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In this study, two different approaches based on taxonomic assemblages and on copepod functional groups were used to investigate the mesozooplankton assemblage structure and its relationship with environmental variables in the main estuaries of the Gulf of Cádiz (Guadalquivir, Guadiana and Tinto-Odiel) during the dry-warm season. In general, the mesozooplankton assemblages were dominated by copepods, especially the calanoid Acartia tonsa, which reached its highest abundance in the inner zones while the adjacent coastal zones were characterized by a mixture of copepods and cladocerans, especially Penilia avirostris. Regarding the trait-based approach, three copepod functional groups were identified, principally sorted by their feeding strategy. Group 1 (composed of omnivorous copepods displaying a mixed feeding strategy and broadcast-spawners) was found mainly in the inner areas, while Groups 2 (omnivorous cyclopoids, sac-spawners that feed via active ambush) and 3 (herbivores-omnivores employing a filter feeding strategy and mostly broadcast-spawners) were predominant in the adjacent coastal zones. The relative abundance of copepod functional groups suggested that Group 1 could be considered the most important contributor to secondary production in the estuarine systems of the Gulf of Cádiz. In relation to environmental factors, salinity was the most influential variable on mesozooplankton assemblages in both approaches. Our results suggest that the studied estuaries, although taxonomically different, have mesozooplankton assemblages that perform similar ecological functions. Both methods provide valuable and complementary information about mesozooplankton assemblage dynamics in the main estuaries of the Gulf of Cádiz.
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Copépodes , Estuários , Zooplâncton , Animais , Copépodes/fisiologia , Zooplâncton/fisiologia , Monitoramento Ambiental , Biodiversidade , Salinidade , Estações do AnoRESUMO
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.
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BACKGROUND: Although people with HIV might be at risk of severe outcomes from infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; coronavirus 2019 [COVID-19]), regional and temporal differences in SARS-CoV-2 testing in people with HIV across Europe have not been previously described. METHODS: We described the proportions of testing, positive test results, and hospitalizations due to COVID-19 between 1 January 2020 and 31 December 2021 in the EuroSIDA cohort and the factors associated with being tested for SARS-CoV-2 and with ever testing positive. RESULTS: Of 9012 participants, 2270 (25.2%, 95% confidence interval [CI] 24.3-26.1) had a SARS-CoV-2 polymerase chain reaction test during the study period (range: 38.3% in Northern to 14.6% in Central-Eastern Europe). People from Northern Europe, women, those aged <40 years, those with CD4 cell count <350 cells/mm3, and those with previous cardiovascular disease or malignancy were significantly more likely to have been tested, as were people with HIV in 2021 compared with those in 2020. Overall, 390 people with HIV (4.3%, 95% CI 3.9-4.8) tested positive (range: 2.6% in Northern to 7.1% in Southern Europe), and the odds of testing positive were higher in all regions than in Northern Europe and in 2021 than in 2020. In total, 64 people with HIV (0.7%, 95% CI 0.6-0.9) were hospitalized, of whom 12 died. Compared with 2020, the odds of positive testing decreased in all regions in 2021, and the associations with cardiovascular disease, malignancy, and use of tenofovir disoproxil fumarate disappeared in 2021. Among study participants, 58.9% received a COVID-19 vaccine (range: 72.0% in Southern to 14.8% in Eastern Europe). CONCLUSIONS: We observed large heterogeneity in SARS-CoV-2 testing and positivity and a low proportion of hospital admissions and deaths across the regions of Europe.
