Pneumocystis jirovecii pneumonia in HIV-1-infected patients in the late-HAART era in developed countries.

BACKGROUND: In developed countries with free access to health care, primary chemoprophylaxis with co-trimoxazole, and antiretroviral treatment, Pneumocystis pneumonia (PCP) in HIV-infected subjects should be restricted to undiagnosed late presenters. METHODS: We retrospectively identified confirmed PCP hospital admissions in HIV-1 patients (period 1986-2010) and examined their characteristics and factors associated with mortality. RESULTS: Three hundred and twelve episodes (median CD4 27 cells/µl) were identified during 3 periods: pre-HAART (1986-1995), 49%; early-HAART (1996-1999), 17.3%; and late-HAART (2000-2010), 33.7%. PCP was the initial AIDS-defining diagnosis in only 86 (27.6%). Thirty-four (10.9%) patients died during their hospital stay, without a significant reduction in mortality in recent periods (p = 0.311). However, the 12-month mortality decreased through the periods (33.3% to 16.2%; p = 0.003). Drug users (p = 0.001) and those naïve to HAART (p < 0.001) decreased in the late-HAART era, while heterosexuals (p = 0.001), immigrants (p < 0.001), and HAART initiation before hospital discharge (p < 0.001) increased. A partial pressure of oxygen (PaO2) ≤ 55 (p = 0.04), intensive care admission (p < 0.001), and the absence of HAART initiation before discharge (p = 0.02) were correlated with mortality. CONCLUSIONS: The epidemiology and 12-month mortality of HIV-1-infected subjects with PCP have changed significantly in the late-HAART era, while mortality during hospital stay has remained unchanged. HIV diagnosed individuals lost to follow-up in care have emerged as the main driver of PCP in developed countries. Like HIV late presenters, they are more likely to have AIDS-defining illnesses, to be hospitalized, and to die. This finding has important implications for the design of better strategies to retain HIV-1-infected individuals in care.

Concentraciones de vitamina B1 en orina y de caroteno, vitamina A y vitamina C en suero de ancianos supuestamente sanos no institucionalizados / Concentrations of vitamin B1 in urine, and of carotene, vitamin A and vitamin C in serum in non-institutionalized, apparently healthy elderly

En un grupo de 132 ancianos supuestamente sanos que viven en sus casas y cuyas edades estaban comprendidas entre 65 y 90 años, se realizaron determinaciones bioquímicas de vitamina A, vitamina C y caroteno en suero y vitamina B1 en orina para evaluar el estado de nutrición con respecto a estas sustancias, así como para conocer la posible asociación de dichas variables con el hábito de fumar y la convivencia. Se encontró que un porcentaje alto de las mujeres y de los hombres tenían deficiencia marginal o subclínica de vitamina A en suero. El 37,5 % de los ancianos fumadores tenían concentraciones de vitamina C en suero < 23 *mol/L. Las concentraciones de vitamina B1 en orina fueron altas. No se encontró diferencia entre los ancianos que vivían solos y los que vivían acompañados; sin ambargo, el 36,4 % de los primeros tenían valores de vitamina A < 1,05 *mol/L