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Gasca-Capote C, Lian X, Gao C, Roseto IC, Jiménez-León MR, Gladkov G, Camacho-Sojo MI, Pérez-Gómez A, Gallego I, Lopez-Cortes LE, Bachiller S, Vitalle J, Rafii-El-Idrissi Benhnia M, Ostos FJ, Collado-Romacho AR, Santos J, Palacios R, Gomez-Ayerbe C, Muñoz-Medina L, Ruiz-Sancho A, Frias M, Rivero-Juarez A, Roca-Oporto C, Hidalgo-Tenorio C, Rull A, Olalla J, Lopez-Ruz MA, Vidal F, Viladés C, Mastrangelo A, Cavassini M, Espinosa N, Perreau M, Peraire J, Rivero A, López-Cortes LF, Lichterfeld M, Yu XG, Ruiz-Mateos E. The HIV-1 reservoir landscape in persistent elite controllers and transient elite controllers. J Clin Invest 2024; 134:e174215. [PMID: 38376918 PMCID: PMC11014653 DOI: 10.1172/jci174215] [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: 07/25/2023] [Accepted: 02/13/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUNDPersistent controllers (PCs) maintain antiretroviral-free HIV-1 control indefinitely over time, while transient controllers (TCs) eventually lose virological control. It is essential to characterize the quality of the HIV reservoir in terms of these phenotypes in order to identify the factors that lead to HIV progression and to open new avenues toward an HIV cure.METHODSThe characterization of HIV-1 reservoir from peripheral blood mononuclear cells was performed using next-generation sequencing techniques, such as full-length individual and matched integration site proviral sequencing (FLIP-Seq; MIP-Seq).RESULTSPCs and TCs, before losing virological control, presented significantly lower total, intact, and defective proviruses compared with those of participants on antiretroviral therapy (ART). No differences were found in total and defective proviruses between PCs and TCs. However, intact provirus levels were lower in PCs compared with TCs; indeed the intact/defective HIV-DNA ratio was significantly higher in TCs. Clonally expanded intact proviruses were found only in PCs and located in centromeric satellite DNA or zinc-finger genes, both associated with heterochromatin features. In contrast, sampled intact proviruses were located in permissive genic euchromatic positions in TCs.CONCLUSIONSThese results suggest the need for, and can give guidance to, the design of future research to identify a distinct proviral landscape that may be associated with the persistent control of HIV-1 without ART.FUNDINGInstituto de Salud Carlos III (FI17/00186, FI19/00083, MV20/00057, PI18/01532, PI19/01127 and PI22/01796), Gilead Fellowships (GLD22/00147). NIH grants AI155171, AI116228, AI078799, HL134539, DA047034, MH134823, amfAR ARCHE and the Bill and Melinda Gates Foundation.
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Affiliation(s)
- Carmen Gasca-Capote
- Institute of Biomedicine of Seville (IBiS), Virgen del Rocio University Hospital, Spanish National Research Council (CSIC), University of Seville, Clinical Unit of Infectious Diseases, Microbiology and Parasitology, Seville, Spain
| | - Xiaodong Lian
- Ragon Institute of MGH, MIT and Harvard, Cambridge, Massachusetts, USA
- Infectious Disease Division, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Ce Gao
- Ragon Institute of MGH, MIT and Harvard, Cambridge, Massachusetts, USA
- Infectious Disease Division, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Isabelle C. Roseto
- Ragon Institute of MGH, MIT and Harvard, Cambridge, Massachusetts, USA
- Infectious Disease Division, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - María Reyes Jiménez-León
- Institute of Biomedicine of Seville (IBiS), Virgen del Rocio University Hospital, Spanish National Research Council (CSIC), University of Seville, Clinical Unit of Infectious Diseases, Microbiology and Parasitology, Seville, Spain
| | - Gregory Gladkov
- Ragon Institute of MGH, MIT and Harvard, Cambridge, Massachusetts, USA
- Infectious Disease Division, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - María Inés Camacho-Sojo
- Institute of Biomedicine of Seville (IBiS), Virgen del Rocio University Hospital, Spanish National Research Council (CSIC), University of Seville, Clinical Unit of Infectious Diseases, Microbiology and Parasitology, Seville, Spain
| | - Alberto Pérez-Gómez
- Institute of Biomedicine of Seville (IBiS), Virgen del Rocio University Hospital, Spanish National Research Council (CSIC), University of Seville, Clinical Unit of Infectious Diseases, Microbiology and Parasitology, Seville, Spain
| | - Isabel Gallego
- Institute of Biomedicine of Seville (IBiS), Virgen del Rocio University Hospital, Spanish National Research Council (CSIC), University of Seville, Clinical Unit of Infectious Diseases, Microbiology and Parasitology, Seville, Spain
| | - Luis E. Lopez-Cortes
- Clinical Unit of Infectious Diseases and Microbiology, Virgen Macarena University Hospital, Seville, Spain
- Department of Medicine and Microbiology, School of Medicine and
- IBiS, Virgen Macarena University Hospital, CSIC, University of Seville, Seville, Spain
- CIBERINFEC, Institute of Health Carlos III (ISCIII), Madrid, Spain
| | - Sara Bachiller
- Institute of Biomedicine of Seville (IBiS), Virgen del Rocio University Hospital, Spanish National Research Council (CSIC), University of Seville, Clinical Unit of Infectious Diseases, Microbiology and Parasitology, Seville, Spain
- Department of Medical Biochemistry, Molecular Biology, and Immunology, School of Medicine, University of Seville, Seville, Spain
| | - Joana Vitalle
- Institute of Biomedicine of Seville (IBiS), Virgen del Rocio University Hospital, Spanish National Research Council (CSIC), University of Seville, Clinical Unit of Infectious Diseases, Microbiology and Parasitology, Seville, Spain
| | - Mohamed Rafii-El-Idrissi Benhnia
- Institute of Biomedicine of Seville (IBiS), Virgen del Rocio University Hospital, Spanish National Research Council (CSIC), University of Seville, Clinical Unit of Infectious Diseases, Microbiology and Parasitology, Seville, Spain
- Department of Medical Biochemistry, Molecular Biology, and Immunology, School of Medicine, University of Seville, Seville, Spain
| | - Francisco J. Ostos
- Institute of Biomedicine of Seville (IBiS), Virgen del Rocio University Hospital, Spanish National Research Council (CSIC), University of Seville, Clinical Unit of Infectious Diseases, Microbiology and Parasitology, Seville, Spain
- Department of Medical Biochemistry, Molecular Biology, and Immunology, School of Medicine, University of Seville, Seville, Spain
| | | | - Jesús Santos
- Infectious Diseases, Microbiology and Preventive Medicine Unit, Virgen de la Victoria University Hospital, Malaga, Spain
| | - Rosario Palacios
- Infectious Diseases, Microbiology and Preventive Medicine Unit, Virgen de la Victoria University Hospital, Malaga, Spain
| | - Cristina Gomez-Ayerbe
- Infectious Diseases, Microbiology and Preventive Medicine Unit, Virgen de la Victoria University Hospital, Malaga, Spain
| | - Leopoldo Muñoz-Medina
- Unit of Infectious Diseases, San Cecilio University Hospital, Biohealth Research Institute, IBS-Granada, Granada, Spain
| | - Andrés Ruiz-Sancho
- Unit of Infectious Diseases, San Cecilio University Hospital, Biohealth Research Institute, IBS-Granada, Granada, Spain
| | - Mario Frias
- CIBERINFEC, Institute of Health Carlos III (ISCIII), Madrid, Spain
- Service of Infectious Diseases, Reina Sofía University Hospital, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Córdoba University, Cordoba, Spain
| | - Antonio Rivero-Juarez
- CIBERINFEC, Institute of Health Carlos III (ISCIII), Madrid, Spain
- Service of Infectious Diseases, Reina Sofía University Hospital, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Córdoba University, Cordoba, Spain
| | - Cristina Roca-Oporto
- Institute of Biomedicine of Seville (IBiS), Virgen del Rocio University Hospital, Spanish National Research Council (CSIC), University of Seville, Clinical Unit of Infectious Diseases, Microbiology and Parasitology, Seville, Spain
| | - Carmen Hidalgo-Tenorio
- Unit of Infectious Diseases, Virgen de las Nieves University Hospital, Biohealth Research Institute, IBS-Granada, Granada, Spain
| | - Anna Rull
- CIBERINFEC, Institute of Health Carlos III (ISCIII), Madrid, Spain
- Joan XXIII University Hospital of Tarragona, IISPV, University of Rovira i Virgili, Tarragona, Spain
| | - Julian Olalla
- Internal Medicine Department, Costa Del Sol Hospital, Marbella, Spain
| | - Miguel A. Lopez-Ruz
- Unit of Infectious Diseases, Virgen de las Nieves University Hospital, Biohealth Research Institute, IBS-Granada, Granada, Spain
| | - Francesc Vidal
- CIBERINFEC, Institute of Health Carlos III (ISCIII), Madrid, Spain
- Joan XXIII University Hospital of Tarragona, IISPV, University of Rovira i Virgili, Tarragona, Spain
| | - Consuelo Viladés
- CIBERINFEC, Institute of Health Carlos III (ISCIII), Madrid, Spain
- Joan XXIII University Hospital of Tarragona, IISPV, University of Rovira i Virgili, Tarragona, Spain
| | | | - Matthias Cavassini
- Service of Infectious Diseases, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Nuria Espinosa
- Institute of Biomedicine of Seville (IBiS), Virgen del Rocio University Hospital, Spanish National Research Council (CSIC), University of Seville, Clinical Unit of Infectious Diseases, Microbiology and Parasitology, Seville, Spain
| | - Matthieu Perreau
- Service of Immunology and Allergy, Lausanne University Hospital and
| | - Joaquin Peraire
- CIBERINFEC, Institute of Health Carlos III (ISCIII), Madrid, Spain
- Joan XXIII University Hospital of Tarragona, IISPV, University of Rovira i Virgili, Tarragona, Spain
| | - Antonio Rivero
- CIBERINFEC, Institute of Health Carlos III (ISCIII), Madrid, Spain
- Service of Infectious Diseases, Reina Sofía University Hospital, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Córdoba University, Cordoba, Spain
| | - Luis F. López-Cortes
- Institute of Biomedicine of Seville (IBiS), Virgen del Rocio University Hospital, Spanish National Research Council (CSIC), University of Seville, Clinical Unit of Infectious Diseases, Microbiology and Parasitology, Seville, Spain
| | - Mathias Lichterfeld
- Ragon Institute of MGH, MIT and Harvard, Cambridge, Massachusetts, USA
- Infectious Disease Division, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Xu G. Yu
- Ragon Institute of MGH, MIT and Harvard, Cambridge, Massachusetts, USA
- Infectious Disease Division, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Ezequiel Ruiz-Mateos
- Institute of Biomedicine of Seville (IBiS), Virgen del Rocio University Hospital, Spanish National Research Council (CSIC), University of Seville, Clinical Unit of Infectious Diseases, Microbiology and Parasitology, Seville, Spain
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Del Amo J, Palacios R, Fuster-Ruiz de Apodaca MJ, Pérez-Molina JA. Are we on track to achieve the UNAIDS goals by 2030 for people with HIV in Spain? Enferm Infecc Microbiol Clin (Engl Ed) 2023; 41:587-588. [PMID: 38044030 DOI: 10.1016/j.eimce.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 10/30/2023] [Indexed: 12/05/2023]
Affiliation(s)
- Julia Del Amo
- Directora de la División de control de VIH, ITS, Hepatitis Virales y Tuberculosis, Ministerio de Sanidad, Madrid, Spain
| | - Rosario Palacios
- President of the Grupo de Estudio del Sida, Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica, Madrid, Spain
| | | | - José A Pérez-Molina
- President of the Sociedad Española Interdisciplinar del Sida, Madrid, Spain.
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Vizcarra P, Moreno A, Vivancos MJ, Muriel García A, Ramirez Schacke M, González-Garcia J, Curran A, Palacios R, Sánchez Guirao AJ, Reus Bañuls S, Moreno Guillén S, Casado JL. A Risk Assessment Tool for Predicting Fragility Fractures in People with HIV: Derivation and Internal Validation of the FRESIA Model. J Bone Miner Res 2023; 38:1443-1452. [PMID: 37545089 DOI: 10.1002/jbmr.4894] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 07/28/2023] [Accepted: 08/01/2023] [Indexed: 08/08/2023]
Abstract
People with HIV have a higher risk of fracture than the general population. Because of the low performance of the existing prediction tools, there is controversy surrounding fracture risk estimation in this population. The aim of the study was to develop a model for predicting the long-term risk of fragility fractures in people with HIV. We included 11,899 individuals aged ≥30 years from the Spanish HIV/AIDS research network cohort. We identified incident fragility fractures from medical records, defined as nontraumatic or those occurring after a casual fall, at major osteoporotic sites (hip, clinical spine, forearm, proximal humerus). Our model accounted for the competing risk of death and included 12 candidate predictors to estimate the time to first fragility fracture. We assessed the discrimination and calibration of the model and compared it with the FRAX tool. The incidence rate of fragility fractures was 4.34 (95% CI 3.61 to 5.22) per 1000 person-years. The final prediction model included age, chronic kidney disease, and chronic obstructive pulmonary disease as significant predictors. The model accurately predicted the 5- and 10-year risk of fragility fractures, with an area under the receiving operator characteristic curve of 0.768 (95% CI 0.722 to 0.814) and agreement between the observed and expected probabilities. Furthermore, it demonstrated better discrimination and calibration than the FRAX tool, improving the classification of over 35% of individuals with fragility fractures compared to FRAX. Our prediction model demonstrated accuracy in predicting the long-term risk of fragility fractures. It can assist in making personalized intervention decisions for individuals with HIV and could potentially replace the current tools recommended for fracture risk assessment in this population. © 2023 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Pilar Vizcarra
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, IRyCIS, Madrid, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Universidad de Alcalá, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Ana Moreno
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, IRyCIS, Madrid, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - María J Vivancos
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, IRyCIS, Madrid, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Alfonso Muriel García
- Unit of Biostatistics, Hospital Universitario Ramón y Cajal, Centro de Investigación Biomédica en Red, Epidemiología y Salud Pública (CIBERESP), Universidad de Alcalá, Madrid, Spain
| | - Margarita Ramirez Schacke
- Unit of Infectious Diseases - HIV, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Juan González-Garcia
- Unit of VIH, Department of Internal Medicine II, Hospital Universitario La Paz, IdiPaz, Madrid, Spain
| | - Adrián Curran
- Infectious Diseases Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Rosario Palacios
- Unit of Infectious Diseases, Hospital Universitario Virgen de la Victoria, Malaga, Spain
| | | | - Sergio Reus Bañuls
- Unit of Infectious Diseases, ISABIAL, Hospital General Universitario Dr. Balmis, Alicante, Spain
| | - Santiago Moreno Guillén
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, IRyCIS, Madrid, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Universidad de Alcalá, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - José L Casado
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, IRyCIS, Madrid, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
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Palacios R, Gómez-Ayerbe C, Casado JL, Tejerina F, Montes ML, Castaño M, Ocampo A, Rial D, Ribera E, Galindo MJ, Hidalgo C, Fariñas C, Montero M, Payeras T, Fanjul F, de la Torre J, Santos J. Efficacy and safety of dolutegravir/rilpivirine in real-world clinical practice. GeSIDA study 1119. HIV Med 2023; 24:933-937. [PMID: 37016556 DOI: 10.1111/hiv.13489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 03/14/2023] [Indexed: 04/06/2023]
Abstract
INTRODUCTION Dolutegravir/rilpivirine (DTG/RPV) is an effective antiretroviral (ART) regimen endorsed by clinical trials as a switch therapy. The aim of our study was to analyse the efficacy and safety of DTG/RPV in real-world clinical practice. METHODS Observational, multicentre study of patients who started DTG/RPV. Efficacy, adverse events and metabolic changes at 48 weeks were analysed. RESULTS A total of 348 patients were included; median time of HIV infection was 21.1 years, 33.7% were AIDS cases; median nadir CD4 was 160 cells/μL; 90.5% had received ≥3 lines of ART and 179 (53.8%) had prior virological failure. Convenience (43.5%), toxicity/intolerance (28.4%) and interactions (17.0%) were the main reasons for starting DTG/RPV. Previous regimens were protease inhibitors (PI) (31.6%), non-nucleoside reverse transcriptase inhibitors (NNRTI) (20.4%) and integrase strand transfer inhibitors (INSTI) (14.9%). Efficacy (HIV-RNA <50 copies/mL) at 48 weeks was 89.7% (95% CI 86.1-92.6) by intention-to-treat (ITT) and 94.2% (95% CI 91.3-96.4) by on treatment (OT); 10 patients (3.1%) were not suppressed (3 had abandoned ART). There was a mean decrease in triglycerides, total cholesterol, low-density lipoprotein-cholesterol, glutamic-pyruvic transaminase (GPT), gamma-glutamyl transferase (GGT) and alkaline phosphatase; creatinine increased with a decrease in glomerular filtration rate. CONCLUSIONS This study confirms the effectiveness, tolerability and safety of DTG/RPV in real-world clinical practice in a different population from clinical trials, with many years of infection, low CD4 nadir, several previous treatment lines, more than half with virological failures, and one-third diagnosed with AIDS. The switch to DTG/RPV was safe with few discontinuations due to adverse effects. Modifications of the lipid and liver profiles were favourable. There were no relevant changes in kidney function.
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Affiliation(s)
- R Palacios
- Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - C Gómez-Ayerbe
- Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - J L Casado
- Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - F Tejerina
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - M L Montes
- Hospital Universitario La Paz, Madrid, Spain
| | - M Castaño
- Hospital Regional Universitario de Málaga, Málaga, Spain
| | - A Ocampo
- Hospital Alvaro Cunqueiro, Vigo, Spain
| | - D Rial
- Hospital Universitario 12 de Octubre, Madrid, Spain
| | - E Ribera
- Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - M J Galindo
- Hospital General de Valencia, Valencia, Spain
| | - C Hidalgo
- Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - C Fariñas
- Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - M Montero
- Hospital Universitario La Fe, Valencia, Spain
| | - T Payeras
- Hospital Son Llàtzer, Palma de Mallorca, Spain
| | - F Fanjul
- Hospital Universitari Son Espaces, Palma de Mallorca, Spain
| | | | - J Santos
- Hospital Universitario Virgen de la Victoria, Málaga, Spain
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Corma-Gómez A, Fernández-Fuertes M, García E, Fuentes-López A, Gómez-Ayerbe C, Rivero-Juárez A, Domínguez C, Santos M, Viñuela L, Palacios R, Real LM, Rivero A, Macías J, Pineda JA, García F. Severe immunosuppression is related to poorer immunogenicity to SARS-CoV-2 vaccines among people living with HIV. Clin Microbiol Infect 2022; 28:1492-1498. [PMID: 35640840 PMCID: PMC9144847 DOI: 10.1016/j.cmi.2022.05.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [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: 02/25/2022] [Revised: 05/13/2022] [Accepted: 05/14/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The aim of this study was to assess the immunogenicity of SARS-CoV-2 available vaccines among people living with HIV (PLWH) after a complete vaccination scheme, and determine predictors of seroconversion. METHODS This multicentre prospective cohort study included 420 PLWH who had received a standard immunization, either with mRNA or adenoviral-vectored COVID-19 vaccines. Antibody response was evaluated within 1 to 2 months after the last dose of the vaccine with a quantitative determination of antitrimeric spike protein-specific IgG antibodies and IgG neutralizing antibodies. RESULTS Overall, 384 of 420 PLWH (91%) showed antibody response to vaccination. Seroconversion was observed in 308 of 326 individuals with cluster of differentiation 4 (CD4) counts ≥350 cells/mm3 (95%), 55 of 61 PLWH with 200 to 349 cells/mm3 (90%), and 21 of 33 PLWH with CD4 counts <200 cells/mm3 (64%; p < 0.001). The median log10 IgG neutralization levels were 2.4 IU/mL (Q1-Q3, 1.0-3.1) among PLWH with CD4 counts <200 cells/mm3, 3.1 IU/mL (Q1-Q3, 2.8-3.4) for the 200 to 349 cells/mm3 group, and 3.1 IU/mL (Q1-Q3, 2.7-3.4) for PLWH with CD4 counts ≥350 cells/mm3 (p = 0.016). In the multivariate analysis, CD4 counts ≥350 cells/mm3 (OR: 7.10; 95% CI, 1.91-26.46; p = 0.004) and receiving mRNA-vectored COVID-19 vaccines (OR: 8.19; 95% CI, 3.24-20.70; p ≤ 0.001) were independently associated with a higher probability of response to vaccination. DISCUSSION HIV-related immunosuppression impairs the antibody response to SARS-CoV-2 vaccines. Specific vaccination schemes should be urgently tailored in this setting, particularly in patients with CD4 cell counts <200 cells/μL. Adenoviral-vectored vaccines should be avoided in PLWH whenever possible.
