42 results on '"De la Mora L"'
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2. Additional file 1 of Increased integrated testing for HIV, hepatitis C and sexually transmitted infections in health care facilities: results from the INTEGRATE Joint Action pilots in Lithuania, Romania and Spain
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Matulionytė, R., Jakobsen, M. L., Grecu, V. I., Grigaitiene, J., Raudonis, T., Stoniene, L., Olteanu, M., de la Mora, L., Raben, D., and Sullivan, A. K.
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body regions ,nervous system ,fungi ,cardiovascular system ,lipids (amino acids, peptides, and proteins) - Abstract
Additional file 1. Patient Information Leaflet.pdf on HIV testing for TB patients, distributed in the TB clinic in Romania.
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- 2021
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3. Jalisco: la historia y sus instrumentos
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Miguel de la Mora L. and Moisés González Navarro
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Jalisco ,educación ,archivos ,bibliotecas ,siglo XX ,History America ,E-F ,Latin America. Spanish America ,F1201-3799 - Published
- 1951
4. Burden of liver steatosis and liver fibrosis in a large cohort of people living with HIV.
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Laguno M, de Lazzari E, Berrocal L, Inciarte A, Martínez-Rebollar M, de la Mora L, Torres B, Gonzalez-Cordón A, Chivite I, Foncillas A, Calvo J, Sempere A, Ambrosioni J, Blanco JL, Miro JM, Mallolas J, and Martínez E
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- Humans, Male, Female, Cross-Sectional Studies, Middle Aged, Adult, Prevalence, Spain epidemiology, Risk Factors, Cohort Studies, Fatty Liver epidemiology, Non-alcoholic Fatty Liver Disease epidemiology, Non-alcoholic Fatty Liver Disease complications, HIV Infections complications, HIV Infections drug therapy, Liver Cirrhosis epidemiology, Liver Cirrhosis pathology
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Background: Liver steatosis (LS) and liver fibrosis (LF) can increase the risk of cardiovascular disease in people with HIV, but their prevalence and associated factors are poorly understood. This study aimed to assess the prevalence of and factors associated with LS and LF in a large cohort of people with HIV., Methods: We conducted a cross-sectional study of consecutive people with HIV attending the Clinic of Barcelona from September 2022 to September 2023, excluding those with chronic B or/and C hepatitis virus coinfection. LS was assessed using the Hepatic Steatosis Index (HSI) and Fatty Liver Index (FLI), and LF was assessed using the Non-Alcoholic Fatty Liver Disease Fibrosis Score (NFS), Fibrosis-4 score (FIB-4), and the European AIDS Clinical Society (EACS) algorithm in both the whole cohort (cohort 1) and in a specific cohort more susceptible to liver disease (cohort 2). We identified independent variables associated with LS and LF using logistic regression., Results: Cohort 1 included 4664 people with HIV; 76% and 37% of them had available HSI and FLI data, LS was present in 28% and 19%, respectively. LF risk was present in 1%, 2%, and 1% of people with HIV according to NFS, FIB-4, and EACS algorithm scores, respectively. Cohort 2 included 1345 people with HIV; 60% and 30% of them had available HSI and FLI data, LS affected 55% and 43% and LF 2%, 5%, or 3%, respectively. Factors associated with LS included current CD4 cell count, diabetes, and hypertension, whereas LF was associated with previous exposure to dideoxynucleoside drugs and current CD4 to LF. Current integrase strand transfer inhibitor (INSTI) therapy appeared protective for LF in cohort 1., Conclusions: In this study, one in four people with HIV had LS, and the prevalence rose to one in two in those with cardiovascular risk factors. The prevalence of LF was low, but it should be considered in older people with HIV with low CD4 counts or high aspartate transaminase levels. A possible protective effect from INSTIs deserves further investigation., (© 2024 The Author(s). HIV Medicine published by John Wiley & Sons Ltd on behalf of British HIV Association.)
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- 2024
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5. Prevalence, risk factors and the impact of tenofovir treatment in SARS-CoV-2 infection and COVID-19 disease among people living with HIV: A cross-sectional population-based study.
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de Lazzari E, Nomah DK, Blanco JL, Rico N, Filella X, Egri N, Ruiz R, Marcos MA, Mosquera MDM, Alcamí J, Sánchez-Palomino S, Bruguera A, Hurtado C, Rovira C, Ambrosioni J, Chivite I, González-Cordón A, Inciarte A, Laguno M, Martínez-Rebollar M, de la Mora L, Torres B, Díaz Y, Martínez E, Mallolas J, and Miro JM
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- Humans, Male, Female, Cross-Sectional Studies, Middle Aged, Risk Factors, Prevalence, Adult, Anti-HIV Agents therapeutic use, Viral Load, Aged, Young Adult, Antibodies, Viral blood, Tenofovir therapeutic use, COVID-19 epidemiology, HIV Infections drug therapy, HIV Infections epidemiology, HIV Infections complications, SARS-CoV-2
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Objectives: The prevalence and risk factors of SARS-CoV-2 infection among unvaccinated people living with HIV (PWH) are not well understood, and the protective role of tenofovir remains controversial. This study aimed to assess the SARS-CoV-2 prevalence and associated risk factors among unvaccinated PWH, and to evaluate the impact of tenofovir., Methods: We conducted as a cross-sectional study between November 2020 and May 2021. Plasma samples from 4,400 of 5,476 PWH were tested for total antibodies, IgG, IgM, and IgA., Results: Among the participants (median age 48 years, 84% male), 92% had undetectable HIV viral loads and 5% had syphilis. The prevalence of SARS-CoV-2 infection was 18% (95% CI 17-19), with 1,180 individuals showing antibodies (IgG 13%, IgA 10%, IgM 11%). Of those seropositive for SARS-CoV-2, 67.5% were asymptomatic, 29% had mild disease, and 3.5% had severe/critical conditions. Risk factors included younger age, being female, men who have sex with men (MSM) status, non-European origin, and a history of syphilis. Neither antiretrovirals nor tenofovir provided protection against SARS-CoV-2 infection or COVID-19 disease., Conclusion: Ongoing surveillance and tailored interventions are crucial for at-risk PWH amid evolving SARS-CoV-2 variants. Tenofovir did not prevent SARS-CoV-2 infection or COVID-19., Competing Interests: Declaration of competing interests JMM has received consulting honoraria and/or research grants from Angelini, Contrafect, Cubist, Genentech, Gilead Sciences, Jansen, Lysovant, Medtronic, MSD, Novartis, Pfizer, and ViiV Healthcare, all outside the current work. DKN received consultation fees from OPIS and is an employee of Aetion Iberia, both outside the current work. All other authors declared no conflicts., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)
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- 2024
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6. Epidemiological changes and outcomes of people living with HIV admitted to the intensive care unit: a 14-year retrospective study.
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Martínez E, Foncillas A, Téllez A, Fernández S, Martínez-Nadal G, Rico V, Tomé A, Ugarte A, Rinaudo M, Berrocal L, De Lazzari E, Miró JM, Nicolás JM, Mallolas J, De la Mora L, and Castro P
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Purposes: Since 2016, the World Health Organization has recommended universal antiretroviral therapy (ART) for all people living with Human Immunodeficiency Virus (PLHIV). This recommendation may have influenced the characteristics and outcomes of PLHIV admitted to the Intensive Care Unit (ICU). This study aims to identify changes in the epidemiological and clinical characteristics of PLHIV admitted to the ICU, and their short- and medium-term outcomes before and after the implementation of universal ART (periods 2006-2015 and 2016-2019)., Methods: This retrospective, observational, single-center study included all adult PLHIV admitted to the ICU of a University Hospital in Barcelona from 2006 to 2019., Results: The study included 502 admissions involving 428 patients, predominantly men (75%) with a median (P25-P75) age of 47.5 years (39.7-53.9). Ninety-one percent were diagnosed with HIV before admission, with 82% under ART and 60% admitted from the emergency department. In 2016-2019, there were more patients on ART pre-admission, reduced needs for invasive mechanical ventilation (IMV) and fewer in-ICU complications. ICU mortality was also lower (14% vs 7%). Predictors of in-ICU mortality included acquired immunodeficiency syndrome defining event (ADE)-related admissions, ICU complications, higher SOFA scores, IMV and renal replacement therapy (RRT) requirement. ART use during ICU admission was protective. Higher SOFA scores, admission from hospital wards, and more comorbidities predicted one-year mortality., Conclusions: The in-ICU mortality of critically ill PLHIV has decreased in recent years, likely due to changes in patient characteristics. Pre- and ICU admission features remain the primary predictors of short- and medium-term outcomes., (© 2024. The Author(s).)
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- 2024
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7. Rapid initiation of bictegravir/emtricitabine/tenofovir alafenamide as first-line therapy in HIV infection. A prospective study.
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Ugarte A, De La Mora L, De Lazzari E, Chivite I, Fernández E, Inciarte A, Laguno M, Ambrosioni J, Solbes E, Berrocal L, González-Cordón A, Martínez-Rebollar M, Foncillas A, Calvo J, Blanco JL, Martínez E, Mallolas J, and Torres B
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- Humans, Male, Adult, Prospective Studies, Female, Heterocyclic Compounds, 4 or More Rings administration & dosage, Heterocyclic Compounds, 4 or More Rings therapeutic use, Heterocyclic Compounds, 4 or More Rings adverse effects, Piperazines administration & dosage, Amides administration & dosage, Amides therapeutic use, Adenine analogs & derivatives, Adenine therapeutic use, Adenine administration & dosage, Adenine adverse effects, Drug Combinations, Heterocyclic Compounds, 3-Ring administration & dosage, Heterocyclic Compounds, 3-Ring therapeutic use, Heterocyclic Compounds, 3-Ring adverse effects, Middle Aged, Young Adult, Viral Load drug effects, HIV Infections drug therapy, Tenofovir therapeutic use, Tenofovir administration & dosage, Tenofovir analogs & derivatives, Emtricitabine therapeutic use, Emtricitabine administration & dosage, Anti-HIV Agents therapeutic use, Anti-HIV Agents administration & dosage, Pyridones administration & dosage, Alanine therapeutic use, Alanine administration & dosage
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Introduction: Rapid initiation of ART after HIV diagnosis is recommended for individual and public health benefits. However, certain clinical and ART-related considerations hinder immediate initiation of therapy., Methods: An open-label, single-arm, single-centre 48-week prospective clinical trial involving ART-naïve HIV-diagnosed adults who started bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) within a week from the first hospital visit, before the availability of baseline laboratory and genotype results. The primary aim was to determine the proportion of people with at least one condition that would hinder immediate initiation of any recommended ART regimen other than BIC/FTC/TAF. Clinicaltrials.gov: NCT04416906., Results: We included 100 participants: 79% men, 64% from Latin America, median age 32 years. According to European AIDS Clinical Society (EACS) and US Department of Health and Human Services 2023 guidelines, 11% (95%CI 6; 19) of participants had at least one condition that made any ART different from BIC/FTC/TAF less appropriate for a rapid ART strategy. Seventy-nine percent of the people started BIC/FTC/TAF within the first 48 hours of their first hospital visit. There were 16 early discontinuations (11 lost to follow-up). By week 48, 92% (95%CI 86; 98) of the participants of the ITT population with observed data achieved viral suppression. Eight grade 3-4 adverse events (AEs), five serious AEs and six ART-related AEs were identified. Adherence remained high., Conclusions: BIC/FTC/TAF is an optimal treatment for rapid initiation of ART. However, additional strategies to improve retention in care must be implemented., (© The Author(s) 2024. Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)
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- 2024
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8. Effectiveness, safety and discontinuation rates of bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) in people with HIV using real-world data: a systematic review and meta-analysis.
