Mixofibrosarcoma: un diagnóstico infrecuente

Myxofibrosarcoma is a mesenchymal tumor typical of elderly patients and it has an infiltrative pattern mainly at local level, which fundamentally requires adequate characterization by nuclear magnetic resonance (MRI) and core needle biopsy (CNB), as well as a multidisciplinary team for its treatment. We present the case of an 85-year-old patient with a painless mass on the right thigh who was admitted to the Internal Medicine Unit for initial treatment of a condensing respiratory infection. Finally, after an extensive study, she was diagnosed with myxofibrosarcoma.El mixofibrosarcoma es una tumoración de estirpe mesenquimal propia de pacientes de edad avanzada que tiene un patrón infiltrativo predominante a nivel local. Precisa de una adecuada caracterización mediante resonancia magnética nuclear (RMN) y biopsia por aguja gruesa (BAG), así como un equipo multidisciplinar para su tratamiento. Presentamos el caso de una paciente de 85 años con una masa indolora a nivel del muslo derecho que ingresó en el Servicio de Medicina Interna para tratamiento inicial por una infección respiratoria condensante. Finalmente se hizo un estudio de extensión y fue diagnosticada de mixofibrosarcoma

Different HCV Exposure Drives Specific miRNA Profile in PBMCs of HIV Patients

Micro RNAs (miRNAs) are essential players in HIV and HCV infections, as both viruses modulate cellular miRNAs and interact with the miRNA-mediated host response. We aim to analyze the miRNA profile of HIV patients with different exposure to HCV to explore specific signatures in the miRNA profile of PBMCs for each type of infection. We massively sequenced small RNAs of PBMCs from 117 HIV+ infected patients: 45 HIV+ patients chronically infected with HCV (HIV/HCV+), 36 HIV+ that spontaneously clarified HCV after acute infection (HIV/HCV-) and 36 HIV+ patients without previous HCV infection (HIV). Thirty-two healthy patients were used as healthy controls (HC). Differential expression analysis showed significantly differentially expressed (SDE) miRNAs in HIV/HCV+ (n = 153), HIV/HCV- (n = 169) and HIV (n = 153) patients. We found putative dysregulated pathways, such as infectious-related and PI3K signaling pathways, common in all contrasts. Specifically, putatively targeted genes involved in antifolate resistance (HIV/HV+), cancer-related pathways (HIV/HCV-) and HIF-signaling (HIV) were identified, among others. Our findings revealed that HCV strongly influences the expression profile of PBMCs from HIV patients through the disruption of its miRNome. Thus, different HCV exposure can be identified by specific miRNA signatures in PBMCs.This work has been supported by grants from Institute of Health Carlos III, [PI15CIII/00031 and PI18CIII/00020/ to AFR and VB] and the Foundation Universidad Alfonso X el Sabio-Santander [grant number 1.010.932 to AFR] and the Spanish AIDS Research Network (RD16CIII/0002/0002), and Centro de Investigación Biomédica en Red (CIBER) en Enfermedades Infecciosas (CB21/13/00044). AFR is supported by the Miguel Servet programme from Fondo de Investigación Sanitaria (ISCIII) [CP14/CIII/00010 and CPII20CIII/0001].info:eu-repo/semantics/publishedVersio

HCV-coinfection is related to an increased HIV-1 reservoir size in cART-treated HIV patients: a cross-sectional study

