Aging-associated symptoms in the physician-patient dialogue in a group of long-term diagnosed HIV-infected individuals

Background: The significant decrease in mortality has resulted in a large number of individuals aged over 50 living with HIV infection. Additionally, the coexistence of certain pathologies suggests premature aging. In this scenario, the presence of aging-associated symptoms in the physician-patient dialogue is yet to be explored. Methods: Cross-sectional observational study to evaluate the presence of aging-associated symptoms in the physician-patient dialogue and to explore the possible differences between genders in a sample of 100 HIV-1 infected subjects diagnosed at least 15 years ago. The survey assessed questions/comments made by the patient, questions/comments made by the physician and patients’ interest in obtaining more information than was provided. Number of patients and percentages were given and compared using the w2 or Fisher exact test (as appropriate). Results: Participants were 60 men and 40 women, diagnosed with HIV infection a median (IQ) of 18 (15.7–21) years ago, who had a nadir CD4 and CD4 cell count at the study entry of 172 (95–272) and 543 (403–677), respectively. Eighty percent of the subjects had VL <25 copies and 42% were HCV/HIV co-infected (31 subjects with low fibrosis stage). The infection route had been mainly intravenous drug use (37%) and MSM (32%). Men and women had similar demographic and clinical characteristics. Sixty-two percent of the participants acknowledged asking their physicians about aging-associated symptoms (58% men vs 66% women; p=0.50), 48% reported that their physicians had provided information without having been asked (48% men vs 55% women; p=0.51) and 75% confirmed that they would like to have more information about aging-associated symptoms (22% men vs 80% women; p<0.001). Conclusions: Around half of the men and women interviewed had discussed aging-associated symptoms with their physician. However, this seemed insufficient for four-fifths of the women, who would have liked to have obtained more information about aging

High Treatment Success Rates When Switching to Once Daily Nevirapine Containing Antiretroviral Therapy

INTRODUCTION: Two recent studies have highlighted low rates of virological response to once daily nevirapine containing combination antiretroviral therapy (CART) in treatment naïve HIV-1 infected subjects. AIM: We assessed factors associated with treatment responses in a cohort of HIV-1 infected, therapy naïve individuals, commencing nevirapine CART with two nucleoside reverse transcriptase inhibitors (NRTI) containing either lamivudine or emtricitabine. RESULTS: Between January 2002 and 2006, 173 subjects (80 female) met the study inclusion criteria. All subjects initially commenced on twice daily nevirapine with six different NRTI backbones. Mean follow up was 802 days. 49 (28%) subjects switched to once daily nevirapine, 23 (13%) within the first year. After 48 weeks of therapy, HIV RNA was < 50 copies/mL in 154/173 subjects (89%). A trend was observed towards improved virological outcome (HIV RNA < 50 copies/mL) and switching to once daily nevirapine during the first year of therapy (p=0.051). CONCLUSION: Whilst awaiting the results of prospective studies assessing once daily nevirapine, our data describe high treatment success rates and good safety responses when switching to once daily nevirapine

Real-world evidence in Alzheimer’s disease: the ROADMAP Data Cube

INTRODUCTION:The ROADMAP project aimed to provide an integrated overview of European real-world data on Alzheimer's disease (AD) across the disease spectrum. METHODS:Metadata were identified from data sources in catalogs of European AD projects. Priority outcomes for different stakeholders were identified through systematic literature review, patient and public consultations, and stakeholder surveys. RESULTS:Information about 66 data sources and 13 outcome domains were integrated into a Data Cube. Gap analysis identified cognitive ability, functional ability/independence, behavioral/neuropsychiatric symptoms, treatment, comorbidities, and mortality as the outcomes collected most. Data were most lacking in caregiver-related outcomes. In general, electronic health records covered a broader, less detailed data spectrum than research cohorts. DISCUSSION:This integrated real-world AD data overview provides an intuitive visual model that facilitates initial assessment and identification of gaps in relevant outcomes data to inform future prospective data collection and matching of data sources and outcomes against research protocols

Interplay between tectonics, climate and fluvial transport during the Cenozoic evolution of the Ebro Basin (NE Iberia).

