questionnaire were used to assess QoL. To examine whether changes in fitness predicted QoL at follow-up, multiple linear regression models were built. The bidirectionallity of the associations (whether changes in QoL predicted fitness at follow-up) was also tested. Outcome values at baseline and age, fat percentage, analgesic consumption, educational level, and occupational status at follow-up were entered as potential confounders in all analyses.

Results:

Changes in fitness were associated with physical function (β=0.160), physical role (β=0.275), bodily pain (β=0.271), general health (β=0.144), and physical component summary (β=0.276) at 2-year follow-up (all,P<0.05) and with changes in physical role (β=0.215) and physical component summary (β=0.135) at 5-year follow-up (all,P<0.05). Changes in physical function (β=0.165), physical role (β=0.230), bodily pain (β=0.230), general health (β=0.130) and physical summary component (β=0.251) were associated with fitness at 2-year follow-up (all,P<0.05). Changes in all dimensions of QoL (β rating from 0.113 to 0.198), as well as the physical (β=0.174) and mental (β=0.164) summary components were associated with fitness at 5-year follow-up (all,P<0.05).

Conclusion:

Increasing levels of physical fitness over time predicts future QoL in women with fibromyalgia, especially for physical domains at 2-year follow-up. In addition, increasing QoL across all domains over time predicts future global fitness at 2- and, specially, 5-year follow-up. Future research is warranted to determine the clinical relevance of the bidirectional association between physical fitness and QoL in fibromyalgia.

References:

[1]Macfarlane GJ, et al. Ann Rheum Dis, 2018; 76(2), 318-328.

[2]Álvarez-Gallardo IC, et al. 2019;99:1481–1494.

Acknowledgments:

This study was supported by the Spanish Ministry of Economy and Competitiveness (I+D+i DEP2010-15639; I+D+I DEP2013-40908-R; BES-2014-067612) and the Spanish Ministry of Education (FPU14/FPU 15/00002)

Disclosure of Interests: :

None declared

THU0457 LONGITUDINAL ASSOCIATION OF SEDENTARY TIME AND PHYSICAL ACTIVITY WITH SLEEP QUALITY IN WOMEN WITH FIBROMYALGIA: THE AL-ÁNDALUS PROJECT

Background:

Sleep disturbances are common in fibromyalgia, and influences quality of life. Recent literature has suggested that non-pharmacological treatments (e.g., physical exercise and cognitive behavioural therapy) may help to improve sleep quality (SQ) and the management of fibromyalgia1. In this regard, sedentary time (ST) and physical activity (PA) intensity levels could play a role on SQ in this population2. However, evidence is scarce and mainly based on cross-sectional data.

Objectives:

This study aimed to examine the longitudinal associations (2- and 5-year follow-up) of ST and PA intensity levels with SQ in women with fibromyalgia.

Methods:

In this prospective cohort study, women diagnosed with fibromyalgia (age: 51.4±7.6 years) with completed data were included at baseline (n=409), at 2-year follow-up (n=214) and at 5-year follow-up (n=218). Sedentary time and PA intensity levels (light and moderate-to-vigorous [MVPA]) were assessed using triaxial accelerometers worn for consecutive 7 days. The percentage of time spent in different behaviours was calculated (e.g., (ST/accelerometer wear time) × 100). The SQ global score was calculated as a sum of all components (score ranges from 0 to 21 where higher values indicate worse SQ) of the Pittsburgh Sleep Quality Index. Linear regressions were performed to analyse the association of changes in ST and PA over time (predictor variables) with SQ at 2- and 5-years follow-up (dependent variables) while considering baseline SQ, age, fat percentage, marital status, educational level, sleep or relaxation medication, and regular menstruation as confounders.

Results:

Overall, after adjusting for confounders, non-statistical significant associations were found between changes in ST and PA intensity levels from baseline to 2-years follow-up with SQ at 2-year follow-up (P>0.05); except for the change in MVPA from baseline to 2-years follow-up, which showed evidence of statistical significance (B=-0.207;P=0.059). Regarding the 5-year follow-up, we did not observe either any association between changes in ST or PA intensity levels from baseline to 5-year follow-up with SQ at 5-year follow-up (P>0.05).

Conclusion:

The main findings suggest that neither ST nor PA intensity levels over time predict SQ at 2- and 5-year follow-up in women with fibromyalgia. Future PA-counselling randomised controlled trials might shed more light on the role that ST and PA could play on SQ.

