RESUMEN
BACKGROUND: Crushing or dissolving bictegravir/tenofovir alafenamide/emtricitabine (BIC/TAF/FTC) tablets is not recommended because there are no data supporting this practice. METHODS: A crossover, randomized trial in healthy adults (NCT04244448) investigated the bioavailability of two off-label uses of BIC/TAF/FTC (50/200/25â mg), dissolved in water or crushed in apple compote, compared with the solid tablet. Pharmacokinetic (PK) parameters were estimated from sequential intensive plasma antiretroviral concentrations over a 72â h period post dose. Bioequivalence was met if the 90% CIs of the geometric least-squares means ratios comparing BIC/TAF/FTC exposures (AUC and Cmax) from the experimental phases were within 80%-125% of the reference. RESULTS: Eighteen subjects participated in each of the three phases. Dissolved tablet Cmax geometric mean ratio (90% CI) for BIC/TAF/FTC was 105% (93-119)/97% (87-108)/96% (74-124), respectively. Dissolved tablet AUC geometric mean ratio (90% CI) for BIC/TAF/FTC was 111% (100-122)/100% (94 to 105)/99% (81 to 120), respectively. Crushed tablet Cmax geometric mean ratio (90%) CI for BIC/TAF/FTC was 110% (97 to 124)/70% (63-78)/66% (51-85), respectively. Crushed tablet AUC geometric mean ratio (90%) CI for BIC/TAF/FTC was 107% (96-118)/86% (82-91)/84% (69-103), respectively. CONCLUSIONS: Crushing BIC/TAF/FTC tablets may lead to suboptimal emtricitabine and tenofovir alafenamide drug exposures. Dissolving BIC/TAF/FTC in water may be acceptable if the tablet cannot be swallowed whole.
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Fármacos Anti-VIH , Infecciones por VIH , Humanos , Adulto , Emtricitabina/uso terapéutico , Tenofovir/uso terapéutico , Infecciones por VIH/tratamiento farmacológico , Disponibilidad Biológica , Estudios Cruzados , Adenina/farmacocinética , Comprimidos , Fármacos Anti-VIH/uso terapéutico , Alanina/uso terapéuticoAsunto(s)
Anticuerpos Heterófilos , Proteína C-Reactiva , Humanos , Reacciones Falso Positivas , InmunoensayoRESUMEN
Enterocytozoon bieneusi microsporidiosis is an emerging disease in immunocompromised patients. We report 2 cases of this disease in allogeneic hematopoietic stem cell transplant patients successfully treated with fumagillin. Thrombocytopenia occurred but without major adverse events. Modifications of immunosuppression could be avoided when E. bieneusi is rapidly identified and fumagillin therapy is started promptly.
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Antifúngicos/administración & dosificación , Ciclohexanos/administración & dosificación , Enterocytozoon/efectos de los fármacos , Ácidos Grasos Insaturados/administración & dosificación , Trasplante de Células Madre Hematopoyéticas , Leucemia Mieloide/inmunología , Microsporidiosis/tratamiento farmacológico , Adulto , Antifúngicos/efectos adversos , Ciclohexanos/efectos adversos , Enterocytozoon/patogenicidad , Enterocytozoon/fisiología , Ácidos Grasos Insaturados/efectos adversos , Femenino , Humanos , Inmunosupresores/uso terapéutico , Leucemia Mieloide/patología , Leucemia Mieloide/terapia , Masculino , Microsporidiosis/diagnóstico , Microsporidiosis/microbiología , Persona de Mediana Edad , Ácido Micofenólico/uso terapéutico , Recuento de Plaquetas , Prednisona/uso terapéutico , Sesquiterpenos/administración & dosificación , Sesquiterpenos/efectos adversos , Trombocitopenia/inducido químicamente , Resultado del TratamientoRESUMEN
Background: Mycobacterium genavense infection is rare and can occur in immunocompromised patients without human immunodeficiency virus (HIV). Methods: We describe 2 cases of M genavense infection in solid organ transplant (SOT) recipients, and we performed a literature review of immunocompromised patients without HIV. Results: Fifty-two cases are reported. Predisposing factors were receipt of SOT (40.4%) and autoimmune disease (36.5%). Infection was disseminated in 86.5% of cases. Organs involved were lymph nodes (72.3%), gastrointestinal tract (56.5%), lung (35.5%), and bone marrow (28.8%). Most patients were treated with at least 3 antimycobacterial agents (98%), with a clinical cure achieved in 54.9%. In multivariate analysis, lack for cure was associated with age of the time infection (odds ratio [OR], 15.81 [95% confidence interval {CI}, 2.92-152.93]; P = .011) and positive bone marrow culture (OR, 1.05 [95% CI, 1.01-1.12]; P = .042). Conclusions: Mycobacterium genavense infection is a rare and generally disseminated disease with a poor prognosis. Optimal treatment regimen and its duration remain to be defined.
