Diagnóstico tardío de la infección por VIH: magnitud, factores asociados e impacto

Comunicación presentada en las II Jornada del Centro Nacional de Epidemiología - 2021.Dentro de la Estrategia mundial contra el SIDA 2021-2026 que tiene como lema "Acabar con las desigualdades - Acabar con el sida" se exponen los objetivos y compromisos que se ambicionan para 2025. Se presenta un estudio sobre la presentación tardía al diagnóstico por VIH, los objetivos son: 1. Estimar prevalencia, factores asociados y variaciones en el tiempo de la presentación tardía. 2. Evaluar el impacto de la presentación tardía en el riesgo de desarrollar eventos sida, no-sida y muerte. 3. Evaluar el impacto de la presentación tardía en la efectividad y seguridad del tratamiento antirretroviral (TAR). Se llega a las siguientes conclusiones: 1. La prevalencia de presentación tardía sigue siendo elevada a pesar de una disminución lenta en la ultima década y non obstante las iniciativas puestas en marcha para promover la detección temprana. 2. La presentación tardía se asocia a un mayor morbilidad y mortalidad y a una peor respuesta inmune. y 3. Es necesario implementar estrategias de diagnostico precoz de la infección por VIH, sobre todo para aquellos con mayor riesgo de presentación tardía

Foetal exposure to maternal stressful events increases the risk of having asthma and atopic diseases in childhood

Background:The natural history of asthma and atopic diseases beginsin utero.Studies investigating the influence of foetal exposure to maternal stressful life eventsduring pregnancy (SLEP) on asthma and atopic diseases are lacking.Aim:To test whether the children of mothers who had experienced SLEP are at anincreased risk for asthma, atopic eczema and allergic rhinitis.Methods:The association between maternal SLEP (at least one among: divorce,mourning or loss of the job) and the occurrence of asthma and atopic diseases inchildhood was studied in a population (n = 3854) of children, aged 3–14 yrs, livingin Northern Italy. The parents filled in a standardized questionnaire about the chil-dren’s health and the events occurred to their mothers during pregnancy.Results:Three hundred and thirty-three (9%) of the mothers experienced SLEP.Their children had a statistically significantly higher lifetime prevalence of wheezing(31.6% vs. 23.1%), asthma (8.9% vs. 5.6%), allergic rhinitis (10.9% vs. 7.3%) andatopic eczema (29.7% vs. 21.1%) than those of mothers without SLEP. Afteradjusting for potential confounders, the foetal exposure to SLEP was positivelyassociated with wheezing (OR: 1.41, 95% CI: 1.03–1.94), asthma (OR: 1.71, 95%CI: 1.02–2.89), allergic rhinitis (OR: 1.75, 95% CI: 1.08–2.84) and atopic eczema(OR: 1.53, 95% CI: 1.11–2.10).Conclusion:The children of mothers who had experienced SLEP were at a moder-ately increased risk of having wheezing, asthma, eczema and allergic rhinitis duringtheir childhood. Maternal stress during pregnancy might enhance the expression ofasthma and atopic phenotypes in children.Pediatric Allergy and Immunology724Pediatric Allergy and Immunology23(2012) 724–729ª2012 John Wiley & Sons A/S. Published by Blackwell Publishing Lt

Measurement of a urinary marker (8-hydroxydeoxy-guanosine, 8-OHdG) of DNA oxidative stress in epidemiological surveys: a pilot study

Background: 8-Hydroxydeoxyguanosine (8-OHdG) is a commonly used marker of DNA oxidative stress in epidemiological studies. The aim of this study was to establish whether the urinary concentration of 8-OHdG varies during the first part of the day, when clinical tests are usually performed, and whether it can therefore be measured without bias in spot urine samples. Material and methods: Spot urine samples were collected using a convenience sample. A linear mixed-effects model for repeated measurements was used to analyze 8-OHdG levels. Results: A significant increasing trend in time in the 8-OHdG concentration was found among smokers, but not in the case of nonsmokers. Conclusions: In epidemiological studies on oxidative stress, all participants should collect their early morning urine specimens – before their first cigarette if they are smokers – to gather information on individual background oxidation levels

Microbioma sanguíneo: un desconocido con mucho que contar

Artículo de divulgación publicado en The Conversation España el día 28/08/2022.Ejércitos de bacterias corren también por nuestras venas. Conocerlas mejor puede ayudar a detectar y tratar diversas enfermedades.N

Trends in the prevalence of asthma and allergic rhinitis in Italy between 1991 and 2010

