Impact of a training project for primary health-care providers (FOCO project) in the HIV screening and HIV late diagnosis

Poster [P043] OBJECTIVE Reducing HIV late diagnosis remains an epidemiological challenge . The objective of this project was to promote early HIV diagnosis through the training of primary health - care providers (PHCP) . METHODS HIV specialists conducted training sessions in 108 primary care centers (PCC) from six Spanish regions during 2016 and 2017 , and with 1804 PHCP involved . The intervention was evaluated using a pre - experimental design collecting the dependent variables both in the six months before and after the intervention . Number of requests for HIV tests from the PCC trained and clinical data of new HIV diagnosed patients were collected . Parametric and non - parametric tests were used to assess differences between pre and post - intervention data . RESULTS 3. Differences in clinical variables in pre and post intervention period

Efectos adversos neuropsiquiátricos de dolutegravir en la práctica clínica real

Introducción Los inhibidores de la integrasa, y especialmente dolutegravir (DTG), son el tratamiento de primera línea antirretroviral por su eficacia y seguridad. Aunque en los ensayos pivotales la tasa de efectos adversos (EA) era baja (2-3%), en los estudios de vida real parece ser mayor, especialmente los EA neuropsiquiátricos. El objetivo fue determinar el porcentaje de EA e interrupción de DTG en nuestro centro y la relación con los antecedentes psiquiátricos. Métodos Estudio descriptivo retrospectivo de pacientes que iniciaron DTG entre 2015-2017. Se registraron: interrupción del tratamiento, EA y enfermedad psiquiátrica. Se realizó seguimiento desde el inicio del del tratamiento con DTG y se registraron las hospitalizaciones y las visitas a urgencias y atención primaria. Fue autorizado por el Comité Ético de Investigación Clínica de Aragón. Resultados Se incluyeron 283 pacientes, entre 11-87 años, 70% varones. El 21% naive. Interrumpieron el tratamiento con DTG el 24%, un 10% por EA. Se detectó un 5% de EA neuropsiquiátricos. Este grupo tenía más antecedentes psiquiátricos (62 vs. 41%; p = 0, 002) que el de pacientes que continuaron el tratamiento, y precisaron más visitas en atención primaria (18, 8 vs. 8, 4%; p = 0, 016) y urgencias (8, 7 vs. 3, 3%; p = 0, 061). Conclusión Los pacientes que interrumpieron el tratamiento con DTG tenían más antecedentes psiquiátricos. Por ello, aunque se precisan más estudios, sería necesario valorar este antecedente previamente al tratamiento con inhibidores de la integrasa. Síntomas como ansiedad, insomnio o depresión pueden ser EA de DTG con una frecuencia mayor de la esperada. Ser identificados por los médicos de atención primaria y urgencias podría evitar una cascada de prescripción innecesaria. Introduction: Integrase inhibitors and especially dolutegravir (DTG) are placed as a first-line antiretroviral treatment for their efficacy and safety. Although in the pivotal trials the rate of adverse effects (AEs) was low (2-3%), in real-life studies it appears to be higher, especially neuropsychiatric AEs. The objective is to determine the percentage of AEs and discontinuation of DTG in our site and the relationship with the psychiatric background. Methods: Retrospective descriptive study of patients starting DTG from 2015 to 2017. Discontinuation of treatment, AEs and previous psychiatric pathology were recorded. Follow-up is carried out since the beginning of the treatment, and hospitalizations and emergency room and primary care visits were registered. The study was authorized by the Ethics Committee for Clinical Research of Aragon. Results: Two hundred and eighty-three patients were included, between 11 and 87 years old, 70% male. 21% were naive. 24% of the patients discontinued treatment with DTG, 10% due to AEs. Neuropsychiatric AEs were detected in 5%. This group of patients had a more frequent previous psychiatric history (62 vs. 41%; P =.002) than the ongoing treatment group and they needed more visits to primary care (18.8 vs. 8.4%; P =.016) and emergency room (8, 7 vs. 3.3%; P =.061). Conclusion: Patients who discontinued treatment with DTG had more psychiatric history. Although more studies are required, it is necessary to assess this background before starting treatment with integrase inhibitors. Symptoms such as anxiety, insomnia or depression can be DTG AEs more frequently than expected. Being identified by primary care and emergency physicians could avoid the unnecessary prescription of other medications