RESUMEN
BACKGROUND: Native joint and bone infections (NJBI) are associated with infective endocarditis (IE) in 15% of cases. There are no studies analyzing the use of cardiac imaging in cases of NJBI. The objective of this study was to identify factors associated with echocardiography suggestive of IE in patients with NJBI. METHODS: This medical records review was conducted in patients hospitalized for NJBI between 2007 and 2017 in Rheumatology and Infectious Diseases departments of 2 university hospitals. Patients included had a microbiologically proven NJBI during their hospitalization. RESULTS: In this cohort of 546 patients, median age 66 years, echocardiography was suggestive of IE in 66 (12%). In multivariate analysis, factors associated with echocardiography suggestive of IE were 2 or more positive blood cultures (OR 11.55 (CI95% 3.24-74.20)), cardiac conditions with a high risk of IE (OR 7.34 (CI95% 2.95-18.61)), unknown heart murmur (OR 4.59 (CI95% 1.79-11.74)), multifocal infection (OR 2.26 (CI95% 1.21-4.23)) and an infection due to S. bovis (OR 3.52 (CI95% 1.26-9.79)). The factor associated with the absence of an echocardiography evocative of IE was infection due to unconventional bacteria for IE (OR 0.13 (CI95% 0.01-0.76)). According to the factors associated with echocardiography evocative of IE, we propose the Normandy score based on three kinds of data: cardiac condition, bacterial strain and NJBI mechanism. Echocardiography should be realized when this score, whose negative predictive value is 100% CI95% (98-100%) for prescription of echocardiography, is more than zero. CONCLUSIONS: A score based on valvular condition, bacterial strain and NJBI mechanism could guide clinicians in prescribing echocardiography during NJBI with an excellent negative predictive value.
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Artritis Infecciosa , Endocarditis Bacteriana , Anciano , Artritis Infecciosa/complicaciones , Estudios de Cohortes , Ecocardiografía/métodos , Endocarditis Bacteriana/complicaciones , Humanos , Estudios Retrospectivos , Factores de RiesgoRESUMEN
Consecutive missed doses may differentially impact the efficacy of antiretroviral therapy associated with the use of a nonnucleoside reverse-transcriptase inhibitor (NNRTI) and a ritonavir-boosted protease inhibitor (PI). In a cohort of 72 subjects receiving a boosted PI, average adherence to dosage was a better predictor of human immunodeficiency virus (HIV) replication than was the duration or frequency of treatment interruption. In contrast with an NNRTI, consecutive missed doses of a boosted PI did not emerge as a major risk factor for HIV replication.
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Fármacos Anti-VIH/uso terapéutico , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/virología , Inhibidores de la Proteasa del VIH/uso terapéutico , Cumplimiento de la Medicación/estadística & datos numéricos , ARN Viral/sangre , Carga Viral , Adulto , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
BACKGROUND: The prevalence of tobacco smoking is high among patients living with HIV, supporting the need for effective targeted interventions. MATERIALS AND METHODS: All current smokers at our outpatient HIV clinic were invited to participate in a smoking cessation program. RESULTS: Of the 716 patients living with HIV, 280 (39%) reported active smoking and were younger, more recently HIV infected and more frequently infected due to intravenous drug use (IDU). One hundred forty-seven (53%) smokers agreed to participate in the smoking cessation program and had a higher Fagerström score and were less likely IDU. During follow-up, 41 (28%) smokers withdrew from the program. After 6 months, 60 (57%) of the 106 smokers who completed the intervention had stopped tobacco smoking and were more likely to use varenicline, adjusting for a history of depression. CONCLUSION: Our smoking cessation program was feasible. However, strategies to reach and retain in smoking cessation program specific groups such as IDU are needed to improve the smoking cessation cascade.
