Dronedarone for Recurrent Ventricular Tachycardia: A Real Alternative?

Sustained ventricular tachycardia (VT) is an important cause of morbidity and sudden death in patients with dilated cardiomyopathy. Although ICD effectively terminate VT episodes and improve survival, shocks reduce quality of life, and episodes of VT predict increased risk of heart failure and death despite effective therapy. Patients suffering recurrent VT episodes remain a challenge. Antiarrhytmic therapy reduces VT episodes, but it is associated with serious adverse events, and disappointing efficacy. Catheter ablation has emerged as an important option to control recurrent VT, but major procedure-related complications, and even death, are still issues to concern. And even with these armamentaria, some patients still have recurrent VT episodes and ICD shocks. We report on a patient with non-ischemic dilated cardiomyopathy and recurrent ventricular tachycardia resistant to multiple antiarrhytmic agents, in whom dronedarone was effective in completely suppressing ventricular tachycardia episodes

Awareness and Use of HIV Self-Testing Among Men Who Have Sex With Men Remains Low in Spain 2 Years After Its Authorization

Objectives: HIV self-testing has been available in Spain since 2017 as a diagnostic tool to promote earlier diagnosis. We aimed to assess awareness and previous use of HIV self-testing in a sample of men who have sex with men (MSM) recruited online more than 2 years after its legal authorization in Spain. Methods: We analyzed 5,492 MSM recruited between May and July 2020 in gay dating apps/websites and other social networks. We estimated the proportion of participants who were aware of the existence of HIV self-testing and the proportion who reported previous use. To identify factors associated with both outcomes we built two Poisson regression models. Among those who reported previous use we described several aspects related to their last self-test. Results: Awareness of HIV self-test was reported by 29.7% and its previous use by 5% of participants. Awareness was independently associated with recruitment in gay dating apps/websites, being ≥40 years old, born in Spain-other European countries, having higher educational level, living in medium-small municipalities and living sex life openly. Independent associations were also found with having received a sexually transmitted infection diagnosis (STI) or an HIV negative test in the last 12 months, and being HIV positive. Use was significantly higher among participants who were paid for sex or diagnosed with an STI in the last 12 months and who received their last HIV test in the preceding year. Self-testing occurred recently, with kits acquired at pharmacies and carried out alone. Conclusion: Awareness and use probably have not increased sufficiently in order to make a relevant impact to the promotion of early HIV diagnosis. Additional efforts, mainly focused on less favored MSM, should be made to take better advantage of the possibilities offered by this testing option.This work received funding from the National Drugs Plan (Ministry of Health, Government of Spain, 2019I017).S

Knowledge and Prior Use of HIV Self-Testing in Madrid and Barcelona among Men Who Have Sex with Men More than One Year after Its Legal Authorization in Spain

HIV self-testing (HIVST); Early diagnosis; Men who have sex with men (MSM)Autodiagnóstico del VIH (HIVST); Diagnóstico precoz; Hombres que tienen sexo con hombres (HSH)Autodiagnòstic del VIH (HIVST); Diagnòstic precoç; Homes que tenen sexe amb homes (HSH)This study assessed the knowledge and prior use of HIV self-testing in a sample of men who have sex with men (MSM) recruited in a sexual health clinic and two community-based testing sites in Madrid and Barcelona, >12 months after its legal authorization. Between March 2019 and December 2020, we recruited 2044 MSM. Participants completed a self-administered questionnaire while waiting to be tested for HIV and other STIs. We built two Poisson regression models to assess factors associated with prior knowledge and with use. Among those who had used self-testing in the past we assessed frequency of use and several aspects related to the last testing episode. The proportion of participants that knew about the existence of self-testing and had already used it was of 26.3% and 5.1% respectively. Both, knowledge and use were independently associated with being born in Spain or other western European countries, university education and more recent HIV testing. Additionally, knowledge was associated with older age, having a more favorable economic situation, and not living sexuality in total secrecy. Use was also associated with having received money in exchange for sex. Most (69.5%) reported having self-tested once, 64.8% had self-tested <12 months ago, 63.8% self-tested alone and 71.4% acquired the kit at a pharmacy over the counter. In spite of its authorization and becoming legally available, knowledge and use of HIV self-testing remain low among MSM attending sites specialized in the diagnosis of HIV and other STIs. When designing scale-up strategies, lower levels of knowledge and use in less favored subgroups of MSM need to be factored in.This study was supported by Delegación del Gobierno para el Plan Nacional sobre Drogas (2019I017) and Convocatoria del Plan de Consolidación de la Investigación del IMIENS (2021)

