J Burgos

Autonomous University of Barcelona, Cerdanyola del Vallès, Catalonia, Spain

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Publications (29)122.16 Total impact

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    ABSTRACT: Objective: To assess the value of several factors to predict the risk of progression to high-grade anal intraepithelial neoplasia (HGAIN) in a cohort of HIV-infected MSM. Design: Longitudinal study of 556 HIV-infected MSM who underwent screening for anal dysplasia (include anal cytology and high-resolution anoscopy at each visit). Methods: Progression rate to HGAIN was estimated by Kaplan-Meier analysis. Predictors of progression were assessed by Cox-proportional hazards regression. Results: Sixty-eight incidents HGAIN cases over 649 person-years of follow-up were diagnosed, resulting in a progression rate of 10.5 cases/100 person-years [95% confidence interval (CI), 8.1-13.3). The cumulative incidence of HGAIN was 7.2% at 12 months (95% CI, 4.3-10.1) and 16.2% at 24 months (95% CI, 11.7-20.7). Independent risk factors for progression were as follows: abnormal cytology [hazard ratio (HR), 2.5 (95% CI, 1.2-4.9) if low-grade squamous intraepithelial lesion, HR 2.76 (95% CI, 1.4-5.3) if atypical squamous cells of uncertain significance and HR 7.73 (95% CI, 2.3-25.4) if high-grade squamous intraepithelial lesion], abnormal high-resolution anoscopy (HR 3.57; 95% CI, 2-6.4) and infection by 16 or 18 human papillomavirus (HR 1.63; 95% CI, 1-2.6). To be receiving HAART (HR 0.4; 95% CI, 0.2-0.7) and have stable sexual couple (HR 0.62; 95% CI, 0.4-0.9) were protective factors. Patients with favorable predictors had an incident rate of 2.86 cases/100 person-years (95% CI, 3.5-10.3). Conclusion: The rate of progression to HGAIN varies according to different predictors that should be considered when assessing the particular risk of each patient. Patients with low risk of progression could be screened at longer intervals. Brief summary: We describe the risk of progression to HGAIN in a cohort of 556 HIV-infected MSM. The incidence rate of HGAIN varies widely according to different predictors. These factors should be considered when assessing the particular risk of each patient.
    AIDS 01/2015; DOI:10.1097/QAD.0000000000000603 · 6.56 Impact Factor
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    ABSTRACT: Objectives The aim of the study was to investigate liver fibrosis outcome and the risk factors associated with liver fibrosis progression in hepatitis C virus (HCV)/HIV-coinfected patients.Methods We prospectively obtained liver stiffness measurements by transient elastography in a cohort of 154 HCV/HIV-coinfected patients, mostly Caucasian men on suppressive antiretroviral treatment, with the aim of determining the risk for liver stiffness measurement (LSM) increase and to identify the predictive factors for liver fibrosis progression. To evaluate LSM trends over time, a linear mixed regression model with LSM level as the outcome and duration of follow-up in years as the main covariate was fitted.ResultsAfter a median follow-up time of 40 months, the median increase in LSM was 1.05 kPa/year [95% confidence interval (CI) 0.72–1.38 kPa/year]. Fibrosis stage progression was seen in 47% of patients, and 17% progressed to cirrhosis. Aspartate aminotransferase (AST) levels and liver fibrosis stage at baseline were identified as independent predictors of LSM change. Patients with F3 (LSM 9.6–14.5 kPa) or AST levels ≥ 64 IU/L at baseline were at higher risk for accelerated LSM increase (ranging from 1.45 to 2.61 kPa/year), whereas LSM change was very slow among patients with both F0−F1 (LSM ≤ 7.5 kPa) and AST levels ≤ 64 IU/L at baseline (0.34 to 0.58 kPa/year). An intermediate risk for LSM increase (from 0.78 to 1.03 kPa/year) was seen in patients with F2 (LSM 7.6–9.5 kPa) and AST baseline levels ≤ 64 IU/L.ConclusionsAST levels and liver stiffness at baseline allow stratification of the risk for fibrosis progression and might be clinically useful to guide HCV treatment decisions in HIV-infected patients.