References:

[1]Macfarlane GJ, et al.Ann Rheum Dis,2017; 76(2):318–328.

[2]Borges-Cosic M, et al.Scand J Med Sci Sports2019; 29:266–274.

Acknowledgments:

This study was supported by the Spanish Ministry of Economy and Competitiveness (I+D+i DEP2010-15639; I+D+I DEP2013-40908-R) and the Spanish Ministry of Education, Culture and Sport (FPU15/00002).

Disclosure of Interests: :

None declared

FRI0647 COMPARATIVE EFFECTIVENESS OF LAND AND WATER-BASED EXERCISE PROGRAMS ON FATIGUE IN WOMEN WITH FIBROMYALGIA: PRELIMINARY FINDINGS FROM THE AL-ÁNDALUS RANDOMISED CONTROLLED TRIAL

Background:

Land and water-based exercise intervention programs have demonstrated positive effects on fibromyalgia symptoms1. However, research comparing the efficacy of both protocols is limited.

Objectives:

The aim of this study was to assess the effect of two exercise interventions (land-based and water-based training) and a subsequent detraining period on fatigue in women with fibromyalgia.

Methods:

Among the 272 participants initially randomised, a total of 161 women (age: 50.7±7.7) completed all the assessments with an attendance of at least of 70% (land-basedn=50, water-basedn=44, controln=67). The intervention groups trained 3 non-consecutive days/week (60 min/ses) during 24 weeks. Each session involved exercises to improve cardiorespiratory fitness, muscle strength, and flexibility. Four dimensions of fatigue were assessed using the Multidimensional Fatigue Inventory. Participants were evaluated at baseline (pre-test), at the end of the intervention (post-test) and following a detraining period of 12 weeks (re-test). Land-based, water-based, and control groups were comparable in sociodemographic characteristics, disease duration, drugs intake, and body mass index. Age, tenderness, and baseline outcomes values were used as covariates in the comparisons (analysis of covariance) of the changes from baseline (post-test vs. pre-test and re-test vs. pre-test) between groups.

Results:

The land-based exercise group reduced general fatigue (mean difference: -1.17; 95% confidence interval: -2.30 to -0.03;P=0.04) and physical fatigue (-2.48; -3.80 to -1.16;P<0.001) compared to the control group. The water-based exercise group reduced physical fatigue compared to the control group (-1.61; -3.04 to -0.19;P=0.02). No significant reductions were observed in other dimensions of fatigue in either group compared to the control group and no differences between intervention groups were observed (all comparisons,P>0.05). The reductions in fatigue were not sustained after the detraining period in any of the intervention groups (all comparisons,P>0.05).

Conclusion:

Twenty-four weeks of land or water-based exercise were both effective in reducing physical fatigue of women with fibromyalgia. Furthermore, land-based exercise led to additional reductions in general fatigue. Reductions in fatigue were not sustained after a 12-week detraining period. Participation in regular exercise, specially land-based, might be an easily accessible treatment option to manage fatigue in this population.

References:

[1] Macfarlane GJ, et al. Ann Rheum Dis, 2018; 76(2), 318-328.

Acknowledgments:

This study was supported by the Spanish Ministry of Economy and Competitiveness (I+D+i DEP2010-15639; I+D+I DEP2013-40908-R) and the Spanish Ministry of Education, Culture and Sport (FPU15/00002).

Disclosure of Interests:

None declared

Week 4 response predicts sustained virological response to all-oral direct-acting antiviral-based therapy in cirrhotic patients with hepatitis C virus genotype 3 infection

OBJECTIVE

The aim of this study was to determine the predictive capacity of response at treatment week (TW) 4 for the achievement of sustained virological response 12 weeks after the scheduled end of therapy date (SVR₁₂) to treatment against hepatitis C virus (HCV) genotype 3 (GT3) infection with all-oral direct-acting antiviral (DAA) -based regimens.

PATIENTS AND METHODS

From a prospective multicohort study, HCV GT3-infected patients who completed a course of currently recommended DAA-based therapy at 33 Spanish hospitals and who had reached the SVR₁₂ evaluation time-point were selected. TW4 HCV-RNA levels were categorized as target-not-detected (TND), below the lower limit of quantification (LLOQ_TD) and ≥LLOQ.

