Prevention and Treatment of SARS-CoV2 Infection in People Living with HIV: The Need for Specific Data.

The HIV pandemic has led to close to 40 million people living with HIV (PLWH) worldwide. To date, SARS-CoV2 has affected > 220 million people, and unprecedented global efforts have resulted in almost 6000 million doses of SARS-CoV2 vaccines being administered. Although several specific COVID-19 antiviral and anti-inflammatory treatments and SARS-CoV2 vaccines have been approved, the data available to support their use in specific populations such as PLWH remain limited. PLWH includes a range of individuals from practically unaffected immunity to severely immunocompromised individuals, and preventive and therapeutic interventions should be tailored for these subgroups . However, in most randomized clinical trials regarding antivirals, immunomodulators and vaccines for COVID-19, PLWH have been excluded or only enrolled in small numbers leading to a paucity of data. We briefly discuss the current evidence for prevention and treatment of COVID-19 in PLWH and identify key areas where more information is required.

Tacrolimus, Sirolimus and Everolimus Doses in HIV-Infected Solid-Organ Recipients, Requiring a Cobicistat-Based Antiretroviral Regimen: Report of Three Cases and Review.

People living with HIV should be considered candidates for solid-organ transplantation (SOT). However, managing HIV-infected patients undergoing SOT represents a major challenge due to the potential drug-drug interactions between antiretroviral drugs and immunosuppressive agents, particularly when resorting to antiretroviral drugs that require pharmacokinetic enhancers. We report three cases of cobicistat-tacrolimus co-administration, two of which also include the co-administration of mTOR inhibitors, in HIV-positive patients undergoing SOT (2 kidney and 1 liver recipient). We review previously reported cases and provide recommendations for initial management following transplantation.

[Candidemia: characteristics in elderly patients]. / Candidemia: características en los adultos mayores.

BACKGROUND: Candidemia is a nosocomial bloodstream infection and an important cause of comorbidity and mortality. Elderly patients present the highest rates of candidemia but data about this population is scarce. AIMS: To describe characteristics of candidemia in elderly patients, to identify risk factors associated with mortality and to evaluate the usefulness of a predictive score. METHODS: A retrospective observational study of candidemia in elderly patients from a tertiary care hospital was carried out. We analyzed all Candida bloodstream infections during an eight-year period in patients older than 60 years. RESULTS: Fifty-nine episodes were included. Diabetes was the most frequent comorbidity. Most candidemia were catheter related infections (45%). Only 17% of patients had a Candida score > 2.5. Overall mortality at 48 hours was 20%, and at 15 days was 49%. Mortality-related factors were shock, assisted mechanical ventilation, thrombocytopenia, renal failure and leukocytosis (p range < 0.0001-0.006). On multivariate analysis septic shock was independently associated with mortality (HR 4.02 [CI 95% 1.18-13.72] p = 0.026). CONCLUSIONS: Nearly half of patients with candidemia died during the first fifteen days. Shock, assisted mechanical ventilation, thrombocytopenia, renal failure, and leukocytosis were factors associated with mortality. The predictive score was not useful in this population.

Candidemia: características en los adultos mayores / Candidemia: characteristics in elderly patients

Resumen Introducción: La candidemia es una micosis sistémica asociada a los cuidados de la salud de elevada morbimortalidad. Los adultos mayores presentan las tasas más altas y la información en esta población es escasa. Objetivos: Describir las características de las candidemias en los adultos mayores, identificar factores asociados a mortalidad y evaluar la utilidad de un score predictor. Métodos: Estudio retrospectivo de las candidemias en adultos mayores en un hospital de la ciudad de Buenos Aires. Se analizaron todos los episodios en pacientes mayores de 60 años en un período de ocho años. Resultados: Se incluyeron 59 episodios. La co-morbilidad más frecuente fue diabetes mellitus. El principal sitio de origen fue infección asociada a catéter (45%). Sólo 17% presentó un Candida score mayor a 2,5. La mortalidad global a las 48 h fue 20% y a 15 días 49%. Las variables asociadas a mortalidad fueron: shock, asistencia respiratoria mecánica (ARM), plaquetopenia, insuficiencia renal y leucocitosis (rango p < 0,0001-0,006). En el análisis multivariado el shock fue la única variable independiente asociada a mortalidad (HR 4,02 [IC 95% 1,18-13,72], p = 0,026). Conclusiones: La mitad de los adultos mayores con candidemia falleció en los primeros 15 días. Shock, ARM, plaquetopenia, insuficiencia renal y leucocitosis fueron factores asociados a mortalidad. El score predictor de uso habitual no fue útil en esta población.

Abstract Background: Candidemia is a nosocomial bloodstream infection and an important cause of comorbidity and mortality. Elderly patients present the highest rates of candidemia but data about this population is scarce. Aims: To describe characteristics of candidemia in elderly patients, to identify risk factors associated with mortality and to evaluate the usefulness of a predictive score. Methods: A retrospective observational study of candidemia in elderly patients from a tertiary care hospital was carried out. We analyzed all Candida bloodstream infections during an eight-year period in patients older than 60 years. Results: Fifty-nine episodes were included. Diabetes was the most frequent comorbidity. Most candidemia were catheter related infections (45%). Only 17% of patients had a Candida score > 2.5. Overall mortality at 48 hours was 20%, and at 15 days was 49%. Mortality-related factors were shock, assisted mechanical ventilation, thrombocytopenia, renal failure and leukocytosis (p range < 0.0001-0.006). On multivariate analysis septic shock was independently associated with mortality (HR 4.02 [CI 95% 1.18-13.72] p = 0.026). Conclusions: Nearly half of patients with candidemia died during the first fifteen days. Shock, assisted mechanical ventilation, thrombocytopenia, renal failure, and leukocytosis were factors associated with mortality. The predictive score was not useful in this population.