The prevalence of asthma increased worldwide until the 1990s, but since then there has been no clear temporal pattern. The present study aimed to assess time trends in the prevalence of current asthma, asthma-like symptoms and allergic rhinitis in Italian adults from 1990 to 2010. The same screening questionnaire was administered by mail or phone to random samples of the general population (age 20–44 yrs) in Italy, in the frame of three multicentre studies: the European Community Respiratory Health Survey (ECRHS) (1991–1993; n56,031); the Italian Study on Asthma in Young Adults (ISAYA) (1998–2000; n518,873); and the Gene Environment Interactions in Respiratory Diseases (GEIRD) study (2007–2010; n510,494). Time trends in prevalence were estimated using Poisson regression models in the centres that repeated the survey at different points in time. From 1991 to 2010, the median prevalence of current asthma, wheezing and allergic rhinitis increased from 4.1% to 6.6%, from 10.1% to 13.9% and from 16.8% to 25.8%, respectively. The prevalence of current asthma was stable during the 1990s and increased (relative risk 1.38, 95% CI 1.19–1.59) from 1998–2000 to 2007–2010, mainly in subjects who did not report allergic rhinitis. The prevalence of allergic rhinitis has increased continuously since 1991. The asthma epidemic is not over in Italy. During the past 20 yrs, asthma prevalence has increased by 38%, in parallel with a similar increase in asthma-like symptoms and allergic rhiniti

L’esposizione fetale a eventi stressanti per la madre aumenta il rischio di asma e malattie atopiche nell’infanzia

Background: La storia naturale dell’asma e delle malattie atopiche comincia in utero. Mancano studi che indagano l’influenza dell’esposizione fetale a eventi stressanti durante la gravidanza (SLEP) sulla comparsa di asma e di malattie atopiche. Obiettivo: Esaminare se i bambini di madri che hanno sperimentato SLEP presentano un rischio maggiore di asma, eczema atopico e rinite allergica. Metodi: L’associazione tra SLEP della madre (almeno un evento tra divorzio, lutto o perdita del lavoro) e la comparsa di asma e di malattie atopiche nell’infanzia è stata studiata in una popolazione (n = 3854) di bambini di età 3-14 anni che vivono nell’Italia del Nord. I genitori hanno compilato un questionario standardizzato sulla salute dei figli e sugli eventi accaduti alle madri durante la gravidanza. Risultati: 333 (9%) madri hanno sperimentato SLEP. I figli di queste madri hanno nel corso della vita una prevalenza significativamente più alta di wheezing (31,6% vs. 23,1%), asma (8,9% vs. 5,6%), rinite allergica (10,9% vs. 7,3%) e eczema atopico (29,7% vs. 21,1%) rispetto ai bambini di madri che non hanno sperimentato SLEP. Dopo aggiustamento per potenziali confondenti, l’esposizione fetale a SLEP è risultata associata positivamente a wheezing (OR: 1,41, 95% CI: 1,03–1,94), asma (OR: 1,71, 95% CI: 1,02–2,89), rinite allergica (OR: 1,75, 95% CI: 1,08–2,84) e eczema atopico (OR: 1,53, 95% CI: 1,11–2,10). Conclusioni: I bambini di madri che hanno sperimentato SLEP hanno un rischio moderatamente più alto di avere wheezing, asma, eczema e rinite allergica durante la loro infanzia. Lo stress materno durante la gravidanza potrebbe incrementare l’espressione di asma e di fenotipi allergici nei bambini

Mortality due to non-AIDS-defining cancers among people living with HIV in Spain over 18 years of follow-up

Purpose: Our aim was to describe non-AIDS-defining cancer (NADC) mortality among people living with HIV (PLWH), to compare it with that of the general population, and to assess potential risk factors. Methods: We included antiretroviral-naive PLWH from the multicentre CoRIS cohort (2004-2021). We estimated mortality rates and standardised mortality ratios (SMRs). We used cause-specific Cox models to identify risk factors. Results: Among 17,978 PLWH, NADC caused 21% of all deaths observed during the follow-up. Mortality rate due to NADC was 1.58 (95%CI 1.36, 1.83) × 1000 person-years and lung and liver were the most frequent cancer-related causes of death. PLWH had 79% excess NADC mortality risk compared to the general population with the highest SMR found for Hodgkin lymphoma, anal and liver cancers. The SMRs decreased with age and were the highest in age groups under 50 years. The most important prognostic factor was low CD4 count, followed by smoking, viral hepatitis and HIV transmission through heterosexual contact or injection drug use. Conclusion: Non-AIDS cancers are an important cause of death among PLWH. The excess mortality related to certain malignancies and the association with immunodeficiency, smoking, and coinfections highlights the need for early detection and treatment of cancer in this population.Purpose: Our aim was to describe non-AIDS-defining cancer (NADC) mortality among people living with HIV (PLWH), to compare it with that of the general population, and to assess potential risk factors. Methods: We included antiretroviral-naive PLWH from the multicentre CoRIS cohort (2004-2021). We estimated mortality rates and standardised mortality ratios (SMRs). We used cause-specific Cox models to identify risk factors. Results: Among 17,978 PLWH, NADC caused 21% of all deaths observed during the follow-up. Mortality rate due to NADC was 1.58 (95%CI 1.36, 1.83) × 1000 person-years and lung and liver were the most frequent cancer-related causes of death. PLWH had 79% excess NADC mortality risk compared to the general population with the highest SMR found for Hodgkin lymphoma, anal and liver cancers. The SMRs decreased with age and were the highest in age groups under 50 years. The most important prognostic factor was low CD4 count, followed by smoking, viral hepatitis and HIV transmission through heterosexual contact or injection drug use. Conclusion: Non-AIDS cancers are an important cause of death among PLWH. The excess mortality related to certain malignancies and the association with immunodeficiency, smoking, and coinfections highlights the need for early detection and treatment of cancer in this population.Open Access funding provided thanks to the CRUE-CSIC agreement with Springer Nature. This research was supported by CIBER -Consorcio Centro de Investigación Biomédica en Red- (CB21/13/00091), Instituto de Salud Carlos III, Ministerio de Ciencia e Innovación and Unión Europea – NextGenerationEU, the Gilead Scholarship Program for Biomedical Research (GLD19_00106) and the ISCIII- Miguel Servet CP19CIII—00002 contract.S