RESULTS

A total of 123 patients were included, 86 (70%) received sofosbuvir/ daclatasvir±ribavirin, 27 (22%) received sofosbuvir/ ledipasvir/ ribavirin and 10 (8.1%) received sofosbuvir/ ribavirin, respectively. In all, 114 (92.7%) of the 123 patients presented SVR₁₂ in an on-treatment approach, but nine (7.3%) patients relapsed, all of them had presented cirrhosis at baseline. In those who achieved TND, LLOQ_TD and ≥LLOQ, SVR₁₂ was observed in 81/83 (98%; 95% CI 91.5%-99.7%), 24/28 (85.7%; 95% CI 67.3%-96%) and 9/12 (75%; 95% CI 42.8%-94.5%), respectively; p_{(linear association)} 0.001. Corresponding numbers for subjects with cirrhosis were: 52/54 (96.3%; 95% CI 87.3%-95.5%), 14/18 (77.8%; 95% CI 52.4%-93.6%) and 7/10 (70%; 95% CI 34.8%-93.3%); p 0.004.

CONCLUSIONS

TW4-response indicates the probability of achieving SVR₁₂ to currently used DAA-based therapy in HCV genotype 3-infected individuals with cirrhosis. This finding may be useful to tailor treatment strategy in this setting.

Physical fitness reference standards in fibromyalgia: The al-Ándalus project

We aimed (1) to report age-specific physical fitness levels in people with fibromyalgia of a representative sample from Andalusia; and (2) to compare the fitness levels of people with fibromyalgia with non-fibromyalgia controls. This cross-sectional study included 468 (21 men) patients with fibromyalgia and 360 (55 men) controls. The fibromyalgia sample was geographically representative from southern Spain. Physical fitness was assessed with the Senior Fitness Test battery plus the handgrip test. We applied the Generalized Additive Model for Location, Scale and Shape to calculate percentile curves for women and fitted mean curves using a linear regression for men. Our results show that people with fibromyalgia reached worse performance in all fitness tests than controls (P < 0.001) in all age ranges (P < 0.001). This study provides a comprehensive description of age-specific physical fitness levels among patients with fibromyalgia and controls in a large sample of patients with fibromyalgia from southern of Spain. Physical fitness levels of people with fibromyalgia from Andalusia are very low in comparison with age-matched healthy controls. This information could be useful to correctly interpret physical fitness assessments and helping health care providers to identify individuals at risk for losing physical independence.

No evidence of firstly acquired acute hepatitis C virus infection outbreak among HIV-infected patients from Southern Spain: a multicentric retrospective study from 2000-2014

Background

Acute hepatitis C virus (HCV) infection (AHCVI) outbreaks have been described recently within defined areas worldwide among HIV-infected homosexual men. This study aims to describe the cumulative frequency and incidence of firstly acquired AHCVI in an HIV-infected population in Southern Spain.

Methods

This is a retrospective study conducted at the Infectious Diseases Units of eight hospitals in Andalusia, Southern Spain. Primary AHC was considered as HCV immunoglobulin G antibody seroconversion. The time of infection was considered the moment between the last negative and the first positive HCV antibody determination.

Results

A total of 23 cases of primary AHCVI have been detected from 2000 to 2014. Incidence rates [IR; 95 % confidence interval (CI)] were 0.036 (2.272–0.054) per 100 person-years (py) in the overall population over a follow-up period of 64170 py. Of the 22 (95.7 %) male subjects, 21 (95.5 %) had acquired AHCVI by homosexual contact, the IR (95 % CI) was 0.039 (0.024–0.06) per 100 py in this subpopulation. There was no evidence of an increase of AHCVI IR. The incidence of AHCVI was slightly lower between 2000 and 2004 as compared to 2005–2009 [IR ratio (IRR) of 8.8 (95 % CI: 1.279–378.794; p = 0.01)] but reached a plateau afterwards [IRR between 2010 and 2014 versus 2005–2009: 0.727 (0.286–1.848; p = 0.5)]. The median (Q1-Q3) time between the last negative anti-HCV and the first positive anti-HCV determination was 4.7 (1.9–11.2) months. Peak (Q1-Q3) ALT and total bilirubin values during AHCVI were 496 (291–656) IU/mL and 1.15 (0.9–1.98) mg/dL, respectively.