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Chivite I, Berrocal L, de Lazzari E, Navadeh S, Lluis-Ganella C, Inciarte A, de la Mora L, González-Cordón A, Martínez-Rebollar M, Laguno M, Torres B, Blanco JL, Martínez E, Mallolas J, and Ambrosioni J
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- Humans, Drug Combinations, Amides therapeutic use, Piperazines, Pyridones, Adenine analogs & derivatives, Adenine therapeutic use, Adenine adverse effects, Adenine administration & dosage, Treatment Outcome, HIV-1 drug effects, HIV-1 genetics, Retrospective Studies, HIV Infections drug therapy, Tenofovir therapeutic use, Tenofovir administration & dosage, Tenofovir analogs & derivatives, Anti-HIV Agents therapeutic use, Anti-HIV Agents administration & dosage, Anti-HIV Agents adverse effects, Emtricitabine therapeutic use, Emtricitabine administration & dosage, Heterocyclic Compounds, 4 or More Rings therapeutic use, Heterocyclic Compounds, 4 or More Rings administration & dosage, Heterocyclic Compounds, 4 or More Rings adverse effects, Alanine therapeutic use, Viral Load drug effects, Heterocyclic Compounds, 3-Ring therapeutic use, Heterocyclic Compounds, 3-Ring adverse effects, Heterocyclic Compounds, 3-Ring administration & dosage
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Background: The use of bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) is based on the results of robust clinical trials., Objectives: To assess the effectiveness and safety of BIC/FTC/TAF in treatment-naïve (TN) and treatment-experienced (TE) people with HIV using available real-world cohort studies., Methods: Systematic review and meta-analysis of publications and communications identified via Boolean search in Medline, PubMed and Embase, and conference abstracts reporting retrospective real-world use of BIC/FTC/TAF, published until 31 January 2024. The primary endpoint was the proportion of TN and TE people with HIV with viral load (VL) < 50 copies/mL at 48 weeks while on treatment., Results: Of the 38 identified publications and conference abstracts, for the present analysis we included 12 publications (comprising 792 TN and 6732 TE individuals). For the three publications including 507 TN participants reporting the primary outcome, VL suppression was 97% [95% confidence intervals (CI): 89-100]. For the nine publications including 4946 TE participants reporting the primary outcome, VL suppression was 95% (95% CI: 94-96), with suppression >93% in all studies. Total discontinuations at 48 weeks in TE individuals were 3% (95% CI: 2-5), 1% (95% CI: 0-2) due to side effects. A total of four publications with 151 TE individuals with previous presence of M184V substitution were identified, reporting a suppression rate at 48 weeks of 95% (95% CI: 88-100)., Conclusions: Real-world studies demonstrate low discontinuation rates and high rates of virologic suppression in individuals treated with BIC/FTC/TAF, both TN and TE with and without previous detection of M184V substitution., (© The Author(s) 2024. Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)
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- 2024
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9. [Epidemiology, treatment and prognosis of HIV infection in 2024: A practical review].
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de la Mora L, Mallolas J, and Ambrosioni J
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- Humans, Prognosis, Anti-HIV Agents therapeutic use, Pre-Exposure Prophylaxis, HIV Infections epidemiology, HIV Infections drug therapy, HIV Infections diagnosis
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In recent years, the epidemiology and prognosis of HIV infection have undergone significant changes thanks to the recommendation of antiretroviral therapy (ART) for all infected persons, the development of more effective and better tolerated drugs, and preventive measures such as pre-exposure prophylaxis (PrEP). The evolution of ART, now with simple oral and injectable options, has also contributed to improvements in comprehensive HIV treatment and care. With early diagnosis and early initiation of ART, the life expectancy of people with HIV has reached the same as the general population. However, many people with HIV remain undiagnosed or are diagnosed late, and some population groups experience greater vulnerability, affecting individual and collective health. In this review we review the current epidemiology, treatment and prognosis of HIV infection., (Copyright © 2024 Elsevier España, S.L.U. All rights reserved.)
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- 2024
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10. Toxic-Induced Encephalopathy Following Chemsex in a Young HIV-Positive Male: A Complex Case of Acute Cognitive Impairment with Anterograde Amnesia and Behavioral Alterations.
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Inciarte A, de la Mora L, Huaier-Arriazu E, Torres B, Cañizares S, Zamora E, Laguno M, Gonzalez-Cordón A, Foncillas A, Chivite I, Calvo J, Ambrosioni J, Martínez E, Blanco JL, Miro JM, Martinez-Rebollar M, and Mallolas J
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Background: A broadened clinical spectrum of concomitant complications emerges among the escalating incidence of substance use, particularly within the 'chemsex' context. This case exemplifies the profound neurotoxic repercussions and neurological risk of chemsex in a young HIV-positive male and addresses the multifaceted challenges of such evolving paradigms in substance utilization., Clinical Finding: After consuming cannabis, poppers, methamphetamine, and cocaine, a 28-year-old HIV-positive male exhibited significant neurological and cognitive impairment. The initial presentation included dysarthria and profound anterograde amnesia. Laboratory findings showed leukocytosis with a PCR of 3 mg/dl - elevated cerebrospinal fluid protein levels with no cells. Urine toxicology returned positive for cannabis and amphetamines. A brain CT scan revealed bilateral and symmetrical hippocampi and pale globes hypodensity, indicative of toxic-metabolic encephalopathy. MRI further identified lesions in the globus pallidus, cerebellum, and hippocampi. Following the detection of toxic encephalopathy, Initial neuropsychological was performed screening using the Montreal Cognitive Assessment (MoCA), which highlighted immediate memory deficits. An in-depth neuropsychological assessment conducted 3 weeks later included the Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV), the Rey Auditory Verbal Learning Test (RAVLT), and tests for visuospatial skills, motor functions, and memory recall. The evaluations revealed pronounced anterograde amnesia, persistent long-term memory inconsistencies, and notable executive function challenges, detailed in Table 1., Conclusions: The detailed analysis of this case underpins the severe neurological consequences that can manifest from heavy substance use. Comprehensive diagnostic evaluations, including neuroimaging and neuropsychological assessments, are crucial in elucidating the full spectrum of substance-induced cognitive impairments. There is an urgent need for enhanced public awareness and preventative measures, especially in the context of chemsex, to bring forth multifaceted health, social, and government implications that modern society must adeptly navigate., (© 2024. The Author(s).)
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- 2024
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11. Evolving AIDS- and non-AIDS Mortality and Predictors in the PISCIS Cohort of People Living With HIV in Catalonia and the Balearic Islands (Spain), 1998-2020.
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Nomah DK, Jamarkattel S, Bruguera A, Moreno-Fornés S, Díaz Y, Alonso L, Aceitón J, Llibre JM, Domingo P, Saumoy M, Homar F, Fanjul F, Navarro J, de la Mora L, Knobel H, Orti A, Martin-Iguacel R, Miró JM, Casabona J, and Reyes-Urueña J
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Background: Effective antiretroviral therapy (ART) has substantially reduced acquired immunodeficiency syndrome (AIDS)-related deaths, shifting the focus to non-AIDS conditions in people living with human immunodeficiency virus (HIV) (PLWH). We examined mortality trends and predictors of AIDS- and non-AIDS mortality in the Population HIV Cohort from Catalonia and Balearic Islands (PISCIS) cohort of PLWH from 1998 to 2020., Methods: We used a modified Coding Causes of Death in HIV protocol, which has been widely adopted by various HIV cohorts to classify mortality causes. We applied standardized mortality rates (SMR) to compare with the general population and used competing risks models to determine AIDS-related and non-AIDS-related mortality predictors., Results: Among 30 394 PLWH (81.5% male, median age at death 47.3), crude mortality was 14.2 per 1000 person-years. All-cause standardized mortality rates dropped from 9.6 (95% confidence interval [CI], 8.45-10.90) in 1998 through 2003 to 3.33 (95% CI, 3.14-3.53) in 2015 through 2020, P for trend = .0001. Major causes were AIDS, non-AIDS cancers, cardiovascular disease, AIDS-defining cancers, viral hepatitis, and nonhepatitis liver disease. Predictors for AIDS-related mortality included being aged ≥40 years, not being a man who have sex with men, history of AIDS-defining illnesses, CD4 < 200 cells/µL, ≥2 comorbidities, and nonreceipt of ART. Non-AIDS mortality increased with age, injection drug use, heterosexual men, socioeconomic deprivation, CD4 200 to 349 cells/µL, nonreceipt of ART, and comorbidities, but migrants had lower risk (adjusted hazard risk, 0.69 [95% CI, .57-.83])., Conclusions: Mortality rates among PLWH have significantly decreased over the past 2 decades, with a notable shift toward non-AIDS-related causes. Continuous monitoring and effective management of these non-AIDS conditions are essential to enhance overall health outcomes., Competing Interests: Potential conflicts of interest. D. N. received consultation fees from OPIS outside the current work. J. M. M. reported receiving a personal 80:20 research grant from Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain, during 2017 through 2024 and consulting honoraria and/or research grants from Angelini, Contrafect, Genentech, Gilead Sciences, Jansen, Lysovant, Medtronic, MSD, Novartis, Pfizer, and ViiV Healthcare, outside the submitted work. P. D. reported that his institution received grants from Gilead Sciences, Janssen & Cilag, and ViiV Healthcare; and he personally received honoraria from Gilead Sciences, Janssen & Cilag, Merck Sharp & Dohme, ViiV Healthcare, Roche, and Thera Technologies. J. M. L. has received consulting honoraria from Gilead Sciences, Janssen-Cilag, and ViiV Healthcare, all of them outside of the present work. J. N. has received honoraria and/or speaking fees and/or financial support for attending conferences from Abbvie, Gilead Sciences, Janssen-Cilag, Merck Sharp & Dohme, and ViiV Healthcare outside the submitted work. H. K. has received honoraria and/or speaking fees and/or financial support for attending conferences from Gilead Sciences, Janssen-Cilag, and ViiV Healthcare outside the submitted work. F. F. has received grants from Gilead/contracts from Gilead/Viiv and support for attending meetings from Gilead, all outside the current work. All other authors report no potential conflicts., (© The Author(s) 2024. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)
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- 2024
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12. Efficacy and safety of raltegravir plus lamivudine maintenance therapy.