Sexualized drug injection among men who have sex with men in Madrid and Barcelona as the first episode of drug injecting

Chemsex; Injecció de fàrmacsChemsex; Inyección de drogasChemsex; Drug injectionBackground We estimate the prevalence of drug injection, the variables associated with having ever injected and the proportion of ever injectors whose first drug injection was for having sex; we describe the first drug injection episode, analyze the drugs most frequently injected and estimate the prevalence of risky injecting behaviors. Methods The participants were 3387 MSM without a previous HIV diagnosis attending four HIV/STI diagnosis services in Madrid and Barcelona. Lifetime prevalence and prevalence ratios (PRs) by different factors were calculated using Poisson regression models with robust variance. We compared the characteristics of first drug injection episode, lifetime injection and risky injecting behaviors of those whose first injection was for sex (FIS) with those whose was not (non-FIS). Results Lifetime prevalence of injection was 2.1% (CI 1.7–2.7). In the multivariate analysis, it was strongly associated with having been penetrated by more than five men in the last 12 months (aPR = 10.4; CI 2.5–43.4) and having met most of their partners at private parties (aPR = 7.5; CI 4.5–12.3), and less strongly with other factors. Of those who had ever injected drugs, 81.9% injected for sex the first time they injected drugs (FIS). At first injection, FIS participants had a mean age of 31 years, 62.7% used mephedrone and 32.2% methamphetamine on that occasion. Of this FIS group 39.0% had ever shared drugs or equipment and 82.6% had always shared for sex. Some 30.8% of non-FIS reported having also injected drugs for sex later on. Conclusions Only two out of a hundred had ever injected, most to have sex and with frequent drug or injecting equipment sharing. Injecting for sex is the most common first episode of drug injection and is the most efficient risky behavior for the transmission of HIV, hepatitis B or C and other blood-borne infections. MSM participating in private parties should be considered a priority group for prevention policies.This study was supported by Delegación del Gobierno para el Plan Nacional sobre Drogas (2019I017). Delegación del Gobierno para el Plan Nacional sobre Drogas had no further role in study design, in the collection, analysis and interpretation of data, in the writing of the report, and in the decision to submit the paper for publication

Injection of Anabolic Steroids in Men Who Had Sex with Men in Madrid and Barcelona: Prevalence Correlates and Role as a Risk Factor for Transmitted Infections

This study describes the prevalence of anabolic-androgenic steroid (AAS) injection, their main correlates, and the prevalence of specific AAS injection risk behaviours among men who have sex with men (MSM), an area insufficiently addressed in scientific research. Participants were HIV-negative MSM attending four HIV/STI diagnosis services: two clinics and two community programmes in Madrid and Barcelona. Participants answered an online self-administered questionnaire. Crude and adjusted lifetime prevalence and prevalence ratios (PRs) were calculated by different factors and using Poisson regression models with robust variance. Of the 3510 participants, 6.1% (95% CI: 5.3-6.9) had injected AAS before and 3.5% (95% CI: 2.9-4.2) had done so in the last 12 months. In the multivariate analysis, AAS injection was independently associated with being over 40 years old (aPR = 3.6; 95% CI: 2.0-6.5) and being born in Latin America (aPR = 2.5; 95% CI:1.9-3.4), and was less strongly associated (aPRs of around two) with having been recruited into STI clinics, having ever been paid for sex before, injected drugs, used drugs for sex, having been diagnosed with an STI before, and having been diagnosed with HIV at the recruitment consultation. Only three participants, 1.4%, of those who had injected AAS before had shared AAS or equipment for preparation or injecting before. Conclusions: In contrast to drugs, AAS injecting behaviours do not play a relevant, direct role in the transmission of blood-borne infections among MSM. However, AAS injectors have a higher prevalence of sexual risk behaviours. These findings should be confirmed using new studies that employ other sampling procedures.This study was supported by the Delegación del Gobierno para el Plan Nacional sobre Drogas (2019I017). The Delegación del Gobierno para el Plan Nacional sobre Drogas had no further role in study design, in the collection, analysis and interpretation of data, in the writing of the report, and in the decision to submit the paper for publication.S

