High drug resistance prevalence among vertically HIV-Infected patients transferred from pediatric care to adult units in Spain

BACKGROUND: Antiretroviral treatment (ART) has contributed to increased life expectancy of HIV-1 infected children. In developed countries, an increasing number of children reaching adulthood are transferred to adult units. The objectives were to describe the demographic and clinical features, ART history, antiviral drug resistance and drug susceptibility in HIV-1 perinatally infected adolescents transferred to adult care units in Spain from the Madrid Cohort of HIV-1 infected children. METHODS: Clinical, virological and immunological features of HIV-1 vertically infected patients in the Madrid Cohort of HIV-infected children were analyzed at the time of transfer. Pol sequences from each patient were recovered before transfer. Resistance mutations according to the InternationaI AIDS Society 2011 list were identified and interpreted using the Stanford algorithm. Results were compared to the non-transferred HIV-1 infected pediatric cohort from Madrid. RESULTS: One hundred twelve infected patients were transferred to adult units between 1997 and 2011. They were mainly perinatally infected (93.7%), with a mean nadir CD4+-T-cells count of 10% and presented moderate or severe clinical symptoms (75%). By the time of transfer, the mean age was 18.9 years, the mean CD4+T-cells count was 627.5 cells/ml, 64.2% presented more than 350 CD4+T-cells/ml and 47.3% had ≤200 RNA-copies/ml. Most (97.3%) were ART experienced receiving Highly Active ART (HAART) (84.8%). Resistance prevalence among pretreated was 50.9%, 76.9% and 36.5% for Protease Inhibitors (PI), Nucleoside Reverse Transcriptase Inhibitors (NRTI) and Non-NRTI (NNRTI), respectively. Resistance mutations were significantly higher among transferred patients compared to non-transferred for the PI+NRTI combination (19% vs. 8.4%). Triple resistance was similar to non-transferred pediatric patients (17.3% vs. 17.6%). CONCLUSION: Despite a good immunological and virological control before transfer, we found high levels of resistance to PI, NRTI and triple drug resistance in HIV-1 infected adolescents transferred to adult units

Impact of long-term viral suppression in CD4+ recovery of HIV-children on Highly Active Antiretroviral Therapy

BACKGROUND: The effects of HAART may differ between children and adults because children have a developing immune system, and the long-term immunological outcome in HIV-infected children on HAART is not well-known. A major aim of our study was to determine CD4+ evolution associated with long-term VL control during 4 years of observation on HAART. METHODS: We carried out a retrospective study on a cohort of 160 vertically HIV-infected children. It was carried out from 1996 to 2004 in six large Spanish pediatric referral hospitals. We compared 33 children who had long-term VL suppression (VL ≤400 copies/ml) in the first 12 months of follow-up and maintained that level throughout follow-up (Responders-group), and 127 children with persistently detectable VL in spite of ART switches (Non-Responders-group). RESULTS: We observed a quick initial and significant increase in CD4(+ )counts from the baseline to 12 months on HAART in both groups (p < 0.01). The Non-Responders group sustained CD4+ increases and most of these children maintained high CD4(+ )level counts (≥25%). The Non-Responders group reached a plateau between 26% and 27% CD4(+ )at the first 12 months of follow-up that remained stable during the following 3 years. However, the Responders group reached a plateau between 30% and 32% CD4(+ )at 24, 36 and 48 months of follow-up. We found that the Responders group had higher CD4(+ )count values and higher percentages of children with CD4(+ )≥25% than the Non-Responders group (p < 0.05) after month 12. CONCLUSION: Long-term VL suppression in turn induces large beneficial effects in immunological responses. However, it is not indispensable to recover CD4(+ )levels

Rate of candidiasis among HIV-infected children in Spain in the era of highly active antiretroviral therapy (1997-2008)

BACKGROUND: Candidiasis is the most common opportunistic infection seen in human immunodeficiency virus (HIV)-infected individuals. The aim of our study was to estimate the candidiasis rate and evaluate its trend in HIV-infected children in Spain during the era of highly active antiretroviral therapy (HAART) compared to HIV-uninfected children. METHODS: We carried out a retrospective study. Data were obtained from the records of the Minimum Basic Data Set from hospitals in Spain. All HIV-infected children were under 17 years of age, and a group of HIV-uninfected children with hospital admissions matching the study group by gender and age were randomly selected. The follow-up period (1997-2008) was divided into three calendar periods: a) From 1997 to 1999 for early-period HAART; b) from 2000 to 2002 for mid-period HAART; and c) from 2003 to 2008 for late-period HAART. RESULTS: Among children with hospital admissions, HIV-infected children had much higher values than HIV-uninfected children during each of the three calendar periods for overall candidiasis rates (150.0 versus 6.1 events per 1,000 child hospital admissions/year (p < 0.001), 90.3 versus 3.1 (p < 0.001), and 79.3 versus 10.7 (p < 0.001), respectively) and for non-invasive Candida mycosis (ICM) rates (118.5 versus 3.8 (p < 0.001), 85.3 versus 2.3 (p < 0.001), and 80.6 versus 6.0 (p < 0.001), respectively). In addition, HIV-infected children also had higher values of ICM rates than HIV-uninfected children, except during the last calendar period when no significant difference was found (32.4 versus 1.2 (p < 0.001), 11.6 versus 0.4 (p < 0.001), and 4.6 versus 2.3 (p = 0.387), respectively). For all children living with HIV/AIDS, the overall candidiasis rate (events per 1,000 HIV-infected children/year) decreased from 1997-1999 to 2000-2002 (18.8 to 10.6; p < 0.001) and from 2000-2002 to 2003-2008 (10.6 to 5.7; p = 0.060). Within each category of candidiasis, both non-ICM and ICM rates experienced significant decreases from 1997-1999 to 2003-2008 (15.9 to 5.7 (p < 0.001) and 4.1 to 0.3 (p < 0.001), respectively). CONCLUSIONS: Although the candidiasis rate still remains higher than in the general population (from 1997 to 2008), candidiasis diagnoses have decreased among HIV-infected children throughout the HAART era, and it has ceased to be a major health problem among children with HIV infection.Financial support: This work has been supported by grants from Instituto de Salud Carlos III (Ref. PI08/0738 and PI11/00245 to SR and PI12/00019 to AAM).S

