Clinical, epidemiological and treatment failure data among HIV-1 non-B-infected patients in the Spanish AIDS Research Network Cohort / Datos clínicos, epidemiológicos y fracaso terapéutico en los pacientes VIH-1 infectados por variantes no-B incluidos en la Cohorte de la Red española de Investigación en Sida (CoRIS)

INTRODUCTION: The prevalence of HIV-1 non-B variants is increasing in Spain, showing a higher number of transmitted drug resistance mutations (TDR) since 2002. This study presents the features of non-B-infected patients enrolled in the cohort of antiretroviral treatment (ART) naïve HIV-infected patients included in the Research Network on HIV/AIDS (CoRIS). METHODS: The study includes a selected group of HIV-1 non-B-infected subjects from 670 subjects with pol sequences collected from 2004 to 2008 in the CoRIS cohort. Epidemiological-clinical-virological data were analyzed since cohort entry until October 2011, considering the presence or absence of treatment failure (TF). RESULTS: Eighty two non-B infected subjects with known HIV-1 variants were selected from 2004 to 2008 in the CoRIS cohort, being mainly female, immigrants, infected by recombinant viruses, and by heterosexual route. They had an intermediate TDR rate (9.4%), a high rate of TF (25.6%), of losses to follow-up (35%), of coinfections (32.9%), and baseline CD4+ counts ≥350 cells/mm3 (61.8%). Non-B subjects with TF showed higher rates of heterosexual infection (85.7% vs. 69.5%, p < 0.05), tuberculosis (30.8%vs. 9.1%, p = 0.10) and hepatitis C (23.8% vs. 13.9%, p = 0.34) coinfections and lower rates of syphilis (0% vs. 21.9%, p < 0.05), and had more frequently received first-line ART including protease inhibitors (PIs) than patients without TF (70% vs. 30%, p < 0.05). Interestingly, infection with non-B variants reduced the risk of TDR to nucleoside reverse transcriptase inhibitors and increased the risk to PIs. CONCLUSION: HIV-1 non-B-infected patients in Spain had a particular epidemiological and clinical profile that should be considered during their clinical management

INTRODUCCIÓN: La prevalencia de variantes no-B del VIH-1 está aumentando en España, mostrando un incremento de las mutaciones de resistencia transmitidas (TDR) desde 2002. Este estudio muestra las características de los pacientes infectados por variantes no-B de la cohorte de infectados por VIH sin tratamiento antirretroviral de la Red de Investigación sobre VIH/SIDA (CoRIS). MÉTODOS: De 670 individuos en CoRIS con secuencias pol recogidas entre 2004 y 2008, se seleccionaron los pacientes infectados por variantes no-B. Se analizaron los datos epidemiológicos, clínicos y virológicos desde su inclusión hasta octubre de 2011, considerando la existencia de fracaso terapéutico (FT). RESULTADOS: Los 82 pacientes infectados por variantes no-B entre 2004 y 2008 fueron principalmente mujeres, inmigrantes, infectados por variantes recombinantes y transmisión heterosexual. Presentaron una tasa intermedia de TDR (9,4%) y elevada frecuencia de FT (25,6%), pérdidas de seguimiento (35%), coinfecciones (32,9%) y recuento basal de CD4+ ≥350 células/mm3 (61,8%). Los pacientes no-B con FT vs. sin FT mostraron mayor porcentaje de transmisión heterosexual (85,7% vs. 69,5%, p < 0,05), coinfecciones por tuberculosis (30,8% vs. 9,1%, p = 0,10), hepatitis C (23,8% vs. 13,9%, p = 0,34) y menores tasas de sífilis (0% vs. 21,9%, p < 0,05). Además recibieron con mayor frecuencia tratamiento de primera línea con inhibidores de la proteasa (IP) (70% vs. 30%, p < 0,05). La infección con variantes no-B redujo el riesgo de TDR a inhibidores de la transcriptasa inversa análogos de nucleósido y aumentó el riesgo a IP. CONCLUSIÓN: Los pacientes infectados por variantes no-B del VIH-1 en España presentan un perfil epidemiológico-clínico característico que deberá ser considerado durante su seguimiento

Clinical, epidemiological and treatment failure data among HIV-1 non-B-infected patients in the Spanish AIDS Research Network Cohort.

INTRODUCTION: The prevalence of HIV-1 non-B variants is increasing in Spain, showing a higher number of transmitted drug resistance mutations (TDR) since 2002. This study presents the features of non-B-infected patients enrolled in the cohort of antiretroviral treatment (ART) naïve HIV-infected patients included in the Research Network on HIV/AIDS (CoRIS). METHODS: The study includes a selected group of HIV-1 non-B-infected subjects from 670 subjects with pol sequences collected from 2004 to 2008 in the CoRIS cohort. Epidemiological-clinical-virological data were analyzed since cohort entry until October 2011, considering the presence or absence of treatment failure (TF). RESULTS: Eighty two non-B infected subjects with known HIV-1 variants were selected from 2004 to 2008 in the CoRIS cohort, being mainly female, immigrants, infected by recombinant viruses, and by heterosexual route. They had an intermediate TDR rate (9.4%), a high rate of TF (25.6%), of losses to follow-up (35%), of coinfections (32.9%), and baseline CD4+ counts ≥350cells/mm(3) (61.8%). Non-B subjects with TF showed higher rates of heterosexual infection (85.7% vs. 69.5%, p<0.05), tuberculosis (30.8% vs. 9.1%, p=0.10) and hepatitis C (23.8% vs. 13.9%, p=0.34) coinfections and lower rates of syphilis (0% vs. 21.9%, p<0.05), and had more frequently received first-line ART including protease inhibitors (PIs) than patients without TF (70% vs. 30%, p<0.05). Interestingly, infection with non-B variants reduced the risk of TDR to nucleoside reverse transcriptase inhibitors and increased the risk to PIs. CONCLUSION: HIV-1 non-B-infected patients in Spain had a particular epidemiological and clinical profile that should be considered during their clinical management.

