[Macrolide-resistant Mycoplasma pneumoniae: Do we know the situation in Europe?] / Mycoplasma pneumoniae y resistencias a macrólidos: ¿Conocemos la situación en Europa?

Mycoplasma pneumoniae is a bacterium that lacks a cell wall. It produces infections all It produces infections world-wide, in epidemic outbreaks every 4-7 years, or endemically. Its clinical manifestations occur mostly in the respiratory tract and it is a common cause of atypical pneumonia. The treatment is with macrolides, tetracyclines or fluoroquinolones. Since 2000, an increase in resistance to macrolides has been detected worldwide, being more frequent in Asia. In Europe the frequency of resistance ranges between 1% and 25%, depending on the country. Molecular techniques and serology techniques provides very high sensitivity in diagnostic confirmation, being very useful for detecting and controlling M. pneumoniae outbreaks. The detection of resistance to macrolides requires a sequencing technique.

[Comparison of clinical features and diagnosis between the A and B subgroups of respiratory syncytial virus.] / Comparación de las características clínicas y diagnósticas de los subgrupos A y B del virus respiratorio sincitial.

BACKGROUND: Lower respiratory tract infection by respiratory syncytial virus (RSV) is the most frequent cause of admission in children under 2 years old. The RSV subgroups A and B may circulate simultaneously. We aimed to determine whether clinical differences exist between RSV subgroups A and B. Additionally, we tested the sensitivity of the rapid antigen detection test (RADT) based on immunochromatography in diagnosing subgroups A and B, taking the polymerase chain reaction assay (RT-PCR) as reference. METHODS: A retrospective observational study was performed in a tertiary hospital from October 2013 to March 2014. Clinical records and analytical variables of all children under 5 admitted with lower respiratory tract infection and RT-PCR positive for RSV in nasal lavage were consulted. Previously, the RADT for RSV had been performed from the same sample. RESULTS: A total of 198 children under 5 were diagnosed with RSV by RT-PCR: 55 (28%) were RSV-A, 132 (67%) RSV-B and 11 (5%) were positive for both subgroups. No differences were observed between subgroups in medical history, symptoms, radiological and analytical findings, and severity. The sensitivity of RADT for RSV was 52%, higher for RSV-A (69%) than for RSV-B (44%, p=0.001). CONCLUSIONS: The two RSV subgroups were indistinguishable in symptoms and prognosis. The sensitivity of RADT compared to RT-PCR was low and limits its usefulness for clinical decision-making. Key words. Respiratory syncytial virus. RSV subgroups. Rapid antigen detection test. Reverse transcription polymerase chain reaction.

Efectividad de los antivirales de acción directa de segunda generación en el tratamiento de la hepatitis C crónica / Effectiveness of second-generation direct-acting antivirals in chronic hepatitis C

Fundamento: Los antivirales de acción directa de segunda generación (AAD) han demostrado porcentajes elevados de respuesta viral sostenida (RVS) en el tratamiento de la hepatitis C crónica en ensayos clínicos. Este estudio tiene como objetivo estimar la efectividad de los AAD en el tratamiento de esta enfermedad. Material y métodos: Se estudiaron pacientes monoinfectados por el virus de la hepatitis C (VHC) y coinfectados por VHC y virus de la inmunodeficiencia humana (VIH) que iniciaron tratamientos libres de interferón con AAD durante 2015. La RVS se definió como una carga viral indetectable a las 12 semanas de finalizar el tratamiento, y fue el indicador principal de efectividad. Resultados: Se incluyeron 293 pacientes, 52 (17,7%) coinfectados por VIH. Los genotipos VHC más prevalentes fueron el 1b en monoinfectados (41,5%) y 1a en coinfectados (40,4%). La proporción de cirróticos fue superior en la población coinfectada (69,2% vs 41,1%; p<0,0001), en su mayoría Child-Pugh A. La cifra global de RVS fue del 96,9% (284/293) en un análisis por intención de tratar (IC 95%: 94,9-98,9%), siendo 4 los pacientes con fracaso virológico. Tanto pacientes naïve como pretratados tuvieron RVS superior al 95%, y en la mayoría de subgrupos establecidos según la presencia o no de cirrosis, la coinfección VIH y el genotipo, la efectividad se situó próxima o por encima del 90%. Conclusiones: Los AAD presentan una efectividad elevada, igual o superior a la descrita en los ensayos clínicos, e incluso en subpoblaciones difíciles de tratar (AU)

