Effect of daily consumption of extra virgin olive oil on the lipid profile and microbiota of HIV-infected patients over 50 years of age.

BACKGROUND: Extra virgin olive oil (EVOO) has shown beneficial effects on the lipid profile and inflammatory parameters in general population. Our goal is to analyze these changes together with those of intestinal microbiota in human immunodeficiency virus (HIV)-infected patients over 50 years of age. METHODS: Experimental single arm open study. HIV patients over the age of 50 with undetectable viral load were selected. EVOO was distributed among the patients so that each one consumed 50 g daily for 12 weeks. Lipid profile, C-reactive protein (CRP), and intestinal microbiota composition were analyzed at the beginning and at the end of the intervention. RESULTS: Total cholesterol decreased significantly (5 mg/dL), and a nonsignificant decrease in low-density lipoprotein cholesterol (12 mg/dL), triglycerides (21 mg/dL), and CRP (1.25 mg/dL) was observed. There was a significant increase in alpha diversity after the intervention in men and a decrease in proinflammatory genera such as Dethiosulfovibrionaceae was observed. Differences were also observed in the microbiota of men and women and according to the type of antiretroviral treatment. CONCLUSION: Sustained consumption of 50 g of EVOO in elderly HIV-infected patients might be associated with an improvement in lipid profile and alfa diversity of intestinal microbiota.

Efficacy and safety of the switch of Triumeq® to generic (abacavir + lamivudine) + Tivicay®: data at 48 weeks.

Introduction: Generic drugs are helpful to enhance the efficiency of the sanitary system. A generic coformulation of abacavir (ABC) and lamivudine (3TC) is available since 2016 in Spain. A report of our experience with its use is exposed. Methods: Patients between February 2017 and June 2017 who were taking Triumeq® were switched to the generic ABC + 3TC plus DTG. Efficacy, safety, reasons for discontinuation and costs savings were evaluated at 48 weeks. Results: Switch was made in 93 patients, with a median age of 47 years and a mean time of 12.33 years with HIV infection. Six patients (6.5%) discontinued the new ART, being toxicity of the central nervous system the most frequent reason. The effective saving derived from the change after 1 year of treatment was 151.127 €. Conclusions: The change from Triumeq® to a generic regimen of ABC + 3TC and another pill of DTG seems to be safe and efficient at 48 weeks.

Experience of Using an App in HIV Patients Older Than 60 Years: Pilot Program.

BACKGROUND: New technologies can promote knowledge of HIV infection among patients suffering from this disease. Older patients with HIV infection represent an increasingly large group that could benefit from the use of specific apps. OBJECTIVE: The aim of the study was to observe the acceptability and use of a mobile app on HIV infection in patients at least 60 years old and offer them the possibility of anonymously establishing contact with their peers. METHODS: A series of clinical and psychosocial parameters were studied in 30 HIV-infected patients of over 60 years. The patients must be at least 60 years old, with a follow-up in the outpatient clinic for at least 1 year and without pathologies that limit his or her life expectancy to less than a year. They must know how to read and write. To be part of the group assigned to the app, they had to have their own smartphone and confirm that they were connected to the internet from that device. Overall, 15 of them were randomized to use an app and 15 were in the control group. All tests were repeated after 6 months. RESULTS: The median age of patients was 66.5 years. Among them, 29 patients had an undetectable viral load at baseline. The median number of comorbid diseases was 2. Overall, 11 of them lived with their partners and 19 lived alone. They spent an average of 5 hours a day sitting down, and 56% (17/30) of them referred high physical activity. They scored 4 out of 5 for general quality of life perception. Moreover, 80% (24/30) presented high adherence to their treatment, and the average number of concomitant medications was 5. In the 6-min walking test, they covered a distance of 400 meters, and 3 of them desaturated during the test. The 15 patients made frequent use of the app, with 2407 sessions and an average of 7 min and 56 seconds time of use with a total of 13,143 screen views. During the 6 months of the trial, 3 non-AIDS events took place. There were no significant modifications to body mass index, blood pressure measurements, lipid profile, or immuno-virology information data. There were no differences in the questionnaire scores for perception of quality of life, confessed physical activity, or antiretroviral treatment (ART) and non-ART treatment adherence. CONCLUSIONS: Significant differences between studied parameters were not objectified in these patients, possibly because this trial has significant limitations, such as a small sample size and only a brief follow-up period. However, patients did use the app frequently, making this a possible intervention to be proposed in future subsequent studies.

Efficacy and safety of the switch of Triumeq® to generic (abacavir + lamivudine) + Tivicay®: data at 24 weeks.

