6 results on '"Miró, José M."'
Search Results
2. Safety and efficacy of daptomycin in outpatient parenteral antimicrobial therapy: a prospective and multicenter cohort study (DAPTODOM trial).
- Author
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Cervera, Carlos, Sanroma, Pedro, González-Ramallo, Víctor, García de la María, Cristina, Sanclemente, Gemma, Sopena, Nieves, Pajarón, Marcos, Segado, Antonio, Mirón, Manuel, Antón, Francisco, Basterretxea, Andima, Cuende, Ana, and Miró, José M.
- Subjects
ANTI-infective agents ,DIAGNOSIS of endocarditis ,PULMONARY embolism ,STAPHYLOCOCCAL disease treatment ,GRAM-positive bacterial infections ,SOFT tissue infections ,TREATMENT effectiveness ,BACTEREMIA ,BLOOD vessels ,CHRONIC diseases ,DIABETES ,DRUG infusion pumps ,DRUG resistance in microorganisms ,CLINICAL drug trials ,HEART diseases ,HEART failure ,HOSPITAL admission & discharge ,PATIENT aftercare ,INTRAVENOUS therapy ,LONGITUDINAL method ,MEDICAL cooperation ,MEDICAL equipment ,PATIENTS ,PATIENT safety ,PEPTIDE antibiotics ,PHYSICIANS ,REPORT writing ,RESEARCH ,RESEARCH funding ,SKIN diseases ,STAPHYLOCOCCUS aureus ,TUMORS ,TREATMENT duration ,METHICILLIN-resistant staphylococcus aureus ,DATA analysis software ,DESCRIPTIVE statistics ,MANN Whitney U Test ,DIAGNOSIS ,BACTERIAL disease treatment ,THERAPEUTICS - Abstract
Background: Daptomycin is an optimal choice for outpatient parenteral antibiotic therapy (OPAT) because of its safety, once-daily administration and its activity against Gram-positive bacteria. Although daptomycin is increasingly being used in OPAT, limited information about its safety in this scenario is available. Methods: We performed a prospective multicentre pilot study to evaluate the safety of daptomycin in outpatients with proved or suspected Gram-positive infections (DAPTODOM). The primary objective was to evaluate the safety and the secondary objective to evaluate the efficacy in OPAT. We also looked at the development of daptomycin resistance in those cases with microbiological failure. Results: We included 54 patients from 12 Spanish hospitals, 67% male with a mean age of 67.1 years. Most patients (87%) had chronic underlying diseases. The main reason for inclusion was skin and soft-tissue infections in 52%, followed by bacteremia or endocarditis in 34%. Staphylococcus aureus accounted for 44% of the isolates (24% were methicillin-resistant), coagulase-negative staphylococci 15% and enterococci 7%. Two patients (4%) had to be readmitted because of complications; only one patient had an adverse effect related to daptomycin (increase in serum creatine kinase levels), which disappeared after discontinuation (2%). At the end of follow-up, 96% of patients had good outcome and only 4% of patients did not have a clinical or microbiological cure. The use of a 2-minute bolus in 18 cases was not associated with adverse effects. Conclusions: Daptomycin was safe and efficacious in outpatients with Gram-positive bacterial infections and can be administered in 2-minute bolus infusion. [ABSTRACT FROM AUTHOR]
- Published
- 2017
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3. Comparative effectiveness of immediate antiretroviral therapy versus CD4-based initiation in HIV-positive individuals in high-income countries: observational cohort study.
