Daniel Fuster

Influence of the type of pegylated interferon on the onset of depressive and neuropsychiatric symptoms in HIV-HCV coinfected patients

Abstract This is a prospective observational comparative 48-week study to assess the impact of the different types of Peg-IFN on depressive and neuropsychiatric symptoms during treatment in HIV-HCV coinfected patients. Thirty-one patients treated with Peg-IFN α-2b 1.5µg/kg/w plus ribavirine (RBV) (Peg-IFN α-2b Group) and 32 patients receiving Peg-IFN α-2a 180µg/w plus RBV (Peg-IFN α-2a Group) were included. Depressive and neuropsychiatric symptoms, quality of life and adherence were assessed. Fifteen subjects (23%) discontinued therapy (pu200a=u200a0.3, between groups). Overall, 37 patients presented mild to moderate depressive symptoms, 9 moderate to severe and 3 severe, without differences between groups. Patients in Peg-IFN α-2b reported higher fatigue and dizziness at weeks 12 (pu200a<u200a0.05) and 24 (pu200a<u200a0.05), and irritability and memory loss at week 24 (pu200a<u200a0.05) with respect to Peg-IFN α-2a Group. At week 12, role functioning, general health perception, vitality, emotional role, mental health and the summary areas of physical health and mental health were lower in Peg-IFN α-2b Group (pu200a<u200a0.05). The same was observed in physical functioning (pu200a=u200a0.05) and role functioning, general health perception, emotional role and mental health (pu200a<u200a0.001) at week 24. Three months after finishing treatment, no patient had depressive or neuropsychiatric symptoms, and quality of life improved. Antiretroviral adherence was low but adherence to anti-HCV therapy remained high in both groups. According to our data, Peg-IFN α-2a and Peg-IFN α-2b exert a similar impact on the overall rate of depressive symptoms, although patients treated with Peg-IFN α-2a experience less fatigue and fewer neuropsychiatric symptoms and a lower impairment in their physical and mental quality of life.

Wide array of T-cell subpopulation alterations in patients with alcohol use disorders

BACKGROUNDnAlcohol abuse impacts innate and adaptive immunity and predisposes to infections. However, prevalence and correlations of cellular immune alterations in large case series is underreported. We aimed to analyze quantitative alterations of T-lymphocyte subpopulations in patients with alcohol use disorder (AUD).nnnMETHODSncross-sectional study in patients admitted for detoxification between January 1, 2002 and December 31, 2012. Socio-demographic and alcohol use characteristics and blood samples for biochemistry, hematology and immune phenotype was obtained at admission.nnnRESULTSn238 patients (79.8%M) were eligible; age at admission was 43 years (interquartile range [IQR]: 38-51 years), the amount of alcohol consumption was 180 g/day (IQR: 120-200 g/day) and median duration of AUD was 18 years (IQR: 9-25 years). Compared to healthy individuals, 50% of patients had significantly fewer double-negative (DN) T-lymphocytes (<34 × 10(9)/L) and 23% had more double-positive (DP) T-cells (>52 × 10(9)/L). In addition, 24% of patients had high number of CD8(+) cells (>735 × 10(9)/L) and 13% had low CD4(+) cell counts (<600 × 10(9)/L). In multivariable analysis, age, sex, serum albumin, and current cocaine use were predictors of T-cell subpopulation alterations. Women were three-times (OR=3.5, 95%CI:1.3-9.5) more likely to present with higher DP T-lymphocytes than men.nnnCONCLUSIONSnQuantitative alterations of T-cell subpopulations are frequent in patients seeking treatment of AUD. Assessment of cellular immunity in this population may help to identify those at increased risk of immune alterations.

HIV Infection and Viral Hepatitis in Drug Abusers

The epidemiology of HIV infection and viral hepatitis among injection drug users (IDUs) is changing in western countries; reductions in the epidemic of blood-borne infections, such as HIV infection, and viral hepatitis among drug users are probably related to the generaliza‐ tion of harm-reduction interventions and to the treatment of both HIV/AIDS and substance abuse. Opioid substitution therapy for the treatment of patients with heroin dependence, needle exchange programmes, access to Highly Active Antiretroviral Therapy (HAART) and supervised injecting facilities, among other preventive interventions, have contributed to reduce the impact of the HIV epidemic among drug users.

Cardiovascular disease burden among human immunodeficiency virus-infected individuals

Human Immunodeficiency Virus (HIV) infection affects 36.7 million people worldwide, it accounted for 1.1 million deaths in 2015. The advent of combined antiretroviral therapy (cART) has been associated with a decrease in HIV-related morbidity and mortality. However, there are increasing concerns about long-lasting effects of chronic inflammation and immune activation, leading to premature aging and HIV-related mortality. Cardiovascular diseases, especially coronary artery disease, are among the leading causes of death in HIV-infected patients, accounting for up to 15% of total deaths in high income countries. Furthermore, as cART availability expands to low-income countries, the burden of cardiovascular related mortality is likely to rise. Hence, over the next decade HIV-associated cardiovascular disease burden is expected to increase globally. In this review, we summarize our understanding of the pathogenesis and risk factors associated with HIV infection and cardiovascular disease, in particular coronary artery disease.

