Risk factors for sexual and erectile dysfunction in HIV-infected men: the role of protease inhibitors

Objectives: To determine the prevalence of erectile dysfunction in a cohort of HIV-infected men in a stable clinical state, the effect of exposure to antiretroviral therapy on sexual dysfunction and to identify the risk factors.Design: This is a cross-sectional, observational study.Methods: HIV-infected men without hepatitis C virus coinfection were included if they were antiretroviral therapy-naive (naive group), on current treatment with an enhanced protease inhibitor (protease inhibitor group) or on current treatment with two to three nucleoside reverse transcriptase inhibitors along with one nonnucleoside reverse transcriptase inhibitor and never having received treatment with protease inhibitor (nonnucleoside reverse transcriptase inhibitor group). Erectile dysfunction was defined as an ejection fraction of 25 or less (International Index of Erectile Function-15).Results: Ninety patients were included, with an age of 42 +/- 8.2 years and CD4 cell count of 465 cells/microl [P25-75 361-676]: 18.9% in Centers for Disease Control and Prevention class C and 72.2% with undetectable viral load. Seventy-six patients (84.4%) were receiving antiretroviral therapy, 39 (43.3%) in the protease inhibitor group. The prevalence of lipodystrophy was 31.5%. Forty-seven (53.4%) patients had an erectile dysfunction. Multivariate logistic regression analysis confirmed that there was an independent association between the patients' age (per decade; odds ratio 2.2, 95% confidence interval 1.04-4.5, P = 0.04) and greater duration of exposure to protease inhibitor (per year; odds ratio 1.6, 95% confidence interval 1.12-2.4, P = 0.01). Older age, depression and lipodystrophy, combined with the duration of exposure to protease inhibitor, determined a lower score on various sexual dysfunction domains (P < 0.05).Conclusion: There is a high prevalence of erectile dysfunction in HIV-infected men, with age and the duration of exposure to protease inhibitor being the only identifiable risk factors

Effectiveness and safety of integrase strand transfer inhibitors in Spain: a prospective real-world study

IntroductionSecond-generation integrase strand transfer inhibitors (INSTIs) are preferred treatment options worldwide, and dolutegravir (DTG) is the treatment of choice in resource-limited settings. Nevertheless, in some resource-limited settings, these drugs are not always available. An analysis of the experience with the use of INSTIs in unselected adults living with HIV may be of help to make therapeutic decisions when second-generation INSTIs are not available. This study aimed to evaluate the real-life effectiveness and safety of dolutegravir (DTG), elvitegravir/cobicistat (EVG/c), and raltegravir (RAL) in a large Spanish cohort of HIV-1-infected patients. MethodsReal-world study of adults living with HIV who initiated integrase INSTIs DTG, EVG/c, and RAL-based regimens in three settings (ART-naive patients, ART-switching, and ART-salvage patients). The primary endpoint was the median time to treatment discontinuation after INSTI-based regimen initiation. Proportion of patients experiencing virological failure (VF) (defined as two consecutive viral loads (VL) & GE;200 copies/mL at 24 weeks or as a single determination of VL & GE;1,000 copies/mL while receiving DTG, EVG/c or RAL, and at least 3 months after INSTI initiation) and time to VF were also evaluated. ResultsVirological effectiveness of EVG/c- and RAL-based regimens was similar to that of DTG when given as first-line and salvage therapy. Treatment switching for reasons other than virological failure was more frequent in subjects receiving EVG/c and, in particular, RAL. Naive patients with CD4+ nadir <100 cells/& mu;L were more likely to develop VF, particularly if they initiated RAL or EVG/c. In the ART switching population, initiation of RAL and EVG/c was associated with both VF and INSTI discontinuation. There were no differences in the time to VF and INSTI discontinuation between DTG, EVG/c and RAL. Immunological parameters improved in the three groups and for the three drugs assessed. Safety and tolerability were consistent with expected safety profiles. DiscussionWhereas second-generation INSTIs are preferred treatment options worldwide, and DTG is one of the treatment of choices in resource-limited settings, first-generation INSTIs may still provide high virological and immunological effectiveness when DTG is not available

