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Daniel Podzamczer,
Esteban Martínez,
Pere Domingo,
Elena Ferrer,
Pompeyo Viciana,
Jordi Curto,
Maria-Jesús Pérez-Elías,
Antonio Ocampo, Ignacio Santos,
Hernando Knobel,
Vicente Estrada,
Eugenia Negredo,
Ferrán Segura,
Joaquín Portilla,
Esteban Ribera,
Josefa Galindo,
Antonio Antela,
Jorge Carmena,
Manuel Castaño
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ABSTRACT: Objectives: To describe the efficacy and tolerability of switching to raltegravir (RAL) in virologically suppressed HIV-1-infected patients during routine clinical practice. Methods: A total of 263 subjects (189 men, median age 48.1 years) with HIV-1 RNA < 50 copies/mL for ≥ 6 months were switched to RAL (400 mg b.i.d). Reasons for change were toxicity (49.0%), drug interactions (6.1%) or convenience (28.6%) (switch from subcutaneous to oral treatment 22.4%, improvement of posology 3.4%). Patients were followed up to 24 months after switching to RAL. Primary end-points were tolerability and virological failure defined as two consecutive measures of HIV-1 RNA > 50 copies/mL. Results: After a median of 12.4 months (range 2.8-26.4 months), virological failure was observed in 6 (2.3%) patients (2.2 per 100 person-years,[95%CI 0.9-4.6]), while AIDS occurred in 1, drug discontinuation in 4, 3 patients died and 10 were lost to follow-up. The median CD4+ T cell count increased from 460 cells/mm3 to 508.6 cells/mm3 (P < 0.001). Conclusions: Switching to RAL in clinical practice was mainly driven by toxicity, convenience or interactions, they were well tolerated and secured virologic suppression in the vast majority of patients.
Current HIV research 10/2012; · 1.98 Impact Factor
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Mar Masiá,
Sergio Padilla,
Débora Alvarez,
Juan Carlos López, Ignacio Santos,
Vicente Soriano,
José Hernández-Quero,
Jesús Santos,
Cristina Tural,
Julia Del Amo,
Félix Gutiérrez
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ABSTRACT: OBJECTIVE:: We aimed to characterize non-AIDS events (NAEs) occurring in newly diagnosed HIV-infected patients in a contemporary cohort. METHODS:: CoRIS is a prospective, multicentre cohort of HIV-infected patients antiretroviral naïve at entry, established in 2004. We evaluated the incidence of- and the mortality due to NAEs and AIDS events through October-2010. Poisson regression was used to investigate factors associated with a higher incidence of NAEs. RESULTS:: Overall, 5,185 patients (13.306 person-years of follow-up), median age (interquartile range) 36 (29-43) years, participated in the study. 86.5% patients had been diagnosed in 2004 or later. The incidence rate (IR) of NAEs was 28.93 per 1000 person-years (95% confidence interval [CI], 26.15-32.07), and of AIDS-defining events 25.23 per 1000 person-years (95% CI, 22.60-28.16). The most common NAEs were psychiatric, hepatic, malignant, renal, and cardiovascular-related. After adjustment, age, higher HIV-viral load and lower CD4 count at cohort entry were associated with the occurrence of NAEs, while likelihood significantly decreased with sexual transmission and higher educational level. Additionally, antiretroviral therapy was inversely associated with the development of some NAEs, specifically of psychiatric (IR ratio [95%CI] 0.54 [0.30-0.96]) and renal-related (IR ratio [95%CI] 0.31 [0.13-0.72]) events. 173 (3.33%) patients died during the study period. NAEs contributed to 28.9% of all deaths, with an IR (95%CI) of 3.75 (2.84-4.94) per 1000-person-years. CONCLUSION:: In patients newly diagnosed of HIV infection, NAEs are a significant cause of morbidity and mortality. Our results suggest a protective effect of antiretroviral therapy in the occurrence of NAEs, in particular of psychiatric and renal-related events.