Conclusions

In contrast to what has been reported from other areas, the incidence of primary AHCVI in the HIV-infected population is stable in Southern Spain and there is no evidence of an epidemic, in spite of the high prevalence of HIV/HCV-coinfection in this area.

Hepatic Safety of Rilpivirine/Emtricitabine/Tenofovir Disoproxil Fumarate Fixed-Dose Single-Tablet Regimen in HIV-Infected Patients with Active Hepatitis C Virus Infection: The hEPAtic Study

OBJECTIVES

The aim of this study was to evaluate the frequency of transaminase elevations (TE) and total bilirubin elevations (TBE) during the first year of therapy with a single tablet regimen including RPV/FTC/TDF (EPA) in HIV/hepatitis C virus (HCV)-coinfected subjects in clinical practice.

METHODS

In a retrospective analysis, HIV/HCV-coinfected subjects who started EPA at 17 centres throughout Spain were included as cases. Subjects who started an antiretroviral therapy (ART) other than EPA during the study period at the same hospitals were randomly selected as controls in a 1:2 ratio. Primary outcome variables were grade (G) 3-4 TE and G4 TBE.

RESULTS

Of the 519 subjects included, 173 individuals started EPA. Nine (5.2%) subjects of the EPA group and 49 (14.2%) controls were naïve to ART. The median (Q1-Q3) follow-up was 11.2 (9.7-13.9) months. TE was observed in 2 [1.2%; 95% confidence interval (CI): 0.14%-4.1%] subjects receiving EPA and 11 (3.2%; 95%CI: 1.6%-5.6%) controls (p = 0.136), all events were G3. No patient discontinued ART due to TE. One (0.6%; 95%CI: 0.01%-3.1%) subject on EPA and 8 (2.3%; 95%CI: 1%-4.5%) subjects in the control group developed TBE (p = 0.141), without developing any other hepatic event during follow-up. Three (2.3%) subjects with cirrhosis versus 10 (3.1%) without cirrhosis showed G3-4 TE (p = 0.451).

CONCLUSION

The frequency of severe liver toxicity in HIV/HCV-coinfected subjects receiving EPA under real-life conditions is very low, TE were generally mild and did not lead to drug discontinuation. All these data suggest that EPA can be safely used in this particular subpopulation.

The association of total and central body fat with pain, fatigue and the impact of fibromyalgia in women; role of physical fitness

BACKGROUND

The relationship between estimates of total and central body fat with fibromyalgia pain, fatigue and overall impact has not been fully described. We aimed to assess the individual and combined association of body fat (total and central) with pain, fatigue and the overall impact in fibromyalgia women; and to study the possible mediation role of physical fitness in these associations.

METHODS

A total of 486 fibromyalgia women with a mean (standard deviation) age of 52.2 (8.0) years participated. Pain was measured with self-reported measures and algometry, whereas fatigue with the Multidimensional Fatigue Inventory. The impact of fibromyalgia was measured with the Revised Fibromyalgia Impact Questionnaire (FIQR) total score. Total and central body fat were assessed by means of bioelectrical impedance and waist circumference, respectively. The Functional Senior Fitness Test battery and the handgrip strength test were used to assess physical fitness.

RESULTS

Total and central body fat were positively associated with pain- and fatigue-related measures and the FIQR total score (β from 0.10 to 0.25; all, p < 0.05). A combined effect of total and central body fat was observed on pain (FIQR and 36-item Short-Form Health Survey), general and physical-related fatigue and FIQR total score (all, overall p < 0.05), so that the group with no total and central obesity had more favourable results than those with total and central obesity. Cardiorespiratory fitness partially mediated (between 22-40% of the total effect) the associations between total and central body fat with pain, general fatigue, physical fatigue and reduced activity, and largely mediated (80%) the association of central body fat with the FIQR total score.

CONCLUSIONS

Physical fitness might potentially explain the association between obesity and fibromyalgia symptoms.

Reliability and feasibility of physical fitness tests in female fibromyalgia patients

The aim of the present study was to determine the reliability and feasibility of physical fitness tests in female fibromyalgia patients. 100 female fibromyalgia patients (aged 50.6±8.6 years) performed the following tests twice (7 days interval test-retest): chair sit and reach, back scratch, handgrip strength, arm curl, chair stand, 8 feet up and go, and 6-min walk. Significant differences between test and retest were found in the arm curl (mean difference: 1.25±2.16 repetitions, Cohen d=0.251), chair stand (0.99±1.7 repetitions, Cohen d=0.254) and 8 feet up and go (-0.38±1.09 s, Cohen d=0.111) tests. Intraclass correlation coefficients (ICC) range from 0.92 in the arm curl test to 0.96 in the back scratch test. The feasibility of the tests (patients able to complete the test) ranged from 89% in the arm curl test to 100% in the handgrip strength test. Therefore, the reliability and feasibility of the physical fitness tests examined is acceptable for female fibromyalgia patients.

