No evidence of firstly acquired acute hepatitis C virus infection outbreak among HIV-infected patients from Southern Spain: a multicentric retrospective study from 2000-2014

Background: Acute hepatitis C virus (HCV) infection (AHCVI) outbreaks have been described recently within defined areas worldwide among HIV-infected homosexual men. This study aims to describe the cumulative frequency and incidence of firstly acquired AHCVI in an HIV-infected population in Southern Spain. Methods: This is a retrospective study conducted at the Infectious Diseases Units of eight hospitals in Andalusia, Southern Spain. Primary AHC was considered as HCV immunoglobulin G antibody seroconversion. The time of infection was considered the moment between the last negative and the first positive HCV antibody determination. Results: A total of 23 cases of primary AHCVI have been detected from 2000 to 2014. Incidence rates [IR; 95 % confidence interval (CI)] were 0.036 (2.272–0.054) per 100 person-years (py) in the overall population over a follow-up period of 64170 py. Of the 22 (95.7 %) male subjects, 21 (95.5 %) had acquired AHCVI by homosexual contact, the IR (95 % CI) was 0.039 (0.024–0.06) per 100 py in this subpopulation. There was no evidence of an increase of AHCVI IR. The incidence of AHCVI was slightly lower between 2000 and 2004 as compared to 2005–2009 [IR ratio (IRR) of 8.8 (95 % CI: 1.279–378.794; p = 0.01)] but reached a plateau afterwards [IRR between 2010 and 2014 versus 2005–2009: 0.727 (0.286–1.848; p = 0.5)]. The median (Q1-Q3) time between the last negative anti-HCV and the first positive anti-HCV determination was 4.7 (1.9–11.2) months. Peak (Q1-Q3) ALT and total bilirubin values during AHCVI were 496 (291–656) IU/mL and 1.15 (0.9–1.98) mg/dL, respectively. Conclusions: In contrast to what has been reported from other areas, the incidence of primary AHCVI in the HIVinfected population is stable in Southern Spain and there is no evidence of an epidemic, in spite of the high prevalence of HIV/HCV-coinfection in this area.Plan Nacional R + D + I RD12/0017/0012ISCIII-Subdirección General de EvaluaciónFondo Europeo de Desarrollo Regional (FEDER) European Union (EU)Instituto de Salud Carlos III PI15/01124, CP13/00187, Programa-I3SN

Changes in the feeding habits of the bat ray Myliobatis californica (Gill 1865) during climatic anomalies off the west coast of the Baja California Peninsula, Mexico

The Mexican Pacific was influenced by “La Mancha” and “El Niño”, from 2014 and until 2016. The increase in sea surface temperature influenced the feeding habits of the bat ray (Myliobatis californica) in the northwest of Baja California Sur, Mexico. To evaluate possible changes in the diet, stomach content analysis and analysis of stable isotopes of carbon (δC) and nitrogen (δN) in muscle was performed during normal (2012 and 2013) and anomalous years (2014, 2015, and 2016). During the normal years, the main prey was the crab Dynomene spp. (% Prey Specific Relative Importance Index (PSIRI) = 29.3) and the stomatopod Hemisquilla californiensis (% PSIRI = 10.6). In contrast, during the anomalous years, these preys were replaced by the pelagic red crab Pleuroncodes planipes (% PSIRI = 28.5) and peanut worms Sipunculus spp. (% PSIRI = 7.9). During normal years the median isotopic values recorded were: δC = −16.2‰ and δN = 15.2‰. During the anomalous years, δC was −16.3‰ and δN was 15.1‰. Between the different periods no trophic (p (probability) > 0.05) or isotopic overlaps (p > 0.3) were found. The change in the diet of M. californica during the anomalous years is an adaptive response to the increase in water temperature caused by “La Mancha” and “El Niño”. The massive presence of P. planipes on the northwest coast of Baja California Sur is associated with the increase in water temperature, which makes P. planipes a food source for M. californica.To Instituto Politécnico Nacional by fellowships (COFAA, EDI). Also to CONACYT by the grant 253700 and IPN-SIP20160084 and 2017056

El conflicto entre cristianos y musulmanes en las relaciones de sucesos : la liberación de Buda

Este trabajo propone el análisis de una selección de textos escritos en romance sobre la derrota turca y la toma de la ciudad de Buda en 1686, que denuncian la exultante acogida popular de la noticia de las gestas cristianas en Centroeuropa, la percepción del eterno conflicto entre Oriente y Occidente y la proyección del imaginario colectivo del siglo xvii acerca de la lucha contra los infieles.This paper offers the analysis of a selection of texts, written in Romance languages, about the Turkish defeat and the conquest of the city of Buda in 1686, which provide evidence of the popular exultation at the news of the Christian achievements in Central Europe, the perception of the eternal conflict between East and West, and the projection of the seventeenth-century collective imagination regarding the struggle against the infidel