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COVID-19 , Infecções por HIV , Hospitalização , SARS-CoV-2 , Humanos , Feminino , COVID-19/epidemiologia , COVID-19/diagnóstico , Masculino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Europa (Continente)/epidemiologia , Adulto , Pessoa de Meia-Idade , Hospitalização/estatística & dados numéricos , Teste para COVID-19/estatística & dados numéricos , Teste para COVID-19/métodos , Estudos de Coortes , Fatores de Risco , Contagem de Linfócito CD4 , IdosoRESUMO
INTRODUCTION: Advancements in and accessibility to effective antiretroviral therapy has improved the life expectancy of people living with HIV, increasing the proportion of people living with HIV reaching older age (≥60 years), making this population's health-related quality of life (HRQoL) more relevant. Our aim was to identify the determinants of poor HRQoL in people living with HIV aged ≥60 years and compare them with those of their younger counterparts. METHODS: We used data from the 'Vive+' study, a cross-sectional survey conducted between October 2019 and March 2020, nested within the PISCIS cohort of people living with HIV in Catalonia and the Balearic Islands, Spain. We used the 12-item short-form survey (SF-12), divided into a physical component summary (PCS) and a mental component summary (MCS), to evaluate HRQoL. We used the least absolute shrinkage and selection operator for variable selection and used multivariable regression models to identify predictors. RESULTS: Of the 1060 people living with HIV (78.6% males) who participated in the study, 209 (19.7%) were aged ≥60 years. When comparing older people living with HIV (≥60 years) and their younger counterparts, older people exhibited a worse PCS (median 51.3 [interquartile range {IQR} 46.0-58.1] vs. 46.43 [IQR 42.5-52.7], p < 0.001) but a similar MCS (median 56.0 [IQR 49.34-64.7] vs. 57.0 [IQR 48.9-66.3], p = 0.476). In the multivariable analysis, cognitive function correlated with a PCS (ß correlation factor [ß] -0.18, p = 0.014), and depressive symptoms and satisfaction with social role correlated with an MCS (ß 0.61 and ß -0.97, respectively, p < 0.001) in people living with HIV aged ≥60 years. CONCLUSION: Depressive symptoms, poor cognitive function, and lower satisfaction with social roles predict poorer HRQoL in older people living with HIV. These factors need to be considered when designing targeted interventions.
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Infecções por HIV , Qualidade de Vida , Masculino , Humanos , Idoso , Feminino , Qualidade de Vida/psicologia , Estudos Transversais , Infecções por HIV/tratamento farmacológico , Infecções por HIV/psicologia , Inquéritos e Questionários , CogniçãoRESUMO
The accuracy of contemporary risk scores in predicting perioperative mortality in infective endocarditis (IE) remains controversial. The aim is to evaluate the performance of existent mortality risk scores for cardiovascular surgery in IE and the impact on operability at high-risk thresholds. A single-center retrospective review of adult patients diagnosed with acute left-sided IE undergoing surgery from May 2014 to August 2019 (n = 142) was done. Individualized risk calculation was obtained according to the available mortality risk scores: EuroScore I and II, PALSUSE, Risk-E, Costa, De Feo-Cotrufo, AEPEI, STS-risk, STS-IE, APORTEI, and ICE-PCS scores. A cross-validation analysis was performed on the score with the best area under the curve (AUC). The 30-day survival was 96.5% (95%CI 91-98%). The score with worse area under the curve (AUC = 0.6) was the STS-IE score, while the higher was for the RISK-E score (AUC = 0.89). The AUC of the majority of risk scores suggested acceptable performance; however, statistically significant differences in expected versus observed mortalities were common. The cross-validation analysis showed that a large number of survivors (> 75%) would not have been operated if arbitrary high-risk threshold estimates had been used to deny surgery. The observed mortality in our cohort is significantly lower than is predicted by contemporary risk scores. Despite the reasonable numeric performance of the analyzed scores, their utility in judging the operability of a given patient remains questionable, as demonstrated in the cross-validation analysis. Future guidelines may advise that denial of surgery should only follow a highly experienced Endocarditis Team evaluation.
