Ana Guelar

Impact of adherence and highly active antiretroviral therapy on survival in HIV-infected patients

Objectives: To assess the effect of antiretroviral therapy (ART) adherence on survival in HIV‐infected patients. Design: Cohort study at a single hospital in Barcelona, Spain. Methods: Data on HIV‐infected patients older than 18 years of age who began ART during the period 1990 to 1999 were analyzed. Patients were considered nonadherent if the total dose of antiretroviral drug was less than 90% of that prescribed. Adherence was assessed through self‐report and hospital pharmacy appointments. Cox regression with time‐dependent variables was used. Results: A total of 1219 patients were included. The first ART was with monotherapy in 23.7% of cases, with two drugs in 30.5%, and with triple therapy in 45.8%. In multivariate analysis, the variables that presented significant differences with respect to mortality were clinical stage at the beginning of treatment (AIDS: relative hazard (RH) = 2.97; 95% confidence interval [CI]: 2.14‐4.13), CD4 cell count (<200 cells/&mgr;L: RH = 5.89; CI: 3.44‐10.10), type of treatment (monotherapy: RH = 9.76; CI: 4.56‐20.90; bi‐therapy: RH = 9.12; CI: 4.23‐19.64), and adherence (nonadherence: RH = 3.87; CI: 1.77‐8.46). Conclusions: The modifiable factors most strongly associated with survival were type of treatment and adherence. It would be desirable to accompany therapy with intervention strategies intended to improve adherence.

A prospective study of the risk of tuberculosis among HIV-infected patients.

ObjectiveTo evaluate the risk of developing active tuberculosis (TB) in a cohort of HIV-1 -infected patients. MethodsProspective longitudinal follow-up of 839 HIV-infected patients, of whom 505 (60%) were parenteral drug users and 269 (32%) homosexual men. Tuberculin skin tests were performed at baseline and annually thereafter. Prophylaxis with isoniazid (300 mg daily for 9 months) was offered to those with a positive tuberculin test (induration ≥5mm). Diagnosis of TB was accepted if it could be confirmed microbiologically (acid-fast bacilli seen in Ziehl—Neelsen stains or grown in Lowenstein—Jensen cultures) or pathologically (presence of caseating granulomas) and patients had consistent clinical manifestations. ResultsActive TB developed in 23 out of the 733 (3.1%) patients with a negative tuberculin skin test after a mean follow-up of 16

High Incidence of Herpes Zoster in Patients with AIDS Soon After Therapy with Protease Inhibitors

pM 11 months (range, 2–52 months), with an estimated cumulative probability of 1.5 and 7% after 1 and 3 years, respectively (or 2.4 per 100 patient-years). None of the 87 patients with a negative tuberculin test but a positive Multitest developed TB. Conversely, 106 patients had a positive tuberculin skin test (97 at baseline and nine who converted during follow-up). Active TB developed in seven out of the 26 not receiving prophylaxis or in whom prophylaxis had to be discontinued (16.2 per 100 patient-years), in four out of 61 patients 3–27 months after having completed 9 months of prophylaxis with isoniazid (8.9 per 100 patient-years) and in none of the 19 still receiving isoniazid. When TB was diagnosed, the mean CD4 lymphocyte count of the 34 patients who developed it during follow-up was 77

Virologic Outcome and Predictors of Virologic Failure of Highly Active Antiretroviral Therapy Containing Protease Inhibitors

pM 103

Influence of HAART on the Clinical Course of HIV-1-Infected Patients With Progressive Multifocal Leukoencephalopathy : Results of an Observational Multicenter Study

106/I (range/ −1–400

Epidemiological characteristics and predictors of late presentation of HIV infection in Barcelona (Spain) during the period 2001-2009

106/l). ConclusionsAmong HIV-infected patients in whom the tuberculin skin test is negative, the risk of developing active TB is sufficient to consider prophylaxis if the CD4 count falls below 400

Risk of progression to high-grade anal intraepithelial neoplasia in HIV-infected MSM.

106/l, at least in those patients with skin anergy living in high-risk geographical areas such as Spain. When the tuberculin skin test was positive, isoniazid (9 months) provided a 45% protection beyond the period of its administration.