No evidence of firstly acquired acute hepatitis C virus infection outbreak among HIV-infected patients from Southern Spain: a multicentric retrospective study from 2000-2014

[Background] Acute hepatitis C virus (HCV) infection (AHCVI) outbreaks have been described recently within defined areas worldwide among HIV-infected homosexual men. This study aims to describe the cumulative frequency and incidence of firstly acquired AHCVI in an HIV-infected population in Southern Spain.[Methods] This is a retrospective study conducted at the Infectious Diseases Units of eight hospitals in Andalusia, Southern Spain. Primary AHC was considered as HCV immunoglobulin G antibody seroconversion. The time of infection was considered the moment between the last negative and the first positive HCV antibody determination.[Results] A total of 23 cases of primary AHCVI have been detected from 2000 to 2014. Incidence rates [IR; 95 % confidence interval (CI)] were 0.036 (2.272–0.054) per 100 person-years (py) in the overall population over a follow-up period of 64170 py. Of the 22 (95.7 %) male subjects, 21 (95.5 %) had acquired AHCVI by homosexual contact, the IR (95 % CI) was 0.039 (0.024–0.06) per 100 py in this subpopulation. There was no evidence of an increase of AHCVI IR. The incidence of AHCVI was slightly lower between 2000 and 2004 as compared to 2005–2009 [IR ratio (IRR) of 8.8 (95 % CI: 1.279–378.794; p = 0.01)] but reached a plateau afterwards [IRR between 2010 and 2014 versus 2005–2009: 0.727 (0.286–1.848; p = 0.5)]. The median (Q1-Q3) time between the last negative anti-HCV and the first positive anti-HCV determination was 4.7 (1.9–11.2) months. Peak (Q1-Q3) ALT and total bilirubin values during AHCVI were 496 (291–656) IU/mL and 1.15 (0.9–1.98) mg/dL, respectively.[Conclusions] In contrast to what has been reported from other areas, the incidence of primary AHCVI in the HIV-infected population is stable in Southern Spain and there is no evidence of an epidemic, in spite of the high prevalence of HIV/HCV-coinfection in this area.This work has been partially funded by the RD12/0017/0012 project as part of the Plan Nacional R + D + I and cofinanced by ISCIII-Subdirección General de Evaluación, the Fondo Europeo de Desarrollo Regional (FEDER), and the Instituto de Salud Carlos III (grant number PI15/01124). K.N. is the recipient of a Miguel Servet research grant from the Instituto de Salud Carlos III (grant number CP13/00187). J.M. is the recipient of a grant from the Servicio Andaluz de Salud de la Junta de Andalucía (grant number B-0037). J.A.P. is recipient of an intensification grant from the Instituto de Salud Carlos III (grant number Programa-I3SNS).Peer reviewe

Response to Hepatitis A Virus Vaccine in HIV-Infected Patients Within a Retrospective, Multicentric Cohort Facing Hepatitis A Outbreaks in the Clinical Practice

Background] Various recent outbreaks of hepatitis A virus (HAV) have been described in men who have sex with men despite the availability of an effective vaccine. This study aimed to determine the current rates of seroconversion after receiving HAV vaccine (HAV-V) in HIV-infected patients under real-life conditions. Setting: Patients were selected from a Southern Spanish multicentric cohort of HIV-infected subjects. Methods: Retrospective analysis of all patients who received 2 doses (standard scheme) from April 2008 to May 2016 or from June 2016 to February 2018 facing an HAV outbreak with shortage of HAV-V, 1 single dose of HAV-V. Response to HAV-V was defined as positive anti-HAV IgG between 1 and 12 months after the last vaccination dose. Results: A total of 522 patients were included, mainly men who have sex with men (86.2%). In the standard-dose group, 303/343 [88.3%; 95% confidence interval (CI): 84.5 to 91.5] patients showed seroconversion as compared with 149/179 (83.2%; 95% CI: 76.9 to 88.4) of the single-dose group (P = 0.107). Undetectable baseline HIV-RNA (adjusted odds ratio: 4.86; 95% CI: 1.86 to 12.75; P = 0.001) and a CD4+ T-cell count ≥350/μL (adjusted odds ratio, 3.96; 95% CI: 1.26 to 12.49; P = 0.019) were independently associated with response to both regimens. A higher CD4/CD8+ ratio was also associated with response after a single dose. Conclusions: HIV-infected patients should be encouraged to undergo HAV-V with 2 standard doses 6 months apart; a single dose achieves a high rate of seroconversion in those patients with favorable response factors and may be enough to limit future outbreaks in case of HAV-V shortage until supply is reestablished.[Setting] Patients were selected from a Southern Spanish multicentric cohort of HIV-infected subjects.[Methods] Retrospective analysis of all patients who received 2 doses (standard scheme) from April 2008 to May 2016 or from June 2016 to February 2018 facing an HAV outbreak with shortage of HAV-V, 1 single dose of HAV-V. Response to HAV-V was defined as positive anti-HAV IgG between 1 and 12 months after the last vaccination dose.[Results] A total of 522 patients were included, mainly men who have sex with men (86.2%). In the standard-dose group, 303/343 [88.3%; 95% confidence interval (CI): 84.5 to 91.5] patients showed seroconversion as compared with 149/179 (83.2%; 95% CI: 76.9 to 88.4) of the single-dose group (P = 0.107). Undetectable baseline HIV-RNA (adjusted odds ratio: 4.86; 95% CI: 1.86 to 12.75; P = 0.001) and a CD4+ T-cell count ≥350/μL (adjusted odds ratio, 3.96; 95% CI: 1.26 to 12.49; P = 0.019) were independently associated with response to both regimens. A higher CD4/CD8+ ratio was also associated with response after a single dose.[Conclusions] HIV-infected patients should be encouraged to undergo HAV-V with 2 standard doses 6 months apart; a single dose achieves a high rate of seroconversion in those patients with favorable response factors and may be enough to limit future outbreaks in case of HAV-V shortage until supply is reestablished.Peer reviewe

