Telemedicine in HIV health care during the COVID-19 pandemic: An implementation research study in Buenos Aires, Argentina.

BACKGROUND: From October 2020 to October 2022, we conducted an implementation study to offer telemedicine (TM) across four HIV units of general public hospitals in Buenos Aires. The intervention used TM to provide a continuum of care to patients with HIV. METHODS AND SETTING: We used the RE-AIM framework to evaluate the strategy. The study started during a COVID-19 outbreak with strict lockdown policies and continued until return to normal practices. Implementation facilitation served as the core implementation strategy. RESULTS: We reached 4118 patients (58% of eligible individuals), and the main perceived benefits were the ability to avoid exposure to infectious diseases and reduced travel time and cost. After a median of 515 days of follow-up, 95.7% of participants with HIV were receiving antiretroviral therapy, and 87.8% were virally suppressed, with a median CD4+ count of 648 cells/µL. In total, 36.6% reported clinical events, and 20.4% presented with COVID-19 infection. The proportion of physicians adopting TM was 69.37%. After enrolment, 2406 of 5640 (43%) follow-up visits were conducted via TM. By the end of the study, 26.29% of appointments offered in the four centres were through TM, whereas 73.71% were in-person appointments. CONCLUSION: It was feasible to implement TM in the four centres in the public health sector in Buenos Aires, Argentina. It was acceptable for both patients and healthcare workers, and effectively reached a large proportion of the population served in these clinics. Both healthcare workers and patients consider it a model of care that will continue to be offered in the future.

Diagnóstico tardío de VIH: diferencias entre nativos y migrantes internacionales. Estudio observacional en un hospital de la Ciudad Autónoma de Buenos Aires / Late diagnosis of HIV-infection: differences between natives and international migrants. Observationalstudy in a hospital of Ciudad Autónoma de BuenosAires

ntroducción: El diagnóstico tardío de la infección por VIH y el acceso de los pacientes con enfermedad avanzada al sistema de salud afectan negativamente los beneficios in-dividuales y colectivos del tratamiento antirretroviral. A nivel mundial existe una alta prevalencia de diagnóstico tardío es-pecialmente en poblaciones vulnerables como los migrantes.Objetivos: Medir la prevalencia de diagnóstico tardío de infección por VIH entre migrantes internacionales y com-pararla con la de los argentinos.Material y métodos: Estudio retrospectivo, observacional, de personas mayores de 16 años asistidas en el Hospital General de Agudos Donación Francisco Santojanni que hubieran recibido diagnóstico de infección por VIH entre 01/1/2018 y el 31/12/2021. Se determinó la mediana de recuento de CD4 basal y la prevalencia de diagnóstico tar-dío. Aplicamos la prueba de la suma de rangos de Wilcoxon para la variable contínua y la prueba de Fisher para com-parar proporciones.Resultados: Incluimos 199 personas (52 migrantes, 147 argentinos). Los migrantes presentaron un nivel basal de linfocitos CD4 significativamente menor [Mediana (RIC 25-75) 248 (79-466) vs. 331 (166-532); p=0,044], mayor tasa de presentación tardía [69,2% vs. 54,4%; RR 1,27 (IC95 1,01-1,61); p=0,072] y con sida [44,2% vs. 30,6%; RR 1,44 (IC95 0,98-2,13); p=0,089] y una menor proporción de diagnós-ticos en etapa temprana [13,5% vs. 29,3%; RR 0,46 (IC95 0,22-0,96); p=0,026].Conclusiones: Los migrantes internacionales accedieron al diagnóstico en peor estado clínico que los argentinos. Conocer este dato es imprescindible para elaborar políti-cas tendientes a mejorar el acceso al diagnóstico de esta población vulnerable.

Introduction: The late diagnosis of HIV infection and the access of patients to health system with advanced disease negatively affect the individual and collective benefits of antiretroviral treatment. There is a worldwide high prevalence of late diagnosis, specially in vulnerable populations, such as migrants.Objectives: to measure the prevalence of late diagnosis of HIV infection among international migrants and compare it with the people born in Argentina.Material and methods: retrospective and observational study of people over 16 years old, assisted at the Donación Francisco Santojanni General Hospital, who had received a diagnosis of HIV infection between 01-01-2018 and 12-31-2021. The median baseline CD4 cell count and the prevalence of late diagnosis were determined. We applied the Wilcoxon rank sum test for the continuous variable and the Fisher test to compare proportions.Results: 199 subjects (52 migrants, 147 Argentinians) were included. Migrants presented a significantly lower baseline CD4 cell count [Median (IQR 25-75) 248 (79-466) vs 331 (166-532); p=0.044], a higher rate of late presentation [69.2% vs 54.4%; RR 1.27 (CI95 1.01-1.61); p=0.072], presentation with aids [44.2% vs 30.6%; RR 1.44 (CI95 0.98-2.13); p=0.089]; and a lower proportion of early stage presentation [13.5% vs 29.3%; RR 0.46 (CI95 0.22-0.96); p=0.026].Conclusions: international migrants accessed to the diagnosis in a worse clinical condition than Argentinians. Knowing this information is essential for the development of policies aimed to improve the access to diagnosis of this vulnerable population

[Impact of COVID-19 related lockdown on the metabolic profile of people with HIV infection in Argentina]. / Impacto de la cuarentena por COVID-19 en el perfil metabólico de personas con infección por VIH en Argentina.