BACKGROUND: Generic drugs may help to support antiretroviral treatment. We want to assess the efficacy and safety at 24 weeks of the change of coformulated (abacavir + lamivudine + dolutegravir) to (abacavir + lamivudine) coformulated as a generic pharmaceutical specialty + dolutegravir. METHODS: Between February and June 2017, switch from Triumeq® to a generic pharmaceutical specialty co-formulated tablet (abacavir + lamivudine) plus Tivicay® was made. Demographic, viroimmunological characteristics and the Charlson index were collected. Six months after switching, efficacy and safety were evaluated. RESULTS: Switch was made in 93 patients, with a mean age of 47 years, after six months there were five patients (5.4%) with viral loads between 50 and 400 copies, no patient had viral loads of greater amount. There were 2 interruptions due to toxicity (2.15%), in relation to symptoms of the central nervous system. There were no differences in the amount of years with HAART, nor in the previous months with the STR regimen based on abacavir + lamivudine + dolutegravir, nor in the Charlson index. The effective saving in 2017 derived from the change in these 93 patients was € 125.512. CONCLUSIONS: The change from a regimen of abacavir + lamivudine + dolutegravir seems to be safe and effective at 24 weeks.

Factors related to NT-proBNP levels in HIV patients aged over 40 years.

OBJECTIVE: To determine the levels of NT-pro BNP in HIV patients over 40 years who are receiving highly active antiretroviral therapy (HAART) and investigating potential independent clinical or laboratory factors. METHOD: We determine levels of NT-pro BNP in peripheral blood of HIV patients from Costa del Sol Hospital, over 40 years. We collected epidemiological, classical cardiovascular risk factors and variables associated with HIV infection status. The qualitative variables were compared using the χ2 test. NT-proBNP levels were taken as the dependent variable. The association between these levels and the quantitative variables were studied by analysis of variance (ANOVA), and the association with the qualitative variables, using Student's t test. RESULTS: Nt-pro BNP levels were determined in 146 HIV patients. We assess the 10-year cardiovascular risk calculated by the Framingham equation, 59 (41.5%) were classified as low risk, 46 (32.4%) as a moderate risk and 37 (26.1%) as a high risk. The higher levels of NT-pro BNP were found in women, and in those patient with lower filtration rate and high levels of triglycerides. An association was also observed between higher levels of NT-proBNP and the recent use of lamivudine and fosamprenavir. After a multivariate analysis we found an association between higher levels of NT-proBNP and the current use of fosamprenavir and a lower glomerular filtration rate. CONCLUSIONS: We found, with the limitations of a small serie, that higher levels of NTproBNP in HIV patients could be linked to the occurrence of cardiovascular events, this fact suggest that NTpro BNP could be used in patients at moderate or high vascular risk in order to optimise the primary prevention of vascular events.

Hipertensión pulmonar en pacientes con infección por el virus de la inmunodeficiencia humana: papel del tratamiento antirretroviral / Pulmonary hypertension in human immunodeficiency virus-infected patients: The role of antiretroviral therapy

Fundamento y objetivo: La hipertensión arterial pulmonar (HAP) es una enfermedad grave más prevalente en la población con infección por el virus de la inmunodeficiencia humana (VIH). No está claramente establecido el papel que el tratamiento antiretroviral de gran actividad (TARGA) desempeña en su desarrollo. Nuestro objetivo fue describir la prevalencia de HAP en una serie de pacientes con infección por VIH e identificar la relación que pudiera existir con el uso actual y acumulado de antirretrovirales. Pacientes y método: Estudio transversal de una cohorte de pacientes con infección por el VIH de un hospital del sur de España. Se recogieron datos demográficos, sobre el estado de la infección VIH y sobre el TARGA actual y acumulado. Se realizó ecocardiografía transtorácica a todos los participantes, definiéndose la HAP como la presencia de una presión sistólica de arteria pulmonar de 36 mmHg o más. Resultados: Participaron 400 pacientes; 178 presentaban insuficiencia tricuspídea y, de estos, 22 tenían HAP (5,5%). No se observaron diferencias en la edad, el sexo, los linfocitos CD4, la proporción de pacientes naive o con sida, ni en el uso acumulado de antirretrovirales. Sin embargo, el uso reciente de lamivudina se asoció a mayor prevalencia de HAP, y el de emtricitabina y tenofovir a una menor. El análisis de regresión logística se realizó incluyendo el uso actual de estos 3 fármacos. Solo el uso actual de tenofovir se asoció a menor presencia de HAP (odds ratio 0,31; intervalo de confianza del 95% 0,17-0,84). Conclusiones: La prevalencia de HAP en nuestro estudio es similar a la publicada en el resto de series en pacientes con infección por VIH. El uso actual de tenofovir podría estar asociado con una menor prevalencia de HAP (AU)

