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BACKGROUND AND AIMS: We assessed long-term clinical outcomes and prognostic factors for liver disease progression after sustained viral response with direct-acting antivirals in patients coinfected with HIV/HCV with advanced fibrosis or cirrhosis. APPROACH AND RESULTS: A total of 1300 patients who achieved sustained viral response with direct-acting antivirals from 2014 to 2017 in Spain were included: 1145 with compensated advanced chronic liver disease (384 advanced fibrosis and 761 compensated cirrhosis) and 155 with decompensated cirrhosis. The median follow-up was 40.9 months. Overall, 85 deaths occurred, 61 due to non-liver non-AIDS-related causes that were the leading cause of death across all stages of liver disease. The incidence (95% CI) of decompensation per 100 person-years (py) was 0 in patients with advanced fibrosis, 1.01 (0.68-1.51) in patients with compensated cirrhosis, and 8.35 (6.05-11.53) in patients with decompensated cirrhosis. The incidence (95% CI) of HCC per 100 py was 0.34 (0.13-0.91) in patients with advanced fibrosis, 0.73 (0.45-1.18) in patients with compensated cirrhosis, and 1.92 (1.00-3.70) per 100 py in patients with decompensated cirrhosis. Prognostic factors for decompensation in patients with compensated advanced chronic liver disease included serum albumin, liver stiffness measurement (LSM), and fibrosis 4. In this population, LSM and LSM-based posttreatment risk stratification models showed their predictive ability for decompensation and HCC. CONCLUSIONS: Non-liver non-AIDS-related events were the leading causes of morbidity and mortality after direct-acting antiviral cure among coinfected patients with advanced fibrosis/cirrhosis. Among those with compensated advanced chronic liver disease, baseline LSM and posttreatment LSM-based models helped to assess decompensation and HCC risk.
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Introducción: La infección por Listeria monocytogenes es una enfermedad grave que afecta mayoritariamente a personas de edad avanzada e inmunodeprimidos y cuya incidencia está aumentando. En este estudio se analizan los casos de listeriosis en dos hospitales con el fin de estudiar cambios en su incidencia, formas de presentación clínica y posibles factores asociados a mortalidad. Material y métodos: Estudio retrospectivo multicéntrico de pacientes con listeriosis diagnosticada por aislamiento microbiológico entre 1977 y 2021 en dos hospitales universitarios de Madrid. Se recogen variables epidemiológicas, clínicas, estado de inmunodepresión, pruebas complementarias y tratamiento. Se analizan factores asociados a mortalidad. Resultados: Se analizaron 194 casos de listeriosis. La incidencia de listeriosis por ingresos aumentó a lo largo del estudio, con una importante caída del número de casos en 2020. La bacteriemia aislada (37,1%) y la afectación del sistema nervioso central (SNC) (36,6%) fueron las presentaciones más frecuentes. El 21% de los casos tuvo síntomas de gastroenteritis. El 16,5% presentó otras infecciones focales, siendo las más frecuentes peritonitis bacteriana espontánea (8,2%), colecistitis (2,1%), infección respiratoria (1,5%) e infección de prótesis vascular (1,5%). La mortalidad intrahospitalaria fue del 24,7%. Fueron factores independientes asociados a mortalidad al ingreso la edad (odds ratio [OR] 1.027, intervalo de confianza [IC] 95% 1.003-1.056) y la presencia de tumor sólido (OR 3.525, IC 95% 1.652-7.524). Conclusiones: En este estudio se constata un aumento de la incidencia de listeriosis en nuestro medio. Las presentaciones más frecuentes fueron la bacteriemia aislada y la afectación del SNC. La mortalidad intrahospitalaria se asoció a la edad y al diagnóstico de tumor sólido.(AU)
