Do ART and chemsex drugs get along? Potential drug-drug Interactions in a cohort of people living with HIV who engaged in chemsex: a retrospective observational study.

Introduction: People living with HIV (PLWH) who engaged in chemsex are at risk of potential drug-drug interactions (pDDIs) with recreational drugs. This study aimed to characterize pDDIs between antiretroviral treatment (ART) and chemsex drugs and evaluate their association with unscheduled relevant hospital consultations. Methods: We conducted a single-center, retrospective, observational study in a series of gay, bisexual, and other men who have sex with men (gbMSM) living with HIV who engaged in chemsex and who attended a tertiary hospital in Barcelona, Spain, from February 2018 through August 2019. Associations between all recorded pDDIs and relevant unscheduled consultations were estimated using the incidence rate (IR) per 100 person-years of those events compared between patients with no pDDI (green flag) or moderate severity pDDI (orange flag) with patients with high severity pDDI (red flag) using the incidence rate ratio (IRR). Results: Among 172 PLWH engaged in chemsex, 249 ART regimens were prescribed: 44% based on integrase inhibitors, 30% on boosted ART, and 26% based on non-nucleoside reverse transcriptase inhibitors. The substances and recreational drugs most frequently used were erectile dysfunction agents (83%), methamphetamine (79%), GHB (77%), and alkyl nitrites (71%). Polydrug use was reported in 52%. We observed 2048 pDDIs. Of these, 23% were orange flag pDDIs; 88% related to boosted ARTs. The IR of the 285 unscheduled relevant episodes in patients with orange flag pDDIs was 64.67 (95% CI 40.07-89.28). The IRR of green flag pDDIs was 1.05 (95% CI 0.60-1.8; p = 0.876). Conclusion: One in four pDDIs were of moderate severity but no significant increase in the incidence of unscheduled relevant consultations was observed. A high number of unscheduled consultations, predominantly for psychiatric events and intoxication, were observed. Beyond using non-boosted ART to minimize pDDIs, other factors related to the practice of chemsex must be addressed, in order to offer a better approach

Using Biotic Interaction Networks for Prediction in Biodiversity and Emerging Diseases

Networks offer a powerful tool for understanding and visualizing inter-species ecological and evolutionary interactions. Previously considered examples, such as trophic networks, are just representations of experimentally observed direct interactions. However, species interactions are so rich and complex it is not feasible to directly observe more than a small fraction. In this paper, using data mining techniques, we show how potential interactions can be inferred from geographic data, rather than by direct observation. An important application area for this methodology is that of emerging diseases, where, often, little is known about inter-species interactions, such as between vectors and reservoirs. Here, we show how using geographic data, biotic interaction networks that model statistical dependencies between species distributions can be used to infer and understand inter-species interactions. Furthermore, we show how such networks can be used to build prediction models. For example, for predicting the most important reservoirs of a disease, or the degree of disease risk associated with a geographical area. We illustrate the general methodology by considering an important emerging disease - Leishmaniasis. This data mining methodology allows for the use of geographic data to construct inferential biotic interaction networks which can then be used to build prediction models with a wide range of applications in ecology, biodiversity and emerging diseases

Current and Future Niche of North and Central American Sand Flies (Diptera: Psychodidae) in Climate Change Scenarios

Ecological niche models are useful tools to infer potential spatial and temporal distributions in vector species and to measure epidemiological risk for infectious diseases such as the Leishmaniases. The ecological niche of 28 North and Central American sand fly species, including those with epidemiological relevance, can be used to analyze the vector’s ecology and its association with transmission risk, and plan integrated regional vector surveillance and control programs. In this study, we model the environmental requirements of the principal North and Central American phlebotomine species and analyze three niche characteristics over future climate change scenarios: i) potential change in niche breadth, ii) direction and magnitude of niche centroid shifts, iii) shifts in elevation range. Niche identity between confirmed or incriminated Leishmania vector sand flies in Mexico, and human cases were analyzed. Niche models were constructed using sand fly occurrence datapoints from Canada, USA, Mexico, Guatemala and Belize. Nine non-correlated bioclimatic and four topographic data layers were used as niche components using GARP in OpenModeller. Both B2 and A2 climate change scenarios were used with two general circulation models for each scenario (CSIRO and HadCM3), for 2020, 2050 and 2080. There was an increase in niche breadth to 2080 in both scenarios for all species with the exception of Lutzomyia vexator. The principal direction of niche centroid displacement was to the northwest (64%), while the elevation range decreased greatest for tropical, and least for broad-range species. Lutzomyia cruciata is the only epidemiologically important species with high niche identity with that of Leishmania spp. in Mexico. Continued landscape modification in future climate change will provide an increased opportunity for the geographic expansion of NCA sand flys’ ENM and human exposure to vectors of Leishmaniases