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Procedimentos Cirúrgicos Cardíacos , Endocardite Bacteriana , Endocardite , Adulto , Humanos , Estudos de Coortes , Medição de Risco , Fatores de Risco , Endocardite/diagnóstico , Endocardite/cirurgia , Estudos RetrospectivosRESUMO
Tuberculous meningitis (TBM) is the most severe and disabling form of tuberculosis (TB), with at least 100,000 cases per year and a mortality rate of up to 50% in individuals co-infected with human immunodeficiency virus type 1 (HIV-1). To evaluate the efficacy and safety of an intensified anti-tubercular regimen and an anti-inflammatory treatment, the INTENSE-TBM project includes a phase III randomised clinical trial (TBM-RCT) in four countries in sub-Saharan Africa (SSA). Within this framework, we designed a comprehensive capacity-building work package ensuring all centres had, or would acquire, the ability to conduct the TBM-RCT and developing a network of skilled researchers, clinical centres and microbiology laboratories. Here, we describe these activities, identify strengths/challenges and share tools adaptable to other projects, particularly in low- and lower-middle income countries with heterogeneous settings and during the coronavirus disease 2019 (COVID-19) pandemic. Despite major challenges, TBM-RCT initiation was achieved in all sites, promoting enhanced local healthcare systems and encouraging further clinical research in SSA. In terms of certified trainings, the achievement levels were 95% (124/131) for good clinical practice, 91% (39/43) for good clinical laboratory practice and 91% (48/53) for infection prevention and control. Platform-based research, developed as part of capacity-building activities for specific projects, may be a valuable tool in fighting future infectious diseases and in developing high-level research in Africa.
The INTENSE-TBM project aimed to design a comprehensive work-package on capacity building, ensuring all centres would acquire the ability to conduct a phase III randomised clinical trial on TBM in sub-Saharan Africa, to reduce tuberculous meningitis mortality and morbidity in patients with/without HIV-1 co-infection. Therefore, the INTENSE-TBM project is an example of how an international clinical research consortium can provide opportunities to enhance local capacity building and promote centres without previous experience in clinical research. This article provides practical approaches for implementing effective capacity-building programmes. We highlight how to overcome limitations imposed by the COVID-19 pandemic to successfully complete clinics, laboratory set-ups and personnel training, so as to optimise resources and empower African institutions on a local level. At the same time, our experience shows how capacity-building programmes can deliver long-lasting impact that extends beyond the original aims of the project (e.g. HIV and TB), and support local health systems in fighting other infectious disease (e.g. COVID-19). Research projects in low- and lower-middle income countries with heterogeneous settings could stand to benefit the most.
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PURPOSE OF REVIEW: The purpose of this review is to use the currently available clinical and epidemiological data, to identify key aspects to improve both the clinical management and public health response to SARS-CoV-2/HIV co-infection among HIV vulnerable populations and people living with HIV (PLWH). RECENT FINDINGS: While at the beginning of the COVID-19 pandemic, the lack of robust information on SARS-CoV-2/HIV co-infection, prevented a clear picture of the synergies between them, currently available data strongly support the importance of common structural factors on both the acquisition and clinical impact of these infections and the relevance of age, comorbidities, and detectable HIV viral load as associated worse prognostic factors among PLWH. Although more information is needed to better understand the biological, clinical, and epidemiological relationship between both infections, a syndemic approach to prevent SARS-CoV-2 among HIV high-risk groups and PLWH, targeting these populations for SARS-CoV-2 vaccines and protocolizing early identification of PLWH with worse COVID-19 prognosis factors, is crucial strategies to decrease the overall impact of SARS-CoV-2 /HIV co-infection.
