José Luis Prada

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.

Economía creativa y desarrollo urbano en España: una aproximación a sus lógicas espaciales

Durante la ultima decada, la llamada economia creativa ha recibido creciente atencion en los estudios sobre desarrollo urbano. El articulo propone, como punto de partida, un analisis critico de algunos conceptos y perspectivas habituales, con el objetivo de precisar su significado actual y las diversas logicas espaciales que presiden su distribucion. Con esa base se analizan los sectores creativos en Espana, considerando tanto su peso en la economia urbana como la logica espacial que determina su distribucion territorial. El estudio se realiza a dos escalas espaciales: por un lado, se considera el sistema urbano en su conjunto, tomando como referencia las areas urbanas definidas por el Ministerio de Fomento; y, por otro, se realiza un analisis comparativo a escala metropolitana entre Madrid y Barcelona. La combinacion de ambas perspectivas permite matizar la habitual referencia a la concentracion espacial de estas actividades y proponer futuras lineas de investigacion.

Durability of the First Antiretroviral Treatment Regimen and Reasons for Change in Patients With HIV Infection

Abstract Background To study the durability of the drugs and coformulations currently used in the first treatment regimen of antiretroviral therapy (ART) for HIV patients, and to examine the reasons for changing this medication. Methods A retrospective observational multicenter study of patients with HIV infection who started a first-line ART regimen between January 2007 and June 2010. The primary outcome variable was the durability of this first ART regimen until discontinued or amended and the reasons for the change. Survival analysis of durability was performed using Kaplan-Meyer curves analysis, and a Cox multiple regression model was constructed to identify associated factors. Results A first-line ART regimen was initiated for 600 patients; after 1 year, it had been changed in 172 (28%) cases, with a median duration of 31 months. The main reason for change was toxicity (20.5% of all patients), followed by loss to follow-up (8.3%) and virological failure (5.3%). The most common type of toxicity was gastrointestinal (30%), followed by cutaneous (23%) and neuropsychiatric (18%). The use of non-nucleoside reverse transcriptase inhibitors (NNRTIs) was associated with greater durability than that of protease inhibitors (43 months vs 21 months; P = .001). Conclusions The durability of the first-line ART regimen, based on current antiretroviral drugs and coformulations, is about 2.5 years, with toxicity being the main reason for its modification. Gastrointestinal toxicity is the type most commonly reported. NNRTI treatment is associated with greater durability of the first treatment regimen.

Hipertensión pulmonar en pacientes con infección por el virus de la inmunodeficiencia humana: papel del tratamiento antirretroviral

BACKGROUND AND OBJECTIVE Pulmonary arterial hypertension (PAH) is a serious disorder, more prevalent in patients infected with human immunodeficiency virus (HIV). It is not entirely clear what role is played by highly active antiretroviral therapy (HAART) in PAH development or course. Our aim was to describe PAH prevalence in a series of HIV-infected patients and identify possible links with cumulative and current use of different antiretrovirals. PATIENTS AND METHOD Cross-sectional study of a cohort of HIV-infected patients attending a hospital in southern Spain. Demographic data, data on HIV infection status and on cumulative and recent antiretroviral treatment were recorded. Transthoracic echocardiography was performed in all study participants. PAH was defined as pulmonary artery systolic pressure of 36mmHg or more. RESULTS A total of 400 patients participated in the study; 178 presented with tricuspid regurgitation and 22 of these presented with PAH (5.5%). No differences were encountered in age, sex, CD4 lymphocytes, proportion of naive patients or patients with AIDS. No differences were encountered in cumulative use of antiretrovirals. However, recent use of lamivudine was associated with a greater presence of PAH, whereas recent use of tenofovir and emtricitabine was associated with a lower presence of PAH. Logistic regression analysis was performed including the use of lamivudine, emtricitabine and tenofovir. Only recent use of tenofovir was associated with a lower presence of PAH (odds ratio 0.31; 95% confidence interval: 0.17-0.84). CONCLUSIONS PAH prevalence in our study was similar to others series. Current use of tenofovir may be associated with lower PAH prevalence.

Left ventricular hypertrophy detected by echocardiography in HIV-infected patients