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Borjabad B, Inciarte A, Chivite I, Gonzalez-Cordon A, Mosquera M, Hurtado C, Rovira C, Gonzalez T, Sempere A, Torres B, Calvo J, De La Mora L, Martinez-Rebollar M, Laguno M, Foncillas A, Ambrosioni J, Blanch J, Rodriguez A, Solbes E, Llobet R, Berrocal L, Mallolas J, Miro JM, Alcami J, Blanco JL, Sanchez-Palomino S, De Lazzari E, and Martinez E
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- Humans, Raltegravir Potassium adverse effects, Lamivudine adverse effects, Prospective Studies, Quality of Life, Drug Therapy, Combination, Viral Load, Treatment Outcome, HIV Infections drug therapy, Anti-HIV Agents adverse effects, Drug-Related Side Effects and Adverse Reactions
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Background: Decreasing medication burden with raltegravir plus lamivudine in virologically suppressed persons with HIV (PWH) maintained efficacy and was well tolerated at 24 weeks, but more comprehensive data over longer follow-up are required., Methods: Prospective 48 week extension phase of the raltegravir plus lamivudine arm from a previous 24 week pilot randomized clinical trial in which virologically suppressed PWH were randomized 2:1 to switch to fixed-dose combination 150 mg lamivudine/300 mg raltegravir twice daily or to continue therapy. In this 48 week extension phase, raltegravir was dosed at 1200 mg/day and lamivudine 300 mg/day. Primary outcome was the proportion of PWH with treatment failure at Week 48. Secondary outcomes were changes in ultrasensitive plasma HIV RNA, HIV DNA in CD4 cells, serum IL-6, ultrasensitive C-reactive protein and sCD14, body composition, sleep quality, quality of life and adverse effects., Results: Between May 2018 and June 2019, 33 PWH were enrolled. One participant experienced virological failure without resistance mutations and re-achieved sustained virological suppression without therapy discontinuation, and two others discontinued therapy due to adverse effects. Treatment failure was 9% (95% CI 2%-24%) and 3% (95% CI 0%-17%) in the ITT and on-treatment populations. There were significant changes between baseline and Week 48 in serum cytokines but not in other secondary outcomes., Conclusions: Switching to raltegravir and lamivudine in PWH with virological suppression maintains efficacy and is well tolerated. This maintenance regimen might be a cost-effective option for PWH at risk of drug-drug interactions or needing to avoid specific toxicities of certain antiretroviral drugs or their negative impact on comorbidities., (© The Author(s) 2023. Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
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- 2024
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13. Tolerability of bictegravir/tenofovir alafenamide/emtricitabine versus dolutegravir/lamivudine as maintenance therapy in a real-life setting.
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Rocabert A, Borjabad B, Berrocal L, Blanch J, Inciarte A, Chivite I, Gonzalez-Cordon A, Torres B, Ambrosioni J, Martinez-Rebollar M, Laguno M, De La Mora L, Foncillas A, Sempere A, Rodriguez A, Solbes E, Llobet R, Miro JM, Mallolas J, Blanco JL, De Lazzari E, and Martinez E
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- Humans, Emtricitabine adverse effects, Lamivudine adverse effects, Tenofovir adverse effects, Heterocyclic Compounds, 3-Ring adverse effects, Pyridones therapeutic use, Adenine therapeutic use, Heterocyclic Compounds, 4 or More Rings adverse effects, HIV Infections drug therapy, Anti-HIV Agents adverse effects
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Background: While both the burden of therapy and the individual drugs in bictegravir/tenofovir alafenamide/emtricitabine (BIC/TAF/FTC) and dolutegravir/lamivudine differ, it is unclear whether their real-life tolerability may be also different., Methods: Single-centre, clinical cohort analysis of all virologically suppressed persons with HIV (PWH) who were first prescribed bictegravir as BIC/TAF/FTC or dolutegravir as dolutegravir/lamivudine and had taken ≥1 dose of study medication. Major outcomes were discontinuations either for any reason or due to toxicity. Incidence was calculated as number of episodes per 100 person-years adjusted through propensity score analysis., Results: Relative to persons treated with BIC/TAF/FTC (n = 1231), persons treated with dolutegravir/lamivudine (n = 821) were older and had more AIDS-defining conditions although better HIV control. After a median follow-up of 52 weeks, adjusted incidence rates for discontinuation were 6.68 (95% CI 5.18-8.19) and 8.44 (95% CI 6.29-10.60) episodes per 100 person-years for BIC/TAF/FTC and dolutegravir/lamivudine, respectively; adjusted incidence rate ratio for dolutegravir/lamivudine was 1.26 (95% CI 0.89-1.78) relative to BIC/TAF/FTC (P = 0.1847). Adjusted incidence rates for discontinuation due to toxicity were 3.88 (95% CI 2.70-5.06) and 4.62 (95% CI 3.05-6.19) episodes per 100 person-years for BIC/TAF/FTC and dolutegravir/lamivudine, respectively; adjusted incidence rate ratio for dolutegravir/lamivudine was 1.19 (95% CI 0.75-1.90) relative to BIC/TAF/FTC (P = 0. 4620). Adverse events leading to discontinuation were neuropsychiatric (n = 42; 2%), followed by gastrointestinal (n = 23; 1%), dermatological (n = 15; 1%) and weight increase (n = 15; 1%), without differences between regimens., Conclusions: Switching to BIC/TAF/FTC or dolutegravir/lamivudine showed no difference in the risks of overall or toxicity-related discontinuations or in the profile of adverse events leading to discontinuation., (© The Author(s) 2023. Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
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- 2023
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14. Clinical use and effectiveness of dolutegravir and lamivudine: a long-term, real-world, retrospective study.
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Martínez-Serra A, De Lazzari E, Berrocal L, Foncillas A, De La Mora L, Inciarte A, Chivite I, González-Cordón A, Martínez-Rebollar M, Torres B, Laguno M, Blanco JL, Martínez E, Mallolas J, and Ambrosioni J
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- Adult, Female, Humans, Lamivudine therapeutic use, Retrospective Studies, Drug Therapy, Combination, Heterocyclic Compounds, 3-Ring therapeutic use, Oxazines therapeutic use, Pyridones therapeutic use, HIV Infections drug therapy, Anti-HIV Agents therapeutic use
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Background: The use of dolutegravir/lamivudine is based on solid clinical trials; however, real-world data remain limited., Objectives: To provide data on the clinical use and effectiveness of dolutegravir/lamivudine in persons with HIV in a real-world scenario., Patients and Methods: Retrospective, single-centre and observational study. We included all adults starting dolutegravir/lamivudine since November 2014. We reported all demographic, virological and immunological variables at baseline and assessed effectiveness [on treatment (OT), modified ITT (mITT) and ITT in those persons who reached 6 and 12 month follow-ups (M6 and M12)., Results: Of the 1058 persons, 9 were treatment-naive; the final analysis included 1049 treatment-experienced people with HIV. Median (IQR) follow-up was 1 (0.3-1.6) years, with 81% and 63% persons reaching M6 and M12, respectively. The longest use of dolutegravir/lamivudine was 7.4 years. Per OT, mITT and ITT, HIV-RNA < 50 copies/mL was 97%, 92% and 81% (M6) and 98%, 90% and 80% (M12), respectively. Females [adjusted risk ratio, aRR (95% CI): 1.69 (1.19-2.40)]; immediate, previous PI-based regimen [aRR (95% CI): 1.67 (1.09-2.56)]; and viral load (VL) ≥ 50 copies/mL at dolutegravir/lamivudine initiation [aRR (95% CI): 3.36 (2.32-4.88)] were independently associated with lack of effectiveness at M12; other demographic, immunological and virological variables like previous M184V/I substitutions or virological failure, were unrelated. Of the total, 944 (90%) continued dolutegravir/lamivudine. The most frequent known reason for discontinuation was toxicity [48 (46%) cases]., Conclusions: In our real-world experience, virological suppression rates were high for treatment-experienced persons on dolutegravir/lamivudine; however, we identified subgroups with a higher risk of lack of effectiveness at M12, who may benefit from closer follow-ups., (© The Author(s) 2023. Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
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- 2023
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15. Increasing of New CA-MRSA Infections Detected in people living with HIV Who Engage in Chemsex in Barcelona: An Ambispective Study.
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De La Mora L, Pitart C, Morata L, Ugarte A, Martinez-Rebollar M, De Lazzari E, Vergara A, Bosch J, Roca I, Piquet M, Rodriguez A, Laguno M, Ambrosioni J, Torres B, González-Cordón A, Inciarte A, Foncillas A, Riera J, Fuertes I, Chivite I, Martinez E, Blanco JL, Soriano A, and Mallolas J
- Abstract
Introduction: There are no data on community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infections in the context of the chemsex phenomenon. This study aimed to characterize CA-MRSA-related infections in a cohort of people living with HIV (PLWH) who engage in chemsex., Methods: At the Hospital Clinic of Barcelona, from February 2018 to January 2022, we analyzed CA-MRSA infections diagnosed in a cohort of PLWH who engage in chemsex. Epidemiological, behavioral and clinical variables were assessed. Mass spectrometry identification and antimicrobial susceptibility testing were performed on MRSA isolates. Pulse field electrophoresis was used to assess the clonality of the MRSA strains. The presence of Panton-Valentine leukocidin was also investigated., Results: Among the cohort of 299 participants who engage in chemsex, 25 (8%) with CA-MRSA infections were identified, 9 at baseline and 16 with incident cases; the cumulative incidence was 5.5% (95% CI: 3.2%, 8.8%). The most common drugs were methamphetamine (96%) and GHB/GBL (92%). Poly-consumption and slamming were reported by 32% and 46%, respectively. CA-MRSA was isolated from the infection sites of 20 participants, and CA-MRSA colonization was confirmed in the remaining 5 persons. Seventy-one percent had used antibiotics in the previous year. All participants presented with skin and soft tissue infections, 28% required hospitalization, and 48% had recurrence. Of the 23 MRSA isolates further studied, 19 (82,6%) belonged to the same clone. Panton-Valentine leukocidin was detected in all isolates., Conclusion: PLWH who engage in chemsex may present with CA-MRSA infections. Clinical suspicion and microbiological diagnosis are required to provide adequate therapy, and CA-MRSA prevention interventions should be designed., (© 2023. The Author(s).)
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- 2023
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16. Doravirine/Lamivudine/Tenofovir Disoproxil Fumarate for Nonoccupational HIV-1 Postexposure Prophylaxis: A Prospective Open-Label Trial (DORAVIPEP).
