Influence of hospital admission in the pharmacotherapy complexity of HIV+ patients / Influencia del ingreso hospitalario en la complejidad farmacoterapéutica de los pacientes VIH+

Objective: To determine the variation in the pharmacotherapy complexity index in HIV+ patients after hospital admission. Method: A retrospective, single-center study with HIV+ patients on antiretroviral treatment (ART) who were admitted to hospital between 2008 and 2015 were conducted. Demographic, analytical, clinical and pharmacotherapy variables were collected, as well as those about the use of healthcare resources. The primary endpoint was the variation in the overall complexity index after a hospital admission, measured through the MRCI tool (University of Colorado). There was also an analysis of the variation in adherence to ART, and of the causes that led to an increase in pharmacotherapy complexity after hospitalization. Results: The study included 146 patients (84.9% male) with 45.3±9.1 years as mean age; 30.8% of these patients had experienced an admission to hospital in the previous year, with a median stay of seven days (IQR: 4-12,5). The mean overall complexity before hospital admission was 14.5±7.2 vs. 16.5±8.0 after admission, with a significant difference (1.97 [CI=0.85;3.09]). The percentage of patients adherent to ART before admission was 58.3% vs. 41.8% after admission (p=0.023). The only factor associated to an increase in complexity was having five or more chronic drugs prescribed before admission (OR=3.146 [1.045-9.471]). Conclusion: The overall pharmacotherapy complexity increased after hospital admission, reducing the adherence to ART. Chronic treatment prescribed before admission was the only factor associated with an increase in complexity after admission (AU)

Objetivo: Determinar la variación del índice de complejidad farmacoterapéutico en pacientes VIH+ tras un ingreso hospitalario. Método: Estudio unicéntrico, retrospectivo de pacientes VIH+ en tratamiento antirretroviral (TAR) que sufrieron un ingreso durante 2008-2015. Se recogieron variables demográficas, analíticas, clínicas, farmacoterapéuticas y de utilización de recursos sanitarios. La variable principal fue la variación del índice de complejidad global tras un ingreso hospitalario, medida a través de la herramienta MRCI (Universidad de Colorado). Además, se analizó la variación de la adherencia al TAR y se analizaron las causas que originaron un incremento de la complejidad farmacoterapéutica tras la estancia hospitalaria. Resultados: Se incluyeron 146 pacientes (84,9% hombres) con una media de edad de 45,3±9,1 años. El 30,8% de los pacientes habían registrado un ingreso en el año previo, con una mediana de duración de 7 días (IQR: 4-12,5). La media de complejidad global previa al ingreso fue de 14,5±7,2 frente a 16,5±8,0 después del mismo, con una diferencia significativa (1,97 [IC: 0,85; 3,09]). El porcentaje de pacientes adherentes al TAR fue 58,3% frente al 41,8%, posterior al ingreso, (p=0,023). El único factor asociado al aumento de la complejidad fue tener prescrito cinco o más fármacos de manera crónica antes del ingreso (OR=3,146 [1,045-9,471]). Conclusión: La complejidad farmacoterapéutica global aumentó tras el ingreso disminuyendo la adherencia al TAR. El tratamiento crónico prescrito antes del ingreso fue el único factor asociado a un aumento de complejidad tras el mismo (AU)

Influence of hospital admission in the pharmacotherapy complexity of HIV+ patients.

