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1. Nutritional Risk and Mortality at One Year for Elderly Patients Hospitalized with Nonvalvular Atrial Fibrillation. NONAVASC Registry

Author

Miquelez A, Calleja M, Gullon A, Reino A, Formiga F, Camafort M, Rodrigo J, Mostaza J, Fernandez C, Diez-Manglano J, and Spanish Soc Internal Med

Subjects
nutrition, cohort study, Atrial fibrillation, elderly, mortality
Abstract

Objectives To determine whether nutritional risk is associated with the mortality of elderly patients hospitalized with nonvalvular atrial fibrillation (NVAF). Design Prospective, multicenter cohort study. Setting Internal medicine departments in Spain. Participants Inpatients >75 years with NVAF. Measurements We measured the thrombotic and hemorrhagic risk at admission using the CHA2DS2-VASc and HAS-BLED scales, respectively, and the nutritional risk with the controlling nutritional status (CONUT) index. We established 4 degrees of nutritional risk: null (CONUT score 0-1 point), low (2-4 points), moderate (5-8 points) and high (9-12 points). We also conducted a 1-year follow-up. Results We included 449 patients, with a mean age of 85.2(5.2) years. The nutritional risk was null for 70(15.6%) patients, low for 206 45.9%), moderate for 152(33.8%) and high for 21(4.7%). At the end of one year, 177(39.4%) patients had died. The score on the CONUT index was higher for the deceased patients (4.6 vs. 3.6, p

Published
2020

2. Switching from boosted PIs to dolutegravir in HIV-infected patients with high cardiovascular risk: 48 week effects on subclinical cardiovascular disease

Author

Gonzalez-Cordon, A, Assoumou, L, Camafort, M, Domenech, M, Guaraldi, G, Domingo, P, Rusconi, S, Raffi, F, Katlama, C, Masia, M, Bernardino, JI, Saumoy, M, Pozniak, A, Gatell, JM, Martinez, E, and NEAT022 Study Grp

Abstract

Background: Switching from boosted PIs to dolutegravir in virologically suppressed HIV-infected patients with high cardiovascular risk significantly decreased total cholesterol and other proatherogenic Lipid fractions at 48 weeks. The impact of this strategy on subclinical cardiovascular disease is unknown. Methods: NEAT022 is a European, multicentre, open-Label, randomized, non-inferiority trial. HIV-infected adults aged >50 years or with a Framingham score >10% were eligible if plasma HIV RNA was 24 weeks on a boosted PI-based regimen. Patients were randomized 1:1 to switch from boosted PIs to dolutegravir or to continue on boosted PIs. Common carotid arteries intima-media thickness (CIMT) and pulse wave velocity (PWV) were measured following a standardized protocol in a subgroup of NEAT022 study participants at baseline and at Week 48. Results: One hundred and fifty-six patients participated in the ultrasonography and arterial stiffness substudies, respectively. In each substudy, population characteristics did not differ between arms and matched those of the main study. At 48 weeks, patients who switched to dolutegravir had Lower mean progression of both right (+4 versus +14.6 mu m) and Left (-6.1 versus +1.6 mu m) CIMT and also a smaller increase in mean PWV (+0.18 versus +0.39 m/s) than patients continuing on boosted PIs, although differences were not statistically significant. CIMT trends were consistent across Framingham score, age and country. Inconsistent effects were seen in arterial stiffness. Conclusions: Relative to continuing on boosted PIs, switching to dolutegravir in virologically suppressed patients with high cardiovascular risk showed consistent favourable although non-significant trends on CIMT progression at 48 weeks.

Published
2020

3. Acute kidney injury is linked to higher mortality in elderly hospitalized patients with non-valvular atrial fibrillation

Author

Novo-Veleiro I, Pose-Reino A, Gullón A, Díez-Manglano J, Cepeda JM, Formiga F, Camafort M, Mostaza JM, and Suárez C

Subjects
Elderly patients, Chronic kidney disease, Mortality, Non-valvular atrial fibrillation, Acute kidney injury
Abstract

AimRenal insufficiency is associated with medical complications in patients with non-valvular atrial fibrillation (NVAF). However, data for elderly patients are scarce. Thus, the main objectives of the present study were to analyze the characteristics of elderly patients with NVAF and acute or chronic renal disease, describe their management in real-life conditions, and detect factors associated with complications.MethodsThe NONAVASC registry includes patients >75years with NVAF, hospitalized by any cause in 64 Spanish Internal Medicine departments. Patients were categorized into acute kidney injury (AKI), chronic kidney disease (CKD) or preserved renal function (PRF). All variables associated with in-hospital mortality with P

Published
2019

4. Empagliflozin and Kidney Function Decline in Patients with Type 2 Diabetes: A Slope Analysis from the EMPA-REG OUTCOME Trial

