A. del Arco

Ankle-branch index and HIV: the role of antiretrovirals.

To study the relationship between antiretroviral (ARV) treatment and abnormal ankle–branch index (ABI) and to compare the risk factors for altered ABI.

Very low prevalence and no clinical significance of occult hepatitis B in a cohort of HIV-infected patients with isolated anti-HBc seropositivity: the BHOI study.

Abstract Purpose: Data on occult HBV infection in HIV patients are conflicting. We aimed to analyse the prevalence and clinical significance of occult hepatitis B in HIV-infected subjects. Method: An open-label, cross-sectional, multicentre study including all subjects with isolated anti-HBc seropositivity from a cohort of 3,030 HIV-infected patients was undertaken. HBsAg and HBsAb were both negative in all cases, and those patients with acute or convalescent hepatitis B were excluded. HBV DNA was quantified by PCR with a detection limit of 20 IU/mL. Results: We found 5 cases (2.5%) of occult hepatitis B among 202 HIV-patients with isolated anti-HBc. The mean HBV DNA was 66 (15–112) IU/mL, none had symptomatic hepatitis, and their features, including aminotransferase levels, were similar to those without occult HBV infection. Conclusions: Occult hepatitis due to HBV is very unusual in HIV-positive patients with isolated anti-HBc. The use of standard regimens of HAART including drugs with activity against HBV might underestimate the prevalence of occult HBV infection. These patients had a very low viral load, no identifiable risk factors, and no greater risk of hypertransaminasaemia or the development of symptomatic hepatitis.

Late Initiation of HAART Among HIV-Infected Patients in Spain Is Frequent and Related to a Higher Rate of Virological Failure but not to Immigrant Status

Abstract Purpose: To determine whether immigrant status is associated with late initiation of highly active antiretroviral treatment (HAART) and/or poor response to antiretrovirals. Methods: GESIDA 5808 is a multicenter, retrospective cohort study (inclusion period January 2005 through December 2006) of treatment-naïve patients initiating HAART that compares HIV-infected patients who are immigrants with Spanish-born patients. A late starter (LS) was defined as any patient starting HAART with a CD4+ lymphocyte count <200 cells/μL and/or diagnosis of an AIDS-defining illness before or at the start of therapy. The primary endpoint was time to treatment failure (TTF), defined as virological failure (VF), death, opportunistic infection, treatment discontinuation/switch (D/S), or missing patient. Secondary endpoints were time to treatment failure as observed data (TTO; censoring missing patients) and time to virological failure (TVF; censoring missing patients and D/S not due to VF). Results: LS accounted for 56% of the patients. Lower educational and socioeconomic level and intravenous drug use (IVDU) were associated with categorization as LS, but immigrant status was not. Cox regression analysis (hazard ratio [HR]; 95% CI) between LS and non-LS patients showed no differences in TTF (0.97; 0.78–1.20) or TTO (1.18; 0.88–1.58), although it did reveal a difference in TVF (1.97; 1.18–3.29). CD4+ lymphocyte recovery was equivalent for both LS and non-LS patients (159 vs 173). Conclusions: In our cohort, immigrant status was not shown to be related to late initiation of HAART. Although LS patients did not have a longer TTF for any reason, TVF was significantly shorter. Despite universal free access to HAART in Spain, measures to ensure early diagnosis and treatment of HIV infection are necessary.

Rapid Improvement in Fasting Lipids and Hepatic Toxicity After Switching From Didanosine/Lamivudine to Tenofovir/Emtricitabine in Patients With Toxicity Attributable to Didanosine

1Infectious Diseases Unit, Hospital Virgen de la Victoria, Malaga, Spain; 2Infectious Diseases Unit, Hospital Reina Sofia, Cordoba, Spain; 3Infectious Diseases Unit, Hospital de la Princesa, Madrid, Spain; 4Infectious Diseases Unit, Hospital Virgen Macarena, Seville, Spain; 5Internal Medici Service, Hospital Costa del Sol, Marbella, Spain; 6Infectious Diseases Service. Hospital Carlos Haya, Malaga, Spain

Severe Crohn's disease in a HIV-HCv Co-infected man.

We report the case of a man 47-year-old, with Human Immunodeficiency Virus (HIV) and Hepatitis C Virus (HCV) infection diagnosis since 1998. When he was twenty, he had been intravenous drug user. In November 2006 he had 608 lymphocytes CD4/μl and a viral load of 12.600 cop/ml of HIV, without antiretroviral treatment (ART), but a HCV viral load of 5.000.000 UI/ml, genotype 1 and portal hypertension in echography. He began treatment with pegylated interferon (p-IFN) and ribavirin at a dose of 180 μg/week and 1500 mg/ day respectively, for his first time, in January 2007. At week 12, the HCV viral load was 185 UI/ml.