Eduardo Carracedo Martínez

HIV/hepatitis C virus-coinfected patients who achieved sustained virological response are still at risk of developing hepatocellular carcinoma.

Objective:To describe the frequency and the characteristics of hepatocellular carcinoma (HCC) cases that appeared in HIV/hepatitis C virus (HCV)-coinfected patients with previous sustained virological response (SVR) and to compare these cases to those diagnosed in patients without SVR. Methods:All HIV/HCV-coinfected patients diagnosed with HCC in 26 hospitals in Spain before 31 December 2012 were analyzed. Comparisons between cases diagnosed in patients with and without previous SVR were made. Results:One hundred and sixty-seven HIV/HCV-coinfected patients were diagnosed with HCC in the participant hospitals. Sixty-five (39%) of them had been previously treated against HCV. In 13 cases, HCC was diagnosed after achieving consecution of SVR, accounting for 7.8% of the overall cases. The median (Q1–Q3) elapsed time from SVR to diagnosis of HCC was 28 (20–39) months. HCC was multicentric and was complicated with portal thrombosis in nine and six patients, respectively. Comparisons with HCC cases diagnosed in patients without previous SVR only yielded a significantly higher proportion of genotype 3 infection [10 (83%) out of 13 cases versus 34 (32%) out of 107; P = 0.001)]. The median (Q1–Q3) survival of HCC was 3 (1–39) months among cases developed in patients with previous SVR, whereas it was 6 (2–20) months in the remaining individuals (P = 0.7). Conclusion:HIV/HCV-coinfected patients with previous SVR may develop HCC in the mid term and long term. These cases account for a significant proportion of the total cases of HCC in this setting. Our findings reinforce the need to continue surveillance of HCC with ultrasound examinations in patients with cirrhosis who respond to anti-HCV therapy.

Long-Term Effectiveness and Safety Outcomes in HIV-1-Infected Patients After a Median Time of 6 Years on Nevirapine

To report long-term data on safety and effectiveness of antiretroviral regimens, including nevirapine. HIV-1-infected patients who received nevirapine-based approaches for at least 4 years were identified in the databases of five centers and included in a retrospective cohort study. Data collected included plasma HIV-RNA (viral load) and CD4+ T-cell counts, lipid and liver function tests, at baseline, 2-year and > 4-year time points. Hepatitis C virus (HCV) coinfection, adverse events, and reasons for using nevirapine were also recorded. Two hundred and twenty-nine patients (139 males/90 females) were included. The mean age was 37 years (range 20-59). Most patients (n = 124; 54%) were former intravenous drug users. One hundred and thirty-five of the patients (59%) were coinfected with HCV. Median time on nevirapine was 72.6 months. The main reasons for nevirapine use included: second- or third-line therapy (39%), simplification of therapy (29%), first-line therapy (18%) and efavirenz intolerance (9%). LDL cholesterol and triglycerides decreased during the >4-year follow-up (135 mg/dl to 109 mg/dl, p = 0.04; and 216 mg/dl to 153 mg/dl, p<0.01, respectively), and HDL cholesterol increased from 48 mg/dl at baseline to 62 mg/dl (p<0.01). Liver enzymes remained without significant changes during follow-up. The reported follow-up pattern of laboratory tests was also found in the subset of HCV-coinfected patients, where men and women were compared and patients with a CD4+ cell count cut-off value of 250/mm(3) were stratified. Mean CD4+ T-cell counts increased from 439/mm(3) at baseline to 628/mm(3) at the last available visit (p<0.001). Ninety-four per cent (172 out of 184) of patients who remained on nevirapine-based therapy at last visit maintained viral load values below the limit of detection (<50 copies/ml). Throughout the follow-up nevirapine was stopped or withdrawn in 43 patients due to virological failure (n = 17), toxicity (n = 5), therapy interruption (n = 3), death (n = 2), dyslipidemia (n = 1), simplification (n = 1) or unknown reasons (n = 14). Adverse events were reported in 40 patients but none was directly attributed to nevirapine. Nevirapine-based antiretroviral therapy provides sustained immunological and virological effectiveness over a more than 4-year treatment period as well as a beneficial lipid metabolic profile and a favorable safety profile, even in HCV-coinfected patients and women with CD4+ cell counts above 250/mm(3). The study data support a nevirapine-based approach as a suitable long-term strategy in the HIV-1-infected population.