Background: Second-generation direct-acting antivirals (DAA) have shown high sustained virologic response (SVR) for the treatment of chronic hepatitis C in clinical trials. The objective of this study is to estimate DAA effectiveness in treatment of this disease. Methods: Hepatitis C virus (HCV) monoinfected patients and HCV-human immunodeficiency virus (HIV) coinfected patients who started interferon-free DAA based regimens during 2015 were included. The primary effectiveness outcome was SVR, defined as an undetectable viral load 12 weeks after the end of treatment. Results: A total of 293 patients were enrolled, and 52 (17.7%) were HIV coinfected. HCV 1b genotype was the most prevalent in monoinfected patients (41.5%) and 1a in HIV coinfected patients (40.4%). The proportion of cirrhosis was higher among HIV coinfected patients (69.2% vs 41.1%; p<0.0001), mostly Child-Pugh A. SVR was achieved by 96.9% of patients (284/293), in an intention-to-treat analysis (CI 95%: 94.9- 98.9), in which just 4 people had virologic failure. Both naïve and pretreated patients had SVR higher than 95%, and in most of subgroups, according to the presence of cirrhosis, HIV coinfection and HVC genotype, effectiveness rates were near or above 90%. Conclusions: DAA are highly effective, with similar or higher rates of SVR than that found in clinical trials, and even among difficult to treat populations (AU)

[Mortality and survival in a cohort of 1,115 HIV-infected patients (1989-97)]. / Estudio de la mortalidad y supervivencia en una cohorte de 1,115 pacientes con infección VIH (1989-97).

BACKGROUND: To study survival and HIV/AIDS-related mortality from 1989 through 1997. To analyze the effect of antiretroviral treatment and prophylaxis against P. carinii pneumonia (PCP-prophylaxis). PATIENTS AND METHODS: We retrospectively studied a cohort of 1,115 HIV (+) outpatients (331 with AIDS-defining criteria) seen in our specific HIV hospital unit from January 1989 through May 1997. We analyzed the effect of different antiretroviral treatments on annual mortality rate. In survival studies we used Cox regression analysis to analyze survival over time as well as the effect of different opportunistic events, adherence and changes in treatment during follow up. RESULTS: Mortality rate was 13.7 per 100 person-years in 1994. It went down to 4.2 during the first half of 1997 (p=0.001). Mortality rate decreased depending on treatment received: 53% (CI 95=34-65%) with monotherapy, 68% (CI 95=38-84%) with bitherapy, 86% (CI 95=40-96%) with triple therapy, and 49% (CI =29-64%) with PCP-prophylaxis. Patients with more than 100 CD4 had an increasing survival over time (p=0.002). In AIDS patients good adherence to antiretroviral treatment and PCP-prophylaxis were associated with a lower risk of death (RR=0.88; CI 95=0.63-1.22 and RR=0.72; CI 95=0.55-0.95 respectively). CONCLUSIONS: In recent years PCP-prophylaxis and antiretroviral treatment (especially combined therapy) have contributed to a decrease in AIDS-related mortality. Adherence to treatments relates to risk of death and survival.

Estudio de la mortalidad y supervivencia en una cohorte de 1.115 pacientes con infección VIH (1989-97) / Mortality and survival in a cohort of 1,115 HIV-infected patients (1989-97)

Fundamento: Analizar la supervivencia y mortalidad por VIH/sida entre 1989 y 1997, y evaluar el impacto que sobre ellas han tenido el tratamiento antirretroviral y la profilaxis frente al Pneumocystis carinii (anti-NPC). Pacientes y métodos: Estudio de una cohorte retrospectiva de 1.115 pacientes (331 con sida) seguidos en una Unidad hospitalaria de VIH en Madrid entre enero de 1989 y mayo de 1997. Se analizó tasa anual de mortalidad y el efecto en la misma del régimen de tratamiento antirretroviral. La regresión de Cox fue utilizada en los estudios de supervivencia para analizar su evolución, la influencia de los distintos eventos oportunistas, el efecto de la adherencia a los tratamientos y del cambio de tratamiento antirretroviral durante el seguimiento. Resultados: La tasa de mortalidad fue de 13,7 por 100 personas-año en 1994 y descendió hasta 4,2 en el primer semestre del 1997 (p=0,001).La monoterapia se asoció a una disminución de la mortalidad del 53 por ciento [IC95=34 por ciento-65 por ciento], la biterapia del 68 por ciento [IC95=38 por ciento-84 por ciento], la triple terapia del 86 por ciento [IC95=40-96 por ciento] y la profilaxis anti-NPC del 49 por ciento [IC95=29 por ciento-64 por ciento]. En los pacientes con CD4>100/mm3la supervivencia mejoró a lo largo del tiempo (p=0,002). En los pacientes con sida, el buen cumplimiento del tratamiento antirretroviral y de la profilaxis antiNPC se asociaron con una disminución del riesgo de muerte (RR=0,88; IC95=0,63-1,22 y RR=0,72; IC95=0,55-0,95 respectivamente). Conclusiones: La profilaxis anti-NPC y el tratamiento antirretroviral, en especial la terapia combinada, han contribuido a disminuir la mortalidad por sida en los últimos años. El grado de adherencia a los tratamientos se relaciona con el riesgo de morir y la supervivencia (AU)