Folate deficiency in patients seeking treatment of alcohol use disorder

INTRODUCTIONnNutritional deficiency is frequent in patients with an alcohol use disorder (AUD). We aimed to analyze serum and erythrocyte folate deficiency in a case series of patients that initiated treatment of AUD.nnnPATIENTS AND METHODSnA cross-sectional study in patients admitted for detoxification between 2007 and 2015 was performed. Sociodemographic characteristics, history of alcohol consumption, type of alcohol, and medical co-morbidity were assessed at admission. Blood samples for biochemistry and hematological parameters were collected at admission. Logistic regression models were used to establish predictors of folate deficiency.nnnRESULTSn211 patients (79.1% men) were eligible; age at admission was 46 years [IQR:40-51], and the amount of alcohol consumption was of 160g/day [IQR:120-200]. Thirty four percent of patients had macrocytosis (MCV>100fL), 12.8% had anemia, 23% of cases presented with serum folate deficiency and 7% presented with erythrocyte folate deficiency. Most (69%) of the patients with serum folate deficiency had normal erythrocyte folate levels. In univariate analysis, macrocytosis (OR=3.4, 95%CI:1.7-6.6), alcohol-related liver disease (ARLD) (OR=2.5, 95%CI:1.0-6.1) and drinking alcoholic beverages other than beer (OR=3.3, 95%CI:1.5-7.3) were associated with folate deficiency. However, only macrocytosis was significantly associated with serum folate deficiency in multivariate analysis (OR=3.1, 95%CI:1.1-8.9). Macrocytosis (P<0.001), ARLD (P=0.01) and the type of alcohol consumption (P<0.001) were factors associated with erythrocyte folate deficiency in univariate analysis. In multivariate analysis only macrocytosis remained significantly associated to erythrocyte folate deficiency (P=0.037).nnnCONCLUSIONnFolate deficiency is a relatively frequent finding in contemporary, middle-aged patients with AUD, and macrocytosis is significantly associated with the deficiency.

Long-Term Mortality of Patients with an Alcohol-Related Wernicke–Korsakoff Syndrome

AimsnTo characterize a series of contemporary patients with alcohol-related Wernickes encephalopathy (WE) or Korsakoffs syndrome (KS) and to update the current prognosis of disease.nnnMethodsnRetrospective and prospective study of patients diagnosed with an alcohol-related WE or KS between 2002 and 2011 in a tertiary hospital. Socio-demographic, alcohol use characteristics, signs and symptoms, co-morbidity and blood parameters were obtained at admission. Patients were followed up until 2013 and causes of death were ascertained through the review of charts.nnnResultsnSixty-one patients were included (51 with WE and 10 with KS). Among patients with WE, 78% were men and age at diagnosis was 57 years (interquartile range (IQR): 49-66). Twenty-three percent fulfilled the classic WE triad. Regarding Caines criteria for WE, 70.6% presented with at least two out of four signs or symptoms. Median follow-up of patients with WE syndrome was 5.3 years (IQR: 2.6-8.8), the cumulated mortality was 45% and death rate of 7.4 × 100 person-years (95% confidence interval (CI): 4.8-10.9). Overall, 50% of patients would be expected to die within 8 years of WE episode and main causes of death included serious bacterial infections (44.5%) and cancer (33.3%).nnnConclusionsnSurvival of patients with an alcohol-related Wernicke-Korsakoff syndrome is poor; pursuing treatment of alcohol use disorder and early diagnosis of thiamine deficiency is a priority for improving clinical outcomes.

HIV And HCV infection among opiate-dependent patients and methadone doses: the PROTEUS study

ABSTRACT Human immunodeficiency virus (HIV) and hepatitis C virus (HCV) are prevalent infections in opiate-dependent patients. Opiate replacement treatment (ORT) with methadone or buprenorphine is associated with several important outcomes among patients with opiate dependence. However, little is known about outcomes in patients with HIV and/or HCV infections that are in ORT. Also, it is not well established whether the presence of HCV or HIV infection could be associated with higher methadone doses. This paper reanalyzes the database of PROTEUS study, using two principal variables: methadone dose and presence of HIV and/or HCV infection. PROTEUS recruited 621 patients (84.1% were male, mean age: 38.9 years, SD: 7.9), information about the presence of HIV in status was available for 390 patients. Of those, 134 (34.4%) were HIV-infected. Whilst, information about HCV infection was available for 377 patients. Of those, 315 (83.6%) were HCV-infected. Information on HIV/HCV coinfection was available for 376 patients, of those, 112 (29.8%) had this coinfection. HIV-infected and HIV/HCV-coinfected patients received higher methadone doses than those without these infections. Antiretroviral therapy (ART) was used in 80% of patients with HIV infection. The proportion of patients taking antiretroviral drugs was significantly higher for patients treated with higher methadone doses (pu2009<u20090.01). Findings suggest that HIV-infected and HIV/HVC-coinfected patients in ORT require higher methadone dose.