Week 4 response predicts sustained virological response to all-oral direct-acting antiviral-based therapy in cirrhotic patients with hepatitis C virus genotype 3 infection

Grupo de Estudio de Hepatitis Vírica, of the Sociedad Andaluza de Enfermedades Infecciosas y Microbiología Clínica: HEPAVIR / Red de Investigación en SIDA (RIS-HEP07); J. C. Alados-Arboledas, H. Albendín, M. R. Alemán, M. del Mar Alonso, V. Asensi, M. J. Blanco, J. Borrallo, R. Cabo, Á. Camacho, M. F. Casas, Á. Castro, J. Cucurull, S. Cuéllar, F. CuencaI.de los Santos-Gil, C. Dueñas, E. Fernández, C. Galera, M. C. Gálvez, D. García, P. Geijo-Martínez, A. Gómez, J. L. Gómez, F. Gutiérrez, J. Hernández, J. Hernández, J. Llenas-García, M. Mancebo, M. Márquez, J. M. Martín, L. Martínez, R. Martínez-Álvarez, O. Martínez Madrid, M. del Mar Masiá, N. Merchante, D. Merino, P. Monje, R. Nuñez, M. Omar, E. Ortega, S. Padilla, C. Robledano, R. Pelazas, E. Pérez, I. Pérez-Camacho, M. Pérez-Pérez, B. Pernas, J. J. Portu, M. Raffo, L. M. Real, G. Reina, A. Rivero, A. Rivero-Juárez, A. Romero-Palacios, J. Portilla, P. Rubio, P. Ryan-Murua, P. S.de la Hoya, J.Santos, M. Serrano, C. Toyas, F. Vera-Méndez, A. Vergara, M. V. Hernández, D. V. García.[Objective] The aim of this study was to determine the predictive capacity of response at treatment week (TW) 4 for the achievement of sustained virological response 12 weeks after the scheduled end of therapy date (SVR12) to treatment against hepatitis C virus (HCV) genotype 3 (GT3) infection with all-oral direct-acting antiviral (DAA) -based regimens.[Patients and methods] From a prospective multicohort study, HCV GT3-infected patients who completed a course of currently recommended DAA-based therapy at 33 Spanish hospitals and who had reached the SVR12 evaluation time-point were selected. TW4 HCV-RNA levels were categorized as target-not-detected (TND), below the lower limit of quantification (LLOQTD) and ≥LLOQ.[Results] A total of 123 patients were included, 86 (70%) received sofosbuvir/ daclatasvir ± ribavirin, 27 (22%) received sofosbuvir/ ledipasvir/ ribavirin and 10 (8.1%) received sofosbuvir/ ribavirin, respectively. In all, 114 (92.7%) of the 123 patients presented SVR12 in an on-treatment approach, but nine (7.3%) patients relapsed, all of them had presented cirrhosis at baseline. In those who achieved TND, LLOQTD and ≥LLOQ, SVR12 was observed in 81/83 (98%; 95% CI 91.5%–99.7%), 24/28 (85.7%; 95% CI 67.3%–96%) and 9/12 (75%; 95% CI 42.8%–94.5%), respectively; p(linear association) 0.001. Corresponding numbers for subjects with cirrhosis were: 52/54 (96.3%; 95% CI 87.3%–95.5%), 14/18 (77.8%; 95% CI 52.4%–93.6%) and 7/10 (70%; 95% CI 34.8%–93.3%); p 0.004.[Conclusions] TW4-response indicates the probability of achieving SVR12 to currently used DAA-based therapy in HCV genotype 3-infected individuals with cirrhosis. This finding may be useful to tailor treatment strategy in this setting.This work has been partially funded by the RD12/0017/0012 project as part of the Plan Nacional R+D+I and co-financed by ISCIII-Subdirección General de Evaluación, the Fondo Europeo de Desarrollo Regional (FEDER) and the Consejería de Salud of the Junta de Andalucía (grant number AC-0095-2013 and PI-0492-2012). JAP is the recipient of an intensification grant from the Instituto de Salud Carlos III (grant number Programa-I3SNS). JM is the recipient of a grant from the Servicio Andaluz de Salud of the Junta de Andalucía (grant number B-0037). KN is the recipient of a Miguel Servet research grant from the Instituto de Salud Carlos III (grant number CP13/00187)