OBJECTIVE: To determine the variation in the pharmacotherapy complexity index in HIV+ patients after hospital admission. METHOD: A retrospective, single-center study with HIV+ patients on antiretroviral treatment (ART) who were admitted to hospital between 2008 and 2015 were conducted. Demographic, analytical, clinical and pharmacotherapy variables were collected, as well as those about the use of healthcare resources. The primary endpoint was the variation in the overall complexity index after a hospital admission, measured through the MRCI tool (University of Colorado). There was also an analysis of the variation in adherence to ART, and of the causes that led to an increase in pharmacotherapy complexity after hospitalization. RESULTS: The study included 146 patients (84.9% male) with 45.3 ± 9.1 years as mean age; 30.8% of these patients had experienced an admission to hospital in the previous year, with a median stay of seven days (IQR: 4-12,5). The  mean overall complexity before hospital admission was 14.5 ± 7.2 vs. 16.5 ± 8.0 after admission, with a significant difference (1.97 [CI = 0.85;3.09]). The percentage of patients adherent to ART before admission was 58.3% vs. 41.8% after admission (p = 0.023). The only factor associated to an increase in complexity was having five or more chronic drugs prescribed before admission (OR = 3.146 [1.045-9.471]). CONCLUSION: The overall pharmacotherapy complexity increased after hospital admission, reducing the adherence to ART. Chronic treatment prescribed before admission was the only factor associated with an increase in complexity after admission.

Objetivo: Determinar la variación del índice de complejidad farmacoterapéutico en pacientes VIH+ tras un ingreso hospitalario.Métodos: Estudio unicéntrico, retrospectivo de pacientes VIH+ en tratamiento antirretroviral (TAR) que sufrieron un ingreso durante 2008-2015. Se recogieron variables demográficas, analíticas, clínicas, farmacoterapéuticas y de utilización de recursos sanitarios. La variable principal fue la variación del índice de complejidad global tras un ingreso hospitalario, medida a través de la herramienta MRCI (Universidad de Colorado). Además, se analizó la variación de la adherencia al TAR y se analizaron las causas que originaron un incremento de la complejidad farmacoterapéutica tras la estancia hospitalaria.Resultados: Se incluyeron 146 pacientes (84,9% hombres) con una media de edad de 45,3 ± 9,1 años. El 30,8% de los pacientes habían registrado un ingreso en el año previo, con una mediana de duración de 7 días (IQR: 4-12,5). La media de complejidad global previa al ingreso fue de 14,5 ± 7,2 frente a 16,5 ± 8,0 después del mismo, con una diferencia significativa (1,97 [IC: 0,85; 3,09]). El porcentaje de pacientes adherentes al TAR fue 58,3% frente al 41,8%, posterior al ingreso, (p = 0,023). El único factor asociado al aumento de la complejidad fue tener prescrito cinco o más fármacos de manera crónica antes del ingreso (OR = 3,146 [1,045-9,471]).Conclusión: La complejidad farmacoterapéutica global aumentó tras el ingreso disminuyendo la adherencia al TAR. El tratamiento crónico prescrito antes del ingreso fue el único factor asociado a un aumento de complejidad tras el mismo.

Changes in the response to treatment against chronic hepatitis C between 1999 and 2015: data from a prospective cohort.

BACKGROUND: The drug options and strategies for treatment against hepatitis C virus (HCV) infection have changed considerably in the last few years. The aim of this study was to compare the changes in the proportion of nonresponders and patients who achieved a sustained virologic response (SVR) from 1999 to 2015 in one single cohort. PATIENTS AND METHODS: A total of 522 patients treated against chronic hepatitis C were included prospectively. The time periods were 1999-2002 [interferon (IFN)/ribavirin (RBV)], 2002-2009 (pegylated-IFN/RBV), 2010-2011 (use of IL28B genotype), 2012-2014 (pegylated-IFN/RBV/direct-acting antivirals) and 2015 (IFN-free direct-acting antiviral-based therapy). RESULTS: The numbers of nonresponders in the study periods in chronological order were as follows: 14 (40%), 76 (21.3%), 7 (8%), 10 (13%), and 0; P=1.1×10 and r=0.837. The corresponding numbers of patients who achieved SVR were 9 (25.7%), 14 (40.9%), 44 (50.6%), 51 (66.2%), and 64 (90.1%), P=3.3×10 and r=0.997. Characteristics that may impair SVR, such as advanced fibrosis, genotype 1 infection, HIV coinfection, or treatment experience, did not decrease in the last time periods. CONCLUSION: The proportion of nonresponders was significantly reduced using the IL28B genotype as a predictive tool and direct-acting antivirals further improved treatment outcome. Concomitantly, the rates of SVR showed a linear increase.