BACKGROUND: The spread of SARS-CoV-2 required widespread lockdown to mitigate the pandemic. Argentine authorities imposed preventive social isolation for 234 days (March 20th to November 9th 2020). This measure led to major changes in the population's lifestyle. AIM: To examine the influence of COVID-19 lockdown measures on the metabolic profile of HIV-infected patients in Argentina. METHODS: Retrospective cohort study of 10,239 HIV-infected patients under follow up in a private clinic for HIV care. Adult patients with ongoing antiretroviral therapy (ART) and a baseline determination of blood glucose, total cholesterol, HDL-cholesterol and triglycerides done before lockdown (BL: second semester of 2019) and a second determination during lockdown (DL: May 2020) were included. Patients with recent changes in ART that may have metabolic impact, those starting lipid/glucose lowering agents and pregnant women were excluded. Categorical variables were compared using the χ2 test or Fisher's exact test, and continuous variables using the t-test or the Mann-Whitney test. A two-tailed value of p < 0.05 was considered significant. RESULTS: 540 individuals were included, median of age was 47 years and 74.6% were male. Median body mass index was 26.1 and 94.6% had low cardiovascular risk. There was a significant increase in the percentage of patients that met criteria for hyperglycemia (BL 4.8% and DL 8.5%, p < 0.001). We also observed significant (p < 0.001) increase in median (IQR) BL vs DL values in LDL-cholesterol [109 (90-128) vs 118 (97-139) mg/dL]; and triglycerides [120 (87-172) vs. 132 mg/dL (96-184)]. The proportion of patients with hyper-LDL cholesterolemia according to individual cardiovascular risk increased from 12.6 to 17.2% (p = 0.04). CONCLUSION: Our results suggest that quarantine, at least in its initial phases, may have a negative impact on the metabolic profile of this population.

Impacto de la cuarentena por COVID-19 en el perfil metabólico de personas con infección por VIH en Argentina / Impact of COVID-19 related lockdown on the metabolic profile of people with HIV infection in Argentina

INTRODUCCIÓN: Para mitigar la propagación del SARS-CoV-2 se requirió de un confinamiento generalizado. Las autoridades argentinas impusieron aislamiento social preventivo durante 234 días (20 de marzo al 9 de noviembre de 2020), modificando el estilo de vida de la población. OBJETIVOS: Examinar la influencia de las medidas de bloqueo en el perfil metabólico de pacientes infectados por VIH en Argentina. PACIENTES Y MÉTODOS: Estudio de cohorte retrospectivo de 10.239 pacientes en seguimiento en una clínica de atención privada de personas con infección por VIH. Se incluyeron pacientes adultos con terapia antirretroviral (TARV) en curso que tuvieran una determinación de glucemia, colesterol total, colesterol HDL y trigliceridemia antes de la cuarentena (Pre-C: segundo semestre 2019) y una segunda determinación durante la misma (Intra-C: mayo 2020). Se excluyeron los pacientes con cambios en la TARV con impacto metabólico, los que iniciaron o suspendieron hipolipemiantes o hipoglucemiantes y mujeres embarazadas. Las variables categóricas se compararon mediante la prueba de la χ2 o la prueba exacta de Fisher y las continuas mediante la prueba t o la prueba de Mann-Whitney según correspondiera. Se consideró significativo un valor de p a dos colas < 0,05. RESULTADOS: Se incluyeron 540 individuos. La mediana de edad fue de 47 años y 74,6% fueron de sexo masculino. La mediana de índice de masa corporal fue 26,1 y 94,6% tenían bajo riesgo cardiovascular. Hubo un aumento significativo en el porcentaje de pacientes con hiperglucemia (Pre-C 5,2% vs Intra-C 8,5%, p 0,04), hipertrigliceridemia (Pre-C 33,9% vs Intra-C 40,7%, p 0,02) e hipercolesterolemia LDL (Pre-C 12,6% vs Intra-C 17,2%, p 0,04). CONCLUSIÓN: Nuestros resultados sugieren que la cuarentena, al menos en sus fases iniciales, puede tener un impacto negativo en el perfil metabólico de esta población.

BACKGROUND: The spread of SARS-CoV-2 required widespread lockdown to mitigate the pandemic. Argentine authorities imposed preventive social isolation for 234 days (March 20th to November 9th 2020). This measure led to major changes in the population's lifestyle. AIM: To examine the influence of COVID-19 lockdown measures on the metabolic profile of HIV-infected patients in Argentina. METHODS: Retrospective cohort study of 10,239 HIV-infected patients under follow up in a private clinic for HIV care. Adult patients with ongoing antiretroviral therapy (ART) and a baseline determination of blood glucose, total cholesterol, HDL-cholesterol and triglycerides done before lockdown (BL: second semester of 2019) and a second determination during lockdown (DL: May 2020) were included. Patients with recent changes in ART that may have metabolic impact, those starting lipid/glucose lowering agents and pregnant women were excluded. Categorical variables were compared using the χ2 test or Fisher's exact test, and continuous variables using the t-test or the Mann-Whitney test. A two-tailed value of p < 0.05 was considered significant. RESULTS: 540 individuals were included, median of age was 47 years and 74.6% were male. Median body mass index was 26.1 and 94.6% had low cardiovascular risk. There was a significant increase in the percentage of patients that met criteria for hyperglycemia (BL 4.8% and DL 8.5%, p < 0.001). We also observed significant (p < 0.001) increase in median (IQR) BL vs DL values in LDL-cholesterol [109 (90-128) vs 118 (97-139) mg/dL]; and triglycerides [120 (87-172) vs. 132 mg/dL (96-184)]. The proportion of patients with hyper-LDL cholesterolemia according to individual cardiovascular risk increased from 12.6 to 17.2% (p = 0.04). CONCLUSION: Our results suggest that quarantine, at least in its initial phases, may have a negative impact on the metabolic profile of this population.

