Utilidad de la ecografía de la arteria femoral complementaria a la exploración carotídea para la detección de ateromatosis subclínica en pacientes con infección por el virus de la inmunodeficiencia humana / Usefulness of artery femoral ultrasound complementary to carotid exploration for the detection of subclinical atheromatosis in patients with human immunodeficiency virus infection

Introducción La detección de la enfermedad ateromatosa subclínica (EAS) en los pacientes con el virus de la inmunodeficiencia humana (VIH) se basa habitualmente en la ecografía carotídea. Sin embargo, estudios en otras enfermedades muestran una infraestimación de la EAS cuando se explora exclusivamente la región carotídea. Este estudio evalúa el impacto de la exploración combinada carotídea y femoral en la detección de la EAS. Métodos Estudio transversal y prospectivo de pacientes con VIH, diagnosticados entre 2008 y 2017. Se realizó ecografía carotídea y femoral. La EAS fue definida según los criterios de Mannheim. Resultados Se incluyeron 102 pacientes (edad media: 40 años, el 73,5% varones). La prevalencia de la EAS por exploración carotídea fue del 15,7% (n=16), y por exploración femoral fue del 18,6% (n=19). La proporción de pacientes con criterios de EAS global (afectación carotídea o femoral) fue del 23,5% (n=24) lo que implica un aumento absoluto de la detección de EAS del 7,84% (IC 95%: 2,63-13,06%). Conclusiones La detección de la EAS aumenta de forma importante con el uso combinado de la ecografía carotídea y femoral en la población con VIH. (AU)

Introduction Detection of subclinical atheromatosis disease (SAD) in patients with human immunodeficiency virus (HIV) infection is usually based on carotid ultrasound. However, studies in other pathologies have shown a probable underestimation of SAD when its detection is exclusively based on carotid exploration. This study evaluates the impact on detection of SAD in patients with HIV through combined carotid and femoral exploration. Methods Cross-sectional and prospective study of patients with HIV, diagnosed between 2008-2017. Carotid and femoral ultrasound examination was performed in all patients. EAS was defined according to Mannheim criteria. Results One hundred two patients were included (mean age: 40 years, 73.5% being male). The prevalence of carotid SAD in the total sample was 15.7% (n=16), and the prevalence of femoral SAD was 18.6% (n=19). The proportion of patients with global SAD criteria (carotid or femoral) was 23.5% (n=24), which implies an absolute increase in SAD detection of 7.84% (95% CI; 2.63-13.06%) at the total sample. Conclusions Detection of SAD is significantly increased by the combined use of carotid and femoral arterial ultrasound in the population affected by HIV infection. (AU)

[Usefulness of artery femoral ultrasound complementary to carotid exploration for the detection of subclinical atheromatosis in patients with human immunodeficiency virus infection]. / Utilidad de la ecografía de la arteria femoral complementaria a la exploración carotídea para la detección de ateromatosis subclínica en pacientes con infección por el virus de la inmunodeficiencia humana.

INTRODUCTION: Detection of subclinical atheromatosis disease (SAD) in patients with human immunodeficiency virus (HIV) infection is usually based on carotid ultrasound. However, studies in other pathologies have shown a probable underestimation of SAD when its detection is exclusively based on carotid exploration. This study evaluates the impact on detection of SAD in patients with HIV through combined carotid and femoral exploration. METHODS: Cross-sectional and prospective study of patients with HIV, diagnosed between 2008-2017. Carotid and femoral ultrasound examination was performed in all patients. EAS was defined according to Mannheim criteria. RESULTS: One hundred two patients were included (mean age: 40 years, 73.5% being male). The prevalence of carotid SAD in the total sample was 15.7% (n=16), and the prevalence of femoral SAD was 18.6% (n=19). The proportion of patients with global SAD criteria (carotid or femoral) was 23.5% (n=24), which implies an absolute increase in SAD detection of 7.84% (95% CI; 2.63-13.06%) at the total sample. CONCLUSIONS: Detection of SAD is significantly increased by the combined use of carotid and femoral arterial ultrasound in the population affected by HIV infection.

[Capillaroscopy, microangiopathy, and HIV. Descriptive study of capillaroscopy findings in HIV positive patients].

