Emilia Condés

Hospital Universitario de Móstoles, Madrid, Madrid, Spain

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Publications (10)28.92 Total impact

  • AIDS (London, England) 10/2014; 28(16):2487-2489. · 4.91 Impact Factor
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    ABSTRACT: To describe the epidemiological characteristics and evolution of a cohort of HIV-infected patients in Madrid (Spain) over a period of 25 years. Longitudinal, prospective, cohort study of all patients diagnosed with HIV infection seen at the Hospital de Móstoles (1983-2008). Of the 2156 patients attended, 73% were men. In 68%, the route of infection was illicit drug use. There was a peak of new diagnoses in 1991 (188 patients) and a subsequent gradual decline. Sexual transmission increased over the time period studied, with a higher rise in heterosexual transmission. The percentage of immigrants with the infection also increased (more than 60% in the last 3 years). Sub-Saharan Africa remains the predominant region of origin of our immigrant patients. Over the period studied, 5% of patients were diagnosed during the acute infection, and 20% to 30% were diagnosed with AIDS within 1 year after detection of HIV infection. The estimated rate of new diagnoses of HIV infection in 2006 was 195 per million population (pmp), 269 pmp in men and 121 pmp in women. Many changes have occurred in the epidemiology of HIV infection in our area in the last 25 years. Routine serologic testing without waiting for warning signs would have an impact on early diagnosis and improving the prognosis of these patients.
    Enfermedades Infecciosas y Microbiología Clínica 09/2009; 28(3):156-61. · 1.48 Impact Factor
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    ABSTRACT: The optimal timing for initiation of highly active antiretroviral therapy (HAART) in patients with AIDS and tuberculosis (TB) is an unresolved question. To assess the effect of HAART on the survival of patients with TB, we designed this study. We selected all HIV patients included in the COMESEM cohort with TB diagnosis after 1996. Clinical and epidemiological data were registered. We compared patients who started HAART at the diagnosis of TB [simultaneous therapy (ST)] or not. Survival was assessed by Cox analysis. Among the 6934 HIV patients included in the cohort, 1217 patients had TB, 322 of them (26.5%) after 1996. At the time of TB diagnosis, 45% of them started HAART (ST). There were no differences between groups regarding basal characteristics, except for a lower viral load in ST patients. ST therapy was associated with improved survival (hazard ratio 0.38; 95% confidence interval 0.20 to 0.72, P = 0.003). By univariate analysis, survival was also associated with no endovenous drug use and a later year of TB diagnosis. After adjusting for other prognostic variables, by Cox multivariate analysis, ST remained robustly associated with improved survival (hazard ratio 0.37; 95% confidence interval 0.17 to 0.66, P = 0.001). Simultaneous HAART and TB treatment in HIV patients with TB is associated with improved survival.
    JAIDS Journal of Acquired Immune Deficiency Syndromes 02/2009; 50(2):148-52. · 4.65 Impact Factor
  • Journal of acquired immune deficiency syndromes 01/2009;
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    ABSTRACT: To evaluate the impact of immigration on tuberculosis (TB)-HIV co-infection in Spain in a prospective cohort of HIV patients. Among 7761 HIV patients, we evaluated 1284 with at least one episode of TB between 1987 and 2006. Variables were compared between immigrants and Spaniards. Incidence of TB decreased from 20 to five cases per 100 patient-years in 2006 (P<0.01) and was always higher in immigrants than in Spaniards. The proportion of immigrants increased, reaching almost 50% of both new cases of HIV and TB-HIV co-infection in 2006. In 34.4% of patients, TB and HIV infection were diagnosed within the same year; simultaneous diagnosis was more frequent in immigrants (83.3%vs. 16.7%, P<0.001). Mortality was associated independently with age [hazard ratio (HR) 1.03, 95% confidence interval (CI) 1.01-1.05], TB diagnosis before 1996 (HR 2.6, 95% CI 1.8-3.6), use of highly active antiretroviral treatment (HR 0.494, 95% CI 0.37-0.66) and CD4 cell count at TB diagnosis (HR 0.996, 95% CI 0.995-0.997). Immigrants have a major impact on the incidence of TB in HIV patients, slowing down the decreasing trend in Spain. Simultaneous diagnosis of the co-infection in immigrants reveals a need to intensify HIV case finding in immigrants in Spain.