BACKGROUND Left ventricular hypertrophy (LVH) is a predictor of overall mortality in the general population. The most sensitive diagnostic method is transthoracic echocardiography (TTE). In this study, we describe the prevalence of LVH, and the factors associated with it, in a group of patients with HIV infection. METHODS TTE was offered to all patients attending the outpatient clinic of the Hospital Costa del Sol (Marbella, Spain) between 1 December 2009 and 28 February 2011. The corresponding demographic and clinical data were obtained. The left ventricular mass (LVM) was calculated and indexed by height(2.7). LVH was defined as LVM >48g/m(2.7) in men or >44g/m(2.7) in women. RESULTS We examined 388 individuals (75.5% male, mean age 45.38years). Of these, 76.1% were receiving HAART; 11.9% had hypertension, 6.2% had diabetes mellitus, 23.2% had dyslipidaemia and 53.6% were tobacco users. The risk of cardiovascular disease at 10years (RV10) was 12.15% (95%CI: 10.99-13.31%). 19.1% of these patients had a high RV10. A total of 69 patients (19.8%) presented high LVM. Age, hypertension, dyslipidaemia, RV10 and the use of nevirapine were associated with a greater presence of LVH in the univariate analysis. In the logistic regression analysis performed, the factors retained in the model were the presence of high RV10 (OR: 2.92, 95%CI: 1.39-6.15) and the use of nevirapine (OR 2.20, 95%CI: 1.18-4.14). CONCLUSIONS In this group of patients, the use of nevirapine and the presence of high RV10 were associated with LVH. The use of nevirapine might be related to its prescription for patients with higher RV10.

Seroprevalence of antibodies to the influenza A (H1N1) virus among healthcare workers prior to the 2009 pandemic peak.

Abstract Objective Our aim was to study the proportion of healthcare workers with a positive serology for Influenza A(H1N1)2009 without having flu, in a Spanish hospital at the beginning of the pandemic. Methods A survey study carried out during August 2009 (before the peak of the pandemic in Spain) in the Hospital Costa del Sol, a second level hospital with almost 300 beds in the South of Spain. The participants were workers in the following hospital units: Emergencies, Medical Area (Internal Medicine, Chest Diseases), Surgical Area (General Surgery and Anaesthesia) of any professional category. A study was made of the proportion of healthcare workers in our hospital with positive serology for the new influenza A (H1N1)2009 virus, as determined by the haemagglutination inhibition technique (≥1/40). The subjects completed a health status questionnaire, and provided a blood sample for serology testing. Results A total of 239 workers participated, of whom 25.1% had positive serology. The hospital area in which most individuals had positive serology was the Emergency Department (36.6%), while the professional category in which most individuals with a positive serology worked was that of the orderlies (41.7%). Conclusion Around 25% of healthcare workers in our hospital had positive serology before the peak of the pandemic, none of them had received vaccine for Influenza A (H1N1) 2009 or had been diagnosed of influenza previously.

Raltegravir en pacientes con infección por el virus de la inmunodeficiencia humana y alto riesgo vascular

OBJECTIVES To record the experience with use of raltegravir (RTG) for devising highly active antiretroviral therapy (HAART) regimens based on RTG in high vascular risk patients. METHODS A retrospective study was conducted on high vascular risk patients taking RTG. Case was a patient who, at the time raltegravir was started, had ≥ 20% 10-year risk of cardiovascular disease, estimated by the algorithm of the European AIDS Clinical Society. Patients should have been on stable HAART including RTG for at least six months. A matched control with ≥ 20% risk of cardiovascular disease, was selected for each case. RESULTS Ten controls and ten cases were selected. After six months using RTG, a significant decreased was seen in levels of HDL cholesterol (median -2,5mg/dL in controls versus 2,5mg/dL in cases, p=0.015), triglycerides (10mg/dL versus -101 mg/dL, p=0.009), and TC/HDL-C ratio (0.17 versus -0.73, p=0.002). Ten-year risk of cardiovascular disease was -4.85% in cases versus -0.05% in controls (p=0.07). CONCLUSIONS RTG shows a good profile to be used in people with high vascular risk, with a decrease in TC/HDL-C ratio and vascular risk.

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.

Papel protector del tratamiento antirretroviral en el deterioro de la función renal en una cohorte de pacientes infectados por el virus de la inmunodeficiencia humana

BACKGROUND AND OBJECTIVE To assess changes in renal function in a cohort of patients infected with the human immunodeficiency virus (HIV) and describe which factors are associated with deterioration. PATIENTS AND METHODS This was a prospective transversal study. The follow-up period was 12 months. Data were collected at baseline and one year including the glomerular filtration rate (GFR). We analyzed epidemiological data, comorbidities, CD4 lymphocytes, viral load, and AIDS status. RESULTS A total of 365 patients. Three hundred and thirteen (85%) were under highly active antiretroviral therapy (HAART); the median CD4 was 606 ± 314 and the CV was undetectable in 85%. At 1-year, we found a mean deterioration in the GFR of 9.7 ml/h. Eighty patients (21.8%) had a fall in GFR > 10 ml/h, while in 20 patients (5.8%) it was > 30 ml/h. An association was found regarding age, treatment with didanosine (DDI) and males (OR 1.89 95% CI 1.3 to 4.08, OR 2.3 95% CI 1.9 to 23 and OR 3.47 95% CI 1.6 to 14.20 respectively). We found a protective role of being under HAART (OR 0.54, 95% CI, 0.25 to 0.8). CONCLUSIONS There was a protective role of HAART in the deterioration of GFR of patients with HIV infection. Male gender, age and use of DDI were associated with worsening renal function. Tenofovir and protease inhibitors were not associated with further deterioration of renal function.