Distinct gut microbiota signatures associated with progression of atherosclerosis in people living with HIV.

BACKGROUND: The relationship of microbiota composition dynamics and the progression of subclinical atherosclerosis in people with HIV (PWH) remains unknown. METHODS: 96-week, prospective, longitudinal study in virologically-suppressed PWH. Carotid intima-media thickness (cIMT) measurements and stool samples were obtained at baseline, 48-week and 96-week visits. cIMT progression was defined as an increase >10% and/or detection of new carotid plaque. To profile the gut microbiome, amplification and sequencing of 16S ribosomal-RNA (V3-V4 variable regions) were carried out following the Illumina protocol. Sequencing was performed with MiSeq platform. RESULTS: 191, 190 and 167 patients had available fecal samples for microbiome analysis at the baseline, 48- and 96-week visits, respectively. 87 (43%) participants showed atherosclerosis progression, and 54 (26.7%) presented new carotid plaque. No significant differences were observed in adjusted α-diversity indices between groups defined by cIMT progression. Beta-diversity determined through principal coordinate analysis distances showed that the groups exhibited distinct microbial profiles (PERMANOVA p-value = 0.03). Longitudinal analysis with ANCOM-BC2 adjusted for traditional cardiovascular risk factors, MSM and nadir CD4 count revealed that cIMT progression was consistently associated with Agathobacter and Ruminococcus_2, while non-progression was consistently associated with Prevotella_7. CONCLUSION: Progression of atherosclerosis in PWH might be associated with distinctive signatures in the gut microbiota.

Early Detection of Cancer and Precancerous Lesions in Persons with HIV through a Comprehensive Cancer Screening Protocol.

BACKGROUND: Non-AIDS defining malignancies present a growing challenge for persons with HIV (PWH), yet tailored interventions for timely cancer diagnosis are lacking. The Spanish IMPAC-Neo protocol was designed to compare two comprehensive cancer screening strategies integrated into routine HIV care. This study reports baseline data on the prevalence and types of precancerous lesions and early-stage cancer among participants at enrolment. Acceptability of the procedure was additionally assessed. METHODS: Cross-sectional analysis of a comprehensive screening protocol to detect precancer and cancer. The readiness of healthcare providers to implement the protocol was evaluated using a validated 4-item survey. RESULTS: Among the 1430 enrolled PWH, 1172 underwent 3181 screening tests, with positive findings in 29.4% of cases, leading to further investigation in 20.7%. Adherence to the protocol was 84%, with HIV providers expressing high acceptability (97.1%), appropriateness (91.4%), and feasibility (77.1%). A total of 145 lesions were identified in 109 participants, including 60 precancerous lesions in 35 patients (3.0%), 9 early-stage cancers in 9 patients (0.8%), and 76 low-risk lesions in 65 subjects (5.5%). Adverse events related to screening occurred in 0.8% of participants, all mild. The overall prevalence of cancer precursors or early-stage cancer was 3.8% (95% CI, 2.74%-5.01%), with highest rates observed in individuals screened for anal and colorectal cancers. CONCLUSIONS: The baseline comprehensive cancer screening protocol of the IMPAC-Neo study successfully identified a significant proportion of PWH with precancerous lesions and early-stage cancer. High adherence rates and positive feedback from providers suggest effective implementation potential in real-world healthcare settings.

Cancer screening in people with HIV: Implementation in clinical practice and barriers perceived by medical specialists in Spain.

OBJECTIVE: To assess the degree of implementation of cancer screening recommendations in people living with HIV (PLHIV) in Spain. METHODS: A self-administered questionnaire was designed on the strategies used for early detection of the main types of cancer in PLHIV. The survey was distributed electronically to HIV physicians participating in the Spanish CoRIS cohort. RESULTS: 106 questionnaires were received from 12 different Spanish Autonomous Communities, with an overall response rate among those who accessed the questionnaire of 60.2%. The majority responded that they followed the CPGs recommendations for the early detection of liver (94.3%), cervical (93.2%) and breast (85.8%) cancers. In colorectal and anal cancer, the proportion was 68.9% and 63.2%, and in prostate and lung cancer of 46.2% and 19.8%, respectively. In hospitals with a greater number of beds, a tendency to perform more cancer screening and greater participation of the Infectious Diseases/HIV Services in the screening programmes was observed. Significant differences were observed in the frequency of colorectal and anal cancer screening among the different Autonomous Communities. The most frequent reasons for not performing screening were the scarcity of material and/or human resources and not being aware of what is recommended in the CPGs. CONCLUSIONS: There are barriers and opportunities to expand cancer screening programmes in PLHIV, especially in colorectal, anal and lung cancers. It is necessary to allocate resources for the early detection of cancer in PLHIV, but also to disseminate CPGs screening recommendations among medical specialists.