[Immigration and HIV-1 infection: clinical manifestations, subtypes and evolution of 78 patients attended during the last 5 years]. / Infección por el virus de la inmunodeficiencia humana tipo 1 e inmigración: manifestaciones clínicas, subtipos y evolución de 78 pacientes ingresados durante los últimos 5 años.

BACKGROUND AND OBJECTIVE: To analyse the characteristics and HIV-1 subtype in a group of HIV+ hospitalised immigrants in our Infectious Diseases Unit. PATIENTS AND METHOD: Clinical reports of 78 immigrants HIV+ were reviewed. HIV-1 subtyping was carried out examining the protease and transcriptase genes by phylogenetic analysis. Statistical study was done by SPSS 11.0 program. RESULTS: 57% of patients come from sub-Saharian Africa. Mainly they had been infected by heterosexual contact. HIV was diagnosed at the hospitalisation time in 35 cases. Only 28% were receiving highly active antiretroviral therapy and 48,7% had CD4+ cells less than 200/microl. The more frequent diagnosed diseases were: tuberculosis (20.5%), candidiasis (24.4%), bacterial pneumonia (19.2%) and malaria (21.8%). HIV-1 subtype B was isolated in 26 patients, none Africans. Twenty nine individuals (52.8%) were infected with HIV-1 non-B subtypes. Relationship between HIV-1 subtype, immunodepression, diagnosed diseases and origin countries was not found apart from malaria. CONCLUSIONS: Most HIV-1 infected immigrants are from Africa, being predominantly infected with HIV-1 non-B subtypes. No relationship between HIV subtype and diagnosed diseases was found.

Infección por el virus de la inmunodeficiencia humana tipo 1 e inmigración: manifestaciones clínicas, subtipos y evolución de 78 pacientes ingresados durante los últimos 5 años / Immigration and HIV-1 infection: clinical manifestations, subtypes and evolution of 78 patients attended during the last 5 years

Fundamento y objetivo: Analizar las características y el subtipo del virus de la inmunodeficiencia humana tipo 1 (VIH-1) en un grupo de inmigrantes seropositivos que ingresaron en nuestro Servicio de Enfermedades Infecciosas. Pacientes y método: Se revisaron los informes de alta de 78 inmigrantes infectados por el VIH. La caracterización del subtipo genético de las variantes del VIH-1 que los infectaron se realizó por análisis filogenético de los genes de la proteasa y de la retrotranscriptasa en el 70,5% de ellos. Para el estudio estadístico se utilizó el programa SPSS, versión 11.0. Resultados: El 57% de los pacientes procedían del África subsahariana, y la transmisión heterosexual fue la vía más frecuente de contagio. La infección por el VIH se diagnosticó en el momento del ingreso en 35 casos. Sólo el 28% recibía tratamiento antirretroviral de gran actividad y un 48,7% tenía menos de 200 linfocitos CD4/µl. Las enfermedades más frecuentes fueron: tuberculosis (20,5%), candidiasis (24,4%), neumonía bacteriana (19,2%) y paludismo (21,8%). El subtipo B del VIH-1 se aisló en 26 de los 78 pacientes, ninguno africano. Se encontraron subtipos diferentes del B en 29 casos (52,8%). No hubo relación entre el subtipo genético del VIH-1, la inmunodepresión, las enfermedades diagnosticadas y el país de origen, excepto en el caso del paludismo. Conclusiones: La mayoría de los inmigrantes con infección por el VIH ingresados en nuestro centro son africanos y en su mayor parte están infectados por subtipos del VIH-1 diferentes del B. No se observó relación entre el subtipo genético y las enfermedades diagnosticadas

Background and objective: To analyse the characteristics and HIV-1 subtype in a group of HIV+ hospitalised immigrants in our Infectious Diseases Unit. Patients and method: Clinical reports of 78 immigrants HIV+ were reviewed. HIV-1 subtyping was carried out examining the protease and transcriptase genes by phylogenetic analysis. Statistical study was done by SPSS 11.0 program. Results: 57% of patients come from sub-Saharian Africa. Mainly they had been infected by heterosexual contact. HIV was diagnosed at the hospitalisation time in 35 cases. Only 28% were receiving highly active antiretroviral therapy and 48,7% had CD4+ cells less than 200/µl. The more frequent diagnosed diseases were: tuberculosis (20.5%), candidiasis (24.4%), bacterial pneumonia (19.2%) and malaria (21.8%). HIV-1 subtype B was isolated in 26 patients, none Africans. Twenty nine individuals (52.8%) were infected with HIV-1 non-B subtypes. Relationship between HIV-1 subtype, immunodepression, diagnosed diseases and origin countries was not found apart from malaria. Conclusions: Most HIV-1 infected immigrants are from Africa, being predominantly infected with HIV-1 non-B subtypes. No relationship between HIV subtype and diagnosed diseases was found