Dalbavancin real-life utilization among diabetic patients suffering from infections in Italy and Spain: The DALBADIA retrospective cohort study.

OBJECTIVES: To retrospectively describe the patterns of use of dalbavancin for treating infections in diabetic patients in Italian and Spanish standard clinical practice. METHODS: DALBADIA [NCT04959799] was a multicentre, observational, retrospective cohort study, conducted in Italy and Spain. The study enrolled 97 adults with type 1 or 2 diabetes mellitus, treated with dalbavancin as per standard clinical practice for a Gram-positive bacterial infection or the Gram-positive component of a mixed infection. RESULTS: Dalbavancin was used to treat cellulitis (18/92 patients, 19.6%), followed by prosthetic joint infection (14 patients, 15.2%), endocarditis (13 patients, 14.1%), and primary bacteraemia (10 patients, 10.9%); 78/92 (84.8%) patients had Gram-positive infections only, and 14 (15.2%) had mixed infections. The most frequently isolated microorganisms were Staphylococcus aureus in 43 (55.8% of the patients with microbial isolation), 25.6% of which methicillin-resistant; Staphylococcus epidermidis in 13 (16.9%), 53.8% of which methicillin-resistant; Enterococcus faecalis in 11 (14.3%). The main reason for the dalbavancin choice was the intent to simplify the antibiotic regimen (81.5% of cases). A multidisciplinary team participated in the treatment choice process for 53 (57.6%) patients. Dalbavancin was given as first-line antibiotic in 34 (37.0%) patients and administered as one infusion in 32 (34.8%), and as two infusions in 39 (42.4%). In total, 57/62 (91.9%) eligible patients with available assessment were judged clinically cured or improved at the end of observation. CONCLUSION: In clinical practice, dalbavancin was used in diabetic patients to treat ABSSSIs and other difficult-to-treat infections with a favourable safety profile and a high rate of positive clinical responses.

Timing in antibiotic therapy: when and how to start, de-escalate and stop antibiotic therapy. Proposals from a stablished antimicrobial stewardship program

The current morbimortality of serious infections is unacceptable and there is a need to promote the increase in the efficacy of empirical and targeted antibiotherapy. This could be achieved by initiatives coming from ASP teams aimed at promoting increased efficacy of antibiotic therapy .In the optimization of the antibiotic therapy there are several critical points in which an adequate timing could achieve benefits in the survival of patients with severe infections: prompt initiation of empirical treatment; de-escalation performance, appropriate targeted treatment; and finally, curtail antibiotic duration. (AU)

Incidence of nephrotoxicity associated with intravenous colistimethate sodium administration for the treatment of multidrug-resistant gram-negative bacterial infections.

Colistimethate sodium (CMS) is the inactive prodrug of colistin, CMS has a narrow antibacterial spectrum with concentration-dependent bactericidal activity against multidrug-resistant gram-negative bacteria, including Pseudomonas aeruginosa and Acinetobacter baumannii. This study aimed to analyze potential correlations between clinical features and the development of CMS-induced nephrotoxicity. This retrospective cohort study was conducted in a tertiary-care university hospital between 1 January 2015 and 31 December 2019. A total of 163 patients received CMS therapy. 75 patients (46%) developed nephrotoxicity attributable to colistin treatment, although only 14 patients (8.6%) discontinued treatment for this reason. 95.7% of CMS were prescribed as target therapy. Acinetobacter baumannii spp. was the most commonly identified pathogen (72.4%) followed by P. aeruginosa (19.6%). Several risk factors associated with nephrotoxicity were identified, among these were age (HR 1.033, 95%CI 1.016-1.052, p < 0.001), Charlson Index (HR 1.158, 95%CI 1.0462-1.283; p = 0.005) and baseline creatinine level (HR 1.273, 95%CI 1.071-1.514, p = 0.006). In terms of in-hospital mortality, risk factors were age (HR 2.43, 95%CI 1.021-1.065, p < 0.001); Charlson Index (HR 1.274, 95%CI 1.116-1.454, p = 0.043), higher baseline creatinine levels (HR 1.391, 95%CI 1.084-1.785, p = 0.010) and nephrotoxicity due to CMS treatment (HR 5.383, 95%CI 3.126-9.276, p < 0.001). In-hospital mortality rate were higher in patients with nephrotoxicity (log rank test p < 0.001). In conclusion, the nephrotoxicity was reported in almost half of the patients. Its complex management, continuous renal dose adjustment and monitoring creatinine levels at least every 48 h leads to a high percentage of inappropriate use and treatment failure.