Long COVID across SARS-CoV-2 variants, lineages, and sublineages.

This prospective study aimed to determine the prevalence of long COVID in patients hospitalized for SARS-CoV-2 infection from March 2020 to July 2022 and assess the impact of different viral lineages. A total of 2,524 patients were followed up for 12 months, with persistent symptoms reported in 35.2% at one month, decreasing thereafter. Omicron variant patients initially showed higher symptom intensity, but this trend diminished over time. Certain viral lineages, notably Delta lineages AY.126 and AY.43, and Omicron sublineages BA.1.17, BA.2.56, and BA.5.1, consistently correlated with more severe symptoms. Overall, long COVID prevalence and severity were similar across SARS-CoV-2 variants. Specific lineages may influence post-COVID sequelae persistence and severity.

Switching to dolutegravir plus rilpivirine versus maintaining current antiretroviral therapy regimen in virologically suppressed people with HIV-1 and the Lys103Asn (K103N) mutation: 48-week results from a randomised, open-label pilot clinical trial.

BACKGROUND: The combination of dolutegravir plus rilpivirine has been studied in people with virologically suppressed HIV with no previous history of treatment failure or resistance. We investigated the potential to maintain viral suppression with dolutegravir plus rilpivirine in people with Lys103Asn mutations whose HIV was previously managed with other treatment regimens. METHODS: In this open-label pilot trial at 32 clinical sites in seven European countries, virologically suppressed, HBsAg-negative adults aged 18 years or older with HIV-1 and Lys103Asn mutations were randomly assigned (2:1) to switch to 50 mg dolutegravir plus 25 mg rilpivirine (given as a single tablet) once daily or to continue their current antiretroviral therapy regimen (control group). After 48 weeks, participants in the control group also switched to dolutegravir plus rilpivirine. Randomisation was stratified by country, and a computer-generated randomisation list with permuted blocks within strata was used to assign participants to treatment groups. The primary endpoints were virological failure (ie, two consecutive measurements of 50 copies or more of HIV RNA per mL at least 2 weeks apart) and virological suppression (the proportion of participants with fewer than 50 copies of HIV RNA per mL) at week 48 (week 96 data will be reported separately). Analyses were done in the modified intention-to-treat population, which included all participants who received at least one dose of the study medication. This trial is registered with ClinicalTrials.gov, NCT05349838, and EudraCT, 2017-004040-38. FINDINGS: Between Nov 5, 2018, and Dec 9, 2020, 140 participants were enrolled and randomly assigned, 95 to the dolutegravir plus rilpivirine group and 45 to the control group. Virological failure was recorded in three participants (3·2%, 95% CI 0·7 to 9·0) in the the dolutegravir plus rilpivirine group and one (2·2%, 0·1 to 11·8) in the control group. The proportion of participants in whom virological suppression was maintained at week 48 was 88·4% (80·2 to 94·1) in the dolutegravir plus rilpivirine group versus 88·9% (75·9 to 96·3) in the control group (difference -0·5, -11·7 to 10·7). Significantly more adverse events were recorded in the dolutegravir plus rilpivirine group than in the control group (234 vs 72; p=0·0034), but the proportion of participants who reported at least one adverse event was similar between groups (76 [80%] of 95 vs 33 [73%] of 45; p=0·39). The frequency of serious adverse events was low and similar between groups. INTERPRETATION: Virological suppression was maintained at week 48 in most participants with Lys103Asn mutations when they switched from standard regimens to dolutegravir plus rilpivirine. The results of this pilot study, if maintained when the week 96 data are reported, support conduct of a large, well-powered trial of dolutegravir plus rilpivirine. FUNDING: ViiV Healthcare.

