Laura Zamora

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

Prevalence of genotypic resistance to nucleoside analogues in antiretroviral-naive and antiretroviral-experienced HIV-infected patients in Spain.

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

Prevalence of genotypic resistance to nucleoside analogues and protease inhibitors in Spain.

pM 103

A New Multidisciplinary Home Care Telemedicine System to Monitor Stable Chronic Human Immunodeficiency Virus-Infected Patients: A Randomized Study

106/I (range/ −1–400

Ex vivo production of autologous whole inactivated HIV-1 for clinical use in therapeutic vaccines.

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

Evaluation of the Roche COBAS® TaqMan® HIV-1 test for quantifying HIV-1 RNA in infected cells and lymphoid tissue

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.

Manejo clínico de la infección aguda y crónica por el virus de la inmunodeficiencia humana antes del inicio del tratamiento antirretroviral

Objective: To determine the prevalence of genotypic resistance to nucleoside analogues (NA) in a large group of HIV‐infected individuals in Spain, some of whom had no previous treatment with antiretroviral drugs (antiretroviral‐naive) and some of whom had such experience (antiretroviral‐experienced). Setting: Cross‐sectional study in outpatient clinics in three reference hospitals for HIV/AIDS located in Barcelona, Madrid and Seville, Spain. Patients and methods: Primary mutant genotypes were examined in plasma HIV RNA collected from 150 antiretroviral‐naive subjects, half in 1993 and the other half in 1997. Furthermore, drug resistance mutations were analysed in plasma collected from another 150 antiretroviral‐experienced patients who had received 2 NA for longer than 1 year, either in sequence as monotherapy or as combination therapy. A line probe assay was used for recognizing mutations conferring resistance to zidovudine (ZDV), didanosine (ddI), zalcitabine (ddC), and lamivudine (3TC). A point‐mutation nested‐PCR assay was used for examining a codon 151 mutation associated with multiple drug resistance. Results: One or more mutations associated with primary resistance to NA were seen in 10 antiretroviral‐naive (13.3%) patients in 1993 and in nine (12%) in 1997. In all but two cases, they were associated with ZDV resistance. In contrast, all but six (96%) of the antiretroviral‐experienced subjects harboured drug‐resistant mutant viruses. The codon 184 mutation (associated with resistance to 3TC) was detected in 92% of patients treated with 3TC, but also in 18% of those treated with only ddI or ddC. The codon 215 mutation was found in 67.3% of patients who had been exposed to ZDV; the codon 69 mutation was found in 15% of patients treated with ddC; and the codon 74 mutation was found in only 7.2% of patients treated with ddI. Finally, the codon 151 multidrug resistant mutation was found in four (2.7%) of 150 patients with a longterm exposure to NA. Conclusions: Overall, the prevalence of drug‐resistant HIV‐1 genotypes was 12.7% in antiretroviral‐naive patients, most of whom had ZDV‐resistant mutants. There is no evidence of an increase during the last 5 years. However, multidrug‐resistant HIV genotypes are currently circulating in Spain.