Treatment of COVID-19 with convalescent plasma in patients with humoral immunodeficiency - Three consecutive cases and review of the literature.

Patients lacking humoral response have been suggested to develop a less severe COVID-19, but there are some reports with a prolonged, relapsing or deadly course. From April 2020, there is growing evidence on the benefits of COVID-19 convalescent plasma (CCP) for patients with humoral immunodeficiency. Most of them had a congenital primary immunodeficiency or were on treatment with anti CD20 antibodies. We report on three patients treated in our hospital and review thirty-one more cases described in the literature. All patients but three resolved clinical picture with CCP. A dose from 200 to 800ml was enough in most cases. Antibody levels after transfusion were negative or low, suggesting consumption of them in SARS-CoV-2 neutralization. These patients have a protracted clinical course shortened after CCP. CCP could be helpful for patients with humoral immunodeficiency. It avoid relapses and chronification. CCP should be transfused as early as possible in patients with COVID-19 and humoral immunodeficiency

Hepatic safety of RPV/FTC/TDF single tablet regimen in HIV/HCV-coinfected patients. Preliminary results of the hEPAtic Study

Introduction: Although hepatotoxicity related to antiretroviral treatment (ART) has become less frequent, hepatotoxic events, such as transaminase elevations (TE), are still a matter of concern. RPV/FTC/TDF (EPA) is a new single tablet regimen which is widely used in real life practice. Clinical trials showed an adequate profile of liver safety in the sub-population of HIV/HCV-coinfected patients receiving rilpivirine. However, the number of individuals included in these analyses is low (1). The aim of this ongoing study is to evaluate the incidence of TE and total bilirubin elevations (TBE) during the first 48 weeks of EPA-based therapy in a large population of HIV/HCV-coinfected subjects outside of clinical trials. Patients and Methods: This is a retrospective analysis of HIV/HCV-coinfected subjects who started EPA at the infectious diseases units of 14 centres throughout Spain, included as cases. Subjects who started an ART different to EPA during the study period at the same hospitals were selected as controls. The primary outcome variables were grade 3 or 4 TE and grade 4 TBE. Results: Of the 191 patients included, 31 (16.2%) subjects were naïve to ART. Eighty-seven individuals started EPA and the remaining ones were controls. The most common NRTI backbone among the controls was TDF/FTC [59 (56.7%) patients] followed by NRTI-sparing regimens [24 (23.1%) individuals] and ABC/3TC [17 (16.3%) subjects]. Among controls, 67 (64.4%) started a ritonavir-boosted protease inhibitor, mainly DRV/r [41 (39.4%) patients] followed by ATV/r [16 (15.4%) subjects]. EFV, ETV and RAL were started in 16 (15.4%), 12 (11.5%) and 13 (12.5%) subjects, respectively. The median (Q1–Q3) follow-up was 5.79 (3.65–8.61) months for the cases and 11.44 (5.8–12.88) months for the controls. TE was observed in two (2.3%) cases versus five (4.8%) controls (p=0.358), accounting for a density of incidence of 4.32/100 person-years versus 5.51/100 person-years [incidence rate difference (95% confidence interval): −1.88 (−9.95–6.2), p=0.354]. All TE were grade 3 and no patient discontinued ART due to TE. None of the cases developed TBE versus four (3.8%) controls, all of them receiving ATV/r. Conclusions: The frequency of grade 3–4 TE associated with EPA in HIV/HCV-coinfected patients under real life conditions is very low. In addition, TE in HIV/HCV-coinfected patients treated with EPA are usually mild and do not lead to treatment discontinuation. TBE was not seen in patients taking EPA. All these data confirm that EPA is safe in this particular subpopulation