[Changes in HIV-related attitudes and knowledge of teenagers following the Aulasida intervention in 1996-1997]. / Cambios en las actitudes y conocimientos de los adolescentes sobre la infección por VIH tras la intervención escolar Aulasida, 1996-1997.

BACKGROUND: Schools being the ideal setting for carrying out Health Education activities, the aim of this study was that of pinpointing and quantifying the changes in attitudes and knowledge on the part of teenagers enrolled in school in Algemesí (Valencia) following an educational intervention regarding HIV infection. METHOD: Eleven schools at which a total of 2,599 teenagers (ages 12-19) were enrolled in eleven different years of study (Secondary Education, Secondary Ed. and School Leaving Certificate, College Preparation Course and Vocational Training) were invited to take part. The Aulasida intervention carried out during the 1996-1997 school year consisted of an informative lecture-panel discussion and student involvement activities in small groups using educational materials. The gauging instrument was a questionnaire. This questionnaire was designed in a before-and-after cross-sectional study. An analysis was made divided into age and educational level strata. The averages were compared with the Student "t" test and the percentages of change with ji square. RESULTS: A total of nine schools accepted taking part. 1575 students answered the "before" test (47.4% males and 52.1% females), the average age being 15.2 (1.96) years old. The average number of correct answers to the "before" test was 13.5 (2.8). The "after" test showed an overall increase of up to 14.7 (3.0) correct answers (p < 0.01). By educational levels, this increase was highly appreciable in the younger age group. The most common sources of information on HIV were: television (80.8%); Aulasida (76.8%), teachers (60.9%), pamphlets (58.4%) and films (53.7%9. CONCLUSIONS: Educational interventions are useful tools for increasing knowledge and improving attitudes regarding HIV infection. Secondary schools are the best environment for this purpose, it being necessary to carry out interventions among younger groups, as a greater impact is thus achieved.

[Evolution of the epidemiologic pattern of the cases of AIDS in Spain]. / Evolución del patrón epidemiológico de los casos de sida en España.

Based on cases reported to the National AIDS Register by end June 1994, we analysed changes in the epidemiological pattern of AIDS in Spain for the periods 1981-1989 and 1990-1992. Cases diagnosed in 1981-1989 were mainly males (83.1%), subjects under 30 years of age (55.9%), and intravenous drug users (63.8%) or homo/bisexual males (16.8%). In 1990-1992 there was an increase in the proportion of females (18.5%), cases older than 29 (55.0%), and mean age diagnosis. Proportions of homo/bisexual, blood components recipients, and mother-to-child transmission decreased, while heterosexual transmission increased from 4.3% to 8.0%. In spite of large inter-regional differences in 1981-1989, some regions, such as La Rioja, Navarre, Murcia, Galicia and Aragon, rose more than Spain as a whole. Although the epidemiological pattern in both periods is similar, significant and independent changes in analysed variables are to be observed.

Changes in AIDS incidence trends in Spain.