BACKGROUND: In this study, we aim to evaluate microangiopathy in HIV positive patients by using capillaroscopy. To date, few studies have been published on the topic. Capillaroscopy may be a tool for early diagnosis of cardiovascular involvement in this patient population. METHODOLOGY: Cross-sectional study with HIV positive patients >18 years. The enrolment period was set from January to June 2018. The following data were collected: demographic (sex, age), laboratory tests (duration of infection, CD4 cell count, CD4:CD8 ratio, coinfection with other viruses), antiretroviral treatment, dyslipidemia, and comorbidities (active smoking, alcoholism, high blood pressure, dyslipidaemia, diabetes, cardiopathy). The capillaroscopy and blood tests were performed simultaneously. The following alterations were evaluated in the capillaroscopy: congestion, tortuosity, haemorrhage, dilations, capillary loss, and presence of megacapillaries. RESULTS: One hundred and two patients were included; 73.5% were male, mean age was 40 years (SD: 10), and mean duration of infection 4.5 years (SD: 3.1). At diagnosis, mean CD4 cell count was 408/mm3 and CD4/CD8 ratio 0.4. A number of patients (14.7%) were coinfected with the hepatitis B virus; 31.3% were active smokers and 13.7% alcoholics. Capillaroscopy alterations were found in most study patients (93.1%): congestion (78.5%), tortuosity (77.5%), haemorrhage (13.8%), dilations (11.8%), capillary loss (5%), and megacapillaries (1%). Capillary tortuosity was associated with age and smoking; and haemorrhage with age, CD4, antiretroviral treatment, and hypertension. CONCLUSION: Prevalence of capillaroscopy alterations is high in HIV positive patients, particularly tortuosity and congestion. To the best of our knowledge, the later alteration has not been previously reported in this group of patients.

Capilaroscopia, microangiopatía y VIH. Estudio descriptivo de hallazgos capilaroscópicos en pacientes con VIH / Capillaroscopy, microangiopathy, and HIV. Descriptive study of capillaroscopy findings in HIV positive patients

Fundamento: El objetivo de este estudio fue valorar la afectación microangiopática mediante capilaroscopia en pacientes infectados por el virus de la inmunodeficiencia humana (VIH). Apenas ha sido estudiada y podría constituir una herramienta de diagnóstico precoz de afectación cardiovascular en estos pacientes. Material y métodos: Estudio transversal que incluyó pacientes mayores de 18 años, diagnosticados de infección por VIH entre 2008 y 2018. Se recogieron variables demográficas (sexo, edad), analíticas (tiempo de infección, CD4, CD4/CD8, coinfección por otros virus), tratamiento antirretroviral y comorbilidades (tabaquismo, enolismo, hipertensión arterial, dislipemia, diabetes, cardiopatía). Se realizó una capilaroscopia y un análisis de sangre en el mismo acto. Las alteraciones capilaroscópicas evaluadas fueron: congestión, tortuosidades, hemorragias, dilataciones, pérdida capilar y megacapilares. Resultados: Se incluyeron 102 pacientes, 73,5% hombres, edad media 40 años (DE: 10) y tiempo medio de infección 4,5 años (DE: 3,1). Al diagnóstico, la media de CD4 fue 408 células/mm3 y la razón CD4/CD8 fue 0,4. El 14,7% presentaban coinfección por el virus de la hepatitis B, el 31,3% tabaquismo y el 13,7% enolismo. El 93,1% de pacientes mostró alguna alteración capilaroscópica. Se observaron, por orden de frecuencia, congestión (78,5%), tortuosidades (77,5%), hemorragias (13,8%), dilataciones (11,8%), pérdida capilar (5%) y megacapilares (1%). Las torutuosidades se asociaron a edad y tabaquismo, y las hemorragias a edad, CD4, tratamiento antirretroviral, e hipertensión. Conclusiones: Los pacientes con infección por VIH presentan una prevalencia importante de alteraciones capilaroscópicas, principalmente tortuosidades y congestión. Es la primera descripción de áreas de congestión como hallazgo capilaroscópico en este grupo de pacientes.(AU)