    HIV Medicine 10/2014; 16(4). DOI:10.1111/hiv.12197 · 3.45 Impact Factor
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    ABSTRACT: Influenza and meteorological factors have been associated with increases in the incidence of invasive pneumococcal disease (IPD). However, scant data regarding the impact of influenza and the environment on the clinical presentation of IPD are available. An observational study of all adults hospitalized with IPD was performed between 1996 and 2012 in our hospital. The incidence of IPD correlated with the incidence rates of influenza and with environmental data. A negative binominal regression was used to assess the relationship between these factors. Clinical presentation of IPD during the influenza and non-influenza periods was compared. During the study, 1,150 episodes of IPD were diagnosed. After adjusting for confounding variables, factors correlating with the rates of IPD were the incidence of influenza infection (IRR 1.229, 95 % CI 1.025-1.472) and the average ambient temperature (IRR 0.921, 95 % CI 0.88-0.964). Patients with IPD during the influenza period had a worse respiratory status. A greater proportion of patients had respiratory failure (45.6 % vs 52 %, p =0.032) and higher requirements for ICU admission (19.3 % vs 24.7 %, p = 0.018) and mechanical ventilation (11 % vs 15.1 %, p = 0.038). When we stratified by invasiveness of pneumococcal serotypes and the presence of comorbid conditions, the increase in the severity of clinical presentation was focused on healthy adults with IPD caused by nonhighly invasive serotypes. Beyond the increase in the burden of IPD associated with influenza, a more severe clinical pattern of pneumococcal disease was observed in the influenza period. This effect varied according to pneumococcal serotype, host comorbidities, and age.
    European Journal of Clinical Microbiology 08/2014; 34(1). DOI:10.1007/s10096-014-2221-9 · 2.54 Impact Factor
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    ABSTRACT: Abstract Several studies have shown the importance of adherence to highly active antiretroviral therapy (HAART) in achieving HIV-1 suppression. However, most have focused on naïve patients and do not assess the impact of HAART on viral load (VL). Our aim was to evaluate the effectiveness of an adherence program in a cohort of multitreated and poorly adherent patients. We performed a cohort study of all adult HIV-1 infected patients with detectable VL who were treatment experienced and poorly adherent to HAART, included in an adherence program since its introduction in 2009 (n=136). The adherence program consisted of a multidisciplinary team with a nurse who specialized in behavioral intervention, counselling on substance abuse, and motivational interviewing, as well as a social worker responsible for referring patients to local healthcare centers. Effectiveness was evaluated as percentage of patients with VL <50 copies/mL at week 48 by modified intent-to-treat (mITT) analysis. Initially, 76.6% of the patients had an adherence <30% according to the Simplified Medication Adherence Questionnaire (SMAQ). At 48 weeks, 48.1% of the patients had VL <50 copies/mL, and the adherence was >90% in 71% of the patients. In multivariate analysis, a ratio of bottle refill per month >0.9 during the study [odds ratio (OR) 14.3; 95% confidence interval (CI) 4.08-50.08, p<0.001] and being on a b.i.d. regimen (OR 12.5; 95% CI 1.81-86.4, p=0.010) were associated with an undetectable VL. In conclusion, the adherence program was successful in almost half of the patients, despite their long treatment experience and prior poor adherence. This strategy may help to prevent disease progression and the risk of HIV transmission in these patients.
    AIDS PATIENT CARE and STDs 08/2014; 28(10). DOI:10.1089/apc.2014.0097 · 3.58 Impact Factor
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    ABSTRACT: Background: The incidence of invasive pneumococcal disease (IPD) appears to be associated with influenza. The objectives of this study were to evaluate the changes in IPD incidence and clinical data as well as the trends in Streptococcus pneumoniae serotype distribution in adults during the peak period of the 2009 influenza A H1N1 pandemic (IAP). Methods: We performed a prospective multicentre study on IPD from week 42 to 48, 2009 in an area of Barcelona (Catalonia, Spain) covering 1,483,781 adult inhabitants. Serotyping was done by Quellung reaction. The data from 2009 were compared to those from the same periods in 2008 and 2010. Results: Two hundred and three cases of IPD were detected during 2009, compared with 182 in 2008 and 139 in 2010. The incidence of IPD during the 7-week study period in 2009 (2.89) was statistically higher than that observed in 2008 (1.96) and 2010 (1.46). IAP was confirmed in 3/30 patients during the 2009 study period. Patients with IPD in 2009 were significantly healthier and younger than those in the other years, although the mortality was higher than in 2008 (p = 0.05) and 2010 (p > 0.05). Eleven (10 non-PCV-7) serotypes not present in 2008 appeared in 2009. Conclusions: During weeks 42 to 48, in which the 2009 IAP peaked in Catalonia, the incidence of IPD was statistically higher than that observed in the same time period in 2008 and 2010, with some differences in the epidemiological data, showing a close relationship between S. pneumoniae and influenza.