OBJECTIVE: To detect changes in the evolution of the AIDS epidemic in Spain. DESIGN: Analysis of time-trends in AIDS incidence. METHODS: AIDS cases reported in Spain up to December 1993 were adjusted for reporting delays. Quarterly time-trends in incidence were analysed for groups divided according to sex, age and transmission category. RESULTS: The adjusted number of cases diagnosed by September 1993 totalled 24,519. Of these, 15,652 were injecting drug users (IDU), 3679 were homosexual/bisexual men and 1753 were cases of heterosexually transmitted infection since 1989. AIDS incidence has exhibited a linear rate of growth. While all groups studied showed an upward trend, variations were found between the different groups. The overall trend resembled the pattern for IDU, the largest but the slope in the growth curve for this category has steepened steadily, and experienced the greatest percentage increases since 1989. AIDS incidence among blood transfusion recipients has risen slowly since 1988, while that for blood factor recipients reached a ceiling in 1989 and has declined progressively thereafter. Within the respective transmission categories, women exhibited trends similar to men. From 1989 onwards, a greater rate of increase was observed among those aged over 30 years than among those under 30. CONCLUSION: The overall trend in AIDS incidence is the sum of the epidemics in the different population groups. While advances in controlling the epidemic have been made in certain groups, the trend as a whole has worsened.

[Estimation of AIDS morbidity and mortality in Spain]. / Estimación de la morbilidad y mortalidad por SIDA en España.

BACKGROUND: To obtain corrected estimates of the cumulative incidence and mortality, as well as prevalence of AIDS in Spain on June 1992. METHODS: The number of cases in the National Register of AIDS by December 1992 was adjusted for reporting delays to estimate the cumulative incidence by June 1992. The prevalence and mortality in this date were obtained using this figure and the probabilities of survival after diagnosis from the AIDS Register of Madrid. This methodology was used for Spain as all, and for each Autonomous Community. RESULTS: The estimated cumulative incidence of AIDS in Spain by June 1992 was 16,486 cases, 13.4% greater than that reported by the same date. The prevalent cases were 6,351 (95% CI, 5,996-6,708) and the remaining 10,135 (61.5%) would have died. This number of deaths is 69.6% greater than the reported figure. There were considerable differences among Autonomous Communities. Some of them exhibited rates more than six times greater than others. CONCLUSIONS: The adjusted estimations provide a view of the actual situation more accurate than the raw figures from the register. These great differences should be taken into account for appropriate allocation of health care resources.

[Loss of potential life years through AIDS in Spain 1981-1990]. / Años potenciales de vida perdidos por síndrome de immunodeficiencia adquirida en España, 1981-1990.

BACKGROUND: To know the importance of AIDS in premature mortality in Spain in relation to the remaining causes of deaths. METHODS: Deaths of patients with AIDS were obtained from the National AIDS Registry and deaths from other causes from the official mortality statistics. The potential years of life lost (PYLL) were compared from birth until the age of 65 in AIDS patients between 1981-1990 with those observed as the principal causes of premature death in 1980-1988. Similar comparisons were carried out for the three Autonomic Communities with the greatest incidence of AIDS (Catalonia, Madrid and the Basque Country). RESULTS: In 1988, there were 670 deaths (21,987 PYLL) in patients with AIDS and in 1990 this number almost doubled with 1312 (42,543 PYLL). In 1988 the PYLL in AIDS cases were situated at the ninth level for cause of premature death (eight in males) and in 1990 it was estimated to be in the eight place, near lung cancer, hepatic cirrhosis and cerebrovascular disease. In 1988, Madrid which has the highest rate adjusted by age of PYLL in AIDS cases, was placed in sixth place and was expected to reach second place in 1990. CONCLUSIONS: Death by AIDS has rapidly increased while death by the remaining cases has remained much more stable with AIDS nearing the level of the main causes of premature death. The need to consider AIDS as one of the health problems which takes priority is confirmed.

[The validity of infant mortality statistics in Navarra]. / Validez de las estadísticas de mortalidad infantil en Navarra.

In order to explore the validity of official infant mortality statistics, the number of infant deaths registered in the cohort of live births and resident in Navarra (Spain) from 1985 to 1989, according to data supplied by the Department of Statistics of Navarra, has been compared with that obtained in a retrospective search into the information of the hospitals. Among 24,383 live births of the cohort, 291 were certified as infant deaths. An over-register of 13 cases (4.5%) and an under-register of 26 cases (8.9%) was detected. By excluding those live births with less than six months of gestation, as done by the National Institute of Statistics, the validity is altered, because apart from the errors mentioned, one must add those resulting from the incorrect filling-in of the "number of weeks pregnant"= variable. When correcting these deficiencies, the final statistics (Infant Mortality Risk = 11.17 per 1000 live births) did not differ much from the official figures (IMR = 11.48 per 1000 live births).