Cost/efficacy analysis of preferred Spanish AIDS study group regimens and the dual therapy with LPV/r+3TC for initial ART in HIV infected adults.

INTRODUCTION: The National AIDS Plan and the Spanish AIDS study group (GESIDA) panel of experts propose 'preferred regimens' of antiretroviral treatment (ART) as initial therapy in HIV-infected patients for 2013 [1]. All these regimens are triple therapy regimens. The Gardel Study assessed the efficacy and safety of a dual therapy (DT) combination of lopinavir/ritonavir (LPV/r) 400/100 mg BID+ lamivudine (3TC) 150 mg BID [2]. The objective of this study is to evaluate the costs and efficiency of initiating treatment with the GESIDA 'preferred regimens' and DT. MATERIALS AND METHODS: Economic assessment of costs and efficiency (cost/efficacy) through decision tree analysis models. Efficacy was defined as the probability of having viral load <50 copies/mL at week 48, in an intention-to-treat analysis. Cost of initiating treatment with an ART regime was defined as the costs of ART and its consequences (adverse effects, changes of ART regime and drug resistance tests) during the first 48 weeks. The payer perspective (Spanish National Health System) was applied considering only differential direct costs: ART (official prizes), management of adverse effects, resistance tests, and determination of HLA B*5701. The setting is Spain and the costs are those of 2013. A sensitivity deterministic analysis was conducted, building three scenarios for each regime: base, most favourable and most unfavourable cases. RESULTS: In the base case scenario, the cost of initiating treatment ranges from 5138 euros for DT, to 12,059 euros for tenofovir DF/emtricitabine (TDF/FTC)+raltegravir (RAL). The efficacy ranges between 0.66 for abacavir (ABC)/3TC+LPV/r and ABC/3TC+atazanavir (ATV)/r, and 0.88 for DT. Efficiency, in terms of cost/efficacy, varies between 5817 and 13,930 euros per responder at 48 weeks, for DT and TDF/FTC+RAL respectively. DT is the most efficient regimen in the most favourable (5503 euros per responder) and most unfavourable (6169 euros per responder) scenarios. CONCLUSIONS: Considering the ART official Spanish prizes, the most efficient regimen was DT, followed by the triple therapy with non-nucleoside containing regimens. The sensitivity analysis confirms the robustness of these findings

¿Lo hicimos todo bien con la COVID-19?: Luces y sombras de la investigación

¿Lo hicimos todo bien con la COVID-19?. José Ramón Arribas López. Jefe de Sección de Medicina Interna del Hospital Universitario La Paz. Profesor titular. Universidad Autónoma de Madrid.N

Sandstone petrofacies and geochemical imprints in a multihistoried intracratonic Rift hasin (Iberian Basin)

Depto. de Mineralogía y PetrologíaFac. de Ciencias GeológicasTRUEpu

Sedimentary evolution and provenance of the Last Fluvial episodes of the Cameros Basin (Lower Cretaceous, North Spain)

Depto. de Mineralogía y PetrologíaFac. de Ciencias GeológicasTRUEpu

Past and future of HIV infection. A document based on expert opinion

HIV infection is now almost 40 years old. In this time, along with the catastrophe and tragedy that it has entailed, it has also represented the capacity of modern society to take on a challenge of this magnitude and to transform an almost uniformly lethal disease into a chronic illness, compatible with a practically normal personal and relationship life. This anniversary seemed an ideal moment to pause and reflect on the future of HIV infection, the challenges that remain to be addressed and the prospects for the immediate future. This reflection has to go beyond merely technical approaches, by specialized professionals, to also address social and ethical aspects. For this reason, the Health Sciences Foundation convened a group of experts in different aspects of this disease to discuss a series of questions that seemed pertinent to all those present. Each question was presented by one of the participants and discussed by the group. The document we offer is the result of this reflectio

Prevalence and factors associated with SARS-CoV-2 seropositivity in the Spanish HIV Research Network Cohort