Liver Toxicity of Current Antiretroviral Regimens in HIV-Infected Patients with Chronic Viral Hepatitis in a Real-Life Setting: The HEPAVIR SEG-HEP Cohort.

OBJECTIVE: To assess the current frequency of ART-associated grade 3-4 transaminase elevations (TE) and grade 4 total bilirubin elevations (TBE) in HIV-infected patients with chronic hepatitis B and/or C, who start a new regimen of ART. PATIENTS AND METHODS: A total of 192 pre-treated or treatment-naive HIV infected patients with HBV and/or HCV-coinfection who started ART in eight Southern Spanish centers from July/2011-December/2013, were followed for 12 months in this prospective study. RESULTS: Forty-one (21.4%) subjects had been naïve to ART, median (IQR) follow-up was 11.6 (5.6-12.9) months. The most frequently initiated NRTI were tenofovir/emtricitabine [49 patients (25.5%)]. Eighty-nine (46.4%) patients started a ritonavir-boosted protease inhibitor and 77 (40.1%) individuals a NNRTI. Raltegravir and maraviroc were initiated in 24 (12.5%) and 9 (4.7%) individuals. Ten [5.21%; 95% confidence interval (CI): 2.53%-9.37%] patients presented grade 3 TE, while 8 (4.17%; 95%CI: 1.82%-8.04%) subjects showed grade 4 TBE. No episodes of grade 4 TE or ART discontinuation due to hepatotoxic events were observed. The use of ritonavir-boosted atazanavir was the only independent predictor for grade 4 TBE [adjusted odds ratio: 7.327 (95%CI: 1.417-37.89); p = 0.018] in an analysis adjusted for age, sex and baseline HIV-RNA levels, while no factor could be independently associated with grade 3-4 TE. CONCLUSIONS: Currently, the frequency of severe ART-associated TE and TBE under real-life conditions in patients with chronic viral hepatitis is similar to what has been reported previously. However, episodes of grade 4 TE are less frequent and severe TE appears to be of lesser concern.

Design and validation of a predictive model for 1-year hospital admission in HIV patients on antiretroviral treatment.

OBJECTIVES: To develop and validate a model for predicting the risk of hospital admission within 1 year in the HIV population under antiretroviral treatment. METHODS: We conducted a retrospective observational study. Patients receiving antiretroviral treatment for at least 1 year who were followed by the pharmacy service in a Spanish-speaking hospital between January 2008 and December 2012 were included. Demographics, and clinical and pharmacotherapy variables, were included in the model design. To find prognostic factors for hospital admission a multivariate logistic regression model was created after performing a univariate analysis. Model validity was determined by the shrinkage method and the model discrimination by Harrell's C-index. RESULTS: 442 patients were included in the study. The variables 'CD4 count <200 (cells/µL)', 'drug/alcohol use', 'detectable viral load (>50 copies/mL)', 'number of previous admissions', and 'number of drugs different from antiretroviral treatment' were the independent predictors of risk of hospital admission. Probabilities predicted by the model showed an R2=0.98 for the development sample and an R2=0.86 for the validation sample. The Harrell's C index for the development and validation data were 0.82 (95% CI 0.77 to 0.87) and 0.80 (95% CI 0.73 to 0.88), respectively. CONCLUSIONS: The model developed in this study may be useful in daily practice for identifying HIV patients at high risk of 1-year hospital admission.

Persistence profile to nucleos(t)ide analogue treatment for patients with chronic hepatitis B.