Analysis of the performance of women with fibromyalgia in the six-minute walk test and its relation with health and quality of life

Fibromyalgia (FM) is a chronic syndrome characterized by widespread musculoskeletal pain that causes a significant reduction in functional capacity, affecting thus health and quality of life (QOL).

AIM

The aim of the present study was to evaluate the performance of FM patients in the 6-Minute Walk Test (6MWT) and its relation with health and QOL.

METHODS

Thirty-six FM patients (all women), differentiated by degree of severity of disease, and 14 healthy women were evaluated. Distance walked in the 6MWT, cardiorespiratory responses, heart rate responses, kinematic parameters of gait, the results of the Fibromyalgia Impact Questionnaire (FIQ), and the results of the Short-Form Healthy Survey (SF-36) were analyzed.

RESULTS

Women with FM covered a shorter distance in the 6MWT, had a lower cardiorespiratory response, and had lower spatio-temporal parameters of gait than healthy women. No correlation was found in FM patients between the total FIQ score and the distance walked in the 6MWT.

CONCLUSION

The analysis of performance parameters in the 6MWT may be an element of clinical relevance in FM patients.

Clinical and virological efficacy of etravirine plus two active Nucleos(t)ide analogs in an heterogeneous HIV-infected population

Etravirine (ETV) is recommended in combination with a boosted protease inhibitor plus an optimized background regimen for salvage therapy, but there is limited experience with its use in combination with two nucleos(t)ide reverse-transcriptase inhibitors (NRTIs). This multicenter study aimed to assess the efficacy of this combination in two scenarios: group A) subjects without virologic failure on or no experience with non-nucleoside reverse-transcriptase inhibitors (NNRTIs) switched due to adverse events and group B) subjects switched after a virologic failure on an efavirenz- or nevirapine-based regimen. The primary endpoint was efficacy at 52 weeks analysed by intention-to-treat. Virologic failure was defined as the inability to suppress plasma HIV-RNA to <50 copies/mL after 24 weeks on treatment, or a confirmed viral load >200 copies/mL in patients who had previously achieved a viral suppression or had an undetectable viral load at inclusion. Two hundred eighty seven patients were included. Treatment efficacy rates in group A and B were 88.0% (CI_95, 83.9–92.1%) and 77.4% (CI₉₅, 65.0–89.7%), respectively; the rates reached 97.2% (CI₉₅, 95.1–99.3%) and 90.5% (CI₉₅, 81.7–99.3), by on-treatment analysis. The once-a-day ETV treatment was as effective as the twice daily dosing regimen. Grade 1–2 adverse events were observed motivating a treatment switch in 4.2% of the subjects. In conclusion, ETV (once- or twice daily) plus two analogs is a suitable, well-tolerated combination both as a switching strategy and after failure with first generation NNRTIs, ensuring full drug activity.

Trial registration

ClinicalTrials.gov NCT01437241

Are there differences in quality of life, symptomatology and functional capacity among different obesity classes in women with fibromyalgia? The al-Ándalus project

Obesity may influence fibromyalgia severity. The present study aimed to examine fibromyalgia (FM) symptomatology, quality of life (QoL), and functional capacity across obesity class categories. A total sample of 208 obese FM patients and 108 obese control women were included in the study. The sample was further categorized following the international criteria for obesity classes: obesity I (BMI 30.0-34.99 kg/m(2)), obesity II (BMI 35.0-39.99 kg/m(2)), and obesity III (BMI ≥40.0 kg/m(2)). QoL was assessed by means of the Short-Form-36 Health Survey (SF-36) and FM symptomatology with the Fibromyalgia Impact Questionnaire (FIQ). Standardized field-based fitness tests were used to assess cardiorespiratory fitness, muscular strength, flexibility, agility, and balance. All the dimensions of QoL, as measured by SF-36, were worse in obese FM patients compared to the obese control group (all p < 0.001). Obese FM patients also scored worse in the entire functional capacity tests studied (all p < 0.001). Except for the higher FIQ-depression across obesity status categories (p < 0.05), no differences between obesity status groups were found in QoL and FM impact. However, upper-body muscular strength and cardiorespiratory fitness were worse across obesity class categories and pairwise comparisons showed differences mainly between obesity I and II (p < 0.05, and p < 0.01, respectively). The absence of clear differences in QoL and FM symptomatology among obesity classes suggests that just avoiding any obese status may be a useful advice for a better management of the disease. Nevertheless, upper-body muscular strength and cardiorespiratory fitness, which are important health indicators highly related to the mortality risk, were worse across obesity categories.