In HIV-1/HCV-coinfected patients, chronic HCV infection leads to an increased T-lymphocyte immune activation compared to HIV-monoinfected patients, thereby likely contributing to increase HIV-1 reservoir that is the major barrier for its eradication. Our objective was to evaluate the influence of HCV coinfection in HIV-1 viral reservoir size in resting (r) CD4+ T-cells (CD25-CD69-HLADR-). Multicenter cross-sectional study of 97 cART-treated HIV-1 patients, including 36 patients with HIV and HCV-chronic co-infection without anti-HCV treatment, 32 HIV patients with HCV spontaneous clearance and 29 HIV-monoinfected patients. rCD4+ T-cells were isolated and total DNA was extracted. HIV viral reservoir was measured by Alu-LTR qPCR. Differences between groups were calculated with a generalized linear model. Overall, 63.9% were men, median age of 41 years and Caucasian. Median CD4+ and CD8+ T-lymphocytes were 725 and 858 cells/mm 3 , respectively. CD4+ T nadir cells was 305 cells/mm 3 . Proviral HIV-1 DNA size was significantly increased in chronic HIV/HCV-coinfected compared to HIV-monoinfected patients (206.21 ± 47.38 vs. 87.34 ± 22.46, respectively; P = 0.009), as well as in spontaneously clarified HCV co-infected patients when compared to HIV-monoinfected individuals (136.20 ± 33.20; P = 0.009). HIV-1/HCV co-infected patients showed a larger HIV-1 reservoir size in comparison to HIV-monoinfected individuals. This increase could lead to a greater complexity in the elimination of HIV-1 reservoir in HIV-1/HCV-coinfected individuals, which should be considered in the current strategies for the elimination of HIV-1 reservoir.Financial support was provided by the Instituto de Salud Carlos III to VB (PI15CIII/00031), by the Spanish Ministry of Economy and Competitiveness to MC (SAF2016–78480-R) and The SPANISH AIDS Research Network RD16CIII/0002/0001, RD16CIII/0002/0002 and RD16/0025/0013 - ISCIII – FEDER. MRLP is supported by ISCIII - Subdirección General de Evaluacion and European Funding for Regional Development (FEDER) (PIE 13/00040 and RD12/0017/0017 RETIC de SIDA). C.P. is supported by the Portuguese Fundação para a Ciência e Tecnologia (FCT) (grant number SFRH/ BPD/77448/2011 is part of the EDCTP2 programme supported by the European Union). V.B., A.F.R. and N.R. are supported by the Miguel Servet programme from Fondo de Investigación Sanitaria (ISCIII) (grant number CP13/00098, CP14/CIII/00010 and CP14/00198, respectively)

Boosted protease inhibitor monotherapy. What have we learnt after seven years of research

Boosted protease inhibitor monotherapy has emerged as an antiretroviral alternative option to avoid the use of nucleosides. After more than seven years of research with hundreds of patients exposed to this kind of therapy, controversy about its use remains. While European and Spanish guidelines for the use of antiretroviral therapy in adults include monotherapy as an alternative for simplification, experts in the USA express the view that this strategy cannot be currently recommended. Our conclusion, after more than seven years of research, is that simplification of a suppressive triple antiretroviral therapy to boosted protease inhibitor monotherapy has demonstrated safety and efficacy in a high proportion of patients. Although this is not a strategy to implement indiscriminately in all patients, it could be a good option for those patients with toxicity related to nucleoside reverse transcriptase inhibitors, or for trying to avoid such toxicities in virologically controlled patients without previous failure to protease inhibitors, restarting nucleosides if the viral load does not remain undetectable. If simplification to monotherapy is selected to treat some patients, twice-daily lopinavir/ritonavir, or preferably once-daily darunavir/ritonavir, should be chosen as data with other boosted protease inhibitors are inconclusive or even nonexistent. Nevertheless, more studies focusing on the control of HIV replication in viral reservoirs with monotherapy, as with triple therapy, are warranted.4.786 JCR (2010) Q1, 23/134 Immunology, 7/58 Infectious disease

Enfermedades no sida (enos) en pacientes con presentación tardía de la infección VIH

Instituto de Investigación Hospital 12 de Octubre1.530 JCR (2015) Q3, 59/83 Infectious diseases; Q4, 97/123 MicrobiologyUE

Tratamiento antirretroviral dual (TAD) basado en inhibidor de proteasa potenciado (IP/R) en la vida real: COHORTE HIV-DOC

Sin financiación2.172 JCR (2014) Q3, 53/78 Infectious diseases, 77/119 MicrobiologyUE

Análisis de las interrupciones del tratamiento del VHC con terapias libres de Interferón en pacientes coinfectados por el VIH

El objetivo de este poster es conocer la prevalencia y describir las características clínicas y epidemiológicas de los pacientes que interrumpen el tratamiento frente al VHC con combinaciones de AAD sin IFN, en una cohorte de pacientes coinfectados por VIH, en vida real. Analizar los posibles factores asociados con la discontinuación.Sin financiación1.714 JCR (2016) Q3, 89/125 Microbiology; Q4, 65/84 Infectious DiseasesUE