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Infecciones por VIH/psicología , Cese del Hábito de Fumar , Fumar/psicología , Adulto , Consejo , Femenino , Francia/epidemiología , Infecciones por VIH/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Derivación y Consulta , Fumar/epidemiología , Nicotiana/efectos adversosRESUMEN
Bloodstream infection (BSI) is a major cause of death in developed countries and the detection of microorganisms is essential in managing patients. Despite major progress has been made to improve identification of microorganisms, blood culture (BC) remains the gold standard and the first line tool for detecting BSIs. Consensus guidelines are available to ensure optimal BSI procedures, but BC practices often deviate from the recommendations. This review provides an update on clinical and technical issues related to blood collection and to BC performance, with a special focus on the blood sample strategy to optimize the sensitivity and specificity of BCs.
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Fármacos Anti-VIH/administración & dosificación , Infecciones por VIH/tratamiento farmacológico , Transcriptasa Inversa del VIH/antagonistas & inhibidores , VIH-1/efectos de los fármacos , Inhibidores de la Transcriptasa Inversa/administración & dosificación , Adulto , Esquema de Medicación , Farmacorresistencia Viral Múltiple , Humanos , MasculinoRESUMEN
Backgrounds. Pyogenic liver abscess is a rare disease whose management has shifted toward greater use of percutaneous drainage. Surgery still plays a role in treatment, but its indications are not clear. Method. We conducted a retrospective study of pyogenic abscess cases admitted to our university hospital between 1999 and 2010 and assessed the factors potentially associated with surgical treatment versus medical treatment alone. Results. In total, 103 liver abscess patients were treated at our center. The mortality was 9%. The main symptoms were fever and abdominal pain. All of the patients had CRP > 6 g/dL. Sixty-nine patients had a unique abscess. Seventeen patients were treated with antibiotics alone and 57 with percutaneous drainage and antibiotics. Twenty-seven patients who were treated with percutaneous techniques required surgery, and 29 patients initially received it. Eventually, 43 patients underwent abscess surgery. The factors associated with failed medical treatment were gas-forming abscess (P = 0.006) and septic shock at the initial presentation (P = 0.008). Conclusion. Medical and percutaneous treatment constitute the standard management of liver abscess cases. Surgery remains necessary after failure of the initial treatment but should also be considered as an early intervention for cases presenting with gas-forming abscesses and septic shock and when treatment of the underlying cause is immediately required.
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Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Fiebre Q/diagnóstico , Fracturas de la Columna Vertebral/diagnóstico por imagen , Aneurisma de la Aorta Abdominal/etiología , Humanos , Dolor de la Región Lumbar/etiología , Masculino , Persona de Mediana Edad , Tomografía de Emisión de Positrones , Fiebre Q/complicaciones , Fracturas de la Columna Vertebral/etiología , Tomografía Computarizada por Rayos XAsunto(s)
Huésped Inmunocomprometido , Sarampión/diagnóstico por imagen , Panencefalitis Esclerosante Subaguda/diagnóstico por imagen , Adulto , Resultado Fatal , Femenino , Humanos , Sarampión/inmunología , Sarampión/patología , Sarampión/virología , Virus del Sarampión/inmunología , Poliangitis Microscópica/tratamiento farmacológico , Poliangitis Microscópica/inmunología , Panencefalitis Esclerosante Subaguda/inmunología , Panencefalitis Esclerosante Subaguda/patología , Panencefalitis Esclerosante Subaguda/virologíaRESUMEN
We report the first case of Enterococcus gallinarum endocarditis developing on normal native heart valves. Using phenotypic and molecular methods, a precise identification of this naturally vancomycin-resistant species allowed an optimal antibiotic therapy and the patient's recovery.