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Affiliation(s)
- Anaïs Corma-Gómez
- Unit of Infectious Diseases and Microbiology, Hospital Universitario Virgen de Valme, Sevilla, Spain; Instituto de Biomedicina de Sevilla, Sevilla, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain
| | - Marta Fernández-Fuertes
- Unit of Infectious Diseases and Microbiology, Hospital Universitario Virgen de Valme, Sevilla, Spain; Instituto de Biomedicina de Sevilla, Sevilla, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain
| | - Estefanía García
- Unit of Infectious Diseases and Microbiology, Hospital Universitario Virgen de Valme, Sevilla, Spain
| | - Ana Fuentes-López
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain; Clinical Microbiology Unit, Hospital Universitario Clínico San Cecilio, Granada, Spain; Instituto de Investigacion Biosanitaria Ibs.Granada, Granada, Spain
| | - Cristina Gómez-Ayerbe
- Unit of Infectious Diseases, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Antonio Rivero-Juárez
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain; Unit of Infectious Diseases, Hospital Universitario Reina Sofia, Córdoba, Spain; Instituto Maimónides de Investigación Biomédica de Córdoba, Córdoba, Spain; University of Córdoba, Córdoba, Spain
| | - Carmen Domínguez
- Unit of Infectious Diseases and Microbiology, Hospital Universitario Virgen de Valme, Sevilla, Spain
| | - Marta Santos
- Unit of Infectious Diseases and Microbiology, Hospital Universitario Virgen de Valme, Sevilla, Spain; Instituto de Biomedicina de Sevilla, Sevilla, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain
| | - Laura Viñuela
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain; Clinical Microbiology Unit, Hospital Universitario Clínico San Cecilio, Granada, Spain; Instituto de Investigacion Biosanitaria Ibs.Granada, Granada, Spain
| | - Rosario Palacios
- Unit of Infectious Diseases, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Luis M Real
- Instituto de Biomedicina de Sevilla, Sevilla, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain; Department of Surgery, Biochemistry and Immunology, School of Medicine, University of Málaga, Málaga, Spain
| | - Antonio Rivero
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain; Unit of Infectious Diseases, Hospital Universitario Reina Sofia, Córdoba, Spain; Instituto Maimónides de Investigación Biomédica de Córdoba, Córdoba, Spain; University of Córdoba, Córdoba, Spain
| | - Juan Macías
- Unit of Infectious Diseases and Microbiology, Hospital Universitario Virgen de Valme, Sevilla, Spain; Instituto de Biomedicina de Sevilla, Sevilla, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain; Medicine Department, University of Sevilla, Sevilla, Spain.
| | - Juan A Pineda
- Unit of Infectious Diseases and Microbiology, Hospital Universitario Virgen de Valme, Sevilla, Spain; Instituto de Biomedicina de Sevilla, Sevilla, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain; Medicine Department, University of Sevilla, Sevilla, Spain
| | - Federico García
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Madrid, Spain; Clinical Microbiology Unit, Hospital Universitario Clínico San Cecilio, Granada, Spain; Instituto de Investigacion Biosanitaria Ibs.Granada, Granada, Spain
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Gómez-Ayerbe C, Palacios R, Mayorga M, Navarrete MN, Ferra S, Ruiz I, Garcia C, Castaño M, Merino D, Collado A, Hidalgo-Tenorio C, Delgado M, Rivero A, Santos J. Weight changes after first-line antiretroviral initiation in a cohort of HIV-positive patients in Southern Spain (CAPOTA study). Int J STD AIDS 2022; 33:1119-1123. [PMID: 36071543 DOI: 10.1177/09564624221125356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Obesity among persons living with HIV (PLWH) has increased and weight gain after antiretroviral therapy (ART) can lead to metabolic disorders and impact survival. Our objective was to analyze weight and metabolic changes in HIV näive patients after 48 weeks of ART. METHODS Observational, retrospective, multicentered cohort study comprising naïve-patients who started tenofovir alafenamide/emtricitabine/elvitegravir/cobicistat (TAF/FTC/EVG/c) or abacavir/lamivudine/dolutegravir (ABC/3TC/DTG), with no change in treatment for 48 weeks. Clinical and metabolic parameters were collected at baseline and week-48. Statistical program used was SPSS 21.0.0. RESULTS The study included 329 participants from 6 hospitals. Participants were 89% male and 10% had AIDS diagnosis. Median age was 35 (IQR 27-43) years. Median baseline CD4 count was 417 (IQR 250-569) cell/mm3 and HIV viral load 4.65 (IQR 4.21-5.18) log10 copies/ml. Baseline median weight was 70 (IQR 62-79) kg, body mass index 23.4 (IQR 21.2-26.0) kg/m2; 22.7% overweight and 6.4% obese. ART regimens: ABC/3TC/DTG (196), TAF/FTC/EVG/c (133). Baseline characteristics were similar in both ART groups. Average weight gain at week-48 was 2.9 (SD 5.5) kg (p < 0.0001) with no differences between both groups. There was an increase in obesity (6.4%-8%; p < 0.003) and overweight (22.7%-28.9%; p < 0.0001). Weight increase was associated with AIDS: OR 3.05 (95%; CI 1.009-9.22), p = 0.048; and lower baseline weight: OR 1.032 (95% CI 1.009-1.05), p = 0.006. CONCLUSIONS After ART initiation patients gain weight regardless of the regimen they take. Weight gain is associated with AIDS and the use of TAF/FTC/EVG/c.
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Affiliation(s)
| | | | | | | | | | | | - Coral Garcia
- 16504Hospital Virgen de Las Nieves, Granada, Spain
| | | | | | | | | | | | | | - Jesús Santos
- 16867Hospital Virgen de La Victoria e IBIMA, Málaga, Spain
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Gonzalez-Serna A, Macias J, Corma-Gomez A, Tellez F, Cucurull J, Real LM, Granados R, Rivero-Juarez A, Hernandez-Quero J, Merino D, Palacios R, Rios MJ, Collado A, Pineda JA. High efficacy of glecaprevir/pibrentasvir for HCV-infected individuals with active drug use. J Infect 2022; 85:322-326. [PMID: 35700867 DOI: 10.1016/j.jinf.2022.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 06/03/2022] [Accepted: 06/07/2022] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Real world data on glecaprevir/pibrentasvir (G/P) among active drug users are scarce. We evaluated the sustained virological response (SVR) rates of G/P among individuals with and without active drug use in routine clinical practice. METHODS Two ongoing prospective multicenter cohorts of individuals starting G/P were analyzed. Overall SVR intention-to-treat (ITT), discontinuations due to adverse effects and dropouts were evaluated. Results in patients with active, past and without active drug use were compared. RESULTS Overall, 644 individuals started G/P and have reached the date of SVR evaluation. Of them, 613 (95.2%) individuals achieved SVR. There were two (0.3%) relapses, one (0.2%) discontinuation due to side effects and 35 (5.4%) dropouts. SVR rates for patients with active drug use, past drug use and those who never used drugs were 85.4%(n/N = 70/82), 96.1%(n/N = 320/333) and 97.4%(n/N = 223/229) respectively (p < 0.001). After adjustment by sex, age, HCV genotype and opioid agonist therapy, active drug use was the only factor independently associated with SVR (ITT) [adjusted OR (95%confidence interval): 0.29(0.09-0.99),p = 0.048]. CONCLUSIONS Active drug use was independently associated with lower SVR rates to G/P, mainly due to voluntary dropout. G/P could be particularly beneficial in this scenario but specific strategies designed to increase the retention in care are needed.
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Affiliation(s)
- Alejandro Gonzalez-Serna
- Hospital Universitario de Valme, Seville, Spain; Departamento de Fisiología, Facultad de Farmacia, Universidad de Sevilla, Sevilla, Spain; Instituto de Biomedicina de Sevilla (IBiS), Sevilla, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Spain; Grupo Estudio Hepatitis Víricas (GEHEP) de la SEIMC. GEHEP-001
| | - Juan Macias
- Hospital Universitario de Valme, Seville, Spain; Instituto de Biomedicina de Sevilla (IBiS), Sevilla, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Spain; Departamento de Medicina, Universidad de Sevilla, Sevilla, Spain; Grupo Estudio Hepatitis Víricas (GEHEP) de la SEIMC. GEHEP-001.
| | - Anaïs Corma-Gomez
- Hospital Universitario de Valme, Seville, Spain; Instituto de Biomedicina de Sevilla (IBiS), Sevilla, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Spain; Grupo Estudio Hepatitis Víricas (GEHEP) de la SEIMC. GEHEP-001
| | - Francisco Tellez
- Hospital Universitario de Puerto Real, Puerto Real, Spain; Grupo Estudio Hepatitis Víricas (GEHEP) de la SEIMC. GEHEP-001
| | - Josep Cucurull
- Fundacio Salut Emporda (Fundació Privada), Figueres, Spain; Grupo Estudio Hepatitis Víricas (GEHEP) de la SEIMC. GEHEP-001
| | - Luis M Real
- Hospital Universitario de Valme, Seville, Spain; Instituto de Biomedicina de Sevilla (IBiS), Sevilla, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Spain; Departamento de Especialidades Quirúrgicas, Bioquímica e Inmunología. Facultad de Medicina, Universidad de Málaga, Málaga, Spain; Grupo Estudio Hepatitis Víricas (GEHEP) de la SEIMC. GEHEP-001
| | - Rafael Granados
- Hospital de Gran Canaria Dr. Negrín, Las Palmas de Gran Canarias, Spain; Grupo Estudio Hepatitis Víricas (GEHEP) de la SEIMC. GEHEP-001
| | - Antonio Rivero-Juarez
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Spain; Instituto Maimonides de Investigación Biomedica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, Córdoba, Spain; Grupo Estudio Hepatitis Víricas (GEHEP) de la SEIMC. GEHEP-001
| | - José Hernandez-Quero
- Hospital Universitario de San Cecilio de Granada, Granada, Spain; Grupo Estudio Hepatitis Víricas (GEHEP) de la SEIMC. GEHEP-001
| | - Dolores Merino
- Hospital Juan Ramón Jiménez, Huelva, Spain; Grupo Estudio Hepatitis Víricas (GEHEP) de la SEIMC. GEHEP-001
| | - Rosario Palacios
- Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain; Grupo Estudio Hepatitis Víricas (GEHEP) de la SEIMC. GEHEP-001
| | - Maria José Rios
- Hospital Universitario Virgen Macarena, Sevilla, Spain; Grupo Estudio Hepatitis Víricas (GEHEP) de la SEIMC. GEHEP-001
| | - Antonio Collado
- Hospital Universitario Torrecárdenas, Almería, Spain; Grupo Estudio Hepatitis Víricas (GEHEP) de la SEIMC. GEHEP-001
| | - Juan A Pineda
- Hospital Universitario de Valme, Seville, Spain; Instituto de Biomedicina de Sevilla (IBiS), Sevilla, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Spain; Departamento de Medicina, Universidad de Sevilla, Sevilla, Spain; Grupo Estudio Hepatitis Víricas (GEHEP) de la SEIMC. GEHEP-001
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Ruiz-Algueró M, Alejos B, García Yubero C, Riera Jaume M, Antonio Iribarren J, Asensi V, Pasquau F, Galera CE, Pascual-Carrasco M, Muñoz A, Jarrín I, Suárez-García I, Moreno S, Jarrín I, Dalmau D, Navarro ML, González MI, Blanco JL, Garcia F, Rubio R, Iribarren JA, Gutiérrez F, Vidal F, Berenguer J, González J, Alejos B, Hernando V, Moreno C, Iniesta C, Garcia Sousa LM, Perez NS, Muñoz-Fernández MÁ, García-Merino IM, Fernández IC, Rico CG, de la Fuente JG, Concejo PP, Portilla J, Merino E, Reus S, Boix V, Giner L, Gadea C, Portilla I, Pampliega M, Díez M, Rodríguez JC, Sánchez-Payá J, Gómez JL, Hernández J, Alemán MR, del Mar Alonso M, Inmaculada Hernández M, Díaz-Flores F, García D, Pelazas R, Lirola AL, Moreno JS, Caso AA, Hernández Gutiérrez C, Novella Mena M, Rubio R, Pulido F, Bisbal O, Hernando A, Domínguez L, Crestelo DR, Bermejo L, Santacreu M, Antonio Iribarren J, Arrizabalaga J, Aramburu MJ, Camino X, Rodríguez-Arrondo F, von Wichmann MÁ, Tomé LP, Goenaga MÁ, Bustinduy MJ, Azkune H, Ibarguren M, Lizardi A, Kortajarena X, Gutiérrez F, Masiá M, Padilla S, Navarro A, Montolio F, Robledano C, Gregori Colomé J, Adsuar A, Pascual R, Fernández M, García E, García JA, Barber X, Muga R, Sanvisens A, Fuster D, Berenguer J, de Quirós JCLB, Gutiérrez I, Ramírez M, Padilla B, Gijón P, Aldamiz-Echevarría T, Tejerina F, José Parras F, Balsalobre P, Diez C, Latorre LP, Vidal F, Peraire J, Viladés C, Veloso S, Vargas M, López-Dupla M, Olona M, Rull A, Rodríguez-Gallego E, Alba V, Montero Alonso M, López Aldeguer J, Blanes Juliá M, Tasias Pitarch M, Hernández IC, Calabuig Muñoz E, Cuéllar Tovar S, Salavert Lletí M, Navarro JF, González-Garcia J, Arnalich F, Arribas JR, de la Serna JIB, Castro JM, Escosa L, Herranz P, Hontañón V, García-Bujalance S, López-Hortelano MG, González-Baeza A, Martín-Carbonero ML, Mayoral M, Mellado MJ, Micán RE, Montejano R, Luisa Montes M, Moreno V, Pérez-Valero I, Rodés B, Sainz T, Sendagorta E, Stella Alcáriz N, Valencia E, Ramón Blanco J, Antonio Oteo J, Ibarra V, Metola L, Sanz M, Pérez-Martínez L, Arazo P, Sampériz G, Dalmau D, Jaén A, Sanmartí M, Cairó M, Martinez-Lacasa J, Velli P, Font R, Xercavins M, Alonso N, Repáraz J, de Alda MGR, de León Cano MT, de Galarreta BPR, Segura F, José Amengual M, Navarro G, Sala M, Cervantes M, Pineda V, Calzado S, Navarro M, de los Santos I, Sanz Sanz J, Aparicio AS, Sarriá Cepeda C, Garcia-Fraile Fraile L, Martín Gayo E, Moreno S, Luis Casado J, Dronda F, Moreno A, Jesús Pérez Elías M, Gómez Ayerbe C, Gutiérrez C, Madrid N, del Campo Terrón S, Martí P, Ansa U, Serrano S, Jesús Vivancos M, Cano A, García AA, Bravo Urbieta J, Muñoz Á, Jose Alcaraz M, Villalba MDC, García F, Hernández J, Peña A, Muñoz L, Casas P, Alvarez M, Chueca N, Vinuesa D, Martinez-Montes C, Romero JD, Rodríguez C, Puerta T, Carlos Carrió J, Vera M, Ballesteros J, Ayerdi O, Antela A, Losada E, Riera M, Peñaranda M, Leyes M, Ribas MA, Campins AA, Vidal C, Fanjul F, Murillas J, Homar F, Santos J, Ayerbe CG, Viciana I, Palacios R, González CM, Viciana P, Espinosa N, López-Cortés LF, Podzamczer D, Ferrer E, Imaz A, Tiraboschi J, Silva A, Saumoy M, Ribera E, Curran A, Olalla J, del Arco A, de la torre J, Prada JL, de Lomas Guerrero JMG, Stachowski JP, Martínez OJ, Vera FJ, Martínez L, García J, Alcaraz B, Jimeno A, Iglesias AC, Souto BP, de Cea AM, Muñoz J, Zubero MZ, Baraia-Etxaburu JM, Ugarte SI, Beneitez OLF, de Munain JL, López MMC, de la Peña M, Lopez M, Galera C, Albendin H, Pérez A, Iborra A, Moreno A, Merlos MA, Vidal A, Amador C, Pasquau F, Ena J, Benito C, Fenoll V, Anguita CG, Rabasa JTA, Suárez-García I, Malmierca E, González-Ruano P, Rodrigo DM, Seco MPR, Vidal MAG, de Zarraga MA, Pérez VE, Molina MJT, García JV, Moreno JPS, Górgolas M, Cabello A, Álvarez B, Prieto L, Sanz Moreno J, Arranz Caso A, Gutiérrez CH, Novella Mena M, Galindo Puerto MJ, Fernando Vilalta R, Ferrer Ribera A, Román AR, Brieva Herrero MT, Juárez AR, López PL, Sánchez IM, Martínez JP, Jiménez MC, Perea RT, Ruiz-Capillas JJJ, Pineda JA. Use of Generic Antiretroviral Drugs and Single-Tablet Regimen De-Simplification for the Treatment of HIV Infection in Spain. AIDS Res Hum Retroviruses 2022; 38:433-440. [PMID: 35357907 DOI: 10.1089/aid.2021.0122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The present study sought to describe the use of generic drugs and single-tablet regimen (STR) de-simplification for the treatment of human immunodeficiency virus (HIV) infection among 41 hospitals from the cohort of the Spanish HIV/AIDS Research Network (CoRIS). In June 2018, we collected information on when generic antiretroviral drugs (ARVs) were introduced in the different hospitals, how the decisions to use them were made, and how the information was provided to the patients. Most of the nine available generic ARVs in Spain by June 2018 had been introduced in at least 85% of the participating hospitals, except for zidovudine (AZT)/lamivudine (3TC) and AZT. The time difference between the effective marketing date of each generic ARV and its first dispensing date in the hospitals was much shorter for the more recently approved generic ARV since the year 2017. However, only up to 20% of the hospitals de-simplified efavirenz (EFV)/tenofovir disoproxil (TDF)/emtricitabine (FTC), dolutegravir (DTG)/abacavir (ABC)/3TC, and rilpivirine (RPV)/TDF/FTC (to generic EFV+TDF/FTC, DTG+generic ABC/3TC, and RPV+generic TDF/FTC, respectively), whereas the generic STR EFV/TDF/FTC was introduced in 87.8% of the centers. The median times between the date of effective marketing of generic TDF/FTC and the date of de-simplification of EFV/TDF/FTC and RPV/TDF/FTC were 723 [interquartile range (IQR): 369-1,119] and 234 (IQR: 142-264) days, respectively; this time was 155 (IQR: 28-287) days for de-simplification of DTG/ABC/3TC. In conclusion, despite the widespread use of generic ARVs, STRs de-simplification was only undertaken in <20% of the hospitals. There was wide variability in the timing of the introduction of each generic ARV after they were available in the market.
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Affiliation(s)
- Marta Ruiz-Algueró
- National Center for Epidemiology, Institute of Health Carlos, Madrid, Spain
- CIBER de Enfermedades Infecciosas, Institute of Health CArlos III, Madrid, Spain
| | - Belén Alejos
- National Center for Epidemiology, Institute of Health Carlos, Madrid, Spain
| | | | | | - José Antonio Iribarren
- Servicio de Enfermedades Infecciosas, Hospital Universitario Donostia, Instituto de Investigación BioDonostia, San Sebastián, Spain
| | - Víctor Asensi
- Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | | | - Mario Pascual-Carrasco
- CIBER de Enfermedades Infecciosas, Institute of Health CArlos III, Madrid, Spain
- Unidad de Investigación en Telemedicina y Salud Digital (UITes), Instituto de Salud Carlos III, Madrid, Spain
| | - Adolfo Muñoz
- CIBER de Enfermedades Infecciosas, Institute of Health CArlos III, Madrid, Spain
- Unidad de Investigación en Telemedicina y Salud Digital (UITes), Instituto de Salud Carlos III, Madrid, Spain
| | - Inmaculada Jarrín
- National Center for Epidemiology, Institute of Health Carlos, Madrid, Spain
- CIBER de Enfermedades Infecciosas, Institute of Health CArlos III, Madrid, Spain
| | - Inés Suárez-García
- CIBER de Enfermedades Infecciosas, Institute of Health CArlos III, Madrid, Spain
- Infectious Diseases Unit, Department of Internal Medicine, Hospital Universitario Infanta Sofía, Madrid, Spain
- Facultad de Ciencias Biomédicas, Universidad Europea de Madrid, Madrid, Spain
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Vega-Castro A, Rodríguez-Gil D, Martínez-Gomariz M, Gallego R, Peña MI, Palacios R. Api m 6 and Api m 10 as Major Allergens in Patients With Honeybee Venom Allergy. J Investig Allergol Clin Immunol 2022; 32:116-123. [PMID: 32856591 DOI: 10.18176/jiaci.0639] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Component-resolved diagnosis plays a key role in the diagnosis and treatment of honeybee venom allergy (HVA). Our aim was to study whether any of the allergens not included in the usual diagnostic platforms are relevant in our population. MATERIAL AND METHODS The allergenic sensitization profile of Spanish patients who experienced a systemic reaction after a honeybee sting and were diagnosed with HVA was studied by immunoblotting based on raw autochthonous Apis mellifera venom characterized using SDS-PAGE and mass spectrometry and a commercial assay (ImmunoCAP). RESULTS Allergens in the International Union of Immunological Societies database were detected in the raw A mellifera venom extract used, except Api m 12. Sera from 51 patients with a median (IQR) age of 46.2 years (35.6-54.6) were analyzed. ImmunoCAP revealed Api m 1 and Api m 10 to be major allergens (88.2% and 74.5%, respectively). Moreover, Api m 6 (85.4%) was detected by immunoblotting. CONCLUSION Api m 1, Api m 6, and Api m 10 are major A mellifera venom allergens in our population.