    Scandinavian Journal of Infectious Diseases 01/2014; 46(3). DOI:10.3109/00365548.2013.867072 · 1.64 Impact Factor
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    ABSTRACT: Background. The 13-valent conjugate pneumococcal vaccine (PCV-13) has recently been approved for use in immunocompromised adults. However, it is unclear whether there is an association between specific underlying conditions and infection by individual serotypes. The objective was to determine the prevalence of serotypes covered by the PCV-13 in a cohort of patients with invasive pneumococcal disease of respiratory origin and to determine whether there are specific risk factors for each serotype. Methods. An observational study of adults hospitalized with invasive pneumococcal disease in two Spanish hospitals was conducted during the period 1996-2011. A multinomial regression analysis was performed to identify conditions associated with infection by specific serotypes (grouped according their formulation in vaccines and individually). Results. 1094 patients were enrolled. The infecting serotype was determined in 993. In immunocompromised patients, 64% of infecting serotypes were covered by the PCV-13. After adjusting for age, smoking, alcohol abuse and non-immunocompromising comorbidities, the group of serotypes not included either in PCV-13 or in PPV23 were more frequently isolated in patients with immunocompromising conditions and cardiopulmonary comorbidities. Regarding individual serotypes, 6A,23F,11A and 33F were isolated more frequently in patients with immunocompromise and specifically in some of their subgroups. The subgroup analysis showed that, in addition to the mentioned above, serotype10A was also associated with HIV infection. Conclusions. There are specific factors related to underlying immunocompromising conditions associated with infection by pneumococcal serotypes. Although the PCV-13 coverage was high, some emerging serotypes not covered by this vaccine were more frequently isolated in immunocompromised patients.
    Clinical Infectious Diseases 09/2013; 57(12). DOI:10.1093/cid/cit640 · 9.42 Impact Factor
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    ABSTRACT: Pneumococcal serotypes are one of the main determinants of pneumococcal disease severity, however there are scarce data about their implication in respiratory failure.We conducted an observational study of adults hospitalised with invasive pneumococcal pneumonia to describe the host- and pathogen-related factors associated with respiratory failure.Of 1258 adults with invasive pneumococcal disease, 615 (48.9%) had respiratory failure at presentation. Patients with respiratory failure were older (62.1 vs. 55.4, p<.001) and had a greater proportion of co-morbid conditions. They also had a greater proportion of septic shock (41.7% vs. 6.1%, p<.001), required more often ICU admission (38.4% vs. 4.2%, p<.001) and had a higher mortality (25.5% vs. 3.5%, p<.001). After adjustment, independent risk factors for respiratory failure were: age >50 years (OR 1.63; 95% CI, 1.15-2.3), chronic lung disease (OR 1.54; 95% CI, 1.1-2.15), chronic heart disease (OR 1.49; 95% CI, 1.01-2.22) infection caused by serotypes 3 (OR 1.97; 95% CI, 1.23-3.16), 19A (OR 2.34; 95% CI, 1.14-4.42) and 19F (OR 3.55; 95% CI, 1.22-10.28).In conclusion, respiratory failure is a frequent complication of pneumococcal pneumonia and causes high morbidity and mortality. Pneumococcal serotypes 3, 19A and 19F are the main risk factors for this complication.
    European Respiratory Journal 07/2013; 43(2). DOI:10.1183/09031936.00050413 · 7.13 Impact Factor
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    ABSTRACT: Latent parasitic infections can reactivate because of immunosuppression. We conducted a prospective observational study of all human immunodeficiency virus (HIV)-infected immigrants who visited the Infectious Diseases Department of the Hospital Universitari Vall d'Hebron, Barcelona, Spain, during June 2010-May 2011. Screening of the most prevalent tropical diseases (intestinal parasitosis, Chagas disease, leishmaniasis, malaria, schistosomiasis, and strongyloidiasis) was performed according to geographic origin. A total of 190 patients were included: 141 (74.2%) from Latin America, 41 (21.6%) from sub-Saharan Africa, and 8 (4.2%) from northern Africa. Overall, 36.8% (70 of 190) of the patients had at least one positive serologic result for any parasitic disease: 5 patients infected with Trypanosoma cruzi, 11 patients infected with Schistosoma mansoni, 35 patients infected with Strongyloides stercoralis, and 7 patients infected with Leishmania infantum. Intestinal parasitosis detected in 37 patients. Malaria was diagnosed in one symptomatic patient. We propose a screening and management strategy of latent parasitic infections in immigrant patients infected with HIV.