Características epidemiológicas de las nuevas infecciones causadas por el VIH comparadas con los casos de sida: La epidemia de VIH/ sida en el País Vasco

Objetivo: Describir las caracteristicas epidemiologicas de los nuevos diagnosticos de infeccion por el VIH en el periodo 1997-2001 y comparlas con los casos de sida (1991-2001). Metodos: Se han recogido retrospectivamente los datos de las nuevas infecciones por el VIH ocurridas en el Pais Vasco (1997-2001) y se han comparado con los casos de sida (1991-2001). Resultados: Se han diagnosticado 912 nuevas infecciones por el VIH. El diagnostico de VIH coincidio con el de sida en 299 (32,8%) de las nuevas infecciones. Las relaciones heterosexuales han sido el mecanismo de transmision mas frecuente, seguido de la transmision por via parenteral y las relaciones homosexuales y bisexuales, con diferencias significativas (p<0,001) respecto a los casos de sida. Conclusiones: La transmision sexual ha reemplazado al consumo de drogas por via parenteral como mecanismo mas frecuente de transmision del VIH. Hay un alto porcentaje de pacientes con diagnostico simultaneo de VIH y sida. Estos datos indican la necesidad de realizar nuevas estrategias de prevencion.

Epidemiological characteristics of new HIV infections compared with AIDS cases: The HIV/AIDS epidemic in the Basque Country [Spain]

OBJECTIVE To describe the epidemiological characteristics of new cases of HIV infection diagnosed from 1997-2001 and compare them with AIDS cases (1991-2001). METHODS Data were retrospectively collected on new cases of HIV infection detected in the Basque Country (1997-2001) and were compared with AIDS cases (1991-2001). RESULTS A total of 912 new cases of HIV infection were diagnosed. In 299 of the new cases (32.8%), HIV and AIDS were diagnosed simultaneously. The most common mechanism of transmission was heterosexual transmission, followed by intravenous and homo/bisexual transmission. Significant epidemiological differences (p < 0.001) were found with regard to AIDS cases. CONCLUSIONS Sexual transmission has replaced intravenous drug use as the most common mechanism of HIV transmission. A large percentage of patients were simultaneously diagnosed with HIV and AIDS, indicating the need for new prevention strategies.

Estudio caso-control de tumores no definitorios de sida en una cohorte prospectiva de pacientes infectados por el VIH

INTRODUCTION We present a case-control study of non-AIDS-defining cancers (NADCs) in a cohort of HIV-infected patients where we value the incidence, survival and prognostic factors of mortality. METHODS All NADCs diagnosis conducted from 2007 to 2011 in 7 hospitals were collected prospectively, with a subsequent follow up until December 2013. A control group of 221 HIV patients without a diagnosis of cancer was randomly selected. RESULTS Two hundred and twenty-one NADCs were diagnosed in an initial cohort of 7,067 HIV-infected patients. The most common were: hepatocellular carcinoma 20.5%, lung 18.7%, head and neck 11.9% and anal 10.5%. The incidence rate of NADCs development was 7.84/1,000 people-year. In addition to aging and smoking, time on ART (OR 1.11; 95% CI 1.05-1.17) and PI use (OR 1.72; 95% CI 1.0-2.96) increased the risk of developing a NADC. During follow-up 53.42% died, with a median survival time of 199.5 days. In the analysis of the prognostic factors of mortality the low values of CD4 at tumour diagnosis (OR 0.99; 95% CI 0.99-1.0; P=.033), and the previous diagnosis of AIDS (OR 2.06; 95% CI 1.08-3.92) were associated with higher mortality. CONCLUSIONS Predictors of NADCs in our cohort were age, smoking, CD4 lymphocytes and time on ART. Mortality is high, with NADC risk factors being low CD4 count and previous diagnosis of AIDS.