Background and objective: Pulmonary arterial hypertension (PAH) is a serious disorder, more prevalent in patients infected with human immunodeficiency virus (HIV). It is not entirely clear what role is played by highly active antiretroviral therapy (HAART) in PAH development or course. Our aim was to describe PAH prevalence in a series of HIV-infected patients and identify possible links with cumulative and current use of different antiretrovirals. Patients and method: Cross-sectional study of a cohort of HIV-infected patients attending a hospital in southern Spain. Demographic data, data on HIV infection status and on cumulative and recent antiretroviral treatment were recorded. Transthoracic echocardiography was performed in all study participants. PAH was defined as pulmonary artery systolic pressure of 36 mmHg or more. Results: A total of 400 patients participated in the study; 178 presented with tricuspid regurgitation and 22 of these presented with PAH (5.5%). No differences were encountered in age, sex, CD4 lymphocytes, proportion of naive patients or patients with AIDS. No differences were encountered in cumulative use of antiretrovirals. However, recent use of lamivudine was associated with a greater presence of PAH, whereas recent use of tenofovir and emtricitabine was associated with a lower presence of PAH. Logistic regression analysis was performed including the use of lamivudine, emtricitabine and tenofovir. Only recent use of tenofovir was associated with a lower presence of PAH (odds ratio 0.31; 95% confidence interval: 0.17-0.84). Conclusions: PAH prevalence in our study was similar to others series. Current use of tenofovir may be associated with lower PAH prevalence (AU)

Durability of the first antiretroviral treatment regimen and reasons for change in patients with HIV infection.

BACKGROUND: To study the durability of the drugs and coformulations currently used in the first treatment regimen of antiretroviral therapy (ART) for HIV patients, and to examine the reasons for changing this medication. METHODS: A retrospective observational multicenter study of patients with HIV infection who started a first-line ART regimen between January 2007 and June 2010. The primary outcome variable was the durability of this first ART regimen until discontinued or amended and the reasons for the change. Survival analysis of durability was performed using Kaplan-Meyer curves analysis, and a Cox multiple regression model was constructed to identify associated factors. RESULTS: A first-line ART regimen was initiated for 600 patients; after 1 year, it had been changed in 172 (28%) cases, with a median duration of 31 months. The main reason for change was toxicity (20.5% of all patients), followed by loss to follow-up (8.3%) and virological failure (5.3%). The most common type of toxicity was gastrointestinal (30%), followed by cutaneous (23%) and neuropsychiatric (18%). The use of non-nucleoside reverse transcriptase inhibitors (NNRTIs) was associated with greater durability than that of protease inhibitors (43 months vs 21 months; P = .001). CONCLUSIONS: The durability of the first-line ART regimen, based on current antiretroviral drugs and coformulations, is about 2.5 years, with toxicity being the main reason for its modification. Gastrointestinal toxicity is the type most commonly reported. NNRTI treatment is associated with greater durability of the first treatment regimen.

[Pulmonary hypertension in human immunodeficiency virus-infected patients: the role of antiretroviral therapy]. / Hipertensión pulmonar en pacientes con infección por el virus de la inmunodeficiencia humana: papel del tratamiento antirretroviral.

BACKGROUND AND OBJECTIVE: Pulmonary arterial hypertension (PAH) is a serious disorder, more prevalent in patients infected with human immunodeficiency virus (HIV). It is not entirely clear what role is played by highly active antiretroviral therapy (HAART) in PAH development or course. Our aim was to describe PAH prevalence in a series of HIV-infected patients and identify possible links with cumulative and current use of different antiretrovirals. PATIENTS AND METHOD: Cross-sectional study of a cohort of HIV-infected patients attending a hospital in southern Spain. Demographic data, data on HIV infection status and on cumulative and recent antiretroviral treatment were recorded. Transthoracic echocardiography was performed in all study participants. PAH was defined as pulmonary artery systolic pressure of 36mmHg or more. RESULTS: A total of 400 patients participated in the study; 178 presented with tricuspid regurgitation and 22 of these presented with PAH (5.5%). No differences were encountered in age, sex, CD4 lymphocytes, proportion of naive patients or patients with AIDS. No differences were encountered in cumulative use of antiretrovirals. However, recent use of lamivudine was associated with a greater presence of PAH, whereas recent use of tenofovir and emtricitabine was associated with a lower presence of PAH. Logistic regression analysis was performed including the use of lamivudine, emtricitabine and tenofovir. Only recent use of tenofovir was associated with a lower presence of PAH (odds ratio 0.31; 95% confidence interval: 0.17-0.84). CONCLUSIONS: PAH prevalence in our study was similar to others series. Current use of tenofovir may be associated with lower PAH prevalence.

Left ventricular hypertrophy detected by echocardiography in HIV-infected patients.