Asma y escuela

Este documento técnico está elaborado por un grupo de expertos y asesorado por la Comisión Asesora del Programa Regional de Control y Prevención del Asma de la Comunidad de Madrid. Recoge los contenidos que los profesores de alumnos asmáticos necesitan para realizar las adaptaciones curriculares, y para que los médicos que tratan a niños y jóvenes asmáticos puedan incluir en sus informes datos útiles y comprensibles para los educadores. El objetivo del documento es acercar la escuela al centro sanitario y viceversa, para que los niños asmáticos puedan disfrutar de una vida escolar integrada y de los beneficios del ejercicio físico. La obra incluye contenidos básicos relacionados con la patología asmática, las normas que obligan a la adaptación de los currículos y las características que deben tener los mismos, con ejemplos para orientar al profesorado, y muestras de cómo debe ser la comunicación entre médicos y educadores. Incorpora un glosario de términos comunes para profesores y médicos, y direcciones de interés.MadridES

Association between airborne pollen and epidemic asthma in Madrid, Spain: A case-control study

Background: Despite the fact that airborne pollen is an important factor in precipitating asthma attacks, its implication in increases of epidemic asthma in usual meteorological conditions has not been reported. A study was undertaken to estimate the relationship between various types of aeroallergens and seasonal epidemic asthma in the region of Madrid, Spain. Methods: A case-control study was carried out in individuals aged 4-79 years who received emergency healthcare for asthma during 2001 in a base hospital covering a population of 750 000 inhabitants of Madrid. A skin prick test was performed with grass pollen, plantain pollen, olive pollen, cypress pollen, plane tree pollen, dust mites and Alternaria and the prevalence of skin reactivity was compared between subjects with asthma requiring emergency care for asthma within (cases) and outside (controls) the seasonal epidemic period. Data were analysed using logistic regression adjusting for age and sex. Results: The response rate was 61.7% for cases (n=95) and 51.6% for controls (n=146). The OR of sensitisation to grass pollen for cases compared with controls was 9.9 (95% CI 4.5 to 21.5); plantain pollen: 4.5 (95% CI 2.5 to 8.2); olive pollen: 7.3 (95% CI 3.5 to 15.2); plane tree pollen: 3.6 (95% CI 2.0 to 6.4); cypress pollen: 3.5 (95% CI 2.0 to 6.2); dust mites: 1.1 (95% CI 0.6 to 1.9); Alternaria: 0.9 (95% CI 0.5 to 1.9). The association with grasses was maintained after adjusting simultaneously for the remaining aeroallergens (OR 5.0 (95% CI 1.5 to 16.4)); this was the only one that retained statistical significance (p=0.007). Conclusions: These results suggest that allergy to pollen, particularly grass pollen, is associated with the epidemic increase in asthma episodes during the months of May and June in the Madrid area of Spain.Peer Reviewe

Predicted resistance level to antiretroviral drugs in pretreated patients from the two studied cohorts.

<p>Resistance level was estimated according to the HIVdb Interpretation Algorithm (Stanford University, Palo Alto, CA, USA) <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0052155#pone.0052155-Liu1" target="_blank">[19]</a>. PI, protease inhibitors: nelfinavir (NFV), saquinavir/r (SQV/r), indinavir/r (IDV/r), atazanavir/r (ATV/r), fosamprenavir/r (FPV/r), lopinavir/r (LPV/r), tipranavir/r (TPV/r) and darunavir/r (DRV/r), where “/r” indicates co-administration with low-dose ritonavir (RTV) for pharmacological “boosting”. NRTI, nucleoside reverse transcriptase inhibitors: zidovudine (AZT), stavudine (d4T), lamivudine (3TC), emtricitabine (FTC), didanosine (DDI), abacavir (ABC), tenofovir (TDF). NNRTI, non-nucleoside reverse transcriptase inhibitors: efavirenz (EFV), nevirapine (NVP), rilpivirine (RPV), etravirine (ETR). **Statistical differences (p<0.05) in resistance levels have been found between transferred and non-transferred patients for these drugs.</p

Campanula sp.

<p>SD, standard deviation; ART, antiretroviral therapy; PI, protease inhibitors; NRTI, nucleoside reverse transcriptase inhibitors; NNRTI, non-NRTI; FI, fusion inhibitors, InI; integrase inhibitors.</p>*<p>Transferred to adult units with available resistance genotyping profile.</p>**<p>Statistical differences (p<0.05) have been found between transferred and non-transferred patients for these features.</p