How can we optimize the diagnostic and therapeutic approach to pneumonia? Expert opinion-based recommendations.

Pneumonia continues to be one of the most frequent infectious syndromes and a relevant cause of death and health resources utilization. The OPENIN ("Optimización de procesos clínicos para el diagnóstico y tratamiento de infecciones") Group is composed of Infectious Diseases specialists and Microbiologists and aims at generating recommendations that can contribute to improve the approach to processes with high impact on the health system. Such task relies on a critical review of the available scientific evidence. The first Group meeting (held in October 2023) aimed at answering the following questions: Can we optimize the syndromic and microbiological diagnosis of pneumonia? Is it feasible to safely shorten the length of antibiotic therapy? And, is there any role for the immunomodulatory strategies based on the adjuvant use of steroids, macrolides or immunoglobulins? The present review summarizes the literature reviewed for that meeting and offers a series of expert recommendations.

Dyspnea and pleuritic chest pain during the COVID-19 pandemic / Disnea y dolor torácico pleurítico durante la pandemia de la COVID-19

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Diferencias epidemiológicas y de mortalidad entre hombres y mujeres con infección por VIH en la cohorte CoRIS entre los años 2004 y 2014 / Differences in epidemiology and mortality between men and women with HIV infection in the CoRIS cohort from 2004 to 2014

Objetivos: Analizar en la cohorte CoRIS las diferencias epidemiológicas y en la mortalidad entre mujeres y hombres que viven con VIH y su evolución en el tiempo. Métodos: Se compararon las variables de interés entre mujeres que viven con VIH y hombres que viven con VIH. Se realizó un análisis de tendencias usando la prueba de Mantel-Haenszel. Para estudiar la supervivencia se utilizaron las curvas de supervivencia de Kaplan Meier y un análisis de regresión de Cox. Resultados: Se incluyeron un total de 10.469 personas, de las cuales 1.742 (16,6%) eran mujeres. En el momento de inclusión en la cohorte las mujeres que viven con VIH con respecto a los hombres que viven con VIH tenían un mayor porcentaje de transmisiones por el uso de drogas intravenosas (UDI), coinfección por el virus de la hepatitisC (VHC), estadio de sida y origen extranjero. También presentaron una peor situación inmunovirológica y nivel de estudios. Estas diferencias se mantuvieron en el estudio de tendencias. En cuanto a la edad, las mujeres que se incluyeron en la cohorte fueron cada vez más mayores, y lo contrario sucedió con los hombres. En el análisis comparativo entre mujeres según su lugar de origen encontramos mujeres más mayores, con más transmisión por UDI y coinfección por VHC en el grupo de las mujeres que viven con VIH españolas; en cambio, la infección por sífilis fue más frecuente entre las nacidas fuera de España. No hubo grandes diferencias en relación con otras características, como el nivel de estudios o la situación de enfermedad. El sexo no fue un condicionante de supervivencia, y sí lo fueron factores que se asociaban más a las mujeres. Conclusiones: Las mujeres infectadas por el VIH se presentaron al diagnóstico con unas características epidemiológicas y asociadas a la infección por VIH que las hacen más vulnerables, y estas tendencias fueron acentuándose o no mejoraron durante los años de observación.(AU)

Introduction: This study sought to analyse differences in epidemiology and survival between women and men living with HIV in the CoRIS cohort and the course of their disease over a 10-year period. Methods: Variables of interest between women living with HIV and men living with HIV were compared. A trend analysis was performed using the Mantel-Haenszel test. Kaplan-Meier survival curves and a Cox regression analysis were used to study survival. Results: A total of 10,469 people were enrolled; of them, 1,742 (16.6%) were women. At the time of enrolment in the cohort, women living with HIV, compared to men living with HIV, had higher rates of transmission due to intravenous drug use (IDU), hepatitisC virus (HCV) coinfection, AIDS-stage disease and foreign origin. They also had a worse immunovirological status and a lower educational level. These differences were maintained in the trend study. Regarding age, the women included in the cohort were older whereas the men were younger. In the comparative analysis between women according to place of origin, we found that the group of Spanish women living with HIV featured older women with higher rates of IDU transmission and HCV coinfection, whereas the group of women living with HIV born outside of Spain featured women with higher rates of syphilis infection. There were no major differences in relation to other characteristics such as educational level or disease status. Although sex was not a determinant of survival, conditions more prevalent in women were determinants of survival. Conclusions: HIV-infected women presented at diagnosis with certain epidemiological and HIV-associated characteristics that made them more vulnerable. These trends became more marked or did not improve during the years of observation.(AU)