Label-Free Plasmonic Biosensor for Rapid, Quantitative, and Highly Sensitive COVID-19 Serology: Implementation and Clinical Validation

COVID-19; Biosensor plasmónico; SerologíaCOVID-19; Biosensor plasmònic; SerologiaCOVID-19; Plasmonic biosensor; SerologySerological tests are essential for the control and management of COVID-19 pandemic (diagnostics and surveillance, and epidemiological and immunity studies). We introduce a direct serological biosensor assay employing proprietary technology based on plasmonics, which offers rapid (<15 min) identification and quantification of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies in clinical samples, without signal amplification. The portable plasmonic device employs a custom-designed multiantigen (RBD peptide and N protein) sensor biochip and reaches detection limits in the low ng mL–1 range employing polyclonal antibodies. It has also been implemented employing the WHO-approved anti-SARS-CoV-2 immunoglobulin standard. A clinical validation with COVID-19 positive and negative samples (n = 120) demonstrates its excellent diagnostic sensitivity (99%) and specificity (100%). This positions our biosensor as an accurate and easy-to-use diagnostics tool for rapid and reliable COVID-19 serology to be employed both at laboratory and decentralized settings for the disease management and for the evaluation of immunological status during vaccination or treatment.ICN2 and UVE acknowledge financial support from H2020 Research and Innovation Programme of the European Commission (H202-SC1-PHE-Coronavirus-2020, CONVAT Project, No. 101003544). The ICN2 is funded by the CERCA program/Generalitat de Catalunya and supported by the Severo Ochoa Centres of Excellence program funded by the Spanish Research Agency (AEI, grant no. SEV-2017-0706). ICN2 group is very grateful to EPI Industries (Barcelona, Spain) for its kind donation supporting our research in COVID-19. O.C.-L. acknowledges the economic support from the Spanish Ministry of Science and Innovation and the Spanish Research Agency and the European Social Fund (ESF) (ref. BES-2017-080527) linked to the TEC 2016-78515-R project Predict. A part of the work was supported by the European Virus Archive GLOBAL (EVA-GLOBAL) project that has received funding from the EU Horizon 2020 (grant agreement No. 871029). A.T. and L.F.-B. acknowledge financial support from GENCAT-DGRIS COVID. We are indebted to all the patients who accepted to participate contributing to science advancement. We are indebted to the HCB-IDIBAPS Biobank for the human samples and data procurement and to the Fundació Glòria Soler for its support to the COVIDBANK collection. We thank the IDIBAPS Biobank for its valuable contribution to sample processing and storage. The authors acknowledge the EU Horizon 2020 Program under grant agreement no. 644956 (RAIS project) for funding the Hospital Vall d’Hebron Biobank. The VHIR-HUVH is supported by Plan Nacional de I + D + i 2013-2016 and ISCIII-Ministerio de Ciencia e Innovación, and Spanish Network for Research in Infectious Diseases (REIPI RD16/0016/0003)─cofinanced by European Development Regional Fund “A way to achieve Europe,” Operative program Intelligent Growth 2014. Part of the samples and data from patients included in this study were provided by the Vall d’Hebron University Hospital Biobank (PT17/0015/0047), integrated in the Spanish National Biobanks Network, and they were processed following standard operating procedures with the appropriate approval of the Ethical and Scientific Committee. The authors kindly appreciate the generous donation of samples and clinical data of the donors of the Sepsis Bank of HUVH Biobank and COVID-19 patients attended at HUVH