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Affiliation(s)
- A Vega-Castro
- Hospital Universitario de Guadalajara, Guadalajara, Spain; Spanish Thematic Network and Co-operative Research Centre ARADyAL, Center RD16/0006/0023
| | | | | | - R Gallego
- Diater Laboratorios S.A., Leganés, Madrid, Spain
| | - M I Peña
- Hospital Universitario de Guadalajara, Guadalajara, Spain; Spanish Thematic Network and Co-operative Research Centre ARADyAL, Center RD16/0006/0023
| | - R Palacios
- Diater Laboratorios S.A., Leganés, Madrid, Spain
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Corma-Gómez A, Macías J, Téllez F, Morano L, Rivero A, Serrano M, Ríos MJ, Vera-Méndez FJ, Santos M, Real LM, Palacios R, Santos IDL, Geijo P, Imaz A, Merino D, Galindo MJ, Reus-Bañuls S, López-Ruz MÁ, Galera C, Pineda JA. Kinetics of emergence of liver complications in hepatitis C virus infected patients and advanced fibrosis, with and without HIV-coinfection, after sustained virological response. AIDS 2021; 35:2119-2127. [PMID: 34049354 DOI: 10.1097/qad.0000000000002959] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE There is scarce available evidence on the distribution over time of liver complications emergence in hepatitis C virus (HCV)-infected patients who achieve sustained virological response (SVR) with direct-acting antiviral (DAA)-based therapy. Therefore, we aimed at describing the kinetics of liver-related events appearance in this setting. DESIGN A multicentric prospective cohort study. METHODS HCV-monoinfected and HIV/HCV-coinfected patients from GEHEP-011 cohort, whose inclusion criteria were had achieved SVR with DAA-based therapy; liver stiffness prior to starting treatment at least 9.5 kPa; and available liver stiffness measurement at SVR. SVR was considered as the baseline time-point. RESULTS One thousand and thirty-five patients were included, 664 (64%) coinfected with HIV. Before DAA-based therapy, 63 (6.1%) individuals showed decompensated cirrhosis. After SVR, 51 (4.9%) patients developed liver complications. Median (Q1-Q3) time to the emergence of hepatic events was hepatic encephalopathy 11 (7-24) months, ascites 14 (6-29) months, hepatocellular carcinoma (HCC) 17 (11-42) months and portal hypertension gastrointestinal bleeding (PHGB) 28 (22-38) months (P = 0.152). We define two profiles of liver complications: those emerging earlier (encephalopathy and ascites) and, those occurring continuously during the follow-up (HCC, PHGB) [median (Q1-Q3) time to emergence 12.7 (6.6-28.2) months vs. 25.4 (12.5-41.53) months, respectively (P = 0.026)]. CONCLUSION The vast majority of HCV-infected patients who develop liver complications after reaching SVR with DAA do it within 3 years after SVR time-point. Specifically, hepatic encephalopathy and ascites do not usually emerge after this period. Conversely, HCC and PHGB may occur in longer term. It is critical to identify patients at risk of developing hepatic events to continue performing surveillance for them.
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Affiliation(s)
- Anaïs Corma-Gómez
- Unit of Infectious Diseases and Microbiology. Hospital Universitario de Valme, Seville
| | - Juan Macías
- Unit of Infectious Diseases and Microbiology. Hospital Universitario de Valme, Seville
| | - Francisco Téllez
- Unit of Infectious Diseases, Hospital Universitario de Puerto Real, Faculty of Medicine, Cadiz
| | - Luis Morano
- Unit of Infectious Pathology, Hospital Universitario Alvaro Cunqueiro, Vigo
| | - Antonio Rivero
- Unit of Infectious Diseases, Hospital Universitario Reina Sofia, Córdoba
| | - Miriam Serrano
- Unit of Infectious Diseases, Hospital Universitario de Gran Canaria Dr Negrín, Las Palmas de Gran Canaria
| | - María José Ríos
- Unit of Infectious Diseases, Hospital Universitario Virgen Macarena, Sevilla
| | - Francisco Jesús Vera-Méndez
- Section of Infectious Medicine/Service of Internal Medicine, Hospital General Universitario Santa Lucía, Cartagena
| | - Marta Santos
- Unit of Internal Medicine, Hospital Universitario del SAS de Jerez, Cadiz
| | - Luis Miguel Real
- Unit of Immunology, Biochemistry, Molecular Biology and Surgery, Faculty of Medicine, Universidad de Málaga
| | - Rosario Palacios
- Unit of Infectious Diseases and Microbiology, Hospital Virgen de la Victoria, Málaga
| | | | - Paloma Geijo
- Unit of Infectious Diseases, Hospital Virgen de la Luz, Cuenca
| | - Arkaitz Imaz
- HIV and STI Unit, Department of Infectious Diseases, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, L'Hospitalet de Llobregat, Barcelona
| | - Dolores Merino
- Unit of Infectious Diseases, Hospital Juan Ramón Jiménez, Huelva
| | - Maria José Galindo
- Unit of Infectious Diseases, Hospital Clínico Universitario de Valencia, Valencia
| | - Sergio Reus-Bañuls
- Unit of Infectious Diseases, Hospital General Universitario de Alicante, Alicante
| | | | - Carlos Galera
- Unit of Infectious Diseases, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Juan A Pineda
- Unit of Infectious Diseases and Microbiology. Hospital Universitario de Valme, Seville
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Stephan Y, Lima-Posada I, Souille M, Bonnard B, Palacios R, Nicol L, Kolkhof P, Jaisser F, Mulder P. The non-steroidal mineralocorticoid receptor antagonist finerenone improves left ventricular function in preclinical chronic kidney disease. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The steroidal MR antagonist spironolactone and eplerenone reduce mortality in patients with heart failure with reduced ejection fraction (HFrEF) but their use in clinical practice in patients with CKD is limited due to the associated risk of hyperkalemia and worsening renal function. Finerenone is a novel non-steroidal mineralocorticoid receptor antagonist which recently reduced the composite kidney and cardiovascular outcomes in the phase III study FIDELIO among 5734 patients with CKD and type 2 diabetes and a mean baseline eGFR of 44 ml/min/1.73 m2. However, the benefit of finerenone on cardiac function in CKD is unknown.
Goal
To test the hypothesis that finerenone improves cardiac function in preclinical CKD.
Methods
CKD was induced by 5/6 nephrectomy in 10–12 weeks old Sprague Dawley rats and finerenone was administered at the dose of 10 mg/kg/d po as preventive or as curative treatment (starting immediately or 1 month after 5/6 nephrectomy, respectively). LV function / hemodynamics (LV catheterization), LV tissue perfusion (MRI) and GFR (transcutaneous FITC-sinistrin) were assessed in vivo at the age of 24 weeks, as well as LV and kidney weights
Results
Twelve weeks after 5/6 nephrectomy, rats showed classical signs of CKD, illustrated by the reduced GFR (1.07±0.09 and 0.46±0.07 ml/min/100g body weight for sham and CKD rats respectively, p<0.05) and increased kidney weight (1.81±0.05 and 2.06±0.22 g respectively; p<0.05) associated with LV diastolic dysfunction, illustrated by the increases in LV end-diastolic pressure (LVEDP; 5.06±0.41 and 9.04±0.88 mmHg respectively, p<0.05), LV relaxation constant (Tau; 9.7±0.3 and 11.2±0.5 msec respectively; p<0.05) and LV end-diastolic pressure volume-relation (LVEDPVR; 1.20±0.11 and 4.43±0.30 mmHg/relative volume unit respectively; p<0.05) without significant changes in LV end-systolic pressure (LVESP; 133±6 and 151±10 mmHg respectively) or LV end-systolic pressure volume-relation (LVESPVR; 27.9±1.3 and 27.9±1.0 mmHg/relative volume unit respectively) while LV perfusion was reduced (9.24±0.22 and 8.01±0.28 ml/min/g LV tissue respectively; p<0.05). Both preventive and curative finerenone treatment did not impact GFR (0.49±0.08 and 0.54±0.09 ml/min/100g body weight) but reduced significantly and to a similar extent, LVEDP (6.68±0.35 and 6.92±0.40 mmHg respectively, p<0.05), Tau (9.0±0.5 and 9.2±0.6 msec, respectively) as well as LV end-diastolic pressure volume-relation (LVEDPVR; 1.97±0.19 and 2.00±0.19 mmHg/relative volume unit respectively; p<0.05) and increased LV tissue perfusion (9.12±0.34 and 9.11±0.71 ml/min/g LV tissue respectively), associated with a normalization of kidney weight (1.86±0.08 and 1.89±0.05 g respectively; p<0.05).
Conclusion
Both preventive as well as curative finerenone treatment improves CKD related LV diastolic function, independently from changes in GFR.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Bayer Pharma
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Affiliation(s)
- Y Stephan
- Inserm U1096, Rouen University Medical School, Rouen, France
| | | | - M Souille
- Inserm U1096, Rouen University Medical School, Rouen, France
| | | | | | - L Nicol
- Inserm U1096, Rouen University Medical School, Rouen, France
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Corma-Gómez A, Macías J, Rivero A, Rivero-Juarez A, de los Santos I, Reus-Bañuls S, Morano L, Merino D, Palacios R, Galera C, Fernández-Fuertes M, González-Serna A, de Rojas I, Ruiz A, Sáez ME, Real LM, Pineda JA. A Genome-Wide Association Study on Liver Stiffness Changes during Hepatitis C Virus Infection Cure. Diagnostics (Basel) 2021; 11:1501. [PMID: 34441435 PMCID: PMC8394459 DOI: 10.3390/diagnostics11081501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/11/2021] [Accepted: 08/16/2021] [Indexed: 02/07/2023] Open
Abstract
Liver stiffness (LS) at sustained virological response (SVR) after direct-acting antivirals (DAA)-based therapy is a predictor of liver events in hepatitis C virus (HCV)-infected patients. The study aim was to identify genetic factors associated with LS changes from the moment of starting anti-HCV therapy to SVR. This prospective study included HCV-infected patients from the GEHEP-011 cohort who achieved SVR with DAA-based therapy, with LS pre-treatment ≥ 9.5 kPa and LS measurement available at SVR. Plink and Magma software were used to carry out genome-wide single-nucleotide polymorphism (SNP)-based and gene-based association analyses, respectively. The ShinyGO application was used for exploring enrichment in Gene Ontology (GO) categories for biological processes. Overall, 242 patients were included. Median (quartile 1, quartile 3) LS values at pre-treatment and at SVR were 16.8 (12, 28) kPa and 12.0 (8.5, 19.3) kPa, respectively. Thirty-five SNPs and three genes reached suggestive association with LS changes from the moment of starting anti-HCV therapy to SVR. GO categories related to DNA packaging complex, DNA conformation change, chromosome organization and chromatin organization were significantly enriched. Our study reports possible genetic factors associated with LS changes during HCV-infection cure. In addition, our results suggest that processes related to DNA conformation are also involved in these changes.
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Affiliation(s)
- Anaïs Corma-Gómez
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital de Valme, 41014 Sevilla, Spain; (A.C.-G.); (J.M.); (M.F.-F.); (A.G.-S.); (J.A.P.)
| | - Juan Macías
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital de Valme, 41014 Sevilla, Spain; (A.C.-G.); (J.M.); (M.F.-F.); (A.G.-S.); (J.A.P.)
- Departamento de Medicina, Universidad de Sevilla, 41009 Sevilla, Spain
| | - Antonio Rivero
- Unidad de Enfermedades Infecciosas, Hospital Universitario Reina Sofía, Instituto Maimonides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba, 14004 Córdoba, Spain; (A.R.); (A.R.-J.)
| | - Antonio Rivero-Juarez
- Unidad de Enfermedades Infecciosas, Hospital Universitario Reina Sofía, Instituto Maimonides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba, 14004 Córdoba, Spain; (A.R.); (A.R.-J.)
| | - Ignacio de los Santos
- Unidad de Medicina Interna y Enfermedades Infecciosas, Hospital de La Princesa, 28006 Madrid, Spain;
| | - Sergio Reus-Bañuls
- Unidad de Enfermedades Infecciosas, Hospital General Universitario de Alicante, 03010 Alicante, Spain;
| | - Luis Morano
- Unidad de Patología Infecciosa, Hospital Universitario Alvaro Cunqueiro, Instituto de Investigación Sanitaria Galicia Sur (IISGS), 36312 Vigo, Spain;
| | - Dolores Merino
- Unidad de Enfermedades Infecciosas, Hospital Universitario Juan Ramón Jiménez, 21005 Huelva, Spain;
| | - Rosario Palacios
- Unidad de Enfermedades Infecciosas y Microbiología, Hospital Virgen de la Victoria, 29010 Málaga, Spain;
| | - Carlos Galera
- Unidad de Medicina Interna, Hospital Clínico Universitario Virgen de la Arrixaca, 30120 Murcia, Spain;
| | - Marta Fernández-Fuertes
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital de Valme, 41014 Sevilla, Spain; (A.C.-G.); (J.M.); (M.F.-F.); (A.G.-S.); (J.A.P.)
| | - Alejandro González-Serna
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital de Valme, 41014 Sevilla, Spain; (A.C.-G.); (J.M.); (M.F.-F.); (A.G.-S.); (J.A.P.)
| | - Itziar de Rojas
- Fundació ACE—Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya (UIC), 08028 Barcelona, Spain; (I.d.R.); (A.R.)
- CIBERNED Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Agustín Ruiz
- Fundació ACE—Institut Català de Neurociències Aplicades, Universitat Internacional de Catalunya (UIC), 08028 Barcelona, Spain; (I.d.R.); (A.R.)
- CIBERNED Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - María E. Sáez
- Centro Andaluz de Estudios Bioinformáticos (CAEBI, SL), 41013 Sevilla, Spain;
| | - Luis M. Real
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital de Valme, 41014 Sevilla, Spain; (A.C.-G.); (J.M.); (M.F.-F.); (A.G.-S.); (J.A.P.)
- Departamento de Especialidades Quirúrgicas, Bioquímica e Inmunología, Universidad de Málaga, 29010 Málaga, Spain
| | - Juan A. Pineda
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital de Valme, 41014 Sevilla, Spain; (A.C.-G.); (J.M.); (M.F.-F.); (A.G.-S.); (J.A.P.)
- Departamento de Medicina, Universidad de Sevilla, 41009 Sevilla, Spain
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Gómez-Ayerbe C, Palacios R, Ríos MJ, Téllez F, Sayago C, Martín-Aspas A, Camacho A, Muñoz L, Santos J. Acute hepatitis C virus infection and direct-acting antiviral drugs: Perfect combination to eliminate the epidemic? Int J STD AIDS 2021; 32:1257-1260. [PMID: 34293985 DOI: 10.1177/09564624211033756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Early diagnosis and treatment of incident cases of hepatitis C virus (HCV) infection is fundamental to eliminate HCV in HIV-positive patients. From January 2016 to December 2019, we attended 40 episodes of acute HCV infection (AHC) in 35 subjects (9 reinfections) who were coinfected with HIV. The patients were treated with direct-acting antiviral agents (DAAs) in seven hospitals in Andalusia, Spain. All were men who have sex with men (MSM), mean age was 42.9 (±8.3) years and median time of HIV infection was 46.6 months (IQR: 20.4-67.2). All received antiretroviral therapy and had undetectable HIV viral load (except 2 with 65 and 68 copies/mL); median CD4 count was 632 cells/mm3 (IQR: 553-896). Over half (74.3%) also had another concomitant sexually transmitted infection, syphilis (48.6%) being the most common. AHC was asymptomatic in 32 cases (80%). Genotypeic distribution was G1a 65%, G4 32.5% and G1b 3%. Median time to DAA was 6 weeks (IQR: 4.3-18.3) and median baseline HCV RNA was 6.1 Log (IQR: 5.6-6.5). DAA regimens were SOF/LDV (19 episodes), SOF/VEL (14), ELB/GZV (5) and GLP/PIB (2). All presented sustained viral response and none discontinued due to adverse effects. In conclusion, early treatment with DAA in AHC patients proved effective and safe. It could be an excellent strategy to eliminate HCV infection in HIV-coinfected MSM.
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Affiliation(s)
- Cristina Gómez-Ayerbe
- Instituto de Investigación Biomédica de Málaga (IBIMA), 16867Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Rosario Palacios
- Instituto de Investigación Biomédica de Málaga (IBIMA), 16867Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Maria J Ríos
- 16582Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Francisco Téllez
- Departamento de Medicina, Universidad de Cádiz, 16875Hospital Universitario de Puerto Real, Puerto Real, Spain
| | - Carmen Sayago
- 16583Hospital Universitario Virgen de Valme, Sevilla, Spain
| | | | | | | | - Jesús Santos
- Instituto de Investigación Biomédica de Málaga (IBIMA), 16867Hospital Universitario Virgen de la Victoria, Málaga, Spain
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Perez Elias MJ, Alejos B, Gutierrez MM, Crespo M, De Los Santos Gil I, Ribera E, Galindo MJ, Lozano F, Payeras Cifre A, Boix V, Montero-Alonso M, Sanz J, De La Torre Lima J, Palacios R, De La Fuente Moral S, Martinez E. Dynamics of creatinine estimated glomerular filtration rate using one or more antiretrovirals that inhibit creatinine tubular secretion. J Antimicrob Chemother 2021; 76:1046-1050. [PMID: 33501995 DOI: 10.1093/jac/dkaa547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 12/03/2020] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Cobicistat, dolutegravir and rilpivirine are all modest inhibitors of proximal tubular creatinine secretion (IPTCrS) and hence a moderate and early non-progressive creatinine estimated glomerular filtration rate (Cr-eGFR) reduction has been observed in clinical trials. Data regarding the impact of combination of those drugs on Cr-eGFR, in the clinical practice, are scarcely known. METHODS Changes in Cr-eGFR after starting darunavir/cobicistat alone or in combination with dolutegravir and/or rilpivirine were studied in a nationwide retrospective cohort study of consecutive HIV-infected patients initiating darunavir/cobicistat. The relationship between Cr-eGFR changes over time and the use of darunavir/cobicistat alone or darunavir/cobicistat plus dolutegravir and/or rilpivirine adjusted by different HIV patient's characteristics, socio-demographics, HIV severity and use of tenofovir concomitant medication other than antiretrovirals was explored through univariate and multivariate analyses. RESULTS The analysis included 725 patients. At 48 weeks, the combination of two or more IPTCrS (darunavir/cobicistat with rilpivirine and/or dolutegravir) was associated with higher decreases in Cr-eGFR [adjusted median difference (±SD) -3.5 ± 1.6 (95% CI -6.6 to -0.3), P = 0.047], and a decrease up to or higher than 15 mL/min/1.73 m2 was more frequent [adjusted OR 3.233 (95% CI 1.343-7.782), P = 0.009], with respect to darunavir/cobicistat alone. The Cr-eGFR changes between darunavir/cobicistat and darunavir/cobicistat with rilpivirine and/or dolutegravir showed more significant decreases in patients taking two or more IPTCrS at 12, 24 and 48 weeks. (ClinicalTrials.gov: NCT03042390). CONCLUSIONS Concomitant use of darunavir/cobicistat plus IPTCrS dolutegravir, rilpivirine, or both produced an additive effect in the expected Cr-eGFR decrease.
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Affiliation(s)
| | - Belen Alejos
- Instituto de Salud Carlos III Madrid, Madrid, Spain
| | | | - Manuel Crespo
- Hospital Universitario Alvaro Cunqueiro, Vigo, Spain
| | | | | | | | | | | | - Vicente Boix
- Hospital General Universitario de Alicante, Alicante, Spain
| | | | - José Sanz
- Hospital Universitario de Guadalajara, Guadalajara, Spain
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15
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Corma-Gómez A, Macías J, Morano L, Rivero A, Téllez F, Ríos MJ, Santos M, Serrano M, Palacios R, Merino D, Real LM, De Los Santos I, Vera-Méndez FJ, Galindo MJ, Pineda JA. Liver Stiffness-Based Strategies Predict Absence of Variceal Bleeding in Cirrhotic Hepatitis C Virus-Infected Patients With and Without Human Immunodeficiency Virus Coinfection After Sustained Virological Response. Clin Infect Dis 2021; 72:e96-e102. [PMID: 33211801 DOI: 10.1093/cid/ciaa1726] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 11/13/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND In the setting of hepatitis C virus (HCV) active infection, liver stiffness (LS)-based strategies identify patients with low risk of developing esophageal variceal bleeding (VB) episodes, in whom unnecessary upper esophagogastroduodenoscopy (UGE) screening can be safely avoided. However, after sustained virological response (SVR), data on the accuracy of the criteria predicting this outcome in HCV-infected patients with cirrhosis, with or without human immunodeficiency virus (HIV) coinfection, are very limited. METHODS This was a multicenter prospective cohort study, where HCV-monoinfected patients and HIV/HCV-coinfected individuals were included if they had (1) SVR with direct-acting antiviral-based therapy; (2) LS ≥9.5 kPa previous to treatment; and (3) LS measurement at the SVR time-point ≥14 kPa. Diagnostic accuracy of HEPAVIR, expanded Baveno VI, and HIV cirrhosis criteria, at the time of SVR, was evaluated. Missed VB episodes, negative predictive values (NPVs), and number of spared UGEs were specifically assessed. RESULTS Four hundred thirty-five patients were included, 284 (65%) coinfected with HIV. Seven (1.6%) patients developed a first episode of VB after SVR. In patients without a previous VB episode, HEPAVIR, expanded Baveno VI and HIV cirrhosis criteria achieved NPV for first VB episode after SVR of 99.5% (95% confidence interval [CI], 97.1%-100%), 100% (95% CI 97.8%-100%), and 100% (95% CI 98%-100%) while sparing 45%, 39%, and 44% of UGEs, respectively. When considering HIV coinfection, the performance of the 3 criteria was similar, both in HCV-monoinfected and HIV/HCV-coinfected individuals. CONCLUSIONS After SVR, predictive LS-based strategies accurately identify HCV-infected patients, HIV coinfected or not, with low risk of developing VB during follow-up. In these specific patients, using HIV cirrhosis criteria maximize the number of spared UGEs while missing no VB episode.