Programa de acompañamiento por pares para personas con diagnóstico reciente de infección por VIH: Experiencia PPP / Peer support program for people with recently diagnosed HIV-infection: PPP experience

Introducción: Para mejorar la retención en el sistema de salud de las personas que viven con VIH (PVVIH) con diagnóstico reciente y promover su adherencia se implementó el programa de acompañamiento de pares "Positivos para Positivos" (PPP).Material y métodos: Se entrenó a PVVIH con excelente adherencia y se les ofreció integrar PPP. Entre 06/2014 y 08/2018 cada individuo con diagnóstico reciente de infección VIH fue invitado a contactar con PPP. Se evaluó prospectivamente la evolución de los pacientes durante un año y se analizaron variables vinculadas a adherencia. Se compararon sus resultados con lo observado entre PVVIH con diagnóstico reciente sin apoyo de pares. Se analizó mediante tablas de 2x2 y la prueba exacta de Fisher (EpiInfo7.2.2.6).Resultados: Se incluyeron 158 PVVIH (40 grupo intervención y 118 grupo control). En el grupo intervención hubo más pacientes que iniciaron TARGA [100% vs 87,3%; RR 1,15 (IC95 1,07-1,23); p=0,024]. Tras excluir a los derivados y fallecidos tempranamente quedaron 37 y 112 pacientes respectivamente. En el grupo intervención se observó mejor control clínico [94,6% vs 75,9%; RR 4,2 (IC95 1,08-16,6); p=0,015] y menos abandono de seguimiento [8,1% vs 25,9%; RR 0,3 (IC95 0,11-0,98); p=0,02]. Entre quienes iniciaron TARGA y tuvieron al menos una consulta con el servicio de Infectología (37 grupo intervención y 97 grupo control) se registraron más pacientes con alta tasa de retiro de TARGA de farmacia [51,4% vs 18,6%; RR 2,77 (IC95 1,64­4,66); p=0,0003]; mayor alcance de CV <50 [100% vs 85,1%; RR 1,18 (IC95 1,06­1,30); p=0,06]; y menos interrupciones RESUMENARTÍCULO ORIGINALISSN 2314-3193. Actualizaciones en sida e infectología. Buenos Aires. noviembre 2020. volumen 28. número 103: 80-92no estructuradas del TARGA [10,8% vs 36,1%; RR 0,3 (IC95 0,11­0,78); p=0,008]. Conclusión: El acompañamiento de pares impactó positivamente en la adherencia de las PVVIH con diagnóstico reciente en el primer año de seguimiento

ntroduction: To improve retention in the health system of recently diagnosed people living with HIV (PLHIV) and promote their adherence, the "Positive for Positive" peer support program (PPP) was implemented.Materials and methods: PLHIV with excellent adherence were trained and offered to integrate PPP. Between June/2014 and August/2018 each individual with a recent diagnosis of HIV infection was invited to contact PPP. Patients were prospectively evaluated for one year and variables linked to adherence were analyzed. Their results were compared with those observed among recently diagnosed PLHIV without peer support. It was analyzed using 2x2 tables and Fisher's exact test (EpiInfo7.2.2.6).Results: 158 PLHIV were included (40 intervention group and 118 control group). In the intervention group more patients started HAART [100% vs 87.3%; RR 1.15 (IC95 1.07-1.23); p=0.024]. After excluding referrals and early deaths, remained 37 and 112 patients, respectively. In the intervention group there was better clinical control [94.6% vs 75.9%; RR 4.2 (IC95 1.08-16.6); p=0.015] and less dropout from follow-up [8.1% vs 25.9%; RR 0.3 (IC95 0.11-0.98); p=0.02]. Among those who initiated HAART and had at least one visit to the Infectious Disease Outpatient Clinic (37 intervention group and 97 control group), more patients showed a high refill rate (51.4% vs. 18.6%); RR 2.77 (IC95 1.64-4.66); p=0.0003]; greater achievement of undetectable viral load [100% vs 85.1%; RR 1.18 (IC95 1.06-1.30); p=0.06]; fewer unstructured HAART interruptions [10.8% vs 36.1%; RR 0.3 (IC95 0.11-0.78); p=0.008].Conclusion: Peer support had a positive impact on adherence among recently diagnosed PLHIV in the first year of follow-up

Candidemia en un paciente que recibió tratamiento para infección por Clostridium difficile: relación directa o casualidad? / Candidemia subsequent to Clostridium difficile infection: direct relationship or coincidence?