Author

Wanner, Christoph, Heerspink, Hiddo J. L., Zinman, Bernard, Inzucchi, Silvio E., Koitka-Weber, Audrey, Mattheus, Michaela, Hantel, Stefan, Woerle, Hans-Juergen, Broedl, Uli C., von Eynatten, Maximilian, Groop, Per-Henrik, Aizenberg, D., Ulla, M., Waitman, J., De Loredo, L., Farias, J., Fideleff, H., Lagrutta, M., Maldonado, N., Colombo, H., Ferre Pacora, F., Wasserman, A., Maffei, L., Lehman, R., Selvanayagam, J., d'Emden, M., Fasching, P., Paulweber, B., Toplak, H., Luger, A., Drexel, H., Prager, R., Schnack, C., Schernthaner, G., Fliesser-Goerzer, E., Kaser, S., Scheen, A., Van Gaal, Luc, Hollanders, G., Kockaerts, Y., Capiau, L., Chachati, A., Persu, A., Hermans, M., Vantroyen, D., Vercammen, C., Van de Borne, P., Mathieu, C., Benhalima, Katrien, Lienart, F., Mortelmans, J., Strivay, M., Vereecken, G., Keymeulen, B., Lamkanfi, F., Chacra, A., Eliaschewitz, F., Zanella, M., Faludi, A., Bertolami, M., Hayashida, C., Nunes Salles, J., Monte, O., Dinato, M., Manenti, E., Rassi, N., Halpern, A., Lima Filho, M., Ayoub, J., Felicio, J., Borges, J., Gross, J., Sgarbi, J., Betti, R., Tiburcio, A., Purisch, S., Schmid, H., Takahashi, M., Castro, M., Rea, R., Hissa, M., Geloneze Neto, B., Saraiva, J., Henein, S., Lochnan, H., Imran, S. A., Clayton, D., Bayly, K., Berlingieri, J., Boucher, P., Chan, Y., Gupta, M., Chehayeb, R., Ouellett, A., Ur, E., Woo, V., Zinman, B., St Amour, E., Terront Lozano, M., Yupanqui Lozno, H., Urina, M., Lopez Jaramillo, P., Jaramillo, N., Sanchez, G., Perez, G., Tusek, S., Mirosevic, G., Goldoni, V., Jurisic-Erzen, D., Balasko, A., Balic, S., Drvodelic-Sunic, E., Varzic, S. Canecki, Machkova, M., Weiner, P., Lastuvka, J., Olsovsky, J., Krarup, T., Ridderstrale, M., Tarnow, L., Boesgaard, T. Wellov, Lihn, A. Saetre, Christensen, P., Juhl, H., Urhammer, S., Lund, P., Adojaan, B., Jakovlev, U., Lanno, R., Lubi, M., Marandi, T., Gouet, D., Courreges, J., Zaoui, P., Choukroun, G., Petit, C., Formagne, L., Estour, B., Mabire, P., Daugenet, C., Lemarie, B., Clavel, S., Aure, P., Remaud, P., Halimi, J., Hadjadj, S., Couffinhal, T., Glonti, S., Metreveli, D., Lominadze, Z., Giorgadze, E., Burtchuladze, T., Javashvili, L., Kurashvili, G., Kurashvili, R., Virsaladze, D., Nadareishvili, L., Khomasuridze, A., Cahill, T., Green, F., MacRury, S., Waldron, M., Middleton, A., McKnight, J., Pearson, E., Butler, M., Choksi, M., Caldwell, I., Farmer, I., Wyatt, N., Patrick, J., O'Brien, I., Devers, M., Bousboulas, S., Pappas, S., Piaditis, G., Vryonidou, A., Tentolouris, N., Karamitsos, K., Manes, C., Benroubi, M., Avramidis, I., Ozaki, R., Tan, K., Siu, S., Tsang, C., Dudas, M., Nagy, K., Salamon, C., Ip, T., Geroo, L., Patkay, J., Tabak, A., Juhasz, F., Szentpeteri, I., Tamas, G., Ghaisas, N., Bantwal, G., Mohan, V., Gupta, J., Sadhu, N., Kulkarni, A., Garg, N., Reddy, S., Deshpande, N., Gutlapalli, K., Pillai, M., Premchand, R., Badgandi, M., Jain, S., Aravind, S., Shamanna, P., Pandey, A., Gupta, S., Pramono, B., Saksono, H. Dante, Agung, P., Wahono, S. Djoko, Suastika, K., Tanggo, Y., Juwana, Y., Siswanto, B., Adawi, F., Efrati, S., Mazen, E., Bashkin, A., Herskovits, T., Jaffe, A., Schiff, E., Wainstein, J., Taddei, S., Aiello, A., Arca, M., Calabro, P., Cignarelli, M., Fioretto, P., Reggiani, G. Marchesini, Gnasso, A., Marchionni, N., Marsilii, A., Bucci, M., Mezzetti, A., Pozzilli, P., Colivicchi, F., Santini, M., Moro, E., Toscano, V., Fucili, A., Semplicini, A., Monno, S., Furui, K., Higashiue, S., Hiramatsu, N., Kawamitsu, K., Takenaka, T., Takahashi, H., Hojo, F., Onishi, Y., Izumino, K., Okubo, M., Wakida, Y., Kondo, Y., Hieshima, K., Jinnouchi, H., Suzuki, A., Ito, M., Park, S., Kim, Y., Hong, T., Park, H., Gwon, H., Kim, H., Kang, K., Jeong, M., Seung, K., Lim, D., Rha, S., Tahk, S., Yang, J., Yoon, J., Shin, M., Kim, D., Jeong, J., Ahmad, N. Nik, Mustafa, N., Mohamed, W. Wan, Fung, Y., Ghani, R. Abdul, Chandramouli, A., Chee, K., Kadir, K. Abdul, Ling, K., Abu Hassan, M., Foo, S., Lee, S., Garcia Hernandez, P., Aguilar-Salinas, C., Vidrio Velazquez, M., Flores, F., Alpizar Salazar, M., Micher Escalante, D., Garcia Soria, M., Cardona Munoz, E., Storms, G., Schaper, N., Kooy, A., Krekels, M., van Bemmel, T., Verhoeven, R., Mulder, H., Oldenburg-Ligtenberg, P., Gonkel, F., de Jong, A., van Soest, J., Viergever, P., Mevissen, H., Lochorn, G., Zwiers, G., Hoogslag, P., Ronner, E., Nierop, P., Al-Windy, N., Kragten, J., Dekelver, P., Benatar, J., Krebs, J., Scott, R., Heggen, E., Berz, A., Fossum, C., Hurtig, U., Langslet, G., Baranowski, M., Sparby, J., Karlsson, T., Karlsson, Thomas, Delgado Torres, C., Rodriguez Escudero, A., Lisson, R., Allemant Maldonado, A., Gallardo Rojas, W., Gonzales Bravo, L., Lema Osores, J., Farfan, J., Zapata, L., Godoy Junchaya, J., Roldan Concha, Y., Urquiaga Calderon, J., Sy, R., Tan, G., Aquitania, G., De Los Santos, G., Panelo, A., Roderos, O., Rosales, R., Toledo, R., Liwag, A., Ramoncito, H., Skokowska, E., Krzyzagorska, E., Ogorek, M., Wojnowski, L., Spyra, J., Konieczny, M., Piesiewicz, W., Kus, W., Ocicka-Kozakiewicz, A., Orlowska-Kunikowska, E., Zmuda, W., Duarte, S., Leitao, A., Monteiro, P., Rita, H., Salgado, V., Pinto, L., Queiros, J., Teixeira, J., Rogado, C., Duarte, R., Sobral do Rosario, F., Silva, A., Andrade, L., Velez, M., Brazao, M., Istratoaie, O., Lichiardopol, R., Catrinoiu, D., Militaru, C., Zetu, C., Barbonta, D., Cosma, D., Crisan, C., Pop, L., Esip, V., Khetagurova, F., Petrov, A., Arutyunov, G., Boyarkin, M., Agafyina, A., Vorokhobina, N., Petunina, N., Libov, I., Zalevskaya, A., Nikolaev, K., Barbarash, O., Potemkin, V., Bystrova, A., Krasilnikova, E., Barbarich, V., Chumakova, G., Tarasov, N., Meleshkevich, T., Zateyshchikov, D., Lantseva, O., Belenkiy, D., Obrezan, A., Rossolko, L., Fillipova, E., Yakhontova, P., Khokhlov, A., Tan, R., Sum, C., Chang, H., Distiller, L., Pretorius, M., Nortje, H., Mitha, E., Burgess, L., Blignaut, S., Venter, T., Moodley, R., Lombaard, J., Govind, U., Naidoo, V., Mookadam, M., Engelbrecht, J., Omar, M., Jurgens, J., Podgorski, G., Vawda, H., Naidoo, D., Emanuel, S., Roodt, A., Amod, A., Van Zyl, L., Segura, J., Brito, M., Fernandez-Cruz, A., Artola, S., Iglesias, R., Toural, E., Garcia-Ortiz, L., Saban, J., Mesa, J., Vidal, J., Linares, J., del Canizo, F., Rigla, M., Suarez, C., Llorente, I., Moreno, B., Antoli, A., Gomez Peralta, F., Iglesias, M., Pereg, V., de Teresa, L., Camafort, M., Trescoli, C., Satarasinghe, R., Somasundaram, N., Siyambalapitiya, S., Antonypillai, C., Bulugahapitiya, D., Medagama, U., Huang, C., Lu, Y., Hwang, J., Chiang, C., Wen, M., Chen, J., Lai, W., Chang, K., Wang, J., Yeh, H., Kriangsak, P., Deerochanawong, C., Suwanwalaikorn, S., Mangklabruks, A., Kaewsuwanna, P., Piyayotai, D., Iabluchanskyi, M., Samoylov, O., Godlevska, O., Kovalyova, O., Voloshyna, O., Tseluyko, V., Zotov, S., Vykhovanyuk, I., Dulgeroff, A., Mayfield, R., Zaniewski-Singh, M., Ullal, J., Aloi, J., De La Rosa, R., Mosely, J., Wittmer, B., Aronoff, S., Rosenfeld, J., Seidner, M., Warren, M., Fishman, N., Weiss, R., Arif, A., Sandberg, M., Lewis, D., Ball, E., Graf, R., Breton, C., Tamayo, R., Richards, R., Cefalu, W., Uwaifo, G., Zayour, D., Hoffman, J., Fitz-Patrick, D., Khan, B., Blaze, K., Bressler, P., Halpern, S., Chappell, D., Bergenstal, R., Cuddihy, R., Matfin, G., Freedman, Z., Gonzalez-Campoy, J., Lerman, S., Rendell, M., Sitar, S., Reeves, M., Howard, T., Soufer, J., Miranda-Palma, B., Laliotis, A., Shomali, M., Teltser, M., Hurley, D., Morawski, E., Cherlin, R., Houchin, V., Welch, M., Goytia-Leos, D., Syed, M., Kowaloff, E., Weinrauch, L., Peniston, J., Brockmyre, A., First, B., Feld, L., Huffman, D., Nassim, O., Gottschlich, G., Patel, A., Knopke, C., Hernandez, M., Diaz, J., Giugliano, G., Nicasio, J., Eagerton, D., Huntley, R., Reed, J., Magee, M., Hippert, R., Sofley, C., Alzohaili, O., Levins, P., Anspach, R., Shah, S., Brusco, O., Naidu, J., Lindenbaum, J., Jacks, R., Hammond, G., Arena, C., Saxman, K., Mach, M., Kerstein, H., Kereiakes, D., Wahlen, J., Wehmeier, K., Chaykin, L., Rothman, J., Fogelfeld, L., Stroger, John H., Bittar, N., Rosenstock, J., Kayne, D., Navarro, J., Colfer, H., Mokshagundam, S., Shandilya, L., Connery, L., Wysham, C., Dela Llana, A., Jardula, M., MacAdams, M., Flippo, G., Heurich, E., Curtis, C., Sanders, D., Rawls, R., Velazquez, F., Osea, E., Mahood, K., Feldman, G., Eder, F., Riley, E., Fowler, W., Jain, M., Shepard, M., Schear, M., Barker, B., Strout, C., Obiekwe, O., Shanik, M., Green, C., Blakney, E., Roberson, K., Bretton, E., Pish, R., Kaveh, K., Maynard, B., Barager, W., Soldyshev, R., Austin, B., Parmar, P., Simpson, R., Chauhan, A., Kasper, J., Burr, R., Patel, N., Mariano, H., Pluto, T., Bratcher, C., Juarez, M., Levinson, L., Awad, A., Longshaw, K., Hoffman, K., Richwine, R., Molter, D., Boscia, J., Kowalyk, S., Lemis, P., Liss, J., Orr, R., Riser, J., Wood, J., Ubani, A., Paine, W., Hassani, F., Miranda, F., Hansen, V., Hansen, Val R., Farris, N., Bowden, R., Ajani, D., Maw, K., Andersen, J., Bergman, B., Dunmyer, S., Brandon, D., Anderson, M., Bononi, P., Prawer, J., Seidman, B., Cruz, H., Wilks, K., DiSanto, L., Buynak, R., Christensen, T., Denker, P., Koppel, W., Stedman, M., Lewy-Alterbaum, L., Karim, S., Shapiro, J., Gardner, T., Oskin, T., Gabra, N., Malano, J., Real World Studies in PharmacoEpidemiology, -Genetics, -Economics and -Therapy (PEGET), Groningen Kidney Center (GKC), Methods in Medicines evaluation & Outcomes research (M2O), and EMPA-REG OUTCOME Investigators

