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3.
Int J Infect Dis ; 53: 46-51, 2016 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-27815225

RESUMEN

INTRODUCTION: Boceprevir (BOC) was one of the first oral inhibitors of hepatitis C virus (HCV) NS3 protease to be developed. This study assessed the safety and efficacy of BOC+pegylated interferon-α2a/ribavirin (PEG-IFN/RBV) in the retreatment of HIV-HCV co-infected patients with HCV genotype 1. METHODS: This was a phase III prospective trial. HIV-HCV (genotype 1) co-infected patients from 16 hospitals in Spain were included. These patients received 4 weeks of PEG-IFN/RBV (lead-in), followed by response-guided therapy with PEG-IFN/RBV plus BOC (a fixed 44 weeks was indicated in the case of cirrhosis). The primary endpoint was the sustained virological response (SVR) rate at 24 weeks post-treatment. Efficacy and safety were evaluated in all patients who received at least one dose of the study drug. RESULTS: From June 2013 to April 2014, 102 patients were enrolled, 98 of whom received at least one treatment dose. Seventy-three percent were male, 34% were cirrhotic, 23% had IL28b CC, 65% had genotype 1a, and 41% were previous null responders. The overall SVR rate was 67%. Previous null-responders and cirrhotic patients had lower SVR rates (57% and 51%, respectively). Seventy-six patients (78%) completed the therapy scheme; the most common reasons for discontinuation were lack of response at week 12 (12 patients) and adverse events (six patients). CONCLUSIONS: Response-guided therapy with BOC in combination with PEG-IFN/RBV led to an overall SVR rate of 67%, but an SVR rate of only 51% in patients with cirrhosis. The therapy was generally well tolerated. Although the current standards of care do not include BOC+PEG-IFN/RBV, the authors believe that this combination can be beneficial in situations where new HCV direct antiviral agent interferon-free therapies are not available yet.


Asunto(s)
Antivirales/uso terapéutico , Infecciones por VIH/tratamiento farmacológico , Hepacivirus/efectos de los fármacos , Hepatitis C/tratamiento farmacológico , Adulto , Coinfección , Quimioterapia Combinada , Femenino , Genotipo , Infecciones por VIH/complicaciones , Hepacivirus/genética , Hepatitis C/complicaciones , Humanos , Interferón-alfa/uso terapéutico , Masculino , Persona de Mediana Edad , Polietilenglicoles/uso terapéutico , Prolina/análogos & derivados , Prolina/uso terapéutico , Estudios Prospectivos , Proteínas Recombinantes/uso terapéutico , Retratamiento , Ribavirina/uso terapéutico , España , Resultado del Tratamiento , Proteínas no Estructurales Virales/antagonistas & inhibidores
4.
Clin Microbiol Infect ; 11(3): 221-5, 2005 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-15715720

RESUMEN

The aim of the present study was to analyse the diagnostic yield of the rose Bengal test for the rapid diagnosis of human brucellosis in an emergency department in an area where the disease is endemic. The study included 711 patients diagnosed initially with brucellosis and 270 controls. Brucellosis patients were divided into three groups: group I, individuals with no regular exposure to or history of brucellosis; group II, individuals exposed repeatedly to Brucella infection; and group III, individuals infected with Brucella who had received appropriate treatment during the previous 12 months. Blood cultures were positive for 445 (62.6%) brucellosis patients, while the remaining 266 (37.4%) patients were diagnosed according to clinical and serological criteria. The overall sensitivity of the rose Bengal test was 92.9%. The specificities for groups I, II and III were 94.3%, 91.7% and 76.9%, respectively, with positive likelihood ratios of 16.5, 10.4 and 4.2, respectively. The diagnostic gain after the performance of the rose Bengal test was good or very good in patients with no previous exposure to Brucella or history of brucellosis, but poor in patients who were exposed repeatedly to Brucella or had a history of brucellosis and a low pre-test probability. Use of the rose Bengal test as the sole technique for the diagnosis of brucellosis in endemic areas should be considered very carefully in the context of patients who are exposed repeatedly to Brucella or have a history of brucellosis.


Asunto(s)
Pruebas de Aglutinación/métodos , Brucelosis/diagnóstico , Rosa Bengala , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Brucelosis/epidemiología , Servicios Médicos de Urgencia , Servicio de Urgencia en Hospital , Femenino , Humanos , Masculino , Persona de Mediana Edad , Sensibilidad y Especificidad , España/epidemiología , Coloración y Etiquetado
5.
Eur J Clin Microbiol Infect Dis ; 23(6): 477-83, 2004 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-15164258

RESUMEN

In order to determine the clinical features and current prognosis of tuberculous vertebral osteomyelitis, the charts of all patients diagnosed with definite or probable tuberculous vertebral osteomyelitis from January 1983 to June 2002 ( n=78) were reviewed. The mean delay to diagnosis was 6.1 months. Sixty-five (83.3%) patients had inflammatory spinal pain, 35 (44.9%) had some neurological deficit, and only 27 (34.6%) had fever. Paravertebral, epidural, and psoas abscesses were detected in 73.1, 65.4, and 24.4% of the cases, respectively. Culture was positive in 48% of the percutaneous biopsies and in 61.7% of the open biopsies. After histological findings were included, the diagnostic yield of percutaneous biopsies was 68%. Fifty-five (70.5%) patients required surgical treatment at some stage of the disease. Although no deaths were directly attributable to tuberculous vertebral osteomyelitis and only 5.1% of patients relapsed, the mean overall hospital stay was 69.1+/-36.9 days, and 30 (38.5%) patients had severe functional sequelae. In conclusion, diagnosis of tuberculous vertebral osteomyelitis requires a high degree of suspicion. Percutaneous biopsy should be undertaken as soon as possible in any patient with compatible symptoms or radiological images in order to initiate suitable therapy.


Asunto(s)
Osteomielitis/diagnóstico , Osteomielitis/terapia , Enfermedades de la Columna Vertebral/diagnóstico , Enfermedades de la Columna Vertebral/terapia , Tuberculosis Osteoarticular/diagnóstico , Tuberculosis Osteoarticular/terapia , Adolescente , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Antituberculosos/uso terapéutico , Distribución de Chi-Cuadrado , Estudios de Cohortes , Terapia Combinada/métodos , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Mycobacterium tuberculosis/aislamiento & purificación , Procedimientos Ortopédicos/métodos , Osteomielitis/epidemiología , Probabilidad , Estudios Retrospectivos , Medición de Riesgo , Índice de Severidad de la Enfermedad , Distribución por Sexo , España/epidemiología , Enfermedades de la Columna Vertebral/epidemiología , Resultado del Tratamiento , Tuberculosis Osteoarticular/epidemiología
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