AIDS (London, England) 09/2012; · 4.91 Impact Factor
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ABSTRACT: Abstract We assessed the relationship between atazanavir (ATV)-based antiretroviral treatment (ART) and plasma hepatitis C virus (HCV) viral load in a population of HIV/HCV-coinfected patients. HIV/HCV-coinfected patients who received ART based on a protease inhibitor (PI) or nonnucleoside reverse transcriptase inhibitor (NNRTI) were included. Patients were stratified by ART drug [ATV/rtv, lopinavir (LPV/rtv), efavirenz (EFV), nevirapine (NVP), and other PIs], HCV genotype (1/4 and 2/3), and IL28B genotype (CC and non-CC). The Kruskal-Wallis test and chi-squared test were used to compare continuous and categorical variables, respectively. Multivariate analysis consisted of a stepwise linear regression analysis. Six hundred and forty-nine HIV/HCV-coinfected patients were included. HCV genotype 1/4 patients who received ATV had higher HCV RNA levels [6.57 (5.9-6.8) log IU/ml] than those who received LPV [6.1 (5.5-6.5) log IU/ml], EFV [6.1 (5.6-6.4) log IU/ml], NVP [5.8 (5.5-5.9) log IU/ml], or other PIs [6.1 (5.7-6.4) log IU/ml] (p=0.014). This association held for the IL28B genotype (CC versus non-CC). The association was not found in patients carrying HCV genotypes 2/3. The linear regression model identified the IL28B genotype and ATV use as independent factors associated with HCV RNA levels. ATV-based therapy may be associated with a higher HCV RNA viral load in HIV/HCV-coinfected patients.
AIDS research and human retroviruses 09/2012; · 2.18 Impact Factor
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ABSTRACT: OBJECTIVE:: To study trends in overall deaths and cause-specific deaths stratified by HCV serostatus in a cohort of combined antiretroviral (cART)-naïve HIV-infected patients in Spain METHODS:: We analyzed data from 1997 to 2008 in 2 calendar periods: 1997-2003 and 2004-2008. Deaths were ascertained through cohort reporting and a cross-match with the Spanish National Death Index. We used Poisson regression to model mortality rates and risk factors. RESULTS:: We analyzed 5,974 HIV-positive cART-naïve patients: 2,471 (1,497 HCV+) in the period 1997-03, and 3,503 (689 HCV+) in the period 2004-08. A total of 232 deaths (158 during the first period, and 74 during the second period) were detected during 19,416 person-years (PYs) of follow-up; the death rate was 12.9/1,000 PYs. Crude overall death rates (95% CI) were 16.5 (14.2-19.1) in 1997-2003 and 8.5 (6.7-10.6) in 2004-08. The incidence rate ratio (IRR) (95%CI) in 2004-08 taking 1997-03 as a reference was 0.51 (0.39-0.67). When we stratified by HCV serostatus, the overall death IRR (95% CI) taking 1997-03 as reference was 0.52 (0.32-0.85) for HCV-negative patients and 1.27 (0.90-1.79) for HCV-positive patients. When we considered cause-specific deaths (liver-related, AIDS-related, and non-liver-related/non-AIDS-related), findings were similar to those for overall-deaths. CONCLUSIONS:: Taking the first years of the cART era as a reference, we observed a decrease in overall and cause-specific mortality. This decrease was only observed in HCV-negative patients.