BACKGROUND: Left ventricular hypertrophy (LVH) is a predictor of overall mortality in the general population. The most sensitive diagnostic method is transthoracic echocardiography (TTE). In this study, we describe the prevalence of LVH, and the factors associated with it, in a group of patients with HIV infection. METHODS: TTE was offered to all patients attending the outpatient clinic of the Hospital Costa del Sol (Marbella, Spain) between 1 December 2009 and 28 February 2011. The corresponding demographic and clinical data were obtained. The left ventricular mass (LVM) was calculated and indexed by height(2.7). LVH was defined as LVM >48g/m(2.7) in men or >44g/m(2.7) in women. RESULTS: We examined 388 individuals (75.5% male, mean age 45.38years). Of these, 76.1% were receiving HAART; 11.9% had hypertension, 6.2% had diabetes mellitus, 23.2% had dyslipidaemia and 53.6% were tobacco users. The risk of cardiovascular disease at 10years (RV10) was 12.15% (95%CI: 10.99-13.31%). 19.1% of these patients had a high RV10. A total of 69 patients (19.8%) presented high LVM. Age, hypertension, dyslipidaemia, RV10 and the use of nevirapine were associated with a greater presence of LVH in the univariate analysis. In the logistic regression analysis performed, the factors retained in the model were the presence of high RV10 (OR: 2.92, 95%CI: 1.39-6.15) and the use of nevirapine (OR 2.20, 95%CI: 1.18-4.14). CONCLUSIONS: In this group of patients, the use of nevirapine and the presence of high RV10 were associated with LVH. The use of nevirapine might be related to its prescription for patients with higher RV10.

Raltegravir en pacientes con infección por el virus de la inmunodeficiencia humana y alto riesgo vascular / Raltegravir in HIV-infected patients with high vascular risk

Introducción: Nos proponemos recoger la experiencia de uso de raltegravir en el contexto del tratamiento antirretroviral de gran actividad (TARGA) en pacientes de alto riesgo vascular. Método: Estudio retrospectivo de casos y controles. Los casos fueron aquellos pacientes que al comenzar con raltegravir presentaban un riesgo de enfermedad cardiovascular ≥ 20% según el algoritmo de la Sociedad Europea de Sida. Debían haber permanecido con dicho tratamiento durante al menos seis meses. Se parearon controles 1:1 con riesgo vascular también ≥ 20%.Resultados: Se seleccionaron diez casos y diez controles. Tras seis meses de uso de raltegravir, se observó un descenso de los valores de colesterol unido a lipoproteínas de alta densidad (colesterol HDL) (-2,5mg/dL en los controles frente a 2,5mg/dL en los casos, p=0,015), triglicéridos (10mg/dL frente a -101mg/dL, p=0,009), y en la ratio colesterol total/colesterol HDL (0,17 frente a -0,73, p=0,002). El riesgo de enfermedad cardiovascular a diez años disminuyó un 4,85% en los casos frente a un 0,05% en los controles (p=0,07). Conclusiones: Raltegravir muestra un buen perfil para ser usado en pacientes de alto riesgo vascular, con descenso de la ratio colesterol total/colesterol HDL y del riesgo vascular (AU)

Objectives: To record the experience with use of raltegravir (RTG) for devising highly active antiretroviral therapy (HAART) regimens based on RTG in high vascular risk patients. Methods:A retrospective study was conducted on high vascular risk patients taking RTG. Case was a patient who, at the time raltegravir was started, had ≥ 20% 10-year risk of cardiovascular disease, estimated by the algorithm of the European AIDS Clinical Society. Patients should have been on stable HAART including RTG for at least six months. A matched control with ≥ 20% risk of cardiovascular disease, was selected for each case. Results:Ten controls and ten cases were selected. After six months using RTG, a significant decreased was seen in levels of HDL cholesterol (median -2,5mg/dL in controls versus 2,5mg/dL in cases, p=0.015), triglycerides (10mg/dL versus -101mg/dL, p=0.009), and TC/HDL-C ratio (0.17 versus -0.73, p=0.002). Ten-year risk of cardiovascular disease was -4.85% in cases versus -0.05% in controls (p=0.07). Conclusions: RTG shows a good profile to be used in people with high vascular risk, with a decrease in TC/HDL-C ratio and vascular risk (AU)

Seroprevalence of antibodies to the influenza A (H1N1) virus among healthcare workers prior to the 2009 pandemic peak.

OBJECTIVE: Our aim was to study the proportion of healthcare workers with a positive serology for Influenza A(H1N1)2009 without having flu, in a Spanish hospital at the beginning of the pandemic. METHODS: A survey study carried out during August 2009 (before the peak of the pandemic in Spain) in the Hospital Costa del Sol, a second level hospital with almost 300 beds in the South of Spain. The participants were workers in the following hospital units: Emergencies, Medical Area (Internal Medicine, Chest Diseases), Surgical Area (General Surgery and Anaesthesia) of any professional category. A study was made of the proportion of healthcare workers in our hospital with positive serology for the new influenza A (H1N1)2009 virus, as determined by the haemagglutination inhibition technique (≥1/40). The subjects completed a health status questionnaire, and provided a blood sample for serology testing. RESULTS: A total of 239 workers participated, of whom 25.1% had positive serology. The hospital area in which most individuals had positive serology was the Emergency Department (36.6%), while the professional category in which most individuals with a positive serology worked was that of the orderlies (41.7%). CONCLUSION: Around 25% of healthcare workers in our hospital had positive serology before the peak of the pandemic, none of them had received vaccine for Influenza A (H1N1) 2009 or had been diagnosed of influenza previously.