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Inciarte A, Ugarte A, Martínez-Rebollar M, Torres B, Fernández E, Berrocal L, Laguno M, De la Mora L, De Lazzari E, Callau P, Chivite I, González-Cordón A, Solbes E, Rico V, Barrero L, Blanco JL, Martínez E, Ambrosioni J, and Mallolas J
- Abstract
Background: New regimens may provide better tolerability, convenience, and safety for nonoccupational human immunodeficiency virus (HIV) postexposure prophylaxis (PEP). For this reason, we evaluated the single-tablet regimen of doravirine/lamivudine/tenofovir disoproxil fumarate (DOR/3TC/TDF) for 28 days., Methods: This was a prospective, open-label, single-arm trial including individuals with potential HIV-1 exposure within 72 hours. The primary endpoint was noncompletion of PEP at day 28. Secondary endpoints were adverse effects, adherence, and rate of seroconversion. We performed follow-up at day 7, week 4, and week 12., Results: Between September 2019 and March 2022, the study enrolled 399 individuals. Median age was 30 (interquartile range [IQR], 27-36) years, and 91% (n = 364) were male. The mode of exposure was sex between men in 84% (n = 331) of cases; risk assessment for HIV-1 transmission was considered as "high" in 97% (n = 385) of the participants. Median time from exposure to consultation was 24 (IQR, 13-40) hours. Noncompletion of PEP was 29% (n = 114) (95% confidence interval [CI], 24%-33%) and 20% (n = 72) (95% CI, 16%-25%) per modified intention-to-treat. Main reasons for noncompletion were loss to follow-up (n = 104 [91%]) and intolerance (n = 8 [7%]). Older age was associated with a lower risk of premature discontinuation (OR, 0.94; P < .001). One hundred twenty-three (31%) participants reported adverse events, mostly mild and self-limited (82%); discontinuation occurred in 8 cases (2%). Adherence to PEP in the assessed users was 96%. There were no HIV seroconversions., Conclusions: DOR/3TC/TDF is a well-tolerated option for nonoccupational PEP. Clinical Trials Registration. NCT04233372., Competing Interests: Potential conflicts of interest. A.I. has received research funding from Gilead, Janssen, and GSK. Additionally, A.I. has served on advisory boards for Almirall, Pfizer, AbbVie, and Bayer. J.A. has been granted research funding by ViiV and Gilead, and has received personal compensation from ViiV, Gilead, Janssen, and MSD. Additionally, J.A. has taken part in Advisory Boards for ViiV, Gilead, Janssen, and MSD, as well as participated in Data Safety Monitoring Boards for HIPRA and Grifols. It is important to note that these activities are separate from the current work. J.M has received research funding from ViiV and Gilead and has also been personally compensated by ViiV, Gilead, Janssen, and Amber. All authors: no conflict of interest to declare related to this work., (© The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)
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- 2023
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17. Perception of quality of care using patient reported experience measures (PREMs) in a cohort of adults with HIV: A cross-sectional study.
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de Lazzari E, Berrocal L, Fernández E, Laguno M, Chivite I, Torres B, González-Cordón A, de la Mora L, Ambrosioni J, Iniciarte A, Blanco JL, Miró JM, Martínez E, Martínez-Rebollar M, and Mallolas J
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- Adult, Humans, Cross-Sectional Studies, Perception, Patient Reported Outcome Measures, Patient Satisfaction, Quality of Life, HIV Infections drug therapy
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Human immunodeficiency virus (HIV) infection is considered a chronic disease. Antiretroviral therapy has allowed persons with HIV (PLWHIV) to achieve the 90-90-90 objectives proposed by the World Health Organization for 2020; but an additional challenge is getting an adequate health-related quality of life. A determining factor in the health-related quality of life of PLWHIV is the health care they perceive to receive. In this sense, we aimed to assess the perception of the outpatient care provided and to identify possible areas for improvement in a single-center, cross-sectional study at the HIV unit of Hospital Clínic, Barcelona. We sought patient reported experience measures by an anonymous e-survey with 11 statements based on a 1 to 6 Likert scale, and a final question measuring user satisfaction and loyalty through the Net Promoter Score (NPS). All PLWHIV with at least a clinical visit between January 1, 2020 and October 14, 2021 were invited. Of 5493 PLWHIV e-mailed, 1633 (30%) responded to the survey. The overall evaluation of clinical care was very favorable. The evaluation of the physical environment and facilities and the time spent in the waiting room received the lowest scores. According to the Net Promoter Score test results, 66% of respondents were willing to recommend this service, and 11% were not. Thus, monitoring patient reported experience measures in PLWHIV actively receiving outpatient care in our hospital allowed to identify the users' perception on quality of the care received, to determine the rate of satisfaction with the care, and to identify areas for improvement., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.)
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- 2023
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18. Sex-based epidemiological and immunovirological characteristics of people living with HIV in current follow-up at a tertiary hospital: a comparative retrospective study, Catalonia, Spain, 1982 to 2020.
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Toyos S, Berrocal L, González-Cordón A, Inciarte A, de la Mora L, Martínez-Rebollar M, Laguno M, Fernández E, Ambrosioni J, Chivite I, de Lazzari E, Blanco JL, Martínez E, Miró JM, Mallolas J, and Torres B
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- Male, Humans, Female, Middle Aged, Spain epidemiology, Retrospective Studies, Tertiary Care Centers, Follow-Up Studies, HIV Infections diagnosis, HIV Infections drug therapy, HIV Infections epidemiology
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BackgroundEpidemiological and immunovirological features of people living with HIV (PLWH) can vary by sex.AimTo investigate, particularly according to sex, characteristics of PLWH who consulted a tertiary hospital in Barcelona, Spain, in 1982-2020.MethodsPLWH, still in active follow-up in 2020 were retrospectively analysed by sex, age at diagnosis, age at data extraction (December 2020), birth place, CD4+ cell counts, and virological failure.ResultsIn total, 5,377 PLWH (comprising 828 women; 15%) were included. HIV diagnoses in women appeared to decrease from the 1990s, representing 7.4% (61/828) of new diagnoses in 2015-2020. From 1997, proportions of new HIV diagnoses from patients born in Latin America seemed to increase; moreover, for women born outside of Spain, the median age at diagnosis appeared to become younger than for those born in Spain, with significant differences observed in 2005-2009 and 2010-2014 (31 vs 39 years (p = 0.001), and 32 vs 42 years (p < 0.001) respectively), but not in 2015-2020 (35 vs 42 years; p = 0.254). Among women, proportions of late diagnoses (CD4+ cells/mm3 < 350) were higher than men (significantly in 2015-2020: 62% (32/52) vs 46% (300/656); p = 0.030). Initially, virological failure rates were higher in women than men, but they were similar in 2015-2020 (12% (6/52) vs 8% (55/659); p = 0.431). Women ≥ 50 years old represented 68% (564/828) of women actively followed up in 2020.ConclusionsWomen still have higher rates of late HIV diagnoses than men. Among currently-followed-up women, ≥ 50 year-olds, who need age-adapted care represent a high percentage. Stratifying PLWH by sex matters for HIV prevention and control interventions.
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- 2023
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19. Evolution of Risk Behaviors, Sexually Transmitted Infections and PrEP Care Continuum in a Hospital-Based PrEP Program in Barcelona, Spain: A Descriptive Study of the First 2 Years' Experience.
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Ugarte A, de la Mora L, García D, Martínez-Rebollar M, de Lazzari E, Torres B, Inciarte A, Ambrosioni J, Chivite I, Solbes E, de Loredo N, Del Carlo GF, González-Cordón A, Blanco JL, Martínez E, Mallolas J, and Laguno M
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Introduction: Pre-exposure prophylaxis (PrEP) is effective for HIV prevention, but the PrEP care continuum also involves improving PrEP awareness, uptake, adherence, and retention in care. Users' awareness is often compromised because of vulnerability factors and risk behaviors, such as chemsex practice or specific substance use, which could lead to risk compensation. Correct adherence and retention in care are essential to achieve the full effectiveness of PrEP. This study describes changes in users' risk behaviors and sexually transmitted infections (STIs), as well also PrEP care continuum details., Methods: This was a descriptive single-center retrospective study including adults at high HIV risk screened between November 2019 and June 2021 in the PrEP program of our hospital. Demographic, behavioral, STI, adherence, and retention in care variables were assessed. Data were collected from medical records and self-report questionnaires., Results: A total of 295 people were included, 94% men and 5% transgender women, with a mean age of 34 years (SD 10) and 10% sex workers. At baseline, 55% disclosed chemsex practice and 3% slamming. During follow-up, condom use for anal intercourse decreased from 41% to 13% (p ≤ 0.0001) and one HIV infection was detected; other risk behaviors and STIs remained stable. Chemsex, group sex, fluid exchange, and condomless anal intercourse were related to STI risk. Adherence was correct in 80% of users, and retention in care was 57%. Discontinuations and loss to follow-up were high, mainly affecting transgender women, sex workers, and people practicing fisting., Conclusion: PrEP program implementation in our hospital was adequate, since it allowed, in a population at high HIV risk, overall users' risk behaviors and STIs to remain stable, with only one HIV diagnosis during the follow-up. We should target specific strategies to improve adherence and retention in care, as vulnerable subgroups at higher risk of loss to follow-up are identified., (© 2022. The Author(s).)
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- 2023
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20. PrEP program experience in a hospital HIV unit. Description of baseline user profile and identification of opportunities for improvement.
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Laguno M, Ugarte A, Martinez-Rebollar M, Sobrino Y, Font G, de Lazzari E, de la Mora L, Torres B, Chivite I, Riera J, Ambrosioni J, Inciarte A, Gonzalez-Cordon A, Rojas J, Cordon E, Blanco JL, Martinez E, and Mallolas J
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- Male, Humans, Female, Adult, Retrospective Studies, Homosexuality, Male, Hospital Units, Hospitals, HIV Infections epidemiology, HIV Infections prevention & control, Substance-Related Disorders epidemiology
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Introduction: Pre-Exposure Prophylaxis (PrEP) is a biomedical intervention to prevent HIV infection in seronegative people at high risk of becoming infected. This strategy was endorsed in October 2019 by the Spanish Ministry of Health., Objective: To present the PrEP initial experience in the HIV Unit of the Hospital Clínic of Barcelona, paying special attention to the analysis of the vulnerability factors in the cohort., Materials and Methods: Retrospective, descriptive study. The epidemiological, sociodemographic, and clinical characteristics of the users included in the program during the first year are analyzed, paying particular attention to Infections, risky practices, and substance use., Results: 190 individuals were included, 177 men and 12 trans women with a mean age of 35 years (8 SD). 70% had higher education, and half had Spanish nationality. An average of 10 couples per trimester and 60% reported unprotected anal sex. 31% had at least one positive PCR for STIs, with N. gonorrhoeae being the most prevalent microorganism (51%) and the rectal sample the most affected (21%). 63% reported chemsex use, 19% polydrug use, and 8% "slamming". Half expressed concern about consumption and/or sexual practices and 25% the need for help., Conclusions: The PrEP user profile attended in our Hospital Unit justifies the creation of multidisciplinary teams that allow us to provide holistic attention to the sexual life of these people., (Copyright © 2021 The Authors. Published by Elsevier España, S.L.U. All rights reserved.)
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- 2023
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21. Chemsex Practices in PrEP: Beyond Addiction and Risk Toward a Healthy Sex Life-Baseline Experiences from a Hospital-Based PrEP Program in Barcelona, Spain.