Subjects
Male, Placebo-controlled study, PROGRESSION, Type 2 diabetes, 030204 cardiovascular system & hematology, PLACEBO-CONTROLLED TRIAL, GLOMERULAR-FILTRATION-RATE, HYPERFILTRATION, law.invention, ESTABLISHED CARDIOVASCULAR-DISEASE, Cohort Studies, MELLITUS, 0302 clinical medicine, Randomized controlled trial, Glucosides, law, Medicine, Diabetic Nephropathies, GFR DECLINE, General Medicine, Middle Aged, Nephrology, diabetes mellitus, randomized controlled trials, Disease Progression, Female, Glomerular Filtration Rate, medicine.medical_specialty, Urology, Renal function, 030209 endocrinology & metabolism, Placebo, 03 medical and health sciences, Double-Blind Method, Clinical Research, Diabetes mellitus, BASE-LINE CHARACTERISTICS, END-POINTS, Empagliflozin, Humans, Benzhydryl Compounds, Sodium-Glucose Transporter 2 Inhibitors, Aged, COTRANSPORTER 2 INHIBITION, Models, Statistical, Dose-Response Relationship, Drug, business.industry, chronic kidney disease, medicine.disease, Confidence interval, Diabetes Mellitus, Type 2, Human medicine, business
Abstract

