Influenza vaccination mitigates severe complications in hospitalized patients: A ten-year observational study, Spain, 2009-2019.

BACKGROUND: Influenza epidemics annually impact a substantial portion of adults worldwide, leading to numerous hospitalizations and fatalities. While the primary goal of vaccination is to prevent influenza virus infection, breakthrough infections can still occur despite vaccination. Evaluating the vaccine effectiveness in preventing severe cases among hospitalized patients is crucial for enhancing vaccination strategies. METHODS: This single-center, observational, cross-sectional, and retrospective study analyzed data from 1,357 patients admitted to La Paz University Hospital for influenza infection between 2009 and 2019. Patients' demographics, clinical variables, comorbidities, vaccination status, and influenza-related outcomes were assessed. Logistic regression analysis was performed to determine the vaccine-independent protective effects. RESULTS: Influenza vaccination independently prevented severe complications, including pneumonia, bacterial superinfection, acute respiratory distress syndrome, and multiple organ failure in hospitalized patients (odds ratio = 0.61, 95% confidence interval: 0.47-0.76). Vaccinated patients had significantly lower intensive care unit admission rates (odds ratio = 0.42, 95% confidence interval: 0.18-0.92). However, there were no significant differences in mortality rates between vaccinated and unvaccinated patients (P = .385). CONCLUSIONS: Our study provides robust evidence supporting the influenza vaccine protective effect against severe outcomes in hospitalized patients during epidemic flu. Vaccination is associated with a significant reduction in severe complications and intensive care unit admissions, emphasizing its importance as a preventive measure. Improving vaccination coverage, especially in specific comorbidities and age groups, could further enhance the vaccine effectiveness in preventing severe influenza cases.

Influenza vaccination for flu infection in hospitalised patients / Vacunación antigripal en pacientes hospitalizados por gripe

Objectives: The objectives of this study are (1) to analyse which group of admitted patients with risk factors is most ­vaccinated, (2) to find out whether vaccinated patients admitted for flu have fewer complications, and (3) to check whether there are differences in demographic and therapeutic characteristics between vaccinated and unvaccinated patients who have been admitted. Patients and methods: This is a single-centre, observational, cross-sectional, and retrospective study of patients admitted for flu at La Paz University Hospital in the 2013–2014 and 2014–2015 seasons, with an analysis of the variables included in the clinical history and mandatory declaration documents. Results: A total of 179 patients were ­admitted for influenza infection in the two seasons studied, of whom 65 (36.3%) patients were vaccinated. Patients with chronic heart disease were significantly more vaccinated than other risk groups. Furthermore, the average age of vaccinated patients was significantly higher than that of unvaccinated patients. We did not find any other significant differences in the remaining ­variables when comparing the two groups, nor did we find any less development of complications in the admitted and ­vaccinated patients. Conclusion: It is important to emphasise vaccination campaigns, increase vaccination coverage, and raise awareness of vaccination among all patients with chronic diseases.(AU)

Objetivos: 1) analizar qué grupo de pacientes con factores de riesgo que ingresa se vacuna más; 2) averiguar si los ­enfermos con gripe hospitalizados que han sido vacunados tienen menor número de complicaciones, y 3) comprobar si existen diferencias en cuanto a las características demográficas y terapéuticas al comparar a los pacientes ingresados vacunados y no vacunados. Pacientes y métodos: Estudio unicéntrico, observacional, transversal y retrospectivo de los pacientes ingresados por gripe en el Hospital Universitario La Paz en las temporadas 2013–2014 y 2014–2015, con análisis de las variables recogidas en el documento del historial clínico y de los documentos de declaración obligatoria. Resultados: 179 pacientes ingresaron por gripe en las dos temporadas estudiadas, de los cuales estaban vacunados 65 (36.3%). Se vacunaron más, de forma significativa, los pacientes con enfermedades cardiacas crónicas frente al resto de grupos de riesgo. La edad media de los vacunados era significativamente mayor. No encontramos otras diferencias significativas en el resto de las variables al comparar los dos grupos, tampoco un menor desarrollo de complicaciones en los pacientes ­ingresados y vacunados. Conclusiones: Es importante hacer hincapié en las campañas de vacunación, es necesario aumentar la cobertura vacunal en, y concienciar sobre la vacunación a, los enfermos con patologías crónicas.(AU)

Transient elastography to rule out esophageal varices and portal hypertensive gastropathy in HIV-infected individuals with liver cirrhosis.