[Raltegravir in HIV-infected patients with high vascular risk]. / Raltegravir en pacientes con infección por el virus de la inmunodeficiencia humana y alto riesgo vascular.

OBJECTIVES: To record the experience with use of raltegravir (RTG) for devising highly active antiretroviral therapy (HAART) regimens based on RTG in high vascular risk patients. METHODS: A retrospective study was conducted on high vascular risk patients taking RTG. Case was a patient who, at the time raltegravir was started, had ≥ 20% 10-year risk of cardiovascular disease, estimated by the algorithm of the European AIDS Clinical Society. Patients should have been on stable HAART including RTG for at least six months. A matched control with ≥ 20% risk of cardiovascular disease, was selected for each case. RESULTS: Ten controls and ten cases were selected. After six months using RTG, a significant decreased was seen in levels of HDL cholesterol (median -2,5mg/dL in controls versus 2,5mg/dL in cases, p=0.015), triglycerides (10mg/dL versus -101 mg/dL, p=0.009), and TC/HDL-C ratio (0.17 versus -0.73, p=0.002). Ten-year risk of cardiovascular disease was -4.85% in cases versus -0.05% in controls (p=0.07). CONCLUSIONS: RTG shows a good profile to be used in people with high vascular risk, with a decrease in TC/HDL-C ratio and vascular risk.

Uso del índice tobillo-brazo en la reclasificación del riesgo vascular en pacientes con infección VIH / Ankle-brachial index in the assessment of cardiovascular risk among HIV infected patients

Background: Vascular risk is an important cause of morbidity and mortality in HIV infected patients. Aim: To study the value of the ankle-brachial index (ABI) in vascular risk stratification in a cohort of people with HIV infection. Patients and Methods: Vascular risk was calculated in all the patients that agreed to participate in the study and clinical reports were reviewed retrospectively. Ten year risk of fatal myocardial infarction was calculated according to Framingham equation, National Cholesterol Education Program (NCEP) III and Systematic Coronary Risk Evaluation (SCORE) project score. ABI was calculated measuring resting systolic blood pressure at the ankle, that was compared with the systolic brachial pressure. The ratio of the two pressures defined ABI, that was considered abnormal if it was d" 0.9 or e" 1.3. Results: A total of 231 HIV infected patients aged 23 to 82 years (80 percent males) were enrolled. Ten years risk according to Framingham equation was 8.4 percent, 95 percent confidence intervals (CI): 7.54-9.15 and according to SCORE scale was 0.8 percent, 95 percent CI: 0.62-1.01. According to NCEP III 9 percent of patients had a high or very high cardiovascular risk. Median ABI was 1.17 (95 percent CI intervals: 1.16-1.19) and 58 patients (25 percent) had an abnormal value. Using ABI results, approximately 20 percent of patients were re-classified as having a high vascular risk. Conclusions: ABI identified approximately 20 percent of this cohort of HIV infected subjects as having high vascular risk.

Papel protector del tratamiento antirretroviral en el deterioro de la función renal en una cohorte de pacientes infectados por el virus de la inmunodeficiencia humana / Protective role of antiretroviral treatment in the impairment of renal function in a cohort of human immunodeficiency virus patients

Fundamento y objetivos: Evaluar los cambios en la función renal en una cohorte de pacientes con infección por el virus de la inmunodeficiencia humana (VIH) y describir cuáles son los factores asociados a su deterioro.Pacientes y método: Estudio transversal prospectivo. El período de seguimiento ha sido de 12 meses. Al inicio del estudio y al cabo de un año se obtuvo el filtrado glomerular (FG). Además, se analizaron datos epidemiológicos, comorbilidades, valores de linfocitos CD4, carga viral (CV) y estadio de sida. Resultados: Se incluyeron un total de 365 pacientes. Estaban con tratamiento antirretroviral de gran actividad (TARGA) 313 pacientes (85%), la media (DE) de linfocitos CD4 era 606 (314) células/mm3 y la CV era indetectable en el 85% de los casos. Al año, se apreció un deterioro medio del FG de 9,7ml/h. Presentaron un descenso del FG > 10ml/h 80 pacientes (21,8%) y mayor de 30ml/h 20 pacientes (5,8%). Se encontró asociación con la edad, tratamiento con didanosina (DDI) y con el sexo masculino (odds ratio [OR] 1,89 e intervalo de confianza del 95% [IC 95%] 0,3-4,08, OR 2,3 e IC 95% 1,9-23, y OR 3,47 e IC 95% 1,6-14,20, respectivamente). Sí hubo asociación entre el hecho de recibir TARGA y presentar un menor deterioro del FG (OR 0,54, IC 95% 0,25-0,8). Conclusiones: Se aprecia un papel protector del tratamiento con TARGA en el deterioro del FG de los pacientes con infección por el VIH. El sexo masculino, la edad y el uso de DDI estuvieron asociados con un mayor deterioro de la función renal. El tenofovir (TDF) y los inhibidores de la proteasa (IP) no se asociaron a un mayor deterioro de la función renal (AU)