Choice of the initial antiretroviral treatment for HIV-positive individuals in the era of integrase inhibitors

BACKGROUND: We aimed to describe the most frequently prescribed initial antiretroviral therapy (ART) regimens in recent years in HIV-positive persons in the Cohort of the Spanish HIV/AIDS Research Network (CoRIS) and to investigate factors associated with the choice of each regimen. METHODS: We analyzed initial ART regimens prescribed in adults participating in CoRIS from 2014 to 2017. Only regimens prescribed in >5% of patients were considered. We used multivariable multinomial regression to estimate Relative Risk Ratios (RRRs) for the association between sociodemographic and clinical characteristics and the choice of the initial regimen. RESULTS: Among 2874 participants, abacavir(ABC)/lamivudine(3TC)/dolutegavir(DTG) was the most frequently prescribed regimen (32.1%), followed by tenofovir disoproxil fumarate (TDF)/emtricitabine (FTC)/elvitegravir(EVG)/cobicistat(COBI) (14.9%), TDF/FTC/rilpivirine (RPV) (14.0%), tenofovir alafenamide (TAF)/FTC/EVG/COBI (13.7%), TDF/FTC+DTG (10.0%), TDF/FTC+darunavir/ritonavir or darunavir/cobicistat (bDRV) (9.8%) and TDF/FTC+raltegravir (RAL) (5.6%). Compared with ABC/3TC/DTG, starting TDF/FTC/RPV was less likely in patients with CD4100.000 copies/mL. TDF/FTC+DTG was more frequent in those with CD4100.000 copies/mL. TDF/FTC+RAL and TDF/FTC+bDRV were also more frequent among patients with CD4<200 cells//muL and with transmission categories other than men who have sex with men. Compared with ABC/3TC/DTG, the prescription of other initial ART regimens decreased from 2014-2015 to 2016-2017 with the exception of TDF/FTC+DTG. Differences in the choice of the initial ART regimen were observed by hospitals' location. CONCLUSIONS: The choice of initial ART regimens is consistent with Spanish guidelines' recommendations, but is also clearly influenced by physician's perception based on patient's clinical and sociodemographic variables and by the prescribing hospital location

Epidemiological trends of HIV/HCV coinfection in Spain, 2015-2019

Altres ajuts: Spanish AIDS Research Network; European Funding for Regional Development (FEDER).Objectives: We assessed the prevalence of anti-hepatitis C virus (HCV) antibodies and active HCV infection (HCV-RNA-positive) in people living with HIV (PLWH) in Spain in 2019 and compared the results with those of four similar studies performed during 2015-2018. Methods: The study was performed in 41 centres. Sample size was estimated for an accuracy of 1%. Patients were selected by random sampling with proportional allocation. Results: The reference population comprised 41 973 PLWH, and the sample size was 1325. HCV serostatus was known in 1316 PLWH (99.3%), of whom 376 (28.6%) were HCV antibody (Ab)-positive (78.7% were prior injection drug users); 29 were HCV-RNA-positive (2.2%). Of the 29 HCV-RNA-positive PLWH, infection was chronic in 24, it was acute/recent in one, and it was of unknown duration in four. Cirrhosis was present in 71 (5.4%) PLWH overall, three (10.3%) HCV-RNA-positive patients and 68 (23.4%) of those who cleared HCV after anti-HCV therapy (p = 0.04). The prevalence of anti-HCV antibodies decreased steadily from 37.7% in 2015 to 28.6% in 2019 (p < 0.001); the prevalence of active HCV infection decreased from 22.1% in 2015 to 2.2% in 2019 (p < 0.001). Uptake of anti-HCV treatment increased from 53.9% in 2015 to 95.0% in 2019 (p < 0.001). Conclusions: In Spain, the prevalence of active HCV infection among PLWH at the end of 2019 was 2.2%, i.e. 90.0% lower than in 2015. Increased exposure to DAAs was probably the main reason for this sharp reduction. Despite the high coverage of treatment with direct-acting antiviral agents, HCV-related cirrhosis remains significant in this population