    The American journal of tropical medicine and hygiene 03/2013; 88(6). DOI:10.4269/ajtmh.12-0714 · 2.53 Impact Factor
  • Joaquín Burgos, Vicenç Falcó, Albert Pahissa
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    ABSTRACT: PURPOSE OF REVIEW: The aim of this review is to highlight recent changes concerning the incidence of empyema. In this article we have focused on community-acquired empyema RECENT FINDINGS: The incidence of empyema seems to have been increasing both in children and adults worldwide in the past decades, mainly in healthy young adults and in older patients. The bacteriology of pleural infection is changing as well. In children, the most common microorganism that causes empyema continues to be Streptococcus pneumoniae. Interestingly, the widespread use of the seven valent conjugate vaccine has produced a replacement phenomenon with the emergence of some pneumococcal serotypes such as serotypes 1, 3 and 19A, which have a higher propensity to cause empyema. Moreover increases in the incidence of empyema due to Staphylococcus aureus have also been observed. In adults, increases in the rate of empyema due to Streptococcus milleri group and S. aureus have been reported. SUMMARY: Continued surveillance in the epidemiology of empyema is needed. Progress in new strategies of prevention, such as a new generation of conjugate pneumococcal vaccines and protein-based vaccines, could become an important step in the control of this important complication.
    Current opinion in pulmonary medicine 03/2013; DOI:10.1097/MCP.0b013e3283606ab5 · 2.96 Impact Factor
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    ABSTRACT: To analyze treatment outcome and the accuracy of positive sputum smear at 2 months to predict treatment failure in a cohort of patients with tuberculosis (TB) in a rural setting in Angola. Observational study of patients with TB from January 2009 to August 2010 in Hospital Nossa Senhora da Paz in Angola. A multivariate analysis was performed to identify variables associated with treatment failure and death. Sensitivity, specificity, positive and negative predictive values and likelihood ratios to define the accuracy of a positive sputum smear at 2 months to predict treatment failure were calculated. One thousand four hundred and twenty-five patients were diagnosed with TB. Overall, 526 patients were cured from TB and 419 had treatment completed, so 945 (66·3%) patients achieved treatment success. The outcomes of the remaining patients were: 91 (6·4%) had treatment failure, 100 (7%) died, 49 (3·4%) interrupted treatment, and 240 (16·8%) were transferred out. Variables associated with a higher risk of treatment failure were previously treated patients (odds ratio, 2·36; 95% confidence interval, 1·32-4·2) and positive sputum smear at 2 months (odds ratio, 9·81; 95% confidence interval, 5·88-16·36). Among the group of 551 patients with sputum smear confirmed at diagnosis and specimens taken at 2 and 5 months, the positive predictive value (31%) and the positive likelihood ratio (3·21) of a positive sputum smear taken at 2 months to predict treatment failure were low. Patients with positive sputum smear at 2 months have a higher risk of treatment failure. However, this by itself is a poor predictor of treatment failure.