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Tratamiento de la sífilis temprana en pacientes infectados con VIH: una dosis de penicilina benzatínica es suficiente / The outcome of treatment of early syphilis in HIV-infected patients: a single dose of benzathine penicillin seems sufficient

Comparar la respuesta clínica y serológica de pacientes infectados con VIH y sífilis temprana según hubieran recibido 1 ó más dosis de penicilina benzatínica, y evaluar factores asociados a fallo del tratamiento. Métodos: estudio retrospectivo, observacional, descriptivo en pacientes infectados con VIH tratados con penicilina benzatínica por sífilis temprana entre 1999-2009. Se consideró régimen corto de enicilina benzatínica 2.400.000 unidades cuando se administró 1 dosis, y régimen largo cuando se administraron más de 1 dosis. Se definió respuesta serológica adecuada al descenso de 4 títulos de la VDRL tras 6-12 meses del tratamiento. Se compraron las frcuencias de las respuestas serológicas mediante tablas de contingencia de 2x2; se determinó la significación estadística mediante la prueba de Chi2 corregida por Yates; las variables continuas se analizaron mediante Mann-Whitney; las proporciones se compararon mediante la prueba de las proporciones para dos muestras (Statistix 7.0). Las diferencias fueron consideradas significativas cuando p fue< 0,05. Resultados: evaluamos 237 eventos de sífilis temprana. Todos los pacientes con sífilis primaria y secundaria resolvieron los signos o síntomas de la enfermedad. Hubo respuesta serológica adecuada en 92,9 % y 90,99 % de quienes recibieron régimen corto versus largo respectivamente (p=0,59). No observamos diferencias significativas en los porcentajes de pacientes con respuesta serológica adecuada entre quienes recibieron el régimen corto o largo en ninguno de los subgrupos conformados: estratos de CD4, pacientes con o sin sida, con o sin TARGA, presentación clínica de la sífilis temprana y título de VDRL. Conclusiones: en nuestra experiencia, para tratar la sífilis temprana en pacientes con VIH, una dosis de penicilina benzatínica fue suficiente. No se halló ningún factor asociado a fallo serológico...

To compare the serological and clinical response to treatment of early syphilis in HIV-infected patients who received a single-dose versus more than 1 dose of benzathine penicillin 2.4 millon U associated with treatment failure. Methods: retrospective, observational, descriptive study (1999-2009). Adequate serological response was defined as at least a four-fold decrease in VDRL titers at 6-12 months of treatment. We compared the rate of response with contingency tables; the statistic significance was determined by Yate's corrected x 2 test; for continuous variables analysis Mann-Whitney was applied; to compare proportions, the proportion test was applied (Statistix 7.0). Differences were considered significant if p< 0,05. Results: 237 HIV-infected patients with early syphilis were evaluated. Every patient with primary or secondary syphilis resolved the signs or sympthoms of the disease. We found an adequate serological response in 92.9 % versus 90.99% of whom received a single-dose versus >1 doses of benzathine penicillin 2.4 million U, respectively (p=0.59). The difference between groups was not statistically significant regardless of their CD4 cell count, antiretroviral tretment, AIDS status or VDRL titer. Conclusions: in our experience, a single dose of benzathine penicillin 2.4 million U for the treatment of early syphilis in HIV-infected patients was sufficient to achieve an adequate serological response. None factor was found to be associated wth serological failure...

Sífilis maligna precoz asociada a VIH / Early malignant syphilis associated with HIV

La sífilis maligna precoz es una manifestación peculiar del período secundario caracterizado por lesiones papulosas y costrosasde carácter mutilante. Presentamos una paciente de 20 años VIH positivo, con lesiones papulosas y úlceras cubiertas por costras rupioides localizadas en cara, tronco, extremidades y región genital, respetando mucosa oral. Motiva esta comunicación la importancia del reconocimiento de esta forma clínica y su asociación con cuadros de inmunosupresión.

Early malignant syphilis is a peculiar manifestation of the secondary period characterized by crusted papules with mutilatingbehaviour. We report an HIV positive 20-year-old patient presenting papular lesions and ulcers covered by rupioid crusts locatedon face, trunk, limbs and genital region. Oral mucosa wasn´t involved. We emphasize the importance of recognition of this clinicalform and its association with immunosuppression states.

Nevirapine-associated toxicity in clinical practice in Buenos Aires, Argentina.

OBJECTIVES: to determine the incidence and risk factors for nevirapine (NVP)-associated toxicity in a cohort of HIV-infected people in Buenos Aires, Argentina. DESIGN: retrospective study. METHODS: HIV-infected adults who received NVP-based highly active antiretroviral therapy (HAART) at least for 2 weeks between May 1997 and March 2008 were included in this study. We analyzed patients' age, gender, HIV transmission route, HIV disease stage, pregnancy, alcohol intake, adverse events, coinfection with hepatitis B or C virus, time until toxicity, and withdrawal rates. RESULTS: a total of 1110 patients (631 men) were included. Rash was the most frequently observed adverse event; it was more frequent in women. The incidence of severe rash and hepatotoxicity was similar in women and men. Female sex was the only variable significantly associated with mild-to-moderate rash. High CD4 count, pregnancy, and chronic hepatitis were not associated with NVP-related toxicity. An undetectable viral load at the time of starting NVP treatment resulted in a lower risk of NVP-related rash.

Mother-child transmission of Chagas disease: could coinfection with human immunodeficiency virus increase the risk?