Background and objective: To assess changes in renal function in a cohort of patients infected with the human immunodeficiency virus (HIV) and describe which factors are associated with deterioration.Patients and methods: This was a prospective transversal study. The follow-up period was 12 months. Data were collected at baseline and one year including the glomerular filtration rate (GFR). We analyzed epidemiological data, comorbidities, CD4 lymphocytes, viral load, and AIDS status. Results: A total of 365 patients. Three hundred and thirteen (85%) were under highly active antiretroviral therapy (HAART); the median CD4 was 606±314 and the CV was undetectable in 85%. At 1-year, we found a mean deterioration in the GFR of 9.7ml/h. Eighty patients (21.8%) had a fall in GFR > 10ml/h, while in 20 patients (5.8%) it was > 30ml/h. An association was found regarding age, treatment with didanosine (DDI) and males (OR 1.89 95% CI 1.3 to 4.08, OR 2.3 95% CI 1.9 to 23 and OR 3.47 95% CI 1.6 to 14.20 respectively). We found a protective role of being under HAART (OR 0.54, 95% CI, 0.25 to 0.8). Conclusions: There was a protective role of HAART in the deterioration of GFR of patients with HIV infection. Male gender, age and use of DDI were associated with worsening renal function. Tenofovir and protease inhibitors were not associated with further deterioration of renal function (AU)

Programa de asesoramiento en tratamiento antibiótico en un hospital de segundo nivel: resultados de un año de actuación / Results of a counselling programme in antibiotic

Objetivo: El uso inadecuado de antibióticos puede originar un incremento en la resistencia bacteriana a los principales antimicrobianos. No existe una previsión en el futuro inmediato de comercialización de nuevos antibióticos de amplio espectro, en especial con actividad frente a enterobacterias. Por este motivo deben implantarse programas para la optimización del tratamiento antimicrobiano. Describimos los resultados de un año de un programa de asesoramiento en tratamiento antibiótico en un hospital de segundo nivel andaluz. Métodos: Se describen 276 intervenciones de un programa multidisciplinar de consejo terapéutico no impositivo en el Hospital Costa del Sol de Marbella. Se valoró la adecuación del tratamiento empírico, posibilidades de desescalado antibiótico, la duración y dosis empleada. Se analizó la evolución del perfil de sensibilidad de los principales microorganismos así como un análisis de coste-eficacia. Resultados: El 90% de los consejos emitidos fueron aceptados. Las principales actuaciones fueron para valoración de tratamiento empírico y desescalado en función de cultivos. Los principales fármacos evaluados fueron imipenem, ertapenem, cefepima y linezolid. El perfil de sensibilidad de imipenem y meropenem mejoró discretamente respecto a años previos. Se constató un considerable ahorro en el gasto farmacéutico anual. Conclusiones: Los programas de asesoramiento no impositivos son herramientas útiles para la optimización del tratamiento antimicrobiano, pueden evitar el incremento de resistencias bacterianas y disminuir el coste del tratamiento antibiótico(AU)

Background: The inappropriate use of antimicrobial agents may contribute to the development of bacterial resistance to the principal antimicrobial drugs. There is no provision in the immediate future of marketing of new broad-spectrum antibiotics, especially with activity against Enterobacteriaceae, so programs should be implemented to optimize antimicrobial therapy. We describe the results of a year of a counselling program in antibiotic treatment in a secondary Andalusian hospital. Methods: We describe 276 interventions of a multidisciplinary non-compulsory counselling program of antimicrobial management on the Costa del Sol Hospital in Marbella. We evaluated the adequacy of empirical treatment, possibility of antibiotic de-escalation, duration and dose used. We analyzed the evolution of the sensitivity profile of the main microorganisms as well as a cost-effective analysis. Results: 90% of the recommendations were accepted. The main actions were assessment of empirical therapy and deescalation in relation with the result of cultures. The main drugs tested were imipenem, meropenem, cefepime, and linezolid. The sensitivity profile of imipenem and meropenem improved slightly over previous years. It was found a considerable savings in annual drug spending. Conclusions: The non-compulsory counselling programs are useful tools for optimization of antimicrobial therapy, can prevent an increase of antimicrobial resistance and reduce the cost of antibiotic treatment(AU)

[Protective role of antiretroviral treatment in the impairment of renal function in a cohort of human immunodeficiency virus patients]. / Papel protector del tratamiento antirretroviral en el deterioro de la función renal en una cohorte de pacientes infectados por el virus de la inmunodeficiencia humana.

