Effectiveness and tolerability of dolutegravir and abacavir/lamivudine administered as two separate pills compared to their equivalent single-tablet regimen in a multicentre cohort in Spain.

INTRODUCTION: We aimed to assess the effectiveness and tolerability of dolutegravir (DTG), abacavir (ABC) and lamivudine (3TC) administered as branded STR (DTG/ABC/3TC) or as two separate pills (DTG and either branded ABC/3TC [DTG+(ABC/3TC)b] or generic ABC/3TC [DTG+(ABC/3TC)g]). METHODS: We included individuals from the multicentre cohort of the Spanish HIV/AIDS Research Network (CoRIS) who received DTG/ABC/3TC, DTG+(ABC/3TC)b or DTG+(ABC/3TC)g during 2015 to 2018. We used multivariable logistic regression to compare the proportion of antiretroviral-naïve individuals who achieved viral suppression (VS) (viral load ≤50 copies/mL) at 24 weeks of initiating with DTG+(ABC/3TC)b or DTG+(ABC/3TC)g versus DTG/ABC/3TC. We also calculated the proportion of virologically suppressed individuals who maintained VS at 24 weeks after switching from DTG/ABC/3TC to DTG+(ABC/3TC)g. RESULTS: During the study period, 829, 68 and 47 treatment-naïve individuals started treatment with DTG/ABC/3TC, DTG+(ABC/3TC)b or DTG+(ABC/3TC)g respectively. The proportions of individuals who changed their regimens due to side effects during the first 24 weeks were 3.7%, 4.4% and 6.4% respectively (p = 0.646). We did not find significant differences in VS at 24 weeks among individuals starting with DTG+(ABC/3TC)b or DTG+(ABC/3TC)g compared to those initiating with DTG/ABC/3TC. Among 177 virologically suppressed individuals who switched from DTG/ABC/3TC to DTG+(ABC/3TC)g, 170 (96.0%) maintained VS at 24 weeks. CONCLUSIONS: In naïve individuals, the effectiveness and tolerability at 24 weeks of DTG plus ABC/3TC administered as two separate pills, either as branded or generic ABC/3TC, was similar to the STR DTG/ABC/3TC. Switching the STR DTG/ABC/3TC to its separate components DTG+(ABC/3TC)g in virologically suppressed individuals did not seem to impair its effectiveness.

Epidemiological and clinical profile of immunosuppressed patients with imported strongyloidiasis: a substudy from a larger cohort of the +REDIVI Spanish Collaborative Network.

The aim of this study was to describe the clinical and epidemiological profile of immunosuppressed patients with imported strongyloidiasis in a non-endemic setting, and to compare these results with non-immunosuppressed patients. This is a case-control substudy from a larger observational retrospective study that included all patients with strongyloidiasis registered in the +REDIVI Spanish Collaborative Network. Overall, 1245 patients with imported strongyloidiasis were included. From these, 80 (6.4%) patients had some kind of immunosuppression. Three (3.8%) patients had a hyperinfection syndrome, and 34 (52.3%) patients had eosinophilia. The percentages of positive results of the formalin-ether technique, the fecal culture and serology were 12.3%, 21.1% and 95.4%, respectively. When comparing the main characteristics, immunosuppressed patients had higher proportion of severe clinical manifestations and lower proportion of eosinophilia. No differences were found regarding yield of microbiological techniques and treatment response. These results stress the importance of strongyloidiasis screening among immunosuppressed patients coming from endemic areas. Serological tests have an acceptable sensitivity to be used as a screening tool.

Imported strongyloidiasis: Data from 1245 cases registered in the +REDIVI Spanish Collaborative Network (2009-2017).

BACKGROUND: Imported strongyloidiasis is increasingly being diagnosed in non-endemic areas. The aim of this study was to describe the epidemiological, clinical and microbiological characteristics of patients with imported strongyloidiasis in Spain. METHODOLOGY: This is an observational retrospective study that included all patients diagnosed of strongyloidiasis registered in the +REDIVI Collaborative Network from 2009 to 2017. Demographic, epidemiological and clinical information was collected from the +REDIVI database, and extra information regarding microbiological techniques, treatment and follow-up was requested to participant centers. FINDINGS: Overall, 1245 cases were included. Most of them were immigrants (66.9%), and South America was the most frequent area of origin. Detection of larvae in stool samples was observed in 21.9% of the patients, and serological tests allowed making the diagnosis in the rest of the cases. Eosinophilia was present in 82.2% of cases. Treatment with ivermectin (compared with albendazole) was the most strongly associated factor to achieve the cure (OR 2.34). CONCLUSIONS: Given the long latency of the infection and the risk of developing a severe presentation, screening of S. stercoralis infection should be mandatory in patients coming from or had traveling to endemic areas, especially in those with immunosuppressant conditions.