    01/2013; 107(1):5-10. DOI:10.1179/2047773212Y.0000000066
  • Vicenç Falcó, Joaquin Burgos, Albert Pahissa
    Clinical Pulmonary Medicine 01/2013; 20(5):214-220. DOI:10.1097/CPM.0b013e3182a2db89
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    ABSTRACT: Purpose of the study: Switching to ritonavir-boosted darunavir (DRV/r) in patients treated with double ritonavir-boosted protease inhibitors (PI/r) may result in better tolerability, less pill burden, better lipid profile and a lower cost, while maintaining virologic efficacy. Methods: Multicentre, concurrent cohort observational study. HIV-infected adults with HIV RNA <50 copies/mL for at least the previous 12 months on a double PI/r-based therapy were offered to switch to DRV/r (DRV group) or to continue on the same regimen (control group). Visits (including blood tests, adherence and side effects assessment) were performed every 3 months, with a follow-up of at least one year. Descriptive values are described as n (%) or median (interquartile range). Changes from baseline in quantitative variables have been calculated with the Wilcoxon Signed Ranks Test and comparisons between groups have been performed with the Mann-Whitney test, using SPSS 20.0 statistical package. Summary of results: 65 patients were included (35 DRV group and 30 control group); median age was 46 (40-49) years, 76% were male. At baseline, double-boosted PI regimens were lopinavir-atazanavir/r 24%, lopinavir-saquinavir/r 46%, lopinavir-fosamprenavir/r 8%, atazanavir-saquinavir/r 18% and others 4%. There were no significant differences between groups in baseline characteristics, except for patients who switched to DRV had a higher number of prior antiretroviral regimens [6 (3-8) vs 2 (1-4), p=.002]. Of the patients who switched to DRV/r, 46% received DRV/r once-daily and 54% twice-daily. After 48 weeks, one patient in each arm had virologic failure and one patient in the DRV arm stopped treatment due to side effects (depressive syndrome); there were no episodes of rash or clinical hepatitis. Efficacy (HIV RNA <50 copies/mL) was similar in the DRV and control groups by intention-to-treat analysis (94 vs. 97%, p=NS). There were no significant differences in laboratory parameters between treatment groups except for a decrease in total bilirrubin in patients who switched to DRV/r (-0.69 vs +0.28 mg/dL, p=.028). Treatment switch represented a median saving of 157 (32-264) euros per patient per month. Conclusions: Switching from a double-boosted PI regimen to DRV maintains virologic efficacy, with good tolerability and a lower cost.
    Journal of the International AIDS Society 11/2012; 15(6):18350. DOI:10.7448/IAS.15.6.18350 · 4.21 Impact Factor
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    ABSTRACT: Purpose of the study: In a prior study in patients switching from efavirenz (EFV) due to neurologic side effects, we compared nevirapine (NVP) full dose (200 mg twice-daily) from the beginning to the standard dosage (200 mg once-daily for two weeks and then increase to 200 mg twice-daily) [1]. Adequate concentrations were seen with the experimental arm but with a trend towards higher toxicity, with 25% of patients having to stop NVP due to rash or hepatitis. Our hypothesis is that NVP 200 mg daily for 1 week and then increasing it to 200 mg twice-daily will achieve adequate plasmatic concentrations with better tolerability. Methods: Patients taking an EFV-based regimen were offered to switch to NVP without changing the backbone. Patients received NVP 200 mg once-daily for 1 week and 200 mg twice-daily thereafter. EFV and NVP plasma trough levels were determined at days 0, 3, 7, 14, 30 and 90. Blood tests were performed at each visit and AE recorded. Chi-squared and Fisher exact test were used for qualitative variables and Mann-Whitney U and Wilcoxon signed rank tests for quantitative variables. Summary of results: 22 patients were included, 73% male, median age 48 years, median CD4 569 cell/mm(3), all with CV <25 copies/mL and 41% had HCV co-infection. Reasons for switch were CNS symptoms in 50%, dyslipidemia in 46% and pregnancy desire in 4%. Backbone was TDF+FTC in 73% and ABC+3TC in 27%. Median NVP trough concentrations were 2.2, 2.7, 4.3, 4.5 and 5.5 µg/mL at 3, 7, 14, 30 and 90 days, respectively. 35% of patients had NVP plasma trough levels >3 µg/mL at day 7 and 88% at day 14. EFV concentrations were subtherapeutic (<1 µg/mL) at day 7 and undetectable in all but one patient at day 14. There was a significant increase in GGT (+22 mg/dL, p=.013) and significant decreases in total cholesterol (-16 mg/dL, p=.035) and triglycerides (-50 mg/dL, p=.005) after 3 months. In the first month, two patients had to stop NVP due to rash and one due to rash and hepatitis. There was no correlation between plasma concentrations and rash or hepatitis. There were no virologic failures. Conclusions: Nevirapine concentrations were adequate when dose was increased to 200 mg twice daily after one week, maintaining virologic efficacy and with good tolerability.