A warm water pool-based exercise program decreases immediate pain in female fibromyalgia patients: uncontrolled clinical trial

Fibromyalgia is characterized by chronic and extended musculoskeletal pain. The combination of exercise therapy with the warm water may be an appropriate treatment. However, studies focusing on the analysis of immediate pain during and after an exercise session are rare. This study aimed to determine the immediate changes of a warm water pool-based exercise program (12 weeks) on pain (before vs. after session) in female fibromyalgia patients. 33 Spanish women with fibromyalgia were selected to participate in a 12 weeks (2 sessions/week) low-moderate intensity warm water pool-based program. We assessed pain by means of a Visual Analogue Scale before and after each single session (i. e., 24 sessions). We observed immediate benefits on pain with a mean decrease ~15% in all sessions, except in the fourth one. There was an association of pain difference (pre-post) session with pain pre session (p=0.005; β=0.097±0.034) and with age (p<0.001; β=0.032±0.008). There were no significant accumulative differences on pain, pre session, post session, and pre-post changes (all p>0.05). Therefore this study showed that a warm water pool-based exercise program for 12 weeks (2 times/week) led to a positive immediate decrease in level of pain in female patients with fibromyalgia. Improvements were higher in older women and in those with more intense pain.

Increasing incidence of hepatocellular carcinoma in HIV-infected patients in Spain

BACKGROUND

To report the clinical and epidemiological characteristics of hepatocellular carcinoma (HCC) diagnosed in a cohort of human immunodeficiency virus (HIV)-infected patients in Spain.

METHODS

All HIV-infected patients diagnosed of HCC in 18 hospitals in Spain before 31 December 2010 were included. The main characteristics of HCC cases are described and comparisons between cases according to the year of diagnosis are presented.

RESULTS

Eighty-two cases of HCC in HIV-infected patients were included, all of them related to viral hepatitis coinfection: hepatitis C virus (HCV) in 66 (81%), hepatitis B virus (HBV) in 6 (7%), and HBV/HCV in 10 (12%). From 1999, when the first case of HCC was diagnosed, a progressive increment in the incidence of HCC in the cohort has occurred. In patients coinfected with HIV/HCV-coinfected patients, the incidence HCC increased from 0.2 to 2.8 cases per 1000 person-years between 2000 and 2009. Death occurred in 65 patients (79%), with a median survival of 91 days (interquartile range, 31-227 days). Three of 11 patients (28%) who received potentially curative therapy died, compared with 62 of 71 patients (87%) who did not receive curative therapy (P = .0001). Compared with cases of HCC diagnosed before 2005, cases diagnosed later did not show a higher survival rate.

CONCLUSIONS

HCC is an emerging complication of cirrhosis in HIV-infected patients. A sharp increase in its incidence has occurred in those also infected by HCV in the recent years. Unfortunately, HCC is frequently diagnosed at an advanced stage, and mortality continues to be very high, with no significant changes in recent years. Earlier diagnosis, which may allow potentially curative therapy, is necessary.

Fitness, fatness and cardiovascular profile in South Spanish and North Moroccan women

INTRODUCTION

We studied the differences on physical fitness, fatness and cardiovascular profile in Spanish and Moroccan women.

MATERIAL AND METHODS

The study comprised 63 and 58 women aged 45-65 years from South of Spain and North of Morocco, respectively. We assessed fitness and body composition using standard procedures. We also assessed resting heart rate (RHR), blood pressure, fasting glucose, total cholesterol, LDL-cholesterol, HDL-cholesterol and triglycerides.