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De La Mora L, Ugarte A, Martínez-Rebollar M, De Lazzari E, García-Hernández D, Font G, De Loredo N, Solbes E, Miquel L, Blanch J, Torres B, Riera J, Chivite I, Ambrosioni J, Inciarte A, González-Cordón A, Martínez E, Blanco JL, Mallolas J, and Laguno M
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- Male, Humans, Homosexuality, Male, Spain epidemiology, Sexual Behavior, Hospitals, Sodium Oxybate, HIV Infections epidemiology, HIV Infections prevention & control, Pre-Exposure Prophylaxis, Methamphetamine, Substance-Related Disorders epidemiology, Sexual and Gender Minorities
- Abstract
Pre-exposure prophylaxis (PrEP) is a biomedical intervention that has demonstrated efficacy in HIV prevention in individuals at high-risk, among them chemsex users. Out of 190 PrEP users followed at Hospital Clinic of Barcelona until October 2020, 89% reported drug use, and 63% disclosed that they had engaged in chemsex practices, initiated in 64% of cases within the past year. Twenty-one percent used 3 or more drugs simultaneously, being GHB/GBL, nitrites, sildenafil, and methamphetamine the most prevalent combination. Eight percent reported slamming. Forty-one percent described having had negative experiences and 8% did not remember the last time they had sober sex. Methamphetamine, mephedrone, GHB/GBL, and having had open relationships, group sex, double penetration, and fisting were significantly more prevalent. Forty-nine percent admitted being worried about chemsex use, and 18% said they needed help. A comprehensive, interdisciplinary approach is mandatory to enable the attainment of a healthy approach to one's sex life., (© 2022. The Author(s).)
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- 2022
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22. Do ART and Chemsex Drugs Get Along? Potential Drug-Drug Interactions in a Cohort of People Living with HIV Who Engaged in Chemsex: A Retrospective Observational Study.
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De La Mora L, Nebot MJ, Martinez-Rebollar M, De Lazzari E, Tuset M, Laguno M, Ambrosioni J, Miquel L, Blanch J, Ugarte A, Torres B, González-Cordón A, Inciarte A, Chivite I, Short D, Salgado E, Martinez E, Blanco JL, and Mallolas J
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Introduction: People living with HIV (PLWH) who engaged in chemsex are at risk of potential drug-drug interactions (pDDIs) with recreational drugs. This study aimed to characterize pDDIs between antiretroviral treatment (ART) and chemsex drugs and evaluate their association with unscheduled relevant hospital consultations., Methods: We conducted a single-center, retrospective, observational study in a series of gay, bisexual, and other men who have sex with men (gbMSM) living with HIV who engaged in chemsex and who attended a tertiary hospital in Barcelona, Spain, from February 2018 through August 2019. Associations between all recorded pDDIs and relevant unscheduled consultations were estimated using the incidence rate (IR) per 100 person-years of those events compared between patients with no pDDI (green flag) or moderate severity pDDI (orange flag) with patients with high severity pDDI (red flag) using the incidence rate ratio (IRR)., Results: Among 172 PLWH engaged in chemsex, 249 ART regimens were prescribed: 44% based on integrase inhibitors, 30% on boosted ART, and 26% based on non-nucleoside reverse transcriptase inhibitors. The substances and recreational drugs most frequently used were erectile dysfunction agents (83%), methamphetamine (79%), GHB (77%), and alkyl nitrites (71%). Polydrug use was reported in 52%. We observed 2048 pDDIs. Of these, 23% were orange flag pDDIs; 88% related to boosted ARTs. The IR of the 285 unscheduled relevant episodes in patients with orange flag pDDIs was 64.67 (95% CI 40.07-89.28). The IRR of green flag pDDIs was 1.05 (95% CI 0.60-1.8; p = 0.876)., Conclusion: One in four pDDIs were of moderate severity but no significant increase in the incidence of unscheduled relevant consultations was observed. A high number of unscheduled consultations, predominantly for psychiatric events and intoxication, were observed. Beyond using non-boosted ART to minimize pDDIs, other factors related to the practice of chemsex must be addressed, in order to offer a better approach., (© 2022. The Author(s).)
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- 2022
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23. Impact of SARS-CoV-2 viral load and duration of symptoms before hospital admission on the mortality of hospitalized COVID-19 patients.
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Rico-Caballero V, Fernández M, Hurtado JC, Marcos MA, Cardozo C, Albiach L, Agüero D, Ambrosioni J, Bodro M, Chumbita M, De la Mora L, Garcia-Pouton N, Gonzalez-Cordón A, Dueñas G, Hernandez-Meneses M, Inciarte A, Laguno M, Leal L, Macaya I, Martínez MJ, Cuesta G, Meira F, Morata L, Puerta-Alcalde P, Rojas J, Torres B, Castro P, Muñoz J, Mensa J, Martínez JA, Sanjuan G, Vila J, García F, Garcia-Vidal C, and Soriano A
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- Antiviral Agents, Hospitals, Humans, Viral Load, COVID-19, SARS-CoV-2
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Purpose: Assess the impact of viral load estimated by cycle threshold (Ct) of reverse transcription real time-polymerase chain reaction (rRT-PCR) and the days from symptoms onset on mortality in hospitalized patients with COVID19., Methods: Retrospective observational study of 782 patients with a positive rRT-PCR from a nasopharyngeal swab was performed within the first 24 h from admission. Demographic data, clinical manifestations and laboratory parameters were collected. Uni- and multivariate analyses were performed to identify factors associated with mortality at 60 days., Results: Ct was divided into three groups and the mortality rate decreased from 27.3 to 20.7% and 9.8% for Ct values of ≤ 20, 21-25 and > 25, respectively (P = 0.0001). The multivariate analysis identified as predictors of mortality, a Ct value < 20 (OR 3.13, CI 95% 1.38-7.10), between 21-25 (OR 2.47, CI 95% 1.32-4.64) with respect to a Ct value > 25. Days from symptoms onset is a variable associated with mortality as well (DSOA) ≤ 6 (OR 1.86, CI 95% 1.00-3.46), among other factors. Patients requiring hospital admission within 6 DSOA with a Ct value ≤ 25 had the highest mortality rate (28%)., Conclusions: The inclusion of Ct values and DSOA in the characterization of study populations could be a useful tool to evaluate the efficacy of antivirals., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.)
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- 2022
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24. Simplification from tenofovir disoproxil fumarate plus lamivudine or emtricitabine plus ritonavir-boosted protease inhibitor to ritonavir-boosted atazanavir plus lamivudine in virologically suppressed HIV-infected adults with osteopenia: a pilot study.
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Blanco JL, Rojas J, de Lazzari E, Inciarte A, Subirana M, Callau P, Martinez-Rebollar M, Laguno M, Mallolas J, de la Mora L, Torres B, Gonzalez-Cordón A, and Martinez E
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- Adult, Atazanavir Sulfate therapeutic use, Emtricitabine therapeutic use, Female, Humans, Lamivudine therapeutic use, Male, Pilot Projects, Ritonavir adverse effects, Ritonavir therapeutic use, Tenofovir adverse effects, Tenofovir therapeutic use, Anti-HIV Agents therapeutic use, Bone Diseases, Metabolic chemically induced, Bone Diseases, Metabolic prevention & control, Drug Substitution, HIV Infections complications, HIV Infections drug therapy, HIV Protease Inhibitors therapeutic use
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Background: Tenofovir disoproxil fumarate, particularly when given with a ritonavir-boosted PI, reduces bone mineral density (BMD) and increases bone turnover markers (BTMs). Ritonavir-boosted atazanavir plus lamivudine is a feasible simplified option. We evaluated whether switching from a triple ritonavir-boosted PI plus tenofovir disoproxil fumarate to a two-drug regimen of lamivudine plus ritonavir-boosted atazanavir would improve BMD., Methods: Single-arm pilot study. Virologically suppressed patients on tenofovir disoproxil fumarate plus lamivudine or emtricitabine plus ritonavir-boosted PI with low BMD, without previous resistance mutations and/or virological failure to study drugs were switched to 100/300 mg of ritonavir-boosted atazanavir plus 300 mg of lamivudine once daily. The primary endpoint was BMD change by DXA at Week 48., Results: There were 31 patients, 4 (13%) female, and median age was 40 years. Seven participants (22.5%) had osteoporosis. At 48 weeks, mean (SD) changes in spine and hip BMD were +0.01 (0.03) (P = 0.0239) and +0.013 (0.03) g/cm2 (P = 0.0046), respectively. Mean (SD) T-score changes were +0.1 (0.23) (P = 0.0089) and +0.25 (0.76) (P = 0.0197), respectively. N-telopeptide and urine tenofovir disoproxil fumarate toxicity markers showed significant improvements. One participant withdrew from the study and two were lost to follow-up. There were no virological failures, or serious or grade 3-4 adverse events., Conclusions: Switching from a tenofovir disoproxil fumarate plus ritonavir-boosted PI triple therapy to a lamivudine plus ritonavir-boosted atazanavir two-drug regimen in virologically suppressed HIV-infected adults with low BMD was safe, increased low BMD and reduced plasma markers of bone turnover and urine markers of tenofovir disoproxil fumarate toxicity over 48 weeks., (© The Author(s) 2022. Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
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- 2022
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25. Clinical Presentation and Outcome of COVID-19 in a Latin American Versus Spanish Population: Matched Case-Control Study.
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Alonso R, Camon AM, Cardozo C, Albiach L, Agüero D, Marcos MA, Ambrosioni J, Bodro M, Chumbita M, de la Mora L, Garcia-Pouton N, Dueñas G, Hernandez-Meneses M, Inciarte A, Cuesta G, Meira F, Morata L, Puerta-Alcalde P, Herrera S, Tuset M, Castro P, Prieto-Gonzalez S, Mensa J, Martínez JA, Sanjuan G, Nicolas JM, Del Rio A, Vila J, Garcia F, Garcia-Vidal C, and Soriano A
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Introduction: Increased mortality has been reported in the Latin American population. The objective is to compare the clinical characteristics and outcome of Latin American and Spanish populations in a cohort of patients hospitalized with COVID-19 during the first year of the pandemic., Methods: We retrospectively analysed all the Latin American patients (born in South or Central America) hospitalized in our centre from February 2020 to February 2021 and compared them with an age- and gender-matched group of Spanish subjects. Variables included were demographics, co-morbidities, clinical and analytical parameters at admission and treatment received. The primary outcomes were ICU admission and mortality at 60 days. A conditional regression analysis was performed to evaluate the independent baseline predictors of both outcomes., Results: From the 3216 patients in the whole cohort, 216 pairs of case-controls (Latin American and Spanish patients, respectively) with same age and gender were analysed. COPD was more frequent in the Spanish group, while HIV was more prevalent in the Latin American group. Other co-morbidities showed no significant difference. Both groups presented with similar numbers of days from symptom onset, but the Latin American population had a higher respiratory rate (21 vs. 20 bpm, P = 0.041), CRP (9.13 vs. 6.22 mg/dl, P = 0.001), ferritin (571 vs. 383 ng/ml, P = 0.012) and procalcitonin (0.10 vs. 0.07 ng/ml, P = 0.020) at admission and lower cycle threshold of PCR (27 vs. 28.8, P = 0.045). While ICU admission and IVM were higher in the Latin American group (17.1% vs. 13% and 9.7% vs. 5.1%, respectively), this was not statistically significant. Latin American patients received remdesivir and anti-inflammatory therapies more often, and no difference in the 60-day mortality rate was found (3.2% for both groups)., Conclusion: Latin American patients with COVID-19 have more severe disease than Spanish patients, requiring ICU admission, antiviral and anti-inflammatory therapies more frequently. However, the mortality rate was similar in both groups., (© 2022. The Author(s).)