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Affiliation(s)
- Anaïs Corma-Gómez
- Unit of Infectious Diseases and Microbiology, Hospital Universitario de Valme, Seville, Spain
| | - Juan Macías
- Unit of Infectious Diseases and Microbiology, Hospital Universitario de Valme, Seville, Spain
| | - Luis Morano
- Unit of Infectious Pathology, Hospital Universitario Alvaro Cunqueiro, Vigo, Spain
| | - Antonio Rivero
- Unit of Infectious Diseases, Hospital Universitario Reina Sofia, Instituto Maimonides de Investigación Biomedica de Córdoba, Universidad de Córdoba, Córdoba, Spain
| | - Francisco Téllez
- Unit of Infectious Diseases, Hospital Universitario de Puerto Real, Facultad de Medicina, Universidad de Cadiz, Cádiz, Spain
| | - Maria José Ríos
- Unit of Infectious Diseases, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Marta Santos
- Unit of Internal Medicine, University Hospital Jerez, Cadiz, Spain
| | - Miriam Serrano
- Unit of Infectious Diseases, Hospital Universitario de Gran Canaria Dr Negrín, Las Palmas de Gran Canaria, Las Palmas, Spain
| | - Rosario Palacios
- Unit of Infectious Diseases and Microbiology, Hospital Virgen de la Victoria, Málaga, Spain
| | - Dolores Merino
- Unit of Infectious Diseases, Hospital Juan Ramón Jiménez, Huelva, Spain
| | - Luis Miguel Real
- Unit of Immunology, Biochemistry, Molecular Biology and Surgery, Faculty of Medicine, University of Malaga, Málaga, Spain
| | - Ignacio De Los Santos
- Unit of Internal Medicine and Infectious Diseases, Hospital La Princesa, Madrid, Spain
| | - Francisco J Vera-Méndez
- Section of Infectious Medicine/Service of Internal Medicine, Hospital General Universitario Santa Lucía, Cartagena, Spain
| | - Maria José Galindo
- Unit of Infectious Diseases, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Juan A Pineda
- Unit of Infectious Diseases and Microbiology, Hospital Universitario de Valme, Seville, Spain
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Gonzalez-Serna A, Macias J, Palacios R, Gómez-Ayerbe C, Tellez F, Rivero-Juárez A, Fernandez M, Santos J, Real LM, Gonzalez-Domenech CM, Gomez-Mateos J, Pineda JA. Incidence of recently acquired hepatitis C virus infection among HIV-infected patients in southern Spain. HIV Med 2020; 22:379-386. [PMID: 33369104 DOI: 10.1111/hiv.13039] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/20/2020] [Accepted: 11/26/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Spain is close to HCV microelimination, so rates of recently acquired HCV infection (RAHC) should decrease. Nowadays, men who have sex with men (MSM) carry the highest risk of HCV acquisition. Our aim was to estimate the incidence of and the factors associated with RAHC, together with reinfection rates, among patients sexually infected by HIV. METHODS Primary RAHC infection was diagnosed when anti-HCV antibody seroconversion was documented. In anti-HCV positive patients, initially without HCV viraemia, a diagnosis of reinfection was established if plasma HCV RNA was detected. RESULTS All 350 patients tested negative for anti-HCV at baseline and had at least one follow-up visit. Among them, there were 16 RAHC cases from 2016 to 2019. RAHC incidence rates [IR (95% confidence interval, CI)] per 100 person-years were 3.77 (0.5-12.9) in 2016, 1.85 (0.6-4.3) in 2017, 1.49 (0.4-3.8) in 2018 and 1.98 (0.6-4.5) in 2019. Only previous sexually transmitted infections [incidence rate ratio (IRR) = 18.23, 95% CI: 1.93-172.1; P = 0.011], male sex (IRR = 8.33, 95% CI: 1.38-54.15; P = 0.026) and sharing chem-sex drugs (IRR: 4.93, 95% CI: 1.17-20.76; P = 0.030), were independently associated with RAHC. Four out of 42 (9.5%) patients became reinfected. CONCLUSIONS The incidence of RAHC among HIV-infected patients showed a decrease after 2016, although a lower but steady incidence of residual cases still remains. HCV reinfections showed a similar pattern. New infections were associated with sharing chem-sex drugs among MSM.
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Affiliation(s)
- A Gonzalez-Serna
- Unidad de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen de Valme, Sevilla, Spain
| | - J Macias
- Unidad de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen de Valme, Sevilla, Spain
| | - R Palacios
- Unidad de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - C Gómez-Ayerbe
- Unidad de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - F Tellez
- UGC Enfermedades Infecciosas, Departamento Medicina, Universidad de Cádiz, Hospital Universitario de Puerto Real, Cádiz, Spain
| | - A Rivero-Juárez
- Unidad de Enfermedades Infecciosas, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - M Fernandez
- Unidad de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen de Valme, Sevilla, Spain
| | - J Santos
- Unidad de Enfermedades Infecciosas, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - L M Real
- Unidad de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen de Valme, Sevilla, Spain
| | - C M Gonzalez-Domenech
- Unidad de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - J Gomez-Mateos
- Unidad de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen de Valme, Sevilla, Spain
| | - J A Pineda
- Unidad de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen de Valme, Sevilla, Spain
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17
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Rivero-Juarez A, Tellez F, Mayorga MI, Merino D, Espinosa N, Macias J, Palacios R, Paniagua M, Collado A, Mohamed O, Perez-Stachowski J, Hernandez-Quero J, Fernandez-Fuertes E, Rivero A. Progression to hepatitis C virus micro-elimination in people living with HIV in Spain. Clin Microbiol Infect 2020; 27:S1198-743X(20)30654-6. [PMID: 33137514 DOI: 10.1016/j.cmi.2020.10.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/16/2020] [Accepted: 10/20/2020] [Indexed: 02/07/2023]
Affiliation(s)
- Antonio Rivero-Juarez
- Infectious Diseases Unit, Instituto Maimonides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía de Córdoba, Universidad de Córdoba, Córdoba, Spain.
| | - Francisco Tellez
- Infectious Diseases Unit, Hospital Universitario de Puerto Real, Medicine Department, Universidad de Cádiz, Cádiz, Spain
| | - Maria Isabel Mayorga
- Infectious Diseases Unit, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Dolores Merino
- Infectious Diseases Unit, Hospital Juan Ramón Jiménez, Huelva, Spain
| | - Nuria Espinosa
- Infectious Diseases Unit, Hospital Universitario Virgen del Rocio, Instituto de Biomedicina de Sevilla (iBiS), Sevilla, Spain
| | - Juan Macias
- Infectious Diseases Unit, Hospital Universitario de Valme, Instituto de Biomedicina de Sevilla (iBiS), Sevilla, Spain
| | - Rosario Palacios
- Infectious Diseases Unit, Hospital Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga, Málaga, Spain
| | - María Paniagua
- Infectious Diseases Unit, Hospital Universitario Virgen Macarena, Instituto de Biomedicina de Sevilla (iBiS), Sevilla, Spain
| | - Antonio Collado
- Infectious Diseases Unit, Complejo Hospitalario Torrecárdenas, Almería, Spain
| | - Omar Mohamed
- Infectious Diseases Unit, Complejo Hospitalario de Jaén, Jaén, Spain
| | | | | | | | - Antonio Rivero
- Infectious Diseases Unit, Instituto Maimonides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía de Córdoba, Universidad de Córdoba, Córdoba, Spain.
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Skaathun B, Borquez A, Rivero-Juarez A, Mehta SR, Tellez F, Castaño-Carracedo M, Merino D, Palacios R, Macías J, Rivero A, Martin NK. What is needed to achieve HCV microelimination among HIV-infected populations in Andalusia, Spain: a modeling analysis. BMC Infect Dis 2020; 20:588. [PMID: 32770955 PMCID: PMC7414743 DOI: 10.1186/s12879-020-05285-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 07/22/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Scale-up of hepatitis C virus (HCV) treatment for HIV/HCV coinfected individuals is occurring in Spain, the vast majority (> 85%) with a reported history of injecting drug use and a smaller population of co-infected men who have sex with men (MSM). We assess impact of recent treatment scale-up to people living with HIV (PLWH) and implications for achieving the WHO HCV incidence elimination target (80% reduction 2015-2030) among PLWH and overall in Andalusia, Spain, using dynamic modeling. METHODS A dynamic transmission model of HCV/HIV coinfection was developed. The model was stratified by people who inject drugs (PWID) and MSM. The PWID component included dynamic HCV transmission from the HCV-monoinfected population. The model was calibrated to Andalusia based on published data and the HERACLES cohort (prospective cohort of HIV/HCV coinfected individuals representing > 99% coinfected individuals in care in Andalusia). From HERACLES, we incorporated HCV treatment among diagnosed PLWH of 10.5%/year from 2004 to 2014, and DAAs at 33%/year from 2015 with 94.8% SVR. We project the impact of current and scaled-up HCV treatment for PLWH on HCV prevalence and incidence among PLWH and overall. RESULTS Current treatment rates among PLWH (scaled-up since 2015) could substantially reduce the number of diagnosed coinfected individuals (mean 76% relative reduction from 2015 to 2030), but have little impact on new diagnosed coinfections (12% relative reduction). However, DAA scale-up to PWLH in 2015 would have minimal future impact on new diagnosed coinfections (mean 9% relative decrease from 2015 to 2030). Similarly, new cases of HCV would only reduce by a mean relative 29% among all PWID and MSM due to ongoing infection/reinfection. Diagnosing/treating all PLWH annually from 2020 would increase the number of new HCV infections among PWLH by 28% and reduce the number of new HCV infections by 39% among the broader population by 2030. CONCLUSION Targeted scale-up of HCV treatment to PLWH can dramatically reduce prevalence among this group but will likely have little impact on the annual number of newly diagnosed HIV/HCV coinfections. HCV microelimination efforts among PWLH in Andalusia and settings where a large proportion of PLWH have a history of injecting drug use will require scaled-up HCV diagnosis and treatment among PLWH and the broader population at risk.
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Affiliation(s)
- Britt Skaathun
- Division of Infectious Diseases and Global Public Health, University of California San Diego, 9500 Gilman Drive MC 0507, La Jolla, CA, 92093, USA.
| | - Annick Borquez
- Division of Infectious Diseases and Global Public Health, University of California San Diego, 9500 Gilman Drive MC 0507, La Jolla, CA, 92093, USA
| | - Antonio Rivero-Juarez
- Infectious Diseases Unit, Instituto Maimonides de Investigaciones Biomedicas de Cordoba (IMIBIC), Hospital Universitario Reina Sofia de Cordoba, Universidad de Cordoba, Cordoba, Spain
| | - Sanjay R Mehta
- Division of Infectious Diseases and Global Public Health, University of California San Diego, 9500 Gilman Drive MC 0507, La Jolla, CA, 92093, USA
| | - Francisco Tellez
- Infectious Diseases Unit Hospital Universitario de Puerto Real, Instituto de Investigación e Innovación en Ciencias Biomédicas de la Provincia de Cádiz. Universidad de Cádiz, Cádiz, Spain
| | | | - Dolores Merino
- Infectious Diseases Unit. Hospitales Juan Ramón Jiménez e Infanta Elena de Huelva, Huelva, Spain
| | - Rosario Palacios
- Infectious Diseases Unit, Hospital Universitario Virgen de la Victoria. Complejo Hospitalario Provincial de Málaga, Málaga, Spain
| | - Juan Macías
- Unidad de Enfermedades Infecciosas, Hospital Universitario de Valme. Instituto de Biomedicina de Sevilla (iBiS), Sevilla, Spain
| | - Antonio Rivero
- Infectious Diseases Unit, Instituto Maimonides de Investigaciones Biomedicas de Cordoba (IMIBIC), Hospital Universitario Reina Sofia de Cordoba, Universidad de Cordoba, Cordoba, Spain
| | - Natasha K Martin
- Division of Infectious Diseases and Global Public Health, University of California San Diego, 9500 Gilman Drive MC 0507, La Jolla, CA, 92093, USA
- Population Health Sciences, University of Bristol, Bristol, UK
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Corma-Gómez A, Macías J, Lacalle-Remigio JR, Téllez F, Morano L, Rivero A, Serrano M, Ríos MJ, Vera-Méndez FJ, Alados JC, Real LM, Palacios R, Santos IDL, Imatz A, Pineda JA. HIV infection is associated with lower risk of hepatocellular carcinoma after sustained virological response to direct-acting antivirals in hepatitis C infected-patients with advanced fibrosis. Clin Infect Dis 2020; 73:e2109-e2116. [PMID: 32766891 DOI: 10.1093/cid/ciaa1111] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The aim of this study was to assess the impact of HIV infection on the risk of developing hepatocellular carcinoma (HCC) in HCV-infected patients who achieve sustained virological response (SVR) with direct-acting antiviral (DAA). METHODS Multisite prospective cohort study, where HCV-monoinfected patients and HIV/HCV-coinfected individuals were included if they met: 1) SVR with DAA-based combination; 2) Liver stiffness (LS) ≥9.5 kPa previous to treatment; 3) LS measurement at the SVR time-point. The main endpoint was the occurrence of HCC. Propensity score (PS) was calculated to address potential confounders due to unbalanced distribution of baseline characteristics of HIV/HCV-coinfected and HCV-monoinfected patients. RESULTS 1035 HCV-infected patients were included, 667 (64%) coinfected with HIV. After a median (Q1-Q3) follow-up time of 43 (31-49) months, 19 (1.8%) patients developed HCC [11 (3.0%) HCV-monoinfected, 8(1.2%) HIV/HCV-coinfected individuals; p=0.013]. In the multivariable analysis, HIV co-infection was associated with a lower adjusted risk of developing HCC [sHR=0.27, 95% IC (0.08-0.90); p=0.034]. Predictors of HCC emergence were: HCV genotype 3 [sHR=7.9 (2.5-24.9); p<0.001], MELD score at SVR>10 [sHR=1.37 (1.01-1.86); p=0.043] and LS value at SVR [sHR=1.03 (1.01-1.06) for 1 kPa increase; p=0.011]. Using inverse probability weighting method on the PS, HIV-infected patients had a lower risk of HCC [powered HR=0.33 (0.11-0.85)]. CONCLUSIONS Among HCV-infected patients with advanced fibrosis, who achieve SVR with DAA, HIV-coinfection seems to be associated with a lower risk of HCC occurrence. The underlying causes for this finding need to be investigated.
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Affiliation(s)
- A Corma-Gómez
- Unit of Infectious Diseases and Microbiology. Hospital Universitario de Valme. Seville. Spain
| | - J Macías
- Unit of Infectious Diseases and Microbiology. Hospital Universitario de Valme. Seville. Spain
| | - J R Lacalle-Remigio
- Division of Preventive Medicine and Public Health, Faculty of Medicine, Universidad de Sevilla, Spain
| | - F Téllez
- Unit of Infectious Diseases, Hospital Universitario de Puerto Real, Faculty of Medicine, Cadiz, Spain
| | - L Morano
- Unit of Infectious Pathology, Hospital Universitario Alvaro Cunqueiro, Vigo, Spain
| | - A Rivero
- Unit of Infectious Diseases, Hospital Universitario Reina Sofia, Córdoba, Spain
| | - M Serrano
- UnitofInfectiousDiseases, Hospital Universitario de Gran Canaria Dr Negrín, Las Palmas de Gran Canaria, Spain
| | - M J Ríos
- Unit of Infectious Diseases, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - F J Vera-Méndez
- Section of Infectious Medicine/Service of Internal Medicine, Hospital General Universitario Santa Lucía, Cartagena, Spain
| | - J C Alados
- Unit of Clinical Microbiology, University Hospital Jerez, Cadiz, Spain
| | - L M Real
- Unit of Immunology, Biochemistry, Molecular Biology and Surgery, Faculty of Medicine, University of Malaga, Spain
| | - R Palacios
- Unit of Infectious Diseases and Microbiology, Hospital Virgen de la Victoria, Málaga, Spain
| | - I De Los Santos
- Unit of Internal Medicine and Infectious Diseases, Hospital La Princesa, Madrid, Spain
| | - A Imatz
- Unit of Infectious Diseases, Hospital Universitario Bellvitge, Barcelona, Spain
| | - J A Pineda
- Unit of Infectious Diseases and Microbiology. Hospital Universitario de Valme. Seville. Spain
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20
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Suárez-García I, Moreno C, Ruiz-Algueró M, Pérez-Elías MJ, Navarro M, Díez Martínez M, Viciana P, Pérez-Martínez L, Górgolas M, Amador C, de Zárraga MA, Jarrín I, Moreno S, Jarrín I, Dalmau D, Navarro ML, González MI, Garcia F, Poveda E, Iribarren JA, Gutiérrez F, Rubio R, Vidal F, Berenguer J, González J, Muñoz-Fernández MÁ, Jarrin I, Alejos B, Moreno C, Iniesta C, Sousa LMG, Perez NS, Rava M, Muñoz-Fernández MÁ, Fernández IC, Merino E, García G, Portilla I, Agea I, Portilla J, Sánchez-Payá J, Rodríguez JC, Gimeno L, Giner L, Díez M, Carreres M, Reus S, Boix V, Torrús D, Lirola AL, García D, Díaz-Flores F, Gómez JL, del Mar Alonso M, Pelazas R, Hernández J, Alemán MR, Hernández MI, Asensi V, Valle E, Carmenado MER, Secades TSZ, Is LP, Rubio R, Pulido F, Bisbal O, Hernando A, Domínguez L, Crestelo DR, Bermejo L, Santacreu M, Iribarren JA, Arrizabalaga J, Aramburu MJ, Camino X, Rodríguez-Arrondo F, von Wichmann MÁ, Tomé LP, Goenaga MÁ, Bustinduy MJ, Azkune H, Ibarguren M, Lizardi A, Kortajarena X, Oyaga MPC, Igartua MU, Gutiérrez F, Masiá M, Padilla S, Navarro A, Montolio F, Robledano C, Colomé JG, Adsuar A, Pascual R, Fernández M, García E, García JA, Barber X, Muga R, Sanvisens A, Fuster D, Berenguer J, de Quirós JCLB, Gutiérrez I, Ramírez M, Padilla B, Gijón P, Aldamiz-Echevarría T, Tejerina F, Parras FJ, Balsalobre P, Diez C, Latorre LP, Fanciulli C, Vidal F, Peraire J, Viladés C, Veloso S, Vargas M, Olona M, Rull A, Rodríguez-Gallego E, Alba V, Castellanos AJ, López-Dupla M, Alonso MM, Aldeguer JL, Juliá MB, Pitarch MT, Hernández IC, Muñoz EC, Tovar SC, Lletí MS, Navarro JF, González-Garcia J, Arnalich F, Arribas JR, de la Serna JIB, Castro JM, Escosa L, Herranz P, Hontañón V, García-Bujalance S, López-Hortelano MG, González-Baeza A, Martín-Carbonero ML, Mayoral M, Mellado MJ, Micán RE, Montejano R, Montes ML, Moreno V, Pérez-Valero I, Rodés B, Sainz T, Sendagorta E, Alcáriz NS, Valencia E, Blanco JR, Oteo JA, Ibarra V, Metola L, Sanz M, Pérez-Martínez L, Arazo P, Sampériz G, Dalmau D, Jaén A, Sanmartí M, Cairó M, Martinez-Lacasa J, Velli P, Font R, Xercavins M, Alonso N, Marcotegui MR, Repáraz J, de Alda MGR, de León Cano MT, de Galarreta BPR, Amengual MJ, Navarro G, Garcia MC, Isbert SC, Vilasaro MN, de los Santos I, Sanz JS, Aparicio AS, Cepeda CS, Fraile LGF, Gayo EM, Moreno S, Osorio JLC, Nuñez FD, Zamora AM, Elías MJP, Gutiérrez C, Madrid N, del Campo Terrón S, Villar SS, Gallego MJV, Sanz JM, Urroz UA, Velasco T, Bernal E, Sanchez AC, García AA, Urbieta JB, Perez AM, Alcaraz MJ, del Carmen Villalba M, García F, Quero JH, Medina LM, Alvarez M, Chueca N, García DV, Martinez-Montes C, Beltran CG, de Salazar Gonzalerz A, Lopez AF, Utrilla MR, Del Romero J, Rodríguez C, Puerta T, Carrió JC, Vera M, Ballesteros J, Ayerdi O, Antela A, Losada E, Riera M, Peñaranda M, Leyes M, Ribas MA, Campins AA, Vidal C, Fanjul F, Murillas J, Homar F, Santos J, Ayerbe CG, Viciana I, Palacios R, López CP, Gonzalez-Domenec CM, Viciana P, Espinosa N, López-Cortés LF, Podzamczer D, Imaz A, Tiraboschi J, Silva A, Saumoy M, Prieto P, Ribera E, Curran A, Sierra JO, Stachowski JP, del Arco A, de la torre J, Prada JL, de Lomas Guerrero JMG, Martínez OJ, Vera FJ, Martínez L, García J, Alcaraz B, Jimeno A, Iglesias AC, Souto BP, de Cea AM, Muñoz J, Zubero MZ, Baraia-Etxaburu JM, Ugarte SI, Beneitez OLF, de Munain JL, López MMC, de la Peña M, Lopez M, Azkarreta IL, Galera C, Albendin H, Pérez A, Iborra A, Moreno A, Merlos MA, Vidal A, Meca M, Amador C, Pasquau F, Ena J, Benito C, Fenoll V, Anguita CG, Rabasa JTA, Suárez-García I, Malmierca E, González-Ruano P, Rodrigo DM, Seco MPR, Mohamed-Balghata MO, Vidal MAG, de Zarraga MA, Pérez VE, Molina MJT, García JV, Moreno JPS, Górgolas M, Cabello A, Álvarez B, Prieto L, Moreno JS, Caso AA, Gutiérrez CH, Mena MN, Puerto MJG, Vilalta RF, Ribera AF, Román AR, Juárez AR, López PL, Sánchez IM, Casas MF, Espejo AC, Jiménez MC, Perea RT, Pineda JA, Mayo PR, Sanchez JM, Gutierrez NM, Real LM, Gomez AC, Fuertes MF, Gonzalez-Serna A, Poveda E, Pérez A, Crespo M, Morano L, Miralles C, Ocampo A, Pousada G. Effectiveness of the combination elvitegravir/cobicistat/tenofovir/emtricitabine (EVG/COB/TFV/FTC) plus darunavir among treatment-experienced patients in clinical practice: a multicentre cohort study. AIDS Res Ther 2020; 17:45. [PMID: 32690099 PMCID: PMC7372769 DOI: 10.1186/s12981-020-00302-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 07/13/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study was to investigate the effectiveness and tolerability of the combination elvitegravir/cobicistat/tenofovir/emtricitabine plus darunavir (EVG/COB/TFV/FTC + DRV) in treatment-experienced patients from the cohort of the Spanish HIV/AIDS Research Network (CoRIS). METHODS Treatment-experienced patients starting treatment with EVG/COB/TFV/FTC + DRV during the years 2014-2018 and with more than 24 weeks of follow-up were included. TFV could be administered either as tenofovir disoproxil fumarate or tenofovir alafenamide. We evaluated virological response, defined as viral load (VL) < 50 copies/ml and < 200 copies/ml at 24 and 48 weeks after starting this regimen, stratified by baseline VL (< 50 or ≥ 50 copies/ml at the start of the regimen). RESULTS We included 39 patients (12.8% women). At baseline, 10 (25.6%) patients had VL < 50 copies/ml and 29 (74.4%) had ≥ 50 copies/ml. Among patients with baseline VL < 50 copies/ml, 85.7% and 80.0% had VL < 50 copies/ml at 24 and 48 weeks, respectively, and 100% had VL < 200 copies/ml at 24 and 48 weeks. Among patients with baseline VL ≥ 50 copies/ml, 42.3% and 40.9% had VL < 50 copies/ml and 69.2% and 68.2% had VL < 200 copies/ml at 24 and 48 weeks. During the first 48 weeks, no patients changed their treatment due to toxicity, and 4 patients (all with baseline VL ≥ 50 copies/ml) changed due to virological failure. CONCLUSIONS EVG/COB/TFV/FTC + DRV was well tolerated and effective in treatment-experienced patients with undetectable viral load as a simplification strategy, allowing once-daily, two-pill regimen with three antiretroviral drug classes. Effectiveness was low in patients with detectable viral loads.