Safety and Tolerability of More than Six Days of Tedizolid Treatment.

Tedizolid has demonstrated its efficacy and safety in clinical trials; however, data concerning its tolerability in long-term treatments are scarce. The aim of the study was to assess the indications and to describe the long-term safety profile of tedizolid. A multicentric retrospective study of patients who received tedizolid for more than 6 days was conducted. Adverse events (AEs) were identified from patients' medical records and laboratory data. The World Health Organization causality categories were used to discern AEs that were probably associated with tedizolid. Eighty-one patients, treated with tedizolid 200 mg once daily for a median (interquartile range [IQR]) duration of 28 (14 to 59) days, were included; 36 (44.4%) had previously received linezolid. The most common reasons for selecting tedizolid were to avoid linezolid potential toxicities or interactions (53.1%) or due to previous linezolid-related toxicities (27.2%). The most common indications were off-label, including prosthetic joint infections, osteomyelitis, and respiratory infections (77.8%). Overall, 9/81 patients (11.1%) experienced a probably associated AE. Two patients (2.5%) developed gastrointestinal disorders, 1 (1.2%) developed anemia, and 6 developed thrombocytopenia (7.4%) after a median (IQR) duration of treatment of 26.5 (17 to 58.5) days. Four (5%) patients discontinued tedizolid due to AEs. Among 23 patients with chronic renal failure (CRF), the rate of myelotoxicity was 17.4%, and only 8.7% had to stop tedizolid; 20 out of 22 with previous linezolid-associated toxicity had no AE. Long-term tedizolid treatments had good tolerance with rates of gastrointestinal AE and hematological toxicity lower than those reported with linezolid, particularly in patients with CRF and in those with a history of linezolid-associated toxicity.

Clinical outcomes of carbapenem de-escalation regardless of microbiological results: A propensity score analysis.

OBJECTIVE: The aim of this study was to evaluate the safety and efficacy of de-escalation in patients under treatment with carbapenems and its impact on clinical outcomes. METHODS: A prospective observational study was conducted for 1year. Patients administered active carbapenems for at least 24h were included. Primary outcomes were in-hospital mortality, mortality at 30 days after carbapenem prescription, and infection-related readmission within 30 days. De-escalation was defined as the substitution of carbapenem with narrower spectrum antimicrobial agents or its discontinuation during the first 96h of treatment. RESULTS: The study included 1161 patients, and de-escalation was performed in 667 (57.5%) of these. In the de-escalation group, 54.9% of cultures were positive. After propensity score matching, 30-day mortality was lower (17.4% vs. 25.7%, p=0.036), carbapenem treatment was 4 days shorter (4 vs. 8 days, p<0.001), total antibiotic therapy duration was 2 days longer (12 vs. 10 days, p=0.003), and length of hospital stay was 5 days shorter (8 vs. 13 days, p=0.008) in the de-escalated versus non-de-escalated patients. In-hospital mortality and 30-day readmission rates did not differ significantly between these groups. CONCLUSION: Carbapenem de-escalation is a safe strategy that does not compromise the clinical status of patients.

Epigastralgia y vómitos en paciente con espondilitis anquilosante / No disponible

No disponible

Effectiveness of Ritonavir-Boosted Protease Inhibitor Monotherapy in Clinical Practice Even with Previous Virological Failures to Protease Inhibitor-Based Regimens.

BACKGROUND AND OBJECTIVE: Significant controversy still exists about ritonavir-boosted protease inhibitor monotherapy (mtPI/rtv) as a simplification strategy that is used up to now to treat patients that have not experienced previous virological failure (VF) while on protease inhibitor (PI) -based regimens. We have evaluated the effectiveness of two mtPI/rtv regimens in an actual clinical practice setting, including patients that had experienced previous VF with PI-based regimens. METHODS: This retrospective study analyzed 1060 HIV-infected patients with undetectable viremia that were switched to lopinavir/ritonavir or darunavir/ritonavir monotherapy. In cases in which the patient had previously experienced VF while on a PI-based regimen, the lack of major HIV protease resistance mutations to lopinavir or darunavir, respectively, was mandatory. The primary endpoint of this study was the percentage of participants with virological suppression after 96 weeks according to intention-to-treat analysis (non-complete/missing = failure). RESULTS: A total of 1060 patients were analyzed, including 205 with previous VF while on PI-based regimens, 90 of whom were on complex therapies due to extensive resistance. The rates of treatment effectiveness (intention-to-treat analysis) and virological efficacy (on-treatment analysis) at week 96 were 79.3% (CI95, 76.8-81.8) and 91.5% (CI95, 89.6-93.4), respectively. No relationships were found between VF and earlier VF while on PI-based regimens, the presence of major or minor protease resistance mutations, the previous time on viral suppression, CD4+ T-cell nadir, and HCV-coinfection. Genotypic resistance tests were available in 49 out of the 74 patients with VFs and only four patients presented new major protease resistance mutations. CONCLUSION: Switching to mtPI/rtv achieves sustained virological control in most patients, even in those with previous VF on PI-based regimens as long as no major resistance mutations are present for the administered drug.

