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

Nurses' perceptions of aids and obstacles to the provision of optimal end of life care in ICU

Contains fulltext : 172380.pdf (publisher's version ) (Open Access

Spatiotemporal Characteristics of the Largest HIV-1 CRF02_AG Outbreak in Spain: Evidence for Onward Transmissions

Background and Aim: The circulating recombinant form 02_AG (CRF02_AG) is the predominant clade among the human immunodeficiency virus type-1 (HIV-1) non-Bs with a prevalence of 5.97% (95% Confidence Interval-CI: 5.41–6.57%) across Spain. Our aim was to estimate the levels of regional clustering for CRF02_AG and the spatiotemporal characteristics of the largest CRF02_AG subepidemic in Spain.Methods: We studied 396 CRF02_AG sequences obtained from HIV-1 diagnosed patients during 2000–2014 from 10 autonomous communities of Spain. Phylogenetic analysis was performed on the 391 CRF02_AG sequences along with all globally sampled CRF02_AG sequences (N = 3,302) as references. Phylodynamic and phylogeographic analysis was performed to the largest CRF02_AG monophyletic cluster by a Bayesian method in BEAST v1.8.0 and by reconstructing ancestral states using the criterion of parsimony in Mesquite v3.4, respectively.Results: The HIV-1 CRF02_AG prevalence differed across Spanish autonomous communities we sampled from (p &lt; 0.001). Phylogenetic analysis revealed that 52.7% of the CRF02_AG sequences formed 56 monophyletic clusters, with a range of 2–79 sequences. The CRF02_AG regional dispersal differed across Spain (p = 0.003), as suggested by monophyletic clustering. For the largest monophyletic cluster (subepidemic) (N = 79), 49.4% of the clustered sequences originated from Madrid, while most sequences (51.9%) had been obtained from men having sex with men (MSM). Molecular clock analysis suggested that the origin (tMRCA) of the CRF02_AG subepidemic was in 2002 (median estimate; 95% Highest Posterior Density-HPD interval: 1999–2004). Additionally, we found significant clustering within the CRF02_AG subepidemic according to the ethnic origin.Conclusion: CRF02_AG has been introduced as a result of multiple introductions in Spain, following regional dispersal in several cases. We showed that CRF02_AG transmissions were mostly due to regional dispersal in Spain. The hot-spot for the largest CRF02_AG regional subepidemic in Spain was in Madrid associated with MSM transmission risk group. The existence of subepidemics suggest that several spillovers occurred from Madrid to other areas. CRF02_AG sequences from Hispanics were clustered in a separate subclade suggesting no linkage between the local and Hispanic subepidemics

Hyperbaric storage at room temperature for food preservation: A study in strawberry juice

Hyperbaric storage at room temperature was evaluated as a new food preservation method. To do that, strawberry juices maintained at different pressure levels (0.1, 25, 100 or 220 MPa) and 20°C for 15 days were compared to raw and thermally pasteurized samples stored at atmospheric pressure and 5°C for the same period. Hyperbaric storage reduced the initial microbial load of the juices by more than 2 log units to levels below the limit of detection. Moreover, pressure was effective to attenuate viscosity and color losses in the samples stored at 20°C. Stability of the samples after the hyperbaric storage was good and microbial load, viscosity and color remained stable when the samples were kept under refrigeration at atmospheric pressure for 15 additional days. All these results show that hyperbaric storage could represent an interesting technology for short-term preservation of food. Industrial relevance: Effective management of the cold chain to maintain the highest quality of food is nowadays expensive and energy consuming and this can jeopardize the sustainability of the food supply chains. The results obtained in this paper suggest that hyperbaric storage at room temperature could be an interesting technology for short-term preservation of strawberry juice. It could imply important energy savings in different sections of the cold chain. © 2012 Elsevier Ltd. All rights reserved.This work has been supported by the R + D + I National Plan of the Spanish Ministry of Education and Science (MEC), through the projects AGL2007-63314/ALI and CSD2007-00045 MALTA CONSOLIDER-INGENIO 2010, by CSIC through the project 201070I033 and by the Madrid Community through the project QUIMAPRES S2009/PPQ-1551Peer Reviewe

Effect of hyperbaric storage at room temperature on pectin methylesterase activity and serum viscosity of strawberry juice