AIDS (London, England) 07/2012; · 4.91 Impact Factor
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Victoria Hernando,
Paz Sobrino-Vegas,
M Carmen Burriel,
Juan Berenguer,
Gemma Navarro, Ignacio Santos,
Jesús Reparaz,
M Angeles Martínez,
Antonio Antela,
Félix Gutiérrez,
Julia Del Amo
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ABSTRACT: OBJECTIVES:: To compare causes of death (CoDs) from two independent sources: National Basic Death File (NBDF) and deaths reported to the Spanish HIV Research cohort [Cohort de adultos con infección por VIH de la Red de Investigación en SIDA CoRIS)] and compare the two coding algorithms: International Classification of Diseases, 10th revision (ICD-10) and revised version of Coding Causes of Death in HIV (revised CoDe). METHODS:: Between 2004 and 2008, CoDs were obtained from the cohort records (free text, multiple causes) and also from NBDF (ICD-10). CoDs from CoRIS were coded according to ICD-10 and revised CoDe by a panel. Deaths were compared by 13 disease groups: HIV/AIDS, liver diseases, malignancies, infections, cardiovascular, blood disorders, pulmonary, central nervous system, drug use, external, suicide, other causes and ill defined. RESULTS:: There were 160 deaths. Concordance for the 13 groups was observed in 111 (69%) cases for the two sources and in 115 (72%) cases for the two coding algorithms. According to revised CoDe, the commonest CoDs were HIV/AIDS (53%), non-AIDS malignancies (11%) and liver related (9%), these percentages were similar, 57, 10 and 8%, respectively, for NBDF (coded as ICD-10). When using ICD-10 to code deaths in CoRIS, wherein HIV infection was known in everyone, the proportion of non-AIDS malignancies was 13%, liver-related accounted for 3%, while HIV/AIDS reached 70% due to liver-related, infections and ill-defined causes being coded as HIV/AIDS. CONCLUSION:: There is substantial variation in CoDs in HIV-infected persons according to sources and algorithms. ICD-10 in patients known to be HIV-positive overestimates HIV/AIDS-related deaths at the expense of underestimating liver-related diseases, infections and ill defined causes. CoDe seems as the best option for cohort studies.
AIDS (London, England) 03/2012; 26(14):1829-1834. · 4.91 Impact Factor
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Susana Monge,
Jorge Del Romero,
Carmen Rodríguez,
Carmen de Mendoza,
Miguel de Górgolas,
Jaime Cosín,
Fernando Dronda,
Elisa Pérez-Cecilia,
José María Peña, Ignacio Santos,
Rafael Rubio,
Julia Del Amo
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ABSTRACT: The objective of this work is to study the impact of HAART at a population level and to identify socio-demographic factors that may affect it, which is essential for deciding interventions.
An open, prospective cohort of HIV seroconverters recruited in the Centro Sanitario Sandoval (1986-2009), and followed up in collaboration with referral hospitals in the Comunidad Autónoma de Madrid. Cumulative incidence of AIDS and death was calculated by the multiple decrements method, and predictive Fine & Gray models were developed to identify associated factors. A calendar period (<1997; ≥ 1997) was introduced as a proxy of HAART availability.
A total of 479 HIV seroconverters were identified. Hazard Ratio (HR) for progression to AIDS was 0.215 (95% CI: 0.11-0.519; P<.01) for the period ≥ 1997. Risk increased with age at the time of seroconversion (for each year older HR=1.071; 95% CI: 1.038-1.105; P<.01), but only prior to 1997. In the following period, only a high educational level showed to be a protective factor (HR=0.982; 95% CI: 0.936-1.031; P=.06). HR for progression to death was 0.134 (95% CI: 0.052-0.346; P<.01) for the period after 1997, 0.383 (95% CI: 0.168-0.875; P=.02) in people with high educational level and 1.048 (95% CI: 1.014-1.084; P<.01) for each year increase in age at seroconversion, both latter effects being homogeneous throughout the two periods.
HAART has had a great impact on the risk of progression to AIDS and death, but this benefit appears to be influenced by age at HIV infection and educational level of the patient, which highlights the importance of a global approach to case management and of the implementation of policies that address social inequities in health.
Enfermedades Infecciosas y Microbiología Clínica 03/2012; 30(3):117-23. · 1.49 Impact Factor
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Pedro L Sánchez,
Federico Gimeno,
Pablo Ancillo,
Juan J Sanz,
Juan H Alonso-Briales,
Francisco Bosa, Ignacio Santos,
Juan Sanchis,
Armando Bethencourt,
Juan López-Messa,
Armando Pérez de Prado,
Joaquin J Alonso,
J Alberto San Román,
Francisco Fernández-Avilés
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ABSTRACT: A catheter-based approach after fibrinolysis is recommended if fibrinolysis is likely to be successful in patients with acute ST-elevation myocardial infarction. We designed a 2x2 randomized, open-label, multicenter trial to evaluate the efficacy and safety of the paclitaxel-eluting stent and tirofiban administered after fibrinolysis but before catheterization to optimize the results of this reperfusion strategy.