BACKGROUND: There are currently five approved nucleos(t)ide analogues (NUCs) for the management of chronic hepatitis B (CHB): lamivudine, adefovir dipivoxil, telbivudine, entecavir, and tenofovir disoproxil fumarate. OBJECTIVE: To determine the persistence rates among patients receiving NUCs for CHB at weeks 48, 96 and 144, compare them in these periods, and analyse the evolution of treatment persistence. METHODS: We conducted a retrospective study that included patients with CHB who initiated antiviral therapy and were attended to by the pharmaceutical care office between January 2002 and December 2011. Patients included in a clinical trial or patients who did not collect their medication personally were excluded. There were two different analyses: a comparative analysis of the persistence rates in three periods (weeks 1-48, weeks 48-96, and weeks 96-144); and a Kaplan-Meier analysis to evaluate the evolution of persistence. RESULTS: A total of 102 patients were included. Persistence rates were different in the three periods. They decreased during the course of the different periods, and the decline was more rapid between the first and second period. There were statistically significant differences in the non-persistence of the five drugs (p<0.005). Entecavir had the best profile of persistence, followed by tenofovir. CONCLUSIONS: This study showed that high genetic barrier drugs had a better profile of persistence in the initial treatment of patients with CHB. Data seem to suggest entecavir may offer better persistence rates than tenofovir, and the persistence rates for all five medications dropped in weeks 48-96.

Diseño y validación de una encuesta de satisfacción con la atención farmacéutica recibida en las consultas de farmacia hospitalaria / Design and validation of a satisfaction survey with pharmaceutical care received in hospital pharmacyconsultation

Objetivo: Diseñar y validar un cuestionario para valorar la satisfacción con la Atención Farmacéutica (AF) recibida en la farmacia hospitalaria. Métodos: Estudio multicéntrico en cinco hospitales andaluces. En enero 2013 se realizó una búsqueda bibliográfica en PUBMED; términos MESH pharmaceutical services, patients satisfaction and questionnaire. Seguidamente se elaboró el cuestionario, según metodología Delphi, formado por 10 ítems, con variables demográficas, sociales, farmacológicas y clínicas; donde se preguntaba al paciente sobre la repercusión de la AF en su tratamiento y enfermedad y sobre la conformidad con el servicio prestado. El paciente podía responder desde uno=muy deficiente a cinco=excelente. Se realizó una fase piloto previa a la fase de validación de los cuestionarios. Análisis descriptivos y la medida del valor del alfa de Cronbach y el coeficiente de correlación intraclase (CCI) se llevaron a cabo en ambas fases. Se utilizó el programa estadístico SPSS versión 20.0. Resultados: Se incluyeron 21 encuestas en la fase piloto y 154 en la fase de validación (índice de respuesta 100%). De esta última fase, el 62% (N=96) eran hombres. Más del 50% de los pacientes contestaron de forma “excelente” a todos los ítems de la encuesta en ambas fases. Los valores del alfa de Cronbach y CCI fueron 0.921 y 0.915 (IC95%: 0.847-0.961) y 0.916 y 0,910 (IC95%: 0.886-0.931) para fase piloto y validación, respectivamente. Conclusión: Se ha diseñado y validado un instrumento de alta fiabilidad para medir la satisfacción de los pacientes con la AF recibida en las consultas de farmacia hospitalaria (AU)

Object: To design and to validate a questionnaire to assess satisfaction with pharmaceutical care (PC) received at the hospital pharmacy. Methods: Multicentric study in five andalusian hospital in January 2013. A bibliography search was performed in PUBMED; MESH term; pharmaceutical services, patients satisfaction and questionnaire. Next, the questionnaire was produced by Delphi methodology with ten items and with the following variables; demographics, socials, pharrmacologicals and clinics which the patient was asked for the consequences of the PC in his treatment and illness and for the acceptance with the received service. The patient could answer between one= very insufficient and five= excellent. Before the validation phase questionnaire, a pilot phase was carried out. Descriptive analysis, Cronbach’s alpha coefficient and intraclass correlation coefficient (ICC) were performed in both phases. Data analysis was conducted using the SPSS statistical software package release 20.0. Results: In the pilot phase were included 21 questionnaires and 154 of them in validation phase (response index of 100%). In the last phase, 62% (N=96) of patients were men. More than 50% of patients answered “excelent” in all items of questionnaire in both phases. The Cronbach’s alpha coefficient and ICC were 0.921 and 0.915 (95%IC: 0.847-0.961) and 0.916 and 0,910 (95%IC: 0.886-0.931) in pilot and validation phases, respectively. Conclusions: A high reliability instrument was designed and validated to evaluate the patient satisfaction with PC received at hospital pharmacy (AU)

[Design and validation of a satisfaction survey with pharmaceutical care received in hospital pharmacyconsultation]. / Diseño y validación de una encuesta de satisfacción con la atención farmacéutica recibida en las consultas de farmacia hospitalaria.

