Silvana Fiorante

Systematic screening and treatment of asymptomatic bacteriuria in renal transplant recipients

We sought to examine the impact of asymptomatic bacteriuria on renal transplant outcome by retrospectively analyzing 189 renal transplant recipients for whom systematic screening uncovered 298 episodes of asymptomatic bacteriuria in 96 recipients. These patients were treated and all were followed for 36 months. Significant risk factors included female gender, glomerulonephritis as the disease that led to transplantation, and double renal transplant. There were no differences in serum creatinine, creatinine clearance, or proteinuria between patients with and without bacteriuria. The incidence of pyelonephritis in these patients was 7.6 episodes per 100 patient-years compared with 1.07 in those without asymptomatic bacteriuria. Between two to five and more than five bacteriuria episodes were significant independent factors associated with pyelonephritis whereas more than five episodes was a significant independent factor associated with rejection. Thus, we found no differences in renal function prognosis between patients who do not develop asymptomatic bacteriuria and those uncovered by systematic screening and who received treatment following kidney transplantation. Despite this treatment, the incidence of pyelonephritis was much higher in the group of patients with detected asymptomatic bacteriuria.

Detection of HIV-1 at between 20 and 49 Copies per Milliliter by the Cobas TaqMan HIV-1 v2.0 Assay Is Associated with Higher Pretherapy Viral Load and Less Time on Antiretroviral Therapy

ABSTRACT New commercial techniques for determination of the viral load (VL) in plasma are able to detect as few as 20 copies of HIV-1 RNA/ml. The relevance of this new technical threshold is uncertain. Upon multivariate analysis, factors associated with detection of VLs between 20 and 49 copies/ml by the Cobas TaqMan HIV-1 v2.0 assay in an HIV clinic were the basal VL and time on antiretroviral therapy.

Progressive increase of resistance in Enterobacteriaceae urinary isolates from kidney transplant recipients over the past decade: narrowing of the therapeutic options

Antibiotic resistance is an emerging phenomenon in kidney transplantation (KT).

Vacunación frente al Streptococcus pneumoniae en sujetos portadores de un trasplante de órgano sólido

The risk of developing invasive pneumococcal disease in transplant patients is estimated at 28 to 36 per 1000 patients/year according to the type of organ transplanted. This rate is much higher than the estimated incidence in the general population. This study reviews the current experience regarding the different types of vaccinations against Streptococcus pneumoniae in transplant patients, the immunogenic response to pneumococcal vaccine in these patients, the clinical experience to date with the use of pneumococcal vaccines, and the utility of a sequential vaccination regime including the heptavalent vaccine and vaccine for the 23 serogroups. The immunogenicity produced by pneumococcal vaccines in transplant patients is lower and not as long-lasting as in immunocompetent individuals, and the revaccination regimen inducing the most favorable immunological response is unknown. Nonetheless, pneumococcal vaccination provides clear benefits to transplant recipients and should be given before transplantation whenever possible.

Sustained Profile of Transmitted Drug Resistance Mutations for More Than 10 Years in an HIV Type 1-Infected Patient

We present an HIV-1-infected patient with a profile of transmitted drug resistance (RT M41L, E44D, V118I, L210W, T215D) sustained during more than 10 years in the absence of treatment. Clonal analysis of different plasma and cellular samples within this period did not reveal any reversion to the wild-type genotype.

Datos clínicos II. Experiencia clínica de tenofovir en combinaciones con inhibidores de proteasa

Tenofovir (TDF) es uno de los farmacos de eleccion en las combinaciones de tratamiento antirretroviral de primera linea. La mayor parte de la informacion acerca de su eficacia y seguridad en este escenario se origino inicialmente en ensayos clinicos en los que se combinaba con no analogos de nucleosidos. Este hecho, asi como la posible interaccion de TDF con algunos inhibidores de proteasa (IP) y la sospecha de que esta combinacion pudiera incrementar el riesgo de nefrotoxicidad, hace imprescindible analizar la experiencia clinica disponible de la combinacion de TDF (asociado a emtricitabina u otro analogo de nucleosido) con un IP. En esta revision se presentan los datos de eficacia y seguridad procedentes en su mayoria de ensayos clinicos. Tomados en su conjunto, estos estudios aportan suficiente informacion para poder afirmar que la combinacion de TDF con IP es eficaz y segura, lo que justifica su eleccion en el tratamiento de primera linea o en el rescate tras el fracaso virologico.