Hepatitis C antibody prevalence and active hepatitis C infection in HIV-negative gay, bisexual, and other men who have sex with men in Barcelona and Madrid, Spain (March 2018-March 2021)

Objectives: Hepatitis C virus (HCV) has been recognized as a sexually transmitted infection (STI) in HIV-positive men who have sex with men (MSM), with an increased notification in HIV-negative MSM. The aim of this study was to determine the prevalence of HCV antibody and active HCV infection in HIV-negative gay, bisexual, and other MSM (GBMSM), and their characteristics, in Barcelona and Madrid, from March 2018 to March 2021. Methods: Cross-sectional study conducted on 3548 HIV-undiagnosed GBMSM, across four HIV/STI testing centers. Respondents submitted an online, self-administered questionnaire after consultation, which collected information on sociodemographics, sexual health history, HCV knowledge, and substance consumption. Prevalence of HCV antibodies was determined by a reactive result in a rapid anti-HCV test or enzyme-linked immunosorbent assay (ELISA), while active HCV infection was determined by participants who were also positive on an HCV-RNA test. Crude and adjusted Poisson analyses with robust variance are presented for both prevalence and active infection. Results: In total, 97.6% of participants (n = 3463) were HIV-negative. Of those, 18 were found to have HCV antibodies (0.52%), of which nine (0.26%) were also HCV-RNA positive. Those with HCV antibodies were associated to have lived with an HCV (+) person (adjusted prevalence ratio [APR]: 7.84, [95% confidence interval: 2.50-24.53]), using injectable drugs for sex (APR: 6.92, [1.20-39.79]) and testing positive for an STI in the previous year (APR: 4.06, [1.09-15.12]). Presenting an active infection was strongly associated with a previous HCV diagnosis (APR: 100.82 [22.16-458.76]), sexualized injectable drug use (APR: 17.53 [2.70-113.76]), and sharing douching material (APR: 7.45, [2.12-25.95]). Conclusion: Sexual practices with a higher risk of bleeding and sexualized drug use, particularly sexualized injectable drug use, were associated with higher rates of HCV diagnosis in GBMSM. Identifying these practices during consultation, contact tracing new cases and regularly testing those with a previous history of HCV, will facilitate HCV eradication.Both a Health Research Grant (Fondo de Investigación en Salud, FIS P117/02077) and an Intramural Strategy Action Grant (PI17CIII/00037), From the Carlos III Institute, at the Science and Innovation Ministry of the Spain Government, supported this study.S

Street outreach rapid HIV testing in university settings: a priority strategy?

OBJECTIVE: To evaluate an HIV testing program in the university environment by analyzing the prevalence of infection, risk behaviors and history of sexually transmitted infections and by performing HIV tests. METHODS: During October-November of 2008 and November-December of 2009, 1668 persons received rapid HIV testing in a mobile unit located in university campuses in the cities of Madrid, Málaga and Salamanca (Spain). While waiting for the test results, participants completed a brief questionnaire. RESULTS: A total of 15.7% were men who had sex with men (MSM), 28.6% were exclusively heterosexual men (HTX), and 55.7% were women. Nearly three-quarters (73.3%) were under 25 years of age, 8.5% were born abroad and only 4% had no secondary education. Fifty-one percent of HTX, 42% of women and 6.3% of MSM had casual sexual partners in the past 12 months without always using a condom. This behavior was also reported by 41.5% of MSM with same sex partners. A sexually transmitted infection had previously been diagnosed in 24.7% of MSMs, 14.7% of women and 5.6% of HTX. Four positive results were found, all in MSM who had been tested in the previous 2 years. The prevalence was 1.6% (95% CI: 0.43-3.95) within this group, and 0.2% overall (95% CI: 0.07-0.62). CONCLUSIONS: Despite the high frequency of risk behaviors, the low prevalence of HIV infection and the history of HIV testing suggest that university campuses are not a priority location to develop these programs, which would achieve greater impact and efficiency in more vulnerable populations.El planteamiento, el diseñoo y el análisis del estudio de evaluación que da lugar a este original fueron financiados por la Fundación para la Investigación y Prevención del Sida en España (FIPSE 36634/07) y por el Fondo de Investigación Sanitaria (FIS: PI09/1706). La realización del programa de prueba rápida aquí descrito fue financiada por GILEAD Sciences, S.L