OBJECT: To design and to validate a questionnaire to assess satisfaction with pharmaceutical care (PC) received at the hospital pharmacy. METHODS: Multicentric study in five andalusian hospital in January 2013. A bibliography search was performed in PUBMED; MESH term; pharmaceutical services, patients satisfaction and questionnaire. Next, the questionnaire was produced by Delphi methodology with ten items and with the following variables; demographics, socials, pharrmacologicals and clinics which the patient was asked for the consequences of the PC in his treatment and illness and for the acceptance with the received service. The patient could answer between one= very insufficient and five= excellent. Before the validation phase questionnaire, a pilot phase was carried out. Descriptive analysis, Cronbach's alpha coefficient and intraclass correlation coefficient (ICC) were performed in both phases. Data analysis was conducted using the SPSS statistical software package release 20.0. RESULTS: In the pilot phase were included 21 questionnaires and 154 of them in validation phase (response index of 100%). In the last phase, 62% (N=96) of patients were men. More than 50% of patients answered "excelent" in all items of questionnaire in both phases. The Cronbach's alpha coefficient and ICC were 0.921 and 0.915 (95%IC: 0.847-0.961) and 0.916 and 0,910 (95%IC: 0.886-0.931) in pilot and validation phases, respectively. CONCLUSIONS: A high reliability instrument was designed and validated to evaluate the patient satisfaction with PC received at hospital pharmacy.

Objetivo: Diseñar y validar un cuestionario para valorar la satisfacción con la Atención Farmacéutica (AF) recibida en la farmacia hospitalaria. Métodos: Estudio multicéntrico en cinco hospitales andaluces. En enero 2013 se realizó una búsqueda bibliográfica en PUBMED; términos MESH pharmaceutical services, patients satisfaction and questionnaire. Seguidamente se elaboró el cuestionario, según metodología Delphi, formado por 10 ítems, con variables demográficas, sociales, farmacológicas y clínicas; donde se preguntaba al paciente sobre la repercusión de la AF en su tratamiento y enfermedad y sobre la conformidad con el servicio prestado. El paciente podía responder desde uno=muy deficiente a cinco=excelente. Se realizó una fase piloto previa a la fase de validación de los cuestionarios. Análisis descriptivos y la medida del valor del alfa de Cronbach y el coeficiente de correlación intraclase (CCI) se llevaron a cabo en ambas fases. Se utilizó el programa estadístico SPSS versión 20.0. Resultados: Se incluyeron 21 encuestas en la fase piloto y 154 en la fase de validación (índice de respuesta 100%). De esta última fase, el 62% (N=96) eran hombres. Más del 50% de los pacientes contestaron de forma "excelente" a todos los ítems de la encuesta en ambas fases. Los valores del alfa de Cronbach y CCI fueron 0.921 y 0.915 (IC95%: 0.847-0.961) y 0.916 y 0,910 (IC95%: 0.886-0.931) para fase piloto y validación, respectivamente. Conclusión: Se ha diseñado y validado un instrumento de alta fiabilidad para medir la satisfacción de los pacientes con la AF recibida en las consultas de farmacia hospitalaria.