Circulating microRNAs in sera correlate with soluble biomarkers of immune activation but do not predict mortality in ART treated individuals with HIV-1 infection: A case control study

Introduction: The use of anti-retroviral therapy (ART) has dramatically reduced HIV-1 associated morbidity and mortality. However, HIV-1 infected individuals have increased rates of morbidity and mortality compared to the non-HIV-1 infected population and this appears to be related to end-organ diseases collectively referred to as Serious Non-AIDS Events (SNAEs). Circulating miRNAs are reported as promising biomarkers for a number of human disease conditions including those that constitute SNAEs. Our study sought to investigate the potential of selected miRNAs in predicting mortality in HIV-1 infected ART treated individuals. Materials and Methods: A set of miRNAs was chosen based on published associations with human disease conditions that constitute SNAEs. This case: control study compared 126 cases (individuals who died whilst on therapy), and 247 matched controls (individuals who remained alive). Cases and controls were ART treated participants of two pivotal HIV-1 trials. The relative abundance of each miRNA in serum was measured, by RTqPCR. Associations with mortality (all-cause, cardiovascular and malignancy) were assessed by logistic regression analysis. Correlations between miRNAs and CD4+ T cell count, hs-CRP, IL-6 and D-dimer were also assessed. Results: None of the selected miRNAs was associated with all-cause, cardiovascular or malignancy mortality. The levels of three miRNAs (miRs -21, -122 and -200a) correlated with IL-6 while miR-21 also correlated with D-dimer. Additionally, the abundance of miRs -31, -150 and -223, correlated with baseline CD4+ T cell count while the same three miRNAs plus miR- 145 correlated with nadir CD4+ T cell count. Discussion: No associations with mortality were found with any circulating miRNA studied. These results cast doubt onto the effectiveness of circulating miRNA as early predictors of mortality or the major underlying diseases that contribute to mortality in participants treated for HIV-1 infection

Development and Validation of a Risk Score for Chronic Kidney Disease in HIV Infection Using Prospective Cohort Data from the D:A:D Study

Ristola M. on työryhmien DAD Study Grp ; Royal Free Hosp Clin Cohort ; INSIGHT Study Grp ; SMART Study Grp ; ESPRIT Study Grp jäsen.Background Chronic kidney disease (CKD) is a major health issue for HIV-positive individuals, associated with increased morbidity and mortality. Development and implementation of a risk score model for CKD would allow comparison of the risks and benefits of adding potentially nephrotoxic antiretrovirals to a treatment regimen and would identify those at greatest risk of CKD. The aims of this study were to develop a simple, externally validated, and widely applicable long-term risk score model for CKD in HIV-positive individuals that can guide decision making in clinical practice. Methods and Findings A total of 17,954 HIV-positive individuals from the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) study with >= 3 estimated glomerular filtration rate (eGFR) values after 1 January 2004 were included. Baseline was defined as the first eGFR > 60 ml/min/1.73 m2 after 1 January 2004; individuals with exposure to tenofovir, atazanavir, atazanavir/ritonavir, lopinavir/ritonavir, other boosted protease inhibitors before baseline were excluded. CKD was defined as confirmed (>3 mo apart) eGFR In the D:A:D study, 641 individuals developed CKD during 103,185 person-years of follow-up (PYFU; incidence 6.2/1,000 PYFU, 95% CI 5.7-6.7; median follow-up 6.1 y, range 0.3-9.1 y). Older age, intravenous drug use, hepatitis C coinfection, lower baseline eGFR, female gender, lower CD4 count nadir, hypertension, diabetes, and cardiovascular disease (CVD) predicted CKD. The adjusted incidence rate ratios of these nine categorical variables were scaled and summed to create the risk score. The median risk score at baseline was -2 (interquartile range -4 to 2). There was a 1: 393 chance of developing CKD in the next 5 y in the low risk group (risk score = 5, 505 events), respectively. Number needed to harm (NNTH) at 5 y when starting unboosted atazanavir or lopinavir/ritonavir among those with a low risk score was 1,702 (95% CI 1,166-3,367); NNTH was 202 (95% CI 159-278) and 21 (95% CI 19-23), respectively, for those with a medium and high risk score. NNTH was 739 (95% CI 506-1462), 88 (95% CI 69-121), and 9 (95% CI 8-10) for those with a low, medium, and high risk score, respectively, starting tenofovir, atazanavir/ritonavir, or another boosted protease inhibitor. The Royal Free Hospital Clinic Cohort included 2,548 individuals, of whom 94 individuals developed CKD (3.7%) during 18,376 PYFU (median follow-up 7.4 y, range 0.3-12.7 y). Of 2,013 individuals included from the SMART/ESPRIT control arms, 32 individuals developed CKD (1.6%) during 8,452 PYFU (median follow-up 4.1 y, range 0.6-8.1 y). External validation showed that the risk score predicted well in these cohorts. Limitations of this study included limited data on race and no information on proteinuria. Conclusions Both traditional and HIV-related risk factors were predictive of CKD. These factors were used to develop a risk score for CKD in HIV infection, externally validated, that has direct clinical relevance for patients and clinicians to weigh the benefits of certain antiretrovirals against the risk of CKD and to identify those at greatest risk of CKD.Peer reviewe