Síndrome de DRESS asociado a Levetiracetam

El síndrome de DRESS es una toxicodermia asociada a eosinofilia con síntomas sistémicos. Presentamos un caso de dicho síndrome tras inicio de Levetiracetam con buena evolución tras inicio de corticoides y retirada del fármaco. Este síndrome, poco conocido y probablemente infradiagnosticado, puede ser potencialmente letal si no se trata de forma precoz

Antiretroviral therapy without nucleoside reverse transcriptase inhibitors: dual therapy with darunavir/p and rilpivirine. Safety and efficacy in clinical practice. RIDAR 2

INTRODUCTION The toxicity of conventional antiretroviral treatments (ART) coupled with The toxicity of conventional antiretroviral treatments (ART), coupled with i d biditi i ti t ith HIV h td th h f i i i aging and comorbidities in patients with HIV, have prompted the search for Figure 1 . Study patient population gg new strategies that do not involve the use of nucleoside analogues One of g y p pp new strategies that do not involve the use of nucleoside analogues. One of the available options is dual therapy with darunavir /p (DRV/p) and rilpivirine (RIL) To date no clinical trials have demonstrated the efficacy and safety of this combination, and the available evidence comes only from real - world data. The aim of this study was to evaluate the results of a 48 week course of DRV/p + RIL in clinical practice in Spain PATIENTS AND METHODS This was a multicenter, retrospective, observational study conducted in 19 Spanish hospitals. All patients over 18 years of age who began dual therapy with DRV/p + RIL, whether for toxicity or to improve adherence, simplify treatment or prevent complications, between May 2012 and December 2017 were included in the study. Patients with active AIDS, hepatitis B, pregnant women, and those with mutations associated with DRV/p and RIL resistance were excluded. The following data were collected from patients'' clinical records: sociodemographic data, HIV-related data (including history of prior treatments), reason for beginning dual therapy, CD4+ count, and viral load at 24 and 48 weeks after starting treatment. The statistical analysis was performed using the IBM SPSS package (version 22). Poster [P115] RESULTS We included 301 patients; 76.1% were men, and median age was 49 (42-54) years. Viral load was undetectable in 81.4% of patients after 24 weeks of treatment and in 89.2% of patients with available information after 48 weeks of treatment

Lesiones costrosas a estudio

Descripción clínica del caso Paciente varón de 36 años con únicos antecedentes de mononucleosis en la infancia, tabaquismo, consumo ocasional de alcohol y cocaína por vía nasal. Presenta lesiones (fig. 1) de un mes de evolución, primero vesiculosas, de predominio en tronco, cuero cabelludo y extremidades. Las lesiones no son pruriginosas, tienen tendencia a progresar con aumento de tamaño, fondo necrótico y borde sobreelevado eritematoso. Inicialmente se sospecha de etiología viral (varicela) y se inicia tratamiento antiviral tópico y oral por siete días sin mejoría. A la exploración destacan las lesiones descritas y una adenopatía laterocervical izquierda sin otras alteraciones reseñables..

Hexavalent chromium removal from aqueous solution by adsorbents synthesized from groundwater treatment residuals

In this study, silica sand coated with groundwater treatment residuals was used as adsorbents for the removal of hexavalent chromium from synthetic wastewater. Batch adsorption experiments were conducted to evaluate the effects of initial Cr(VI) concentration, solution pH, adsorbent dosage, solution temperature, contact time, as well as ionic strength on Cr(VI) removal. Results show that low solution pH and high ionic strength improve Cr(VI) adsorption onto the residual coated sand. At pH 4, the highest adsorption capacity was computed at 0.27 mg g−1. The Freundlich isotherm model best described the adsorption process. From 298 to 318 K, the high correlation of the kinetic data with the pseudo-second order model (R2 > 0.981) and a highly positive activation energy value (22.7 kJ mol−1) indicate that chemisorption is the rate-controlling step of the adsorption process