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- 2022
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26. Integrase resistance emergence with dolutegravir/lamivudine with prior HIV-1 suppression.
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Revollo B, Viñuela L, de la Mora L, García F, Noguera-Julián M, Parera M, Paredes R, and Llibre JM
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- Drug Resistance, Viral genetics, Heterocyclic Compounds, 3-Ring adverse effects, Humans, Integrases, Lamivudine therapeutic use, Leukocytes, Mononuclear, Male, Oxazines therapeutic use, Piperazines, Pyridones therapeutic use, RNA-Directed DNA Polymerase, Viremia drug therapy, HIV Infections drug therapy, HIV Integrase Inhibitors pharmacology, HIV Integrase Inhibitors therapeutic use, HIV Seropositivity drug therapy, HIV-1 genetics
- Abstract
Objectives: Integrase resistance has not been reported with co-formulated dolutegravir/lamivudine in clinical trials or real-life cohorts. We aim to report, to the best of our knowledge, the first case of selection of the key integrase mutation R263K in a subject treated with this regimen started as a switch strategy with undetectable plasma HIV-1 viraemia., Methods: Clinical case report., Results: A patient with long-term suppressed HIV-1 viraemia (<50 copies/mL) with no known risk factors for virological failure and never exposed previously to an integrase inhibitor developed virological failure (consecutive plasma HIV-1 RNA 149 and 272 copies/mL) with 322 CD4 cells/mm3 despite good treatment adherence. He was receiving the anticonvulsant clobazam, considered to have a potential weak interaction with dolutegravir, unlikely to require a dose adjustment. Plasma HIV-1 genotypic deep sequencing (Vela System) revealed the emergence of R263K (79.6%) and S230N (99.4%) mutations in the integrase region (intermediate resistance to dolutegravir, score = 30 Stanford HIVDB 9.0). The reverse transcriptase and protease regions could not be amplified due to low viral loads. PBMC DNA deep sequencing performed some months later revealed mutations M184I (14.29%) and M230I (6.25%) in the reverse transcriptase and G163R (9.77%) and S230N (98.8%) in the integrase. R263K was only found at extremely low levels (0.07%)., Conclusions: This case illustrates that integrase resistance can emerge in patients treated with co-formulated dolutegravir/lamivudine and raises awareness of the need to carefully consider and monitor drug-drug interactions, even when regarded as having a low potential, in subjects treated with dolutegravir/lamivudine., (© The Author(s) 2022. Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
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- 2022
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27. Impact of coronavirus disease 2019 epidemics on prevention and care for HIV and other sexually transmitted infections.
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de Lazzari E, Martínez-Mimbrero A, Chivite I, González-Cordón A, Mosquera MM, Laguno M, Costa J, Bosch J, Blanco JL, Álvarez-Martinez M, Ugarte A, Inciarte A, de la Mora L, Torres B, Martínez-Rebollar M, Ambrosioni J, Fernaández E, Hurtado JC, Mallolas J, Miró JM, Marcos MA, and Martínez E
- Subjects
- Adult, Cholesterol, Humans, Lipids, Retrospective Studies, COVID-19 epidemiology, Chlamydia Infections epidemiology, Epidemics, Gonorrhea epidemiology, Gonorrhea prevention & control, HIV Infections drug therapy, HIV Infections epidemiology, HIV Infections prevention & control, Sexually Transmitted Diseases epidemiology, Sexually Transmitted Diseases prevention & control
- Abstract
Objective: To assess the impact of coronavirus disease 2019 (COVID-19) epidemics on the prevention and care for HIV and other sexually transmitted infections at a major reference centre providing preventive and clinical services in Catalonia, Spain., Design: We retrospectively compared anonymized clinical and laboratory data from March to December 2020 vs. 2019., Methods: Monthly clinical data on HIV preexposure and postexposure prophylaxis users and on adults with HIV infection were retrieved from the administrative hospital database. Monthly tests for HIV, hepatitis B and C, Treponema pallidum, Neisseria gonorrhoeae,and Chlamydia trachomatis, and plasma lipids and glucose were recovered from the laboratory database., Results: There were less (↓28%, P = 0.003) but more advanced (mean CD4+ cells/μl 305 vs. 370, P < 0.001) HIV infections and more gonorrhoea (↑39%, P < 0.001) and chlamydia (↑37%, P < 0.001) infections in 2020 vs. 2019. In people with HIV, rates of HIV RNA less than 50 copies/ml remained stable (11 vs. 11%, P = 0.147) despite less scheduled visits (↓25%, P < 0.001). However, they had less antiretroviral prescription changes (↓10%, P = 0.018), worse plasma lipids [mean total cholesterol 190 vs. 185 mg/dl, P < 0.001;mean low-density lipoprotein (LDL) cholesterol 114 vs. 110 mg/dl, P < 0.001; mean triglycerides 136 vs. 125 mg/dl, P < 0.001; mean high-density lipoprotein (HDL) cholesterol 47 vs. 48 mg/dl, P = 006], and an excess of mortality (↑264%, P = 0.006) due in great part not only to COVID-19 but also to other causes., Conclusion: In our setting, COVID-19 epidemics was associated with an increase in some prevalent sexually transmitted infections, with less but more advanced HIV infections, and with worse nonvirologic healthcare outcomes and higher mortality in people living with HIV., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2022
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28. Correction to: Impact of Sexualized Substance Use and Other Risk Practices on HCV Microelimination in gbMSM Living with HIV: Urgent Need for Targeted Strategies. Results of a Retrospective Cohort Study.
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Martínez-Rebollar M, De La Mora L, Campistol M, Cabrera B, Bagué A, De Lazzari E, Torres B, González-Cordón A, Inciarte A, Ambrosioni J, Martínez E, Blanco JL, Forns X, Blanch J, Mallolas J, and Laguno M
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- 2022
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29. Real-life experience with bictegravir/emtricitabine/tenofovir alafenamide in a large reference clinical centre.
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Ambrosioni J, Rojas Liévano J, Berrocal L, Inciarte A, de la Mora L, González-Cordón A, Martínez-Rebollar M, Laguno M, Torres B, Ugarte A, Chivite I, Leal L, de Lazzari E, Miró JM, Blanco JL, Martinez E, and Mallolas J
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- Adult, Alanine therapeutic use, Amides, Emtricitabine therapeutic use, Heterocyclic Compounds, 3-Ring, Humans, Piperazines, Pyridones therapeutic use, Retrospective Studies, Tenofovir analogs & derivatives, Anti-HIV Agents adverse effects, HIV Infections drug therapy
- Abstract
Background: The use of bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) is mainly based on robust, pivotal clinical trials., Objectives: To provide data on clinical use of BIC/FTC/TAF in real life., Patients and Methods: This was an observational, retrospective and single-centre study. We included all adult, treatment-naive (TN) and treatment-experienced (TE) people living with HIV (PLWH) starting BIC/FTC/TAF from 8 June 2018. We evaluated effectiveness [on treatment (OT), modified intention-to-treat (mITT) and intention-to-treat (ITT)], tolerability and safety in those patients who reached 6 months of follow-up (M6)., Results: We included 1584 PLWH [213 TN (13%) and 1371 TE (87%)]. The median (IQR) follow-up was 16 (7-21) months, with 81% and 53% of PLWH reaching M6 and M12, respectively. By OT, mITT and ITT, HIV-RNA <50 copies/mL was 77%, 70% and 62% at M6 and 92%, 77% and 63% at M12 for TN PLWH and 94%, 89% and 83% at M6 and 93%, 85% and 78% at M12 for TE PLWH, respectively. In PLWH carrying an M184V/I substitution, OT RNA <50 copies/mL was 89.5% at M6. The median CD4 cell count increased from 329 to 511/μL in TN PLWH and from 630 to 683/μL in TE PLWH at M6. Of the total, 1148 (88%) PLWH continued on BIC/FTC/TAF at M6. The most frequent known reason for discontinuation was toxicity [42 (69%) cases]; only 7 cases were considered virological failures (0.6% of the total OT cohort at M6), with no emerging resistance substitutions., Conclusions: In real life, BIC/FTC/TAF showed high rates of virological suppression and also in PLWH carrying lamivudine/emtricitabine resistance substitutions. The tolerability and safety of BIC/FTC/TAF were good, with high persistence observed for patients on this regimen at M6., (© The Author(s) 2022. Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
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- 2022
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30. C-reactive protein cut-off for early tocilizumab and dexamethasone prescription in hospitalized patients with COVID-19.
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Camon AM, Alonso R, Muñoz FJ, Cardozo C, Bernal-Maurandi J, Albiach L, Agüero D, Marcos MA, Ambrosioni J, Bodro M, Chumbita M, De la Mora L, Garcia-Pouton N, Dueñas G, Hernandez-Meneses M, Inciarte A, Cuesta G, Meira F, Morata L, Puerta-Alcalde P, Rico V, Herrera S, Tuset M, Castro P, Prieto-González S, Almuedo A, Muñoz J, Mensa J, Sanjuan G, Nicolas JM, Del Rio A, Vila J, García F, Martínez JA, Garcia-Vidal C, and Soriano A
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- Aged, Female, Humans, Male, Retrospective Studies, SARS-CoV-2, Antibodies, Monoclonal, Humanized therapeutic use, C-Reactive Protein metabolism, Dexamethasone therapeutic use, COVID-19 Drug Treatment
- Abstract
Dexamethasone and tocilizumab have been associated with reduction in mortality, however, the beneficial effect is not for all patients and the impact on viral replication is not well defined. We hypostatized that C-reactive protein (CRP) could help in the identification of patients requiring anti-inflammatory therapy. Patients admitted for > 48 h in our hospital for a confirmed or suspected infection by SARS-CoV-2 from February 2020 to February 2021 were retrospectively evaluated. The primary outcome was mortality at 30 days. Demographics and the most relevant variables related with the outcome were included. CRP was stratified by percentiles. Univariate and multivariate analysis were performed. A total of 3218 patients were included with a median (IQR) age of 66 (74-78) years and 58.9% were males. The rate of intensive care unit admission was 24.4% and the 30-day mortality rate was 11.8%. Within the first 5 days from admission, 1018 (31.7%) patients received dexamethasone and 549 tocilizumab (17.1%). The crude analysis showed a mortality reduction in patients receiving dexamethasone when CRP was > 13.75 mg/dL and > 3.5 mg/dL for those receiving tocilizumab. Multivariate analysis identified the interaction of CRP > 13.75 mg/dL with dexamethasone (OR 0.57; CI 95% 0.37-0.89, P = 0014) and CRP > 3.5 mg/dL with tocilizumab (0.65; CI95%:0.44-0.95, P = 0.029) as independent predictors of mortality. Our results suggest that dexamethasone and tocilizumab are associated with a reduction in mortality when prescribed to patients with a certain inflammatory activity assessed by C-reactive protein., (© 2022. The Author(s).)