Background: In this study, we aim to evaluate microangiopathy in HIV positive patients by using capillaroscopy. To date, few studies have been published on the topic. Capillaroscopy may be a tool for early diagnosis of cardiovascular involvement in this patient population. Methodology: Cross-sectional study with HIV positive patients >18 years. The enrolment period was set from January to June 2018. The following data were collected: demographic (sex, age), laboratory tests (duration of infection, CD4 cell count, CD4:CD8 ratio, coinfection with other viruses), antiretroviral treatment, dyslipidemia, and comorbidities (active smoking, alcoholism, high blood pressure, dyslipidaemia, diabetes, cardiopathy). The capillaroscopy and blood tests were performed simultaneously. The following alterations were evaluated in the capillaroscopy: congestion, tortuosity, haemorrhage, dilations, capillary loss, and presence of megacapillaries. Results: One hundred and two patients were included; 73.5% were male, mean age was 40 years (SD: 10), and mean duration of infection 4.5 years (SD 3.1). At diagnosis, mean CD4 cell count was 408/mm3 and CD4/CD8 ratio 0.4. A number of patients (14.7%) were coinfected with the hepatitis B virus; 31.3% were active smokers and 13.7% alcoholics. Capillaroscopy alterations were found in most study patients (93.1%): congestion (78.5%), tortuosity (77.5%), haemorrhage (13.8%), dilations (11.8%), capillary loss (5%), and megacapillaries (1%). Capillary tortuosity was associated with age and smoking; and haemorrhage with age, CD4, antiretroviral treatment, and hypertension. Conclusion. Prevalence of capillaroscopy alterations is high in HIV positive patients, particularly tortuosity and congestion. To the best of our knowledge, the later alteration has not been previously reported in this group of patients.(AU)

Temporal Trends and Geographic Variability in the Prescription of Antiretroviral Treatments in People Living with HIV in Spain, 2004-2020.

BACKGROUND: The purpose of this study was to describe temporal trends in the use of antiretroviral therapy (ART) among people living with HIV (PLWHIV) from the cohort of the Spanish HIV/AIDS research network (CoRIS), 2004-2020. METHODS: We described the yearly evolution of the proportion of patients receiving ART and the most frequently prescribed antiretroviral drugs among newly recruited treatment-naïve patients and among all patients with active follow-up. RESULTS: Of 15,539 patients included, 14,618 (94.1%) started ART during their follow-up. Regarding initial regimens, the use of 2NRTI plus 1NNRTI (which were the most frequently prescribed until 2014) and 2NRTI plus 1bPI decreased after 2014, being gradually replaced by INI-based triple therapies. Since 2019, other regimens started to be prescribed, mainly dual therapies. TDF/FTC/EFV was the single-tablet regimen (STR) most frequently prescribed as initial ART until 2012, decreasing thereafter as TDF/FTC/RPV, TDF/FTC/EVG/COBI, and ABC/3TC/DTG became available. TAF/FTC/BIC accounted for 53.6% of initial prescriptions in 2020, followed by DTG/3TC (24%). The percentage of patients on ART increased from 45.7% in 2004 to 98.2% in 2020. Among all patients receiving ART, regimens based on 2NRTI plus 1INI increased from 0.1% in 2007 to 53.3% in 2020. During 2007-2015, most patients were receiving TDF/FTC/EFV, which was replaced after 2017 by ABC/3TC/DTG. In 2020, 13.0% of patients were receiving dual therapies. CONCLUSIONS: Robust real-world data on ART use in PLWHIV over more than 15 years show historical trends in prescriptions with an unprecedented visualization of the contemporary treatment patterns.

El reto del envejecimiento y la complejidad farmacoterapéutica en el paciente VIH + / The challenge of aging and pharmacoterapeutic complexity in the HIV + patient