La profesión del diseño. Expresiones y experiencias

Universidad Autónoma del Estado de MéxicoEl mundo de las profesiones está cambiando rápidamente en las última tres décadas, no existe profesión alguna que permanezca estática ante el impacto del desarrollo tecnológico. En el caso de la profesión del diseño se ha trastocado su concepción, fundamento y acción ante el advenimiento de la era digital. El desarrollo tecnológico de la era digital ha provocado una disrupción en la industria y en los servicios, estamos ante la cuarta revolución industrial y de servicios (4.0 RIS), que demanda un nuevo diseñador con cualidades renovadas preparado para el manejo de nuevas tecnologías y de nuevos materiales con ideas innovadoras y creativas que responda a una visión sustentable, aplicable y funcional de los objetos, productos, sistemas y procesos. Frente a la emergencia de ecosistemas industriales y de servicios emergentes la profesión de diseño se coloca como la profesión del futuro. Esto exige conocer la realidad actual de ésta profesión para pensar en el futuro mediato; con este espíritu, nace la obra que el lector tiene en sus manos: La profesión del diseño, expresiones y experiencias. Estamos ciertos que hoy existe una convivencia de paradigmas de las revoluciones industriales, diseños basados en tecnologías manuales, mecánicas, automáticas y digitales. Cada tecnología trae consigo su marco interpretativo teórico, contextual e histórico, riqueza que se muestra, en esta dirección, en las páginas de este libro. En este libro participan diseñadores industriales y gráficos –y uno que otro invitado no diseñador- que nos comparten de forma apasionada sus expresiones y experiencias que van desde la preocupación con miras al futuro del 2030 hasta propuesta de una formación creativa para el diseñador a través del desarrollo del Jugendgarten. También, se presenta la dimensión simbólica del diseño arquitectónico a través de sus formas geométricas y sus rituales sagrados. No se olvidan las dimensiones del desarrollo humano y de las expresiones posmodernas del diseño; así como, de las miradas antropológica, sociocultural, de identidad y de género. Sin duda alguna, se muestra tres momentos históricos del diseño: artesanal, industrial y digital.La profesión del diseño, expresiones y experiencias, es un libro orgánico con la participación de especialistas en diseño que comparten sus puntos de vista y sus experiencias. Brinda un profundo análisis de la situación que guarda el diseño en los contextos social, industrial, empresarial y académico. Una de las conclusiones relevantes es que la profesión del diseño es una profesión del futuro porque la acción de diseñar es inherente a la transformación del mundo en la cuarta revolución industrial resultado de la evolución científica y tecnológica. Sus coordinadores, estudiosos de la temática, gozan del prestigio en la comunidad científica, son integrantes del Sistema Nacional de Investigadores, la Dra. Ana María Reyes Fabela (Nivel I) y el Dr. René Pedroza Flores (Nivel II); además, este último, es integrante de la Academia Mexicana de la Ciencia (Máximo órgano de la comunidad de científicos en México)

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)

Effectiveness and safety of integrase strand transfer inhibitors in Spain: a prospective real-world study

IntroductionSecond-generation integrase strand transfer inhibitors (INSTIs) are preferred treatment options worldwide, and dolutegravir (DTG) is the treatment of choice in resource-limited settings. Nevertheless, in some resource-limited settings, these drugs are not always available. An analysis of the experience with the use of INSTIs in unselected adults living with HIV may be of help to make therapeutic decisions when second-generation INSTIs are not available. This study aimed to evaluate the real-life effectiveness and safety of dolutegravir (DTG), elvitegravir/cobicistat (EVG/c), and raltegravir (RAL) in a large Spanish cohort of HIV-1-infected patients.MethodsReal-world study of adults living with HIV who initiated integrase INSTIs DTG, EVG/c, and RAL-based regimens in three settings (ART-naïve patients, ART-switching, and ART-salvage patients). The primary endpoint was the median time to treatment discontinuation after INSTI-based regimen initiation. Proportion of patients experiencing virological failure (VF) (defined as two consecutive viral loads (VL) ≥200 copies/mL at 24 weeks or as a single determination of VL ≥1,000 copies/mL while receiving DTG, EVG/c or RAL, and at least 3 months after INSTI initiation) and time to VF were also evaluated.ResultsVirological effectiveness of EVG/c- and RAL-based regimens was similar to that of DTG when given as first-line and salvage therapy. Treatment switching for reasons other than virological failure was more frequent in subjects receiving EVG/c and, in particular, RAL. Naïve patients with CD4+ nadir &lt;100 cells/μL were more likely to develop VF, particularly if they initiated RAL or EVG/c. In the ART switching population, initiation of RAL and EVG/c was associated with both VF and INSTI discontinuation. There were no differences in the time to VF and INSTI discontinuation between DTG, EVG/c and RAL. Immunological parameters improved in the three groups and for the three drugs assessed. Safety and tolerability were consistent with expected safety profiles.DiscussionWhereas second-generation INSTIs are preferred treatment options worldwide, and DTG is one of the treatment of choices in resource-limited settings, first-generation INSTIs may still provide high virological and immunological effectiveness when DTG is not available

Bifurcation analysis of synchronized microwave circuits using commercial software

In this paper a new method is proposed for obtaining the complete synchronization curves of injected oscillators or analog frequency dividers, using harmonic balance (HB) commercial simulators. The bifurcation loci on the input power-input frequency plane, globally providing the circuit operating bands can also be obtained. The new method offers an invaluable aid to microwave designers, avoiding the need for specific in-house simulation tools and taking advantage of the flexibility and friendliness of standard commercial software. The method is illustrated by means of its application to the design of a frequency divider by two, obtaining for the first time, to our knowledge, complete synchronization curves and bifurcation loci from a commercial simulator. Under some modifications, the method is applicable to tuned circuits. Simulation and measurements of a MMIC VCO are shown for experimental validation

Nueva tecnica de extraccion para modelos de FET y HEMT

International audienc

Modelo mejorado de FET para applicaciones de alta potencia

International audienc

Topologia optima de amplificadores distribuidos de potencia a MESFET

International audienc

A pulsed S-parameters measurement setup for the nonlinear characterization of FETs and bipolar power transistors

International audienceA pulsed I(V) and S-parameters setup for the RF modeling of semi-conductor devices is described. The management of the whole setup as well as the database is made by an object-oriented software, which provides a large amount of modularity and reusability of the different tools developed. Measurements capability on power devices is demonstrated as well as the S-parameters measurements capabilities in critical regions of FET devices. I(V) and RF measures are presented. These measurements provide a nonlinear small-signal equivalent circuit function of the command voltages