    Journal of the International AIDS Society 11/2012; 15(6):18346. DOI:10.7448/IAS.15.6.18346 · 4.21 Impact Factor
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    ABSTRACT: BACKGROUND: Despite the reported decrease in the incidence and mortality rates of central nervous system (CNS) infections after the introduction of highly active antiretroviral therapy (HAART), few studies have focused on the global incidence and the relationship of these diseases with immune reconstitution inflammatory syndrome (IRIS) in the developed world. METHODS: A descriptive cohort study of all consecutive adult HIV-infected patients with CNS opportunistic infections diagnosed between 2000 and 2010 in a tertiary hospital in Spain was carried out. Demographic, clinical, laboratory, and microbiological data were recorded. Patients were followed up until death or loss to follow-up or until 30 July 2011, when the study finished. The significance of differences in the incidence rate between early and late HAART periods was determined using the Mantel-Haenszel test. Survival distribution was estimated using the Kaplan-Meier method. RESULTS: A total of 110 cases of CNS infections were diagnosed. The incidence of CNS opportunistic infections decreased from 9 cases per 1000 HIV-infected patients per year in the early HAART period to 3.8 in the late HAART period (P = 0.04). Overall, the estimated mean survival time was 58.8 months (95% confidence interval 47.1-70.6 months). Of the 110 patients, 18 (16.4%) met the criteria of IRIS, 10 (55.6%) were paradoxical and eight (44.4%) were unmasking. IRIS was not associated with a higher mortality rate. CONCLUSIONS: The annual incidence of CNS infections decreased progressively during the period of study. The mortality rate associated with these diseases remains high despite HAART. The development of IRIS associated with neurological infections had no influence on prognosis.
    HIV Medicine 06/2012; DOI:10.1111/j.1468-1293.2012.01033.x · 3.45 Impact Factor
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    ABSTRACT: To assess the effectiveness of simplification to a dual antiretroviral regimen containing a ritonavir-boosted protease inhibitor (PI/r) in treatment-experienced HIV-1-infected patients. Retrospective analysis of 131 HIV-1-infected patients on suppressive antiretroviral treatment (HIV-RNA <50 copies/mL) who switched to a maintenance dual antiretroviral regimen, containing a PI/r, in three hospitals in Spain. Virological failure was defined as confirmed HIV-RNA >50 copies/mL. The percentage of patients remaining free of therapeutic failure was estimated using the time-to-loss-of-therapeutic-response algorithm, by intent-to-treat analysis. Median baseline characteristics of the patients were 14 years on antiretroviral therapy, five prior HAART regimens and 10 different drugs, 24 months on a suppressive regimen and 522 CD4+ cells/mL. Reasons for simplification to dual therapy were nucleoside reverse transcriptase inhibitor-related toxicity (46.6%), removal of lamivudine/emtricitabine due to resistance (16.8%), simplification from regimens containing a dual PI, enfuvirtide or tipranavir (20.6%) and simplification from other complex regimens (16.0%). Darunavir (58.0%), lopinavir (16.8%) or atazanavir (13.0%) were the preferred PIs, used in combination with tenofovir (50.4%), raltegravir (22.1%) or etravirine (12.2%). At the end of follow-up (median 14 months), 90.1% of patients remained free of therapeutic failure; corresponding data at treatment weeks 24, 48 and 96 were 93.6% (95% CI, 89.3-97.9), 90.9% (95% CI, 84.9-95.9) and 87.4% (95% CI, 80.7-94.1), respectively. Two (1.5%) patients had virological failure and 11 (8.4%) discontinued treatment due to side effects or were lost to follow-up. Simplification to a dual-therapy regimen including a PI/r might be useful to enhance convenience and/or diminish toxicity in selected treatment-experienced patients.
    Journal of Antimicrobial Chemotherapy 06/2012; 67(10):2479-86. DOI:10.1093/jac/dks227 · 5.34 Impact Factor
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    ABSTRACT: Clin Microbiol Infect ABSTRACT: The introduction of the 7-valent pneumococcal conjugate vaccine in children has led to a change in the pattern of pneumococcal serotypes causing pneumococcal disease. The aim of this study was to compare the clinical presentation and outcome of invasive pneumococcal pneumonia (IPP) in adults between the pre and post-vaccine era. We have conducted an observational study of all adults hospitalized with IPP, from 1996 to 2001 (pre-vaccine period), and from 2005 to 2009 (post-vaccine period). Incidence, serotype distribution and clinical data were compared between both periods. A total of 653 episodes of IPP were diagnosed. The overall incidence of IPP increased from 14.2 to 17.9 cases per 100 000 population-year (p 0.003). In the post-vaccine period IPP caused by vaccine serotypes decreased (-36%; 95% CI, -52 to -15) while IPP caused by non-vaccine serotypes increased (71%; 95% CI, 41-106). IPP in the post-vaccine period was associated with higher rates of septic shock (19.1% vs. 31.1%, p <0.001). Among patients aged 50-65 years there was a trend towards a greater proportion of case-fatalities (11.6-23.5%, p 0.087). Independent risk factors for septic shock were IPP caused by serotype 3 (OR 2.38; 95% CI, 1.16-4.87) and serotype 19A (OR 6.47, 95% CI, 1.55-27). Serotype 1 was associated with a lower risk of death (OR 0.1; 95% CI, 0.01-0.78). In conclusion, the incidence of IPP in the post-vaccine period has increased in our setting, it is caused mainly by non-vaccine serotypes and it is associated with higher rates of septic shock.