Antiretroviral therapy as a factor protective against anal dysplasia in HIV-infected males who have sex with males.

OBJECTIVES: Chronic infection with oncogenic HPV genotype is associated with the development of anal dysplasia. Antiretroviral therapy (ART) has been shown to decrease the incidence of cervical carcinoma in women with HIV. We sought to: 1) describe the prevalence and grade of anal dysplasia and HPV infection in our study subjects; 2) analyze the grade of correlation between anal cytology, PCR of high-risk HPV, and histology; 3) identify the factors associated with the appearance of ≥ AIN2 lesions. DESIGN: Cross-sectional, prospective study. METHODS: A cohort of HIV-positive males (n = 140, mean age  = 37 years) who have sex with males (MSM) had epidemiological, clinical and analytical data collected. Anal mucosa samples were taken for cytology, HPV PCR genotyping, and anoscopy for histological analysis. RESULTS: Within the cohort, 77.1% were being treated with ART, 8.5% anoscopy findings were AIN2, and 11.4% carcinoma in situ; 74.2% had high-risk (HR), 59.7% low-risk (LR) HPV genotypes and 46.8% had both. The combination of cytology with PCR identifying HR-HPV better predicts the histology findings than either of these factors alone. Logistic regression highlighted ART as a protective factor against ≥ AIN2 lesions (OR: 0.214; 95%CI: 0.054-0.84). Anal/genital condylomas (OR: 4.26; 95%CI: 1.27-14.3), and HPV68 genotype (OR: 10.6; 95%CI: 1.23-91.47) were identified as risk factors. CONCLUSIONS: In our cohort, ART has a protective effect against dysplastic anal lesions. Anal/genital warts and HPV68 genotype are predictors of ≥ AIN2 lesions. Introducing PCR HPV genotype evaluation improves screening success over that of cytology alone.

[CD4 lymphocytes as a protective factor against infection by oncogenic genotypes of human papillomavirus in the anal mucosa of men who have sex with human immunodeficiency virus positive men]. / Linfocitos CD4 como factor protector frente a la infección por genotipos oncogénicos del virus del papiloma humano en la mucosa del canal anal de varones que tienen sexo con varones infectados por el virus de la inmunodeficiencia humana.

BACKGROUND AND OBJECTIVES: To analyze the prevalence of human papillomavirus (HPV) genotypes and anal dysplasia in a cohort of human immunodeficiency virus (HIV) infected men who have sex with men (MSM) from southern Spain, and the variables associated with the appearance of dysplastic lesions and oncogenic HPV genotypes. PATIENTS AND METHODS: A cross-sectional study involving a prospective cohort of HIV-positive MSM included consecutively after signing an informed consent form. During the consultation 2 samples were taken from the anal mucosa: one for HPV detection using polymerase chain reaction (PCR), and the other for cytological evaluation; the Bethesda system was used to classify the cytology. RESULTS: One hundred and thirty-four consecutive patients were included. 91.1% patients were colonized by HPV, 66.1% by high-grade types and 41.52% by genotypes of low and high-grade malignancy. The most prevalent genotypes were: 6, 11, 16, 18, 51 and 53. 72.2% samples sent for cytology showed dysplasia, of which 71.4% were low-grade squamous intraepithelial lesions, 23.1% were atypical squamous cell, and 0% was high-grade squamous intraepithelial lesions. The multivariate analysis of risk factors associated with the appearance of dysplasia revealed association with smoking (95% confidence interval [95% CI] 1.196-9.303; odds ratio [OR] 3.336; P=.02) and number of oncogenic HPV types (95% CI 1.387-3.811; OR 2.229; P=.001). With regard to the presence of oncogenic HPV genotypes the multivariate analysis showed a high CD4 cell count was a protective factor against infection by these viruses (95% CI 1.098-5.58; OR 2.48; P=.029). CONCLUSIONS: The prevalence of anal dysplasia among HIV-positive MSM in this study is very high, fundamentally in smokers and a high number of oncogenic HPV genotypes. The presence of oncogenic HPV genotypes was associated with a lower CD4 cell count.