BACKGROUND/AIMS: It is recommended that patients with cirrhosis undergo endoscopic screening to rule out the presence of gastroesophageal varices: a noninvasive predictive method to identify cirrhotic patients with a very low risk of esophageal varices could potentially avoid unnecessary endoscopies. METHODS: We studied in 85 HIV-infected patients with cirrhosis the association between the absence of esophageal varices and portal hypertensive gastropathy, assessed by endoscopy, and liver stiffness measurement by transient elastography. We analyzed other parameters related to portal hypertension and hepatic function. RESULTS: Values of transient elastography and platelet count were significantly associated with absence of esophageal varices/portal hypertensive gastropathy. The area under the receiver operating characteristics curve [95% confidence interval (CI)] of transient elastography for the prediction of the absence of esophageal varices/portal hypertensive gastropathy was 0.7 (0.58-0.81). A liver stiffness measurement value less than 20 kPa was highly predictive of the absence of esophageal varices and portal hypertensive gastropathy. The combination of transient elastography (<20 kPa) and platelet count (>120 × 10 cells/l) had the highest negative predictive value (100%, CI 95% 77.2-100) for absence of esophageal varices and portal hypertensive gastropathy. CONCLUSION: Transient elastography combined with platelet count is useful for predicting the absence of esophageal varices and portal hypertensive gastropathy and, therefore, avoid unnecessary diagnostic endoscopies in HIV-infected patients with liver cirrhosis.

Estrategia de inducción-mantenimiento / The ®induction-maintenance» strategy

La estrategia de inducción-mantenimiento con lopinavirpotenciado con ritonavir (LPV/r) consiste en iniciartratamiento antirretoviral en un paciente naïve con 2nucleósidos más LPV/r. Cuando el paciente ha alcanzadouna carga viral indetectable por debajo de 50 copias/ml deácido ribonucleico (ARN) de virus de la inmunodeficienciahumana (VIH) durante un período definido, se procede asuspender los nucleósidos y el paciente continúarecibiendo tratamiento antirretroviral sólo con LPV/r enmonoterapia.La estrategia de inducción-mantenimiento con LPV/r se haanalizado en el ensayo clínico M03-613. En el M03-613, sealeatorizó a pacientes naïve para tratamientoantirretroviral a recibir zidovudina/lamivudina más LPV/r(n = 104) o efavirenz (n = 51). Los pacientes aleatorizados arecibir LPV/r que alcanzaron una carga viral por debajo de50 copias/ml de ARN de VIH durante 3 meses consecutivosprocedieron a suspender los nucleósidos. En un análisispor intención de tratar (datos perdidos igual a fracasos), un60% de los pacientes aleatorizados a recibir a LPV/r y un63% de los aleatorizados a recibir efavirenz mantuvieronuna carga viral menor de 50 copias/ml de ARN de VIH a las96 semanas de seguimiento (p = 0,73; intervalo deconfianza del 95% para la diferencia de –19 a 13%). Elestudio demostró además que los pacientes aleatorizadosa LPV/r experimentaron menos lipoatrofia que lospacientes aleatorizados a recibir efavirenz.El estudio M03-613 indica que la estrategia de inducciónmantenimientocon LPV/r es segura en la mayoría de lospacientes. Sin embargo las tasas de eficacia virológica sonmenores que con la estrategia de simplificación. Además,el estudio demuestra los beneficios importantes en lapreservación de la grasa periférica que puede tener unaestrategia de monoterapia con LPV/r(AU)

The strategy of induction-maintenance therapy withlopinavir-ritonavir (LPV7r) consists of initiatingantiretroviral therapy in a treatment-naïve patient withtwo nucleosides plus LPV/r. When the patient hasachieved an undetectable HIV RNA viral load of < 50copies/mL for a specified time period, the nucleosides arewithdrawn and the patient continues to receiveantiretroviral therapy with LPV/r monotherapy.The induction-maintenance strategy with LPV/r has beenanalyzed in the M03-613 clinical trial. In this trial,antiretroviral - naïve patients were randomized to receivezidovudine/lamivudine plus LPV/r (n = 104) or efavirenz (n= 51). In patients randomized to receive LPV/r whoachieved an HIV RNA viral load of < 50 copies/mL for 3consecutive months, nucleoside therapy was suspended.In an intention-to-treat analysis (missing equals failure),60% of the patients randomized to receive LPV/r and 63%of those randomized to receive efavirenz maintained anHIV RNA viral load of < 50 copies/mL at 96 weeks offollow-up (p = 0.73; 95% confidence interval for thedifference –19% to 13%). Moreover, this study showed thatpatients randomized to LPV/r experienced less lipoatrophythan those randomized to efavirenz.The M03-613 trial suggests that the induction-maintenancestrategy with LPV/r is safe in most patients. However,rates of virological efficacy are lower than those achievedwith the simplification strategy. Moreover, this trialdemonstrates that LPV/r monotherapy may have majorbenefits in peripheral fat preservation(AU)