BACKGROUND: Empagliflozin slowed the progression of CKD in patients with type 2 diabetes and cardiovascular disease in the EMPA-REG OUTCOME Trial. In a prespecified statistical approach, we assessed treatment differences in kidney function by analyzing slopes of eGFR changes.METHODS: Participants (n=7020) were randomized (1:1:1) to empagliflozin 10 mg/d, empagliflozin 25 mg/d, or placebo added to standard of care. We calculated eGFR slopes using random-intercept/random-coefficient models for prespecified study periods: treatment initiation (baseline to week 4), chronic maintenance treatment (week 4 to last value on treatment), and post-treatment (last value on treatment to follow-up).RESULTS: Compared with placebo, empagliflozin was associated with uniform shifts in individual eGFR slopes across all periods. On treatment initiation, adjusted mean slope (eGFR change per week, ml/min per 1.73 m2) decreased with empagliflozin (-0.77; 95% confidence interval, -0.83 to -0.71; placebo: 0.01; 95% confidence interval, -0.08 to 0.10; PCONCLUSIONS: The hemodynamic effects of empagliflozin, associated with reduction in intraglomerular pressure, may contribute to long-term preservation of kidney function.

Published
2018

5. Rivaroxaban: searching the integral vascular protection

Author

Barrios, V, Almendro-Delia, M, Facila, L, Garcia-Moll, X, Mazon, P, Camafort, M, Cepeda, JM, Garcia, JDM, Reino, AP, and Fernandez, CS

Subjects
cardiovascular disease, vascular protection, ROCKET-AF, Atrial fibrillation, COMPASS, rivaroxaban
Abstract

Introduction: Residual cardiovascular risk remains high in patients with atherosclerotic cardiovascular disease despite current antithrombotic therapy. On the other hand, patients with atrial fibrillation have an increased risk of myocardial infarction and cardiovascular death. As a result, a new antithrombotic approach appears necessary to reduce this risk. Areas covered: In this article, the role of rivaroxaban on vascular protection in patients with cardiovascular disease and/or atrial fibrillation was reviewed, with a particular focus, but not limited, on clinical trials. Expert commentary: Previous data have shown that factor Xa plays a key role in the etiopathogenesis of atherothrombosis. Experimental data suggest that rivaroxaban exhibits antiinflammatory and anti-oxidative stress properties, and may improve endothelial dysfunction. The COMPASS trial showed that among patients with stable atherosclerotic vascular disease, the addition of rivaroxaban 2.5 mg twice daily (vascular dose) to aspirin provided a higher cardiovascular protection than aspirin alone. In ROCKET-AF trial, compared with warfarin, rivaroxaban 20 mg once daily (15 mg if moderate renal dysfunction) (anticoagulant dose) was, at least, as effective as warfarin for the prevention of stroke or systemic embolism among patients with nonvalvular atrial fibrillation, with a trend toward a reduction in the risk of cardiovascular outcomes. All these data suggest that rivaroxaban might have a vascular protective effect beyond its stroke/systemic embolism preventive activity.

Published
2018

6. Rivaroxaban: searching the integral vascular protection

Author

Barrios V, Almendro-Delia M, Facila L, Garcia-Moll X, Mazón P, Camafort M, Cepeda JM, Mediavilla Garcia JD, Pose Reino A, and Suarez Fernandez C

Subjects
Atrial fibrillation, COMPASS, ROCKET-AF, cardiovascular disease, rivaroxaban, vascular protection
Abstract

Introduction: Residual cardiovascular risk remains high in patients with atherosclerotic cardiovascular disease despite current antithrombotic therapy. On the other hand, patients with atrial fibrillation have an increased risk of myocardial infarction and cardiovascular death. As a result, a new antithrombotic approach appears necessary to reduce this risk. Areas covered: In this article, the role of rivaroxaban on vascular protection in patients with cardiovascular disease and/or atrial fibrillation was reviewed, with a particular focus, but not limited, on clinical trials. Expert commentary: Previous data have shown that factor Xa plays a key role in the etiopathogenesis of atherothrombosis. Experimental data suggest that rivaroxaban exhibits antiinflammatory and anti-oxidative stress properties, and may improve endothelial dysfunction. The COMPASS trial showed that among patients with stable atherosclerotic vascular disease, the addition of rivaroxaban 2.5 mg twice daily (vascular dose) to aspirin provided a higher cardiovascular protection than aspirin alone. In ROCKET-AF trial, compared with warfarin, rivaroxaban 20 mg once daily (15 mg if moderate renal dysfunction) (anticoagulant dose) was, at least, as effective as warfarin for the prevention of stroke or systemic embolism among patients with nonvalvular atrial fibrillation, with a trend toward a reduction in the risk of cardiovascular outcomes. All these data suggest that rivaroxaban might have a vascular protective effect beyond its stroke/systemic embolism preventive activity.

Published
2018

7. Factors associated with discontinuing or not starting oral anticoagulant therapy in older hospitalized patients with non-valvular atrial fibrillation

Author

Díez-Manglano J, Mostaza JM, Pose A, Formiga F, Cepeda JM, Gullón A, Camafort M, Castiella J, Rovira E, Jarauta E, and Suárez C

Subjects
oral anticoagulation, cohort study, atrial fibrillation
Abstract

AimTo determine the factors associated with discontinuing or not starting oral anticoagulation (OA) therapy in older patients with non-valvular atrial fibrillation (NVAF). MethodsA prospective, multicenter cohort study was carried out of patients aged >75years with NVAF hospitalized in internal medicine departments in Spain. For each patient, we recorded creatinine, hemoglobin and platelets levels, as well as CHA2DS2-VASc and HAS-BLED scores and the Charlson Comorbidity Index. We measured the ability to carry out basic activities of daily life with the Barthel Index, and the cognitive state with the Short Portable Mental Status questionnaire. ResultsWe included 723 patients with NVAF, with a mean age of 84.8years (SD 5.2years); 390 (53.9%) of the patients were women. Before admission, 375 (51.9%) patients were treated with OA. Previously diagnosed NVAF (OR 4.099, 95% CI 1.824-9.211, P=0.001), the number of errors in the Short Portable Mental Status questionnaire (OR 1.180, 95% CI 1.020-1.365, P=0.026), peripheral arterial disease (OR 0.285, 95% CI 0.114-0.711, P=0.007) and hemoglobin levels (OR 0.812, 95% CI 0.682-0.966, P=0.019) were independently associated with not starting OA therapy at discharge. Of the 375 patients treated with OA at admission, 87 (23.2%) had their OA discontinued at discharge. The HAS-BLED score (OR 1.516, 95% CI 1.211-1.897, P

Published
2018

8. Baseline functional status as the strongest predictor of in-hospital mortality in elderly patients with non-valvular atrial fibrillation: Results of the NONAVASC registry

