Historia natural y clasificación de la infección por VIH-1

El espectro de la infección por VIH varía ampliamente desde la infección asintomática hasta una fase de inmunodeficiencia celular grave. Factores dependientes del virus, del huésped y cofactores ambientales condicionan la gran variabilidad existente en la pro¬gresión a SIDA. La carga vírica y el nivel de linfocitos CD4+ se han perfilado como los parámetros más útiles para predecir la evolución a SIDA. En los últimos años con la introducción de la terapia antirretrovírica de alta eficacia se está observando un cam¬bio en la historia natural de la infección, con un marcado descenso de la mortalidad por SIDA, apreciándose un incremento en la mortalidad por causas independientes del propio VIH, tales como hepatopatias y cáncer. En el presente trabajo se revisan las diferentes definiciones de SIDA y se analiza la necesidad de incorporar a los sistemas de vigilancia epidemiológica la notificación de la infección por VIH como complementa¬ria a la de los casos de SIDA

Demographic, clinical, and functional determinants of antithrombotic treatment in patients with nonvalvular atrial fibrillation

Altres ajuts: Alliance Bristol-Myers Squibb/Pfizer.Background: This study assessed the sociodemographic, functional, and clinical determinants of antithrombotic treatment in patients with nonvalvular atrial fibrillation (NVAF) attended in the internal medicine setting. Methods: A multicenter, cross-sectional study was conducted in NVAF patients who attended internal medicine departments for either a routine visit (outpatients) or hospitalization (inpatients). Results: A total of 961 patients were evaluated. Their antithrombotic management included: no treatment (4.7%), vitamin K antagonists (VKAs) (59.6%), direct oral anticoagulants (DOACs) (21.6%), antiplatelets (6.6%), and antiplatelets plus anticoagulants (7.5%). Permanent NVAF and congestive heart failure were associated with preferential use of oral anticoagulation over antiplatelets, while intermediate-to high-mortality risk according to the PROFUND index was associated with a higher likelihood of using antiplatelet therapy instead of oral anticoagulation. Longer disease duration and institutionalization were identified as determinants of VKA use over DOACs. Female gender, higher education, and having suffered a stroke determined a preferential use of DOACs. Conclusions: This real-world study showed that most elderly NVAF patients received oral anticoagulation, mainly VKAs, while DOACs remained underused. Antiplatelets were still offered to a proportion of patients. Longer duration of NVAF and institutionalization were identified as determinants of VKA use over DOACs. A poor prognosis according to the PROFUND index was identified as a factor preventing the use of oral anticoagulation