Síndrome general, tos y nódulo pulmonar cavitado en una paciente con VIH sin tratamiento antirretroviral / Systemic symptoms, cough and cavitated pulmonary nodule in an untreated HIV patient

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Surgical treatment of multiple mycotic aneurysms: in the ascending aorta, aortic arch, and descending aorta.

We report a clinical case of multiple mycotic aneurysms, in the ascending aorta, aortic arch, and descending aorta. The patient underwent surgery to replace the ascending aorta and aortic arch by means of a highly modified "elephant trunk" technique and with the aid of arterial cannulation from the right subclavian artery, which provided antegrade cerebral perfusion. Samples of purulent material taken from the aneurysmal wall yielded cultures positive for Staphylococcus aureus. The patient was treated with antibiotics for 6 weeks and then underwent a 2nd procedure for the aneurysmal resection of the descending thoracic aorta and the abdominal aorta, through a thoracic laparo-phrenicectomy. We comment on the clinical and surgical aspects of the case.

[Incidence of bacteremia among histologic groups of hematologic malignancies]. / Incidencia de bacteriemia en grupos histológicos de neoplasias hematológicas.

INTRODUCTION: Subgroups having dissimilar prognoses are being identified among cancer patients with infection. Previous studies have suggested that these differences may be related to the histologic diagnosis, but this issue has not as yet been demonstrated. METHODS: We reviewed the medical records of all patients admitted with acute leukemia (AL) or lymphoma (ML) from 1988 to 1998. Incidence of bacteremia was calculated for the following subgroups: acute lymphocytic leukemia (ALL), acute myelocytic leukemia (AML), AML following refractory anaemia with excess blasts (AML-RAEB), high-grade ML (HGML), intermediate-grade ML (IGML), low-grade ML (LGML) and indeterminate ML (IML). Kaplan-Meier curves of time to the first positive blood culture were constructed and compared by means of log-rank test. RESULTS: In the period covered there were 244 new diagnoses of AL or ML: 62 AML, 32 ALL, 20 AML-RAEB, 78 HGML, 7 IGML, 37 LGML and 6 IML. At the end of the study period, 44 patients were alive, 147 were known to have died at a certain date and 53 had been formally lost to follow-up (most of them, transferred for hospice care). Among 684 blood cultures, there were 51 contaminations and 155 significant isolates. Among the latter, gram-positive bacteria were isolated in 74 and gram-negative bacteria in 47; in 27 cases more than 1 bacterial species were recovered. Fungi were isolated in 7 cases. The incidence of bacteremia expressed as cases per 1000 patient-days was 5.80 for AML, 5.03 for AML-RAEB, 1.56 for ALL, 0.21 for HGML and 0.40 for the remaining ML. Time to the first positive blood culture was significantly shorter for AML than for any other group, and was shorted for ALL and AML-RAEB than for ML. CONCLUSION: Differences in the incidence of bacteremia were observed among histologically-defined groups of unselected patients with hematologic malignancies.

Incidencia de bacteriemia en grupos histológicos de neoplasias hematológicas / Incidence of bacteremia among histologic groups of hematologic malignancies