A study was conducted on all newborns from mothers with Chagas disease who were attended at Hospital Donación F. Santojanni between January 1, 2001, and August 31, 2007. Each child was investigated for the presence of Trypanosoma cruzi parasitemia through direct examination of blood under the microscope using the buffy coat method on three occasions during the first six months of life. Serological tests were then performed. Ninety-four children born to mothers infected with Trypanosoma cruzi were attended over the study period. Three of these children were born to mothers coinfected with the human immunodeficiency virus. Vertical transmission of Chagas disease was diagnosed in 13 children, in all cases by identifying parasitemia. The overall Chagas disease transmission rate was 13.8% (13/94). It was 100% (3/3) among the children born to mothers with HIV infection and 10.9% (10/91) among children born to mothers without HIV [Difference = 0.89; CI95 = 0.82-0.95; p = 0.0021]. We concluded that coinfection with HIV could increase the risk of vertical transmission of Chagas disease.

Mother-child transmission of Chagas disease: could coinfection with human immunodeficiency virus increase the risk? / Transmissão materno-fetal da doença de Chagas: poderia a co-infecção com vírus da imunodeficiência humana aumentar o risco?

A study was conducted on all newborns from mothers with Chagas disease who were attended at Hospital Donación F. Santojanni between January 1, 2001, and August 31, 2007. Each child was investigated for the presence of Trypanosoma cruzi parasitemia through direct examination of blood under the microscope using the buffy coat method on three occasions during the first six months of life. Serological tests were then performed. Ninety-four children born to mothers infected with Trypanosoma cruzi were attended over the study period. Three of these children were born to mothers coinfected with the human immunodeficiency virus. Vertical transmission of Chagas disease was diagnosed in 13 children, in all cases by identifying parasitemia. The overall Chagas disease transmission rate was 13.8 percent (13/94). It was 100 percent (3/3) among the children born to mothers with HIV infection and 10.9 percent (10/91) among children born to mothers without HIV [Difference = 0.89; CI95 = 0.82-0.95; p = 0.0021]. We concluded that coinfection with HIV could increase the risk of vertical transmission of Chagas disease.

Foi realizado um estudo com todos os recém nascidos de mães chagásicas atendidas no Hospital Donación F. Santojanni, no período de1 de janeiro de 2001 a 31 de agosto de 2007. Cada criança foi submetida a pesquisa de parasitemia por Trypanosoma cruzi através do exame microscópico direto do sangue pelo método buffy coat, em três oportunidades, nos primeiros seis meses de vida. Após, foram realizados exames sorológicos. Foram avaliadas 94 crianças nascidas de mães infectadas com Trypanosoma cruzi durante o período do estudo. Três destas crianças eram filhas de mães co-infectadas pelo vírus da imunodeficiência humana. A transmissão vertical de doença de Chagas foi diagnosticada em 13 crianças, todos os casos por identificação de parasitemia. A taxa de transmissão global de doença de Chagas foi de 13,8 por cento (13/94); 100 por cento (3/3) entre os recém nascidos de mães infectadas com HIV e de 10,9 por cento (10/91) entre as crianças nascidas de mães sem HIV [Diferenta=0,89; IC95=0,82-0,95; p=0,0021]. Concluímos que a co-infecção com HIV pode aumentar o risco de transmissão vertical de doença de Chagas.

Thrombophilia in human immunodeficiency virus-infected patients with osteonecrosis: Is there a real connection? The first case-control study.

Several reports have described an increased incidence of osteonecrosis in human immunodeficiency virus-infected patients (HIV+), but the cause has not been established. The association between thrombophilia and osteonecrosis in HIV+ was studied. A case-control study in HIV+, 19 cases and 38 controls, was designed. Magnetic resonance imaging was made in both groups to confirm or exclude hip osteonecrosis. The extensive tests of thrombophilia were measured, and the clinical data were recorded, nadir of CD4(+) cell count and well-known risk factors for osteonecrosis. Thrombophilia has been frequently found both in patients with and without osteonecrosis (thrombophilia, 68.4% vs 60.5%), but no specific thrombophilia tests were significantly associated with osteonecrosis. A low nadir of CD4(+) (<60 cells/microL) and corticoid use were significantly (P < .05) associated with osteonecrosis. In multivariate analysis, only nadir of CD4(+) <60 cells/microL remained a predictor of osteonecrosis (odds ratio = 7.33; 95% confidence interval, 1.80-29.82, P = .005). Thrombophilia might have a limited role in the development of osteonecrosis in HIV+. Nadir of CD4(+) <60 cells/microL and corticoid use were main factors.

[Rosuvastatin for the treatment of dyslipidemia in HIV-infected patients receiving highly active antiretroviral therapy. Preliminary experience]. / Rosuvastatina para tratamiento de la dislipidemia en pacientes infectados con VIH en tratamiento antirretroviral de gran actividad. Experiencia preliminar.