    HIV Medicine 05/2008; 9(4):227-33. · 3.16 Impact Factor
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    ABSTRACT: Little is known about the global effects of HAART on the use of medical resources after the complete implementation of this therapy in Spain. This study was designed to determine the use of medical resources and the costs of health care for HIV-infected patients. All patients with HIV infection who came to our institution during the year 2002 were included in the study. We analyzed the global assistance data and pharmaceutical costs during the year. Costs were calculated based on a unitary cost for DRG and an officially assigned standard cost for outpatient clinic, visits to the day care unit and to the emergency room (ER), outpatient surgery, and total costs of pharmacy. The total cost for HIV-related health care assistance was euro739,048. The cost related to admissions was euro150,766.60; euro8631 per first visit and euro49,199.40 per successive visit; euro5085.10 per day care unit; euro14,920 per outpatient surgery; euro7655.70 per ER visit; and euro491,342.40 per antiretroviral treatment. A significant proportion of the total outpatient assistance was given by physicians other than HIV specialists, namely, 63% of the costs attributed to the first visit and 41% per successive visit. More than 50% of the costs of caring for HIV-infected patients are still attributed to antiretroviral therapy. Specialists other than infectious disease specialists provide a significant proportion of outpatient assistance. A method to control HIV costs is greatly needed.
    European Journal of Internal Medicine 10/2007; 18(5):400-4. · 2.30 Impact Factor
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    ABSTRACT: The aim of this study was to evaluate the frequency, characteristics and risk factors of lipid changes associated with lopinavir/ritonavir treatment in antiretroviral-naive patients. A prospective cohort of 107 antiretroviral-naive HIV-infected patients was followed for 12 months after starting lopinavir/ritonavir-based highly active antiretroviral therapy. At 12 months, percentages of patients with hypercholesterolaemia and hypertriglyceridaemia were 17.4% and 40%, respectively. Mean increases in total cholesterol and triglycerides were 40.7 and 73.3 mg/dL. There was a significant increase in both low-density and high-density (HDL) cholesterol, and no increase in the total cholesterol/HDL ratio (from 4.16 at baseline to 4.49 after 12 months). Baseline cholesterol > 200 mg/dL and triglycerides > 150 mg/dL were independent risk factors for dyslipidaemia, while hepatitis C coinfection appeared to be protective. Patients with elevated lipid values at baseline have the greatest risk of developing hypercholesterolaemia and hypertriglyceridaemia after starting lopinavir/ritonavir. Antiretroviral-naive patients coinfected with hepatitis C have a low risk of developing hyperlipidaemia after starting lopinavir/ritonavir.
    Journal of Antimicrobial Chemotherapy 05/2005; 55(5):800-4. · 5.34 Impact Factor
  • Medicina Clínica 08/2002; 119(6):238; author reply 238-9. · 1.25 Impact Factor
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    ABSTRACT: Hemos leído con interés el artículo de López de Munain et al 1 en el que se describen las características clinicoepidemiológicas de los nuevos diagnósticos de infección por el VIH efec-tuados en Basurto en el período 1998-2000. El «Grupo de estudio de la cohorte COMESEM» (Corona Metropolitana Sur-Este de Madrid) re-gistra todos los casos diagnosticados de infec-ción por el VIH retrospectivamente desde la apertura de los mismos hasta junio de 2000, y prospectivamente con posterioridad 2 . Los cen-tros incluidos en la cohorte COMESEM son los únicos responsables de la atención a los pa-cientes con infección por el VIH de 4 áreas sa-nitarias de la corona metropolitana de Madrid, y asisten a una población cercana a 1.300.000 habitantes. En enero de 2002 se encontraban incluidos en la cohorte un total de 6.065 pa-cientes. Las principales características clinicoe-pidemiológicas de los pacientes en función de la fecha registrada de primera seropositividad frente al VIH se resumen en la tabla 1. Nuestros datos coinciden a grandes rasgos con las observaciones de López de Munain et al 1 , sobre todo en lo referente al incremento en la edad de los pacientes (35,9 años de media-na de edad en 2001, con un 14,4% de pa-cientes mayores de 50 años) y a la presencia de un porcentaje cada vez más relevante de pacientes inmigrantes (21,5% en 2001). El número de nuevos diagnósticos de infección por el VIH ha disminuido a lo largo de la última década (incidencia acumulada de 39,9/100.000 habitantes-año en 1989-1991 frente a 13,0 en 2001). El uso de