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21
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Jarrin I, Suarez-Garcia I, Moreno C, Tasias M, Del Romero J, Palacios R, Peraire J, Gorgolas M, Moreno S. Durability of first-line antiretroviral regimens in the era of integrase inhibitors: a cohort of HIV-positive individuals in Spain, 2014-2015. Antivir Ther 2020; 24:167-175. [PMID: 30747107 DOI: 10.3851/imp3297] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND We compared time to treatment change (TC), viral suppression (VS) and change in CD4+ T-cell counts of first-line antiretroviral regimens (ART). METHODS We analysed HIV treatment-naive adults from the Cohort of the Spanish HIV/AIDS Research Network (CoRIS) initiating the most commonly used ART regimens from September 2014 to November 2015. We used proportional hazards models on the sub-distribution hazard to estimate sub-distribution hazard ratios (sHR) for time to TC, logistic regression to estimate odds ratios (ORs) for VS (viral load <50 copies/ml), and linear regression to assess mean differences in CD4+ T-cell changes from ART initiation. RESULTS Among 960 individuals, tenofovir (TDF)/emtricitabine (FTC)/rilpivirine (RPV) was the most frequently prescribed regimen (24.2%), followed by elvitegravir (EVG)/cobicistat (COBI)/TDF/FTC (22.8%), abacavir (ABC)/lamivudine (3TC)/dolutegavir (DTG; 17.4%), TDF/FTC+darunavir/ritonavir (DRV/r) or darunavir/cobicistat (DRV/c; 12.1%), TDF/FTC/efavirenz (EFV; 8.8%), TDF/FTC+raltegravir (RAL; 7.7%) and TDF/FTC+DTG (7.0%). Initiating ART with TDF/FTC+DRV/r or DRV/c (adjusted sHR: 2.96; 95% CI: 1.44, 6.08), TDF/FTC/EFV (2.18; 0.98, 4.82), TDF/FTC+RAL (2.37; 1.08, 5.22) and TDF/FTC+DTG (6.34; 3.18, 12.64) was associated with a higher risk of TC compared to ABC/3TC/DTG. At 24 weeks, VS was lower in TDF/FTC+DRV/r or DRV/c (adjusted OR: 0.37, 95% CI: 0.18, 0.74) compared with ABC/3TC/DTG, and CD4+ T-cell increase was lower in patients initiating with TDF/FTC/RPV (adjusted mean difference: -75.9, 95% CI: -130.6, -21.2) compared with those who did with ABC/3TC/DTG. CONCLUSIONS Time to TC, VS and change in CD4+ T-cell counts varies by initial regimen. These differences may be useful for making decision when initiating ART.
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Affiliation(s)
- Inmaculada Jarrin
- Centro Nacional de Epidemiologia, Instituto de Salud Carlos III, Madrid, Spain
| | - Ines Suarez-Garcia
- Hospital Infanta Sofia, Madrid, Spain.,Universidad Europea, Madrid, Spain
| | - Cristina Moreno
- Centro Nacional de Epidemiologia, Instituto de Salud Carlos III, Madrid, Spain
| | - Maria Tasias
- Hospital Universitario y Politecnico de La Fe, Valencia, Spain
| | | | | | - Joaquim Peraire
- Hospital Joan XXIII, Tarragona, Spain.,Institut d'Investigació Sanitaria Pere Virgili, Tarragona, Spain.,Universitat Rovira y Virgili, Tarragona, Spain
| | - Miguel Gorgolas
- Hospital Universitario Fundacion Jimenez Diaz, Madrid, Spain
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22
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Casado JL, Vizcarra P, Blanco JL, Montejano R, Negredo E, Espinosa N, Montero M, Mena A, Palacios R, Lopez JC, Vergas J, Galindo MJ, Cabello A, Deltoro MG, Diaz De Santiago A. Maintenance of virologic suppression and improvement in comorbidities after simplification to raltegravir plus boosted darunavir among treatment-experienced HIV-infected patients. Int J STD AIDS 2020; 31:467-473. [PMID: 32138618 DOI: 10.1177/0956462419896478] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The use of two potent, well-tolerated, drugs could permit the maintenance of virologic suppression even in heavily pretreated people living with HIV. In this retrospective, multicenter, simplification study (NCT03348449), we included those patients with virologic suppression who switched to raltegravir (RAL) plus boosted darunavir (b/DRV). Overall, 345 patients (75 females, 25%) were included. Patients were largely pretreated (mean, 9.4 regimens), suppressed for a median of 41.1 months. Fifty patients had ≥1 mutation against DRV. At 96 weeks, the efficacy by intention-to-treat analysis (snapshot) was 73% (95%CI, 68.4–77.8%), but 97.1% (95%CI, 95.4–98.9) excluding changes due to non-virologic reasons, and virologic failure was rare (0.9%; 95%CI, 0.1–1.2%). Median CD4/CD8 ratio increased from 0.59 to 0.62 (p < 0.01), CD4+ cell count by +90 cells/µl (p < 0.01), and mean estimated glomerular filtration rate (eGFR) increased from 85.2 to 88.5 ml/min at 96 weeks, greater for patients receiving tenofovir disoproxil fumarate (eGFR, +3.6 ml/min, p = 0.04; serum phosphate +0.33 mg/dl; p < 0.01). There was a continued and significant improvement in the total cholesterol/high-density lipoprotein-cholesterol ratio. In conclusion, the simplification to a dual regimen with the combination of RAL and b/DRV is associated with maintenance of virologic suppression, even in largely pretreated patients, with improvements in CD4+ cell count, CD4/CD8 ratio, and in renal and lipid parameters.
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Affiliation(s)
| | | | | | | | - Eugenia Negredo
- Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | | | | | - Alvaro Mena
- Complexo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - Rosario Palacios
- Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain
| | - Juan C Lopez
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
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23
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Corma-Gómez A, Macías J, Téllez F, Freyre-Carrillo C, Morano L, Rivero-Juárez A, Ríos MJ, Alados JC, Vera-Méndez FJ, Merchante N, Palacios R, Granados R, Merino D, De Los Santos I, Pineda JA. Liver Stiffness at the Time of Sustained Virological Response Predicts the Clinical Outcome in People Living With Human Immunodeficiency Virus and Hepatitis C Virus With Advanced Fibrosis Treated With Direct-acting Antivirals. Clin Infect Dis 2019; 71:2354-2362. [DOI: 10.1093/cid/ciz1140] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 11/20/2019] [Indexed: 12/12/2022] Open
Abstract
Abstract
Background
Some people living with hepatitis C virus (HCV) with sustained virological response (SVR) develop hepatic complications. Liver stiffness (LS) predicts clinical outcome in people living with human immunodeficiency virus (HIV) with active HCV coinfection, but information after SVR is lacking. We aimed to analyze the predictive ability of LS at SVR for liver complications in people living with HIV/HCV with advanced fibrosis treated with direct-acting antivirals (DAA).
Methods
In sum, 640 people living with HIV/HCV fulfilling the following criteria were included: (i) Achieved SVR with DAA-including regimen; (ii) LS ≥ 9.5 kPa before therapy; and (iii) LS measurement available at SVR. The primary endpoint was the occurrence of a liver complication—hepatic decompensation or hepatocellular carcinoma (HCC)—or requiring liver transplant after SVR.
Results
During a median (Q1–Q3) follow-up of 31.6 (22.7–36.6) months, 19 (3%) patients reached the primary endpoint. In the multivariate analysis, variables (subhazard ratio [SHR] [95% confidence interval]) associated with developing clinical outcomes were: prior hepatic decompensations (3.42 [1.28–9.12]), pretreatment CPT class B or C (62.5 [3.08–1246.42]) and MELD scores (1.37 [1.03–1.82]), CPT class B or C at SVR (10.71 [1.32–87.01]), CD4 cell counts <200/µL at SVR time-point (4.42 [1.49–13.15]), FIB-4 index at SVR (1.39 [1.13–1.70]), and LS at SVR (1.05 [1.02–1.08] for 1 kPa increase). None of the 374 patients with LS <14kPa at SVR time-point developed a liver complication or required hepatic transplant.
Conclusions
LS at the time of SVR after DAA therapy predicts the clinical outcome of people living with HIV/HCV with advanced fibrosis. These results suggest that LS measurement may be helpful to select candidates to be withdrawn from surveillance programs.
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Affiliation(s)
- A Corma-Gómez
- Unit of Infectious Diseases and Microbiology, Hospital Universitario de Valme, Seville, Spain
| | - J Macías
- Unit of Infectious Diseases and Microbiology, Hospital Universitario de Valme, Seville, Spain
| | - F Téllez
- Unit of Infectious Diseases, Hospital Universitario de Puerto Real, Facultad de Medicina, Universidad de Cadiz, Spain
| | - C Freyre-Carrillo
- Unit of Microbiology, Hospital Universitario de Puerto Real, Facultad de Medicina, Universidad de Cadiz, Spain
| | - L Morano
- Unit of Infectious Pathology, Hospital Universitario Alvaro Cunqueiro, Vigo, Spain
| | - A Rivero-Juárez
- Unit of Infectious Diseases, Hospital Universitario Reina Sofia, Instituto Maimonides de Investigación Biomedica de Córdoba (IMIBIC), Universidad de Córdoba (UCO), Spain
| | - M J Ríos
- Unit of Infectious Diseases, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - J C Alados
- Unit of Clinical Microbiology, University Hospital Jerez, Cadiz, Spain
| | - F J Vera-Méndez
- Section of Infectious Medicine/Service of Internal Medicine, Hospital General Universitario Santa Lucía, Cartagena, Spain
| | - N Merchante
- Unit of Infectious Diseases and Microbiology, Hospital Universitario de Valme, Seville, Spain
| | - R Palacios
- Unit of Infectious Diseases and Microbiology, Hospital Virgen de la Victoria, Málaga, Spain
| | - R Granados
- Unit of Infectious Diseases, Hospital Universitario de Gran Canaria Dr Negrín, Las Palmas de Gran Canaria, Spain
| | - D Merino
- Unit of Infectious Diseases, Hospitales Juan Ramón Jiménez e Infanta Elena, Huelva, Spain
| | - I De Los Santos
- Unit of Internal Medicine and Infectious Diseases, Hospital La Princesa, Madrid, Spain
| | - J A Pineda
- Unit of Infectious Diseases and Microbiology, Hospital Universitario de Valme, Seville, Spain
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Estrada V, Domingo P, Suarez-Lozano I, Gutiérrez F, Knobel H, Palacios R, Antela A, Blanco JR, Refoyo E. Risk of cardiovascular disease in patients with HIV infection undergoing antiretroviral therapy. Rev Clin Esp 2019; 220:149-154. [PMID: 31690452 DOI: 10.1016/j.rce.2019.05.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 05/12/2019] [Accepted: 05/14/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND The increased survival of patients with HIV infection thanks to antiretroviral therapy (ART) is accompanied by a higher rate of cardiovascular disease (CVD). We analysed the prevalence of the cardiovascular risk factors (CRFs) and estimated the risk of CVD in a cohort of patients with HIV in Spain. METHODS We conducted a cross-sectional, observational study of CRFs in the Spanish VACH cohort of patients with HIV who undergo ART. RESULTS The study assessed 15,559 patients with HIV (76% men; mean age, 46 years). Some 3.7% had experienced at least 1 CVD event. The prevalence of CRFs was high (hyperlipidaemia, 64%; tobacco use, 47%; arterial hypertension, 22%; and diabetes, 16%). According to the Framingham scale, 10.9% of the patients presented a high CVD risk, and 28.8% presented a moderate risk. Of the patients with a high CVD risk, 49% took protease inhibitors and 43% took abacavir. Fifty-three percent of the patients diagnosed with arterial hypertension took antihypertensive drugs, and 2.6% of the patients with diabetes took antidiabetic agents. CONCLUSIONS Classical CRFs are common in patients with HIV undergoing ART in Spain, and a large proportion of them have a moderate-high risk of CVD. Therefore, controlling the modifiable CRFs in patients with HIV should be improved, and the use of drugs with a better cardiovascular risk profile should be assessed.
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Affiliation(s)
- V Estrada
- Hospital Clínico San Carlos-IdiSSC, Universidad Complutense de Madrid, Madrid, España.
| | - P Domingo
- Hospital Sant Pau, Universitat Autònoma de Barcelona, Barcelona, España
| | | | - F Gutiérrez
- Hospital General Universitario de Elche, Universidad Miguel Hernández, Elche, Alicante, España
| | - H Knobel
- Hospital del Mar, Barcelona, España
| | - R Palacios
- Hospital Universitario Virgen de la Victoria, Málaga, España
| | - A Antela
- Hospital Clínico Universitario, Santiago de Compostela, España
| | - J R Blanco
- Hospital San Pedro-CIBIR, Logroño, España
| | - E Refoyo
- Hospital Universitario La Paz, Madrid, España
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Merchante N, Rivero-Juárez A, Téllez F, Merino D, Ríos-Villegas MJ, Villalobos M, Omar M, Rincón P, Rivero A, Pérez-Pérez M, Raffo M, López-Montesinos I, Palacios R, Gómez-Vidal MA, Macías J, Pineda JA. Sustained virological response to direct-acting antiviral regimens reduces the risk of hepatocellular carcinoma in HIV/HCV-coinfected patients with cirrhosis. J Antimicrob Chemother 2019; 73:2435-2443. [PMID: 29982683 DOI: 10.1093/jac/dky234] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Accepted: 05/22/2018] [Indexed: 12/30/2022] Open
Abstract
Objectives To assess the impact of all-oral direct-acting antiviral agent (DAA) regimens on the risk of hepatocellular carcinoma (HCC) in HIV/HCV-coinfected patients with cirrhosis. Methods This was a multicentre prospective cohort study recruiting HIV/HCV-coinfected patients with a new diagnosis of compensated cirrhosis. Patients were followed up until HCC, death or the censoring date (March 2017). The primary endpoint was the emergence of HCC. The incidence rate (IR) (95% CI) of HCC in different groups was computed. Time-to-event analyses were performed to identify predictors of HCC emergence. Results The study included 495 HIV/HCV-coinfected patients with cirrhosis. After a median (IQR) follow-up of 59 (27-84) months, 22 (4.4%; 95% CI 2.6-6.3) patients developed an HCC. The IR (95% CI) of HCC was 0.93 (0.06-1.42) per 100 person-years (PY). Three hundred and three (61%) patients achieved sustained virological response (SVR) during follow-up, 79 after interferon (IFN)-based regimens and 224 after an all-oral DAA regimen. The IR (95% CI) of HCC after all-oral DAA was 0.35 (0.14-0.85) per 100 PY whereas it was 1.79 (1.11-2.88) per 100 PY in the remaining cohort (P = 0.0005). When only patients with SVR were considered, the IR (95% CI) of HCC after all-oral DAA was 0.32 (0.12-0.86) whereas it was 0 per 100 PY among those with SVR after IFN-based therapies (P = 0.27). Achieving SVR with an all-oral DAA regimen during follow-up was independently associated with a lower risk of HCC emergence (subhazard ratio 0.264; 95% CI 0.070-0.991; P = 0.049). Conclusions SVR with all-oral DAA regimens reduces the risk of HCC in HIV/HCV-coinfected patients with compensated cirrhosis.
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Affiliation(s)
- Nicolás Merchante
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario de Valme, Sevilla, Spain
| | - Antonio Rivero-Juárez
- Unidad de Enfermedades Infecciosas, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, Universidad de Córdoba (UCO), Córdoba, Spain
| | - Francisco Téllez
- Unidad de Enfermedades Infecciosas, Hospital Universitario de Puerto Real, Cádiz, Spain
| | - Dolores Merino
- Unidad de Gestión Clínica de Enfermedades Infecciosas, Hospitales Juan Ramón Jiménez e Infanta Elena, Huelva, Spain
| | - María J Ríos-Villegas
- Unidad de Enfermedades Infecciosas, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Marina Villalobos
- Unidad de Gestión Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Instituto de Biomedicina de Málaga (IBIMA), Hospital Virgen de la Victoria, Málaga, Spain
| | - Mohamed Omar
- Unidad de Enfermedades Infecciosas, Complejo Hospitalario de Jaén, Jaén, Spain
| | - Pilar Rincón
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario de Valme, Sevilla, Spain
| | - Antonio Rivero
- Unidad de Enfermedades Infecciosas, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, Universidad de Córdoba (UCO), Córdoba, Spain
| | - Montserrat Pérez-Pérez
- Unidad de Gestión Clínica de Enfermedades Infecciosas y Microbiología, Hospital de La Línea de la Concepción, AGS Campo de Gibraltar, Cádiz, Spain
| | - Miguel Raffo
- Unidad de Gestión Clínica de Enfermedades Infecciosas, Hospitales Juan Ramón Jiménez e Infanta Elena, Huelva, Spain
| | | | - Rosario Palacios
- Unidad de Gestión Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Instituto de Biomedicina de Málaga (IBIMA), Hospital Virgen de la Victoria, Málaga, Spain
| | - María A Gómez-Vidal
- Unidad de Enfermedades Infecciosas, Complejo Hospitalario de Jaén, Jaén, Spain
| | - Juan Macías
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario de Valme, Sevilla, Spain
| | - Juan A Pineda
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario de Valme, Sevilla, Spain
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Palacios R, Mayorga M, González-Domenech CM, Hidalgo-Tenorio C, Gálvez C, Muñoz-Medina L, de la Torre J, Lozano A, Castaño M, Omar M, Santos J. Safety and Efficacy of Dolutegravir Plus Rilpivirine in Treatment-Experienced HIV-Infected Patients: The DORIVIR Study. J Int Assoc Provid AIDS Care 2019. [PMID: 29529910 PMCID: PMC6748491 DOI: 10.1177/2325958218760847] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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] [Indexed: 11/16/2022] Open
Abstract
Objectives: To analyze the efficacy and safety of dolutegravir/rilpivirine (DTG/RPV) in HIV-infected patients who switched from any other antiretroviral therapy (ART). Methods: Open-label, multicenter study including patients who switched to DTG/RPV between February 2015 and February 2016. Efficacy (HIV RNA <50 copies/mL), adverse events, and metabolic changes at 24 weeks were analyzed. Results: A total of 104 participants were included, who switched for the following reasons: toxicity/intolerance (42.3%), convenience (27.8%), and drug interactions (17.3%). Prior regimens are protease inhibitor (56.7%), integrase strand transfer inhibitor (26.9%), and non-nucleoside reverse transcriptase inhibitor (16.3%). Efficacy at 24 weeks was 88.4% (intention to treat) and 96.8% (per protocol). Triglyceride levels were reduced, on average, by 12.7% and a mean decrease of 9.0% in the glomerular filtration rate was observed as well (P values of .003 and .002, respectively), whereas total cholesterol, HDL cholesterol, LDL cholesterol, creatinine, and glutamic-pyruvic transaminase remained unchanged. No patient discontinued due to adverse events. Conclusions: Dolutegravir/RPV is effective and safe in long-term HIV-infected patients under any prior ART. Toxicity, convenience, and interactions were the main reasons for changing. At 24 weeks, the lipid profile improved with a decrease in triglycerides.