BACKGROUND AND OBJECTIVE: To assess changes in renal function in a cohort of patients infected with the human immunodeficiency virus (HIV) and describe which factors are associated with deterioration. PATIENTS AND METHODS: This was a prospective transversal study. The follow-up period was 12 months. Data were collected at baseline and one year including the glomerular filtration rate (GFR). We analyzed epidemiological data, comorbidities, CD4 lymphocytes, viral load, and AIDS status. RESULTS: A total of 365 patients. Three hundred and thirteen (85%) were under highly active antiretroviral therapy (HAART); the median CD4 was 606 ± 314 and the CV was undetectable in 85%. At 1-year, we found a mean deterioration in the GFR of 9.7 ml/h. Eighty patients (21.8%) had a fall in GFR > 10 ml/h, while in 20 patients (5.8%) it was > 30 ml/h. An association was found regarding age, treatment with didanosine (DDI) and males (OR 1.89 95% CI 1.3 to 4.08, OR 2.3 95% CI 1.9 to 23 and OR 3.47 95% CI 1.6 to 14.20 respectively). We found a protective role of being under HAART (OR 0.54, 95% CI, 0.25 to 0.8). CONCLUSIONS: There was a protective role of HAART in the deterioration of GFR of patients with HIV infection. Male gender, age and use of DDI were associated with worsening renal function. Tenofovir and protease inhibitors were not associated with further deterioration of renal function.

[Ankle-brachial index in the assessment of cardiovascular risk among HIV infected patients]. / Uso del índice tobillo-brazo en la reclasificación del riesgo vascular en pacientes con infección VIH.

BACKGROUND: Vascular risk is an important cause of morbidity and mortality in HIV infected patients. AIM: To study the value of the ankle-brachial index (ABI) in vascular risk stratification in a cohort of people with HIV infection. PATIENTS AND METHODS: Vascular risk was calculated in all the patients that agreed to participate in the study and clinical reports were reviewed retrospectively. Ten year risk of fatal myocardial infarction was calculated according to Framingham equation, National Cholesterol Education Program (NCEP) III and Systematic Coronary Risk Evaluation (SCORE) project score. ABI was calculated measuring resting systolic blood pressure at the ankle, that was compared with the systolic brachial pressure. The ratio of the two pressures defined ABI, that was considered abnormal if it was ≤ 0.9 or ≥ 1.3. RESULTS: A total of 231 HIV infected patients aged 23 to 82 years (80% males) were enrolled. Ten years risk according to Framingham equation was 8.4%, 95% confidence intervals (CI): 7.54-9.15 and according to SCORE scale was 0.8%, 95% CI: 0.62-1.01. According to NCEP III 9% of patients had a high or very high cardiovascular risk. Median ABI was 1.17 (95% CI intervals: 1.16-1.19) and 58 patients (25%) had an abnormal value. Using ABI results, approximately 20% of patients were re-classified as having a high vascular risk. CONCLUSIONS: ABI identified approximately 20% of this cohort of HIV infected subjects as having high vascular risk.

Factores asociados a índice tobillo-brazo alterado en una cohorte de pacientes con infección por el virus de la inmunodeficiencia humana de tipo 1 / Factors associated with an abnormal ankle-braquial index in a cohort of patients with HIV-1 infection

Introducción y objetivo: El índice tobillo-brazo (ITB) alterado se relaciona en población general con un aumento de la mortalidad vascular. En población con infección por el virus de la inmunodeficiencia humana (VIH), la prevalencia de ITB alterado es mayor que en población general. Nos proponemos estudiar esta prevalencia en una cohorte de pacientes con infección crónica por el VIH e investigar los factores asociados. Método: Se realizó determinación del ITB de forma consecutiva a todos los pacientes que consintieron. Se consideró ITB alterado aquel menor de 0,9 o mayor de 1,3. Se registraron variables demográficas, concernientes a su riesgo vascular y a la situación de su infección por el VIH y tratamiento antirretroviral. Resultados: Un total de 231 pacientes participaron en el estudio, de los que un 25% mostraba ITB alterado (solo en 3 era <0,9). La edad, la prevalencia de hipertensión, el uso de hipolipidemiantes, el riesgo de infarto a 10 años calculado por la ecuación de Framingham, la proporción de pacientes con sida, los CD4 nadir, la antigüedad de la infección y el uso de inhibidores de la proteasa eran mayores en el grupo de ITB alterado. Al realizar el análisis multivariante, permanecieron en el modelo, asociados a ITB alterado, el uso de hipolipidemiantes (odds ratio: 0,39; intervalo de confianza del 95%: 0,16–0,94) y el uso de inhibidores de la proteasa (odds ratio: 2,59; intervalo de confianza del 95%: 1,33–5,05).Conclusión: El uso de inhibidores de la proteasa se asocia a un ITB alterado, sobre todo a expensas de valores >1,3 (AU)