Low CD4/CD8 ratio is associated with increased morbidity and mortality in late and non-late presenters: results from a multicentre cohort study, 2004–2018

Background To study whether the association between the CD4/CD8 ratio variation over time and the development of clinical outcomes vary in late presenters (CD4 count 0.4, CD4/CD8 ratio 0.4, regardless of the late presentation status. Conclusions A low CD4/CD8 measured over time is associated with increased risk of morbidity and mortality in people living with HIV independently of their late presentation status. These data support the prognostic role of CD4/CD8 over time and can help defining a subgroup of patients who need closer monitoring to avoid comorbidities

Late presentation for HIV remains a major health issue in Spain: Results from a multicenter cohort study, 2004-2018.

With the purpose of reducing the well-known negative impact of late presentation (LP) on people living with HIV (PLWH), guidelines on early HIV diagnosis were published in 2014 in Spain, but since then no data on LP prevalence have been published. To estimate prevalence and risk factors of LP and to evaluate their impact on the development of clinical outcomes in the Cohort of the Spanish HIV/AIDS Research Network (CoRIS) during 2004-2018. CoRIS is an open prospective multicenter cohort of PLWH, adults, naive to ART at entry. LP was defined as HIV diagnosis with CD4 count ≤350 cells/μL or an AIDS defining event (ADE). Multivariable Poisson regression models were used to estimate both prevalence ratios (PR) for the association of potential risk factors with LP and Incidence rate ratios (IRRs) for its impact on the development of the composite endpoint (first ADE, first serious non-AIDS event [SNAE] or overall mortality). 14,876 individuals were included. Overall, LP prevalence in 2004-2018 was 44.6%. Risk factors for LP included older age, having been infected through injection drug use or heterosexual intercourse, low educational level and originating from non-European countries. LP was associated with an increased risk of the composite endpoint (IRR: 1.34; 95%CI 1.20, 1.50), ADE (1.39; 1.18, 1.64), SNAE (1.22; 1.01, 1.47) and mortality (1.71; 1.41, 2.08). LP remains a health problem in Spain, mainly among certain populations, and is associated with greater morbidity and mortality. Public policies should be implemented to expand screening and early diagnosis of HIV infection, for a focus on those at greatest risk of LP.RR received funds from Gilead for this work.The funders had no role in study design,data collection and analysis, decision to publish,or preparation of the manuscript.S

Are Reduced Levels of Coagulation Proteins Upon Admission Linked to COVID-19 Severity and Mortality?

Background: The link between coagulation system disorders and COVID-19 has not yet been fully elucidated. Aim: Evaluating the association of non-previously reported coagulation proteins with COVID-19 severity and mortality. Design: Cross-sectional study of 134 COVID-19 patients recruited at admission and classified according to the highest COVID-19 severity reached (asymptomatic/mild, moderate, or severe) and 16 healthy control individuals. Methods: Coagulation proteins levels (antithrombin, prothrombin, factor_XI, factor_XII, and factor_XIII) and CRP were measured in plasma by the ProcartaPlex Panel (Invitrogen) multiplex immunoassay upon diagnosis. Results: We found higher levels of antithrombin, prothrombin, factor XI, factor XII, and factor XIII in asymptomatic/mild and moderate COVID-19 patients compared to healthy individuals. Interestingly, decreased levels of antithrombin and factors XI, XII, and XIII were observed in those patients who eventually developed severe illness. Additionally, survival models showed us that patients with lower levels of these coagulation proteins had an increased risk of death. Conclusion: COVID-19 provokes early increments of some specific coagulation proteins in most patients. However, lower levels of these proteins at diagnosis might "paradoxically" imply a higher risk of progression to severe disease and COVID-19-related mortality.This study was supported by grants from Instituto de Salud Carlos III [ISCIII; Grant Number COV20/1144 (MPY224/20) to AF-R/MJ-S]. AF-R, MJ-S, and MR are Miguel Servet researchers supported and funded by ISCIII (Grant Numbers: CP14CIII/00010 to AF-R, CP17CIII/00007 to MJ-S, and CP19CIII/00002 to MR).S