RESULTS AND DISCUSSION

Moroccan women had a better performance in the main health-related physical fitness components, i.e. higher levels of cardiorespiratory fitness (P = 0.01) and (lower-body) muscular strength (P < 0.001). Diastolic blood pressure (P = 0.004), RHR and total cholesterol (both P = 0.04) were lower in Moroccan women. No differences were observed in the prevalence of metabolic syndrome.

CONCLUSIONS

The women from Morocco had a healthier fitness and cardiovascular profile than the women from Spain. Further research on physical fitness and other health indicators in understudied populations is needed.

Usefulness of tenderness to characterise fibromyalgia severity in women

OBJECTIVES

To investigate the usefulness of tenderness (tender points count (TPC) and algometer score) to characterise fibromyalgia (FM) severity and symptomatology in women.

METHODS

The study sample comprised 174 women aged 51±7 years. We ossesse tenderness using pressure algometry; quality of life by means of the Short-Form 36 Health Survey (SF-36) and the Hospital Anxiety and Depression Scale (HADS). We used the FM impact questionnaire (FIQ) to assess FM severity and symptomatology. Patients were categorised according to three FIQ-derived categories: FIQ<70 vs. ≥70; FIQ<59 vs. ≥59; and FM-type I and II.

RESULTS

TPC was significantly higher in the group of patients with FIQ≥59 (16.9±2 vs. 15.6±4, p=0.02), whereas no differences between groups were observed according to FIQ≥70 (17.0±2 vs. 16.2±3, p=0.12) or FM type (16.8±3 for type II vs. 15.9±4 for type I, p=0.13). We observed a significant association between TPC and FIQ-job difficulty, pain, morning tiredness and stiffness dimensions (all p<0.05), yet it was not correlated with total score of FIQ, FIQ-anxiety, fatigue and depression dimensions (all p>0.05). Algometer score was lower in the FIQ≥70 (45.7±12 vs. 51.1±14, p=0.05) and FIQ≥59 (46.7±13 vs. 52.7±14, p=0.05) groups, and there were no difference between FM types (48.7±13 vs. 49.5±14 for type II and I respectively, p=0.81). Algometer score was not associated with total score of FIQ or FIQ dimensions (all p≥0.1).

CONCLUSIONS

Widespread pain and pain hypersensitivity, as measured by TPC and algometer score, do not seem to be useful to characterise FM severity and symptomatology (measured by FIQ) in women.

Fibromyalgia's key symptoms in normal-weight, overweight, and obese female patients

Factors affecting the symptomatology of fibromyalgia (FM) are not fully understood. The aim of the present study was to analyze the relationship of weight status with pain, fatigue, and stiffness in Spanish female FM patients, with special focus on the differences between overweight and obese patients. The sample comprised 177 Spanish women with FM (51.3 ± 7.3 years old). We assessed tenderness (using pressure algometry), pain and vitality using the General Health Short-Form Survey (SF36), and pain, fatigue, morning tiredness, and stiffness using the Fibromyalgia Impact Questionnaire (FIQ). The international criteria for body mass index was used to classify the patients as normal weight, overweight, or obese. Thirty-two percent were normal-weight, 35% overweight, and 32% obese. Both overweight and obese patients had higher levels of pain than normal-weight patients, as assessed by FIQ and SF36 questionnaires and tender point count (p < .01). The same pattern was observed for algometer score, yet the differences were not significant. Both overweight and obese patients had higher levels of fatigue, and morning tiredness, and stiffness (p < .05) and less vitality than normal-weight patients. No significant differences were observed in any of the variables studied between overweight and obese patients. In conclusion, FM symptomatology in obese patients did not differ from overweight patients, whereas normal-weight patients significantly differed from overweight and obese patients in the studied symptoms. These findings suggest that keeping a healthy (normal) weight is not only associated with decreased risk for developing FM but might also be a relevant and useful way of improving FM symptomatology in women.