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- 2022
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31. Impact of remdesivir according to the pre-admission symptom duration in patients with COVID-19.
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Garcia-Vidal C, Alonso R, Camon AM, Cardozo C, Albiach L, Agüero D, Marcos MA, Ambrosioni J, Bodro M, Chumbita M, de la Mora L, Garcia-Pouton N, Dueñas G, Hernandez-Meneses M, Inciarte A, Cuesta G, Meira F, Morata L, Puerta-Alcalde P, Herrera S, Tuset M, Castro P, Prieto-Gonzalez S, Almuedo-Riera A, Mensa J, Martínez JA, Sanjuan G, Nicolas JM, Del Rio A, Muñoz J, Vila J, Garcia F, and Soriano A
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- Adenosine Monophosphate analogs & derivatives, Aged, Alanine analogs & derivatives, Antiviral Agents therapeutic use, Humans, Male, Respiration, Artificial, Retrospective Studies, SARS-CoV-2, COVID-19 Drug Treatment
- Abstract
Background: The use of remdesivir has demonstrated a significant reduction in the time to recovery in patients with COVID-19. However, the impact on mortality is still controversial. Therefore, it is necessary to evaluate whether there is a specific subgroup of patients in whom an active antiviral therapy also reduces the mortality., Methods: Patients admitted for >48 h in our hospital for a SARS-CoV-2 confirmed or suspected infection from February 2020 to February 2021 were retrospectively analysed. The primary outcome of the study was mortality at 30 days. Univariate and multivariate analyses were performed to identify predictors of mortality., Results: In total, 2607 patients (438 receiving remdesivir and 2169 not) were included with a median (IQR) age of 65 (54-77) years and 58% were male. Four hundred and seventy-six were admitted to the ICU (18.3%) and 264 required invasive mechanical ventilation (10.1%). The global 30 day mortality rate was 10.7%. Pre-admission symptom duration of 4-6 days and ≤3 days was associated with a 1.5- and 2.5-fold increase in the mortality rate, respectively, in comparison with >6 days and treatment with remdesivir was independently associated with a lower mortality rate (OR = 0.382, 95% CI = 0.218-0.671). The analysis showed that the major difference was among patients with shorter pre-admission symptom duration (<6 days)., Conclusions: Patients with ≤3 days and 4-6 days from symptom onset to admission are associated with a 2.5- and 1.5-fold higher risk of death, respectively. Remdesivir was associated with 62% reduced odds of death versus standard-of-care and its survival benefit increased with shorter duration of symptoms., (© The Author(s) 2021. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For permissions, please email: journals.permissions@oup.com.)
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- 2021
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32. Factors associated with the use and composition of two-drug regimens in a large single-centre HIV cohort.
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de Lazzari E, Gonzalez-Cordon A, Inciarte A, Ugarte A, de la Mora L, Martinez-Rebollar M, Laguno M, Ambrosioni J, Torres B, Mallolas J, Blanco JL, Miro JM, and Martinez E
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- Adult, Drug Resistance, Viral, Humans, Retrospective Studies, Anti-HIV Agents therapeutic use, HIV Infections drug therapy, HIV Integrase Inhibitors pharmacology, HIV Integrase Inhibitors therapeutic use, Pharmaceutical Preparations
- Abstract
Objectives: We aimed to assess the clinical characteristics associated with the use of two-drug regimens (2DRs) and the factors associated with specific antiretrovirals in 2DRs in a large single-centre HIV cohort., Methods: Retrospective analysis of demographics, HIV characteristics and AIDS events, antiretroviral prescription, virological failure and genotypic resistance testing, and laboratory results from all adult people with HIV (PWH) prospectively followed at the Hospital Clinic of Barcelona who were receiving a 3DR or a 2DR in January 2020. We assessed factors associated with the probability of receiving 2DRs relative to three-drug regimens (3DRs) using a logistic regression model, controlling for age, sex and year of HIV diagnosis. The same methodology was applied to identify factors associated with the prescription of integrase inhibitor-based regimens or PI-based regimens among PWH receiving 2DRs., Results: There were 3432 (88%) PWH receiving 3DRs and 463 (12%) receiving 2DRs. In the final adjusted model, ≥2 previous virological failures, previous resistance mutations, previous AIDS diagnosis, longer time on current regimen, higher total cholesterol or triglycerides and lower baseline haemoglobin were independent factors associated with 2DRs. The majority of 2DRs included an integrase inhibitor or/and a PI. We identified independent factors associated with the inclusion of integrase inhibitors (lower HDL cholesterol) or PIs (prior AIDS, prior genotypic resistance mutations and lower CD4/CD8 ratio) in the 2DR., Conclusions: In this large single-centre HIV cohort, a worse cardiometabolic status or more archived resistance were key factors associated with inclusion of integrase inhibitors or PIs, respectively, in 2DRs., (© The Author(s) 2021. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For permissions, please email: journals.permissions@oup.com.)
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- 2021
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33. Impact of Sexualized Substance Use and Other Risk Practices on HCV Microelimination in gbMSM Living with HIV: Urgent Need for Targeted Strategies. Results of a Retrospective Cohort Study.
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Martínez-Rebollar M, De La Mora L, Campistol M, Cabrera B, Bagué A, De Lazzari E, Torres B, González-Cordón A, Inciarte A, Ambrosioni J, Martínez E, Blanco JL, Forns X, Blanch J, Mallolas J, and Laguno M
- Abstract
Introduction: The objective of the present study is to describe the incidence of recently acquired hepatitis C (RAHCV) in a large cohort of people living with HIV (PLWHIV) and sexualized drug use and other related risk behaviours., Methods: Observational study including all PLWHIV with a RAHCV episode between June 2005 and December 2019 at the Hospital Clinic of Barcelona, Spain. Incidence of RAHCV was determined per person calendar year (py) in those patients who were HCV RNA negative. Data were collected on high-risk sexual practices for HCV transmission focused on gay, bisexual and other men having sex with men (gbMSM)., Results: A total of 340 RAHCV were diagnosed in 290 PLWHIV; 274 (94%) of them were gbMSM and developed 324 RAHCV, mainly since 2010 (90%). Overall incidence rate (IR) of RAHCV in gbMSM was 0.10 py (95% CI 0.09-0.11), with a 40% decreased observed since 2017 (IR 0.06, 95% CI 0.03-0.09 in 2019). Sixty reinfections were detected in 50 gbMSM (n = 244, 20%). The overall reinfection IR was 0.17 per py (95% CI 0.12-0.23) and the proportion of reinfection among total RAHCV increased to 47% cases in 2019, mainly in patients engaged in sexualized substance use (76%), unprotected anal intercourse (94%), sex partying (80%), fisting (43%), slamming (14%) and 60% of concomitant sexually transmitted infections (STIs)., Conclusions: Despite RAHCV incidence decline in our cohort since 2017, HCV reinfection increased. High sexualized substance use and other risk behaviours are described in this context, indicating the need for public health tailored strategies to reduce this transmission and achieve HCV microelimination in gbMSM living with HIV., (© 2021. The Author(s).)
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- 2021
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34. [Methamphetamine use in chemsex and its consequences on mental health: a descriptive study.]
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Gavín P, Arbelo N, Monràs M, Nuño L, Bruguera P, de la Mora L, Martínez-Rebollar M, Laguno M, Blanch J, and Miquel L
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- Humans, Longitudinal Studies, Male, Retrospective Studies, Spain epidemiology, Homosexuality, Male psychology, Homosexuality, Male statistics & numerical data, Mental Disorders epidemiology, Methamphetamine adverse effects, Sexual Behavior statistics & numerical data, Substance-Related Disorders psychology
- Abstract
Objective: Chemsex is a term applicable to the use of drugs related to sex among men who have sex with men (MSM). Because it is a recent trend, there is little information about its management and consequences. The aim of the study was to describe the clinical profile of a sample of chemsex users who consulted for treatment., Methods: This is a longitudinal and retrospective study of 53 patients who consulted for chemsex in an addiction unit of a general hospital in Barcelona, from January 2017 to June 2019. Data was collected from electronic medical records and a descriptive analysis was performed by calculating proportions and means., Results: The most common drug used in chemsex was methamphetamine (81.1%; n=43) and 67.4% (n=29) of these used at least other two drugs. The prevalence of HIV infection was high (71.2%; n=37) and 72.1% (n=41) had psychiatric comorbidity, being the most common psychosis (37.2%; n=16)., Conclusions: Methamphetamine was the most common drug chemsex user's seeked for treatment. Furthermore, there is a high prevalence of HIV diagnosis in this population. Both conditions can enhance the risk of suffering from psychosis and may explain why psychiatric comorbidity is so high in the sample.
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- 2021
35. Gustatory and olfactory dysfunctions in hospitalised patients with COVID-19 pneumonia: a prospective study.
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Inciarte A, Cardozo C, Chumbita M, Alcubilla P, Torres B, González Cordón A, Rico V, Aguero D, García-Pouton N, Hernández-Meneses M, Albiach L, Meira F, De la Mora L, Linares L, Puerta-Alcalde P, Macaya I, Mensa J, Laguno M, Ambrosioni J, Ramos A, Morata L, Bodro M, Moreno-García E, Moreno A, Sola M, Rojas J, Leal L, Torres M, Garcia-Vidal C, Martínez JA, Alobid I, Soriano A, and Garcia F
- Subjects
- Female, Humans, Male, Middle Aged, Prospective Studies, Retrospective Studies, SARS-CoV-2, Taste Disorders, COVID-19, Olfaction Disorders epidemiology, Olfaction Disorders etiology
- Abstract
Importance: Identifying undetected clinical signs is imperative in the prevention of SARS-CoV-2., Objective: To establish the prevalence of clinical gustatory and olfactory dysfunctions in patients with COVID-19 pneumonia. Clinical outcomes and recovery rates associated with gustatory and olfactory dysfunctions were also assessed., Design: A prospective study was performed in 80 patients admitted to Hospital Clínic of Barcelona (Spain) for COVID-19 pneumonia. Patients were re-evaluated in the ward daily until discharge. Gustatory and olfactory dysfunction symptoms were retrospectively collected from emergency room (ER) charts after first assessments. Follow-up was performed in telemedicine consultation., Setting: The single-centre study was performed in a hospitalisation ward at a university hospital., Participants: Consecutive patients meeting hospitalisation criteria for COVID-19 pneumonia were eligible. Study exclusion criteria were patients who could not speak, had previous gustatory and olfactory dysfunctions or whose PCR tests for SARS-CoV-19 were negative., Interventions: Systematic assessment of gustatory and olfactory symptoms with standardised questions., Outcomes: Prevalence of gustatory and olfactory dysfunctions in patients with COVID-19 pneumonia., Results: Of the 80 study subjects, 62.5% were male and the median age was 57 years. Half of the cohort (n=40) presented with comorbidities. The prevalence of chemosensitive disorder was 73.8% (n=59) (95% CI: 63.8 to 83.8), although self-reported symptoms were recorded in only 26.3% (n=21) of patients in the ER. Gustatory and olfactory dysfunctions were observed in 58.8% (n=47) and 55% (n=44) of cases, respectively. They were also the first symptoms in 25% (n=20) of patients. Anosmia was associated with ageusia, OR: 7, 95% CI: 2.3 to 21.8, p=0.001). No differences in clinical outcomes were observed when patients with and without gustatory and olfactory dysfunctions were compared. Recovery rates were 20% (n=10) and 85% (n=42) at days 7 and 45, respectively., Conclusion: The prevalence of gustatory and olfactory dysfunctions in COVID-19 pneumonia was much higher than in self-report. Presence of gustatory and olfactory dysfunctions was not a predictor of clinical outcomes., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
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- 2021
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36. PrEP program experience in a hospital HIV unit. Description of baseline user profile and identification of opportunities for improvement.