Penetración en reservorios / Penetration in reservoirs

La monoterapia de mantenimiento con lopinavir potenciado con ritonavir (LPV/r) es una estrategia segura y efectiva a corto y medio plazo. Para afrontar su efectividad a largo plazo, necesitamos despejar la incógnita de si una teórica disminución de la potencia del tratamiento puede reducir la capacidad de suprimir la actividad replicativa del virus de la inmunodeficiencia humana (VIH) en los reservorios o compartimentos biológicos, donde LPV/r tiene más dificultades de difundirse. Hemos aprendido que el LPV/r penetra bastante bien en el peor de los reservorios, el sistema nervioso central. Pero, sobre todo, hemos aprendido que la capacidad de difundirse en los reservorios no es una condición crítica para conseguir la eficacia. Y es que el principal escenario de la batalla frente al VIH es el compartimento plasmático. Lo que allí conseguimos con el tratamiento antirretroviral puede extrapolarse fielmente al líquido cefalorraquídeo y casi siempre al líquido seminal. Lo que ocurre en el tejido linfoide y en la mucosa intestinal, cuya fisiopatología se inicia con intensidad desde el comienzo de la enfermedad, es más oscuro y más difícil de interpretar. En cualquier caso, los problemas marginales que unos reservorios repletos del VIH y relativamente impermeables a LPV/r pudieran generar serían poco relevantes en el escenario del tratamiento de simplificación, en el que sólo se ofrece monoterapia de mantenimiento con LPV/r a pacientes estables y con buen control inmunovirológico de la enfermedad(AU)

Maintenance monotherapy with lopinavir/ritonavir (LPV/r) is a safe and effective strategy in the short and medium term. To evaluate its effectiveness in the long term, the question of whether a theoretical decrease in the potency of treatment could reduce suppression of viral replication in reservoirs or in biological compartments where LPV/r penetration is lower must be answered. LPV/r penetrates fairly well in the most impenetrable reservoir, the central nervous system. However, the ability to penetrate reservoirs is not essential to achieve efficacy, since the main battlefield in the fight against HIV is the plasma compartment. What can be achieved in this compartment with antiretroviral therapy can be faithfully extrapolated to cerebrospinal fluid and almost always to seminal fluid. What occurs in lymphoid tissue and in intestinal mucosa, whose physiopathology is intensely initiated at the beginning of the disease, is more obscure and difficult to interpret. The marginal problems that might be generated by some reservoirs that harbor HIV and are relatively impermeable to LPV/r would be of little importance in simplification therapy, which is only offered as maintenance monotherapy with LPV/r to clinically stable patients with good immunological and virological control(AU)

Características químicas, mecanismo de acción y actividad antiviral de darunavir / Chemical characteristics, mechanism of action and antiviral activity of darunavir

Darunavir es el resultado de una amplia y profundainvestigación en el campo de la farmacología del bloqueode la proteasa del virus de la inmunodeficiencia humana(VIH). Se trata de un inhibidor de la proteasa (IP) nopeptídico, con una estructura química distinta que,confiriéndole una mayor y mejor afinidad por la diana yuna mayor estabilidad frente a su disociación, lo hace máspotente que el resto de los IP conocidos.Sus características farmacocinéticas exigen lacoadministración de dosis bajas de ritonavir y permitenbien la administración oral (preferentemente con lascomidas), la administración una vez al día frente a cepasdel VIH no resistentes y una dosificación cómoda en muyvariadas situaciones, incluyendo las insuficiencias renal yhepática leves-moderadas.Su potencial de interacciones farmacológicas se asumefácilmente y puede administrarse sin ajuste de dosis concasi todos los antirretrovirales, excepto maraviroc,lopinavir, saquinavir y tipranavir. Tampoco hay problemasde antagonismo farmacodinámico con ninguno de ellos.Las dosis citotóxicas están muy por encima de las dosisterapéuticas, lo que le otorga un amplio margen deseguridad.Su espectro de acción es muy amplio, y resulta eficazfrente a todos los subtipos del VIH-1 y frente al VIH-2, yactúa bien en las líneas celulares mononucleares ymonociticomacrofágicas. Además, es activo frente a lamayoría de los VIH resistentes al resto de los IP, y surobustez frente a los mecanismos conocidos de resistenciadel VIH es también superior al del resto de los IPdisponibles, de tal manera que la inducción y selección demutaciones que confieren resistencia a este fármacoparece ser más lenta y difícil, lo que le podría permitirmantener su efecto antiviral inalterado durante largosperíodos(AU)

