34 research outputs found
Eligibility for and outcome of treatment of latent tuberculosis infection in a cohorte of HIV-infected people in Spain
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
Prevalence and Resistance Mutations of HIV-1 non-B subtypes Among Immigrants in Southern Spain Along the Decade 2000-2010
High-resolution anoscopy in HIV-infected men: Assessment of the learning curve and factors that improve the performance
To determine the required learning time for high-resolution anoscopy (HRA)-guided biopsy to detect
histological high-risk squamous intraepithelial lesions (hHSIL) and to identify factors that impact on the training
process.
Methods: All HIV-infected, screening-naïve men-who-have-sex-with-men who underwent HRA conducted by one
single observer from 2010 to 2017 in a Spanish HIV-outpatient clinic were analysed.
Results: Eighty-five (14.7%) of the 581 patients included presented hHSIL. The factors associated with the capacity
to detect hHSIL [adjusted odds ratio (aOR), 95% confidence interval (95%CI)] were the presence of
cytological HSIL (3.04, 1.78–5.21; p < 0.001), infection with high-risk human papilloma virus (HR-HPV) (2.89,
1.38–6.05; p=0.005), the number of biopsies taken/HRA (aOR: 1.28, 1.07–1.52; p=0.006) and tobacco
smoking (1.75; 1.12–2.73; p=0.014). Two events independently augmented the detection rate of hHSIL: one
single experienced pathologist interpreted biopsies after 409 HRA (2.80, 1.74–4.48; p=0.035) and the anoscopist
underwent an additional training after 536 HRA (2.57, 1.07–6.16; p=0.035). A learning process could be
observed throughout the whole study with stable HR-HPV prevalence.
Conclusion: The data support the growing evidence that the proposed training volume of 50–200 performances is
underestimated. Extensive training of both anoscopist and pathologist is warranted and the development of tools to support the diagnostic performance may be considered.Plan Nacional R+D+I y Red de Investigación en SIDA RD16/0025/0020-ISCIII-FEDMiguel Servet research grant, Instituto de Salud Carlos III CPII18/0003
Método de detección precoz de resistencias al tratamiento antirretroviral en VIH
Método de detección precoz de resistencias al
tratamiento antirretroviral en VIH.
La invención se refiere a una pareja de cebadores
capaces de amplificar el gen pol del virus de
inmunodeficiencia humana (VIH) a partir de muestras
plasmáticas que contienen bajos niveles de carga
viral (entre 10 y 1.000 copias de RNA viral/mL de
plasma, más preferiblemente entre 20 y 1.000
copias/mL y aún más preferiblemente entre 20 y 100
copias/mL). Así, estos cebadores permiten la
detección de VIH en muestras biológicas que
presentan baja carga viral. El ARN del VIH así
detectado se puede genotipar para, posteriormente,
establecer un perfil de mutaciones de resistencia al
tratamiento antirretroviral (TAR) en el VIH en
pacientes que presentan una carga viral baja. Los
métodos de la invención pueden, por tanto, ser
empleados para la detección temprana de las
mutaciones que en el VIH son responsables del
fracaso del TAR incluso en los casos en los que los
niveles de viremia en plasma son bajos, lo que
permite modificar el tratamiento precozmente, evitar
la aparición de nuevas mutaciones y proteger la
eficacia de fármacos del régimen de tratamiento
actual y de otros que puedan ser administrados en un
futuro.Españ
Impact of late presentation of HIV infection on short-, mid- and long-term mortality and causes of death in a multicenter national cohort: 2004–2013
SummaryObjectivesTo analyze the impact of late presentation (LP) on overall mortality and causes of death and describe LP trends and risk factors (2004–2013).MethodsCox models and logistic regression were used to analyze data from a nation-wide cohort in Spain. LP is defined as being diagnosed when CD4 < 350 cells/ml or AIDS.ResultsOf 7165 new HIV diagnoses, 46.9% (CI95%:45.7–48.0) were LP, 240 patients died.First-year mortality was the highest (aHRLP.vs.nLP = 10.3[CI95%:5.5–19.3]); between 1 and 4 years post-diagnosis, aHRLP.vs.nLP = 1.9(1.2–3.0); and >4 years, aHRLP.vs.nLP = 1.5(0.7–3.1).First-year's main cause of death was HIV/AIDS (73%); and malignancies among those surviving >4 years (32%). HIV/AIDS-related deaths were more likely in LP (59.2% vs. 25.0%; p < 0.001). LP declined from 55.9% (2004–05) to 39.4% (2012–13), and reduced in 46.1% in men who have sex with men (MSM) and 37.6% in heterosexual men, but increased in 22.6% in heterosexual women.Factors associated with LP: sex (ORMEN.vs.WOMEN = 1.4[1.2–1.7]); age (OR31–40.vs.<30 = 1.6[1.4–1.8], OR41–50.vs.<30 = 2.2[1.8–2.6], OR>50.vs.<30 = 3.6[2.9–4.4]); behavior (ORInjectedDrugUse.vs.MSM = 2.8[2.0–3.8]; ORHeterosexual.vs.MSM = 2.2[1.7–3.0]); education (ORPrimaryEducation.vs.University = 1.5[1.1–2.0], ORLowerSecondary.vs.University = 1.3[1.1–1.5]); and geographical origin (ORSub-Saharan.vs.Spain = 1.6[1.3–2.0], ORLatin-American.vs.Spain = 1.4[1.2–1.8]).ConclusionsLP is associated with higher mortality, especially short-term- and HIV/AIDS-related mortality. Mid-term-, but not long-term mortality, remained also higher in LP than nLP. LP decreased in MSM and heterosexual men, not in heterosexual women. The groups most affected by LP are low educated, non-Spanish and heterosexual women