Introduction: Listeria monocytogenes infection is a severe disease affecting mainly aged people and patients with immune depression. The incidence of listeriosis seems to be increasing. In the present study cases of listeriosis from two hospitals are analyzed with the aims of studying changes in its incidence, clinical forms of presentation and possible factors associated with mortality. Methods: Retrospective multicentric study of patients with culture-proven listeriosis in two university hospitals in Madrid between 1977 and 2021. Epidemiological and clinical variables, as well as factors for immune depression, complementary studies and treatments were registered. Factors associated with mortality were analyzed. Results: A total of 194 cases of listeriosis were analyzed. The incidence of listeriosis among in-patients increased through the study period, with a significant drop in the number of cases in 2020. The most common clinical presentations were isolated bacteriemia (37.1%) and central nervous system involvement (CNS) (36.6%). Symptoms of gastroenteritis occurred in 21% of cases. Other focal infections were present in 16.5% of patients, the most frequent were spontaneous bacterial peritonitis (8.2%), cholecystitis (2.1%), respiratory infection (1.5%) and vascular prothesis infection (1.5%). In-hospital mortality was 24.7%. Independent factors associated with mortality at admission were age (odds ratio [OR] 1.027, 95% confidence interval [95% CI]1.0031.056) and a diagnosis of a solid tumor (OR 3.525, 95% CI1.6527.524). Conclusions: This study confirms an increasing incidence of listeriosis in our millieu. The most common clinical presentations were isolated bacteriemia and central nervous system involvement. In-hospital mortality was associated with age and the diagnosis of a solid tumor.(AU)
Subject(s)
Humans , Male , Female , Listeriosis , Prognosis , Listeria monocytogenes , Mortality , Central Nervous System Infections , Bacteremia , Retrospective Studies , Incidence , Microbiology , Microbiological TechniquesABSTRACT
Introducción Listeria monocytogenes es una causa poco común de enfermedad en la población general. Es una causa importante de bacteriemia y meningoencefalitis en recién nacidos, embarazadas, ancianos e inmunodeprimidos. Además, se ha descrito de forma excepcional como agente patógeno en infecciones de prótesis articular. Métodos Descripción de un caso de infección sobre prótesis de rodilla en un adulto de 74 años. Se realizó revisión sistemática de la literatura médica (Medline, hasta noviembre de 2007) y síntesis de los casos previamente comunicados. Resultados Se han comunicado 16 casos de infección de prótesis articular por L. monocytogenes, que afectaron preferentemente a ancianos (media de 67,4 años; moda de 70 años) e inmunodeprimidos. En la mayoría de los casos la infección fue tardía. Conclusión La L. monocytogenes se debe tener en consideración como agente causal en las infecciones de prótesis articular, especialmente en el caso de pacientes ancianos o con enfermedades o tratamientos que conlleven inmunodepresión. De la revisión realizada se puede concluir que el tratamiento antibiótico de elección es la ampicilina parenteral durante al menos 6 semanas. Siempre que sea posible, se debe asociar la retirada de la prótesis infectada (AU)
Introduction Listeria monocytogenes is an unusual pathogenic agent in the general population, but is an important cause of bacteriemia and meningoencephalitis among newborns, pregnant women, the elderly population, and immunosuppressed patients. In rare cases, it has been described in joint prosthesis infections. Methods A case description of prosthetic joint infection caused by Listeria in a 74-year-old man is presented. A systematic review of the literature (MEDLINE up to November 2007) was performed, and the reported cases are summarized. Results Sixteen cases of prosthetic joint infection by L. monocytogenes have been reported, mainly in patients of advanced age (mean, 67.4 years; mode, 70 years) and immunosuppressed patients. Most cases were late infections. ConclusionL. monocytogenes should be kept in mind as a pathogen involved in joint prosthesis infection, particularly among the elderly and immunosuppressed populations. Based on the literature review, parenteral ampicillin for at least 6 weeks is the treatment of choice. If possible, prosthesis removal should also be performed(AU)