Objetivo:Describir el conocimiento actual y el manejo del envejecimiento y la complejidad farmacoterapéutica en pacientes VIH +. Método: Se realizó una revisión bibliográfica, incluyéndose artículos, originales o revisiones, publicados en lengua inglesa o española, desde 2007 al 2017, que analizaron el envejecimiento y la complejidad farmacoterapéutica en pacientes VIH + . Se combinaron los términos: "Polypharmacy"/"Polifarmacia", "Aging"/"Envejecimiento", "Frailty"/"Fragilidad", "Complejidad Farmacoterapéutica"/"Medication Regimen Complexity" y "HIV"/"VIH". La revisión se realizó de forma independiente por dos autores. Se analizó el grado de concordancia según el índice Kappa. Resultados: Se analizaron 208 referencias bibliográficas, incluyéndose finalmente 68. Se ha identificado un envejecimiento de la población y un incremento de las comorbilidades asociadas, especialmente a partir de los 50 años. Se han descrito cambios inmunológicos similares a los que se generan en la población anciana no infectada. Esto condiciona, según estudios identificados, la prescripción del tratamiento antirretroviral. Paralelamente, el concepto de polifarmacia está cada vez más presente, definiéndose exclusivamente por el uso concomitante de cinco fármacos. La complejidad farmacoterapéutica, a través del Medication Regimen Complexity Index, se ha empezado a analizar y a relacionar con resultados en salud. Se ha evidenciado una necesidad de profundizar y aplicar conceptos ya conocidos en la población no VIH envejecida, como desprescripción, medicación potencialmente inapropiada, riesgo colinérgico, etc., aunque existen pocos resultados disponibles. Conclusiones: Existe un interés creciente en profundizar en la relación VIH y envejecimiento. La complejidad farmacoterapéutica está empezando a utilizarse como criterio de seguimiento farmacoterapéutico por su influencia en los resultados en salud. Es necesario manejar e incorporar nuevos conceptos que ayuden a la optimización farmacoterapéutica en esta población

Objective:To describe the current knowledge and management of aging and pharmacotherapeutic complexity in HIV + patients. Method: A review of literature was carried out, including articles, originals or reviews, published in English or Spanish, from 2007 to 2017, which analysed the aging and pharmacotherapeutic complexity in HIV + patients. The terms «Polypharmacy»/«Polifarmacia», «Aging»/«Envejecimiento», «Frailty»/«Fragilidad», «Complejidad Farmacoterapéutica»/«Medication Regimen Complexity» and «HIV»/«VIH» were combined. The review was carried out independently by two authors. The degree of agreement, according to the Kappa index, was analysed. Results: A total of 208 references were analysed, including, finally, only 68. An aging of the population and an increase in associated comorbidities have been identified, especially over 50 years-old. Immunological changes similar to those that are generated in a non-infected elderly population have been described. These conditions influencing the prescription of antiretroviral treatment, according to studies identified. In parallel, polypharmacy is increasingly present, being defined exclusively by the concomitant use of five drugs. Pharmacotherapeutic complexity, through the Medication Regimen Complexity Index, has begun to analyse and relate to health outcomes. There has been a need to know and apply concepts already known in non-HIV-aged population, such as deprescription, potentially inappropriate medication, cholinergic risk, although few results are available. Conclusions: There is a growing interest to know about the relationship between HIV and aging. Pharmacotherapeutic complexity is beginning to be used as a pharmacotherapeutic follow-up criterion due to its influence on health outcomes. It is necessary to manage and incorporate new concepts that help pharmacotherapeutic optimization in this population

The challenge of aging and pharmacoterapeutic complexity in the HIV + patient.

OBJECTIVE: To describe the current knowledge and management of aging and  pharmacotherapeutic complexity in HIV + patients. METHOD: A review of literature was carried out, including articles, originals or  reviews, published in English or Spanish, from 2007 to 2017, which analysed the aging and pharmacotherapeutic complexity in HIV + patients. The terms  «Polypharmacy¼/¼Polypharmacy¼, «Aging¼/¼Aging¼, «Frailty¼/¼Fragility¼,  «Pharmacotherapeutic Complexity¼/¼Medication Regimen Complexity¼ and  «HIV¼/"HIV¼ were combined. The review was carried out independently by two  authors. The degree of agreement, according to the Kappa index, was analysed. Results: A total of 208 references were analysed, including, finally, only 68. An  aging of the population and an increase in associated comorbidities have been  identified, especially over 50 years-old. Immunological changes similar to those  that are generated in a non-infected elderly population have been described.  These conditions influencing the prescription of antiretroviral treatment,  according to studies identified. In parallel, polypharmacy is increasingly present,  being defined exclusively by the concomitant use of five drugs.  Pharmacotherapeutic complexity, through the Medication Regimen Complexity  Index, has begun to analyse and relate to health outcomes. There has been a  need to know and apply concepts already known in non-HIV-aged population,  such as de-prescription, potentially inappropriate medication, cholinergic risk, although few results are available. CONCLUSIONS: There is a growing interest to know about the relationship between HIV and aging. Pharmacotherapeutic complexity is  beginning to be used as a pharmacotherapeutic follow-up criterion due to its influence on health outcomes. It is necessary to manage and incorporate new  concepts that help pharmacotherapeutic optimization in this population.