Author

Gullón A, Formiga F, Camafort M, Mostaza JM, Díez-Manglano J, Cepeda JM, Novo-Veleiro I, Pose A, Suárez Fernández C, and NONAVASC study group. Vascular Risk Group of the Spanish Society of Internal Med

Abstract

Objectives: Atrial fibrillation (AF) has been associated with higher mortality. We aimed to identify the baseline predictors of in-hospital mortality among elderly patients with non-valvular AF (NVAF) hospitalised for any reason. Methods: Observational, prospective and multicentre study was carried out on patients with NVAF over the age of 75, who had been admitted for any acute medical condition to Internal Medicine departments in Spain. Results: We evaluated 804 patients with a mean age of 85 +/- 5.1 years, of which 53.9% were females. During the hospitalization 10.1% (n=81) of the patients died. The patients who died were older, had a greater percentage of institutionalization, worse previous basic functional status (Barthel Index), worse cognitive performance at admission and greater proportion of frailty and sarcopenia. Logistic regression multivariate analysis identified that the strongest determinants of in-hospital mortality were the baseline functional status (Barthel Index) (OR for total dependency 4.73, 95% CI 2.32-9.63), and admissions for stroke (OR 3.55, 95% CI 1.41-8.90) and acute renal failure (OR 1.93, 95% CI 1.12-3.32). Conclusion: The overall in-hospital mortality of elderly patients with NVFA is high. Among all factors evaluated in the global geriatric assessment the baseline functional status was the strongest predictor for in-hospital mortality on this population. (C) 2017 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

Published
2018

9. Antithrombotic treatment and characteristics of elderly patients with non-valvular atrial fibrillation hospitalized at Internal Medicine departments. NONAVASC registry

Author

Gullón A, Suárez C, Díez-Manglano J, Formiga F, Cepeda JM, Pose A, Camafort M, Castiella J, Rovira E, and Mostaza JM

Subjects
Elderly, Antithrombotic treatment, Non-valvular atrial fibrillation
Abstract

Background and objetives: The prevalence of non-valvular atrial fibrillation (NVAF) increases with the patient's age and is associated with high morbi-mortality rates. The main goal of this study was to describe the characteristics of hospitalized elderly patients with NVAF and to identify the clinical and functional factors which determine the use of different antithrombotic strategies. Patients and methods: Observational, prospective, multicentre study carried out on patients with NVAF over the age of 75, who had been admitted for any medical condition to Internal Medicine departments. Results: We evaluated 804 patients with a mean age of 85 years (range 75-101), of which 53.9% were females. The prevalence of risk factors and cardiovascular disease was high: hypertension (87.6%), heart failure (65.4%), ischemic cardiomyopathy (24.4%), cerebrovascular disease (22.4%) and chronic kidney disease (45%). Among those cases with previous diagnoses of NVAF, antithrombotic treatment was prescribed in 86.2% of patients: anticoagulants (59.7%), antiplatelet medication (17.8%) and double therapy (8.7%). The factors associated with the use of antithrombotic treatment were history of acute coronary syndrome and atrial fibrillation progression longer than one year. Older age, atrial-fibrillation for less than one year, higher HAS-BLED scores and severe cognitive impairment were associated with the use of anti-platelet drugs. Permanent atrial fibrillation favoured the use of anticoagulants. Conclusions: Hospitalized patients older than 75 years old with NVAF showed numerous comorbidities. 'The percentage of anticoagulation was small and 18% received only anti-platelet therapy. The patient's age, atrial fibrillation's progression time and the severity of the cognitive impairment influenced this therapy choice. (C) 2016 Elsevier Espana, S.L.U. All rights reserved.

Published
2017

10. Antithrombotic treatment and characteristics of elderly patients with non-valvular atrial fibrillation hospitalized at Internal Medicine departments. NONAVASC registry

Author

Gullón A, Suárez C, Díez-Manglano J, Formiga F, Cepeda JM, Pose A, Camafort M, Castiella J, Rovira E, Mostaza JM, and en representación de los investigadores del estudio NONAVASC

Abstract

Background and objetives: The prevalence of non-valvular atrial fibrillation (NVAF) increases with the patient's age and is associated with high morbi-mortality rates. The main goal of this study was to describe the characteristics of hospitalized elderly patients with NVAF and to identify the clinical and functional factors which determine the use of different antithrombotic strategies. Patients and methods: Observational, prospective, multicentre study carried out on patients with NVAF over the age of 75, who had been admitted for any medical condition to Internal Medicine departments. Results: We evaluated 804 patients with a mean age of 85 years (range 75-101), of which 53.9% were females. The prevalence of risk factors and cardiovascular disease was high: hypertension (87.6%), heart failure (65.4%), ischemic cardiomyopathy (24.4%), cerebrovascular disease (22.4%) and chronic kidney disease (45%). Among those cases with previous diagnoses of NVAF, antithrombotic treatment was prescribed in 86.2% of patients: anticoagulants (59.7%), antiplatelet medication (17.8%) and double therapy (8.7%). The factors associated with the use of antithrombotic treatment were history of acute coronary syndrome and atrial fibrillation progression longer than one year. Older age, atrial-fibrillation for less than one year, higher HAS-BLED scores and severe cognitive impairment were associated with the use of anti-platelet drugs. Permanent atrial fibrillation favoured the use of anticoagulants. Conclusions: Hospitalized patients older than 75 years old with NVAF showed numerous comorbidities. 'The percentage of anticoagulation was small and 18% received only anti-platelet therapy. The patient's age, atrial fibrillation's progression time and the severity of the cognitive impairment influenced this therapy choice. (C) 2016 Elsevier Espana, S.L.U. All rights reserved.

Published
2017

11. Adiponectin: An emerging cardiovascular risk factor. The REFERENCE study | Adiponectina, un factor de riesgo cardiovascular emergente. Estudio REFERENCE