Infección congénita por el VIH con cribado serológico gestacional negativo. Importancia de la implementación de la segunda prueba en el tercer trimestre de gestación / Congenital HIV infection after failure of serological screening. Importance of implementing a second screening for HIV infection during the third trimester of pregnancy

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Riesgo de cáncer en personas con VIH en España, 2004-2015. Estudio de la cohorte CoRIS / Risk of cancer in HIV-infected patients in Spain, 2004-2015. The CoRIS cohort study

INTRODUCCIÓN: El cáncer constituye una causa importante de mortalidad en personas con VIH. MÉTODOS: Se ha analizado la incidencia de cáncer en pacientes con VIH de CoRIS en los períodos 2004-2009 y 2010-2015 y se ha comparado con la de la población general española estimada a partir de los datos de la Red Española de Registros de Cáncer. RESULTADOS: Entre enero de 2004 y noviembre de 2015 se incluyeron en CoRIS 12.239 pacientes y se diagnosticaron 338 casos incidentes de cáncer. La incidencia global por cada 100.000 personas/año (IC 95%) fue de 702,39 (629,51-781,42) sin diferencias significativas entre los 2 períodos. El 38% de las neoplasias fueron tumores definitorios de sida (TDS) y el 62% no definitorios de sida (TNDS). En el período 2010-2015 se observó un descenso significativo en la incidencia de TDS (cociente de tasas de incidencia estandarizadas [SIR]; IC 95%: 0,38; 0,21-0,66) y predominaron los TNDS. En comparación con la población general, la incidencia de cáncer fue el doble en varones con VIH. Se documentaron riesgos relativos (SIR; IC 95%) más altos de linfoma Hodgkin en ambos sexos (varones: 8,37; 5,13-14,17; mujeres: 21,83; 2,66-47,79), linfoma no Hodgkin en varones (5,30; 2,86-8,45) y cáncer de cérvix (7,43; 3,15-13,87) y cabeza y cuello (3,28; 1,21-5,82) en mujeres. CONCLUSIONES: La incidencia global de cáncer en personas con VIH es mayor que en la población general española y se mantiene estable desde 2004, con un predominio actual de los TNDS. Estos datos indican que deben realizarse esfuerzos adicionales en la prevención y detección precoz de cáncer en estos pacientes

INTRODUCTION: Cancer is a leading cause of death in individuals with HIV. METHODS: The incidence of cancer in HIV patients of the CoRIS cohort in the 2004-2009 and 2010-2015 periods has been analysed and compared to the incidence in the Spanish general population, estimated from data of the Spanish Cancer Registry Network. RESULTS: Between January 2004 and November 2015, 12,239 patients were included in CoRIS and 338 incident cancer cases were diagnosed. The overall incidence of cancer per 100,000 persons-year (95% CI) was 702.39 (629.51-781.42) with no significant differences between the 2periods. A 38% of the incident cancer cases were AIDS defining cancers (ADC) and 62% non-AIDS defining cancers (NADC). In the period 2010-2015, there was a significant decrease in the incidence of ADC (standardised incidence ratio [SIR]); 95% CI: 0.38; 0.21-0.66) and NADC predominated. Compared to the general population, the incidence of cancer was double in men with HIV. Higher relative risks were documented (SIR; 95% CI) for Hodgkin's lymphoma in both sexes (males: 8.37, 5.13-14.17; females: 21.83, 2.66-47.79), non-Hodgkin's lymphoma in males (5.30, 2.86-8.45) and cervical cancer (7.43, 3.15-13.87) and head and neck cancer (3.28, 1.21-5.82) in women. CONCLUSIONS: The overall incidence of cancer in individuals with HIV is higher than in the Spanish general population, and it has remained stable since 2004 with a current predominance of NADC. These data suggest that additional efforts should be made in the prevention and the early detection of cancer in these patients