Safety and Efficacy of Dolutegravir in Treatment-Experienced Subjects With Raltegravir-Resistant HIV Type 1 Infection: 24-Week Results of the VIKING Study
Background. Dolutegravir (DTG; S/GSK1349572), a human immunodeficiency virus type 1 (HIV-1) integrase inhibitor, has limited cross-resistance to raltegravir (RAL) and elvitegravir in vitro. This phase IIb study assessed the activity of DTG in HIV-1–infected subjects with genotypic evidence of RAL resistance.Methods. Subjects received DTG 50 mg once daily (cohort I) or 50 mg twice daily (cohort II) while continuing a failing regimen (without RAL) through day 10, after which the background regimen was optimized, when feasible, for cohort I, and at least 1 fully active drug was mandated for cohort II. The primary efficacy end point was the proportion of subjects on day 11 in whom the plasma HIV-1 RNA load decreased by ≥0.7 log10 copies/mL from baseline or was <400 copies/mL.Results. A rapid antiviral response was observed. More subjects achieved the primary end point in cohort II (23 of 24 [96%]), compared with cohort I (21 of 27 [78%]) at day 11. At week 24, 41% and 75% of subjects had an HIV-1 RNA load of <50 copies/mL in cohorts I and II, respectively. Further integrase genotypic evolution was uncommon. Dolutegravir had a good, similar safety profile with each dosing regimen.Conclusion. Dolutegravir 50 mg twice daily with an optimized background provided greater and more durable benefit than the once-daily regimen. These data are the first clinical demonstration of the activity of any integrase inhibitor in subjects with HIV-1 resistant to RAL
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
Spatiotemporal Characteristics of the Largest HIV-1 CRF02_AG Outbreak in Spain: Evidence for Onward Transmissions
Background and Aim: The circulating recombinant form 02_AG (CRF02_AG) is the predominant clade among the human immunodeficiency virus type-1 (HIV-1) non-Bs with a prevalence of 5.97% (95% Confidence Interval-CI: 5.41–6.57%) across Spain. Our aim was to estimate the levels of regional clustering for CRF02_AG and the spatiotemporal characteristics of the largest CRF02_AG subepidemic in Spain.Methods: We studied 396 CRF02_AG sequences obtained from HIV-1 diagnosed patients during 2000–2014 from 10 autonomous communities of Spain. Phylogenetic analysis was performed on the 391 CRF02_AG sequences along with all globally sampled CRF02_AG sequences (N = 3,302) as references. Phylodynamic and phylogeographic analysis was performed to the largest CRF02_AG monophyletic cluster by a Bayesian method in BEAST v1.8.0 and by reconstructing ancestral states using the criterion of parsimony in Mesquite v3.4, respectively.Results: The HIV-1 CRF02_AG prevalence differed across Spanish autonomous communities we sampled from (p < 0.001). Phylogenetic analysis revealed that 52.7% of the CRF02_AG sequences formed 56 monophyletic clusters, with a range of 2–79 sequences. The CRF02_AG regional dispersal differed across Spain (p = 0.003), as suggested by monophyletic clustering. For the largest monophyletic cluster (subepidemic) (N = 79), 49.4% of the clustered sequences originated from Madrid, while most sequences (51.9%) had been obtained from men having sex with men (MSM). Molecular clock analysis suggested that the origin (tMRCA) of the CRF02_AG subepidemic was in 2002 (median estimate; 95% Highest Posterior Density-HPD interval: 1999–2004). Additionally, we found significant clustering within the CRF02_AG subepidemic according to the ethnic origin.Conclusion: CRF02_AG has been introduced as a result of multiple introductions in Spain, following regional dispersal in several cases. We showed that CRF02_AG transmissions were mostly due to regional dispersal in Spain. The hot-spot for the largest CRF02_AG regional subepidemic in Spain was in Madrid associated with MSM transmission risk group. The existence of subepidemics suggest that several spillovers occurred from Madrid to other areas. CRF02_AG sequences from Hispanics were clustered in a separate subclade suggesting no linkage between the local and Hispanic subepidemics