Author

Barrios Alonso, V., Gómez-Huelgas, R., Rodríguez, R., Pedro de Pablos Velasco, Madruga, F., Velasco, E., Giménez, R., Rubio, J. M., López, J. A., Toril, J., Ordóñez, A., Yoldi, A., Montagud, J. B., Pinar, J., Fernández, M. L., Gómez, R., Sánchez, A., Martín, J. A., Mateos, L., Díaz, J. A., Suárez, M. A., Saban, J., Arroyo, R., López, J., Fontanals, C., López, A., Marín, R., Chacón, A., Carretero, J. F., Hernández, C., Pérez, L., Villar, M. R., Villar, J. R., Gorgojo, J. J., Barroso, E., Álvarez, P., Campillo, M., Camafort, M., Mazzanti, G., Garre, J., Morales, C., Conde, F. J., Gómez, P., Fernández, F., Suárez, S., Villarroel, M. T., Salgado, F. M., Egido, J., Enjuto, J., Gargallo, M. A., García, J. A., Azcona, L. M., Zamorano, J. L., Candel, I., Serra, V., García, A. M., Luis, D., Romero, E., Guerra, J. M., Gómez, F. J., Fuertes, J., Daniel, C., Gunther, S. J., Bellido, D., Yañez, J. C., Soto, F., Rigueiro, P., García, J. M., Díaz, J. L., Sotres, G., Rondan, J. J., Aziz, A., Barriales, V., Asensio, F., Richard, J. M., García, S., Rodrigo, A., Pérez, J., Ruiz, P., Angel, J., Gascueña, R., Ortiz, R., Rayo, M., Martínez, E., González, O., Ortiz, A., Gómez, L. F., Donnay, S., Melehi, D., Horcajo, P., García, F., Gómez, J., Calderón, A., Fernández, M. C., Pujadas, R., Rafael, J., Alfani, O., Virgos, G., Elsaheb, M., Recio, J., Montull, S., Abardia, X., Sucunza, N., Borrallo, R. M., Palos, M. A., Fernández, L. A., Arribas, J. M., Quintas, L., Camacho, I., Montes, P. M., Novales, J. A., Catalán, J. I., Arteaga, R., Ezcurdia, J., Moreno, C., Morillas, M., García, H., Ribas, M., Ortiz, J., Segura, I., Soler, J., Ripoll, T., Fosch, J., Moreno, R., Domenech, M., Antonio, M. T., Viguera, J., Paytubi, C., Blanch, P., Cuatrecasas, G., Gómez, J. M., Laguna, A., Mayos, J., Lapuebla, M. C., Morales, A., Silva, C., Taberna, S., Cordero, A., Pérez, S., Madariaga, I., Elejalde, J. I., Ancin, R., Tiberio, G., Gracia, M. L., Berdun, M. A., García, A., Gayán, R., Sanz, A., Férriz, P., Piedecausa, M. M., Toral, A., Hernández, E., Carnero, A., Arribas, J., Hernández, A., García, B., Gonzálvez, M., Martínez, T., Mediavilla, J. D., Fernández, C., Romero, J. A., González, A., Fajardo, R., Ramos, E., Aramburu, O., Rivera, F. J., Arias, J. L., Beltrán, J., Melguizo, I., Mateos, P. C., Mendoza, M. E., Romero, S. P., Motero, J., Guevara, J. A., Sánchez, H., Espino, A., Varela, J. M., Lobon, J. A., Jiménez, B., Arizón, J. M., Mora, J., Piñero, I., Gaitán, D., Fernández, D., Carmona, J. R., Garrido, A. M., Gómez, J. J., Costo, A., Alfredo, O., Marcos, G., Porras, Y., Hernández, J., Morales, J., Pérez, J. C., Suárez, M. M., Jiménez, P., and Martínez, F. J.

12. Statement of the Spanish Interdisciplinary Vascular Prevention Committee on the updated European Guidelines on Cardiovascular Disease Prevention,Comentario del CEIPV a las nuevas Guías Europeas de Prevención Cardiovascular 2021

Author

Brotons, C., Camafort, M., Castellanos, M. D. M., Clarà, A., Cortés, O., ANGEL DIAZ RODRIGUEZ, Elosúa, R., Gorostidi, M., Hernández, A. M., Herranz, M., Justo, S., Lahoz, C., Niño, P., Pallarés-Carratalá, V., Pedro-Botet, J., Pérez Pérez, A., Royo-Bordonada, M. Á, Santamaría, R., Tresserras, R., Zamora, A., Zuza, I., and Armario, P.

13. Neurohormonal blockade in patients with heart failure at discharge from hospital,Bloqueo neurohormonal al alta en pacientes con insuficiencia cardiaca

Author

Casado Cerrada, J. M., Visus, E., Recio, J. P., MARIA SANCHEZ-LEDESMA, Chimeno, M., Roca, B., Conthe, P., Casado, J., Casademont, J., Ramos, J., Forteza-Rey, J., García-Alegría, J., Montero, M., Cortés, B., Michán, A., Pinilla, B., Méndez, M., Ryan, P., Chivite, D., Duaso, E., Tiberio, G., Muniesa, M., Moreno, J., Ferreira, E., Herrero, A., Torre, J. A., Montes, J., Sánchez, M., Puerto, E., Barrios, M., Camafort, M., Román, P., Samperiz, P., Irazola, A. C., Tirado, R., Ramos, R. M., Pujol, R., Llopis, F., Solé, A., Alegre, J., and Rivas, B.

14. Prevalence of M. tuberculosis infection and tuberculosis disease among HIV-infected people in Spain

Author

Diez, M., Diaz, A., Bleda, M. J., Aldamiz, M., Camafort, M., Camino, X., Concepción Cepeda, Costa, A., Ferrero, O., Geijo, P., Iribarren, J. A., Moreno, S., Moreno, M. E., Labarga, P., Pinilla, J., Portu, J., Pulido, F., Rosa, C., Santamaria, J. M., Telenti, M., Trapiella, L., Trastoy, M., and Viciana, R.

Subjects
Adult, Male, Risk Factors, Spain, Multivariate Analysis, Odds Ratio, Prevalence, Humans, Tuberculosis, Female, HIV Infections, Mycobacterium tuberculosis, Middle Aged
Abstract

To study the prevalence of Mycobacterium tuberculosis infection (MTBI) and past/current tuberculosis (TB) among human immunodeficiency virus (HIV) infected persons in Spain.Longitudinal study conducted between 2000 and 2003 at 10 HIV hospital-based clinics. Data were drawn from clinical records. Associations were measured using odds ratios (ORs) and their 95% confidence intervals (95%CI).Of the 1242 persons who met the eligibility criteria, most were male (75%), aged40 years (75%) and unemployed (40%). HIV infection occurred through intravenous drug use (53%), heterosexual sex (29%) and sex between men (16%). In the initial evaluation, 315 subjects had evidence of MTBI: 84 (6.8%) had a history of TB, 23 (1.8%) current TB and 208 (16.8%) latent tuberculosis infection (LTBI). MTBI was associated with male sex, age 30-49 years, contact with a TB case, homelessness, poor education, and negatively with CD4100 cells/mm(3). Among subjects with MTBI, past/current TB was associated with retirement/disability (OR 6, 95%CI 1.6-22.5), CD4200 cells/mm(3) (OR 9.7, 95%CI 3.8-24.6), viral load55,000 copies (OR 5.3, 95%CI 1.4-20.0), and negatively, with skilled work (OR 0.4, 95%CI 0.1-1.0) or administrative/managerial/professional work (OR 0.05, 95%CI 0.01-0.4).Social context has an impact on the effectiveness of HIV and TB control programmes even in industrialised countries with free access to health care.