Sofosbuvir plus daclatasvir as an alternative for patients on haemodialysis with genotype 2 hepatitis C virus infection / Sofosbuvir más daclatasvir como alternativa en pacientes con infección por el virus de la hepatitis C genotipo 2 en hemodiálisis

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Executive summary of the consensus document on osteoporosis in HIV-infected individuals / Resumen ejecutivo del documento de consenso sobre la osteoporosis en las personas infectadas por VIH

Osteoporosis has become an emerging comorbid condition in people living with HIV (PLWH). The increase in survival and the progressive aging of PLWH will make this complication more frequent in the near future. In addition to the traditional risk factors affecting the general population, factors directly or indirectly associated with HIV infection, including antiretroviral therapy, can increase the risk of osteoporosis. The present article is an executive summary of the document that updates the previous recommendations on the prevention and treatment of osteoporosis in PLWH. This document is intended for all professionals who work in clinical practice in the field of HIV infection

La osteoporosis se ha convertido en una situación comórbida emergente en las personas infectadas por VIH. El incremento de la supervivencia y el envejecimiento progresivo de las personas infectadas por VIH harán que esta complicación sea más frecuente en un futuro cercano. Además de los factores de riesgo tradicionales, los factores directa o indirectamente asociados a la infección por VIH, incluyendo el tratamiento antirretroviral, pueden incrementar el riesgo de presentar osteoporosis. El presente artículo constituye un resumen ejecutivo del documento que actualiza las recomendaciones previas sobre la prevención y el tratamiento de la osteoporosis en las personas infectadas por VIH. Este documento va dirigido a todos los profesionales que ejercen la práctica clínica en el campo de la infección por VIH

Talleres integrados de medicina clínica: un enfoque innovador para fomentar la adquisición de competencias clínicas transversales en el grado de medicina / Clinical medicine workshops: An innovative approach to promote cross-discipline clinical skills in the medical degree

El aprendizaje de la medicina clínica es largo y complejo. Los estudiantes necesitan adquirir una serie de conocimientos, habilidades y actitudes que les capaciten para el desempeño profesional independiente. Se acepta que para lograr este objetivo es necesario que la enseñanza se integre en la práctica clínica, utilizando la resolución de problemas como base del aprendizaje. La inclusión en los planes de estudios de asignaturas de medicina clínica integradas por diversas disciplinas académicas, en las que se favorezca el desarrollo de competencias clínicas, puede ser útil para reducir la desconexión existente entre teoría y práctica, y acercar al estudiante al ejercicio profesional. La Universidad Miguel Hernández, para adaptarse al Espacio Europeo de Educación Superior, ha incorporado a su plan de estudios 4 asignaturas denominadas «talleres integrados» en las que se desarrollan diversas actividades docentes para integrar conocimientos y habilidades clínicas de varias disciplinas y fomentar la adquisición de competencias transversales. En este artículo describimos la organización y métodos didácticos empleados en «Talleres Integrados III», una asignatura nueva en la que se integran 7 disciplinas clínicas impartidas en los 2 cuatrimestres anteriores

Learning Clinical Medicine is long and complex. Students need to acquire a body of knowledge, skills and attitudes that enable them to perform as independent professionals. To achieve this aim, it is accepted that teaching needs to be integrated into clinical practice, using problem solving as a basis for learning. The inclusion of Clinical Medicine courses to develop clinical skills in a variety of academic disciplines in the curriculum should be beneficial in reducing the gap between theory and practice, and provide students with the practice. In order to adapt to European Higher Education Area, the Miguel Hernández University has added four subjects to its curriculum called "integrated workshops", in which several educational activities are developed in order to integrate knowledge and clinical skills of various clinical disciplines, as well as to promote the acquisition of clinical competences. In this article a description is presented of the organization and teaching methods used in "integrated workshops III", a new subject in which seven clinical disciplines taught in the previous two quarters are integrated

La enseñanza de las enfermedades infecciosas en el grado de Medicina en el marco del espacio europeo de educación superior / Teaching infectious diseases in the Medical Degree within the European higher education area