drogas por vía parenteral (UDVP) se ha reducido llamativamente, viéndose refleja-da esta circunstancia tanto en los números tota-les (incidencia acumulada de 32,56/100.000 habitantes-año en 1989-1991 frente a 6,92 en 2001) como en los porcentajes sobre el total de pacientes con nuevos diagnósticos de cada perí-odo (81,6% en 1989-1991 frente a 29,6% en 2001). No obstante, sigue siendo una importan-te vía de transmisión, y las políticas de preven-ción dirigidas a ella no deberían relajarse. La vía de transmisión sexual, y sobre todo la heterose-xual, ha pasado a ser la principal vía de transmi-sión de los pacientes recién diagnosticados. Sin embargo, si nos fijamos en los números totales de pacientes diagnosticados en cada período, concluiremos que esta vía no parece haber au-mentado (incidencia acumulada de 4,74/100.000 habitantes-año en 1992-1994 frente a 4,85 en 2001). Es más, si tenemos en cuenta que la mayoría de los casos de infección por VIH diag-nosticados en inmigrantes (70/104 de los diag-nosticados en 1998-2001) reconoce una vía de transmisión heterosexual, podríamos concluir que la transmisión heterosexual en realidad po-dría incluso haber disminuido en nuestra pobla-ción autóctona (incidencia acumulada de 2,61/100.000 habitantes-año en 2001), obser-vación acorde con la de Moreno et al 3 referente a nuevos diagnósticos de infección por el VIH anteriores a 1999 en las Comunidades de Astu-rias, Navarra y La Rioja. Aunque los pacientes diagnosticados en es-tadios avanzados de la enfermedad, al expe-rimentar la primera enfermedad oportunista, indicadora de inmunodepresión intensa, si-guen siendo numerosos, han experimentado una importante reducción con los años (418/1.374, 30,4% de los nuevos diagnósticos en el trienio 1989-1991 frente a 33/142, 23,2% en 2001; p de Pearson = 0,006). Como señalan López de Munain et al 1 , el diagnóstico tardío se relaciona con la edad (1.472/4.827, 30,5% en los pacientes menores de 50 años frente a 89/167, 53,3% en los mayores; p de Pearson < 0,001) y, en nuestra experiencia, también con el sexo (1.262/3.956, 31,9% en los varones frente a 348/1.273, 27,3% en las mujeres; p de Pearson = 0,002) y la conducta de riesgo de infección por el VIH (1.116/3.810, 29,3% en los UDVP; 226/746, 30,3%, para la vía heterosexual; 169/454, 37,2% para la vía homosexual; 97/214, 45,13%, para los pa-cientes con conducta de riesgo indeterminada; p de Pearson < 0,001). En definitiva, nuestros datos apoyan las consi-deraciones de López de Munain et al 1 y Moreno et al 3 relativas a la conveniencia de sustituir, también en nuestro país, el sistema de vigilan-cia epidemiológica basado en el seguimiento de nuevos «casos de sida» por el de «nuevos diag-nósticos de infección por el VIH», al igual que en otros países de nuestro entorno 4,5 , ya que sólo así se verán reflejados la totalidad de pa-cientes, muchos de los cuales no llegarán a «caso SIDA», y además se verían reflejados en menor lapso los cambios que se den en las vías de contagio incidentes en la población general.
    Medicina Clínica 07/2002; · 1.25 Impact Factor
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    ABSTRACT: Extra-laryngeal head and neck tuberculosis is exceptional. Therefore, a retrospective multicenter study in patients with head and neck tuberculosis, excluding solitary lymphadenitis and laryngeal locations was carried out. We reviewed the patients with these features and tuberculosis confirmation by culture and/or histologic granuloma with presence of acid-fast bacilli (AFB). We found 16 patients with the following locations: eight in oral cavity and/or pharynx, four in ear, two in salivary glands, one in nose and one in frontal sinuses. The average duration of symptoms was 11.5 months. Purified protein derivative (PPD) was positive (> 10 mm) in all but one patient in whom it was performed (six of seven). Except tuberculous otitis, which occured without reactive lymphadenitis, this was present in 50% of the rest (six of the 12). In all cases a biopsy was required for diagnosis. Only in four patients, all with pharyngeal locations, was coincident pulmonary tuberculosis confirmed. One patient with tuberculous otitis developed meningitis and died; three additional patients (two with otitis) were cured but with sequelae; the evolution of the remaining patients was satisfactory with medical therapy. Extra-laryngeal head and neck tuberculosis has a slow course. The diagnosis is difficult due to the common absence of lung involvement and the usual requirements for biopsy procedures. The outcome is usually favorable with antituberculous drugs alone although in tuberculous otitis there are possibilities of complications.
    Clinical Microbiology and Infection 12/2000; 6(12):644-8. · 4.58 Impact Factor