INTRODUCTION: Highly active antiviral therapy (HAART) results in a sharp decrease in HIV-related morbidity and mortality, but also induces adverse effects such as dyslipidemia, which is difficult treat because of drug interactions. Guidelines recommend lipid-lowering therapy with pravastatin or atorvastatin to reduce LDL cholesterol in these patients, and gemfibrozil or fenofibrate for treating hypertriglyceridemia. The use of statins in the management of dyslipidemia is complicated by drug interactions with some of the components of HAART. Rosuvastatin, a statin with minimal cytochrome P-450-mediated metabolism, could be an alternative option for this population. METHODS: Retrospective study to evaluate the efficacy and safety of rosuvastatin (10 mg/day) for 16 weeks in HAART-treated HIV-infected patients with dyslipidemia, and moderate to high cardiovascular risk. Results were analyzed with the Shapiro-Wilks, K-S Lilliefors, and sign tests. Percentages were analyzed with the chi-square test. RESULTS: Seventy-eight patients were started on rosuvastatin for dyslipidemia, 60 as single therapy. After 16 weeks of treatment, a significant median decrease was seen in both LDL-cholesterol and non-HDL cholesterol (31.3% reduction in LDL and 29.9% in non-HDL). The therapeutic goal for non-HDL was achieved in 65.8% of patients. The decrease in triglyceride levels was also significant (34.1%); 35% of subjects achieved the therapeutic goal. The drug was withdrawn in 2 patients because of myositis, and in 1 because of gastrointestinal intolerance. There were no differences in efficacy or toxicity between patients receiving protease inhibitors, non-nucleoside reverse transcriptase inhibitors, or fibrates. CONCLUSION: Rosuvastatin was safe and effective for treating dyslipidemia in HAART-treated HIV-infected patients. Results were similar to those observed in the HIV-uninfected population.

HPV perianal en pacientes HIV positivos: anoscopía magnificada y determinación de serotipos por biología molecular / Perianal HPV in HIV patients: high resolution anoscopy and virus type determination by molecular biology

Introducción: La incidencia de cáncer anal se ha incrementado notablemente en los últimos años. La asociación de esta patología con la presencia de infección anal por el virus HPV permite identificar una población de riesgo, principalmente en pacientes con serología positiva para HIV y con prácticas homosexuales. Objetivo: Determinar la incidencia de lesiones perianales clínicas y subclínicas vinculables a la infección por HPV (virus del papiloma humano) en una población de individuos infectados por HIV (virus de la inmunodeficiencia humana). Material y Método: Entre el 1 de Noviembre de 2006 y 31 de Junio de 2007 se analizaron prospectivamente 33 pacientes con diagnóstico de HIV, 60 por ciento sexo femenino, edad media de 40 años (r = 19-62). Las variables en estudio fueron edad, sexo, recuento de CD4, nadir de CD4, carga viral, antecedentes de HPV previo, hábito sexual, tratamiento antirretroviral, HIV status, antecedentes de ETS (Enfermedades de transmisión sexual), inspección y anoscopía, anoscopía magnificada, citología, biopsia, serotipo de riesgo, tratamiento. Resultados: Los resultados genéticos confirmaron 54.5 por ciento (18) casos de infección; correspondiendo 77.7 por ciento a cepas de bajo riesgo y 22.2 por ciento a cepas de alto riesgo. La inspección y anoscopía simple mostró lesión sospechosa de HPV en 30 por ciento de los pacientes y la anoscopía magnificada en el 45 por ciento de los pacientes. La citología mostró lesión sugestiva de HPV en 36.3 por ciento y atipía citológica en 27.2 por ciento. Las biopsias revelaron 27.2 por ciento de lesiones típicas de condiloma, 18.2 por ciento de lesiones AIN (neoplasia intraepitelial anal) y 3 por ciento de hiperparaqueratosis. La sensibilidad y especificidad para la inspección, anoscopía magnificada y cepillado fue de 44.4 por ciento, 72 por ciento y 77 por ciento; y de 86 por ciento, y 53.3 por ciento respectivamente...

Background: The incidence of anal cancer has increased in the last years. The association between anal cancer and HPV anal infection let us identify a risk population, principally HIV patients with men sexual men practices. Aim: To asses the incidence of anal and perianal lesions associated with HPV (human papillomavirus) infection in HIV (human immunodeficiency virus) positive patients. Material and Methods: Between 1 November 2006, to 31 June 2007, 33 patients with positive serology for HIV infection were prospectively analyzed, 60 per cent females, median age 40 years (r = 19-62). The variables included in the study were age, gender, CD4 recount, CD4 nadir, viral charge, HPV previous history, sexual habits, type of retroviral treatment, HIV status, sexually transmitted disease history, simple anoscopy, high resolution anoscopy, pap cytology, pathology results, viral HPV type, treatment. Results: Genetic reports informed 54,5 per cent (18) of positive HPV patients, 77,7 per cent low risk viral type and 22 per cent of high risk. Inspection and conventional anoscopy showed 30 per cent of suspicious HPV lesions and high resolution anoscopy 45 per cent of them. Citology report informed 36,3 per cent of cellular changes associated with HPV infections and 27,2 per cent of atypia. The pathology report confirmed 27,2 per cent of typical HPV warms, 18,2 per cent of AIN (anal intraepithelial neoplasia) and 3 per cent of ASCUS (anal squamous cells of uncertain significance). Inspection and conventional anoscopy, high resolution anoscopy and citology by anal brushing showed sensibility and specificity of 44,4 per cent, 72 per cent and 77 per cent and 86 per cent, 86 per cent, 53,3 per cent respectively. Conclusions: HPV anal and perianal infection in HIV patients is frequent independently of sexual habits. High resolution Anoscopy and molecular diagnostic with viral type determination allow us to find sub clinical lesions of risk.