INTRODUCCIÓN. Se están identificando subgrupos con pronóstico diferente entre los pacientes con cáncer e infecciones. Estudios previos han sugerido diferencias relacionadas con el diagnóstico histológico que no han sido demostradas definitivamente. MÉTODOS. Se revisaron las historias clínicas de los pacientes ingresados con diagnóstico de leucemia aguda o linfoma maligno entre 1988 y 1998. Se calculó la incidencia de bacteriemia para los siguientes subgrupos; leucemia linfoblástica aguda (LLA); leucemia mieloblástica aguda (LMA); LMA con antecedente de anemia refractaria con exceso de blastos (AREB); linfoma maligno de alto grado (LMAG); linfoma maligno de grado intermedio (LMGI); linfoma maligno de bajo grado (LMBG); y linfoma maligno indeterminado (LMI). Se construyeron las curvas de Kaplan-Meier de tiempo hasta el primer hemocultivo positivo y se compararon por el test del rango logarítmico. RESULTADOS. Se diagnosticaron 244 nuevas leucemias agudas o linfomas en el período estudiado: 62 LMA, 34 LLA, 20 LMA-AREB, 78 LMAG, 7 LMGI, 37 LMBG y 6 LMI.En el momento del cierre del estudio, 44 pacientes estaban vivos, 147 tenían una fecha de fallecimiento conocida y 53 habían sido formalmente perdidos del seguimiento (la mayoría, trasladados para tratamiento paliativo). En 684 hemocultivos se detectaron 51 contaminaciones y 155 aislamientos significativos. De ellos, 74 fueron bacterias grampositivas; 47, gramnegativas; 27, polimicrobianas, y 7, hongos. La incidencia de bacteriemia en casos por 1.000 paciente-días fue 5,80 para la LMA, 5,03 para la LMA-AREB, 1,56 para la LLA, 0,21 para los LMAG y 0,40 para los restantes linfomas. El tiempo hasta el primer hemocultivo positivo fue significativamente menor para la LMA que para cualquier otro grupo; y para la LLA y LMA-AREB que para los linfomas. CONCLUSIÓN. Se observó una diferencia en la incidencia de bacteriemia entre grupos definidos histológicamente de pacientes no seleccionados con neoplasias hematológicas (AU)

Obstrucción intestinal en una mujer previamente sana / Intestinal occlusion in a previously healthy woman

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[A cross-sectional study on the epidemiological and clinical characteristics of HIV-1 infection in gypsies and in other minorities in Bilbao, Northern Spain]. / Estudio transversal sobre las características clínicas y epidemiológicas de la infección por el virus de la inmunodeficiencia humana en gitanos y otras minorías en Bilbao.

BACKGROUND: The health status and needs of gypsies have been insufficiently studied. PATIENTS AND METHOD: We studied the clinicoepidemiological characteristics of all HIV-1 infected patients attending in our outpatients clinic and hospitalized who were classified according to their ethnic origin as <>, <> (Caucasian non-gypsy Spanish natives) or <>. RESULTS: Overall, there were 563 patients out of 674 previously appointed (83%). Intravenous drug use (IVDU) was the HIV acquisition mechanism in 70%, 95% and 25% (p < 0.000) and attendance was considered regular in 89%, 48% and 89% payos, gypsies and immigrants (p < 0.01), respectively. CONCLUSIONS: IVDU as the HIV transmission mechanism and lower clinic attendance rates were the most relevant differences observed between gypsy and payo subjects.

Características clinicoepidemiológicas de los pacientes recién diagnosticados de infección por el VIH / Clinico-epidemiological characterístic of recently diagnoses HIV-infected patients

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Características clinicoepidemiológicas de los nuevos diagnósticos de infección por el virus de la inmunodeficiencia humana / Clinical and epidemiological characteristics of persons newly diagnosed of HIV infection

FUNDAMENTO: Describir las características de las personas recientemente diagnosticadas de infección por el virus de la inmunodeficiencia humana. PACIENTES Y MÉTODO: Serie de 126 nuevos casos de infección por VIH diagnosticados en un Servicio de Enfermedades Infecciosas. RESULTADOS: La transmisión sexual fue la más frecuente (74 por ciento). El 15 por ciento eran mayores de 50 años y un 16 por ciento inmigrantes. El diagnóstico tardio (estadio C) ocurrió en el 36 por ciento de los casos y se asoció con tener más de 50 años (odds ratio [OR]: 5,1; intervalo de confianza [IC] del 95 por ciento: 1,6-16,8). CONCLUSIONES: Es necesario implantar sistemas de notificación de infecciones por VIH y mejorar los servicios preventivos (AU)

Fiebre y dolor inguino-púbico de cinco meses de evolución / Fever and pain in the inginal-pubic area of five-month duration

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