Three-dimensional modeling that integrates fluvial sediment transport, crustal-scale tectonic deformation, and lithospheric flexural subsidence is carried out to simulate the landscape and drainage evolution of the Ebro sedimentary basin (NE Iberia). The Ebro Basin underwent a long period of closed intramountain drainage as a result of tectonic topography generation at the Pyrenees, the Iberian Range, and the Catalan Coastal Range. In the late Oligocene, the Catalan Coastal Range underwent extension leading to the formation of the Valencia Trough (NW Mediterranean), but the Ebro Basin remained closed for nearly 15 Myr more before the Ebro River cut through the remnants of the topographic barrier. This drainage opening caused widespread basin incision that shaped spectacular outcrops of the syntectonic and posttectonic infill. Here we investigate the processes controlling these major drainage changes. The modeling results, constrained by a large data set on the tectonic and transport evolution of the area, predict a closed phase characterized by a large lake in the central eastern Ebro Basin. Dry climatic conditions probably lowered the lake level and contributed, together with rift flank uplift, to prolong this endorheic basin stage. The age and amount of reworked sediment after the opening are consistent with an onset of basin incision between 13 and 8.5 Ma as a result of lake capture by escarpment erosion and lake level rise associated with sediment accumulation and wetter climatic conditions. Sea level changes in the Mediterranean had no major impact in the large-scale drainage evolution of the Ebro Basin.This work has been funded by the Netherlands Center for Integrated Solid Earth Science (ISES)

Differential body composition effects of protease inhibitors recommended for initial treatment of HIV infection: A randomized clinical trial

This article has been accepted for publication in Clinical Infectious Diseases ©2014 The Authors .Published by Oxford University Press on Clinical Infectious Disease 60.5. DOI: 10.1093/cid/ciu898Background. It is unclear whether metabolic or body composition effects may differ between protease inhibitor-based regimens recommended for initial treatment of HIV infection. Methods. ATADAR is a phase IV, open-label, multicenter randomized clinical trial. Stable antiretroviral-naive HIV-infected adults were randomly assigned to atazanavir/ritonavir 300/100 mg or darunavir/ritonavir 800/100 mg in combination with tenofovir/emtricitabine daily. Pre-defined end-points were treatment or virological failure, drug discontinuation due to adverse effects, and laboratory and body composition changes at 96 weeks. Results. At 96 weeks, 56 (62%) atazanavir/ritonavir and 62 (71%) darunavir/ritonavir patients remained free of treatment failure (estimated difference 8.2%; 95%CI -0.6 to 21.6); and 71 (79%) atazanavir/ritonavir and 75 (85%) darunavir/ritonavir patients remained free of virological failure (estimated difference 6.3%; 95%CI -0.5 to 17.6). Seven vs. five patients discontinued atazanavir/ritonavir or darunavir/ritonavir due to adverse effects. Total and HDL cholesterol similarly increased in both arms, but triglycerides increased more in atazanavir/ritonavir arm. At 96 weeks, body fat (estimated difference 2862.2 gr; 95%CI 726.7 to 4997.7; P=0.0090), limb fat (estimated difference 1403.3 gr; 95%CI 388.4 to 2418.2; P=0.0071), and subcutaneous abdominal adipose tissue (estimated difference 28.4 cm2; 95%CI 1.9 to 55.0; P=0.0362) increased more in atazanavir/ritonavir than in darunavir/ritonavir arm. Body fat changes in atazanavir/ritonavir arm were associated with higher insulin resistance. Conclusions. We found no major differences between atazanavir/ritonavir and darunavir/ritonavir in efficacy, clinically-relevant side effects, or plasma cholesterol fractions. However, atazanavir/ritonavir led to higher triglycerides and total and subcutaneous fat than darunavir/ritonavir and fat gains with atazanavir/ritonavir were associated with insulin resistanceThis is an Investigator Sponsored Research study. It was supported in part by research grants from Bristol‐Myers Squibb and Janssen‐Cilag; Instituto de Salud Carlos III (PI12/01217) and Red Temática Cooperativa de Investigación en SIDA G03/173 (RIS‐EST11), Ministerio de Ciencia e Innovación, Spain. (Registration number: NCT01274780; registry name: ATADAR; EUDRACT; 2010‐021002‐38)

Factors associated with the number of drugs in darunavir/cobicistat regimens.