Rosuvastatina para tratamiento de la dislipidemia en pacientes infectados con VIH en tratamiento antirretroviral de gran actividad. Experiencia preliminar / Rosuvastatin for the treatment of dyslipidemia in HIV-infected patients receiving highly active antiretroviral therapy. Preliminary experience

INTRODUCCIÓN. El tratamiento antirretroviral combinado de gran actividad (TARGA) redujo la morbimortalidad por la infección por el virus de la inmunodeficiencia humana(VIH), pero indujo efectos adversos como la dislipidemia, cuyo tratamiento se dificulta por interacciones farmacológicas. En las guías para su tratamiento sepropuso usar pravastatina o atorvastatina para reducir el colesterol de las lipoproteínas de baja densidad (c-LDL), y gemfibrozil o fenofibrato para tratar la hipertrigliceridemia. Rosuvastatina, una estatina con escaso metabolismo hepático, podría ser una nueva alternativa. MÉTODOS. Estudio retrospectivo para evaluar la efectividad y la toxicidad del uso de rosuvastatina (10 mg/día) por 16 semanas en pacientes con dislipidemia, portadores del VIH con TARGA y riesgo cardiovascular de moderado a muy elevado. Los resultados se analizaron mediante las pruebas de Shapiro-Wilks, K-S Lilliefors y el test del signo; los porcentajes se compararon mediante la prueba de chi al cuadrado. RESULTADOS. Setenta y ocho pacientes recibieron rosuvastatina, 60 como único hipolipemiante. Tras16 semanas, el descenso mediano del c-LDL y del colesterol no ligado a las lipoproteínas de alta densidad(c-no-HDL) fue significativo (–31,3 y –29,9%,respectivamente); el 65,8% de los pacientes lograron la meta para c-no-HDL. La reducción de la trigliceridemia también fue significativa (–34,1%); el 35% de los pacientes alcanzaron la meta terapéutica para trigliceridemia. Dos individuos suspendieron la droga por toxicidad muscular y uno por intolerancia digestiva. No hubo diferencia en la toxicidad y la eficacia de acuerdo a si los pacientes recibían concomitantemente inhibidores de proteasa, inhibidores de transcriptasa inversa no nucleosídicos o fibratos. CONCLUSIÓN. Rosuvastatina fue efectiva y segura para tratar la dislipidemia de pacientes VIH con TARGA, logrando resultados similares a los descritos en población no infectada por VIH (AU)

INTRODUCTION. Highly active antiviral therapy (HAART)results in a sharp decrease in HIV-related morbidity and mortality, but also induces adverse effects such as dyslipidemia, which is difficult treat because of drug interactions. Guidelines recommend lipid-lowering therapy with pravastatin or atorvastatin to reduce LDL cholesterol in these patients, and gemfibrozil or fenofibrate for treating hypertriglyceridemia. The use of statins in the management of dyslipidemia is complicated by drug interactions with some of the components of HAART. Rosuvastatin, a statin with minimal cytochrome P-450-mediated metabolism, could be an alternative option for this population. METHODS. Retrospective study to evaluate the efficacy and safety of rosuvastatin (10 mg/day) for 16 weeks in HAART-treated HIV-infected patients with dyslipidemia, and moderate to high cardiovascular risk. Results were analyzed with the Shapiro-Wilks, K-S Lilliefors, and sign tests. Percentages were analyzed with the chi-square test. RESULTS. Seventy-eight patients were started on rosuvastatin for dyslipidemia, 60 as single therapy. After 16 weeks of treatment, a significant median decrease was seen in both LDL-cholesterol and non-HDL cholesterol (31.3% reduction in LDL and 29.9% in non-HDL). The therapeutic goal for non-HDL was achieved in 65.8% of patients. The decrease in triglyceride levels was also significant (34.1%); 35% of subjects achieved the therapeutic goal. The drug was withdrawn in 2 patients because of myositis, and in 1 because of gastrointestinal intolerance. There were no differences in efficacy or toxicity between patients receiving protease inhibitors, non-nucleoside reverse transcriptase inhibitors, or fibrates. CONCLUSION. Rosuvastatin was safe and effective for treating dyslipidemia in HAART-treated HIV-infected patients. Results were similar to those observed in the HIV-uninfected population (AU)

[Enfuvirtide: the first step for a new strategy of antiretroviral therapy]. / Enfuvirtide: el primer paso de una nueva estrategia de tratamiento antirretroviral.

Enfuvirtide (T-20) is the first approved HIV-1 entry into cells' inhibitor. It is a peptide with an amino acid sequence analogue to HR2 region of the viral surface glycoprotein gp41. Its mechanism of action is the competitive binding to HR1 region of the gp41, preventing the interaction between HR1 and HR2 and impeding the conformational changes in gp41 necessary for fusion of the virus with the cell. Its application is by subcutaneous injection. The main clinical trials of enfuvirtide (TORO 1 and 2) were performed in HIV-infected patients with virological failure, high antiretroviral experience and highly resistant viral isolates. Those trials showed that the addition of enfuvirtide to an optimized HAART (chosen with a resistance test) provided better results than HAART alone, measured by drop in viral load and immunologic benefit. The best results were observed in the subgroup of patients with more useful drugs in HAART (according to the information of the resistance test), a lower viral load, and a higher CD4 cell count at baseline. The most important adverse event is the production of injection drug hypersensitivity reaction in 98% of patients. The high cost is compensated by a reduction in costs derived from admissions.