Cambios en la prevalencia y distribución genotípica de la coinfección por el virus de la hepatitis C en pacientes infectados por el virus de la inmunodeficiencia humana / Prevalence and genotype distribution changes in hepatitis C virus co-infection among human immunodeficiency virus-infected patients

INTRODUCCIÓN: La prevalencia de hepatitis C es menor en los nuevos casos de pacientes infectados por VIH en España. El uso creciente del tratamiento frente al VHC podría haber cambiado la distribución genotípica del VHC. El objetivo de este estudio fue analizar los cambios en la prevalencia de la coinfección por VHC y en la distribución genotípica del VHC en pacientes infectados por VIH. Métodos Estudio de prevalencia seriada. Se incluyeron todos los pacientes infectados por VIH que acudieron a las consultas de un hospital de Andalucía entre septiembre de 2008 y febrero de 2009 (primer periodo) y entre enero y junio de 2013 (segundo periodo).Resultados Se incluyeron 520 y 651 pacientes en el primer y segundo periodos, respectivamente. El factor de riesgo de infección por VHC en el primer y segundo periodo fue: UDVP 319 (61%) vs. 348 (53%); contacto heterosexual, 111 (21%) vs. 135 (21%); homosexual, 76 (15%) vs. 114 (22%) (p = 0,006). La prevalencia de anti-VHC por periodos fue del 69% vs. el 58% (p=<0,001), y la de ARN-VHC detectable fue 49% vs. 37% (p=<0,001). En ambos periodos, la distribución genotípica fue: 1, 137 (60%) vs. 138 (59%); 3, 45 (20%) vs. 42 (18%); 4, 42 (18%) vs. 47 (20%) (p = 0,881). CONCLUSIONES: La prevalencia de infección por el VHC ha disminuido en los pacientes infectados por VIH en nuestro medio, incluyendo tanto la exposición al virus como la infección activa, en los últimos 5 años. Sin embargo, la distribución de los genotipos del VHC no ha cambiado

BACKGROUND: The prevalence of hepatitisC is decreasing among new diagnoses of HIV/HCV coinfection in Spain. The increasing use of the HCV treatment could have changed the HCV genotype distribution. The aim of this study is to analyze changes in the prevalence of HCV coinfection and in HCV genotype distribution among HIV-infected patients. METHODS: A serial cross-sectional study was conducted that included all HIV-infected patients who attended the Outpatient Clinic of a hospital in Andalusia, between September 2008 and February 2009 (first period), and between January 2013 and June 2013 (second period). RESULTS: A total of 520 and 651 patients were included in the first and second period, respectively. The risk factors of HCV infection in the first vs. second period were: IDU, 319 (61%) vs. 348 (53%); heterosexual contact, 111 (21%) vs. 135 (21%); homosexual men, 76 (15%) vs. 114 (22%) (P=.006). The prevalence of HCV antibody per period was: 358 (69%) vs. 380 (58%) (P=<.001), and for the HCV-RNA was 255 (49%) vs. 240 (37%) (P=<.001). In both periods, the HCV genotype distribution was: 1, 137 (60%) vs. 138 (59%); 3, 45 (20%) vs. 42 (18%); 4, 42 (18%) vs. 47 (20%) (P=.881). CONCLUSIONS: The prevalence of HCV infection in HIV-infected patients has decreased in our area, including overall exposure to HCV virus and active infection during the last 5 years. However, the HCV genotype distribution has not changed

[Prevalence and genotype distribution changes in hepatitis C virus co-infection among human immunodeficiency virus-infected patients]. / Cambios en la prevalencia y distribución genotípica de la coinfección por el virus de la hepatitis C en pacientes infectados por el virus de la inmunodeficiencia humana.