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COVID-19 , Coinfecção , Infecções por HIV , COVID-19/epidemiologia , Vacinas contra COVID-19 , Coinfecção/epidemiologia , Infecções por HIV/complicações , Infecções por HIV/epidemiologia , Humanos , Pandemias , Saúde Pública , SARS-CoV-2RESUMO
BACKGROUND: Our aim was to compare pediatric infective endocarditis (IE) with the clinical profile and outcomes of IE in adults. METHODS: Prospective multicenter registry in 31 Spanish hospitals including all patients with a diagnosis of IE from 2008 to 2020. RESULTS: A total of 5590 patients were included, 49 were <18 years (0.1%). Congenital heart disease (CHD) was present in 31 children and adolescents (63.2%). Right-sided location was more common in children/adolescents than in adults (46.9% vs. 6.3%, P < 0.001). Pediatric pulmonary IE was more frequent in patients with CHD (48.4%) than in those without (5.6%), P = 0.004. Staphylococcus aureus etiology tended to be more common in pediatric patients (32.7%) than in adults (22.3%), P = 0.082. Heart failure was less common in pediatric patients than in adults, due to the lower rate of heart failure in children/adolescents with CHD (9.6%) with respect to those without CHD (44.4%), P = 0.005. Inhospital mortality was high in both children, and adolescents and adults (16.3% vs. 25.9%; P = 0.126). CONCLUSIONS: Most IE cases in children and adolescents are seen in patients with CHD that have a more common right-sided location and a lower prevalence of heart failure than patients without CHD. IE in children and adolescents without CHD has a more similar profile to IE in adults. IMPACT: Infective endocarditis (IE) in children and adolescents is often seen in patients with congenital heart disease (CHD). Right-sided location is the most common in patients with CHD and heart failure is less common as a complication compared with patients without CHD. Infective endocarditis (IE) in children/adolescents without CHD has a more similar profile to IE in adults. In children/adolescents without CHD, locations were similar to adults, including a predominance of left-sided IE. Acute heart failure was the most frequent complication, seen mainly in adults, and in children/adolescents without CHD.
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Endocardite Bacteriana , Endocardite , Cardiopatias Congênitas , Insuficiência Cardíaca , Adulto , Criança , Humanos , Adolescente , Estudos Prospectivos , Endocardite/complicações , Endocardite/epidemiologia , Endocardite/diagnóstico , Endocardite Bacteriana/complicações , Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/epidemiologia , Cardiopatias Congênitas/complicações , Cardiopatias Congênitas/epidemiologia , Cardiopatias Congênitas/diagnóstico , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/epidemiologia , Estudos RetrospectivosRESUMO
Many human activities in or near aquatic habitats generate alterations in their environmental conditions, which could affect the organisms that inhabit them. Maintenance dredging of navigation channels in order to allow large ships access to inland ports is one such source of disturbance. In this study, by taking multiple approaches (immediate-, short- and medium term), we analysed the effects of a maintenance dredging operation on physiochemical variables and the early life stages of fish and other macrofauna groups present in two zones of the Guadalquivir estuary with different salinity ranges (poly- and mesohaline). Most physiochemical variables were homogenized in the water column immediately after the water mass passed by the dredger, including sediment resuspension. However, this process seemed to be transient as no significant increments in the depth-averaged levels of turbidity were observed in the short- and medium-terms. Instead, metal concentrations of Cr, Fe and Zn increased in the polyhaline station. Even so, these perturbations did not appear to be severe enough to influence the macrofauna. Still, organisms can suffer direct mechanical impacts of the trailer suction. Hyperbenthic species, like Pomatoshcistus spp. or decapods, tended to decrease slightly, while pelagic species such as Engraulis encrasicolus or mysids did not, indicating that benthic organisms are usually more susceptible to high entrainment. Nonetheless, the possible effects of this disturbance were of the same order or less than those of natural ones; therefore, organisms of the macrofauna could be well adapted to cope with them.
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Estuários , Poluentes Químicos da Água , Animais , Monitoramento Ambiental , Sedimentos Geológicos , Humanos , Salinidade , Água , Poluentes Químicos da Água/análiseRESUMO
BACKGROUND: Using 2004-2007 TB:HIV Study data
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Coinfecção , Infecções por HIV , Mycobacterium tuberculosis , Tuberculose , Antituberculosos/uso terapêutico , Coinfecção/tratamento farmacológico , Atenção à Saúde , Europa (Continente)/epidemiologia , Feminino , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Humanos , América Latina/epidemiologia , Masculino , Testes de Sensibilidade Microbiana , Modelos de Riscos Proporcionais , Tuberculose/diagnóstico , Tuberculose/tratamento farmacológicoRESUMO
In this study we assessed the effects of the recurrent disposal of dredged material from the Guadalquivir estuary (south-western Spain) in a marine disposal area. We analysed shifts in sediment characteristics as well as bioaccumulation and biomagnification of heavy metals through the benthic food web. Results showed that the significant increase in concentration of some heavy metals observed in the marine disposal area after the latest disposal event could be attributed to the deposition of river-dredged sediments. This increase could also explain the decreased amphipod survival in the ecotoxicology analysis. Heavy metal concentrations in organisms indicated some bioaccumulation in deposit feeders and predators but with no clear patterns nor biomagnification through the food web. Hence, combining studies that monitor shifts in sediment characteristics and their possible consequences for the food web seems to be an interesting approach that should be assessed further in this type of studies.