Objetivo: Describir el conocimiento actual y el manejo del envejecimiento y la  complejidad farmacoterapéutica en pacientes VIH ≥ .Método: Se realizó una revisión bibliográfica, incluyéndose artículos, originales o revisiones, publicados en lengua inglesa o española, desde 2007 al 2017, que analizaron el envejecimiento y la complejidad farmacoterapéutica  en pacientes VIH ≥ . Se combinaron los términos:  "Polypharmacy"/"Polifarmacia", "Aging"/"Envejecimiento", "Frailty"/"Fragilidad",  "Complejidad Farmacoterapéutica"/"Medication Regimen Complexity" y  "HIV"/"VIH". La revisión se realizó de forma independiente por dos autores. Se  analizó el grado de concordancia según el índice Kappa.Resultados: Se analizaron 208 referencias bibliográficas, incluyéndose finalmente 68. Se ha identificado un envejecimiento de la  población y un incremento de las comorbilidades asociadas, especialmente a  partir de los 50 años. Se han descrito cambios inmunológicos similares a los que  se generan en la población anciana no infectada. Esto condiciona, según estudios identificados, la prescripción del tratamiento antirretroviral. Paralelamente, el concepto de polifarmacia está cada vez más  presente, definiéndose exclusivamente por el uso concomitante de cinco  fármacos. La complejidad farmacoterapéutica, a través del Medication Regimen Complexity Index, se ha empezado a analizar y a relacionar con  resultados en salud. Se ha evidenciado una necesidad de profundizar y aplicar conceptos ya conocidos en la población no VIH envejecida, como  desprescripción, medicación potencialmente inapropiada, riesgo colinérgico, etc., aunque existen pocos resultados disponibles.Conclusiones: Existe un interés creciente en profundizar en la relación VIH y  envejecimiento. La complejidad farmacoterapéutica está empezando a utilizarse  como criterio de seguimiento farmacoterapéutico por su influencia en los  resultados en salud. Es necesario manejar e incorporar nuevos conceptos que  ayuden a la optimización farmacoterapéutica en esta población.

Insuficiencia suprarrenal iatrogénica por la interacción entre ritonavir y fluticasona inhalada. Revisión de la literatura / Iatrogenic adrenal insufficiency secondary to an interaction between ritonavir and inhaled fluticasone. A review of the literature

INTRODUCCIÓN: El tratamiento antirretroviral de alta eficacia ha incrementado la expectativa de vida en los pacientes con infección por el virus de inmunodeficiencia humana (VIH), lo que ha traído consigo un aumento de comorbilidades propias del envejecimiento de la población, como es el caso de la enfermedad pulmonar obstructiva crónica (EPOC). Todo esto conlleva la necesidad de utilizar un mayor número de medicamentos y un aumento en el riesgo de interacciones farmacológicas con los antirretrovirales, especialmente con los inhibidores de la proteasa. MÉTODOS: Describimos un caso de insuficiencia suprarrenal iatrogénica por interacción entre ritonavir y fluticasona inhalada en un paciente diagnosticado de infección por VIH y EPOC. Posteriormente realizamos una revisión de casos clínicos publicados en adultos en la literatura médica (Medline) hasta diciembre del 2012. RESULTADOS: En el periodo estudiado se identificaron 34 casos, con una media de edad de 48 años. La dosis promedio de ritonavir fue de 187 mg/día, mientras que la de fluticasona fue de 866 μg/día. El promedio de tiempo de la interacción entre el ritonavir y la fluticasona fue de 8 meses. En el 85% de los casos se retiró la fluticasona una vez hecho el diagnóstico de insuficiencia suprarrenal/síndrome de Cushing. El 90% de los pacientes presentó una resolución completa del cuadro clínico con la modificación del tratamiento. CONCLUSIÓN: En los pacientes en tratamiento antirretroviral con un inhibidor de la proteasa potenciado con ritonavir en los que sea preciso el uso de corticoides inhalados, la beclometasona sería la mejor opción terapéutica

