Prospective study for the early detection of lung carcinoma in patients with HIV infection (GESIDA study 8815).

INTRODUCTION: Lung cancer (LC) screening detects tumors early. The prospective GESIDA 8815 study was designed to assess the usefulness of this strategy in HIV + people (PLHIV) by performing a low-radiation computed tomography (CT) scan. PATIENTS AND METHODS: 371 heavy smokers patients were included (>20 packs/year), >45 years old and with a CD4+ <200 mm3 nadir. One visit and CT scan were performed at baseline and 4 for follow-up time annually. RESULTS: 329 patients underwent the baseline visit and CT (CT0) and 206 completed the study (CT1 = 285; CT2 = 259; CT3 = 232; CT4 = 206). All were receiving ART. A total >8 mm lung nodules were detected, and 9 early-stage PCs were diagnosed (4 on CT1, 2 on CT2, 1 on CT3 and 2 on CT4). There were no differences between those who developed LC and those who did not in sex, age, CD4+ nadir, previous lung disease, family history, or amount of packets/year. At each visit, other pathologies were diagnosed, mainly COPD, calcified coronary artery and residual tuberculosis lesions. At the end of the study, 38 patients quit smoking and 75 reduced their consumption. Two patients died from LC and 16 from other causes (p = 0.025). CONCLUSIONS: The design of the present study did not allow us to define the real usefulness of the strategy. Adherence to the test progressively decreased over time. The diagnosis of other thoracic pathologies is very frequent. Including smokers in an early diagnosis protocol for LC could help to quit smoking.

Prevention and treatment of opportunistic infections and other coinfections in HIV-infected patients: may 2015 / Prevención y tratamiento de infecciones oportunistas y otras coinfecciones en pacientes infectados por el VIH: mayo de 2015

Despite the huge advance that antiretroviral therapy represents for the prognosis of infection by the human immunodeficiency virus (HIV), opportunistic infections (OIs) continue to be a cause of morbidity and mortality in HIV-infected patients. OIs often arise because of severe immunosuppression resulting from poor adherence to antiretroviral therapy, failure of antiretroviral therapy, or unawareness of HIV infection by patients whose first clinical manifestation of AIDS is an OI. The present article updates our previous guidelines on the prevention and treatment of various OIs in HIV-infected patients, namely, infections by parasites, fungi, viruses, mycobacteria, and bacteria, as well as imported infections. The article also addresses immune reconstitution inflammatory syndrome

A pesar del gran avance que ha supuesto el tratamiento antirretroviral (TAR) para el pronóstico de la infección por el VIH, las infecciones oportunistas (IO) continúan siendo causa de morbilidad y mortalidad en estos pacientes. Ello ocurre en muchos casos debido a la inmunodepresión grave, bien ante la falta de adherencia al TAR, el fracaso del mismo o el desconocimiento de la existencia de la infección por el VIH en pacientes que comienzan con una IO. El presente artículo actualiza las recomendaciones de prevención y tratamiento de diferentes infecciones en pacientes con infección por VIH: parasitarias, fúngicas, víricas, micobacterianas, bacterianas e importadas, además del síndrome de reconstitución inmune

Executive summary: Prevention and treatment of opportunistic infections and other coinfections in HIV-infected patients: may 2015 / Executive summary: Prevención y tratamiento de infecciones oportunistas y otras coinfecciones en pacientes infectados por el VIH: mayo de 2015

Opportunistic infections continue to be a cause of morbidity and mortality in HIV-infected patients. They often arise because of severe immunosuppression resulting from poor adherence to antiretroviral therapy, failure of antiretroviral therapy, or unawareness of HIV infection by patients whose first clinical manifestation of AIDS is an opportunistic infection. The present article is an executive summary of the document that updates the previous recommendations on the prevention and treatment of opportunistic infections in HIV-infected patients, namely, infections by parasites, fungi, viruses, mycobacteria, and bacteria, as well as imported infections. The article also addresses immune reconstitution inflammatory syndrome. This document is intended for all professionals who work in clinical practice in the field of HIV infection

