Teira R

Mortality according to CD4 count at start of combination antiretroviral therapy among HIV positive patients followed for up to 15 years after start of treatment: collaborative cohort study

The strong association of CD4 count at start of combination therapy with subsequent survival in HIV-infected patients diminished during the first 5 years of treatment. After 5 years, lower baseline CD4 counts were not associated with higher mortality.

Patrón epidemiológico de la infección por el VIH en 15 hospitales españoles: casos de nuevo diagnóstico incluidos en la cohorte VACH en 2001 y 2002*

Antecedentes El estudio de los cambios en las tendencies de la epidemia del virus de la inmunodeficiencia humana (VIH) constituye un metodo util para evaluar los resultados de los planes preventivos actuales, asi como para definir futuras necesidades y objetivos de los proximos. Metodos Estudio descriptivo transversal de los casos nuevos incluidos en la cohorte VACH. Definimos “caso nuevo” a los sujetos cuyo diagnostico de infeccion por el VIH se realizo entre enero de 2001 y diciembre de 2002. Comparamos sus caracteristicas epidemiologicas con las de los sujetos incluidos en la misma cohorte diagnosticados de infeccion por el VIH entre enero de 1998 y diciembre de 2000. Resultados Estudiamos 603 nuevos casos (27% mujeres). En 146 (24,4%) el riesgo de transmision habia sido el uso de drogas (usuarios de drogas por via parenteral, UDVP), 171 (28,6%) eran hombres que tuvieron relaciones sexuales con otros hombres (HSH) y 247 (41,3%) reconocian alguna exposicion heterosexual de riesgo. La mediana de edad fue 36 anos (limites: 16-80). Solamente 1,5% tenian menos de 20 anos y 32,1% superaban 40 anos. Este porcentaje fue significativamente superior al correspondiente al trienio 98-00 (27,5%; p Conclusiones Confirmamos las tendencias observadas en estudios previos: crecimiento de la proporcion de mujeres con diagnostico reciente de VIH, progresiva disminucion de la proporcion de UDVP y aumento de HSH y tendencia al diagnostico en edades mas avanzadas.

Stevens-Johnson syndrome caused by indinavir

A case is presented of an HIV-infected man who developed Stevens-Johnson syndrome shortly after the initiation of treatment with indinavir. This is the first case ever reported of this adverse drug reaction occurring with an HIV protease inhibitor.

Late Initiation of HAART Among HIV-Infected Patients in Spain Is Frequent and Related to a Higher Rate of Virological Failure but not to Immigrant Status

Abstract Purpose: To determine whether immigrant status is associated with late initiation of highly active antiretroviral treatment (HAART) and/or poor response to antiretrovirals. Methods: GESIDA 5808 is a multicenter, retrospective cohort study (inclusion period January 2005 through December 2006) of treatment-naïve patients initiating HAART that compares HIV-infected patients who are immigrants with Spanish-born patients. A late starter (LS) was defined as any patient starting HAART with a CD4+ lymphocyte count <200 cells/μL and/or diagnosis of an AIDS-defining illness before or at the start of therapy. The primary endpoint was time to treatment failure (TTF), defined as virological failure (VF), death, opportunistic infection, treatment discontinuation/switch (D/S), or missing patient. Secondary endpoints were time to treatment failure as observed data (TTO; censoring missing patients) and time to virological failure (TVF; censoring missing patients and D/S not due to VF). Results: LS accounted for 56% of the patients. Lower educational and socioeconomic level and intravenous drug use (IVDU) were associated with categorization as LS, but immigrant status was not. Cox regression analysis (hazard ratio [HR]; 95% CI) between LS and non-LS patients showed no differences in TTF (0.97; 0.78–1.20) or TTO (1.18; 0.88–1.58), although it did reveal a difference in TVF (1.97; 1.18–3.29). CD4+ lymphocyte recovery was equivalent for both LS and non-LS patients (159 vs 173). Conclusions: In our cohort, immigrant status was not shown to be related to late initiation of HAART. Although LS patients did not have a longer TTF for any reason, TVF was significantly shorter. Despite universal free access to HAART in Spain, measures to ensure early diagnosis and treatment of HIV infection are necessary.