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Laguno M, Ugarte A, Martinez-Rebollar M, Sobrino Y, Font G, de Lazzari E, de la Mora L, Torres B, Chivite I, Riera J, Ambrosioni J, Inciarte A, González-Cordón A, Rojas J, Cordón E, Blanco JL, Martínez E, and Mallolas J
- Abstract
Introduction: Pre-Exposure Prophylaxis (PrEP) is a biomedical intervention to prevent HIV infection in seronegative people at high risk of becoming infected. This strategy was endorsed in October 2019 by the Spanish Ministry of Health., Objective: To present the PrEP initial experience in the HIV Unit of the Hospital Clínic of Barcelona, paying special attention to the analysis of the vulnerability factors in the cohort., Materials and Methods: Retrospective, descriptive study. The epidemiological, sociodemographic, and clinical characteristics of the users included in the program during the first year are analyzed, paying particular attention to Infections, risky practices, and substance use., Results: 190 individuals were included, 177 men and 12 trans women with a mean age of 35 years (8 SD). 70% had higher education, and half had Spanish nationality. An average of 10 couples per trimester and 60% reported unprotected anal sex. 31% had at least one positive PCR for STIs, with N. gonorrhoeae being the most prevalent microorganism (51%) and the rectal sample the most affected (21%). 63% reported chemsex use, 19% polydrug use, and 8% "slamming". Half expressed concern about consumption and/or sexual practices and 25% the need for help., Conclusions: The PrEP user profile attended in our Hospital Unit justifies the creation of multidisciplinary teams that allow us to provide holistic attention to the sexual life of these people., (Copyright © 2021 Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. Publicado por Elsevier España, S.L.U. All rights reserved.)
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- 2021
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37. Efficacy of Elbasvir/Grazoprevir in Early Chronic G1/G4 Hepatitis C infection in HIV/HCV co-infected patients with mild fibrosis.
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Laguno Centeno M, Alvarez B, Martínez-Rebollar M, de la Mora L, Prieto L, de Lazzari E, González-Cordón A, Torres B, Cabello A, Gorgolas M, and Mallolas J
- Subjects
- Adult, Benzofurans adverse effects, Drug Combinations, Genotype, Hepacivirus genetics, Homosexuality, Male, Humans, Imidazoles adverse effects, Liver Cirrhosis complications, Male, Middle Aged, Pilot Projects, Prospective Studies, Quinoxalines adverse effects, Severity of Illness Index, Treatment Outcome, Benzofurans therapeutic use, Coinfection drug therapy, HIV Infections complications, Hepatitis C, Chronic complications, Hepatitis C, Chronic drug therapy, Imidazoles therapeutic use, Quinoxalines therapeutic use
- Abstract
Background: Acute hepatitis C virus (AHC) infection is increasingly common among HIV+ men who have sex with men (MSM). Until 2017, the guidelines recommended therapy with pegylated-interferon plus ribavirin with a mild sustained virological response (SVR). This prompted many patients to reject that treatment, at that time, waiting to be treated with better and safer options with new Direct-Acting-Antivirals (DAA)., Objectives: Assess the efficacy and safety of Elbasvir/Grazoprevir to treat recent chronic hepatitis C infection, genotype 1 or 4, in HIV+ MSM patients., Methods: Prospective, open-labeled, two center, pilot study. SVR is analyzed for treatment with Elbasvir/Grazoprevir (8 weeks in GT1b or 12 in GT1a or GT4) in patients with a recent chronic HCV infection, defined as HCV infection lasting less than 4 years and mild liver fibrosis (liver stiffness <8kPa)., Results: Forty-eight patients were included (May 2017-March 2018): 2 GT1b, 24 GT1a and 22 GT4. HCV-RNA>800000UI in 63% and medium liver stiffness 4.9kPa. The SVR was 98%, one patient failed due to poor adherence. 67% of patients had adverse effects, but only 16% treatment related. The most frequent side effects were gastrointestinal (19%), related with the central nervous system (18%), respiratory (16%) and systemic symptoms (15%). During one year of follow-up post-therapy, 4 AHC and 18 patients with sexually transmitted diseases (STD) were diagnosed., Conclusions: Treatment with Elbasvir/Grazoprevir in this scenario is highly effective and safe. Patients with risky sexual practices must remain linked to the medical care system to detect new STD and HCV reinfection., (Copyright © 2020 Elsevier España, S.L.U. All rights reserved.)
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- 2021
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38. An unexpected adverse effect: Elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide-induced cholestasis.
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Ugarte A, De la Mora L, Martínez-Rebollar M, Mallolas J, and Laguno M
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- Alanine, Cobicistat adverse effects, Emtricitabine adverse effects, Humans, Quinolones, Tenofovir analogs & derivatives, Anti-HIV Agents adverse effects, Cholestasis
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- 2021
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39. Clinical characteristics, risk factors, and incidence of symptomatic coronavirus disease 2019 in a large cohort of adults living with HIV: a single-center, prospective observational study.
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Inciarte A, Gonzalez-Cordon A, Rojas J, Torres B, de Lazzari E, de la Mora L, Martinez-Rebollar M, Laguno M, Callau P, Gonzalez-Navarro A, Leal L, Garcia F, Mallolas J, Mosquera M, Marcos MA, Ambrosioni J, Miro JM, Martinez E, and Blanco JL
- Subjects
- Adult, Anti-HIV Agents therapeutic use, Betacoronavirus, CD4 Lymphocyte Count, COVID-19, Female, HIV Infections drug therapy, Humans, Incidence, Male, Middle Aged, Pandemics, Prospective Studies, Risk Factors, SARS-CoV-2, Spain epidemiology, Coronavirus Infections mortality, Coronavirus Infections physiopathology, HIV Infections complications, Pneumonia, Viral mortality, Pneumonia, Viral physiopathology
- Abstract
Background: It is unclear how characteristics, risk factors, and incidence of coronavirus disease 2019 (COVID-19) in people living with HIV (PLWH) differ from the general population., Methods: Prospective observational single-center cohort study of adult PLWH reporting symptoms of COVID-19. We assessed clinical characteristics, risk factors for COVID-19 diagnosis and severity, and standardized incidence rate ratio for COVID-19 cases in PLWH cohort and in Barcelona., Results: From 1 March 2020 to 10 May 2020, 53 out of 5683 (0.9% confidence interval 0.7-1.2%) PLWH were diagnosed with COVID-19. Median age was 44 years, CD4 T cells were 618/μl and CD4/CD8 was 0.90. All but two individuals were virologically suppressed. Cough (87%) and fever (82%) were the most common symptoms. Twenty-six (49%) were admitted, six (14%) had severe disease, four (8%) required ICU admission, and two (4%) died. Several laboratory markers (lower O2 saturation and platelets, and higher leukocytes, creatinine, lactate dehydrogenase, C reactive protein, procalcitonin, and ferritin) were associated with COVID-19 severity. No HIV or antiretroviral-related factors were associated with COVID-19 diagnosis or severity. Standardized incidence rate ratios of confirmed or confirmed/probable COVID-19 in PLWH were 38% (95% confidence interval 27-52%, P < 0.0001) and 33% (95% confidence interval 21-50%, P < 0.0001), respectively relative to the general population., Conclusion: PLWH with COVID-19 did not differ from the rest of the HIV cohort. Clinical presentation, severity rate, and mortality were not dependent on any HIV-related or antiretroviral-related factor. COVID-19 standardized incidence rate was lower in PLWH than in the general population. These findings should be confirmed in larger multicenter cohort studies.
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- 2020
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40. Contributing awareness of autoimmune hepatitis in HIV patients.
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Martínez-Rebollar M, Pascual PP, de la Mora L, Londoño MC, Llovet LP, Forns X, Mallolas J, and Laguno M
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- Adult, Female, Humans, Male, Middle Aged, HIV Infections immunology, Hepatitis, Autoimmune virology
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- 2019
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41. Barriers to hepatitis C virus elimination in MSM living with HIV: The high risk of reinfection. Case study: A patient with 6 episodes.
- Author
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Laguno M, Martínez-Rebollar M, de la Mora L, Pérez-Del-Pulgar S, and Mallolas J
- Subjects
- Acute Disease, Coinfection virology, HIV Infections complications, HIV Infections virology, Hepatitis C drug therapy, Humans, Male, Middle Aged, Recurrence, Risk Factors, HIV Infections drug therapy, Hepacivirus, Hepatitis C complications, Homosexuality, Male, Unsafe Sex
- Published
- 2019
- Full Text
- View/download PDF
42. Pneumocystis jirovecii pneumonia in a patient with pustular psoriasis with an IL-36RN deficiency treated with infliximab: Case report and review of the literature.
- Author
-
Podlipnik S, de la Mora L, Alsina M, and Mascaró JM Jr
- Subjects
- Humans, Immunologic Factors therapeutic use, Interleukin 1 Receptor Antagonist Protein therapeutic use, Interleukins deficiency, Male, Middle Aged, Psoriasis genetics, Immunosuppressive Agents adverse effects, Infliximab adverse effects, Interleukins genetics, Pneumonia, Pneumocystis chemically induced, Psoriasis drug therapy
- Abstract
Pneumocystis jirovecii pneumonia (PCP) is a relatively rare complication in non-HIV patients receiving immunosuppressive treatment. Since the introduction of tumour necrosis factor-α inhibitors cases of this complication have increased. We report the case of a 54-year-old, HIV-negative patient, who presented to our department with a long history of pustular psoriasis with poor response to traditional treatments. During the last admission he developed a severe flare that was unresponsive to cyclosporine, therefore infliximab was initiated. After the third dose he developed PCP that required admission to the intensive care unit, with a positive response to i.v. administration of trimethoprim/sulfamethoxazole. During follow up a mutation in the IL36RN gene compatible with an IL-36RN deficiency was found and anakinra was started, with rapid improvement of his psoriasis. PCP is a severe complication in patients receiving immunosuppressive therapy and is probably underreported by dermatologists. There are no clinical guidelines for PCP prophylaxis in dermatological patients who will receive immunosuppressive or biological treatments. We believe that it is necessary to report the cases of PCP to assess the real impact of this complication and develop appropriate prophylaxis guidelines., (© 2016 The Australasian College of Dermatologists.)
- Published
- 2017
- Full Text
- View/download PDF
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