INTRODUCTION: Highly effective antiretroviral treatment has improved the life expectancy of human immunodeficiency virus (HIV) infected patients, but has led to an increase in the comorbidities related to aging, such as the chronic obstructive pulmonary disease (COPD). All this implies the need for a greater number of drugs and an increasing risk of drugs interactions with antiretroviral treatment, particularly protease inhibitors. METHODS: We report a case of iatrogenic adrenal insufficiency interaction secondary to ritonavir and inhaled fluticasone in an HIV-infected patient with COPD. A review was made of the cases reported in adults in the medical literature (Medline) up to December 2012. RESULTS: A total of 34 cases were reported. The mean age was 48 years. The mean dose of ritonavir was 187 mg/day, while the fluticasone dose was 866 μg/day. The average time of the interaction between ritonavir and fluticasone was 8 months. In 85% of cases fluticasone was discontinued at the time of diagnosis of adrenal insufficiency/Cushing syndrome. Almost all (90%) patients had a complete resolution of the symptoms after changing the treatment. CONCLUSION: HIV-infected patients on antiretroviral therapy with protease inhibitor boosted with ritonavir which requires the use of inhaled corticosteroids, beclomethasone would be the best treatment option

[Iatrogenic adrenal insufficiency secondary to an interaction between ritonavir and inhaled fluticasone. A review of the literature]. / Insuficiencia suprarrenal iatrogénica por la interacción entre ritonavir y fluticasona inhalada. Revisión de la literatura.

INTRODUCTION: Highly effective antiretroviral treatment has improved the life expectancy of human immunodeficiency virus (HIV) infected patients, but has led to an increase in the comorbidities related to aging, such as the chronic obstructive pulmonary disease (COPD). All this implies the need for a greater number of drugs and an increasing risk of drugs interactions with antiretroviral treatment, particularly protease inhibitors. METHODS: We report a case of iatrogenic adrenal insufficiency interaction secondary to ritonavir and inhaled fluticasone in an HIV-infected patient with COPD. A review was made of the cases reported in adults in the medical literature (Medline) up to December 2012. RESULTS: A total of 34 cases were reported. The mean age was 4 years. The mean dose of ritonavir was 187 mg/day, while the fluticasone dose was 866 µg/day. The average time of the interaction between ritonavir and fluticasone was 8 months. In 85% of cases fluticasone was discontinued at the time of diagnosis of adrenal insufficiency/Cushing syndrome. Almost all (90%) patients had a complete resolution of the symptoms after changing the treatment. CONCLUSION: HIV-infected patients on antiretroviral therapy with protease inhibitor boosted with ritonavir which requires the use of inhaled corticosteroids, beclomethasone would be the best treatment option.

Infección por el virus de la inmunodeficiencia humana en diferentes grupos de edad: implicaciones potenciales para la prevención. Cohorte CoRIS, España, 2004–2008 / HIV infection in different age groups: Potential implications for prevention. CoRIS Cohort, Spain, 2004–2008

Fundamento y objetivo: Describir las características de pacientes adultos con infección por el virus de la inmunodeficiencia humana (VIH) según su edad al momento de la inclusión en la Cohorte de la Red de Investigación en Sida (CoRIS). Pacientes y métodos: Análisis de una cohorte abierta, prospectiva, multicéntrica de adultos con infección por el VIH sin tratamiento antirretroviral previo, atendidos por primera vez entre enero de 2004 y noviembre de 2008, en 28 hospitales españoles (CoRIS). Se analizaron sus características en la primera visita y la distribución de las enfermedades definitorias de sida (EDS) a lo largo de la vida, según la edad al momento de la inclusión. El retraso diagnóstico se definió como pacientes con diagnóstico de sida o cifra de CD4+ inferior a 200 cel/μl durante el año posterior al diagnóstico de la infección por el VIH. Resultados: Participaron 4.418 personas; el 30,4% con 30 años o menos, el 60,6% de entre 31 y 50 años y el 8,9% de mayores de 50 años. El 31,6% de los pacientes eran inmigrantes (el 44,1% entre los jóvenes), el 79,6% correspondía a transmisión sexual y el 15,2% tenía diagnóstico de sida en la primera visita (el 28,1% entre los mayores de 50 años). El 34,6% de los pacientes tenía retraso diagnóstico (el 53,3% en los mayores de 50 años). La distribución de las EDS varió con la edad: las tuberculosis son más frecuentes en jóvenes y la neumonía por Pneumocystis jiroveci, la leucoencefalopatía multifocal progresiva, la encefalopatía por VIH, la neumonía recurrente y el linfoma cerebral primario son más frecuentes en los mayores. Conclusiones: Las características inmunológicas y las EDS varían con la edad. El porcentaje de personas con retraso diagnóstico es inaceptablemente alto, lo que indica que deben diseñarse intervenciones dirigidas a efectuar un diagnóstico más precoz (AU)