- Author
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Lodi S, Phillips A, Logan R, Olson A, Costagliola D, Abgrall S, van Sighem A, Reiss P, Miró JM, Ferrer E, Justice A, Gandhi N, Bucher HC, Furrer H, Moreno S, Monge S, Touloumi G, Pantazis N, Sterne J, Young JG, Meyer L, Seng R, Dabis F, Vandehende MA, Pérez-Hoyos S, Jarrín I, Jose S, Sabin C, and Hernán MA
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- Adult, CD4 Lymphocyte Count, Cohort Studies, Developed Countries, Europe, Female, HIV Infections diagnosis, HIV-1 genetics, Humans, Male, Mass Screening, Middle Aged, Policy, Survival Rate, Time Factors, United States, Viral Load, Young Adult, Antiretroviral Therapy, Highly Active, Comparative Effectiveness Research, HIV Infections drug therapy, HIV Infections mortality
- Abstract
Background: Recommendations have differed nationally and internationally with respect to the best time to start antiretroviral therapy (ART). We compared effectiveness of three strategies for initiation of ART in high-income countries for HIV-positive individuals who do not have AIDS: immediate initiation, initiation at a CD4 count less than 500 cells per μL, and initiation at a CD4 count less than 350 cells per μL., Methods: We used data from the HIV-CAUSAL Collaboration of cohort studies in Europe and the USA. We included 55,826 individuals aged 18 years or older who were diagnosed with HIV-1 infection between January, 2000, and September, 2013, had not started ART, did not have AIDS, and had CD4 count and HIV-RNA viral load measurements within 6 months of HIV diagnosis. We estimated relative risks of death and of death or AIDS-defining illness, mean survival time, the proportion of individuals in need of ART, and the proportion of individuals with HIV-RNA viral load less than 50 copies per mL, as would have been recorded under each ART initiation strategy after 7 years of HIV diagnosis. We used the parametric g-formula to adjust for baseline and time-varying confounders., Findings: Median CD4 count at diagnosis of HIV infection was 376 cells per μL (IQR 222-551). Compared with immediate initiation, the estimated relative risk of death was 1·02 (95% CI 1·01-1·02) when ART was started at a CD4 count less than 500 cells per μL, and 1·06 (1·04-1·08) with initiation at a CD4 count less than 350 cells per μL. Corresponding estimates for death or AIDS-defining illness were 1·06 (1·06-1·07) and 1·20 (1·17-1·23), respectively. Compared with immediate initiation, the mean survival time at 7 years with a strategy of initiation at a CD4 count less than 500 cells per μL was 2 days shorter (95% CI 1-2) and at a CD4 count less than 350 cells per μL was 5 days shorter (4-6). 7 years after diagnosis of HIV, 100%, 98·7% (95% CI 98·6-98·7), and 92·6% (92·2-92·9) of individuals would have been in need of ART with immediate initiation, initiation at a CD4 count less than 500 cells per μL, and initiation at a CD4 count less than 350 cells per μL, respectively. Corresponding proportions of individuals with HIV-RNA viral load less than 50 copies per mL at 7 years were 87·3% (87·3-88·6), 87·4% (87·4-88·6), and 83·8% (83·6-84·9)., Interpretation: The benefits of immediate initiation of ART, such as prolonged survival and AIDS-free survival and increased virological suppression, were small in this high-income setting with relatively low CD4 count at HIV diagnosis. The estimated beneficial effect on AIDS is less than in recently reported randomised trials. Increasing rates of HIV testing might be as important as a policy of early initiation of ART., Funding: National Institutes of Health., (Copyright © 2015 Elsevier Ltd. All rights reserved.)
- Published
- 2015
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4. Impact of antiretroviral therapy on tuberculosis incidence among HIV-positive patients in high-income countries.
- Author
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del Amo J, Moreno S, Bucher HC, Furrer H, Logan R, Sterne J, Pérez-Hoyos S, Jarrín I, Phillips A, Lodi S, van Sighem A, de Wolf W, Sabin C, Bansi L, Justice A, Goulet J, Miró JM, Ferrer E, Meyer L, Seng R, Toulomi G, Gargalianos P, Costagliola D, Abgrall S, and Hernán MA
- Subjects
- AIDS-Related Opportunistic Infections microbiology, Adult, Anti-HIV Agents adverse effects, CD4 Lymphocyte Count, Cohort Studies, Developed Countries, Drug Therapy, Combination, Europe epidemiology, Female, HIV Infections virology, HIV Seropositivity drug therapy, HIV Seropositivity epidemiology, Humans, Immune Reconstitution Inflammatory Syndrome complications, Incidence, Male, Middle Aged, Mycobacterium tuberculosis isolation & purification, Pneumocystis carinii, Pneumonia, Pneumocystis epidemiology, Pneumonia, Pneumocystis microbiology, RNA, Viral analysis, Tuberculosis microbiology, United States epidemiology, Viral Load drug effects, AIDS-Related Opportunistic Infections epidemiology, Anti-HIV Agents therapeutic use, HIV Infections drug therapy, Tuberculosis epidemiology
- Abstract
Background: The lower tuberculosis incidence reported in human immunodeficiency virus (HIV)-positive individuals receiving combined antiretroviral therapy (cART) is difficult to interpret causally. Furthermore, the role of unmasking immune reconstitution inflammatory syndrome (IRIS) is unclear. We aim to estimate the effect of cART on tuberculosis incidence in HIV-positive individuals in high-income countries., Methods: The HIV-CAUSAL Collaboration consisted of 12 cohorts from the United States and Europe of HIV-positive, ART-naive, AIDS-free individuals aged ≥18 years with baseline CD4 cell count and HIV RNA levels followed up from 1996 through 2007. We estimated hazard ratios (HRs) for cART versus no cART, adjusted for time-varying CD4 cell count and HIV RNA level via inverse probability weighting., Results: Of 65 121 individuals, 712 developed tuberculosis over 28 months of median follow-up (incidence, 3.0 cases per 1000 person-years). The HR for tuberculosis for cART versus no cART was 0.56 (95% confidence interval [CI], 0.44-0.72) overall, 1.04 (95% CI, 0.64-1.68) for individuals aged >50 years, and 1.46 (95% CI, 0.70-3.04) for people with a CD4 cell count of <50 cells/μL. Compared with people who had not started cART, HRs differed by time since cART initiation: 1.36 (95% CI, 0.98-1.89) for initiation <3 months ago and 0.44 (95% CI, 0.34-0.58) for initiation ≥3 months ago. Compared with people who had not initiated cART, HRs <3 months after cART initiation were 0.67 (95% CI, 0.38-1.18), 1.51 (95% CI, 0.98-2.31), and 3.20 (95% CI, 1.34-7.60) for people <35, 35-50, and >50 years old, respectively, and 2.30 (95% CI, 1.03-5.14) for people with a CD4 cell count of <50 cells/μL., Conclusions: Tuberculosis incidence decreased after cART initiation but not among people >50 years old or with CD4 cell counts of <50 cells/μL. Despite an overall decrease in tuberculosis incidence, the increased rate during 3 months of ART suggests unmasking IRIS.