We randomly assigned 436 patients with acute ST-elevation myocardial infarction to (1) bare-metal stent without tirofiban, (2) bare-metal stent with tirofiban, (3) paclitaxel-eluting stent without tirofiban, and (4) paclitaxel-eluting stent with tirofiban. All patients were initially treated with tenecteplase and enoxaparin. Tirofiban was started 120 minutes after tenecteplase in those patients randomly assigned to tirofiban. Cardiac catheterization was performed within the first 3 to 12 hours after inclusion, and stenting (randomized paclitaxel or bare stent) was applied to the culprit artery. The primary objectives were the rate of in-segment binary restenosis of paclitaxel-eluting stent compared with that of bare-metal stent and the effect of tirofiban on epicardial and myocardial flow before and after mechanical revascularization. At 12 months, in-segment binary restenosis was similar between paclitaxel-eluting stent and bare-metal stent (10.1% versus 11.3%; relative risk, 1.06; 95% confidence interval, 0.74 to 1.52; P=0.89). However, late lumen loss (0.04+/-0.055 mm versus 0.27+/-0.057 mm, P=0.003) was reduced in the paclitaxel-eluting stent group. No evidence was found of any association between the use of tirofiban and any improvement in the epicardial and myocardial perfusion. Major bleeding was observed in 6.1% of patients receiving tirofiban and in 2.7% of patients not receiving it (relative risk, 2.22; 95% confidence interval, 0.86 to 5.73; P=0.14).
This trial does not provide evidence to support the use of tirofiban after fibrinolysis to improve epicardial and myocardial perfusion. Compared with bare-metal stent, paclitaxel-eluting stent significantly reduced late loss but appeared not to reduce in-segment binary restenosis.
URL: http://clinicaltrials.gov. Unique identifier: NCT00306228.
Circulation Cardiovascular Interventions 08/2010; 3(4):297-307. · 6.06 Impact Factor
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Paz Sobrino-Vegas,
Lucía García-San Miguel,
Ana M Caro-Murillo,
José M Miró,
Pompeyo Viciana,
Cristina Tural,
Maria Saumoy, Ignacio Santos,
Julio Sola,
Julia del Amo,
Santiago Moreno
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ABSTRACT: To study the prevalence of Delayed HIV Diagnosis (DHD) and its associated risk factors, to evaluate the effect of DHD on virological and immunological responses to HAART and to estimate the impact of DHD on all-causes mortality. Prospective cohort of 2, 564 HIV-positive HAART-naïve subjects attending 19 hospitals in Spain, 2004-2006. Estimations were made by logistic regression and survival analyses by Cox regression models. Prevalence of DHD was 37.3% (35.0-39.6). DHD was related to low educational level (OR:1.31, 95% CI:1.0-1.7). Compared to men who have sex with men (MSM), DHD was more frequent in heterosexuals (OR:1.9 95% CI:1.5-2.5) and injection drug users (IDUs) (OR:2.0 95% CI:1.5-2.8). An interaction between age and sex was found. Although risk of having DHD did not increase after age 30 in women, it increased linearly with age in men. No differences in virological (OR 1.2 95% CI: 0.8-1.8) and CD4 T cell (OR 1.1 95% CI: 0.7-1.8) responses to HAART were seen. The adjusted hazard ratio for death in patients with DHD was 5.2, (95% CI: 1.9-14.5). DHD is very common, especially in older men, heterosexuals and IDUs. Although we did not find differences in virological and immunological responses to HAART, we did observe higher mortality in people with DHD. Increased efforts to early diagnose HIV infection are urgently needed.