Durante los estudios de Medicina deben adquirirse competencias básicas en diferentes áreas de conocimiento, una de ellas es la patología infecciosa. La formación en enfermedades infecciosas es imprescindible para la práctica médica general y para la especialización académica o profesional en muchas áreas de la Medicina, tanto médicas como quirúrgicas. La gran cantidad de conocimientos que se genera continuamente sobre las enfermedades infecciosas exige un programa de aprendizaje bien estructurado y enmarcado en un entorno dominado por la globalización. La incorporación de España al espacio europeo de educación superior ha obligado a adecuar los planes de enseñanza de las facultades de Medicina y establecer los contenidos y objetivos docentes de todas las materias de estudio. En este artículo comentamos las implicaciones de la integración del sistema universitario español en el espacio europeo de educación superior («Plan Bolonia») en la docencia de las enfermedades infecciosas en el grado de Medicina, y describimos el programa de aprendizaje de la patología infecciosa en la Universidad Miguel Hernández de Elche (Alicante) basado en resultados y competencias

During their medical studies, students must acquire basic competencies in different areas of knowledge, one of which is infectious diseases. Training in infectious diseases is essential for general medical practice and for academic or professional expertise in many areas of medicine, both medical and surgical. The vast amount of knowledge that is continuously generated about infectious diseases requires a well-structured undergraduate medical education program and framed in a setting dominated by globalization. The incorporation of Spain to the European higher education area has forced medical schools to adapt their curriculum and to establish the content and learning objectives of all courses of study. In this paper, we discuss the implications of the integration of the Spanish university system in the European higher education area («Bologna Process») in the teaching of infectious diseases in the Degree of Medicine, and describe the learning program in infectious diseases of the University Miguel Hernández of Elche (Alicante, Spain) based on learning outcomes and competencies

Muertes por enfermedades no asociadas directamente con el sida en pacientes con infección por el VIH: un estudio de 14 años (1998-2011) / Deaths due to non-AIDS diseases among HIV infected patients: A 14-year study (1998-2011)

FUNDAMENTO Y OBJETIVO: El objetivo del estudio fue analizar las muertes por enfermedades no asociadas directamente con el sida en una cohorte de pacientes con VIH atendidos entre 1998 y 2011. Pacientes y método: La información sobre las causas de la muerte se recogió retrospectivamente y se clasificaron siguiendo el algoritmo CoDe. Se compararon las características de los pacientes en 2 periodos: 1998-2004 y 2005-2011. Resultados: Fallecieron 159 de los 1.070 pacientes atendidos en ese espacio de tiempo, 56 (35%) por eventos sida y 86 (54%) por eventos no sida (ENOS); en 17 (11%) no pudo determinarse la causa. Globalmente, las principales causas de muerte fueron infecciones (32%), neoplasias (17%) y muertes no naturales (17%). Durante el segundo período hubo menor mortalidad por sida (18,5 vs 47%; p < 0,001) y mayor mortalidad por ENOS (68 vs 45%; p = 0,006). Se produjo un aumento muy acusado de las neoplasias no asociadas a sida (18,5 vs 2,1%; p = 0,001) y aumentaron las muertes por enfermedad cardiovascular (9,2 vs 2,1%; p = 0,06). Los pacientes que murieron en el segundo periodo tenían mayor edad, mejor situación inmunovirológica a la entrada en la cohorte y antes de fallecer, recibieron tratamiento antirretroviral (TAR) con mayor frecuencia, y estaban más a menudo suprimidos virológicamente antes del fallecimiento (61,5 vs 24%; p < 0,001). Conclusiones: Las neoplasias no asociadas a sida, las muertes no naturales y los eventos cardiovasculares constituyen ahora causas importantes de muerte en los pacientes con VIH. En los últimos años la mayoría de los pacientes fallecidos están en TAR y suprimidos virológicamente