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- 2012
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5. Heart transplantation in HIV-infected patients: more cases in Europe.
- Author
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Castel MA, Pérez-Villa F, and Miró JM
- Subjects
- Adult, Anti-Retroviral Agents therapeutic use, Comorbidity, Europe epidemiology, Female, HIV Infections drug therapy, Humans, Male, Resource Allocation, HIV Infections epidemiology, Heart Diseases epidemiology, Heart Diseases surgery, Heart Transplantation statistics & numerical data
- Published
- 2011
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6. [HIV infection in immigrants in Spain: Epidemiological characteristics and clinical presentation in the CoRIS Cohort (2004-2006)].
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Caro-Murillo AM, Gutiérrez F, Manuel Ramos J, Sobrino P, Miró JM, López-Cortés LF, Tural C, Moreno A, de Los Santos I, Murillas J, Camino X, Salavert M, Rubio R, Moreno S, and del Amo J
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- AIDS-Related Opportunistic Infections epidemiology, Adolescent, Adult, Africa South of the Sahara ethnology, Aged, Aged, 80 and over, CD4 Lymphocyte Count, Cohort Studies, Comorbidity, Europe ethnology, Female, Follow-Up Studies, HIV Infections transmission, Hepatitis B epidemiology, Hepatitis C epidemiology, Histoplasmosis epidemiology, Humans, Latin America ethnology, Male, Middle Aged, North America ethnology, Risk Factors, Spain epidemiology, Tuberculosis epidemiology, Viral Load, Young Adult, Emigrants and Immigrants statistics & numerical data, HIV Infections epidemiology
- Abstract
Introduction: A growing number of immigrants are using the public health services for HIV in Spain. We describe the sociodemographic, epidemiological, and clinical characteristics of a cohort of naïve HIV-infected subjects (CoRIS cohort) according to their place of origin., Methods: CoRIS is an open, hospital-based cohort of naïve, HIV-infected persons attended in 19 hospitals from 9 of the 19 autonomous regions in Spain. We describe the characteristics of the cohort members by place of origin, and compare them with the Spanish cases identified from January 2004 to October 2006, using the chi-square and Fisher exact tests., Results: Of 2507 patients, 76.3% were men and median age was 36 years. By origin, 71.5% were Spanish, 16.0% Latin Americans (LA), 5.8% sub-Saharan Africans (SSA), 3.7% Western Europeans (WE), 1.7% Eastern Europeans (EE) and 1.4% North Africans (NA). Compared to Spaniards, there were significant differences by origin in sex, age, and transmission category. Median CD4 count at cohort entry was 352 cell/microL, with no differences according to origin. Median viral load was 48 962 copies/mL and was significantly lower for SSA. Over 11.4 months of follow-up, 57.9% initiated HAART with no differences by origin. Hepatitis C prevalence was 29.9% in Spaniards, 7.3% in Latin Americans, 11.7% in SSA, and 45.7% in EE (P<0.05). Overall, 13.4% were Mantoux-positive (28.6% in SSA and 30.8% in NA). Tuberculosis was more common among cases from EE (9.5%) and SSA (8.3%) compared to Spaniards (4.8%) (P<0.05)., Conclusions: Almost one third of naïve HIV-infected patients in CoRIS are foreign-born. Their sociodemographic, epidemiological and clinical characteristics reflect the epidemic in their places of origin. However, their immunological status at cohort entry and initiation of HAART is no different from that of Spaniards.
- Published
- 2009
- Full Text
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