16. Immunological and virological activity of zalcitabine and zidovudine in combination in HIV-positive people with CD4 cell counts of between 200-500 cells/mm3

Author

Ibáfiez, A., Peraire, J., Arnó, A., Gutiérrez, C., Cervantes, M., Colomer, J., Villalonga, C., Camafort, M., Ruiz, L., Balaguer, M., Francesc Vidal, Richart, C., and Clotet, B.

Subjects
Anti-HIV Agents, Zalcitabine, HIV Seropositivity, Humans, RNA, Viral, Drug Therapy, Combination, Zidovudine, CD4 Lymphocyte Count
Abstract

We evaluated the effect of combination therapy with zidovudine (AZT) plus zalcitabine (ddC) in human immunodeficiency virus type 1 (HIV-1)-infected patients who had not previously received antiretroviral treatment ('naive' patients). The immunological and virological parameters evaluated were CD4 cell count, syncytium-inducing (SI) viral phenotype and plasma HIV-1 RNA copies/ml (HIV viral load). A total of 75 patients entered the study, with CD4 cell counts between 200 and 500 cells/mm3. All received zidovudine (200 mg) plus zalcitabine (0.75 mg) three times daily for 24 weeks. Treatment was well tolerated. However, four patients presented with anaemia (haemoglobin10.0 g/dl) and one patient had both anaemia and neutropenia (0.8 x 10(9) neutrophils/l). Combination therapy with zidovudine plus zalcitabine resulted in a pronounced improvement of virological and immunological markers. Approximately 25% of patients achieved undetectable plasma HIV RNA levels (200 copies/ml) at week 24. At the end of the study (24 weeks) a significant reduction (0.5 log) of plasma HIV RNA was observed in approximately 70% of patients and in 50% an even greater decrease (1 log) was achieved. The most significant decrease in mean plasma HIV RNA levels was observed at week 4, whereas the highest increase in CD4 cell count was found at week 24. Approximately 80% of patients who showed baseline plasma HIV RNA levels below 20000 copies/ml had less than 5000 copies/ml at week 24. The plasma HIV RNA reduction observed at week 4 was significantly maintained at week 24. Therefore, we can rapidly select those who will not respond to therapy and adjust the treatment after a short interval. Our study supports the idea of early therapy because all patients who reached undetectable levels of plasma HIV RNA at week 24 had at baseline a median plasma HIV RNA load of 2560 copies/ml. In conclusion, zidovudine in combination with zalcitabine was well tolerated in the majority of patients and led to a significant reduction in plasma HIV RNA copies in most of the patients with initial viraemia lower than 20000 copies/ml.

17. Adiponectin: An emerging cardiovascular risk factor. The REFERENCE study,Adiponectina, un factor de riesgo cardiovascular emergente. Estudio REFERENCE

Author

Barrios Alonso, V., Gómez-Huelgas, R., Rodríguez, R., Pablos-Velasco, P., Madruga, F., Velasco, E., Giménez, R., Rubio, J. M., López, J. A., Toril, J., Ordóñez, A., Yoldi, A., Montagud, J. B., Pinar, J., Fernández, M. L., Gómez, R., Sánchez, A., Martín, J. A., Mateos, L., Díaz, J. A., Suárez, M. A., Saban, J., Arroyo, R., López, J., Fontanals, C., López, A., Marín, R., Chacón, A., Carretero, J. F., Hernández, C., Pérez, L., Villar, M. R., Villar, J. R., Gorgojo, J. J., Barroso, E., Álvarez, P., Campillo, M., Camafort, M., Mazzanti, G., Garre, J., Morales, C., Conde, F. J., Gómez, P., Fernández, F., Suárez, S., Villarroel, M. T., Salgado, F. M., Egido, J., Enjuto, J., Gargallo, M. A., García, J. A., Azcona, L. M., Zamorano, J. L., Candel, I., Serra, V., García, A. M., Luis, D., Romero, E., Guerra, J. M., Gómez, F. J., Fuertes, J., Daniel, C., Gunther, S. J., Bellido, D., Yañez, J. C., Soto, F., Rigueiro, P., García, J. M., Díaz, J. L., Sotres, G., Rondan, J. J., Aziz, A., Barriales, V., Asensio, F., Richard, J. M., García, S., Rodrigo, A., Pérez, J., Ruiz, P., Angel, J., Gascueña, R., Ortiz, R., Rayo, M., Martínez, E., González, O., Ortiz, A., Gómez, L. F., Donnay, S., Melehi, D., Horcajo, P., García, F., Gómez, J., Calderón, A., Fernández, M. C., Pujadas, R., Rafael, J., Alfani, O., Virgos, G., Elsaheb, M., Recio, J., Montull, S., Abardia, X., Sucunza, N., Borrallo, R. M., Palos, M. A., Fernández, L. A., Arribas, J. M., Quintas, L., Camacho, I., Montes, P. M., Novales, J. A., Catalán, J. I., Arteaga, R., Ezcurdia, J., Moreno, C., Morillas, M., García, H., Ribas, M., Ortiz, J., Segura, I., Soler, J., Ripoll, T., Fosch, J., Moreno, R., Domenech, M., Antonio, M. T., Viguera, J., Paytubi, C., Blanch, P., Cuatrecasas, G., Gómez, J. M., Laguna, A., Mayos, J., Lapuebla, M. C., Morales, A., Silva, C., Taberna, S., Cordero, A., Pérez, S., Madariaga, I., Elejalde, J. I., Ancin, R., Tiberio, G., Gracia, M. L., Berdun, M. A., García, A., Gayán, R., Sanz, A., Férriz, P., Piedecausa, M. M., Toral, A., Hernández, E., Amancio Carnero, Arribas, J., Hernández, A., García, B., Gonzálvez, M., Martínez, T., Mediavilla, J. D., Fernández, C., Romero, J. A., González, A., Fajardo, R., Ramos, E., Aramburu, O., Rivera, F. J., Arias, J. L., Beltrán, J., Melguizo, I., Mateos, P. C., Mendoza, M. E., Romero, S. P., Motero, J., Guevara, J. A., Sánchez, H., Espino, A., Varela, J. M., Lobon, J. A., Jiménez, B., Arizón, J. M., Mora, J., Piñero, I., Gaitán, D., Fernández, D., Carmona, J. R., Garrido, A. M., Gómez, J. J., Costo, A., Alfredo, O., Marcos, G., Porras, Y., Hernández, J., Morales, J., Pérez, J. C., Suárez, M. M., Jiménez, P., and Martínez, F. J.