Subject(s)
Humans , Male , Aged , Listeriosis/microbiology , Prosthesis-Related Infections/microbiology , Listeria monocytogenes/isolation & purification , Joint Prosthesis/microbiology , Knee Prosthesis/microbiology , Immunocompromised Host , Anti-Bacterial Agents/therapeutic useABSTRACT
Introducción. Los objetivos del estudio son estimar la prevalencia de las coinfecciones por virus de la hepatitis en la población española infectada por el VIH y determinar el porcentaje de pacientes candidatos a tratamiento de la hepatitis C crónica (HCC) y a trasplante hepático dentro de esta población. Métodos. Estudio transversal de dos poblaciones de pacientes infectados por el VIH realizado en el año 2002: 1.260 pacientes de la población de 39 centros de toda la geografía española (P1) y 1.560 pacientes de la de tres hospitales de tercer nivel de Madrid (P2). Resultados. La prevalencia sérica de virus de las hepatitis A (VHA), B (VHB) y HCC encontrada respectivamente en P1 y P2. IgG anti-VHA1: 74% y 78%. HBsAg1: 4,9 y 4,8%. HBsAg, anti-HBc1, anti-HBs1: 39 y 39%. HBsAg, anti-HBc1, anti-HBs: 25 y 31%. HBsAg, anti-HBc, anti-HBs1: 7 y 8%. HBsAg, anti-HBc, anti-HBs: 22 y 16%. Anti-VHC1: 61 y 65%. Entre estos 88,8 y 84,6% tenían una PCR VHC1. Coinfección múltiple por virus de la hepatitis 3,2 y 2,8% y de estos, 70 y 78% con coinfección por el VHB, el VHC y el VHD. Cirrosis hepática el 5,8 y 9,6% de los pacientes coinfectados por el VIH y el VHC, con indicación de considerar trasplante hepático aproximadamente en uno de cada seis. El 43 y 37% de los coinfectados por el VHC eran buenos candidatos a tratamiento de HCC, pero sólo el 14 y el 15% lo habían iniciado. Conclusiones. Un elevado porcentaje de pacientes infectados por el VIH en España están coinfectados por virus de hepatitis, especialmente por el tipo C (VHC). El número de posibles candidatos a trasplante hepático es elevado y puede aumentar en los próximos años. En el futuro será necesario un mayor esfuerzo de tratamiento en los pacientes coinfectados por el VIH y virus de hepatitis (AU)
Introduction. The aims of this study were to estimate the prevalence of HIV and hepatitis virus coinfection in the Spanish population and to determine the percentage of patients who are candidates for chronic hepatitis C virus (HCV) treatment and liver transplantation within this population. Methods. A cross-sectional study was performed in 2002 in two Spanish populations of HIV-infected patients: 1,260 patients from 39 centers throughout Spain (P1) and 1,560 patients from three tertiary teaching hospitals in Madrid (P2).Results. The following hepatitis A virus (HAV), hepatitis B virus (HBV) and HCV serological prevalence were found in the P1 and P2 groups, respectively: HAV-IgG antibodies: 74% and 78%; HBsAg1: 4.9% and 4.8%; HBsAg, anti-HBc1, anti-HBs1: 39% and 39%; HBsAg, anti-HBc1, anti-HBs: 25% and 31%; HBsAg, anti-HBc, anti-HBs1: 7% and 8%; HBsAg, anti-HBc, anti-HBs: 22% and 16%. Anti-HCV1: 61% and 65%, respectively. Of the patients with positive HCV serology, 88.8% and 84.6% of each group were positive for HCV-RNA by polymerase chain reaction. Multiple coinfections with hepatitis viruses were found in 3.2% and 2.8%, respectively; of these, 70% and 78% had coinfection with HBV, HCV and HDV. Liver cirrhosis was found in 5.8% and 9.6% of the patients coinfected with HIV and HCV, respectively. Liver transplant was indicated in approximately one out of every six coinfected patients with liver cirrhosis. The 43 and 37% of the HCV coinfected patients were good candidates for anti-HCV treatment, but only 14% and 15% of patients had initiated it. Conclusions. A high percentage of HIV-infected patients in Spain were coinfected with hepatitis viruses, especially HCV. The number of possible candidates for liver transplantation is rising and could increase in the next few years. In the future, greater efforts to treat HIV-and hepatitis virus-coinfected patients will be required (AU)