Las infecciones oportunistas siguen siendo una causa importante de morbi mortalidad en pacientes con infección por VIH. Ello ocurre en muchos casos debido a la inmunodepresión grave, bien ante la falta de adherencia al tratamiento antirretroviral, el fracaso del mismo o el desconocimiento de la existencia de la infección por el VIH en pacientes que comienzan con una infección oportunista. Este artículo es un resumen del documento de consenso que actualiza las recomendaciones previas de GESIDA respecto a la prevención y el tratamiento de las diferentes infecciones oportunistas en pacientes infectados por VIH: parasitarias, fúngicas, víricas, micobacterianas, bacterianas e importadas, además del síndrome de reconstitución inmune. Está dirigido a los profesionales que trabajan en la práctica clínica en el campo del VIH, con el objetivo de facilitarles una atención de calidad en la prevención y tratamiento de estas infecciones

Impact of inosine triphosphatase gene variants on the risk of anemia in HIV/hepatitis C virus-coinfected patients treated for chronic hepatitis C.

The role of rs1127354/rs7270101 alleles at the inosine triphosphatase (ITPA) gene on ribavirin-induced anemia was assessed in 74 patients with hepatitis C virus and human immunodeficiency virus coinfection. Anemia developed in 80% of patients with normal ITPA activity compared with 33% of those with reduced ITPA activity. In contrast, ITPA variants did not influence sustained virological response.

La comorbilidad como factor limitante del TARGA / Comorbidity as a factor limiting HAART

Desde el año 1997, y coincidiendo con la generalización del tratamiento antirretroviral de gran actividad (TARGA), se ha observado un descenso marcado de las infecciones y las enfermedades oportunistas, definitorias o no de sida, y una mejoría de la calidad de vida de los pacientes infectados por el virus de la inmunodeficiencia humana (VIH). Pero esto no se ha producido sin pagar un precio. A los efectos adversos a corto plazo estudiados en los ensayos clínicos y que plantean los problemas de tolerancia y adherencia iniciales, se añaden otros a largo plazo, como la lipodistrofia o las alteraciones metabólicas. En la actualidad siguen apareciendo infecciones oportunistas como la tuberculosis, se ha observado un incremento de la incidencia de tumores y, además, las complicaciones relacionadas con la hepatopatía por el virus de la hepatitis B y/o C son cada vez más preocupantes. Por otra parte, la media de edad de las personas infectadas va aumentando y con ello, al igual que en la población general, aparecen nuevas enfermedades y aumenta la incidencia de otras, como las cardiovasculares o las degenerativas. En estos momentos, pese a conseguir un buen control de la infección, es imposible la erradicación del virus, lo que conduce a un tratamiento de por vida, salvo en escenarios específicos. Se hace necesario un mejor conocimiento de la infección por el VIH y de los fármacos y sus combinaciones, así como el diseño de estrategias adecuadas para conseguir mantener la eficacia del tratamiento con el menor coste posible para los pacientes

Since 1997, the number of opportunistic infections and AIDS-defining and other illnesses has markedly decreased while the quality of life of HIV-infected patients has improved with the widespread use of highly active antiretroviral therapy (HAART). However, these improvements have not come without a price. There are both short-term adverse effects, which have been well studied in clinical trials and which lead to problems of initial adherence and tolerance, and long-term adverse events, such as lipodystrophy and metabolic abnormalities. Currently, opportunistic infections such as tuberculosis continue to appear, the incidence of tumors has increased, and the problems related to chronic hepatitis B and/or C are causing increasing concern. In addition, the mean age of HIV-infected patients is rising and consequently, as in the general population, these patients develop new diseases and the incidence of others, such as cardiovascular and degenerative diseases, increases. At the present time, although good control of HIV infection has been achieved, there is still no cure and treatment is for life, with few exceptions. Better knowledge of HIV infection, antiretroviral drugs and their combinations is essential, as is the design of appropriate strategies to maintain treatment effectiveness at the lowest cost possible to these patients