Efectos secundarios asociados al tratamiento con maraviroc y otros antagonistas de CCR5. Impacto potencial del bloqueo del receptor CCR5 / Secondary effects of treatment with maraviroc and other CCR5 antagonists. Potential impact of the CCR5 blocker

Maraviroc es el primer inhibidor de los correceptores CCR5 comercializado como antirretroviral. Los estudiospreclínicos y los ensayos de fase 3 han demostrado que superfil de seguridad es muy favorable. No se ha identificado un efecto adverso característico de maraviroc. En contraste con aplaviroc, cuyo desarrollo clínico fue interrumpido por hepatotoxicidad grave, no se ha demostrado un incremento de toxicidad hepática enpacientes tratados con maraviroc incluso si estáncoinfectados por virus hepatotropos. Tampoco se haevidenciado un incremento en la incidencia de neoplasiaso infecciones graves en pacientes tratados con maraviroc.En un estudio de pacientes naive, maraviroc causócambios no significativos en colesterol total, lipoproteínas de baja densidad, lipoproteínas de alta densidad y triglicéridos.Aunque los correceptores CCR5 desempeñan un papel enla respuesta inmunitaria del organismo, no se hademostrado que los individuos homocigotos para sudeleción (mutación delta-32) tengan un riesgoincrementado de infecciones graves, con la posibleexcepción de la encefalitis por el virus del Nilo occidental. Sin embargo, es necesario un seguimiento a largo plazo de los pacientes tratados con maraviroc para poder descartar una susceptibilidad incrementada a infecciones o neoplasias

Maraviroc is the first inhibitor of CCR5 co-receptors to be marketed as an antiretroviral. The pre-clinical studies and phase III trials have shown that it has a very favourable safety profile. No characteristic adverse effect of maraviroc has been identified. Unlike with aplaviroc, where its clinical development was stopped due to serious hepatoxicity, no increase in liver toxicity has been demonstrated in patients treated with maraviroc even if they are co-infected by hepatotropic virus. Nor was there any evidence of an increase in the incidence of neoplasms or serious infections in patients treated with maraviroc. Ina study on naive patients, maraviroc produced nonsignificant changes in total cholesterol, LDL, HDL andtriglycerides.Although CCR5 co-receptors play a role in the immuneresponse of the body, it has not been shown whetherindividuals homozygote for its deletion (delta-32 mutation) have an increased risk of serious infections, with the possible exception of encephalitis due to the West Nile virus. However, long-term follow up is required on patients treated with to be able to rule out any increased susceptibility to infections or neoplasms

Efectos secundarios asociados al tratamiento con maraviroc y otros antagonistas de CCR5. Impacto potencial del bloqueo del receptor CCR5 / Secondary effects of treatment with maraviroc and other CCR5 antagonists. Potential impact of the CCR5 blocker

Maraviroc es el primer inhibidor de los correceptores CCR5comercializado como antirretroviral. Los estudiospreclínicos y los ensayos de fase 3 han demostrado que superfil de seguridad es muy favorable. No se ha identificadoun efecto adverso característico de maraviroc. Encontraste con aplaviroc, cuyo desarrollo clínico fueinterrumpido por hepatotoxicidad grave, no se hademostrado un incremento de toxicidad hepática enpacientes tratados con maraviroc incluso si estáncoinfectados por virus hepatotropos. Tampoco se haevidenciado un incremento en la incidencia de neoplasiaso infecciones graves en pacientes tratados con maraviroc.En un estudio de pacientes naive, maraviroc causócambios no significativos en colesterol total, lipoproteínasde baja densidad, lipoproteínas de alta densidad ytriglicéridos.Aunque los correceptores CCR5 desempeñan un papel enla respuesta inmunitaria del organismo, no se hademostrado que los individuos homocigotos para sudeleción (mutación delta-32) tengan un riesgoincrementado de infecciones graves, con la posibleexcepción de la encefalitis por el virus del Nilo occidental.Sin embargo, es necesario un seguimiento a largo plazo delos pacientes tratados con maraviroc para poder descartaruna susceptibilidad incrementada a infecciones o neoplasias(AU)