Background: Darunavir/cobicistat can be used as mono, dual, triple or more than triple therapy. Objectives: To assess factors associated with the number of drugs in darunavir/cobicistat regimens. Methods: A nationwide retrospective cohort study of consecutive HIV-infected patients initiating darunavir/cobicistat in Spain from July 2015 to May 2017. Baseline characteristics, efficacy and safety at 48 weeks were compared according to the number of drugs used. Results: There were 761 patients (75% men, 98% were antiretroviral-experienced, 32% had prior AIDS, 84% had HIV RNA <50 copies/mL and 88% had ≥200 CD4 cells/mm3) who initiated darunavir/cobicistat as mono (n=308, 40%), dual (n=173, 23%), triple (n=253, 33%) or four-drug (n=27, 4%) therapy. Relative to monotherapy, triple therapy was more common in men aged <50 years, with prior AIDS and darunavir plus ritonavir use, and with CD4 cells <200/mm3 and with detectable viral load at initiation of darunavir/cobicistat; dual therapy was more common with previous intravenous drug use, detectable viral load at initiation of darunavir/cobicistat and no prior darunavir plus ritonavir; and four-drug therapy was more common with prior AIDS and detectable viral load at initiation of darunavir/cobicistat. Monotherapy and dual therapy showed a trend to better virological responses than triple therapy. CD4 responses and adverse effects did not differ among regimens. Discussion: Darunavir/cobicistat use in Spain has been tailored according to clinical characteristics of HIV-infected patients. Monotherapy and dual therapy have been common and preferentially addressed to older patients with a better HIV status, suggesting that health issues other than HIV infection may have been strong determinants of its prescription.The CODAR study (Gesida Study no 9316) was sponsored by Sociedad Española de Enfermedades Infecciosas y Microbiología-Grupo de Estudio del SIDA (SEIMC-GESIDA). This work was supported by Janssen Cilag S.A. and Red de Investigacion en Sida (RIS): RIS-EST29 and RD12/0017/0001, RD12/0017/0005, RD17/0017/0022 and RD17/0017/0029

European survey on laboratory preparedness, response and diagnostic capacity for crimean-congo haemorrhagic fever, 2012

Crimean-Congo haemorrhagic fever (CCHF) is an infectious viral disease that has (re-)emerged in the last decade in south-eastern Europe, and there is a risk for further geographical expansion to western Europe. Here we report the results of a survey covering 28 countries, conducted in 2012 among the member laboratories of the European Network for Diagnostics of 'Imported' Viral Diseases (ENIVD) to assess laboratory preparedness and response capacities for CCHF. The answers of 31 laboratories of the European region regarding CCHF case definition, training necessity, biosafety, quality assurance and diagnostic tests are presented. In addition, we identifi

A retrospective cohort study of risk factors for mortality among nursing homes exposed to COVID-19 in Spain

Long-term care (LTC) facilities have shown remarkably high mortality rates during the coronavirus disease 2019 (COVID-19) outbreak in many countries1, and different risk factors for mortality have been identified in this setting2–5. Using facilities as the unit of analysis, we investigated multiple variables covering facility characteristics and socioeconomic characteristics of the geographic location to identify risk factors for excess mortality from a comprehensive perspective. Furthermore, we used a clustering approach to detect patterns in datasets and generate hypotheses regarding potential relationships between types of nursing homes and mortality trends. Our retrospective analysis included 167 nursing homes providing LTC to 8,716 residents during the COVID-19 outbreak in Catalonia (northeast Spain). According to multiple regression analysis, COVID-19-related and overall mortality at the facility level were significantly associated with a higher percentage of patients with complex diseases, lower scores on pandemic preparedness measures and higher population incidence of COVID-19 in the surrounding population. When grouping nursing homes into eight clusters based on common features, we found higher mortality rates in four clusters, mainly characterized by a higher proportion of residents with complex chronic conditions or advanced diseases, lower scores on pandemic preparedness, being located in rural areas and larger capacity, respectively