Darunavir is the result of wide and in-depth investigationinto HIV protease inhibitors (PIs). This drug is a nonpeptidePI, with a distinct chemical structure that, byconferring it drug with enhanced binding affinity and aslower dissociation rate, makes it more potent than theremaining PIs developed to date.Because of its pharmacokinetic characteristics, darunavirmust be coadministered with low doses of ritonavir.Furthermore, these characteristics allow oraladministration (preferably with meals), once-dailyadministration in non-resistant HIV strains, and a lesscomplicated treatment regimen with improvedconvenience in highly varied contexts, including mild-tomoderaterenal and hepatic impairment.The potential of darunavir for pharmacological interactionsis highly acceptable and this drug can be administeredwithout dose adjustments with almost all antiretroviralagents except maraviroc, lopinavir, saquinavir andtipranavir. There are no problems of pharmacodynamicantagonism with any of these drugs.Cytotoxic doses are well above therapeutic doses,providing a wide safety margin.The spectrum of action is very wide, and darunavir iseffective against all subtypes of HIV-1 and against HIV-2and acts well in mononuclear and monocyte/macrophagecell lines. Darunavir is also active against most HIV strainsresistant to the remaining PIs and the robustness of thisdrug against the known mechanisms of resistance of HIVis also superior to that of the other available PIs.Consequently, the induction and selection of mutationsconferring resistance to this drug may be slower and moredifficult, resulting in its antiviral effect remainingunchanged for prolonged periods(AU)

Características químicas, mecanismo de acción y actividad antiviral de darunavir / Chemical characteristics, mechanism of action and antiviral activity of darunavir

Darunavir es el resultado de una amplia y profundainvestigación en el campo de la farmacología del bloqueode la proteasa del virus de la inmunodeficiencia humana(VIH). Se trata de un inhibidor de la proteasa (IP) nopeptídico, con una estructura química distinta que,confiriéndole una mayor y mejor afinidad por la diana yuna mayor estabilidad frente a su disociación, lo hace más potente que el resto de los IP conocidos.Sus características farmacocinéticas exigen lacoadministración de dosis bajas de ritonavir y permitenbien la administración oral (preferentemente con lascomidas), la administración una vez al día frente a cepasdel VIH no resistentes y una dosificación cómoda en muyvariadas situaciones, incluyendo las insuficiencias renal y hepática leves-moderadas. Su potencial de interacciones farmacológicas se asume fácilmente y puede administrarse sin ajuste de dosis con casi todos los antirretrovirales, excepto maraviroc, lopinavir, saquinavir y tipranavir. Tampoco hay problemasde antagonismo farmacodinámico con ninguno de ellos.Las dosis citotóxicas están muy por encima de las dosisterapéuticas, lo que le otorga un amplio margen deseguridad. Su espectro de acción es muy amplio, y resulta eficaz frente a todos los subtipos del VIH-1 y frente al VIH-2, y actúa bien en las líneas celulares mononucleares y monociticomacrofágicas. Además, es activo frente a la mayoría de los VIH resistentes al resto de los IP, y su robustez frente a los mecanismos conocidos de resistencia del VIH es también superior al del resto de los IP disponibles, de tal manera que la inducción y selección de mutaciones que confieren resistencia a este fármaco parece ser más lenta y difícil, lo que le podría permitir mantener su efecto antiviral inalterado durante largos períodos

Darunavir is the result of wide and in-depth investigation into HIV protease inhibitors (PIs). This drug is a nonpeptide PI, with a distinct chemical structure that, by conferring it drug with enhanced binding affinity and a slower dissociation rate, makes it more potent than the remaining PIs developed to date.Because of its pharmacokinetic characteristics, darunavirmust be coadministered with low doses of ritonavir.Furthermore, these characteristics allow oraladministration (preferably with meals), once-daily administration in non-resistant HIV strains, and a lesscomplicated treatment regimen with improvedconvenience in highly varied contexts, including mild-tomoderate renal and hepatic impairment.The potential of darunavir for pharmacological interactions is highly acceptable and this drug can be administered without dose adjustments with almost all antiretroviral agents except maraviroc, lopinavir, saquinavir and tipranavir. There are no problems of pharmacodynamic antagonism with any of these drugs.Cytotoxic doses are well above therapeutic doses,providing a wide safety margin.The spectrum of action is very wide, and darunavir iseffective against all subtypes of HIV-1 and against HIV-2and acts well in mononuclear and monocyte/macrophagecell lines. Darunavir is also active against most HIV strains resistant to the remaining PIs and the robustness of this drug against the known mechanisms of resistance of HIV is also superior to that of the other available PIs. Consequently, the induction and selection of mutations conferring resistance to this drug may be slower and more difficult, resulting in its antiviral effect remaining unchanged for prolonged periods

[Penetration in reservoirs]. / Penetración en reservorios.