Current HIV research 04/2009; 7(2):224-30. · 1.98 Impact Factor
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Paz Sobrino-Vegas,
Lucia G.a.r.c.i.a-S.a.n. Miguel,
Ana M. Caro- Murillo,
Jose M. Miro,
Pompeyo Viciana,
Cristina Tural,
Maria Saumoy, Ignacio Santos,
Julio Sola,
Julia d. Amo,
Santiago Moreno,
CoRIS
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ABSTRACT: To study the prevalence of Delayed HIV Diagnosis (DHD) and its associated risk factors, to evaluate the effect of DHD on virological and immunological responses to HAART and to estimate the impact of DHD on all-causes mortality. Prospective cohort of 2, 564 HIV-positive HAART-naive subjects attending 19 hospitals in Spain, 2004-2006. Estimations were made by logistic regression and survival analyses by Cox regression models. Prevalence of DHD was 37.3% (35.0-39.6). DHD was related to low educational level (OR:1.31, 95%CI:1.0-1.7). Compared to men who have sex with men (MSM), DHD was more frequent in heterosexuals (OR:1.9 95%CI:1.5-2.5) and injection drug users (IDUs) (OR:2.0 95%CI:1.5-2.8).. An interaction between age and sex was found. Although risk of having DHD did not increase after age 30 in women, it increased linearly with age in men. No differences in virological (OR 1.2 95%CI: 0.8-1.8) and CD4 T cell (OR 1.1 95%CI: 0.7-1.8) responses to HAART were seen. The adjusted hazard ratio for death in patients with DHD was 5.2, (95%CI: 1.9-14.5). DHD is very common, especially in older men, heterosexuals and IDUs. Although we did not find differences in virological and immunological responses to HAART, we did observe higher mortality in people with DHD. Increased efforts to early diagnose HIV infection are urgently needed.
Current HIV Research 02/2009; 7(2):224-230. · 1.75 Impact Factor
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Eugenia Vispo,
Pablo Barreiro,
Juan A Pineda,
José A Mira,
Ivana Maida,
Luz Martín-Carbonero,
Sonia Rodríguez-Nóvoa, Ignacio Santos,
Luis F López-Cortes,
Dolores Merino,
Antonio Rivero,
Vincent Soriano
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ABSTRACT: There is little information about the influence of antiretroviral drugs on the antiviral activity of pegylated interferon (PEG-IFN) plus ribavirin (RBV) against hepatitis C virus (HCV).
All HIV-infected patients with chronic hepatitis C who received first-line PEG-IFN plus RBV were retrospectively analyzed. Only patients in whom virological stopping rules were applied and who did not change their antiretrovirals were chosen. Plasma RBV concentrations were measured at week 4.
A total of 493 patients (78% males, mean age 41 years, 78% on antiretroviral therapy, mean CD4+ T-cell count 561 cells/microl) fit the study inclusion criteria. Mean baseline serum HCV RNA was 5.89 log10 IU/ml, 65% were infected by genotypes 1 or 4 and 40% had advanced liver fibrosis (Metavir F3F4). The overall rate of sustained virological response (SVR) was 38%. Factors associated with lack of SVR in the multivariate analyses (odds ratio [95% confidence interval], P-value) were higher baseline serum HCV RNA (2.42 per log10 IU/ml [1.31-4.46], 0.005), HCV genotypes 1 or 4 (5.95 [2.50-14.29], < 0.001) and lower RBV plasma trough concentrations (1.74 per microg/ml [1.15-2.63], 0.009). Interestingly, a trend was noticed for abacavir use (2.22 [0.91-5.40], 0.08), which become significant when only considering the subset of patients with RBV plasma levels < 2.3 microg/ml (7.63 [1.39-41.67], 0.02).
The use of abacavir might interfere with the anti-HCV activity of PEG-IFN plus RBV. As both antivirals are guanosine analogues, an inhibitory competition between abacavir and RBV might explain this observation, which is more prominent in patients with lower RBV exposure.
Antiviral therapy 02/2008; 13(3):429-37. · 3.16 Impact Factor
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José A Mira,
Bárbara Valera-Bestard,
Ana Arizcorreta-Yarza,
Mercedes González-Serrano,
Julián Torre-Cisneros, Ignacio Santos,
Salvador Vergara,
Alicia Gutiérrez-Valencia,
José A Girón-González,
Juan Macías,
Luis F López-Cortés,
Juan A Pineda
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ABSTRACT: The clinical applicability of early viral kinetics at week 4 in predicting sustained virological response (SVR) of pegylated interferon (peg-IFN) plus ribavirin (RBV) in HIV/HCV-coinfected patients is unclear. Our objective was to determine if rapid virological response (RVR) at week 4 of therapy with peg-IFN and RBV could predict SVR among HIV/HCV-coinfected patients.