BACKGROUND: The prevalence of hepatitisC is decreasing among new diagnoses of HIV/HCV coinfection in Spain. The increasing use of the HCV treatment could have changed the HCV genotype distribution. The aim of this study is to analyze changes in the prevalence of HCV coinfection and in HCV genotype distribution among HIV-infected patients. METHODS: A serial cross-sectional study was conducted that included all HIV-infected patients who attended the Outpatient Clinic of a hospital in Andalusia, between September 2008 and February 2009 (first period), and between January 2013 and June 2013 (second period). RESULTS: A total of 520 and 651 patients were included in the first and second period, respectively. The risk factors of HCV infection in the first vs. second period were: IDU, 319 (61%) vs. 348 (53%); heterosexual contact, 111 (21%) vs. 135 (21%); homosexual men, 76 (15%) vs. 114 (22%) (P=.006). The prevalence of HCV antibody per period was: 358 (69%) vs. 380 (58%) (P=<.001), and for the HCV-RNA was 255 (49%) vs. 240 (37%) (P=<.001). In both periods, the HCV genotype distribution was: 1, 137 (60%) vs. 138 (59%); 3, 45 (20%) vs. 42 (18%); 4, 42 (18%) vs. 47 (20%) (P=.881). CONCLUSIONS: The prevalence of HCV infection in HIV-infected patients has decreased in our area, including overall exposure to HCV virus and active infection during the last 5 years. However, the HCV genotype distribution has not changed.

Prevalencia y factores asociados al insomnio y mala calidad de sueño en pacientes con VIH/SIDA en Sevilla, España / Prevalence and associated factors to insomnia and poor sleep in patients with HIV/AIDS at Seville, Spain

Antecedentes: La mala calidad de sueño puede tener un impacto negativo sobre la calidad de vida de lapoblación en general, y en pacientes VIH+ puede influir negativamente sobre la adherencia del tratamientoantirretroviral. A pesar de ello, hay pocos trabajos que hayan estudiado la cantidad de personas con VIH/SIDA que padecen este trastorno del sueño. Objetivos: Determinar la prevalencia y factores asociadosal insomnio y mala calidad de sueño en un grupo de pacientes con VIH+ en España. Método: Estudioobservacional descriptivo trasversal. En el estudio se incluyó a pacientes mayores de 18 años diagnosticadoscon VIH/SIDA pertenecientes al programa de Atención Farmacéutica del servicio de farmaciadel Hospital Virgen de Valme de Sevilla (España). Todos los pacientes completaron el Pittsburgh SleepQuality Index para medir la calidad de sueño, y el Insomnia Severity Index para medir la gravedad delinsomnio. Los factores asociados con la calidad de sueño fueron determinados mediante una regresiónlogística multivariante. Por su parte, los factores asociados a la gravedad del insomnio fueron estudiadosmediante una regresión lineal multivariante. Resultados: Se incluyó 188 pacientes con una edad mediade 45 años (desviación estándar DE = 8,4). El 78,7% fueron hombres. El recuento medio de CD4+ fue609,3 (DE = 318,0), y de CD8+ fue 868,7 (DE = 446,7). La media del PSQI fue de 7,0 (DE = 4,6), y105 (55,9%) pacientes fueron clasificados como malos dormidores (PSQI > 5). La puntuación mediaobtenida en el ISI fue 7,3 (DE = 9,1). En los buenos dormidores la puntuación media fue de 1,3 (DE =2,3) y en los malos dormidores fue de 12,0 (DE = 9,7) (p < 0,001). En los malos dormidores, el 40,9%tuvieron insomnio moderado o grave. La correlación entre la puntuación del PSQI y el ISI fue 0,775 (p< 0,001). Variables como adherencia, género, edad, recuento de CD4 ó CD8 no estuvieron relacionadascon el trastorno del sueño...

Background:Poor sleep quality could have a negative impact on quality of life in general population, and in HIV-infected patients could have a negative influence on adherence to antiretroviral treatment. However,only a few researches have studied the amount of patients VIH-infected that have this sleep disorder.Objective: To determine the prevalence and associated factors of poor sleep quality and insomnia in HIV+ patients in Spain.Method: Cross-sectional study.Subjects aged 18 or older diagnosed with HIV/AIDS and that were participating in a pharmaceutical care program of the Virgen de Valme Hospital of Seville (Spain) were included. All patients completed the Pittsburgh Sleep Quality Index to measure sleep quality and Insomnia Severity Index to measure severity of insomnia. Associations of factors with sleep quality were determined by multivariate logistic regression. On the other hand, associations of factors with severity of insomnia were found by means of multivariate linear regression.