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Affiliation(s)
- Rosario Palacios
- 1 UGC Enfermedades Infecciosas y Microbiología, Hospital Virgen de la Victoria, Málaga, Spain
| | - M Mayorga
- 2 UGC Enfermedades Infecciosas y Microbiología, Hospital Carlos Haya, Málaga, Spain
| | - C M González-Domenech
- 1 UGC Enfermedades Infecciosas y Microbiología, Hospital Virgen de la Victoria, Málaga, Spain
| | - C Hidalgo-Tenorio
- 3 Servicio de Enfermedades Infecciosas, Complejo Hospitalario Universitario Granada, Granada, Spain
| | - C Gálvez
- 4 UGC Enfermedades Infecciosas, Hospital Torrecárdenas, Málaga, Spain
| | - L Muñoz-Medina
- 3 Servicio de Enfermedades Infecciosas, Complejo Hospitalario Universitario Granada, Granada, Spain
| | - J de la Torre
- 5 UGC Enfermedades Infecciosas, Hospital Costa del Sol, Málaga, Spain
| | - A Lozano
- 6 UGC Enfermedades Infecciosas, Hospital de Poniente, Almería, Spain
| | - M Castaño
- 2 UGC Enfermedades Infecciosas y Microbiología, Hospital Carlos Haya, Málaga, Spain
| | - M Omar
- 7 UGC Enfermedades Infecciosas, Complejo hospitalario de Jaén, Jaén, Spain
| | - Jesús Santos
- 1 UGC Enfermedades Infecciosas y Microbiología, Hospital Virgen de la Victoria, Málaga, Spain
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Frías M, Rivero-Juárez A, Téllez F, Palacios R, Jiménez-Arranz Á, Pineda JA, Merino D, Gómez-Vidal MA, Pérez-Camacho I, Camacho Á, Rivero A. Evaluation of hepatitis C viral RNA persistence in HIV-infected patients with long-term sustained virological response by droplet digital PCR. Sci Rep 2019; 9:12507. [PMID: 31467339 PMCID: PMC6715682 DOI: 10.1038/s41598-019-48966-9] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 08/13/2019] [Indexed: 12/12/2022] Open
Abstract
Several studies have reported the persistence of HCV RNA in liver and/or peripheral blood mononuclear cells (PBMCs) in spite of undetectable viremia in patients who have achieved sustained virological response (SVR). This event, defined as occult HCV infection, remains controversial and low titers of persistent virus may be underestimated because it has not yet been analyzed by a highly sensitive test such as droplet digital PCR (ddPCR). This method provides an alternate ultra-sensitive detection technique for very low numbers of copies of viral RNA or DNA. The aim of this study was to evaluate the persistence of HCV in HIV-coinfected patients with long-term SVR using ddPCR. For each patient, the presence of HCV RNA in serum and PBMCs at baseline was determined by nested RT-ddPCR. Patients with HCV RNA in PBMCs at baseline were followed until the end of the study. One hundred and twenty-three patients were analyzed for persistence of HCV RNA in serum and PBMCs. Persistence of HCV was not found in serum in any patient. HCV RNA was detected in PBMCs in one patient (0.81%; 95% CI: 0.04–3.94) and resolved spontaneously during follow-up. Persistence of HCV RNA in PBMCs is not a common event in HIV/HCV co-infected patients with long-term SVR evaluated by RT-ddPCR.
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Affiliation(s)
- Mario Frías
- Unidad de Enfermedades Infecciosas. Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía de Córdoba, Universidad de Córdoba, Córdoba, Spain
| | - Antonio Rivero-Juárez
- Unidad de Enfermedades Infecciosas. Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía de Córdoba, Universidad de Córdoba, Córdoba, Spain.
| | - Francisco Téllez
- Unidad Gestión Clínica Enfermedades Infecciosas, Hospital La Línea, AGS Campo de Gibraltar, Cádiz, Spain
| | - Rosario Palacios
- Unidad de Enfermedades Infecciosas. Hospital Universitario Virgen de la Victoria, Complejo Hospitalario Provincial de Málaga, Málaga, Spain
| | - Álvaro Jiménez-Arranz
- Unidad de Genómica. Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, Universidad de Córdoba, Córdoba, Spain
| | - Juan A Pineda
- Unidad de Enfermedades Infecciosas y Microbiología, Hospital Universitario de Valme, Instituto de Biomedicina de Sevilla (iBiS), Sevilla, Spain
| | - Dolores Merino
- Unidad de Enfermedades Infecciosas, Hospitales Juan Ramón Jiménez e Infanta Elena de Huelva, Huelva, Spain
| | | | - Inés Pérez-Camacho
- Unidad de Enfermedades Infecciosas, Hospital de Poniente, El Ejido, Spain
| | - Ángela Camacho
- Unidad de Enfermedades Infecciosas. Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía de Córdoba, Universidad de Córdoba, Córdoba, Spain
| | - Antonio Rivero
- Unidad de Enfermedades Infecciosas. Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía de Córdoba, Universidad de Córdoba, Córdoba, Spain
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28
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González Domenech CM, Viciana-Ramos I, Sena-Corrales G, Mora Navas L, Ojeda G, Nuño E, Clavijo E, Palacios R, Santos J. A8 Epidemiological study of transmission clusters in a local HIV-1 cohort. Virus Evol 2019. [PMCID: PMC6735940 DOI: 10.1093/ve/vez002.007] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Integration of molecular, clinical, and demographic data represents a powerful tool to understand the dynamics of local HIV-1 transmission chains (TCs). The aim of our study was the phylogenetic analysis of the TCs within a HIV-1 cohort and the description of the relevant patient data within a TC. We performed a phylogenetic analysis of 757 sequences from newly HIV-1 diagnosed patients in Málaga (Southern Spain) during the period 2004–15. We used partial pol gene sequences in a preliminary phylogenetic reconstruction using the Neighbour Joining method (MEGA v6.06 program). After eliminating branches with bootstrap values <80 per cent, we constructed a new phylogeny by Maximum likelihood method (FastTree program). We considered as TC any cluster with bootstrap values ≥ 90 per cent. Patient sequences within and outside TCs were compared. Resistance mutations in the protease (PR) and reverse transcriptase (RT) sequences were analyzed using the Stanford algorithm. Four hundred and fifty-one out of 757 patients (59.6%) were grouped into fifty-three TCs, seventeen of them with five or more subjects. The largest number of patients associated within a TC was ninety. Patients younger than 40 years [odds ratio (OR) 1.75, 95% confidence interval (95% CI) 1.2–2.4, P = 0.002], men who have sex with men (MSM) (OR 2.14, 95% CI 1.3–3.2, P < 0.0001), non-Spanish (OR 1.48, 95% CI 1.0–2.1, P = 0.038), with a non-B subtype HIV-1 (OR 3.12, 95% CI 2.0–4.8, P < 0.0001), and presenting primary resistance mutations (OR 14.1, 95% CI 3.1–62.6, P = 0.001) were more likely to be associated within a cluster. Ninety-four out of 118 patients (79.6%) with transmission resistance mutations were included in some TC. The most frequent mutations associated with clusters were T69D/N, L210W, and K219E/Q, for NRTIs, K103N, and G190A/S for NNRTIs, and the I54L/M and L90M mutations for PIs. The prevalence for resistance to NNRTIs in TCs was 13.7 per cent. There were two TCs of rarer non-B subtypes: CRF19_cpx, with twenty-one individuals, sixteen of them (76.2%) with mutation G190A; and CRF51_01B with thirty-nine patients, twenty of them with the K103N mutation. Approximately 60 per cent of newly HIV-1 diagnosed patients were included in a TC. Younger patients, MSM, non-Spanish, with non-B subtype HIV-1 and primary resistance mutations were more likely to belong to a cluster. NNRTI mutations were the most frequent ones among patients in TCs. We observed two TCs represented by infrequent non-B subtypes in our area—CRF19_cpx and CRF51_01B—both of which were associated to the transmission of primary resistance.
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Affiliation(s)
| | - Isabel Viciana-Ramos
- Infectious Diseases and Clinical Microbiology Unit, Virgen de la Victoria University Hospital, Malaga, Spain
- Institute of Biomedical Investigation of Malaga (IBIMA), Malaga, Spain
| | - Gabriel Sena-Corrales
- Infectious Diseases and Clinical Microbiology Unit, Virgen de la Victoria University Hospital, Malaga, Spain
| | - Laura Mora Navas
- Infectious Diseases and Clinical Microbiology Unit, Virgen de la Victoria University Hospital, Malaga, Spain
| | - Guillermo Ojeda
- Infectious Diseases and Clinical Microbiology Unit, Virgen de la Victoria University Hospital, Malaga, Spain
| | - Enrique Nuño
- Infectious Diseases and Clinical Microbiology Unit, Virgen de la Victoria University Hospital, Malaga, Spain
| | - Encarnación Clavijo
- Infectious Diseases and Clinical Microbiology Unit, Virgen de la Victoria University Hospital, Malaga, Spain
| | - Rosario Palacios
- Infectious Diseases and Clinical Microbiology Unit, Virgen de la Victoria University Hospital, Malaga, Spain
- Institute of Biomedical Investigation of Malaga (IBIMA), Malaga, Spain
| | - Jesus Santos
- Infectious Diseases and Clinical Microbiology Unit, Virgen de la Victoria University Hospital, Malaga, Spain
- Institute of Biomedical Investigation of Malaga (IBIMA), Malaga, Spain
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Macías J, Morano LE, Téllez F, Granados R, Rivero-Juárez A, Palacios R, Ríos M, Merino D, Pérez-Pérez M, Collado A, Figueruela B, Morano A, Freyre-Carrillo C, Martín JM, Rivero A, García F, Pineda JA. Response to direct-acting antiviral therapy among ongoing drug users and people receiving opioid substitution therapy. J Hepatol 2019; 71:45-51. [PMID: 30853642 DOI: 10.1016/j.jhep.2019.02.018] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 02/15/2019] [Accepted: 02/25/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS People who inject drugs (PWID) and are on opioid agonist therapy (OAT) might have lower adherence to direct-acting antivirals (DAAs) against hepatitis C virus (HCV) and, therefore, lower rates of sustained virologic response (SVR). Because of this, we compared the SVR rates to interferon-free DAA combinations in individuals receiving OAT and those not receiving OAT in a real-world setting. METHODS The HEPAVIR-DAA cohort, recruiting HIV/HCV-coinfected patients (NCT02057003), and the GEHEP-MONO cohort (NCT02333292), including HCV-monoinfected individuals, are ongoing prospective multicenter cohorts of patients receiving DAAs in clinical practice. We compared SVR 12 weeks after treatment (SVR12) in non-drug users and PWID, including those receiving or not receiving OAT. Intention-to-treat and per protocol analyses were performed. RESULTS Overall, 1,752 patients started interferon-free DAA treatment. By intention-to-treat analysis, 778 (95%, 95% CI 93%-96%) never injectors, 673 (92%, 95% CI 89%-93%) PWID not on OAT and 177 (89%, 95% CI 83%-92%) PWID on OAT achieved SVR12 (p = 0.002). SVR12 rates for ongoing drug users (with or without OAT) were 68 (79%) compared with 1,548 (95%) for non-drug users (p <0.001). Among ongoing drug users, 15 (17%) were lost-to-follow-up, and 3 (3.5%) became reinfected. In the per protocol analysis, 97% never injectors, 95% PWID not on OAT and 95% PWID on OAT achieved SVR12 (p = 0.246). After adjustment, ongoing drug use was associated with SVR12 (intention-to-treat) and OAT use was not. CONCLUSIONS HCV-infected PWID achieve high SVR12 rates with DAAs whether they are on OAT or not, but their response rates are lower than those of patients who never used drugs. This is mainly attributable to more frequent loss to follow-up. Accounting for active drug use during DAA therapy nearly closed the gap in SVR rates between the study groups. LAY SUMMARY Patients with hepatitis C virus infection who are on opioid agonist therapy can achieve high cure rates with current treatments. The use of illicit drugs during treatment can drive drop-outs and reduce cure rates. However, hepatitis C can be cured in most of those using drugs who complete treatment and follow-up. Clinical trial number: HEPAVIR-DAA cohort, NCT02057003; GEHEP-MONO cohort, NCT02333292.
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Affiliation(s)
- Juan Macías
- Infectious Diseases and Microbiology Unit, Hospital Universitario de Valme, Seville, Spain.
| | - Luis E Morano
- Infectious Diseases Unit, Hospital Universitario Alvaro Cunqueiro, Vigo, Spain
| | - Francisco Téllez
- Infectious Diseases and Microbiology Unit, Hospital Universitario de Puerto Real, School of Medicine, Cadiz University, Instituto de Investigación e Innovación en Ciencias Biomédicas de la Provincia de Cádiz (INiBICA), Cadiz, Spain
| | - Rafael Granados
- Infectious Diseases Unit, Hospital Universitario de Gran Canaria Dr. Negrín, Gran Canaria, Spain
| | - Antonio Rivero-Juárez
- Infectious Diseases Unit, Hospital Universitario Reina Sofía, Instituto Maimonides de Investigación Biomedica de Córdoba (IMIBIC), Cordoba University, Cordoba, Spain
| | - Rosario Palacios
- Infectious Diseases, Microbiology and Preventive Medicine Unit, Hospital Universitario Virgen de la Victoria, Malaga, Spain
| | - MªJosé Ríos
- Infectious Diseases Unit, Hospital Universitario Virgen Macarena, Seville, Spain
| | - Dolores Merino
- Infectious Diseases Unit, Hospital Universitario Juan Ramón Jiménez, Huelva, Spain
| | | | - Antonio Collado
- Infectious Diseases Unit, Hospital Torrecárdenas, Almeria, Spain
| | - Blanca Figueruela
- Digestive Diseases Unit, Hospital Universitario de Valme, Seville, Spain
| | - Aitana Morano
- Infectious Diseases Unit, Hospital Universitario Alvaro Cunqueiro, Vigo, Spain
| | - Carolina Freyre-Carrillo
- Infectious Diseases and Microbiology Unit, Hospital Universitario de Puerto Real, School of Medicine, Cadiz University, Instituto de Investigación e Innovación en Ciencias Biomédicas de la Provincia de Cádiz (INiBICA), Cadiz, Spain
| | - José M Martín
- Infectious Diseases Unit, Hospital Universitario de Gran Canaria Dr. Negrín, Gran Canaria, Spain
| | - Antonio Rivero
- Infectious Diseases Unit, Hospital Universitario Reina Sofía, Instituto Maimonides de Investigación Biomedica de Córdoba (IMIBIC), Cordoba University, Cordoba, Spain
| | - Federico García
- Microbiology Service, Hospital Universitario San Cecilio, Granada, Spain
| | - Juan A Pineda
- Infectious Diseases and Microbiology Unit, Hospital Universitario de Valme, Seville, Spain
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Corma-Gómez A, Macías J, Merino Muñoz D, Téllez F, Granados R, Morano LE, De Los Santos Gil I, Vera-Méndez FJ, Collado A, Palacios R, Pineda JA. Higher relapse rate among HIV/HCV-coinfected patients receiving sofosbuvir/ledipasvir for 8 vs 12 weeks. J Infect 2019; 79:30-35. [PMID: 31100364 DOI: 10.1016/j.jinf.2019.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 12/22/2018] [Accepted: 05/10/2019] [Indexed: 02/08/2023]
Abstract
OBJECTIVES To compare the efficacy of sofosbuvir/ledipasvir (SOF/LDV) for 8 weeks (SL8) versus a 12-week course of SOF/LDV (SL12) among HIV/HCV-coinfected patients in clinical practice. In addition we compared sustained virological response (SVR) rates achieved with SL8 in HCV-monoinfected and HIV/HCV-coinfected patients in a real life setting. METHODS HCV-infected patients were retrospectively selected from the HEPAVIR-DAA and GEHEP-MONO real-life prospective cohorts if they fulfilled the following criteria: 1) Infected with genotype 1; 2) Treatment with SL8 or SL12; 3) Treatment naïve prior to receiving SL8 or SL12; 4) Absence of cirrhosis; 5) Baseline HCV RNA<6 × 106 IU/mL; 6) Reached the scheduled time-point for SVR (SVR12) assessment. SVR12 and relapse rates of HCV-monoinfected and HIV/HCV-coinfected patients were compared on an intention to treat basis. The responses with SL8 and SL12 were also compared. RESULTS In the SL8 group, 107 (51%) HCV-monoinfected and 102 (49%) HIV/HCV-coinfected patients were included. One hundred and sixty-four (43%) HCV-monoinfected subjects and 220 (57%) HIV/HCV-coinfected patients received SL12. SVR12 rates for HIV/HCV-coinfected patients treated with SL8 vs SL12 were SVR12 92.2% vs. 97.3% (p = 0.044) and the respective relapse rates were 4.9% vs. 0.5% (p = 0.013). SVR12 rates for SL8 among HCV-monoinfected and HIV/HCV-coinfected patients were: 96.3% vs. 92.2% (p = 0.243), respectively. The corresponding relapse rates were 0.9% vs. 4.9% (p = 0.112). CONCLUSION HIV/HCV-coinfected patients reach high rates of SVR12 with SL8, although lower than with SL12, mainly due to a higher probability of relapse. SVR12 rates with SL8 are numerically lower and the proportion of relapses higher in HIV/HCVcoinfected patients than in HCV-monoinfected subjects.
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Affiliation(s)
- Anaïs Corma-Gómez
- Unit of Infectious Diseases and Microbiology, Hospital Universitario de Valme, Seville, Spain
| | - Juan Macías
- Unit of Infectious Diseases and Microbiology, Hospital Universitario de Valme, Seville, Spain.
| | - Dolores Merino Muñoz
- Unit of Infectious Diseases, Hospitales Juan Ramón Jiménez e Infanta Elena, Huelva, Spain
| | - Francisco Téllez
- Unit of Infectious Diseases and Microbiology, Hospital Universitario de Puerto Real, Cádiz, Spain; Instituto de Investigación e Innovación en Ciencias Biomédicas de la provincia de Cádiz (INiBICA), Cádiz, Spain
| | - Rafael Granados
- Unit of Infectious Diseases, Hospital Universitario de Gran Canaria Dr Negrín, Las Palmas de Gran Canaria, Spain
| | - Luis E Morano
- Unit of Infectious Pathology, Hospital Universitario Alvaro Cunqueiro, Vigo, Spain
| | | | - Francisco J Vera-Méndez
- Section of Infectious Medicine/Service of Internal Medicine, Hospital General Universitario Santa Lucía, Cartagena, Spain
| | - Antonio Collado
- Infectious Diseases Unit, Hospital Universitario Torrecárdenas, Almeria, Spain
| | - Rosario Palacios
- Unit of Infectious Diseases and Microbiology, Hospital Virgen de la Victoria, Málaga, Spain
| | - Juan A Pineda
- Unit of Infectious Diseases and Microbiology, Hospital Universitario de Valme, Seville, Spain
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Domingo P, Suarez-Lozano I, Gutierrez F, Estrada V, Knobel H, Palacios R, Antela A, Blanco JR, Fulladosa X. Predictive factors of renal impairment in HIV-infected patients on antiretroviral therapy: Results from the VACH longitudinal cohort study. Nefrologia 2019; 39:497-505. [PMID: 31027896 DOI: 10.1016/j.nefro.2019.01.009] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 11/23/2018] [Accepted: 01/14/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND The use of combination antiretroviral therapy has led to dramatic improvements in the life expectancy of HIV-infected persons. As result, the HIV population is aging and increasingly facing illnesses typically seen in the elderly, such as chronic kidney disease (CKD). METHODS A retrospective longitudinal study was conducted using data from years 2010 and 2014 in all HIV-infected persons enrolled at the Spanish VACH cohort. We analyzed the prevalence and the predictive factors for developing CKD (estimated glomerular filtration rate, eGFR<60mL/min/1.73m2). RESULTS The CKD prevalence at baseline was 456/8968, 5.1% [4.6-5.6%]. Of 8512 HIV-positive individuals examined without CKD at baseline (73.7% male, median age 44 years-old), 2.15% developed CKD (eGFR<60mL/min/1.73m2). The odds ratios [95%CI] for the independent predictive factors identified were gender (male) 0.54 [0.39-0.75], age (per year) 1.08 [1.07-1.10], AIDS diagnosis 1.40 [1.03-1.91], protease inhibitor-based regimens 1.49 [1.10-2.02], hypertension 1.37 [0.94-1.99], diabetes 1.84 [1.33-2.55] and history of cardiovascular events 1.66 [0.96-2.86]. CONCLUSION The prevalence and risk factors for CKD and its progression are high in the VACH cohort. Thus, preventive measures such as control of hypertension, diabetes and obesity, as well as efforts for avoiding exposure to nephrotoxic drugs, including some antiretrovirals, are warranted in this aging HIV population.