Hyperbaric storage at room temperature (HS-RT) has been lately proposed as a promising technology for food preservation. In this paper, the effect of HS-RT on pectin methylesterase (PME) activity and viscosity decay was evaluated in strawberry juice. To do so, two complementary studies were performed: one in crude strawberry PME extract and the other in strawberry juice. The results showed that, at the assayed conditions, the catalytic activity of the PME extract was not affected by pressure up to 200 MPa. Moreover, in strawberry juices, no pressure PME inactivation was observed during storage, at 0.1-200 MPa and 20 °C, for 1, 2, 5, 7, 10, and 15 days. HS-RT enhanced viscosity decay, especially at the beginning of storage, although no increase in PME activity was observed in this phase. Therefore, chemical and/or enzymatic reactions, other than PME de-esterification, could be pressure enhanced and affect pectin characteristics and serum viscosity. Industrial relevance Hyperbaric storage at room temperature (HS-RT) can involve substantial energy savings in food preservation. As food is preserved with no temperature control, the only energy consumption is produced at the beginning of storage, during compression. HS-RT could be applied in different sections of the cold chain in industrialized countries but also in developing countries in which the continuous supply of electric energy is difficult. However, before industrial implementation, much more research is needed to clarify the effect of the storage pressure on mechanisms implied in food quality degradation.This work was supported by the R + D + I National Plan of the Spanish Ministry of Education and Science (MEC) through projects AGL2007-63314/ALI (partially financed by FEDER funds) and CSD2007-00045 MALTA CONSOLIDER-INGENIO 2010, by CSIC through project 201070I033, and by the Madrid Community (CAM) through project QUIMAPRES S2009/PPQ-1551.Peer Reviewe

Activida pectolítica en zumo de fresa durante su almacenamiento hiperbárico a temperatura ambiente

Ponencia presentada en el VII Congreso Español de Ingenieria de Alimentos, Ciudad Real, 7-9 de Noviembree. 2012El almacenamiento hiperbárico a temperatura ambiente podría ser un nuevo método de conservación de alimentos que suponga un ahorro energético frente a la refrigeración tradicional. Experimentos previos han demostrado que es efectivo para evitar el crecimiento microbiano en zumo de fresa fresco almacenado por 15 días y para atenuar las pérdidas de color y viscosidad en el producto. Sin embargo, estas pérdidas de viscosidad no son despreciables. Debido a la importancia de la viscosidad en los zumos de frutas, el objetivo de este trabajo ha sido estudiar la actividad pectolítica en el zumo de fresa durante su almacenamiento hiperbárico a temperatura ambiente. Para ello, se almacenó zumo de fresa fresco bajo diferentes presiones (0.1, 50 y 200 MPa) a 20 ºC y se midió el contenido de metanol y la viscosidad en las muestras después de diferentes períodos de almacenamiento (0, 1, 2, 5 y 10 días). Los resultados obtenidos indican que la presión es un parámetro que afecta significativamente a la actividad pectolítica del zumo de fresa durante su almacenamiento a 20 ºC.Este trabajo ha sido financiado por el Ministerio de Educación y Ciencia de España a través de los proyectos AGL2007-63314/ALI y CSD2007-00045 MALTA CONSOLIDER-INGENIO 2010, por el CSIC a través del proyecto 201070I033 y por la Comunidad de Madrid a través del proyecto QUIMAPRES s2009/PPQ-1551.Peer Reviewe

Almacenamiento de alimentos en alta presión hidrostática

Peer Reviewe

Kinetics of thermal and high-pressure inactivation of avocado polygalacturonase

Despite high-pressure (HP) processed avocado products are nowadays commercialized, there is no information about the effect of pressure on avocado polygalacturonase (PG) yet. In the present study, PG inactivation kinetics in crude avocado extract was investigated under isobaric conditions at 20°C. Moreover, PG inactivation kinetics under isothermal conditions at atmospheric pressure was also included to make comparisons with the processing technique usually employed in the industry. Both temperature and pressure inactivation of avocado PG, either at 60–70°C/0.1MPa or at 20°C/350–500MPa, could be mathematically described by first-order inactivation models. No thermal or pressure resistant fractions were detected. Thus, avocado PG appeared a rather labile enzyme which could be completely inactivated after relatively mild thermal or pressure treatments (10min/70°C/0.1MPa or 15min/20°C/450MPa). PG inactivation models developed for PG in crude avocado extract could predict PG inactivation in avocado purée relatively well.High-pressure processed avocado products are, nowadays, commercially available, but no data exist about the effect of high-pressure on pectinases yet. This paper provides, for the first time in the literature, scientific data about kinetics of thermal and high-pressure inactivation of avocado polygalacturonase. Moreover, first-order inactivation models are issued to mathematically describe inactivation. All these data should be of high interest for the food industry since polygalacturonase can affect the texture of avocado halves and chunks and the rheological properties of guacamole, avocado purée and sauces during the storage.status: publishe