Maintenance monotherapy with lopinavir/ritonavir (LPV/r) is a safe and effective strategy in the short and medium term. To evaluate its effectiveness in the long term, the question of whether a theoretical decrease in the potency of treatment could reduce suppression of viral replication in reservoirs or in biological compartments where LPV/r penetration is lower must be answered. LPV/r penetrates fairly well in the most impenetrable reservoir, the central nervous system. However, the ability to penetrate reservoirs is not essential to achieve efficacy, since the main battlefield in the fight against HIV is the plasma compartment. What can be achieved in this compartment with antiretroviral therapy can be faithfully extrapolated to cerebrospinal fluid and almost always to seminal fluid. What occurs in lymphoid tissue and in intestinal mucosa, whose physiopathology is intensely initiated at the beginning of the disease, is more obscure and difficult to interpret. The marginal problems that might be generated by some reservoirs that harbor HIV and are relatively impermeable to LPV/r would be of little importance in simplification therapy, which is only offered as maintenance monotherapy with LPV/r to clinically stable patients with good immunological and virological control.

[Chemical characteristics, mechanism of action and antiviral activity of darunavir]. / Características químicas, mecanismo de acción y actividad antiviral de darunavir.

Darunavir is the result of wide and in-depth investigation into HIV protease inhibitors (PIs). This drug is a nonpeptide PI, with a distinct chemical structure that, by conferring it drug with enhanced binding affinity and a slower dissociation rate, makes it more potent than the remaining PIs developed to date. Because of its pharmacokinetic characteristics, darunavir must be coadministered with low doses of ritonavir. Furthermore, these characteristics allow oral administration (preferably with meals), once-daily administration in non-resistant HIV strains, and a less complicated treatment regimen with improved convenience in highly varied contexts, including mild-to-moderate renal and hepatic impairment. The potential of darunavir for pharmacological interactions is highly acceptable and this drug can be administered without dose adjustments with almost all antiretroviral agents except maraviroc, lopinavir, saquinavir and tipranavir. There are no problems of pharmacodynamic antagonism with any of these drugs. Cytotoxic doses are well above therapeutic doses, providing a wide safety margin. The spectrum of action is very wide, and darunavir is effective against all subtypes of HIV-1 and against HIV-2 and acts well in mononuclear and monocyte/macrophage cell lines. Darunavir is also active against most HIV strains resistant to the remaining PIs and the robustness of this drug against the known mechanisms of resistance of HIV is also superior to that of the other available PIs. Consequently, the induction and selection of mutations conferring resistance to this drug may be slower and more difficult, resulting in its antiviral effect remaining unchanged for prolonged periods.

[Impact of demographic and psychosocial factors on adherence to antiretroviral treatment]. / Impacto de los factores demográficos y psicosociales en la no adherencia a los fármacos antirretrovirales.

BACKGROUND AND OBJECTIVE: Antiretroviral efficacy is closely related to the degree of adherence. The aim of this study is to assess the association between psychosocial and demographic variables and adherence to antiretroviral treatment. PATIENTS AND METHODS: A cross-sectional survey of 320 patients under antiretroviral treatment was conducted in four Andalusian hospitals, using a semi-structured questionnaire given by health care professionals. RESULTS: Median age was 39.7 years. Nearly 12% of the sample was considered non-compliant to antiretroviral treatment. An interaction was observed between psychological morbidity and mental health quality of life scores. Among patients who presented psychological morbidity, a higher mental quality of life score was associated with a lower risk of non-compliance (P = 0.04). This association was not found among patients without psychological morbidity. Older age, homosexual or bisexual status and the use of injecting drugs for a shorter period of time was associated with non-compliance. CONCLUSIONS: Demographic and psychological factors have an influence on adherence to antiretroviral treatment.