Liver toxicity of antiretroviral combinations including fosamprenavir plus ritonavir 1400/100 mg once daily in HIV/hepatitis C virus-coinfected patients

Abstract Our objective was to evaluate the liver toxicity of antiretroviral regimens including fosamprenavir plus ritonavir (FPV/r) 1400/100 mg once daily (QD) in HIV/hepatitis C virus (HCV)-coinfected patients. This was a prospective cohort study that included 117 HIV/HCV-coinfected patients who started FPV/r 1400/100 mg QD-based antiretroviral therapy (ART) and who neither had received a previous antiretroviral regimen containing FPV nor had a past history of virologic failure while receiving protease inhibitors (PI). The primary end point of the study was the occurrence of grade 3-4 liver enzymes elevations (LEE) within 1 year after starting FPV/r QD. Factors potentially associated with grade 3-4 LEE, including baseline liver fibrosis, were analyzed. Eleven (9%) patients had a grade 3-4 LEE during the follow-up, resulting in an incidence of severe liver toxicity of 9% (95% confidence interval 4.1-14.6%). None of these cases led to FPV/r discontinuation. Baseline liver fibrosis could be assessed in 97 (83%) patients. Six of 71 patients (8%) with significant fibrosis had a grade 3-4 LEE versus 2 of 26 (8%) without significant fibrosis (p=1.0). Twenty (21%) patients had cirrhosis at baseline. There were no cases of LEE among cirrhotics. In conclusion, the incidence of severe liver toxicity after 1 year of therapy with FPV/r QD-based ART in HIV/HCV-coinfected patients is similar to what has been reported with other boosted PIs. In addition, the presence of significant fibrosis or cirrhosis was not associated with the emergence of liver toxicity. Thus, ART regimens containing FPV/r QD may be considered safe in HIV/HCV-coinfected patients, including those with cirrhosis.

Handgrip strength in men with fibromyalgia

OBJECTIVES

To examine the association of muscular strength, as measured by handgrip strength test (HGs), with the presence/absence of fibromyalgia (FM) and FM severity in men.

METHODS

A total of 20 men (age, (mean age±standard deviation) of 48.0±8.0 years) with FM and 60 healthy subjects (age, 49.5±7.3 years) participated in the study. The HGs was measured by a maximal isometric test using a dynamometer with adjustable grip in both hands, and the average score was used in the analysis. All FM patients completed the Spanish version of the Fibromyalgia Impact Questionnaire (FIQ). Patients were classified as having moderate FM if the FIQ was <70 and as having severe FM if the FIQ was ≥70.

RESULTS

HGs was ~17% lower in FM patients compared to healthy men (p=0.005) and ~27% lower in men with severe FM compared to those with moderate FM (p=0.03). Age-adjusted logistic regression models showed that 1 kilogram increment in HGs was associated with an 8% reduced risk of having FM (OR=0.92, 95% CI: 0.86-0.97, p=0.002). In the FM group, 1 kilogram increment in HGs was associated with a 13% reduced risk for having severe FM (OR=0.87, 95% CI: 0.76-0.99, p=0.04). HGs was negatively associated with pain, fatigue, stiffness and with the total score from the FIQ (all p<0.05).

CONCLUSIONS

HGs is reduced in male FM patients and is inversely related to FM severity and symptomatology. HGs testing could be used as a complementary tool in the assessment and monitoring of FM. Further research on male FM patients is needed to confirm or contrast these findings.

The effect of sodium citrate intake on anaerobic performance in normoxia and after sudden ascent to a moderate altitude

BACKGROUND

The effect of sodium citrate intake on anaerobic performance in normoxia and acute hypoxia was tested in 17 healthy male subjects.

METHODS

The subjects underwent a high-intensity exercise protocol in conditions of normoxia (N) and at 2320 m above the sea level (H). Each condition was combined with the intake of a placebo (Pl) or sodium citrate (C).

RESULTS

The results obtained showed a drop in the maximum HR (p<0.001), due to the effect of the altitude (185+/-8 vs 176+/-8 bpm for N and H under Pl conditions and 189+/-9 vs 178+/-8 bpm for N and H under C conditions). C caused an increase in the RER (p<0.05) and the maximum Lac (p<0.01). The action of this same factor brought about a drop in the maximum VE (p<0.01) (182.60+/-21.58 vs 177.38+/-20.29 l x min(-1) in N and 185.71+/-22.98 vs 179.06+/-22.91 l x min(-1) in H). The interaction of both C and H affected the maximum concentration of lactate obtained (p<0.01), which fell as regards that expected by the corresponding action of both factors separately (14.33+/-2.94 vs 17.8+/-2.74 mMol x l(-1) with Pl and C in N and 15.29+/-2.15 vs 15.54+/-2.59 mMol x l(-1) in H). There were no significant differences in the length of work time in each of the conditions established.

CONCLUSIONS

It would, therefore, seem that in the conditions described, the intake of sodium citrate does not cause appreciable changes in anaerobic performance.