HIV/HCV-coinfected patients in whom an HCV viral load determination had been carried out at week 4 of therapy were included in the study. The positive predictive value (PPV) and the negative predictive value (NPV) of RVR (undetectable serum HCV RNA at 4 week) for SVR were calculated in the study population. Receiver operating characteristic curves were calculated to determine the best cutoff of HCV RNA decrease to predict treatment failure.
A total of 101 HIV/HCV-coinfected patients were included. RVR and SVR were observed in 39 (39%) and in 49 (48%) individuals, respectively. Of patients with RVR, 37/39 patients achieved SVR (PPV: 95%), whereas 50/62 individuals without RVR did not show SVR (NPV: 81%). The highest NPV (96%) was reached by using a cutoff level of HCV RNA decrease of 0.6 log10. By applying this cutoff level, treatment could have been discontinued in 25 (25%) patients.
An undetectable serum HCV RNA determination at week 4 of treatment with peg-IFN plus RBV is a reliable predictor of SVR in HIV/HCV-coinfected patients. In addition, a decrease of HCV RNA less than 0.6 log10 at this point of treatment could identify an appreciable proportion of individuals who will fail to achieve SVR.
Antiviral therapy 02/2007; 12(4):523-9. · 3.16 Impact Factor
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Juan Berenguer,
María Jesús Pérez-Elías,
José María Bellón,
Hernando Knobel,
Pablo Rivas-González,
José María Gatell,
Máximo Miguélez,
José Hernández-Quero,
Juan Flores,
Vicente Soriano, Ignacio Santos,
Daniel Podzamczer,
Monserrat Sala,
Manuel Camba,
Salvador Resino
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ABSTRACT: To analyze the safety and effectiveness of abacavir, lamivudine, and zidovudine (ABC/3TC/ZDV) in antiretroviral therapy (ART)-naive HIV-infected patients.
Retrospective observational cohort study.
We analyzed all consecutive ART-naive HIV-infected patients who initiated ABC/3TC/ZDV in 71 centers throughout Spain and had a clinical visit and laboratory data at least 16 weeks after initiating this regimen. We assessed safety, mortality, new AIDS-defining conditions (ADCs) and treatment failure, the latter defined by any of the following: (1) reduction in plasma HIV-1 viral load (pVL) <1 log during the first 12 weeks of ART, unless it was less than the lower limit of quantification (LOQ); (2) failure to achieve a pVL <LOQ after 24 weeks of ART; and (3) rebound to 2 consecutive pVLs > or = LOQ after achieving a pVL <LOQ.
A total of 730 patients were included, median patient age was 37 years, prior ADCs occurred in 20%, median pVL was 4.76 log, and median CD4 count was 255 cells/mm; 109 (14.9%) patients had <100 CD4 cells/mm. After a median follow-up of 50.5 weeks (interquartile ratio: 28-78), 104 (14.25%) patients discontinued therapy because of adverse events and 36 (4.93%) had a suspected hypersensitivity reaction to ABC. The frequency of treatment failure according to an intention-to-treat (ITT) analysis of observed data was 14.4%. In a more rigorous approach considering losses to follow-up and interruptions or switches of therapy as failures, however, the frequency of treatment failure was 22.92%. Factors independently associated with treatment failure by observed data ITT analysis were adherence <90% (hazard ratio [HR] = 4.248, 95% confidence interval [CI]: 2.640 to 6.833), methadone use (HR = 2.116, 95% CI: 1.180 to 3.797), baseline pVL (HR = 1.651, 95% CI: 1.190 to 2.292 per log), and prior ADC (HR = 1.639, 95% CI: 1.009 to 2.662).
The triple-nucleoside regimen of ABC/3TC/ZDV is a reasonable option for ART-naive patients with a pVL <100,000 copies/mL in whom, for any reason, preferred regimens are not advisable, even in patients with a baseline CD4 cell count <100 cells/mm.