Enfuvirtide: el primer paso de una nueva estrategia de tratamiento antirretroviral / Enfuvirtide: the first step for a new strategy of antiretroviral therapy

Enfuvirtide (antes T-20) es el primer inhibidor de la entrada a la célula del HIV-1 en ser aprobado. Es un péptido análogo de la porción HR2 de la glucoproteína de superficie viral gp41. Su mecanismo de acción consiste en la unión competitiva a la porción HR1 de la gp41 para impedir los cambios conformacionales del complejo gp41-gp120 tras la unión del HIV-1 a los receptores celulares, impidiendo así el acercamiento y posterior fusión entre el virus y la célula. Se aplica por vía subcutánea. Los resultados de los principales estudios clínicos (TORO 1 y 2) llevados a cabo en pacientes con fallo virológico, tratamientos previos con antirretrovirales y portadores de cepas virales altamente resistentes, mostraron que quienes recibieron enfuvirtide + HAART optimizado, elegido mediante un test de resistencia, presentaron mayores beneficios que quienes sólo recibieron HAART optimizado, en términos de mejor recuperación inmune y mayor descenso de la carga viral de HIV. Los mejores resultados se observaron en el subgrupo de pacientes con más drogas útiles en el HAART según el test de resistencia, una menor carga viral de HIV y un mayor recuento de linfocitos CD4 basales. El principal efecto adverso es el desarrollo de lesiones por hipersensibilidad en los sitios de aplicación. El alto costo de enfuvirtide se vio compensado por una reducción en los costos de internación.

Enfuvirtide (T-20) is the first approved HIV-1 entry into cells' inhibitor. It is a peptide with an amino acid sequence analogue to HR2 region of the viral surface glycoprotein gp41. Its mechanism of action is the competitive binding to HR1 region of the gp41, preventing the interaction between HR1 and HR2 and impeding the conformational changes in gp41 necessary for fusion of the virus with the cell. Its application is by subcutaneous injection. The main clinical trials of enfuvirtide (TORO 1 and 2) were performed in HIV-infected patients with virological failure, high antiretroviral experience and highly resistant viral isolates. Those trials showed that the addition of enfuvirtide to an optimized HAART (chosen with a resistance test) provided better results than HAART alone, measured by drop in viral load and immunologic benefit. The best results were observed in the subgroup of patients with more useful drugs in HAART (according to the information of the resistance test), a lower viral load, and a higher CD4 cell count at baseline. The most important adverse event is the production of injection drug hypersensitivity reaction in 98% of patients. The high cost is compensated by a reduction in costs derived from admissions.

Enfuvirtide: el primer paso de una nueva estrategia de tratamiento antirretroviral / Enfuvirtide: the first step for a new strategy of antiretroviral therapy

Enfuvirtide (antes T-20) es el primer inhibidor de la entrada a la célula del HIV-1 en ser aprobado. Es un péptido análogo de la porción HR2 de la glucoproteína de superficie viral gp41. Su mecanismo de acción consiste en la unión competitiva a la porción HR1 de la gp41 para impedir los cambios conformacionales del complejo gp41-gp120 tras la unión del HIV-1 a los receptores celulares, impidiendo así el acercamiento y posterior fusión entre el virus y la célula. Se aplica por vía subcutánea. Los resultados de los principales estudios clínicos (TORO 1 y 2) llevados a cabo en pacientes con fallo virológico, tratamientos previos con antirretrovirales y portadores de cepas virales altamente resistentes, mostraron que quienes recibieron enfuvirtide + HAART optimizado, elegido mediante un test de resistencia, presentaron mayores beneficios que quienes sólo recibieron HAART optimizado, en términos de mejor recuperación inmune y mayor descenso de la carga viral de HIV. Los mejores resultados se observaron en el subgrupo de pacientes con más drogas útiles en el HAART según el test de resistencia, una menor carga viral de HIV y un mayor recuento de linfocitos CD4 basales. El principal efecto adverso es el desarrollo de lesiones por hipersensibilidad en los sitios de aplicación. El alto costo de enfuvirtide se vio compensado por una reducción en los costos de internación.(AU)

Enfuvirtide (T-20) is the first approved HIV-1 entry into cells inhibitor. It is a peptide with an amino acid sequence analogue to HR2 region of the viral surface glycoprotein gp41. Its mechanism of action is the competitive binding to HR1 region of the gp41, preventing the interaction between HR1 and HR2 and impeding the conformational changes in gp41 necessary for fusion of the virus with the cell. Its application is by subcutaneous injection. The main clinical trials of enfuvirtide (TORO 1 and 2) were performed in HIV-infected patients with virological failure, high antiretroviral experience and highly resistant viral isolates. Those trials showed that the addition of enfuvirtide to an optimized HAART (chosen with a resistance test) provided better results than HAART alone, measured by drop in viral load and immunologic benefit. The best results were observed in the subgroup of patients with more useful drugs in HAART (according to the information of the resistance test), a lower viral load, and a higher CD4 cell count at baseline. The most important adverse event is the production of injection drug hypersensitivity reaction in 98% of patients. The high cost is compensated by a reduction in costs derived from admissions.(AU)