BACKGROUND AND OBJECTIVE: The objective of this study was to analyze the deaths caused by non-AIDS diseases in a cohort of HIV-infected patients treated between 1998 and 2011. PATIENTS AND METHODS: Information on the causes of death was collected retrospectively, and then classified according to the deaths code (CoDe) algorithm. Patient characteristics and causes of death were compared for two periods: 1998-2004 and 2005-2011. RESULTS: A total of 159 out of the 1070 patients cared for in study period died, 56 (35%) due to AIDS events and 86 (54%) due to non-AIDS events (NAEs); in 17 (11%) the cause of death could not be determined. Overall, the main causes of death were infections (32%), cancer (17%), and unnatural deaths (17%). There was lower mortality from AIDS-related conditions during the second period (18.5% vs 47%;P < .001) and higher mortality from NAEs (68% vs 45%; P = .006). There was a very sharp increase in non-AIDS-defining cancers (18.5% vs 2.1%, p = 001), and increased deaths from cardiovascular disease (9.2% vs 2.1%, P = .06). Patients who died in the second period were older, and had a better immunological and virological status at cohort entry and before death. They received antiretroviral therapy (ART) more often and were more often virologically suppressed before death (61.5% vs 24%;P = .001). CONCLUSIONS: Non-AIDS-defining cancers, unnatural deaths, and cardiovascular diseases are now major causes of death in patients with HIV. In recent years the majority of deceased patients are on ART and with virological suppression

Deficiencia de vitamina D: ¿una pieza más en el puzle del riesgo cardiovascular de los pacientes con infección por el virus de la inmunodeficiencia humana? / Vitamin D deficiency: One more piece of the puzzle of cardiovascular risk in human immunodeficiency virus-infected patients?

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Incidencia y factores de riesgo de carcinomas definitorios de SIDA en una cohorte de pacientes con infección por VIH: importancia de la definición de casos incidentes / Incidence and risk factors of AIDS-defining cancers in a cohort of HIV-positive adults: Importance of the definition of incident cases

Introducción El objetivo de este estudio es analizar la incidencia y factores de riesgo para el desarrollo de carcinomas definitorios de SIDA (CDS), e investigar el efecto de diferentes definiciones de casos incidentes. Métodos Se diseñó un estudio de cohortes. Se analizaron incidencia y factores de riesgo mediante regresión de Poisson. Se realizó el análisis para tres definiciones de casos incidentes: retraso de 0, 14 y 30 días desde la inclusión en la cohorte. Resultados Se incluyeron 6393 sujetos con infección por VIH. La incidencia de CDS cambió según las definiciones de casos incidentes (retraso 0, 14 y 30 días). Diferentes factores se asociaron con el riesgo de CDS para diferentes definiciones de casos incidentes. Para el retraso 0, el riesgo de sarcoma de Kaposi (KS) y linfoma no Hodgkin (LNH) fue mayor para valores de CD4 <200/ml. La terapia HAART se asoció a un menor riesgo de LNH y SK. Los hombres que tienen sexo con hombres tuvieron mayor riesgo de SK. SK y LNH no se asociaron con carga viral, género, hepatitis B o C. Para los retrasos de 14 y 30 días, los resultados fueron similares; sin embargo, la hepatitis C se asoció de forma significativa con el LNH. Conclusiones Nuestro estudios muestra la importancia de la definición de casos incidentes en los estudios de cohortes. Diferentes definiciones pueden influir en la estimación de la incidencia de CDS y en el análisis de los factores de riesgo (AU)

Background The aim of this study was to investigate the incidence and risk factors for the development of AIDS-defining cancers (ADCs); and to investigate the effect of making different assumptions on the definition of incident cases. Methods A multicentre cohort study was designed. Poisson regression was used to assess incidence and risk factors. To account for misclassification, incident cases were defined using lag-times of 0, 14 and 30 days after enrolment. Results A total of 6393 HIV-positive subjects were included in the study. The incidences of ADCs changed as the lag periods were varied from 0 to 30 days. Different risk factors emerged as the definition of incident cases was changed. For a lag time of 0, the risk of Kaposi sarcoma [KS] and non-Hodgkin lymphoma [NHL] increased at CD4 counts <200/ml. HAART was associated with lower risk of NHL and KS. Men who had sex with men had a higher risk of KS. KS and NHL were not associated with viral load, gender, or hepatitis B or C. The results were similar for a lag-time of 14 and 30 days; however, hepatitis C was significantly associated with NHL. Conclusions This analysis shows the importance of the definition of incident cases in cohort studies. Alternative definitions gave different incidence estimates, and may have implications for the analysis of risk factors (AU)

¿Es la infección por el virus de la inmunodeficiencia humana una enfermedad inflamatoria? / Is human immunodeficiency virus infection an inflammatory disease?