Impacto de los factores demográficos y psicosociales en la no adherencia a los fármacos antirretrovirales / Impact of demographic and psychosocial factors on adherence to antiretroviral treatment

Antecedentes y objetivo. La efectividad de los antirretrovirales está asociada de forma muy estrecha al grado de adhesión. Este trabajo pretende determinar la asociación de las variables demográficas y psicosociales con la adherencia al tratamiento antirretroviral. Pacientes y métodos. Se realizó un estudio transversal con 320 pacientes en tratamiento antirretroviral, atendidos en cuatro hospitales de la Comunidad Autónoma Andaluza. Se utilizó un cuestionario semiestructurado, administrado por personal sanitario. Resultados. La edad media de la muestra fue 39,7 años. El 11,9% de la muestra estudiada fue considerada no adherida al tratamiento antirretroviral. Se detectó una interacción entre la presencia de morbilidad psíquica y la puntuación del índice de salud mental (ISM). Así, entre aquellos que padecían morbilidad psíquica a una mejor calidad de vida mental se les asoció un menor riesgo de no adherirse al tratamiento (p = 0,04), no describiéndose esta asociación entre aquéllos sin morbilidad psíquica. Una mayor edad, ser homosexual y haber estado menos años como consumidor de drogas por vía parenteral mostraron una tendencia a asociarse a la no adherencia. Conclusiones. Los factores demográficos y psicosociales influyen en la adherencia al tratamiento antirretroviral (AU)

Background and objective. Antiretroviral efficacy is closely related to the degree of adherence. The aim of this study is to assess the association between psychosocial and demographic variables and adherence to antiretroviral treatment. Patients and methods. A cross-sectional survey of 320 patients under antiretroviral treatment was conducted in four Andalusian hospitals, using a semi-structured questionnaire given by health care professionals. Results. Median age was 39.7 years. Nearly 12% of the sample was considered non-compliant to antiretroviral treatment. An interaction was observed between psychological morbidity and mental health quality of life scores. Among patients who presented psychological morbidity, a higher mental quality of life score was associated with a lower risk of non-compliance (P = 0.04). This association was not found among patients without psychological morbidity. Older age, homosexual or bisexual status and the use of injecting drugs for a shorter period of time was associated with non-compliance. Conclusions. Demographic and psychological factors have an influence on adherence to antiretroviral treatment (AU)

[Clinical status, adherence to HAART and quality of life in HIV-infected patients receiving antiretroviral treatment]. / Estado clínico, adherencia al TARGA y calidad de vida en pacientes con infección por el VIH tratados con antirretrovirales.

INTRODUCTION: Quality of life is one of the most frequently used subjective measures in chronic health problems. The aim of this study is to analyze the association between clinical and therapeutic parameters, and 11 quality of life domains in HIV-infected patients. METHODS: A cross-sectional survey of 320 patients on antiretroviral treatment was conducted in four Andalusian hospitals (Spain). A semi-structured questionnaire was administered by health care professionals. Health-related quality of life was assessed with the MOS-HIV questionnaire, an instrument designed specifically for HIV-infected patients. RESULTS: Almost three-quarters of the population were men (73.4%); 35.6% had developed aids, and 88.1% were considered adherent to treatment. Patients with greater viral load presented lower quality of life scores for all the domains, except cognitive functioning. Patients who had developed aids showed poorer quality of life for 10 of the 11 domains. Patients with adequate adherence to antiretroviral treatment showed better quality of life for 10 domains. No statistically significant differences in the domain scores except for quality of life were found between patients with a treatment regimen including protease inhibitors and those without. CONCLUSION: The patient's clinical status and adherence affect not only survival, but also quality of life.

Estado clínico, adherencia al TARGA y calidad de vida en pacientes con infección por el VIH tratados con antirretrovirales / Clinical status, adherence to HAART and quality of life in HIV-infected patients receiving antiretroviral treatment

Introducción. La calidad de vida es uno de los métodos de evaluación subjetiva más utilizados en enfermedades de carácter crónico. El objetivo de este estudio es analizar la asociación entre parámetros clínicos y terapéuticos y las 11 dimensiones de calidad de vida en pacientes infectados por el virus de la inmunodeficiencia humana (VIH). Métodos. Se realizó un estudio transversal con 320 pacientes en tratamiento antirretroviral de 4 hospitales andaluces. Se utilizó un cuestionario semiestructurado administrado por personal sanitario. La calidad de vida relacionada con la salud se midió a través del cuestionario MOS-HIV (Medical Outcomes Study HIV Health Survey), que es un instrumento específico para pacientes con VIH. Resultados. El 73,4% de los entrevistados eran varones, el 35,6% tenían sida y el 88,1% fue considerado adherente al tratamiento. Los pacientes con una mayor carga viral presentaron puntuaciones más bajas en todas las dimensiones de la calidad de vida, a excepción de la función cognitiva. Los pacientes con sida mostraron una peor calidad de vida en 10 de las 11 dimensiones. Aquéllos con una adherencia adecuada al tratamiento antirretroviral mostraron una mejor calidad de vida en 10 dimensiones. No se detectaron diferencias estadísticamente significativas en las medias de las dimensiones del cuestionario MOS-HIV entre pacientes cuya combinación farmacológica incluía inhibidores de la proteasa y aquellos que no, a excepción de la dimensión de calidad de vida. Conclusión. El estado clínico y la adherencia del paciente no sólo afectan a su supervivencia, sino también a diferentes dimensiones de su calidad de vida (AU)