"Artículo escrito por un elevado número de autores, solo se referencian el que aparece en primer lugar, el nombre del grupo de colaboración, si le hubiere, y los autores pertenecientes a la UAM"Objectives: We aimed to assess the prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and factors associated with seropositivity and asymptomatic coronavirus disease 2019 (COVID-19) among people with HIV (PWH). Methods: This was a cross-sectional study carried out within the cohort of the Spanish HIV Research Network. Participants were consecutive PWH with plasma collected from 1st April to 30th September 2020. We determined SARS-CoV-2 antibodies (Abs) in plasma. Illness severity (NIH criteria) was assessed by a review of medical records and, if needed, participant interviews. Multivariable logistic regression analysis was used to identify predictors of seropositivity among the following variables: sex, age, country of birth, education level, comorbidities (hypertension, chronic heart disease, diabetes mellitus, non-AIDS-related cancer, chronic kidney disease, cirrhosis), route of HIV acquisition, prior AIDS, CD4+ cell count, HIV viral load, nucleoside/nucleotide reverse transcriptase inhibitor (N [t]RTI) backbone, type of third antiretroviral drug, and month of sample collection. Results: Of 1076 PWH (88.0% males, median age 43 years, 97.7% on antiretroviral therapy, median CD4+ 688 cells/mm3, 91.4% undetectable HIV viral load), SARS-CoV-2 Abs were detected in 91 PWH, a seroprevalence of 8.5% (95%CI 6.9–10.3%). Forty-five infections (45.0%) were asymptomatic. Variables independently associated with SARS-CoV-2 seropositivity were birth in Latin American countries versus Spain (adjusted odds ratio (aOR) 2.30, 95%CI 1.41–3.76, p 0.001), and therapy with tenofovir disoproxil fumarate plus emtricitabine (TDF/FTC) versus tenofovir alafenamide (TAF)/FTC as the N(t)RTI backbone (aOR 0.49, 95%CI 0.26–0.94, p 0.031). Conclusions: Many SARS-CoV-2 infections among PWH were asymptomatic, and birth in Latin American countries increased the risk of SARS-CoV-2 seropositivity. Our analysis, adjusted by comorbidities and other variables, suggests that TDF/FTC may prevent SARS-CoV-2 infection among PWH.This work was supported by the Instituto de Salud Carlos III (ISCII) (grant number COV20/00108) and the Spanish AIDS Research Network (RD16/0025), which is included in the Spanish I þ D þ I Plan and is co-funded by ISCIII-Subdirección General de Evaluacion and European Funding for Regional Development (FEDER)

Integrated Activities in Primary Care – Minor Surgery in Family Medicine

Minor surgery is defined as the overall surgical procedures of short duration that are generally applied on surface structures. They usually require the application of local anaesthesia and involve performing low and minimal complication risk

Sedimentología de sucesiones sinrift tempranas en un semigraben marginal de un rift extensional: la Cuenca de Bijuesca, Jurásico superior de la Cordillera Ibérica (Zaragoza, España)

Un estudio sedimentológico detallado de los primeros depósitos continentales sinrift que aparecen en el Semigraben de Bijuesca (Formaciones Ciria y Bijuesca), ha permitido entender la arquitectura estratigráfica de los sedimentos que representan el principio de la extensión en esta estructura. La Fm Bijuesca está formada por sedimentos detríticos organizados en tres asociaciones de facies diferentes (de abanico aluvial proximal, medio y distal). La unidad está constituida por dos secuencias retrogradantes formadas por sedimentos siliciclásticos y carbonáticos procedentes de la erosión del Jurásico marino prerift. Las dos secuencias representan la sedimentación en un sistema aluvial de baja eficacia de transporte. La Fm Ciria está formada por sedimentos carbonáticos lacustres organizados en secuencias elementales de somerización. El predominio de las modificaciones pedogenéticas que afectan a estos sedimentos y la ausencia de facies lacustres profundas permiten clasificar el sistema lacustre como uno con margen de tipo rampa con bajo gradiente y baja energía. Las características de los dos sistemas deposiconales concuerdan con la situación tectónica de los estadios tempranos de un sistema de rift. [ABSTRACT] A detailed sedimentological study of the first synrift continental deposits recorded in the Bijuesca Halfgraben (Bijuesca and Ciria Formations), has allowed to understand the stratigraphic architecture of the sediments which record the beginning of the extension in this structure. The Bijuesca Fm consists of detrital sediments arranged in three different alluvial fan (i.e., proximal, medium and distal) facies associations. This unit is made up by two retrograding sequences that consist of siliciclastics and carbonate detrital deposits eroded from the Jurassic prerift units. These sequences record sedimentation in an alluvial fan system with low-efficiency of transport. The Ciria Fm consists of lacustrine carbonate sediments arranged in shallowing-upwards sequences. The predominance of pedogenic modifications affecting the lacustrine sediments and the absence of deep lacustrine facies, allow classifying this lake system as a low-gradient ramp margin lake with low energy. The characteristics of both depositional systems agree with the tectonic situation supposed for the early stages of a rift system