JAIDS Journal of Acquired Immune Deficiency Syndromes 02/2006; 41(2):154-9. · 4.43 Impact Factor
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Juan Macías,
José A Mira,
Luis F López-Cortés, Ignacio Santos,
José A Girón-González,
Mercedes González-Serrano,
Dolores Merino,
José Hernández-Quero,
Antonio Rivero,
Nicolás Merchante,
Mónica Trastoy,
Raquel Carrillo-Gómez,
Ana Arizcorreta-Yarza,
Jesús Gómez-Mateos,
Juan A Pineda
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ABSTRACT: Cohort studies have shown that highly active antiretroviral therapy (HAART) can improve liver-related mortality in HIV/hepatitis C virus (HCV)-coinfected patients. A reduction in the accelerated liver fibrosis progression observed in HIV infection induced by HAART could explain these findings. A few studies have assessed the impact of HAART on liver fibrosis, but with contradictory results. Therefore, we evaluated the associations between the use of different antiretroviral drug classes and HAART combinations, and liver fibrosis in HIV-infected patients with chronic hepatitis C. Six hundred and eighty-three HIV/HCV-coinfected patients, who underwent a liver biopsy and who had not received anti-HCV treatment were included. Age at HCV infection < 23years (adjusted odds ratio [AOR] = 0.7, 95% confidence interval [95% CI] = 0.3-0.9, P = 0.05) and protease inhibitor (PI)-based HAART versus no use of HAART (AOR = 0.5, 95% CI = 0.3-0.9, P = 0.01) were negatively associated with advanced fibrosis (> or = F3). PI-based HAART versus no use of HAART (AOR = 0.4, 95% CI = 0.2-0.7, P = 0.001) was negatively associated with fibrosis progression rate > or = 0.2 units/year and independently of age at HCV infection and CD4+ T-cell counts. Fifteen (17%) patients treated only with PIs and zidovudine plus lamivudine showed > or = F3, compared with 65 (37%) patients without HAART (P = 0.001). Forty (31%) patients on PI and stavudine plus lamivudine showed > or = F3 (P = 0.3, when compared with patients with no HAART). The use of PI-based HAART in HIV/HCV-coinfected patients is associated with less severe fibrosis and slower progression of fibrosis. The nucleoside analogue backbone in a HAART regimen may influence this association.
Antiviral therapy 02/2006; 11(7):839-46. · 3.16 Impact Factor
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ABSTRACT: In patients with acute coronary syndrome (ACS), the prevalence of a primary inflammatory pathogenic component of coronary instability, as detectable by elevated C-reactive protein (CRP), varies considerably. The aim of the present study was to assess the prevalence of inflammation in patients with ACS according to the different electrocardiographic (ECG) patterns on admission.
Hundred and thirty-six consecutive patients with the diagnosis of acute myocardial infarction were divided in three groups according to the ECG pattern on admission. Group 1 included 59 patients with ST segment elevation, group 2 included 50 patients with ST depression and/or T wave inversion and group 3 included 27 patients with no ECG changes. CRP was measured on admission in all patients. For the prevalence of inflammation analysis, we used a cutoff value of 3 mg/l.
CRP was above cutpoint significantly more often in patients with ST depression and/or T wave inversion (44.1% in group 1, 70% in group 2 and 40.7% in group 3; p=0.009). Patients with similar ECG pattern and CRP levels above the cutpoint presented a poorer outcome (coronary death, myocardial infarction and recurrence of instability) at one-year follow-up: 54 versus 27% for group 1, 74 versus 27% for group 2 and 45 versus 31% for group 3.
Patients with ST depression and/or T wave inversion on admission exhibit a higher prevalence of elevated CRP than those with ST elevation or no ECG changes, suggesting an important heterogeneity of the role of inflammatory triggers of the clinical syndromes of coronary instability.