Introduction. Quality of life is one of the most frequently used subjective measures in chronic health problems. The aim of this study is to analyze the association between clinical and therapeutic parameters, and 11 quality of life domains in HIV-infected patients. Methods. A cross-sectional survey of 320 patients on antiretroviral treatment was conducted in four Andalusian hospitals (Spain). A semi-structured questionnaire was administered by health care professionals. Health-related quality of life was assessed with the MOS-HIV questionnaire, an instrument designed specifically for HIV-infected patients. Results. Almost three-quarters of the population were men (73.4%); 35.6% had developed aids, and 88.1% were considered adherent to treatment. Patients with greater viral load presented lower quality of life scores for all the domains, except cognitive functioning. Patients who had developed aids showed poorer quality of life for 10 of the 11 domains. Patients with adequate adherence to antiretroviral treatment showed better quality of life for 10 domains. No statistically significant differences in the domain scores except for quality of life were found between patients with a treatment regimen including protease inhibitors and those without. Conclusion. The patient's clinical status and adherence affect not only survival, but also quality of life (AU)

Impacto del apoyo social y la morbilidad psíquica en la calidad de vida en pacientes tratados con antirretrovirales / The impact of the social support and the psychic morbidity on the quality of life of patients with antiretroviral therapy

El objeto de este estudio es analizar la relación existente entre la morbilidad psíquica y el apoyo social con la calidad de vida. Por otro, el papel que realiza el apoyo social como amortiguador de la morbilidad psíquica en estos pacientes. Se estudiaron a 320 pacientes VIH positivos en tratamiento con antirretrovirales, que acudieron a las consultas externas del servicio de infecciosos de cuatro hospitales de la comunidad autónoma andaluza. Así, una mejor calidad de vida se asoció a una ausencia de morbilidad psíquica y a la presencia de apoyo social, a la vez que se observa el papel fundamental que juega el apoyo social como amortiguador de la morbilidad psíquica en este tipo de pacientes. Estos resultados ponen de relieve la importancia que los factores psicosociales tienen durante el transcurso de enfermedades de carácter crónico

The aim of this study is to analyse the existing relation between the psychic morbidity and social support and the quality of life. Besides this, the paper analyses the buffer roll that social support plays on the psychic morbidity in these patients. We studied 320 HIV+ patients in treatment with antiretrovirals, who attended the infectious disease services of four hospitals of the Autonomous Andalusian Community. Being associated a better quality of life to an absence of psychic morbidity and to the presence of social support, it is observed the relevant buffer role that the social support like shock absorber of the psychic morbidity in this one type of patients. These results show the importance that the psycho-social factors have during the course of chronic diseases

Visceral leishmaniasis caused by Leishmania infantum in a Spanish patient in Argentina: What is the origin of the infection? Case report.

BACKGROUND: The question "Where have you been?" is a common one asked by doctors in Northern Europe and America when faced with clinical symptoms not typical of their country. This question must also arise in the clinics of developing countries in which non-autochthonous cases such as the one described here can appear. Important outbreaks of Leishmania infantum have been recorded in the last decade in several Latin American countries but its presence has not yet been recorded in Argentina. We report the first case of visceral leishmaniasis owing to L. infantum in this country. CASE PRESENTATION: A 71-year-old Spanish woman who has been living in Mendoza, Argentina, during the last 40 years presented with a history of high fever and shivering, anemia, leukopenia and splenomegaly over two years. Argentinian doctors did not suspect visceral leishmaniasis even when the histological analysis revealed the presence of "intracytoplasmatic spheroid particles compatible with fungal or parasitic infection". After a serious deterioration in her health, she was taken to Spain where she was evaluated and visceral leishmaniasis was established. Specific identification of the parasite was done by PCR-ELISA, isoenzyme electrophoresis and RAPD-PCR. CONCLUSION: We would like to point out that: i) cases such as the one described here, which appear in non-endemic areas, can pass unnoticed by the clinical physician. ii) in countries in which these introduced cases reside, in-depth parasitological studies are required into vectors and possible reservoirs to rule out the rare case of local infection and, once infection has taken place, to ensure that this does not spread by anthroponotic transmission or a competent reservoir.