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Estuários , Metais Pesados , Monitoramento Ambiental , Sedimentos Geológicos , Metais Pesados/análise , Rios , EspanhaRESUMO
The COVID-19 pandemic has greatly impacted the daily clinical practice of cardiologists and cardiovascular surgeons. Preparedness of health workers and health services is crucial to tackle the enormous challenge posed by SARS-CoV-2 in wards, operating theatres, intensive care units, and interventionist laboratories. This Clinical Review provides an overview of COVID-19 and focuses on relevant aspects on prevention and management for specialists within the cardiovascular field.
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Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Betacoronavirus/patogenicidade , Betacoronavirus/fisiologia , COVID-19 , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/transmissão , Endocardite/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/diagnóstico , Pneumonia Viral/transmissão , Infecções Relacionadas à Prótese/cirurgia , SARS-CoV-2RESUMO
Hydrological, geomorphological, physicochemical and biological factors influence the nursery function of estuaries. Our study compared the environmental conditions and the assemblages of early life stages of fish in the main four estuaries of the Gulf of Cadiz (Cadiz Bay, Guadalquivir, Odiel-Tinto and Guadiana). Samples were taken within each estuary and on their adjacent coast, during the dry-warm seasons of 2016, 2017 and 2018. Results showed that rivers with smaller basins had a very low freshwater input and their estuaries, Odiel-Tinto and Cadiz Bay, were essentially sea extensions into the land, containing similar physicochemical conditions to nearshore zones, as well as similar assemblages and densities of early life stages of fish. Open water masses of these estuaries do not have important nursery functions. In contrast, inner zones of estuaries with bigger basins and higher freshwater discharges, Guadalquivir and Guadiana, have different environmental characteristics and a long transition zone with a well-defined salinity gradient. Their assemblages and densities of early life stages of fish were different between them and with other estuaries. The Guadalquivir estuary held the highest abundance of larval and early juvenile fish, as well as macrozooplankton biomass. The most abundant fish species in all zones of every estuary was the anchovy Engraulis encrasicolus; the Guadalquivir inner zone had the highest density. High concentration of suspended organic matter, provided by freshwater input and correlated with total suspended solid, suspended inorganic matter and turbidity, was the physicochemical characteristic more typical of the Guadalquivir. This characteristic, in addition to the salinity gradient, could explain the highest densities of macrozooplankton found in this estuary, and consequently, of early fish stages. Recurrent jellyfish blooms were observed in Cadiz Bay and the inner zone of Guadiana, affecting their nursery functions. Odiel-Tinto showed altered physicochemical and biological characteristics, which may need further specific research.
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Estuários , Peixes , Animais , Água Doce , Rios , Salinidade , Estações do AnoRESUMO
The EuroSIDA study was initiated in 1994 and follows adult people living with HIV (PLHIV) in 100 collaborating clinics across 35 countries covering all European regions, Israel and Argentina. The study aims to study the long-term virological, immunological and clinical outcomes of PLHIV and to monitor temporal changes and regional differences in outcomes across Europe. Annually collected data include basic demographic characteristics, information on AIDS- and non-AIDS-related clinical events, and details about antiretroviral therapy (ART), hepatitis C treatment and other medications, in addition to a range of laboratory values. The summer 2016 data set held data from a total of 23 071 individuals contributing 174 481 person-years of follow-up, while EuroSIDA's unique plasma repository held over 160 000 samples. Over the past 25 years, close to 300 articles have been published in peer-reviewed journals (h-index 52), covering a range of scientific focus areas, including monitoring of clinical and virological outcomes, ART uptake, efficacy and adverse events, the influence of hepatitis virus coinfection, variation in the quality of HIV care and management across settings and regions, and biomarker research. Recognizing that there remain unresolved issues in the clinical care and management of PLHIV in Europe, EuroSIDA was one of the cohorts to found The International Cohort Consortium of Infectious Disease (RESPOND) cohort consortium on infectious diseases in 2017. In celebration of the EuroSIDA study's 25th anniversary, this article aims to summarize key scientific findings and outline current and future scientific focus areas.