Ultrasound findings of liver damage in a series of patients consecutively admitted for treatment of alcohol use disorder

BACKGROUNDnTo analyze ultrasound findings of liver damage in alcohol use disorder (AUD) patients.nnnMETHODSnA cross-sectional analysis of detoxification patients. Clinical and laboratory parameters were obtained at admission. Analytical liver injury (ALI) was defined as at least two of the following: aspartate aminotransferase (AST) levels ≥74u202f<u202f300 U/L, AST/alanine aminotransferase (ALT) ratio >2, and total bilirubin >1.2u202fmg/dL. Advanced liver fibrosis (ALF) was defined as a FIB-4 score ≥3.25. Abdominal ultrasound was used to identify steatosis, hepatomegaly, heterogeneous liver, and portal hypertension. Predictors of these findings were determined by logistic regression.nnnRESULTSnWe included 301 patients (80% male) with a median age of 46 years (IQR: 39-51 years) and alcohol consumption of 180u202fg/day (IQR: 120-201u202fg). The prevalence of Hepatitis C virus (HCV) was 21.2%; AST and ALT serum levels were 42 U/L (IQR: 23-78 U/L) and 35 U/L (IQR: 19-60 U/L), respectively; 16% of patients had ALI and 24% ALF. Ultrasound findings were: 57.2% steatosis, 49.5% hepatomegaly, 17% heterogeneous liver, and 16% portal hypertension; 77% had at least one ultrasound abnormality, and 45% had ≥2. HCV infection was associated with heterogeneous liver (pu202f=u202f0.046) and portal hypertension (pu202f<u202f0.01). ALI and ALF were associated with steatosis (both pu202f<u202f0.01) and hepatomegaly (both pu202f<u202f0.01), ALI with portal hypertension (pu202f=u202f0.08), and ALF with heterogeneous liver (pu202f<u202f0.01). In logistic regression, ALI and ALF were associated with ≥2 abnormalities [OR (95%CI): 5.2 (2.1-12.8), pu202f<u202f0.01 and 4.7 (2.2-9.7), pu202f<u202f0.01; respectively].nnnCONCLUSIONSnUltrasound findings of liver damage may facilitate clinical decisions and alcohol cessation in AUD patients.

Current Opioid Access, Use, and Problems in Central and Western European Jurisdictions

Purpose of the ReviewTo provide recent data on opioid use in Central and Western Europe and available treatments, with focus on Spain and Switzerland.Recent FindingsThe prevalence of opioid use in Europe is around 0.4%, which represents 1.3 million individuals. Heroin use remains the main reason for treatment among patients with an opioid use disorder (>u200980%). Opioid agonist treatment (OAT) is generally available, with methadone and buprenorphine being the most often used treatments. In some European countries, pharmaceutical heroin (diacetylmorphine, DAM) is also available as an OAT option.SummaryThe prevalence of opioid use disorder is decreasing in Western Europe and OAT is widely available. Heroin remains the opioid of most concern but changes in the prevalence of use of other opioids should be closely monitored.

Acceptability of HIV Vaccine - Efficacy Trials in Drug Users and Sexual Partners of HIV Infected Patients in Barcelona, Spain

The epidemiology of HIV infection in Spain has changed during the past decade. Surveillance of HIV infection occurs in 15 of the country’s 17 regions, and 2,264 new HIV infections were diagnosed in 2009 (Ministerio de Sanidad y Politica Social, Ministerio de Ciencia e Innovacion, 2010). As previously reported (Hernandez-Aguado, 1999), the HIV epidemic in Spain has been largely driven by injecting drug users (IDUs). Reductions in the rates of new infections among drug users were reported a decade ago for the first time since the beginning of the epidemic (Castilla, 2006). In 2009, 77.0% of new infections were acquired through sexual transmission, and IDUs represented less than 10% of reported cases (Ministerio de Sanidad y Politica Social, Ministerio de Ciencia e Innovacion, 2010). The HIV epidemic among IDUs continues to develop heterogeneously across different parts of Europe. In the European Union, the reported rates of newly diagnosed cases of HIV infection in IDUs are mostly stable or in decline (European Monitoring Centre for Drugs and Drug Addiction, 2009). Data on newly reported cases of HIV infection in IDUs for 2007 suggest that rates of infection are still declining in Europe following a peak in 2002, which was caused by outbreaks in Estonia, Latvia and Lithuania. In 2007, the overall rate of newly reported infections of HIV among IDUs in the 24 EU member states for which national data