    Clinical Microbiology and Infection 04/2012; DOI:10.1111/j.1469-0691.2012.03895.x · 4.58 Impact Factor
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    ABSTRACT: To assess the efficacy and safety of dual-antiretroviral therapy containing a ritonavir-boosted protease inhibitor (PI/r) in treatment-experienced patients failing a current antiretroviral regimen. Retrospective analysis of 60 consecutive HIV-1-infected patients who started a dual-antiretroviral rescue regimen containing a PI/r, in three hospitals in Spain. Virological failure was defined as confirmed HIV RNA >50 copies/mL at treatment week 24 or later. The percentage of patients remaining free of therapeutic failure was estimated using the Kaplan-Meier method, by intent-to-treat analysis (missing, changes and virological failure = therapeutic failure). Median baseline characteristics of patients were: 13 years on antiretroviral therapy (four prior highly active antiretroviral therapy regimens and eight different drugs), 380 CD4 cells/mm(3) and HIV RNA 3.04 log(10) copies/mL. All patients had resistance mutations to at least two drug classes, although only 9.3% had specific mutations to darunavir. A darunavir-based regimen was started in 47 (78.4%) patients, combined with etravirine (26.7%), tenofovir (26.7%) or raltegravir (25%). Three (5%) patients discontinued treatment due to side effects. At the end of follow-up, 86.7% of patients remained free of therapeutic failure; the percentages of patients with no therapeutic failure at treatment weeks 24, 48 and 96 were 96.6% (95% CI, 91.9-101.3); 90.1% (95% CI, 81.9-98.3) and 79.8% (95% CI, 66.1-93.5), respectively. Our results suggest that a dual-therapy rescue regimen including a PI/r is convenient, well tolerated and potent enough to achieve persistent viral suppression in selected pre-treated patients with low viral load and few PI resistance mutations.
    Journal of Antimicrobial Chemotherapy 03/2012; 67(6):1453-8. DOI:10.1093/jac/dks057 · 5.34 Impact Factor
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    ABSTRACT: Few data exist on the implications of widespread use of 7-valent pneumococcal conjugate vaccine in children in the invasive pneumococcal disease (IPD) in HIV-infected adults. We conducted a multicenter study to analyze differences in clinical presentation of IPD between HIV-infected and non-HIV-infected adults in the prevaccine and postvaccine era. Study of all cases of IPD in HIV-infected adults diagnosed since 1996 to 2010. Episodes were classified into prevaccine (1996-2001), early postvaccine (2002-2004), and late postvaccine period (2005-2010). For each case, we identified an HIV-negative control patient with IPD matched by hospital, age, and vaccine period. Two hundred twenty-one episodes of IPD in HIV-infected patients were diagnosed. The incidence of IPD decreased from 7.81 to 3.69 episodes per 1000 patient-years (-53%; 95% confidence interval: -65% to -36%, P < 0.001) between prevaccine and late postvaccine period. There was an 81% (95% confidence interval: -88% to -69%, P < 0.001) decrease of IPD caused by vaccine serotypes. In late postvaccine period IPD in HIV-infected patients was associated to higher rates of respiratory failure (28.4% vs. 48.4%, P = 0.011), greater intensive care unit admission (8.2% vs. 21.7%, P = 0.02) and a higher need for mechanical ventilation (5.9% vs. 16.3%, P = 0.033). In the prevaccine period, non-HIV-infected patients had a more severe illness than in those with HIV infection; however, these differences disappeared in the late postvaccine period. In the late postvaccine era, the incidence of IPD in HIV-infected patients has decreased, however, clinical presentation seems to have changed to a more severe illness. The widespread use of highly active antiretroviral therapy, polyssacharide vaccine, and 7-valent pneumococcal conjugate vaccine has contributed to these changes.