Maraviroc is the first inhibitor of CCR5 co-receptors to bemarketed as an antiretroviral. The pre-clinical studies andphase III trials have shown that it has a very favourablesafety profile. No characteristic adverse effect of maravirochas been identified. Unlike with aplaviroc, where itsclinical development was stopped due to serious hepatoxicity, no increase in liver toxicity has beendemonstrated in patients treated with maraviroc even ifthey are co-infected by hepatotropic virus. Nor was thereany evidence of an increase in the incidence of neoplasmsor serious infections in patients treated with maraviroc. Ina study on naive patients, maraviroc produced nonsignificantchanges in total cholesterol, LDL, HDL andtriglycerides.Although CCR5 co-receptors play a role in the immuneresponse of the body, it has not been shown whetherindividuals homozygote for its deletion (delta-32 mutation)have an increased risk of serious infections, with thepossible exception of encephalitis due to the West Nilevirus. However, long-term follow up is required onpatients treated with to be able to rule out any increasedsusceptibility to infections or neoplasms(AU)

[The "induction-maintenance" strategy]. / Estrategia de inducción-mantenimiento.

The strategy of induction-maintenance therapy with lopinavir-ritonavir (LPV7r) consists of initiating antiretroviral therapy in a treatment-naïve patient with two nucleosides plus LPV/r. When the patient has achieved an undetectable HIV RNA viral load of < 50 copies/mL for a specified time period, the nucleosides are withdrawn and the patient continues to receive antiretroviral therapy with LPV/r monotherapy. The induction-maintenance strategy with LPV/r has been analyzed in the M03-613 clinical trial. In this trial, antiretroviral-naïve patients were randomized to receive zidovudine/lamivudine plus LPV/r (n = 104) or efavirenz (n = 51). In patients randomized to receive LPV/r who achieved an HIV RNA viral load of < 50 copies/mL for 3 consecutive months, nucleoside therapy was suspended. In an intention-to-treat analysis (missing equals failure), 60% of the patients randomized to receive LPV/r and 63% of those randomized to receive efavirenz maintained an HIV RNA viral load of < 50 copies/mL at 96 weeks of follow-up (p = 0.73; 95% confidence interval for the difference -19% to 13%). Moreover, this study showed that patients randomized to LPV/r experienced less lipoatrophy than those randomized to efavirenz. The M03-613 trial suggests that the induction-maintenance strategy with LPV/r is safe in most patients. However, rates of virological efficacy are lower than those achieved with the simplification strategy. Moreover, this trial demonstrates that LPV/r monotherapy may have major benefits in peripheral fat preservation.

[Secondary effects of treatment with maraviroc and other CCR5 antagonists. Potential impact of the CCR5 blocker]. / Efectos secundarios asociados al tratamiento con maraviroc y otros antagonistas de CCR5. Impacto potencial del bloqueo del receptor CCR5.

Maraviroc is the first inhibitor of CCR5 co-receptors to be marketed as an antiretroviral. The pre-clinical studies and phase III trials have shown that it has a very favourable safety profile. No characteristic adverse effect of maraviroc has been identified. Unlike with aplaviroc, where its clinical development was stopped due to serious hepatoxicity, no increase in liver toxicity has been demonstrated in patients treated with maraviroc even if they are co-infected by hepatotropic virus. Nor was there any evidence of an increase in the incidence of neoplasms or serious infections in patients treated with maraviroc. In a study on naive patients, maraviroc produced nonsignificant changes in total cholesterol, LDL, HDL and triglycerides. Although CCR5 co-receptors play a role in the immune response of the body, it has not been shown whether individuals homozygote for its deletion (delta-32 mutation) have an increased risk of serious infections, with the possible exception of encephalitis due to the West Nile virus. However, long-term follow up is required on patients treated with to be able to rule out any increased susceptibility to infections or neoplasms.