Cardiology 02/2005; 104(1):45-50. · 1.71 Impact Factor
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Marina Núnez,
Nuria Camino,
Belén Ramos,
Miguel Angel Berdún,
Pablo Barreiro,
Elena Losada, Ignacio Santos,
Santiago Echevarría,
Antonio Ocampo,
Celia Miralles,
Piedad Arazo,
Luz Martín-Carbonero,
Miriam Romero,
Javier García-Samaniego,
Vincent Soriano
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ABSTRACT: The use of pegylated interferon (PEG-IFN) plus ribavirin (RBV) is currently the recommended treatment for chronic hepatitis C virus (HCV) infection. Coinfection with HIV is a negative predictor of response, for reasons not well understood.
We examined the virological response at weeks 4 and 12 in 198 HCV/HIV-coinfected patients enrolled in a prospective trial in which PEG-IFN alpha 2a (180 microg per week) and RBV (1000-1200 mg daily) were provided.
In an on-treatment analysis, 52.8% of patients achieved undetectable HCV-RNA (<600 IU/ml) at week 4, while 63% and 77.2% of patients had a decline of at least 2 and 1 log10, respectively. At week 12, 73.1% of patients reached undetectable HCV-RNA, and 83.5% and 89% achieved at least a 2- and 1-log10 drop, respectively. More than 85% of HCV genotypes 2/3 cleared HCV-RNA at week 4, a proportion significantly higher when compared with genotypes 1 (33.8%) and 4 (28.6%). Multivariate logistic regression analysis identified genotype 3 and RBV exposure (mg/kg of body weight) as independent predictors of virological response at week 12 of therapy.
Early virological response rates to PEG-IFN plus RBV in HCV/HIV-coinfected patients seem to be similar to those reported for HCV-monoinfected subjects. The use of suboptimal doses of RBV in most earlier trials might account for the low response rates seen in coinfected patients. To our knowledge, this is the first report demonstrating that RBV exerts a significant independent effect on early virological response. Therefore, strategies aimed at optimizing doses and adherence to RBV might help to improve responses to HCV therapy in coinfected patients.
Antiviral therapy 02/2005; 10(5):657-62. · 3.16 Impact Factor
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María Jesús Perez-Elias,
Isabel Garcia-Arota,
Vicente Muñoz, Ignacio Santos,
José Sanz,
Victor Abraira,
José R Arribas,
Juan González,
Ana Moreno,
Fernando Dronda,
Antonio Antela,
María Pumares,
Paloma Martí-Belda,
Jose L Casado,
Paloma Geijos,
Santiago Moreno
[show abstract]
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ABSTRACT: Resistance testing is useful in the management of virological failure patients, although the best method to be used in clinical practice has not been determined.
A prospective, randomized, double-blind, multicentre, controlled clinical trial was performed to compare the usefulness of drug resistance testing with a recombinant viral phenotype method or with a virtual phenotype, a genotyping interpretation system. Planned 300 HIV-infected adults failing their current antiretroviral therapy (HIV RNA > 1000 copies/ml) were centrally randomized 1:1 to resistance testing with a recombinant viral phenotype method or with a virtual phenotype, after stratifying according to previous drug exposure (one or two versus three drug classes). Percent of patients with HIV RNA suppression (% < 400 copies/ml) after 24 weeks was the primary outcome variable. Median HIV RNA concentration and change from baseline in HIV RNA concentration were also used to compare effectiveness. An extended analysis was performed at week 48.
Of the 300 patients enrolled, a total of 276 patients could be analysed; 139 patients were randomized to the phenotype group and 137 patients were randomized to the virtual phenotype group. After 24 weeks of follow-up, 46.8 and 56.2% of patients had HIV RNA < 400 copies/ml (P = 0.1) in the phenotype and virtual phenotype, respectively. Mean decrease from baseline in viral load was 1.0 and 1.3 log copies/ml in the phenotype and virtual phenotype groups, respectively (P = 0.017). In a multivariate linear regression analysis, after adjusting for baseline HIV RNA and adherence to treatment, the virtual phenotype was associated with a greater mean decrease in plasma HIV RNA (P = 0.0063). The results observed at week 48 were similar.
Virtual phenotype is at least as effective as phenotype when used to select an optimized treatment for patients who have failed one or more antiretroviral regimens.
Antiviral therapy 12/2003; 8(6):577-84. · 3.16 Impact Factor