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Infecções por HIV/tratamento farmacológico , HIV/imunologia , Hepatite C/tratamento farmacológico , RNA Viral/genética , Argentina , Contagem de Linfócito CD4 , Coinfecção , Europa (Continente) , Feminino , HIV/genética , Infecções por HIV/imunologia , Infecções por HIV/virologia , Humanos , Israel , Perda de Seguimento , Masculino , Estudos Multicêntricos como Assunto , Resultado do Tratamento , Carga ViralRESUMO
Mycobacterial infection-related morbidity and mortality in patients following cardiopulmonary bypass surgery is high and there is a growing need for a consensus-based expert opinion to provide international guidance for diagnosing, preventing and treating in these patients. In this document the International Society for Cardiovascular Infectious Diseases (ISCVID) covers aspects of prevention (field of hospital epidemiology), clinical management (infectious disease specialists, cardiac surgeons, ophthalmologists, others), laboratory diagnostics (microbiologists, molecular diagnostics), device management (perfusionists, cardiac surgeons) and public health aspects.
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Infecção Hospitalar , Infecções por Mycobacterium não Tuberculosas , Mycobacterium , Antibacterianos/uso terapêutico , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Procedimentos Cirúrgicos Cardíacos/métodos , Cardiologia , Ponte Cardiopulmonar , Doenças Transmissíveis , Infecção Hospitalar/diagnóstico , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/microbiologia , Infecção Hospitalar/prevenção & controle , Contaminação de Equipamentos , Humanos , Mycobacterium/isolamento & purificação , Infecções por Mycobacterium não Tuberculosas/diagnóstico , Infecções por Mycobacterium não Tuberculosas/tratamento farmacológico , Infecções por Mycobacterium não Tuberculosas/prevenção & controle , Fatores de Risco , Sociedades Médicas , Reino UnidoRESUMO
As a result of the increased urban and agricultural development in coastal environments, estuaries are among the most modified and threatened aquatic ecosystems. This study used stable isotopes to examine the effects of human impacts by contrasting the food web structures of two Iberian estuaries exposed to different degrees of human pressure. More complex feeding pathways were found in the more altered estuary (Guadalquivir). Greater spread among species along the carbon axis suggests that the primary consumers exploit organic matter with various origins, whereas different nitrogen signals of the secondary consumers suggest that they feed on different suites of prey. In contrast, the similar isotopic signals of secondary consumers in the relatively little influenced estuary (Guadiana) suggests similarity in diet composition and feeding on the same organic matter sources. Understanding trophic interactions in estuaries is vital for defining proper management and conservation, and the preliminary data provided here are one step in this direction.