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Affiliation(s)
- Pere Domingo
- Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
| | | | - Félix Gutierrez
- Infectious Diseases Unit, Hospital Universitario de Elche, Alicante, Spain
| | - Vicente Estrada
- Infectious Diseases Unit, Hospital Clínico San Carlos, Madrid, Spain
| | - Hernando Knobel
- Infectious Diseases Unit, Hospital del Mar, Barcelona, Spain
| | - Rosario Palacios
- Infectious Diseases Unit, Hospital Universitario Virgen de la Victoria, Malaga, Spain
| | - Antonio Antela
- Infectious Diseases Unit, Complexo Hospitalario Universitario, Santiago de Compostela, Spain
| | | | - Xavier Fulladosa
- Nephrology Unit, Hospital Universitario de Bellvitge, Barcelona, Spain
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Macías J, Granados R, Téllez F, Merino D, Pérez M, Morano LE, Palacios R, Paniagua M, Frías M, Merchante N, Pineda JA. Similar recovery of liver function after response to all-oral HCV therapy in patients with cirrhosis with and without HIV coinfection. J Viral Hepat 2019; 26:16-24. [PMID: 30141222 DOI: 10.1111/jvh.12990] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 06/14/2018] [Accepted: 07/31/2018] [Indexed: 12/12/2022]
Abstract
Among patients with cirrhosis, recovery of liver function after SVR to all-oral direct-acting antivirals (DAA) in HIV/HCV coinfection could be different to that in HCV monoinfection. Because of this, we compared the changes in several markers of liver function between HCV-monoinfected and HIV/HCV-coinfected patients with cirrhosis who achieved SVR12 to DAA combinations. In this retrospective cohort study, cirrhotics included in the HEPAVIR-DAA and GEHEP-MONO cohorts were selected if they had SVR12 to all-oral DAAs. Patients treated with atazanavir were excluded. Liver function improvement was defined as Child-Pugh-Turcotte (CPT) decrease ≥1 and/or MELD decrease ≥2 between baseline and SVR12. Liver function worsening was defined as a CPT increase ≥1 and/or MELD increase ≥2 and/or decompensations between baseline and SVR12. We included 490 patients, 270 (55%) of them with HIV coinfection. Liver function improved in 50 (56%) HCV-infected individuals and in 82 (57%) HIV/HCV-coinfected patients (P = 0.835). Liver function worsened in 33 (15%) HCV-monoinfected patients and in 33 (13%) HIV/HCV-coinfected patients (P = 0.370). Factors independently related with liver function improvement were male gender [adjusted OR (AOR) 2.1 (95% confidence interval, 95% CI: 1.03-4.2), P = 0.040], bilirubin < 1.2 mg/dL (AOR 1.8 [95% CI: 1.004-3.3], P = 0.49), and INR < 1.3 (AOR 2.4 [95% CI: 1.2-5.0], P = 0.019) at baseline. After multivariate analysis, albumin < 3.5 g/dL was associated with liver function worsening (AOR 6.1 [95% CI: 3-12.5], P < 0.001). Liver function worsening and improvement rates after responding to DAA are similar among HCV-monoinfected and HIV/HCV-coinfected cirrhotics. Gender, INR, bilirubin, and albumin levels were associated with liver function changes after response to DAAs.
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Affiliation(s)
- Juan Macías
- Infectious Diseases and Microbiology Unit, Hospital Universitario de Valme, Seville, Spain
| | - Rafael Granados
- Infectious Diseases Unit, Hospital Universitario de Gran Canaria Dr. Negrín, Gran Canaria, Spain
| | - Francisco Téllez
- Infectious Diseases and Microbiology Unit, Hospital Universitario de Puerto Real, Instituto de Investigación e Innovación en Ciencias Biomédicas de la Provincia de Cádiz (INiBICA), Puerto Real, Spain
| | - Dolores Merino
- Infectious Diseases Unit, Hospital Juan Ramón Jiménez, Huelva, Spain
| | | | - Luis E Morano
- Infectious Diseases Unit, Hospital Universitario Álvaro Cunqueiro, Vigo, Spain
| | - Rosario Palacios
- Infectious Diseases Unit, Hospital Universitario Virgen de la Victoria, Malaga, Spain
| | - María Paniagua
- Infectious Diseases and Microbiology Unit, Hospital Universitario Virgen Macarena, Seville, Spain
| | - Mario Frías
- Instituto Maimonides de Investigación Biomedica de Córdoba (IMIBIC), Hospital Universitario Reina Sofia, Cordoba, Spain
| | - Nicolás Merchante
- Infectious Diseases and Microbiology Unit, Hospital Universitario de Valme, Seville, Spain
| | - Juan A Pineda
- Infectious Diseases and Microbiology Unit, Hospital Universitario de Valme, Seville, Spain
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Macías J, Téllez F, Rivero-Juárez A, Palacios R, Morano LE, Merino D, Collado A, García-Fraile L, Omar M, Pineda JA. Early emergence of opportunistic infections after starting direct-acting antiviral drugs in HIV/HCV-coinfected patients. J Viral Hepat 2019; 26:48-54. [PMID: 30199593 DOI: 10.1111/jvh.13003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 07/19/2018] [Accepted: 08/15/2018] [Indexed: 12/14/2022]
Abstract
Varicella-zoster virus and hepatitis B virus reactivations have been reported after starting interferon-free direct-acting antiviral agent (DAA) combinations. HIV/HCV-coinfected patients could be a high-risk group for the reactivation of latent infections. Because of these, we report the occurrence of severe infections after starting DAA regimens in HIV/HCV-coinfected patients. Individuals included in the HEPAVIR-DAA (NCT02057003) cohort were selected if they had received all-oral DAA combinations. A retrospective review of clinical events registered between the start of DAAs and 12 months after SVR12 was carried out. Overall, 38 (4.5%) of 848 patients presented infections. The incidence (95% confidence interval) of infections was 4.6 (3.3-6.3) cases per 100 person-years. The median (Q1-Q3) time to the infection since baseline was 23 (7.3-33) weeks. Five (13%) of the patients with infections died; four of them had cirrhosis. The frequency of previous AIDS was 21 (54%) for patients with infections and 324 (40%) for those without infections (P = 0.084). The median (Q1-Q3) nadir CD4 cell count of individuals with and without infections was 75 (53-178) and 144 (67-255) cells/μL, respectively (P = 0.047). Immunodepression-associated infections were observed in 9 (1.1%) patients. All of them had suppressed HIV replication with antiretroviral therapy. In conclusion, severe infections are relatively common among HIV/HCV-coinfected patients receiving all-oral DAA combinations. Some unusual reactivations of latent infections in patients with suppressed HIV replication seem to be temporally linked with DAA use.
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Affiliation(s)
- Juan Macías
- Infectious Diseases and Microbiology Unit, Hospital Universitario de Valme, Seville, Spain
| | - Francisco Téllez
- Infectious Diseases and Microbiology Unit, Hospital Universitario de Puerto Real, Instituto de Investigación e Innovación en Ciencias Biomédicas de la Provincia de Cádiz (INiBICA), Cadiz, Spain
| | - Antonio Rivero-Juárez
- Instituto Maimonides de Investigación Biomedica de Córdoba (IMIBIC), Hospital Universitario Reina Sofia, Cordoba, Spain
| | - Rosario Palacios
- Infectious Diseases, Microbiology and Preventive Medicine Unit, Hospital Universitario Virgen de la Victoria, Malaga, Spain
| | - Luis E Morano
- Infectious Diseases Unit, Hospital Universitario Alvaro Cunqueiro, Vigo, Spain
| | - Dolores Merino
- Infectious Diseases Unit, Hospital Juan Ramón Jiménez, Huelva, Spain
| | - Antonio Collado
- Infectious Diseases Unit, Hospital Torrecárdenas, Almeria, Spain
| | - Lucio García-Fraile
- Infectious Diseases-Internal Medicine Service, Hospital Universitario de la Princesa, Madrid, Spain
| | - Mohamed Omar
- Infectious Diseases Unit, Hospital de Jaen, Jaen, Spain
| | - Juan A Pineda
- Infectious Diseases and Microbiology Unit, Hospital Universitario de Valme, Seville, Spain
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Dizeo C, Chirino DA, Volverg V, Ferrer L, Rinaldi MC, Coyle J, Marquez G, Guthmann MG, Palacios R, Calderon G. P1600High sensitive cardiac troponin elevations in patients with Chagas disease without evidence of structural heart affection. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- C Dizeo
- Sanatorio Franchin, Cardiology, Buenos aires, Argentina
| | - D A Chirino
- Sanatorio Franchin, Cardiology, Buenos aires, Argentina
| | - V Volverg
- Sanatorio Franchin, Cardiology, Buenos aires, Argentina
| | - L Ferrer
- Sanatorio Franchin, Cardiology, Buenos aires, Argentina
| | - M C Rinaldi
- Sanatorio Franchin, Cardiology, Buenos aires, Argentina
| | - J Coyle
- Sanatorio Franchin, Cardiology, Buenos aires, Argentina
| | - G Marquez
- Sanatorio Franchin, Cardiology, Buenos aires, Argentina
| | - M G Guthmann
- Sanatorio Franchin, Cardiology, Buenos aires, Argentina
| | - R Palacios
- Sanatorio Franchin, Cardiology, Buenos aires, Argentina
| | - G Calderon
- Sanatorio Franchin, Cardiology, Buenos aires, Argentina
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Pulido F, Ribera E, Lagarde M, Pérez-Valero I, Palacios R, Iribarren JA, Payeras A, Domingo P, Sanz J, Cervero M, Curran A, Rodríguez-Gómez FJ, Téllez MJ, Ryan P, Barrufet P, Knobel H, Rivero A, Alejos B, Yllescas M, Arribas JR. Dual Therapy With Darunavir and Ritonavir Plus Lamivudine vs Triple Therapy With Darunavir and Ritonavir Plus Tenofovir Disoproxil Fumarate and Emtricitabine or Abacavir and Lamivudine for Maintenance of Human Immunodeficiency Virus Type 1 Viral Suppression: Randomized, Open-Label, Noninferiority DUAL-GESIDA 8014-RIS-EST45 Trial. Clin Infect Dis 2018; 65:2112-2118. [PMID: 29020293 DOI: 10.1093/cid/cix734] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Accepted: 08/12/2017] [Indexed: 11/13/2022] Open
Abstract
Background Our objective was to assess the therapeutic noninferiority of dual therapy with darunavir/ritonavir and lamivudine compared to triple therapy with darunavir/ritonavir plus 2 nucleos(t)ides for maintenance of human immunodeficiency virus type 1 (HIV-1) suppression. Methods This was a multicenter, open-label, noninferiority trial (margin 12%). Patients with HIV-1 RNA <50 copies/mL for 6 months or longer on triple therapy with darunavir/ritonavir and 2 nucleos(t)ides (tenofovir disoproxil fumarate and emtricitabine or abacavir and lamivudine) and with no resistance were randomized to continue therapy (n = 128) or switch to darunavir/ritonavir and lamivudine (n = 129). The primary endpoint was the proportion of participants with HIV-RNA <50 copies/mL after 48 weeks of follow-up according to the snapshot algorithm. Results A total of 249 participants received study drugs (intention-to-treat exposed). The proportion of participants with HIV-RNA <50 copies/mL in the dual- and triple-therapy arms was 88.9% (112/126) and 92.7% (114/123; difference, -3.8%; 95% confidence interval, -11.0 to 3.4), respectively. Four participants in the dual-therapy arm and 2 in the triple-therapy arm developed protocol-defined virological failure. Switching to dual therapy was associated with a significant increase in total, low-density lipoprotein, and high-density lipoprotein (HDL) cholesterol, but not in the total-to-HDL cholesterol ratio. Serious adverse events and study drug discontinuations due to adverse events occurred in 4.8% vs 4.9%P = .97) and in 0.8% (1/126) vs 1.6% P = .55) in dual therapy vs triple therapy, respectively. Conclusions Dual therapy with darunavir/ritonavir and lamivudine demonstrated noninferior therapeutic efficacy and similar tolerability compared to triple therapy. Clinical Trials Registration NCT02159599.
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Affiliation(s)
| | | | - María Lagarde
- Hospital Universitario Doce de Octubre, imas12, UCM, Madrid
| | | | - Rosario Palacios
- Hospital Clínico Universitario Virgen de la Victoria, IBIMA, Málaga
| | - José A Iribarren
- Hospital Universitario Donostia, Instituto de Investigación BioDonostia, San Sebastian
| | | | | | | | | | | | | | | | - Pablo Ryan
- Hospital Universitario Infanta Leonor, Madrid
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Shah SK, Kimmelman J, Lyerly AD, Lynch HF, Miller FG, Palacios R, Pardo CA, Zorrilla C. Response-Evaluating human trials: FDA's role. Science 2018; 360:1308-1309. [PMID: 29930129 DOI: 10.1126/science.aau0865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- S K Shah
- Treuman Katz Center for Pediatric Bioethics, University of Washington and Seattle Children's Research Institute, Seattle, WA 98101, USA.
| | - J Kimmelman
- Biomedical Ethics Unit, McGill University, Montreal, QC H3A 1X1, Canada
| | - A D Lyerly
- Center for Bioethics and Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - H F Lynch
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - F G Miller
- Weil Cornell Medical College, New York, NY 10065, USA
| | | | - C A Pardo
- Department of Neurology, Neurovirus Emerging in the Americas Study (NEAS), Johns Hopkins University, Baltimore, MD 21205, USA
| | - C Zorrilla
- University of Puerto Rico School of Medicine, San Juan, PR 00921, USA
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Shah SK, Kimmelman J, Lyerly AD, Lynch HF, Miller FG, Palacios R, Pardo CA, Zorrilla C. Bystander risk, social value, and ethics of human research. Science 2018; 360:158-159. [PMID: 29650663 DOI: 10.1126/science.aaq0917] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- S K Shah
- University of Washington and Seattle Children's Research Institute, Seattle, WA, USA.
| | | | - A D Lyerly
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - H F Lynch
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - F G Miller
- Weil Cornell Medical College, New York, NY, USA
| | | | - C A Pardo
- Johns Hopkins University, Baltimore, MD, USA
| | - C Zorrilla
- University of Puerto Rico School of Medicine, San Juan, Puerto Rico, USA
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Pallan P, Wholey M, Palacios R, Lutz J, Castillo AM, Mehta A. 4:21 PM Abstract No. 42 Transarterial chemoembolization with 40-micron drug-eluting beads: a multicenter study, a San Antonio experience. J Vasc Interv Radiol 2018. [DOI: 10.1016/j.jvir.2018.01.050] [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: 11/27/2022] Open
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González-Domenech CM, Palacios R, Santos J. [Pharmacological aspects of darunavir/cobicistat]. Enferm Infecc Microbiol Clin 2018; 34 Suppl 1:30-33. [PMID: 28081761 DOI: 10.1016/s0213-005x(17)30006-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
| | - Rosario Palacios
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, España; UGC de Enfermedades Infecciosas, Microbiología Clínica y Medicina Preventiva, Hospital Virgen de la Victoria, Málaga, España
| | - Jesús Santos
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, España; UGC de Enfermedades Infecciosas, Microbiología Clínica y Medicina Preventiva, Hospital Virgen de la Victoria, Málaga, España.
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Benito JM, Ortiz MC, León A, Sarabia LA, Ligos JM, Montoya M, Garcia M, Ruiz-Mateos E, Palacios R, Cabello A, Restrepo C, Rodriguez C, Del Romero J, Leal M, Muñoz-Fernández MA, Alcamí J, García F, Górgolas M, Rallón N. Class-modeling analysis reveals T-cell homeostasis disturbances involved in loss of immune control in elite controllers. BMC Med 2018; 16:30. [PMID: 29490663 PMCID: PMC5830067 DOI: 10.1186/s12916-018-1026-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 02/13/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Despite long-lasting HIV replication control, a significant proportion of elite controller (EC) patients may experience CD4 T-cell loss. Discovering perturbations in immunological parameters could help our understanding of the mechanisms that may be operating in those patients experiencing loss of immunological control. METHODS A case-control study was performed to evaluate if alterations in different T-cell homeostatic parameters can predict CD4 T-cell loss in ECs by comparing data from EC patients showing significant CD4 decline (cases) and EC patients showing stable CD4 counts (controls). The partial least-squares-class modeling (PLS-CM) statistical methodology was employed to discriminate between the two groups of patients, and as a predictive model. RESULTS Herein, we show that among T-cell homeostatic alterations, lower levels of naïve and recent thymic emigrant subsets of CD8 cells and higher levels of effector and senescent subsets of CD8 cells as well as higher levels of exhaustion of CD4 cells, measured prior to CD4 T-cell loss, predict the loss of immunological control. CONCLUSIONS These data indicate that the parameters of T-cell homeostasis may identify those EC patients with a higher proclivity to CD4 T-cell loss. Our results may open new avenues for understanding the mechanisms underlying immunological progression despite HIV replication control, and eventually, for finding a functional cure through immune-based clinical trials.
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Affiliation(s)
- José M Benito
- IIS-Fundación Jiménez Díaz, UAM, Av. Reyes Católicos, 2, 28040, Madrid, Spain. .,Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, Spain.
| | | | - Agathe León
- Hospital Clinic-IDIBAPS, HIVACAT, Universidad de Barcelona, Barcelona, Spain
| | | | - José M Ligos
- Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
| | - María Montoya
- Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
| | - Marcial Garcia
- IIS-Fundación Jiménez Díaz, UAM, Av. Reyes Católicos, 2, 28040, Madrid, Spain.,Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, Spain
| | | | - Rosario Palacios
- Unidad de E. Infecciosas. Hospital Virgen de la Victoria e IBIMA, Málaga, Spain
| | - Alfonso Cabello
- Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Clara Restrepo
- IIS-Fundación Jiménez Díaz, UAM, Av. Reyes Católicos, 2, 28040, Madrid, Spain.,Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, Spain
| | - Carmen Rodriguez
- Centro Sanitario Sandoval, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Jorge Del Romero
- Centro Sanitario Sandoval, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | | | - María A Muñoz-Fernández
- Laboratory of Molecular Immuno-Biology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - José Alcamí
- AIDS Immunopathology Unit, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
| | - Felipe García
- Hospital Clinic-IDIBAPS, HIVACAT, Universidad de Barcelona, Barcelona, Spain
| | - Miguel Górgolas
- Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Norma Rallón
- IIS-Fundación Jiménez Díaz, UAM, Av. Reyes Católicos, 2, 28040, Madrid, Spain. .,Hospital Universitario Rey Juan Carlos, Móstoles, Madrid, Spain.
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Pineda JA, Rivero-Juárez A, de Los Santos I, Collado A, Merino D, Morano-Amado LE, Ríos MJ, Pérez-Pérez M, Téllez F, Palacios R, Pérez AB, Mancebo M, Rivero A, Macías J. Paritaprevir/ritonavir/ombitasvir plus dasabuvir in HIV/HCV-coinfected patients with genotype 1 in real-life practice. HIV Clin Trials 2018; 19:23-30. [PMID: 29447085 DOI: 10.1080/15284336.2018.1436637] [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] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Background Data on the efficacy, safety, and concomitant use with other drugs of the combination ritonavir-boosted paritaprevir/ombitasvir plus dasabuvir (PrOD) in HIV/HCV-coinfected patients in real life are limited. The objectives of this study were to analyze these topics in HIV/HCV-coinfected subjects bearing HCV genotype 1 (GT1). Methods One hundred and eighty-two HIV/HCV-coinfected patients with GT1 (87 1a, 71 1b, 23 other) treated with PrOD, plus ribavirin (RBV) in 119 cases, in routine clinical practice were analyzed. The main variable of efficacy was sustained virological response (SVR) 12 weeks after completing therapy in an intention-to-treat (ITT) analysis and that of safety treatment discontinuation because of adverse effects. Factors associated with SVR were analyzed with a modified ITT (mITT) strategy. Results One hundred and seventy-two (94%) patients attained SVR, 3 (2%) experienced a relapse and two (1%) discontinued therapy due to adverse events. The rates of SVR in subjects with GT 1a and 1b by mITT were, respectively, 97% and 98%. Sixty-five (98%) out of 66 patients with cirrhosis and 107 (98%) out of 110 (p = 1) non-cirrhotics achieved SVR. Fifty-five (95%) patients on concomitant darunavir therapy developed SVR vs. 117 (99%) (p = 0.105) of those without DRV. RBV dose was reduced in 13 (11%) patients and permanently discontinued in 2 (2%), with no impact on SVR. Conclusions PrOD is highly effective and well tolerated in HIV/HCV-coinfected patients with GT1 in routine clinical practice. RBV is often required. However, RBV dose reduction or discontinuation is uncommonly needed and do not impair the SVR rate.