Comparison of Plasma Lipoprotein Composition and Function in Cerebral Amyloid Angiopathy and Alzheimer’s Disease

Cerebral amyloid angiopathy (CAA) refers to beta-amyloid (Aβ) deposition in brain vessels and is clinically the main cause of lobar intracerebral hemorrhage (ICH). Aβ can also accumulate in brain parenchyma forming neuritic plaques in Alzheimer's disease (AD). Our study aimed to determine whether the peripheral lipid profile and lipoprotein composition are associated with cerebral beta-amyloidosis pathology and may reflect biological differences in AD and CAA. For this purpose, lipid and apolipoproteins levels were analyzed in plasma from 51 ICH-CAA patients (collected during the chronic phase of the disease), 60 AD patients, and 60 control subjects. Lipoproteins (VLDL, LDL, and HDL) were isolated and their composition and pro/antioxidant ability were determined. We observed that alterations in the lipid profile and lipoprotein composition were remarkable in the ICH-CAA group compared to control subjects, whereas the AD group presented no specific alterations compared with controls. ICH-CAA patients presented an atheroprotective profile, which consisted of lower total and LDL cholesterol levels. Plasma from chronic ICH-CAA patients also showed a redistribution of ApoC-III from HDL to VLDL and a higher ApoE/ApoC-III ratio in HDL. Whether these alterations reflect a protective response or have a causative effect on the pathology requires further investigation

Association of candidate genetic variants and circulating levels of ApoE/ApoJ with common neuroimaging features of cerebral amyloid angiopathy

IntroductionCerebral amyloid angiopathy (CAA) is characterized by the accumulation of amyloid-beta (A beta) in brain vessels and is a main cause of lobar intracerebral hemorrhage (ICH) in the elderly. CAA is associated with magnetic resonance imaging (MRI) markers of small vessel disease (SVD). Since A beta is also accumulated in Alzheimer's disease (AD) in the brain parenchyma, we aimed to study if several single nucleotide polymorphisms (SNPs) previously associated with AD were also associated with CAA pathology. Furthermore, we also studied the influence of APOE and CLU genetic variants in apolipoprotein E (ApoE) and clusterin/apolipoprotein J (ApoJ) circulating levels and their distribution among lipoproteins. MethodsThe study was carried out in a multicentric cohort of 126 patients with lobar ICH and clinical suspicion of CAA. ResultsWe observed several SNPs associated with CAA neuroimaging MRI markers [cortical superficial siderosis (cSS), enlarged perivascular spaces in the centrum semiovale (CSO-EPVS), lobar cerebral microbleeds (CMB), white matter hyperintensities (WMH), corticosubcortical atrophy and CAA-SVD burden score]. Concretely, ABCA7 (rs3764650), CLU (rs9331896 and rs933188), EPHA1 (rs11767557), and TREML2 (rs3747742) were significantly associated with a CAA-SVD burden score. Regarding circulating levels of apolipoproteins, protective AD SNPs of CLU [rs11136000 (T) and rs9331896 (C)] were significantly associated with higher HDL ApoJ content in the lobar ICH cohort. APOE epsilon 2 carriers presented higher plasma and LDL-associated ApoE levels whereas APOE epsilon 4 carriers presented lower plasma ApoE levels. Additionally, we observed that lower circulating ApoJ and ApoE levels were significantly associated with CAA-related MRI markers. More specifically, lower LDL-associated ApoJ and plasma and HDL-associated ApoE levels were significantly associated with CSO-EPVS, lower ApoJ content in HDL with brain atrophy and lower ApoE content in LDL with the extent of cSS. DiscussionThis study reinforces the relevance of lipid metabolism in CAA and cerebrovascular functionality. We propose that ApoJ and ApoE distribution among lipoproteins may be associated with pathological features related to CAA with higher ApoE and ApoJ levels in HDL possibly enhancing atheroprotective, antioxidative, and anti-inflammatory responses in cerebral beta-amyloidosis