Infecciones de transmisión sexual con afectación anorrectal: agentes causales, coinfecciones, infección por el VIH y conductas de riesgo / Sexually transmitted diseases of the anus and rectum: Causal agents, coinfections, HIV infection and high-risk sexual behaviour

Introducción y objetivo: Las infecciones de transmisión sexual con afectación anorrectal (ITS-AR) afectan principalmente a hombres que tienen sexo con hombres (HSH). Material y métodos: Estudio retrospectivo realizado en pacientes diagnosticados de ITS-AR en una unidad de ITS entre 2014 y 2015. Se recogieron datos epidemiológicos, microbiológicos, clínicos y de conducta sexual. Resultados: Se analizaron 95 individuos, todos HSH. El 88,42% estaban infectados por el VIH; el 67,17% refirió que la última relación sexual fue desprotegida; el 17,91% tuvo sexo con trabajadores sexuales y, en el año previo, el 72,22% había consumido drogas previamente a las relaciones sexuales. El 32,92% presentaron sintomatología durante más de 30 días. El 54,73% de los diagnósticos fue linfogranuloma venéreo (LGV). Todos los pacientes que consultaron por úlcera asociada a proctitis presentaron infección por LGV. Todos los que consultaron por úlcera perianal sin proctitis asociada fueron diagnosticados de sífilis. Conclusiones: Todos los pacientes con ITS-AR fueron HSH, la mayoría positivos para el VIH, con conductas sexuales de riesgo y un tiempo de evolución largo. Las características clínicas, epidemiológicas y microbiológicas de las ITS-AR en nuestro entorno podrían ayudar a ajustar mejor el tratamiento empírico

Introduction and objective: Sexually transmitted infections of the rectum and anus (STI-RA) mainly affect men who have sex with men (MSM). The incidence of STI-RA among them has increased in recent years. Material and methods: Retrospective study in patients with diagnoses of STI-RA in an STI unit during the years 2014 and 2015. Epidemiological, clinical and microbiological data were collected. Results: We included 95 patients, all of whom were MSM; 88.42% were HIV+; 67.17% did not use a condom during their most recent sexual intercourse; 17.91% had had sex with sex workers and 72.22% had used drugs during sexual intercourse during the previous year. A percentage of 32.92 reported symptoms that had lasted longer than 30 days. Lymphogranuloma venereum (LGV) was diagnosed in 54.73% of the patients. All patients who presented with proctitis and perianal ulcers were diagnosed with LGV infection. All those who presented perianal ulcers without proctitis were diagnosed with syphilis. Conclusions: All the patients affected by STI-RA were MSM, most of them HIV+, had engaged in high-risk sexual behaviour and had suffered prolonged symptomatology. Clinical and microbiological characteristics of STI-AR could help adjust the empiric therapy

Sexually transmitted diseases of the anus and rectum: Causal agents, coinfections, HIV infection and high-risk sexual behaviour. / Infecciones de transmisión sexual con afectación anorrectal: agentes causales, coinfecciones, infección por el VIH y conductas de riesgo.

INTRODUCTION AND OBJECTIVE: Sexually transmitted infections of the rectum and anus (STI-RA) mainly affect men who have sex with men (MSM). The incidence of STI-RA among them has increased in recent years. MATERIAL AND METHODS: Retrospective study in patients with diagnoses of STI-RA in an STI unit during the years 2014 and 2015. Epidemiological, clinical and microbiological data were collected. RESULTS: We included 95 patients, all of whom were MSM; 88.42% were HIV+; 67.17% did not use a condom during their most recent sexual intercourse; 17.91% had had sex with sex workers and 72.22% had used drugs during sexual intercourse during the previous year. A percentage of 32.92 reported symptoms that had lasted longer than 30 days. Lymphogranuloma venereum (LGV) was diagnosed in 54.73% of the patients. All patients who presented with proctitis and perianal ulcers were diagnosed with LGV infection. All those who presented perianal ulcers without proctitis were diagnosed with syphilis. CONCLUSIONS: All the patients affected by STI-RA were MSM, most of them HIV+, had engaged in high-risk sexual behaviour and had suffered prolonged symptomatology. Clinical and microbiological characteristics of STI-AR could help adjust the empiric therapy.

Darunavir como tratamiento de inicio de la infección por virus de la inmunodeficiencia humana y como estrategia de cambio no motivado por fracaso / Darunavir as initial therapy for human immunodeficiency virus infection and as a strategy for switching regimen not motivated by virological failure

La evolución de los avances en el tratamiento del virus de la inmunodeficiencia humana ha pasado de ser aritmética en los primeros años a geométrica en estos últimos años. Actualmente se dispone de 6 clases de fármacos antirretrovirales aprobados para el tratamiento de pacientes naïve y experimentados. Estas 6 clases son los inhibidores de la transcriptasa inversa análogos de nucleósidos o nucleótidos (ITIAN) -que son la columna vertebral de la terapia-, los inhibidores de la transcriptasa inversa no nucleósidos (ITINN), los inhibidores de la proteasa (IP), un inhibidor de la fusión (IF), un antagonista del CCR5 y los inhibidores de la integrasa -inhibidores de la transferencia del ADN proviral- (INSTI)

The trend in treatment advances in human immunodeficiency virus has changed from being arithmetic in the first few years to being geometric in the last few years. There are currently 6 classes of antiretroviral drugs approved for use in treatment-naïve and treatment-experienced patients. These 6 classes are nucleotide/nucleoside reverse transcriptase analogue inhibitors (NRTIs) -which are the backbone of therapy-, non-nucleoside reverse transcriptase analogue inhibitors (NNRTIs), protease inhibitors (PI), entry inhibitors (EI), a CCR5 antagonist and integrase strand transfer inhibitors (INSTIs)

Dolutegravir: an exciting new kid on the block.

INTRODUCTION: Dolutegravir is the first second-generation integrase inhibitor approved for the treatment of naïve as well as experienced HIV-infected individuals. AREAS COVERED: Data from pharmacokinetics, efficacy, safety, tolerability and resistance are reviewed from in vitro studies, Phase II and III clinical trials published in PubMed (Dolutegravir; S/GSK1349572) or presented in international meetings. EXPERT OPINION: Data from studies and clinical trials indicate that dolutegravir is safe, well tolerated and highly efficacious in the treatment of both antiretroviral-naïve and treatment-experienced patients and appears to have a higher genetic barrier to resistance than first-generation integrase inhibitors.