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Affiliation(s)
- Juan A Pineda
- a Unit of Infectious Diseases and Microbiology , Hospital Universitario de Valme , Seville , Spain
| | - Antonio Rivero-Juárez
- b Unit of Infectious Diseases , Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, Córdoba University , Córdoba , Spain
| | - Ignacio de Los Santos
- c Unit of Infectious Diseases , Hospital Universitario de La Princesa , Madrid , Spain
| | - Antonio Collado
- d Unit of Infectious Diseases , Hospital Universitario Torrecárdenas , Almería , Spain
| | - Dolores Merino
- e Unit of Infectious Diseases , Complejo Hospitalario Universitario de Huelva , Huelva , Spain
| | - Luis E Morano-Amado
- f Unit of Infectious Pathology , Hospital Universitario Alvaro Cunqueiro , Vigo , Spain
| | - María J Ríos
- g Unit of Infectious Diseases , Hospital Universitario Virgen Macarena , Seville , Spain
| | - Montserrat Pérez-Pérez
- h Unit of Infectious Diseases , Hospital La Línea, AGS Campo de Gibraltar , Cádiz , Spain
| | - Francisco Téllez
- i Unit of Infectious Diseases and Microbiology, Instituto de Investigación e Innovación en Ciencias Biomédicas de la Provincia de Cádiz (INiBICA) , Hospital Universitario de Puerto Real , Puerto Real , Spain
| | - Rosario Palacios
- j Unit of Infectious Diseases , Hospital Universitario Virgen de la Victoria, Campus de Teatinos S/N , Málaga , Spain
| | - Ana B Pérez
- k Department of Clinical Microbiology, Unit of Infectious Diseases and Clinical Microbiology , Hospital Universitario San Cecilio, Instituto de Investigación Biosanitaria (Ibs) , Granada , Spain
| | - María Mancebo
- a Unit of Infectious Diseases and Microbiology , Hospital Universitario de Valme , Seville , Spain
| | - Antonio Rivero
- b Unit of Infectious Diseases , Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, Córdoba University , Córdoba , Spain
| | - Juan Macías
- a Unit of Infectious Diseases and Microbiology , Hospital Universitario de Valme , Seville , Spain
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Armentia A, Santos J, Serrano Z, Martín B, Martín S, Barrio J, Fernández S, González-Sagrado M, Pineda F, Palacios R. Molecular diagnosis of allergy to Anisakis simplex and Gymnorhynchus gigas fish parasites. Allergol Immunopathol (Madr) 2017; 45:463-472. [PMID: 28341528 DOI: 10.1016/j.aller.2016.12.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 12/03/2016] [Indexed: 10/19/2022]
Abstract
BACKGROUND There has been an increase in the prevalence of hypersensitivity to Anisakis simplex. There are fish parasites other than Anisakis simplex whose allergenicity has not yet been studied. OBJECTIVE To assess IgE hypersensitivity caused by fish parasite allergens in patients with gastro-allergic symptoms after consumption of fish, shellfish or cephalopods, compared with healthy subjects, pollen allergic individuals and children with digestive symptoms after eating marine food. METHODS We carried out in vivo tests (skin prick) and in vitro tests (specific IgE determination, Western blot) and component resolved diagnostics (CRD) using microarray analysis in all patients. RESULTS CRD better detected sensitisation to allergens from marine parasites than skin prick tests and determination of specific IgE by CAP. Sensitisation to Gymnorhynchus gigas was detected in 26% of patients measured by skin prick tests and 36% measured by IgE. CONCLUSIONS The prevalence of hypersensitivity to marine parasite allergens other than Anisakis simplex should be studied, and the most appropriate technique for this is CRD.
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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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Armentia A, Pineda F, Martin-Armentia B, Ramos C, Gil Martin FJ, Palacios R. Endophthalmitis related to lemon allergy in a heroin addict. Allergol Immunopathol (Madr) 2016; 44:472-4. [PMID: 27087565 DOI: 10.1016/j.aller.2015.12.003] [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: 07/18/2015] [Revised: 11/17/2015] [Accepted: 12/03/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Heroin and its contaminants may be an important source of allergens in young people. We present a case of severe endophthalmitis in a patient that also suffered from anaphylactoid symptoms (hypotension, urticaria, glottic oedema) whenever he ingested lemon. METHODS Prick tests with a battery of 42 aeroallergens including fruits and citrus fruits (orange, mandarin, grapefruit and lemon) and specific IgE to these allergens were carried out. Immunodetection was performed using the patient's serum and the following allergens: lemon, Candida, Aspergillus, Penicillium and Alternaria recombinant Alt 1 (Laboratories Diater). RESULTS Skin tests were negative for Candida, Penicillium, Aspergillus and Cladosporium (ALK-Spain) as were specific IgE antibodies for CAP (Thermofisher, Sweden) and positive only for lemon and, doubtfully, to Candida. Specific IgE tests to pollen, arthropods, fungi, dander and foods were positive only for lemon (0.49kU/L). Serological study of fungi ruled out fungal infection at that time. The immunodetection showed that the patient's serum recognised a protein of approximately 25kDa of lemon peel, one of approximately 12-13kDa of Penicillium, and perfectly recognised Alt a 1. CONCLUSIONS Lemon surface can be contaminated by Candida and other fungi. In heroin addicts with positive skin tests for lemon, the possibility of these serious complications should be taken into account.
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Affiliation(s)
- A Armentia
- Allergy Unit, Rio Hortega University Hospital, Valladolid, Spain.
| | - F Pineda
- DIATER Laboratories, Madrid, Spain
| | | | - C Ramos
- Immunology, Microbiology and Parasitology Department, Rio Hortega University Hospital, Valladolid, Spain
| | - F J Gil Martin
- Immunology, Microbiology and Parasitology Department, Rio Hortega University Hospital, Valladolid, Spain
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Rivero A, Pérez-Molina JA, Blasco AJ, Arribas JR, Crespo M, Domingo P, Estrada V, Iribarren JA, Knobel H, Lázaro P, López-Aldeguer J, Lozano F, Moreno S, Palacios R, Pineda JA, Pulido F, Rubio R, de la Torre J, Tuset M, Gatell JM. Costs and cost-efficacy analysis of the 2016 GESIDA/Spanish AIDS National Plan recommended guidelines for initial antiretroviral therapy in HIV-infected adults. Enferm Infecc Microbiol Clin 2016; 35:88-99. [PMID: 27459919 DOI: 10.1016/j.eimc.2016.06.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 06/14/2016] [Accepted: 06/14/2016] [Indexed: 11/16/2022]
Abstract
INTRODUCTION GESIDA and the AIDS National Plan panel of experts suggest preferred (PR), alternative (AR), and other regimens (OR) for antiretroviral treatment (ART) as initial therapy in HIV-infected patients for the year 2016. The objective of this study is to evaluate the costs and the efficacy of initiating treatment with these regimens. METHODS Economic assessment of costs and efficiency (cost/efficacy) based on decision tree analyses. Efficacy was defined as the probability of reporting a viral load <50copies/mL at week 48 in an intention-to-treat analysis. Cost of initiating treatment with an ART regimen was defined as the costs of ART and its consequences (adverse effects, changes of ART regimen, and drug resistance studies) during the first 48 weeks. The payer perspective (National Health System) was applied, only taking into account differential direct costs: ART (official prices), management of adverse effects, studies of resistance, and HLA B*5701 testing. The setting is Spain and the costs correspond to those of 2016. A sensitivity deterministic analysis was conducted, building three scenarios for each regimen: base case, most favourable, and least favourable. RESULTS In the base case scenario, the cost of initiating treatment ranges from 4663 Euros for 3TC+LPV/r (OR) to 10,894 Euros for TDF/FTC+RAL (PR). The efficacy varies from 0.66 for ABC/3TC+ATV/r (AR) and ABC/3TC+LPV/r (OR), to 0.89 for TDF/FTC+DTG (PR) and TDF/FTC/EVG/COBI (AR). The efficiency, in terms of cost/efficacy, ranges from 5280 to 12,836 Euros per responder at 48 weeks, for 3TC+LPV/r (OR), and RAL+DRV/r (OR), respectively. CONCLUSION Despite the overall most efficient regimen being 3TC+LPV/r (OR), among the PR and AR, the most efficient regimen was ABC/3TC/DTG (PR). Among the AR regimes, the most efficient was TDF/FTC/RPV.
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Affiliation(s)
- Antonio Rivero
- Unidad de Gestión Clínica de Enfermedades Infecciosas, Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba, Córdoba, Spain
| | | | | | - José Ramón Arribas
- Servicio de Medicina Interna, Unidad de VIH, IdiPAZ, Hospital Universitario La Paz, Madrid, Spain
| | - Manuel Crespo
- Hospital Universitari Vall d'Hebron, Vall d'Hebron Institute of Research (VHIR), Barcelona, Spain
| | - Pere Domingo
- Hospitals Universitaris Arnau de Vilanova & Santa María, Universitat de Lleida, Institut de Recerca Biomèdica (IRB) de Lleida, Lieida, Spain
| | - Vicente Estrada
- Hospital Clínico San Carlos, IdISSC; Universidad Complutense, Madrid, Spain
| | - José Antonio Iribarren
- Servicio de Enfermedades Infecciosas, Hospital Universitario Donostia, San Sebastián, Spain
| | - Hernando Knobel
- Servicio de Enfermedades Infecciosas, Hospital del Mar, Barcelona, Spain
| | | | - José López-Aldeguer
- Servicio de Medicina Interna y Unidad de Enfermedades Infecciosas, Hospital Universitario La Fe, Valencia, Spain
| | - Fernando Lozano
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario de Valme, Sevilla, Spain
| | - Santiago Moreno
- Servicio de Enfermedades Infecciosas, Hospital Ramón y Cajal, Universidad de Alcalá de Henares, Instituto de Investigación Sanitaria Ramón y Cajal (IRYCIS), Alcalá de Henares, Madrid, Spain
| | - Rosario Palacios
- Unidad de Enfermedades Infecciosas, Hospital Virgen de la Victoria, Málaga, Spain
| | - Juan Antonio Pineda
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario de Valme, Sevilla, Spain
| | - Federico Pulido
- Unidad VIH, i+12, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Rafael Rubio
- Unidad VIH, i+12, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Javier de la Torre
- Grupo de Enfermedades Infecciosas de la Unidad de Medicina Interna, Hospital Costa del Sol, Marbella, Málaga, Spain
| | | | - Josep M Gatell
- Servicio de Enfermedades Infecciosas, Hospital Clínic-IDIBAPS, Universidad de Barcelona, Barcelona, Spain
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Abstract
Our objective is to analyse patients diagnosed with late-stage HIV infection in the highly active antiretroviral therapy (HAART) area. A prospective, observational study of all patients with an initial CD4<50 × 106/L was carried out. Epidemiological, clinical and HAART-associated data were analysed. Survival rates were estimated and pairs of survival curves were compared. The statistical program used was SPSS® (version 10). In all, 349 HIV-infected patients were diagnosed, 117 (33.5%) had late-stage disease, mean CD4 23.9 × 106/L and mean viral load (VL) 5.38 log10. In 98 men, mean age 39.5 years, percentage of AIDS cases at their first attendance was 83.8%. The median follow-up period was 28 months and 27 died. Pneumocystis carinii was the most frequent cause of AIDS (24.4%) and death (18.5%). Survival rates at 12, 24 and 36 months were 95.6%, 85.8% and 72.4%. HAART was started in 82.1%. VLs <50 copies/mL at one, two and three years of treatment were 55.2%, 55.7% and 58.0%. Resource utilization included 0.58 hospitalization/patient/year and 0.07 events/patient/year. HAART-related complications were as follows: 50% lipodystrophy, 9.7% hypertension, 22.2% hyperglycaemia, 26.4% hypercholesterolaemia, 31.9% hypertrygliceridaemia and 18.1% mixed hyperlipaemia. Over one-third of our patients have advanced HIV infection at diagnosis. However, the outcome is favourable, with a good immunovirological response and few new opportunistic events. HAART-related complications were frequent.
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Affiliation(s)
- J Santos
- Infectious Diseases Unit, Internal Medicine Service, Hospital Virgen de la Victoria, Campus Teatinus s/n, 29010 Málaga, Spain.
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Ng BF, New TH, Palacios R. Effects of leading-edge tubercles on wing flutter speeds. Bioinspir Biomim 2016; 11:036003. [PMID: 27070824 DOI: 10.1088/1748-3190/11/3/036003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The dynamic aeroelastic effects on wings modified with bio-inspired leading-edge (LE) tubercles are examined in this study. We adopt a state-space aeroelastic model via the coupling of unsteady vortex-lattice method and a composite beam to evaluate stability margins as a result of LE tubercles on a generic wing. The unsteady aerodynamics and spanwise mass variations due to LE tubercles have counteracting effects on stability margins with the former having dominant influence. When coupled, flutter speed is observed to be 5% higher, and this is accompanied by close to 6% decrease in reduced frequencies as an indication of lower structural stiffness requirements for wings with LE tubercles. Both tubercle amplitude and wavelength have similar influences over the change in flutter speeds, and such modifications to the LE would have minimal effect on stability margins when concentrated inboard of the wing. Lastly, when used in sweptback wings, LE tubercles are observed to have smaller impacts on stability margins as the sweep angle is increased.
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Affiliation(s)
- B F Ng
- School of Mechanical and Aerospace Engineering, Nanyang Technological University, 50 Nanyang Avenue, 639798, Singapore
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Avendaño MS, Martínez-Revelles S, Aguado A, Simões MR, González-Amor M, Palacios R, Guillem-Llobat P, Vassallo DV, Vila L, García-Puig J, Beltrán LM, Alonso MJ, Cachofeiro MV, Salaices M, Briones AM. Role of COX-2-derived PGE2 on vascular stiffness and function in hypertension. Br J Pharmacol 2016; 173:1541-55. [PMID: 26856544 DOI: 10.1111/bph.13457] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 01/08/2016] [Accepted: 01/29/2016] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND AND PURPOSE Prostanoids derived from COX-2 and EP receptors are involved in vascular remodelling in different cardiovascular pathologies. This study evaluates the contribution of COX-2 and EP1 receptors to vascular remodelling and function in hypertension. EXPERIMENTAL APPROACH Spontaneously hypertensive rats (SHR) and angiotensin II (AngII)-infused (1.44 mg · kg(-1) · day(-1), 2 weeks) mice were treated with the COX-2 inhibitor celecoxib (25 mg · kg(-1) · day(-1) i.p) or with the EP1 receptor antagonist SC19220 (10 mg · kg(-1) · day(-1) i.p.). COX-2(-/-) mice with or without AngII infusion were also used. KEY RESULTS Celecoxib and SC19220 treatment did not modify the altered lumen diameter and wall : lumen ratio in mesenteric resistance arteries from SHR-infused and/or AngII-infused animals. However, both treatments and COX-2 deficiency decreased the augmented vascular stiffness in vessels from hypertensive animals. This was accompanied by diminished vascular collagen deposition, normalization of altered elastin structure and decreased connective tissue growth factor and plasminogen activator inhibitor-1 gene expression. COX-2 deficiency and SC19220 treatment diminished the increased vasoconstrictor responses and endothelial dysfunction induced by AngII infusion. Hypertensive animals showed increased mPGES-1 expression and PGE2 production in vascular tissue, normalized by celecoxib. Celecoxib treatment also decreased AngII-induced macrophage infiltration and TNF-α expression. Macrophage conditioned media (MCM) increased COX-2 and collagen type I expression in vascular smooth muscle cells; the latter was reduced by celecoxib treatment. CONCLUSIONS AND IMPLICATIONS COX-2 and EP1 receptors participate in the increased extracellular matrix deposition and vascular stiffness, the impaired vascular function and inflammation in hypertension. Targeting PGE2 receptors might have benefits in hypertension-associated vascular damage.
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Affiliation(s)
- M S Avendaño
- Dept. Farmacología, Universidad Autónoma de Madrid (UAM), Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
| | - S Martínez-Revelles
- Dept. Farmacología, Universidad Autónoma de Madrid (UAM), Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
| | - A Aguado
- Dept. Farmacología, Universidad Autónoma de Madrid (UAM), Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
| | - M R Simões
- Dept. Farmacología, Universidad Autónoma de Madrid (UAM), Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Madrid, Spain.,Dept. Physiological Sciences, Federal University of Espirito Santo, Vitoria, Brazil
| | - M González-Amor
- Dept. Farmacología, Universidad Autónoma de Madrid (UAM), Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
| | - R Palacios
- Dept. Farmacología, Universidad Autónoma de Madrid (UAM), Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
| | - P Guillem-Llobat
- Centro de Biología Molecular "Severo Ochoa", UAM-CSIC, Madrid, Spain
| | - D V Vassallo
- Dept. Physiological Sciences, Federal University of Espirito Santo, Vitoria, Brazil
| | - L Vila
- Laboratorio de Angiología, Biología Vascular e Inflamación, Instituto de Investigación Biomédica (IIB Sant Pau), Barcelona, Spain
| | - J García-Puig
- Servicio de Medicina Interna, Hospital Universitario La Paz, UAM, IdiPaz, Madrid, Spain
| | - L M Beltrán
- Servicio de Medicina Interna, Hospital Universitario La Paz, UAM, IdiPaz, Madrid, Spain
| | - M J Alonso
- Dept Ciencias Básicas de la Salud, Universidad Rey Juan Carlos, Alcorcón, Spain
| | - M V Cachofeiro
- Dept. Fisiología, Facultad de Medicina, Universidad Complutense, Madrid, Spain
| | - M Salaices
- Dept. Farmacología, Universidad Autónoma de Madrid (UAM), Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
| | - A M Briones
- Dept. Farmacología, Universidad Autónoma de Madrid (UAM), Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
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Palacios R, Pérez-Hernández IA, Martínez MA, Mayorga ML, González-Domenech CM, Omar M, Olalla J, Romero A, Romero JM, Pérez-Camacho I, Hernández-Quero J, Santos J. Efficacy and safety of switching to abacavir/lamivudine (ABC/3TC) plus rilpivirine (RPV) in virologically suppressed HIV-infected patients on HAART. Eur J Clin Microbiol Infect Dis 2016; 35:815-9. [PMID: 26879392 DOI: 10.1007/s10096-016-2602-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 02/01/2016] [Indexed: 11/25/2022]
Abstract
We analysed the efficacy and safety of switching from a regimen based on nonnucleoside reverse transcriptase inhibitors (NNRTI) or integrase inhibitors (INI) to ABC/3TC + RPV in virologically suppressed HIV-infected patients. This multicentre, retrospective study comprised asymptomatic HIV-infected patients who switched from 2 NRTI + NNRTI or 2 NRTI + INI to ABC/3TC + RPV between February 2013 and December 2013; all had undetectable HIV viral load prior to switching. Efficacy and safety, and changes in lipids and cardiovascular risk (CVR) were analysed at 48 weeks. Of 85 patients (74.1 % men, mean age 49.5 years), 83 (97.6 %) switched from a regimen based on NNRTI (EFV 74, RPV 5, ETV 2, NVP 2), and 45 (53 %) switched from TDF/FTC to ABC/3TC. The main reasons for switching were toxicity (58.8 %) and convenience (29.4 %). At 48 weeks, 78 (91.8 %) patients continued taking the same regimen; efficacy was 88 % by intention to treat, and 96 % by per protocol. Two patients were lost to follow-up and five ceased the new regimen (4 due to adverse effects and 1 virologic failure). Mean CD4 cell counts increased (744 vs. 885 cells/μL; p = 0.0001), and there were mean decreases in fasting total cholesterol (-15.9 mg/dL; p < 0.0001) and LDL-cholesterol (-11.0 mg/dL; p < 0.004), with no changes in HDL-cholesterol, triglycerides, total cholesterol:HDL-cholesterol ratio, and CVR. ABC/3TC + RPV is effective and safe in virologically-suppressed patients on antiretroviral therapy (ART). Forty-eight weeks after switching the lipid profile improved with decreases in total and LDL cholesterol.
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Affiliation(s)
- R Palacios
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain.
- UGC Enfermedades Infecciosas, Hospital Clínico Universitario Virgen de la Victoria, 29010, Málaga, Spain.
| | - I A Pérez-Hernández
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
- UGC Enfermedades Infecciosas, Hospital Clínico Universitario Virgen de la Victoria, 29010, Málaga, Spain
| | - M A Martínez
- Hospital Universitario de San Cecilio de Granada, Granada, Spain
| | - M L Mayorga
- Hospital Regional Universitario Carlos Haya, Málaga, Spain
| | | | - M Omar
- Hospital Universitario Ciudad de Jaén, Jaén, Spain
| | - J Olalla
- Hospital Costa del Sol, Marbella, Spain
| | - A Romero
- Hospital Universitario de Puerto Real, Cádiz, Spain
| | | | | | | | - J Santos
- Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain
- UGC Enfermedades Infecciosas, Hospital Clínico Universitario Virgen de la Victoria, 29010, Málaga, Spain
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Palacios R, Mayorga M, Pérez-Hernández IA, Rivero A, Arco AD, Lozano F, Santos J. Lipid Changes in Virologically Suppressed HIV-Infected Patients Switching from any Antiretroviral Therapy to the Emtricitabine/Rilpivirine/Tenofovir Single Tablet: GeSida Study 8114. J Int Assoc Provid AIDS Care 2016; 15:189-93. [PMID: 26858314 DOI: 10.1177/2325957416629785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
We carried out a retrospective, multicenter study of a cohort of 298 asymptomatic HIV-infected patients who switched from a regimen based on 2 nucleoside reverse transcriptase inhibitors + protease inhibitor (PI)/nonnucleoside reverse transcriptase inhibitor or ritonavir-boosted PI monotherapy to emtricitabine/rilpivirine/tenofovir disoproxil fumarate (FTC/RPV/TDF) to analyze lipid changes. At 24 weeks, 284 (95.3%) patients were still taking the same regimen, maintaining similar CD4 counts as at baseline (651 versus 672 cells/mm(3), P = .08), and 98.9% of them with an undetectable viral load. Eight of the other 14 patients were lost to follow up and 6 (2.0%) ceased the new regimen: 3 due to adverse effects, 2 due to virologic failure, and 1 due to abandonment. The mean levels of fasting total cholesterol (TC), low-density lipoprotein cholesterol, high-density lipoprotein cholesterol (HDL-C), and triglycerides fell at 12 and 24 weeks, with no changes detected in the TC to HDL-C ratio.
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Affiliation(s)
- Rosario Palacios
- Hospital Virgen de la Victoria, Málaga, Spain Instituto de Investigación Biomédica de Málaga (IBIMA), Spain
| | | | - Isabel A Pérez-Hernández
- Hospital Virgen de la Victoria, Málaga, Spain Instituto de Investigación Biomédica de Málaga (IBIMA), Spain
| | | | | | | | - Jesús Santos
- Hospital Virgen de la Victoria, Málaga, Spain Instituto de Investigación Biomédica de Málaga (IBIMA), Spain
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