Changes in lipid profile during and after hepatitis C virus (HCV) treatment with direct-acting antiviral (DAA), interferon-free regimens in patients co-infected with HIVSID

Sin financiación6.296 JCR (2016) Q1, 23/151 Immunology, 6/84 Infectious DiseasesUE

Efectividad y tolerancia de los nuevos antivirales de acción directa en el tratamiento de la infección crónica por el VHC en pacientes con infección por el VIH

El objetivo de este póster es describir la efectividad y tolerancia frente al VHC de las combinaciones de AAD sin IFN, en una cohorte de pacientes con coinfección por VIH y VHC, en vida real.Sin financiación1.714 JCR (2016) Q3, 89/125 Microbiology; Q4, 65/84 Infectious DiseasesUE

Changes of liver function parameters and estimated fibrosis after HCV eradication with IFN-free therapy in cirrhotic HIV co-infected patients

Objectives: laboratory parameters improve in cirrhotic HCV mono-infected patients after sustained virological response (SVR24) with all-oral direct-acting antivirals (DAA). We analyzed biochemical tests of liver function, liver stiffness (LS) and clinical events in HIV/HCV co-infected patients with cirrhosis after HCV eradication with DAA. Methods: HIV/HCV patients included in the cohort “VIH-DOC” were eligible if treated with DAA between 9th January 2015 and 31st August 2016, presented LS≥14.6 kPa or unequivocal clinical data of cirrhosis before treatment, and confirmed SVR24. Serum albumin, total bilirubin, platelet count, serum creatinine and International Normalized Ratio (INR) values were collected at baseline, week 4, end of therapy (EOT) and SVR24. The Model for End-stage Liver Disease (MELD) score was calculated at baseline, EOT and SRV24, excluding patients with oral anticoagulation and/or atazanavir as treatment. LS was evaluated and FIB-4 calculated at baseline and SVR24. Means were compared with T-Student tests or repeated measures ANOVA tests. Results: There were 129 patients with LS≥14.6 kPa and one patient with lower LS but clinical evidence of cirrhosis. SVR24 was confirmed in 119 (91.5%) Table 1 Age: mean (years) (SD) 51.0 (5.1) Gender: n (%) Male / Female 87 (73.1) / 32 (26.9) Transmission mechanism: n (%) People who inject(ed) drugs / Heterosexual / Men who have sex with men 108 (90.8) / 10 (8.4) / 1 (0.8) Time since HCV infection or diagnosis: median (years) (IQR) 29.4 (24.7 - 33.4) Basal HCV-RNA: median (UI/mL) (IQR) 1765728 (351886 - 4193546) Basal liver stiffness estimated by transient elastography: median (kPa) (IQR) 25.7 (18.0 - 35.3) Basal Fibrosis-4 (FIB4) score: median (IQR) 4.24 (2.70 - 6.13) Previous diagnosis of hepatocellular carcinoma: n (%) 4 (3.4) Previous clinical liver decompensation event: n (%) 26 (21.8) Previous liver transplant with HCV relapse on the liver graft: n (%) 1 (0.8) [Table 1: Baseline characteristics] shows baseline characteristics. At SVR24 vs. baseline, there were higher albumin (4.55 g/dL vs. 4.25 g/dL, p< 0.001) and platelet count (135800/mcL vs. 118700/mcL, p< 0.001); and lower bilirubin (0.91 mg/dL vs. 1.21 mg/dL, p< 0.001) and MELD score (7.96 vs. 8.39, p=0.045). When comparing baseline vs. SVR24, LS mean decrease was 6.27 kPa (95%CI: 3.71-8.83, p< 0.001) and FIB-4 mean decrease was 1.79 (95%CI: 1.44-2.14, p< 0.001). Two and eight patients developed liver decompensation during or after treatment, respectively. Three deaths occurred in the follow-up (2.5%): two of them due to malignant neoplasms; the third because of a spontaneous intracranial hemorrhage. Conclusion: SVR24 associates improvement in liver function and fibrosis tests of HIV/HCV co-infected patients with cirrhosis. Nevertheless, clinical events still happen.Sin financiaciónNo data (2017)UE