Dyslipidaemia in HIV-infected women on antiretroviral therapy. Analysis of 922 patients from the Spanish VACH cohort

BackgroundInformation concerning lipid disturbances in HIV-infected women on antiretroviral therapy (ART) is scarce. The objective of the study is to describe the lipid profile in a large cohort of HIV-infected women on contemporary ART and analyse differences between regimes and patients characteristics.MethodsObservational, multicentre, cross-sectional study from the Spanish VACH Cohort. 922 women on stable ART without lipid-lowering treatment were included.ResultsMedian age was 42 years, median CD4 lymphocyte count was 544 cells/mm3, and 85.6% presented undetectable HIV-1 viral load. Median total cholesterol (TC) was 189 mg/dL (interquartile range, IQR, 165-221), HDL cholesterol 53 mg/dL (IQR, 44-64), LDL cholesterol 108 mg/dL (IQR, 86-134), and triglycerides 116 mg/dL (IQR, 85-163). Mean accumulated time on ART was 116 months; 47.4% were on NNRTI-based regimes, 44.7% on PI, and 6.7% on only-NRTI therapy. 43.8% were also hepatitis C (HCV) coinfected. Patients on PI treatment presented higher TC/HDL ratio than those on NNRTI (p < 0.001). Significantly higher HDL values were observed in NNRTI-treated patients. HCV-coinfected patients presented lower TC/HDL ratio than the non HCV-coinfected. In multivariate analysis, factors independently associated with TC/HDL ratio were age, triglyceride levels and HCV co-infection. PI treatment presented a non-significant association with higher TC/HDL ratio.ConclusionsIn HIV-infected women, the NNRTI-based ART is associated with a better lipid profile than the PI-based. Factors unrelated to ART selection may also exert an independent, significant influence on lipids; in particular, age, and triglyceride levels are associated with an increased TC/HDL ratio while HCV co-infection is associated with a reduced TC/HDL ratio.

The Safety of Pyrimethamine and Sulfadoxine for the Prevention of Pneumocystis carinii Pneumonia

The medical records of 157 patients taking pyrimethamine-sulfadoxine for Pneumocystis carinii pneumonia prophylaxis were reviewed for assessment of safety and tolerance. 11 patients had experienced side effects, 7 (1 each: neutropenia, Stevens-Johnson, hepatic abnormalities; 2 each: subjective and hypersensitivity reactions) leading to a discontinuation of the drugs.

Estudio transversal sobre las características clínicas y epidemiológicas de la infección por el virus de la inmunodeficiencia humana en gitanos y otras minorías en Bilbao

BACKGROUND: The health status and needs of gypsies have been insufficiently studied. PATIENTS AND METHOD: We studied the clinicoepidemiological characteristics of all HIV-1 infected patients attending in our outpatients clinic and hospitalized who were classified according to their ethnic origin as >, > (Caucasian non-gypsy Spanish natives) or >. RESULTS: Overall, there were 563 patients out of 674 previously appointed (83%). Intravenous drug use (IVDU) was the HIV acquisition mechanism in 70%, 95% and 25% (p < 0.000) and attendance was considered regular in 89%, 48% and 89% payos, gypsies and immigrants (p < 0.01), respectively. CONCLUSIONS: IVDU as the HIV transmission mechanism and lower clinic attendance rates were the most relevant differences observed between gypsy and payo subjects.

Recurrent salmonella enteritidis meningitis in a patient with AIDS

The profound impairment of cellular immunity associated with HIV infection predisposes to salmonella infections with recurrent bacteremia as a well recognized opportunistic infection in patients with AIDS. However, salmonella meningitis is extremely rare in this group of patients and only 4 cases have been reported so far. We present 1 case of recurrent Salmonella enteritidis meningitis in an AIDS patient. The infection recurred despite prolonged antimicrobial therapy. Treatment of salmonella infections in AIDS patients may be very difficult and, in some cases, lifelong maintenance therapy may be required.