    JAIDS Journal of Acquired Immune Deficiency Syndromes 01/2012; 59(1):31-8. DOI:10.1097/QAI.0b013e31823d0f5f · 4.39 Impact Factor
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    ABSTRACT: To compare 48-week changes in body fat distribution and bone mineral density (BMD) between patients switching from a ritonavir-boosted protease inhibitor (PI/r) to raltegravir (RAL) and patients continuing with PI/r. Substudy of the prospective, randomized, open-label, multicenter SPIRAL study. Patients were randomized (1 : 1) to continue with the PI/r-based regimen or switch to RAL, maintaining the rest of the treatment unchanged. Dual-energy X-ray absorptiometry and computed tomography scans were performed at baseline and after 48 weeks to measure body fat and bone composition, analyzing intragroup and intergroup differences. Eighty-six patients were included and 74 patients (39 RAL, 35 PI/r) completed the substudy. Significant increases in median [interquartile range (IQR)] visceral adipose tissue (VAT) [20.7 (-2.4 to 45.6) cm(2), P = 0.002] and total adipose tissue (TAT) [21.4 (-1.3 to 55.4) cm(2), P = 0.013] were seen within the PI/r group. No significant changes in body fat were seen with RAL or between treatment groups. Regarding bone composition, total BMD [0.01 (0 to 0.02) g/cm(2), P = 0.002], total hip BMD [0.01 (0 to 0.03) g/cm(2), P = 0.015] and total hip T score [0.12 (-0.05 to 0.21) SD, P = 0.004] significantly increased with RAL, with no significant changes within the PI/r group. Differences between treatment groups were significant in femoral neck BMD [0.01 (-0.02 to 0.02) g/cm(2), P = 0.032] and T score [0.01 (-0.18 to 0.18) SD, P = 0.016]. Although there were no significant changes in body fat between groups, maintaining a PI/r-based regimen was associated with a significant increase in VAT and TAT. Switching to RAL led to a significant increase in femoral neck BMD when comparing between groups.
    AIDS (London, England) 11/2011; 26(4):475-81. DOI:10.1097/QAD.0b013e32834f3507 · 6.56 Impact Factor
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    ABSTRACT: Increased rates of empyema have been reported in children after the introduction of the pneumococcal conjugate vaccine (PCV7). Our objective was to describe the risk factors for pneumococcal empyema in adults and to analyze the differences in the incidence, disease characteristics, and serotype distribution between the pre- and post-PCV7 eras. An observational study of all adults hospitalized with invasive pneumococcal disease (IPD) who presented with empyema in 2 Spanish hospitals was conducted during the periods 1996-2001 (prevaccine period) and 2005-2009 (postvaccine period). Incidences of empyema were calculated. A multivariate analysis was performed to identify variables associated with pneumococcal empyema. Empyema was diagnosed in 128 of 1080 patients with invasive pneumococcal disease. Among patients aged 18-50 years, the rates of pneumococcal pneumonia with empyema increased from 7.6% to 14.9% (P = .04) and the incidence of pneumococcal empyema increased from 0.5 to 1.6 cases per 100,000 person-years (198% [95% confidence interval {CI}, 49%-494%]). The incidence of empyema due to serotype 1 increased significantly from 0.2 to 0.8 cases per 100,000 person-years (253% [95% CI, 67%-646%]). Serotype 1 caused 43.3% of cases of empyema during the postvaccine period. Serotypes 1 (odds ratio [OR], 5.88; [95% CI, 2.66-13]) and 3 (OR, 5.49 [95% CI, 1.93-15.62]) were independently associated with development of empyema. The incidence of pneumococcal empyema in young adults has increased during the postvaccine period, mainly as a result of the emergence of serotype 1. Serotypes 1 and 3 are the main determinants of development of this suppurative complication.
    Clinical Infectious Diseases 08/2011; 53(3):254-61. DOI:10.1093/cid/cir354 · 9.42 Impact Factor

Publication Stats

144 Citations
122.16 Total Impact Points


  • 2013–2014
    • Autonomous University of Barcelona
      • Department of Medicine
      Cerdanyola del Vallès, Catalonia, Spain
  • 2011–2014
    • University Hospital Vall d'Hebron
      • Department of Infectious Diseases
      Barcino, Catalonia, Spain
  • 1990–1995
    • Hospital Universitario Virgen del Rocío
      • • Servicio de Cardiología
      • • Departamento de Medicina
      Hispalis, Andalusia, Spain