Background and objective: To describe the characteristics of HIV infected adults according to their age at recruitment in CoRIS. Patients and methods: Analysis of an open, prospective, multicentric cohort of HIV+ adults without previous antiretroviral treatment, attended for the first time from January/2004 to November/2008, in 28 Spanish hospitals (CoRIS). We analyzed their characteristics at recruitment and the distribution of AIDS defining illnesses (ADI) prior to cohort entry and during follow up, according to their age at recruitment. Delayed diagnosis was defined as a patient with AIDS diagnosis and/or CD4+ cell count lower than 200 cells/μl within the first year after HIV diagnosis. Results: Of 4,418 patients included, 30.4% were <=30 years old, 60.6% between 31 and 50 and 8.9% older than 50 at cohort entry; 31.6% of patients were immigrants (44.1% in the youngest group), 79.6% had been sexually transmitted and 15.2% had an AIDS diagnosis at cohort entry (28.1% between those older than 50). In 34.6% of cases there was a late diagnosis (53.3% in the oldest group). The ADIs varied according to age; tuberculosis was more frequent in the youngest. Pneumocystis jiroveci pneumonia, progressive multifocal leukoencephalopathy, HIV related encephalopathy, recurrent pneumonia and primary lymphoma of brain were more frequent among the oldest. Conclusions: The immunological characteristics and the distribution of ADIs varied according to age. The proportion of late diagnosis was unacceptably high, suggesting the need of specific interventions designed to promote earlier diagnosis (AU)

[HIV infection in different age groups: Potential implications for prevention. CoRIS Cohort, Spain, 2004-2008]. / Infección por el virus de la inmunodeficiencia humana en diferentes grupos de edad: implicaciones potenciales para la prevención. Cohorte CoRIS, España, 2004-2008.

BACKGROUND AND OBJECTIVE: To describe the characteristics of HIV infected adults according to their age at recruitment in CoRIS. PATIENTS AND METHODS: Analysis of an open, prospective, multicentric cohort of HIV+ adults without previous antiretroviral treatment, attended for the first time from January/2004 to November/2008, in 28 Spanish hospitals (CoRIS). We analyzed their characteristics at recruitment and the distribution of AIDS defining illnesses (ADI) prior to cohort entry and during follow up, according to their age at recruitment. Delayed diagnosis was defined as a patient with AIDS diagnosis and/or CD4+ cell count lower than 200 cells/microl within the first year after HIV diagnosis. RESULTS: Of 4,418 patients included, 30.4% were < or =30 years old, 60.6% between 31 and 50 and 8.9% older than 50 at cohort entry; 31.6% of patients were immigrants (44.1% in the youngest group), 79.6% had been sexually transmitted and 15.2% had an AIDS diagnosis at cohort entry (28.1% between those older than 50). In 34.6% of cases there was a late diagnosis (53.3% in the oldest group). The ADIs varied according to age; tuberculosis was more frequent in the youngest. Pneumocystis jiroveci pneumonia, progressive multifocal leukoencephalopathy, HIV related encephalopathy, recurrent pneumonia and primary lymphoma of brain were more frequent among the oldest. CONCLUSIONS: The immunological characteristics and the distribution of ADIs varied according to age. The proportion of late diagnosis was unacceptably high, suggesting the need of specific interventions designed to promote earlier diagnosis.