Introduction and objectives: An abnormal ankle-braquial index (ABI) has been related to a higher vascular mortality in the general population. People with HIV infection have a higher prevalence of abnormal ABI than general population. Our aim was to study that prevalence in a cohort of patients with HIV chronic infection and associated factors with an abnormal ABI.Methods: ABI was calculated consecutively in all the patients who agreed to participate. Abnormal ABI was defined as that lower than 0.9 or higher than 1.3. Demographic variables and those related to vascular risk, HIV infection status and antiretroviral therapy were assessed. Results: 231 patients collaborated in the study, and 25% of them had abnormal ABI (<0.9 in only 3 patients). Age, hypertension, lipid lowering agents use, vascular risk using Framingham equation, proportion of AIDS, CD4 nadir, years with the infection and protease inhibitors use were greater in the group with abnormal ABI. In logistic regression, lipid lowering agents use (OR: 0.39, CI95%: 0.16–0.94) and protease inhibitors use (OR: 2.59, CI95%: 1.33–5.05) remained in the model. Conclussion: Protease inhibitors use is associated with abnormal ABI, overall with an ABI greater than 1.3 (AU)

Prospective, randomized, two-arm controlled study to evaluate two interventions to improve adherence to antiretroviral therapy in Spain

Context Proper adherence is essential to obtain the desired results of antiretroviral therapy; thus, new interventional strategies for this purpose must be sought. Objective Comparison of 2 interventions, one conducted by a health professional and the other by a peer (patient on antiretroviral therapy), to improve adherence to antiretroviral therapy. Design and setting In 2003, a randomized, concurrent, follow-up study was conducted at 3 hospitals. Participants Patients were recruited consecutively at infectious disease visits scheduled to monitor their disease from May to September 2003. A sealed envelope was used to assign patients to each intervention group. A previous phase was conducted to unify data collection, and the intervention consisted of 4 visits at weeks 0, 8, 16, and 24.ResultsAmong the 240 patients included, 198 completed follow-up, and in 11 of these, treatment was interrupted at the doctor's decision. At baseline, 46.8% were classified as adherent. Multilevel analysis showed that as the visits progressed, the probability of adhering to treatment increased (OR 1.23; P<.01). Although differences were not significant, the group treated by a peer showed better results than the group treated by a health professional (OR 1.60; P=0.25). A lower probability of antiretroviral adherence was observed in patients receiving a drug combination including a protease inhibitor (OR 0.27; P<0.01) and in those with psychological distress (OR 0.44; P=0.03). Patients with a higher score on the physical quality of life index (OR 1.05; P<0.01) presented a higher probability of adherence. Conclusions The psychoeducational intervention studied is viable and effective for improving antiretroviral adherence. When the intervention is conducted by a peer the results are at least as good as those obtained by a health professional, and this implies cost-saving for the health system (AU)

Introducción La adecuada adherencia es esencial para obtener los resultados deseados de la terapia antirretroviral, y por tanto, deben buscarse nuevas estrategias de intervención para este fin. Objetivo Comparación de 2 de intervenciones para mejorar la adherencia a la terapia antirretroviral: una realizado por un profesional de la salud y el otro por un «igual» (paciente VIH+ en terapia antirretroviral).DiseñoEn 2003 se llevo a cabo en 3 hospitales, un ensayo clinico aleatorizado. Participantes Los pacientes fueron reclutados consecutivamente en las unidades de infecciosas en sus visitas programadas para controlar su enfermedad desde mayo a septiembre de 2003. La asignación a cada grupo de intervención se realizó mediante un sobre cerrado. Previamente a la intervención se realizó entrenamiento para unificar la recolección de datos, y la intervención consistió en 4 visitas en las semanas 0, 8, 16 y 24.ResultadosDe los 240 pacientes incluidos, 198 completaron el seguimiento, y en 11 de estos, el tratamiento fue interrumpido por decisión del médico. Al inicio del estudio, el 46,8% fueron clasificados como adherente. Mediante análisis multinivel se mostró que a medida que avanzaban las visitas, la probabilidad de adherirse al tratamiento aumento (OR: 1,23; p<0,01). Si bien las diferencias no fueron significativas, el grupo tratado por un «igual» mostró mejores resultados que el grupo tratado por un profesional de la salud (OR: 1,60, p=0,25). Una menor probabilidad de adherencia a los fármacos antirretrovirales se observó en los pacientes que recibieron una combinación de farmacos que incluía un inhibidor de la proteasa (OR: 0,27; p<0,01) y en aquellos con trastornos psicológicos (OR: 0,44, p=0,03). Los pacientes con una puntuación más alta en el índice de calidad física de vida (OR: 1,05; p<0,01) presentaron una mayor probabilidad de cumplimiento terapeutico. (..) (AU)