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Estuários , Cadeia Alimentar , Atividades Humanas , Isótopos de Carbono/análise , Ecossistema , Humanos , Isótopos de Nitrogênio/análise , EspanhaRESUMO
OBJECTIVES: The aim of the study was to assess the rates of discontinuation of integrase inhibitor regimens because of any neuropsychiatric adverse event (NPAE) and the factors associated with discontinuation. METHODS: A population-based, prospective, multicentre cohort study was carried out. Treatment-naïve subjects starting therapy with a regimen containing integrase inhibitors, or those switching to such a regimen, with plasma HIV-1 RNA < 50 HIV-1 RNA copies/mL in 14 hospitals in Catalonia or the Balearic Islands (Spain) were included in the study. Every discontinuation because of adverse events (AEs) was double-checked directly with treating physicians. Multivariable Cox models identified factors correlated with discontinuation. RESULTS: A total of 4165 subjects (37% treatment-naïve) started regimens containing dolutegravir (n = 1650; 91% with abacavir), raltegravir (n = 930) or elvitegravir/cobicistat (n = 1585). There were no significant differences among regimens in the rate of discontinuation because of any AE. Rates of discontinuation because of NPAEs were low but higher for dolutegravir/abacavir/lamivudine [2.1%; 2.9 (95% confidence interval (CI) 2.0, 4.2) discontinuations/100 patients/year] versus elvitegravir/cobicistat (0.5%; 0.8 (95% CI 0.3, 1.5) discontinuations/100 patients/year], with significant differences among centres for dolutegravir/abacavir/lamivudine and NPAEs (P = 0.003). We identified an association of female gender and lower CD4 count with increased risk of discontinuation because of any AE [Incidence ratio (IR) 2.3 (95% CI 1.4, 4.0) and 1.8 (95% CI 1.1, 2.8), respectively]. Female gender, age > 60 years and abacavir use were not associated with NPAE discontinuations. NPAEs were commonly grade 1-2, and had been present before and improved after drug withdrawal. CONCLUSIONS: In this large prospective cohort study, patients receiving dolutegravir, raltegravir or elvitegravir/cobicistat did not show significant differences in the rate of discontinuation because of any toxicity. The rate of discontinuations because of NPAEs was low, but was significantly higher for dolutegravir than for elvitegravir/cobicistat, with significant differences among centres, suggesting that greater predisposition to believe that a given adverse event is caused by a given drug of some treating physicians might play a role in the discordance seen between cohorts.
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Cobicistat/efeitos adversos , Infecções por HIV/tratamento farmacológico , Compostos Heterocíclicos com 3 Anéis/efeitos adversos , Quinolonas/efeitos adversos , Raltegravir Potássico/efeitos adversos , Adulto , Contagem de Linfócito CD4 , Cobicistat/administração & dosagem , Feminino , Infecções por HIV/imunologia , Compostos Heterocíclicos com 3 Anéis/administração & dosagem , Humanos , Masculino , Pessoa de Meia-Idade , Oxazinas , Piperazinas , Modelos de Riscos Proporcionais , Estudos Prospectivos , Piridonas , Quinolonas/administração & dosagem , Raltegravir Potássico/administração & dosagem , EspanhaRESUMO
OBJECTIVE: To describe the epidemiology of acute/recent human immunodeficiency virus (HIV) infection over two decades in Barcelona (Spain). METHODS: Prospective, single-centre cohort including all patients with an acute/recent HIV infection (<180 days) since 1997. Patients were stratified into four periods. Phylogenetic analysis was performed to determine clusters of transmission. RESULTS: A total of 346 consecutive acute/recently infected patients were included. The annual proportion of recent infections among total new HIV diagnoses increased over time from 1% (29 out of 1964) to 8% (112 out of 1474) (p <0.001). Proportion of men who have sex with men (MSM) in the cohort increased from 62% (18 out of 29) to 89% (100 out of 112) (p <0.001). The proportion of migrants showed a non-significant increasing trend (24% (7 of 29) to 40% (45 of 112)) likewise the non-B subtype (0% to 22% (22 of 112)). The mean time from infection to diagnosis was 53.6 days (interquartile range (IQR) 50-57), comparable among all periods. Mean time from infection to treatment decreased over the years from 575 (IQR 467-683) to 471 (IQR 394-549) days (p <0.001) without significant differences between migrants and non-migrants (133 (IQR 71-411) versus 208 (IQR 90-523) days p 0.089). Almost 50% (152 of 311) of recently infected individuals were included in a cluster of transmission, and 92% (137 of 149) of them were MSM. CONCLUSION: The MSM population has progressively grown within acutely/recently infected patients in Barcelona, and is frequently involved in transmission clusters. Although the time between diagnosis and treatment has been reduced, the time between infection and diagnosis still needs to be shortened.