A modo de epílogo.

4 páginas.- Sociedad Española para el Estudio de los Pastos . Reunión Científica (43ª. 2003. Granada)Peer reviewe

El papel del ganado doméstico en la naturalización del monte mediterráneo

El desarrollo económico y la consiguiente evolución de las demandas sociales están conllevando que muchos montes mediterráneos se manejen con criterios predominantemente conservacionistas, entendiendo como tales los “técnicamente conservacionistas”. En este contexto, y bajo el nombre de naturalización, en España se viene desarrollando un conjunto de actuaciones que pretenden transformar las simplificadas masas forestales en ecosistemas más complejos. En aparente contradicción con esta visión hipertecnica, reivindicamos aquí el importante papel que pueden desempeñar el ser humano y sus prácticas silvopastorales más sostenibles en muchos de los objetivos de restauración funcional del monte mediterráneo. En este territorio, gran parte de la flora coevolucionó con grandes herbívoros (muchos de ellos hoy extintos), desarrollando una prolongada dinámica de interrelaciones que hoy sólo puede remedarse, parcialmente, con el auxilio de la ganadería extensiva. El actual contexto de abandono de las actividades agrarias y de cambio global conlleva síntomas preocupantes de pérdidas de diversidad, valor del monte, patrimonio rural y capacidad de uso de la tierra, mientras se incrementan los riesgos, entre los que destacan los incendios forestales. Ante todo ello, entendemos que la integración de la ganadería extensiva en la gestión del medio natural es una valiosa respuesta a los desafíos y amenazas que afronta la conservación del monte mediterráneo

Pastoralism in natural parks of Andalucia (Spain): a tool for fire prevention and the naturalization of ecosystems

----------------------------------------------------------- To cite th is article / Pou r citer cet article Abstract. The Environment Department of the Government of Andalusia (Spain) has recently undertaken the responsibility of integrating extensive livestock grazing as a tool for fire prevention in several Natural Parks of the region. With the participation of 19 shepherds, 910 ha of fuelbreaks are being maintained by sheep and goat flocks. Their effect is being monitored and specific research is being carried out to adjust the system. In exchange for the service provided, shepherds are paid proportionally both to the surface of fuelbreaks they maintain, and to the biomass control outcome they achieve. This is an extra income that drives their production systems towards sustainable activities integrated in the conservation of forest resources. On the other hand, extensive and scarcely managed forest pine plantations and oak-tree communities are in need of diversification (naturalization) actions. Intense grazing -by domestic or wild herbivores -has always been present in Mediterranean forest and rangelands, contributing to their diversity and dynamics. Therefore, livestock grazing is nowadays a tool that can efficiently collaborate with other initiatives in the naturalization of many simplified forest ecosystems. Both fire prevention and naturalization are main forest management issues in the 21 st century, and livestock breeders have the opportunity to team up, enhance their extensive production systems and benefit from the increased social and economical recognition of their activity. Keywords. Mediterranean -Silvopastoral -Forest management -Conservation -Diversification. Pastoralisme dans les parcs naturels d'Andalousie : un outil pour la prévention des incendies et le retour à l'état naturel des écosystèmes Résumé. Le Département pour l'Environnement du Gouvernement Autonome de l'Andalousie (Espagne) a récemment pris la responsabilité d'intégrer l'élevage extensif comme outil pour la protection contre les incendies dans plusieurs parcs naturels de la région. Avec la participation d

La prevención de incendios forestales mediante pastoreo controlado: el estado del arte en Andalucía.