Effectiveness and safety of didanosine, lamivudine and efavirenz versus zidovudine, lamivudine and efavirenz for the initial treatment of HIV-infected patients from the Spanish VACH cohort

BACKGROUND Preliminary data suggest that a once-daily combination of lamivudine, didanosine and efavirenz is an effective alternative regimen for antiretroviral-naive HIV-1-infected patients. However, data from randomized trials comparing this combination versus standard first-line regimens are not available yet. In an observational study, we analyse the efficacy and tolerability of didanosine plus lamivudine and efavirenz versus zidovudine plus lamivudine and efavirenz in a cohort of therapy naive patients. METHODS We performed an observational study on prospectively collected data from patients participating in a multicentre Spanish treatment-naive cohort (VACH cohort). Efficacy was assessed comparing time to therapeutic failure and CD4 cell recovery. Safety was analysed comparing the proportion of patients who discontinued therapy for toxicity or any other reason. RESULTS Overall, 219 patients treated with once-daily didanosine/lamivudine/efavirenz and 409 patients receiving twice-daily zidovudine/lamivudine (Combivir) plus efavirenz were evaluated. By intent-to treat analysis (non-completers and therapeutic change=failure), time to treatment failure was similar in both groups of treatment: 40.0 months (95% CI 23.3-56.8 months) among patients on didanosine/lamivudine/efavirenz and 33.3 months (95% CI 25.6-41.1 months) in patients treated with zidovudine/lamivudine/efavirenz (P=0.253). The risk of failure due to treatment change was almost double among patients treated with zidovudine/lamivudine/efavirenz compared with those who received didanosine/lamivudine/efavirenz. CONCLUSIONS Our data suggest that didanosine/lamivudine/efavirenz is a combination with an efficacy comparable to zidovudine/lamivudine/efavirenz as first-line therapy for HIV infection. The risk of treatment change was significantly higher among patients treated with zidovudine/lamivudine/efavirenz than in those starting therapy with didanosine/lamivudine/efavirenz.

Incidencia de bacteriemia en grupos histolÓgicos de neoplasias hematolÓgicas

INTRODUCTION: Subgroups having dissimilar prognoses are being identified among cancer patients with infection. Previous studies have suggested that these differences may be related to the histologic diagnosis, but this issue has not as yet been demonstrated. METHODS: We reviewed the medical records of all patients admitted with acute leukemia (AL) or lymphoma (ML) from 1988 to 1998. Incidence of bacteremia was calculated for the following subgroups: acute lymphocytic leukemia (ALL), acute myelocytic leukemia (AML), AML following refractory anaemia with excess blasts (AML-RAEB), high-grade ML (HGML), intermediate-grade ML (IGML), low-grade ML (LGML) and indeterminate ML (IML). Kaplan-Meier curves of time to the first positive blood culture were constructed and compared by means of log-rank test. RESULTS: In the period covered there were 244 new diagnoses of AL or ML: 62 AML, 32 ALL, 20 AML-RAEB, 78 HGML, 7 IGML, 37 LGML and 6 IML. At the end of the study period, 44 patients were alive, 147 were known to have died at a certain date and 53 had been formally lost to follow-up (most of them, transferred for hospice care). Among 684 blood cultures, there were 51 contaminations and 155 significant isolates. Among the latter, gram-positive bacteria were isolated in 74 and gram-negative bacteria in 47; in 27 cases more than 1 bacterial species were recovered. Fungi were isolated in 7 cases. The incidence of bacteremia expressed as cases per 1000 patient-days was 5.80 for AML, 5.03 for AML-RAEB, 1.56 for ALL, 0.21 for HGML and 0.40 for the remaining ML. Time to the first positive blood culture was significantly shorter for AML than for any other group, and was shorted for ALL and AML-RAEB than for ML. CONCLUSION: Differences in the incidence of bacteremia were observed among histologically-defined groups of unselected patients with hematologic malignancies.