18. Eligibility for and outcome of treatment of latent tuberculosis infection in a cohort of HIV-infected people in Spain

Author

Juan Miguel Santamaría, Carmen Rosa, Joseba Portu, Asunción Díaz, Paloma Geijo, Mónica Trastoy, Concepción Cepeda, Federico Pulido, Mikel Aldamiz, María Elena Moreno, Mauricio Telenti, Luis Trapiella, Pompeyo Viciana, Xabier Camino, Santiago Moreno, Javier Pinilla, Miguel Camafort, Oscar Ferrero, Asuncion Costa, Pablo Labarga, Mercedes Díez, María José Bleda, José Antonio Iribarren, Fundación para la Investigación y la Prevención del Sida en España, [Diaz,A, Bleda,MJ] Unidad de Epidemiología del VIH/SIDA, Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain. [Diez,M] Secretaria del Plan Nacional sobre el sida, Ministerio de Sanidad y Política Social, Madrid, Spain. [Aldamiz.M, Portu,J] Servicio Medicina Interna, Hospital Txagorritxu,Vitoria, Spain. [Camafort,M] Servicio Medicina Interna, Hospital Mora d'Ebre, Instituto de Investigación Sanitaria 'Pere Virgili', Universidad 'Rovira i Virgili', Mora d'Ebre, Spain. [Camino,X, Iribarren,JA] Servicio de Enfermedades Infecciosas, Hospital Ntra Sra de Aranzazu, San Sebastián, Spain. [Cepeda,C, Costa,A, Pulido,F] Unidad VIH, Hospital Doce de Octubre, Madrid, Spain. [Ferrero,O, Santamaría,JM] Servicio Enfermedades Infecciosas, Hospital de Basurto, Bilbao, Spain. [Geijo,P, Rosa,C] Servicio Medicina Interna, Hospital Virgen de la Luz, Cuenca, Spain. [Moreno,S, Moreno,ME] Servicio de Enfermedades Infeccciosas, Hospital Ramón y Cajal, Madrid, Spain. [Labarga,P, Pinilla,J] Servicio de Medicina Interna, Hospital San Millán, Logroño, Spain. [Telenti,M, Trapiella,L] Unidad de Enfermedades Infecciosas, Hospital Universitario Central de Asturias, Oviedo, Spain. [Trastoy,M, Viciana,P] Servicio Enfermedades Infecciosas, Hospital Virgen del Rocío, Sevilla, Spain., and This work was funded by a grant (3041/99) from the Foundation for AIDS Research and Prevention in Spain (Fundación para la Investigación y la Prevención del SIDA en España-FIPSE).

Subjects
Male, España, Antitubercular Agents, HIV Infections, Named Groups::Persons::Age Groups::Adult::Middle Aged [Medical Subject Headings], Health Care::Health Care Quality, Access, and Evaluation::Delivery of Health Care::Attitude to Health::Patient Acceptance of Health Care::Patient Compliance::Medication Adherence [Medical Subject Headings], Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::Humans [Medical Subject Headings], Prospective Studies, Prospective cohort study, Geographicals::Geographic Locations::Europe::Spain [Medical Subject Headings], Latent tuberculosis, Adulto, Estudios Prospectivos, Middle Aged, Humanos, Infectious Diseases, Treatment Outcome, Cohort, Diseases::Immune System Diseases::Immunologic Deficiency Syndromes::HIV Infections [Medical Subject Headings], Female, Antituberculosos, medicine.drug, Research Article, Adult, medicine.medical_specialty, Tuberculosis, Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Epidemiologic Study Characteristics as Topic::Epidemiologic Studies::Cohort Studies::Longitudinal Studies::Prospective Studies [Medical Subject Headings], Resultado del Tratamiento, Check Tags::Male [Medical Subject Headings], Tuberculin, lcsh:Infectious and parasitic diseases, Medication Adherence, Cumplimiento de la Medicación, Latent Tuberculosis, Internal medicine, Named Groups::Persons::Age Groups::Adult [Medical Subject Headings], medicine, Humans, lcsh:RC109-216, Analytical, Diagnostic and Therapeutic Techniques and Equipment::Diagnosis::Prognosis::Treatment Outcome [Medical Subject Headings], business.industry, Odds ratio, Chemicals and Drugs::Chemical Actions and Uses::Pharmacologic Actions::Therapeutic Uses::Anti-Infective Agents::Anti-Bacterial Agents::Antitubercular Agents [Medical Subject Headings], Pyrazinamide, medicine.disease, Infecciones por VIH, Check Tags::Female [Medical Subject Headings], Spain, Immunology, business, Rifampicin
Abstract

BACKGROUND: Previous studies have demonstrated the efficacy of treatment for latent tuberculosis infection (TLTBI) in persons infected with the human immunodeficiency virus, but few studies have investigated the operational aspects of implementing TLTBI in the co-infected population.The study objectives were to describe eligibility for TLTBI as well as treatment prescription, initiation and completion in an HIV-infected Spanish cohort and to investigate factors associated with treatment completion. METHODS: Subjects were prospectively identified between 2000 and 2003 at ten HIV hospital-based clinics in Spain. Data were obtained from clinical records. Associations were measured using the odds ratio (OR) and its 95% confidence interval (95% CI). RESULTS: A total of 1242 subjects were recruited and 846 (68.1%) were evaluated for TLTBI. Of these, 181 (21.4%) were eligible for TLTBI either because they were tuberculin skin test (TST) positive (121) or because their TST was negative/unknown but they were known contacts of a TB case or had impaired immunity (60). Of the patients eligible for TLTBI, 122 (67.4%) initiated TLTBI: 99 (81.1%) were treated with isoniazid for 6, 9 or 12 months; and 23 (18.9%) with short-course regimens including rifampin plus isoniazid and/or pyrazinamide. In total, 70 patients (57.4%) completed treatment, 39 (32.0%) defaulted, 7 (5.7%) interrupted treatment due to adverse effects, 2 developed TB, 2 died, and 2 moved away. Treatment completion was associated with having acquired HIV infection through heterosexual sex as compared to intravenous drug use (OR:4.6; 95% CI:1.4-14.7) and with having taken rifampin and pyrazinamide for 2 months as compared to isoniazid for 9 months (OR:8.3; 95% CI:2.7-24.9). CONCLUSIONS: A minority of HIV-infected patients eligible for TLTBI actually starts and completes a course of treatment. Obstacles to successful implementation of this intervention need to be addressed. This work was funded by a grant (3041/99) from the Foundation for AIDS Research and Prevention in Spain (Fundación para la Investigación y la Prevención del SIDA en España-FIPSE). Sí

Published
2010

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