Subject(s)
Adult , Humans , Hepatitis/complications , Hepatitis/immunology , Hepatitis, Chronic/prevention & control , Liver Cirrhosis/etiology , Liver Cirrhosis/physiopathology , Liver Transplantation/adverse effects , Liver Transplantation/immunology , Hepatitis/metabolism , Liver Cirrhosis/pathology , HIV/physiology , Anti-Retroviral Agents/therapeutic useABSTRACT
El trasplante de órgano sólido puede ser la única alternativa terapéutica en ciertos pacientes infectados por el virus de la inmunodeficiencia humana (VIH). La experiencia acumulada en América del Norte y Europa en los últimos 5 años indica que la supervivencia a los 3 años del trasplante de órgano sólido es similar a la de los pacientes no infectados por el VIH. Los criterios consensuados para seleccionar a los pacientes infectados por el VIH con indicación de trasplante son: no haber tenido infecciones oportunistas (a excepción de la tuberculosis, candidiasis esofágica o neumonía por Pneumocystis jiroveci antes carinii), tener una cifra de linfocitos CD4 > 200 cél./μl (100 cél./μl en el caso del trasplante hepático) y una carga viral del VIH indetectable o suprimible con tratamiento antirretroviral. También se exige una abstinencia a la heroína y cocaína de 2 años de duración, pudiendo estar el paciente en programa de metadona. Los principales problemas del período postrasplante son las interacciones farmacocinéticas y farmacodinámicas entre los antirretrovirales y los inmunosupresores, el rechazo y la posibilidad de que la recidiva de la infección por el virus de la hepatitis C (VHC), que es una de las principales causas de mortalidad postrasplante hepático, siga una evolución peor. La experiencia del tratamiento con interferón pegilado y ribavirina es escasa en esta población hasta el momento actual (AU)
Solid organ transplantation may be the only therapeutic option for some human inmunodeficience virus (HIV)-infected patients. Experience in North America and Europe over the last five years has shown that three-year survival of these patients following organ transplantation is similar to that of HIV-negative patients. The consensus criteria for the selection of HIV patients for transplantation include the following: no opportunistic infections (except tuberculosis, esophageal candidiasis or Pneumocystis jiroveci previously carinii pneumonia), CD4 lymphocyte count above 200 cells/μl (100 cells/μl in the case of liver transplantation) and HIV viral load that is undetectable or suppressible with antiretroviral therapy. Also required is a two-year abstinence from heroin and cocaine, although the patient may be in a methadone program. The main problems in the post-transplantation period in these patients are pharmacokinetic and pharmacodynamic interactions between antiretorivirals and immunosuppressors, rejection, and the fact that the risk of relapsed HCV infection is exacerbated, and this is one of the main causes of post-liver transplantation (..) (AU)
Subject(s)
Adult , Humans , Patient Selection/ethics , HIV Infections/complications , HIV Infections/immunology , Graft Survival/physiology , Organ Transplantation/ethics , Organ Transplantation/standards , Viral Load , Anti-Retroviral Agents/therapeutic use , Spain/epidemiologyABSTRACT
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Subject(s)
Adult , Female , Humans , Immunocompromised Host , Hematopoietic Stem Cell Transplantation , Respiratory Syncytial Virus, Human , Respiratory Syncytial Virus Infections , Registries , Ribavirin , Self-Help Groups , Antiviral Agents , gamma-GlobulinsABSTRACT
No disponible