En la actualidad nos encontramos con un entorno forestal muy propenso a los incendios, en el que los medios de extinción están alcanzando techos de efectividad. Resulta, por tanto, indispensable incrementar la atención hacia aquellas labores preventivas que colaboren a disminuir los riesgos y a facilitar las tareas de extinción. En tal sentido, viene proponiéndose en diversos foros nacionales e internacionales la integración de actividades planificadas de pastoreo en la prevención de los incendios, como una herramienta complementaria más. El pastoreo controlado en áreas pasto-cortafuegos constituye una práctica agraria sostenible, en la que el ganado colabora a reducir los riesgos de incendio y cumple una función ecológica importante en el monte mediterráneo. Además, su incorporación al conjunto de herramientas de manejo del monte estimula la vigilancia y el interés de la población local por la conservación del mismo, fomentando el trabajo coordinado entre técnicos y ganaderos, lo que refuerza la prevención social de los incendios. Mediante la creación del grupo de trabajo “Pastores por el monte mediterráneo”, integrado por profesionales de distintos sectores, la Junta de Andalucía ensaya desde el año 2005 la utilización del pastoreo como sistema complementario de prevención de incendios. Lo hace en 16 montes de las provincias de Almería, Granada, Málaga y Cádiz, alcanzando una superficie de actuación próxima a las 800 ha. En cada monte se planifican las actividades de pastoreo y se evalúan sus efectos desde un punto de vista técnico y científico. Para estimular la labor de los pastores, formalizar su participación y retribuirla, se ha establecido una remuneración económica ajustada a los compromisos y circunstancias de cada lugar. La puesta en marcha de este sistema de gestión presenta ciertas dificultades y limitaciones, de las que exponemos ejemplos. Esta comunicación, en su parte final, recoge también algunas ideas sobre el futuro de este programa en Andalucía.Peer reviewe

EFECTOS DEL MANEJO DEL SUELO EN LA PRODUCCIÓN Y COMPOSICIÓN BOTÁNICA DE LOS PASTOS DE UNA "DEHESA DE ALMENDROS" EN EL SUDESTE IBÉRICO

La vegetación espontánea que crece bajo los cultivos de almendros puede constituir una fuente de alimento importante para el ganado ovino en el sudeste ibérico. Este trabajo evalúa la producción y composición florística de los pastos naturales desarrollados bajo cultivos de almendros con distintos tipos de manejo: 1) sin labrar (durante 2 y 3 años) y pastoreado (Tratamiento A, años 2004 y 2005), y 2) laboreo reciente (anterior otoño) y sin pastoreo (Tratamiento B, año 2006). Las producciones de pastos (rango: 1247- 1899 kg ha') y el porcentaje de cobertura vegetal (54-82%) no mostraron diferencias significativas, probablemente, debido a la heterogeneidad de las parcelas, aunque ambas cifras fueron mayores en el año más lluvioso. Las precipitaciones y el tipo de manejo del suelo determinaron la composición ñorística. El Tratamiento B mostró una mayor diversidad ñorística y riqueza de familias, y se desarrollaron, principalmente, especies de comunidades arvenses (Verónica hederifolia L., Papaver rhoeas L., Roemeria hybrida (L.) DC, Descurainia sophia (L.) Webb ex Prantl); mientras que en el Tratamiento A, menos diverso y menos rico en familias, dominaron las especies de pastos terofíticos nitrófilos y subnitrófilos de la zona (Lolium rigidum Gaudin, Hordeum murinum L., Trigonella polyceratia L. y Medicago mínima (L.) L.). Por otro lado, las bajas precipitaciones en 2005 (seco) respecto a 2004 (lluvioso) se reñejaron en un descenso de la riqueza específica de los pastos y de la proporción de especies de mayor interés pascícola (leguminosas). Nuestros resultados indican que los pastos bajo los cultivos de almendros, en el sudeste ibérico, están compuestos por numerosas especies de aptitud forrajera, aunque la pluviometría y el tipo de manejo (tiempo transcurrido desde el último laboreo) condiciona la presencia de aquellas de mayor calidad nutiritiva (como L. rigidum y las leguminosas