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Aim: The aim of this study is to compare the utility of several supervised machine learning (ML) algorithms for predicting clinical events in terms of their internal validity and accuracy. The results, which were obtained using two statistical software platforms, were also compared., Materials and Methods: The data used in this research come from the open database of the Framingham Heart Study, which originated in 1948 in Framingham, Massachusetts as a prospective study of risk factors for cardiovascular disease. Through data mining processes, three data models were elaborated and a comparative methodological study between the different ML algorithms - decision tree, random forest, support vector machines, neural networks, and logistic regression - was carried out. The global selection criterium for choosing the right set of hyperparameters and the type of data manipulation was the area under a curve (AUC). The software tools used to analyze the data were R-Studio® and RapidMiner®., Results: The Framingham study open database contains 4240 observations. The algorithm that yielded the greatest AUC when analyzing the data in R-Studio was neural network applied to a model that excluded all observations in which there was at least one missing value (AUC = 0.71); when analyzing the data in RapidMiner and applying the same model, the best algorithm was support vector machines (AUC = 0.75)., Conclusions: ML algorithms can reinforce the diagnostic and prognostic capacity of traditional regression techniques. Differences between the applicability of those algorithms and the results obtained with them were a function of the software platforms used in the data analysis., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Objective: To describe the epidemiological characteristics and evolution of a cohort of HIV-infected patients in Madrid (Spain) over a period of 25 years., Methods: Longitudinal, prospective, cohort study of all patients diagnosed with HIV infection seen at the Hospital de Móstoles (1983-2008)., Results: Of the 2156 patients attended, 73% were men. In 68%, the route of infection was illicit drug use. There was a peak of new diagnoses in 1991 (188 patients) and a subsequent gradual decline. Sexual transmission increased over the time period studied, with a higher rise in heterosexual transmission. The percentage of immigrants with the infection also increased (more than 60% in the last 3 years). Sub-Saharan Africa remains the predominant region of origin of our immigrant patients. Over the period studied, 5% of patients were diagnosed during the acute infection, and 20% to 30% were diagnosed with AIDS within 1 year after detection of HIV infection. The estimated rate of new diagnoses of HIV infection in 2006 was 195 per million population (pmp), 269 pmp in men and 121 pmp in women., Conclusions: Many changes have occurred in the epidemiology of HIV infection in our area in the last 25 years. Routine serologic testing without waiting for warning signs would have an impact on early diagnosis and improving the prognosis of these patients., (Copyright 2008 Elsevier España, S.L. All rights reserved.)

Introduction: The optimal timing for initiation of highly active antiretroviral therapy (HAART) in patients with AIDS and tuberculosis (TB) is an unresolved question. To assess the effect of HAART on the survival of patients with TB, we designed this study., Methods: We selected all HIV patients included in the COMESEM cohort with TB diagnosis after 1996. Clinical and epidemiological data were registered. We compared patients who started HAART at the diagnosis of TB [simultaneous therapy (ST)] or not. Survival was assessed by Cox analysis., Results: Among the 6934 HIV patients included in the cohort, 1217 patients had TB, 322 of them (26.5%) after 1996. At the time of TB diagnosis, 45% of them started HAART (ST). There were no differences between groups regarding basal characteristics, except for a lower viral load in ST patients. ST therapy was associated with improved survival (hazard ratio 0.38; 95% confidence interval 0.20 to 0.72, P = 0.003). By univariate analysis, survival was also associated with no endovenous drug use and a later year of TB diagnosis. After adjusting for other prognostic variables, by Cox multivariate analysis, ST remained robustly associated with improved survival (hazard ratio 0.37; 95% confidence interval 0.17 to 0.66, P = 0.001)., Conclusions: Simultaneous HAART and TB treatment in HIV patients with TB is associated with improved survival.

Background: Assessment of patient satisfaction with antiretroviral therapy is generating increasing interest in clinical practice, since the outcome is directly related with compliance with therapy and its effectiveness. Currently, there is no validated patient satisfaction questionnaire to evaluate this factor as related to control of the disease., Patients and Methods: An "ad hoc" questionnaire--Cuestionario Español de Satisfacción con el Tratamiento Antiretroviral (CESTA), Spanish Antiretroviral Treatment Satisfaction Questionnaire--was developed to evaluate satisfaction in patients switching to a simplified regimen. In a second phase, the questionnaire was validated in an observational study including 321 patients divided into two cohorts (patients switching to a simplified regimen and patients maintaining the same regimen)., Results: A total of 99% and 93% patients, respectively, completed the questionnaire at baseline and at the end-of-study visit. Cronbach's alpha coefficient for internal consistency and test-retest reliability were 0.82 and 0.69, respectively. Patients switching to a simplified regimen showed a statistically significant higher overall satisfaction score at the third-month visit than at baseline., Conclusions: The CESTA questionnaire is a valid instrument for use in clinical practice and provides valuable information on patient satisfaction with antiretroviral therapy.

Objectives: The aim of this study was to evaluate the frequency, characteristics and risk factors of lipid changes associated with lopinavir/ritonavir treatment in antiretroviral-naive patients., Methods: A prospective cohort of 107 antiretroviral-naive HIV-infected patients was followed for 12 months after starting lopinavir/ritonavir-based highly active antiretroviral therapy., Results: At 12 months, percentages of patients with hypercholesterolaemia and hypertriglyceridaemia were 17.4% and 40%, respectively. Mean increases in total cholesterol and triglycerides were 40.7 and 73.3 mg/dL. There was a significant increase in both low-density and high-density (HDL) cholesterol, and no increase in the total cholesterol/HDL ratio (from 4.16 at baseline to 4.49 after 12 months). Baseline cholesterol > 200 mg/dL and triglycerides > 150 mg/dL were independent risk factors for dyslipidaemia, while hepatitis C coinfection appeared to be protective., Conclusions: Patients with elevated lipid values at baseline have the greatest risk of developing hypercholesterolaemia and hypertriglyceridaemia after starting lopinavir/ritonavir. Antiretroviral-naive patients coinfected with hepatitis C have a low risk of developing hyperlipidaemia after starting lopinavir/ritonavir.