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Enfermedades importadas y no importadas en la población inmigrante. Una década de experiencia desde una unidad de enfermedades infecciosas / Imported and non-imported diseases in the immigrant population. A decade of experience from an infectious diseases unit

Introducción La inmigración es un proceso imparable. Los inmigrantes pueden tener infecciones comunes en nuestro medio o exóticas o más prevalentes en su entorno. Material y métodos Estudio de todos los pacientes inmigrantes atendidos en una unidad de enfermedades infecciosas de un hospital general desde junio de 2001 hasta mayo de 2010.ResultadosSe estudió a 1.071 pacientes: procedentes de América Latina (405; 37,8%), África del norte (281; 26,2%), Europa del este (186; 17,4%), África subsahariana (178; 16,6%) y Asia (21; 2,0%). Las enfermedades infecciosas transmisibles fueron la primera causa de consulta (53,8%), más común entre los originales de África del norte (61,6%) y Europa del este (69,4%) (p=0,001). La segunda causa de consulta fueron las enfermedades infecciosas comunes (29%). Acudieron por enfermedades infecciosas tropicales el 16,4%, especialmente los procedentes del África subsahariana (36%) y Latinoamérica (25,9%) (p<0,001). Los diagnósticos más comunes fueron la infección tuberculosa latente (20,8%) (más frecuente en los procedentes de Europa del este [27,4%] [p=0,004]), infección respiratoria (12,5%), infecciones de transmisión sexual (10,6%) (más frecuentes en los de África del norte [17,1%] [p=0,004]), hepatitis crónica (10,4%) (más frecuente en los de Europa del este [26,3%] [p < 0,001] y África subsahariana [16,9%] [p=0,004]) y tuberculosis activa (8,7%) (más frecuente en los del África subsahariana [15,7%] [p=0,001]).Conclusiones El espectro de las enfermedades infecciosas en la población inmigrante en nuestro entorno es muy amplio e incluye numerosas enfermedades tropicales y transmisibles, pero también infecciones comunes. Aunque las enfermedades transmisibles son la primera causa de consulta, las infecciones comunes son una parte importante de la actividad asistencial (AU)

Introduction: Immigration is an inexorable process. Immigrants may suffer infectious diseases commonly seen in our environment, or those more exotic or more prevalent in their own environment. Material and methods: A study was performed including all immigrants see in an Infectious Diseases Unit of a general hospital from June 2001 to May 2010.Results: We studied 1,071 patients from Latin America (n = 405, 37.8%), Northern Africa (n = 281, 26.2%),Eastern Europe (n = 186, 17.4%), sub-Saharan Africa (n = 178, 16.6%), and Asia (21, 2.0%). Transmissible infectious diseases were the leading cause of consultation (53.8%), and they were more common among people coming from Northern Africa (61.6%) and Eastern Europe (69.4%) (P = .001). The second reason for consultation was for common infectious diseases (29%). Tropical infectious diseases were diagnosed in16.4% of the patients, particularly from sub-Saharan Africa (36%), and Latin America (25.9%) (P < .001). The most common diagnoses were latent tuberculous infection (20.8%) [most common in those from Eastern Europe (27.4%) (P = .004)], respiratory tract infection (12.5%), sexually transmitted infections (10.6%)[most common in patients from Northern Africa (17.1%) (P = .004)], chronic hepatitis (10.4%) [most common in patients from Eastern Europe (26.3%) (P < .001) and sub-Saharan Africa (16.9%) (P = .004)], and active tuberculosis (8.7%) [most common in sub-Saharan Africa patients (15.7%) (P = .001)].Conclusions: The spectrum of infectious diseases in the immigrant population in our area is broad, and includes a wide variety of tropical and communicable diseases, but also of common infections. While communicable diseases are the leading cause of consultation, common infections constitute an important part of health care activity (AU)

Enfermedad arterial periférica: un nuevo desafío para los pacientes con infección por el virus de la inmunodeficiencia humana / Peripheral arterial disease: a new challenge for HIV - infected patients

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