Inflammatory, procoagulant markers and HIV residual viremia in patients receiving protease inhibitor monotherapy or triple drug therapy: a cross-sectional study.

BACKGROUND: Protease inhibitor monotherapy is associated with more frequent episodes of viral rebounds above 50 copies/mL than triple therapy. OBJECTIVE: To evaluate if, compared to triple-drug therapy, protease inhibitor monotherapy is associated with increased levels of inflammatory/procoagulant markers and more frequent plasma residual viremia detection. METHODS: In this cross-sectional study, we included patients treated for ≥ 1 year with darunavir/ritonavir or lopinavir/ritonavir as monotherapy (n=72) or with two nucleos(t)ides (n=74). All samples were tested for CRP, IL-6, fibrinogen and D-dimer. Residual viremia was determined using an ultrasensitive qualitative nested-PCR of the HIV pol gene with a limit of detection of 1 copy of HIV-RNA. RESULTS: We found no differences in levels of inflammatory/procoagulant markers or in the proportion of patients with plasma residual viremia detection by treatment group. CONCLUSION: The long-term treatment with protease inhibitor monotherapy in the setting of routine clinical practice is not associated with a higher prevalence of plasma residual viremia or more elevated inflammatory/procoagulant markers levels than triple drug therapy.

Randomized Trial Evaluating the Neurotoxicity of Dolutegravir/Abacavir/Lamivudine and Its Reversibility After Switching to Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Alafenamide: GESIDA 9016.

BACKGROUND: Despite evidence shown of dolutegravir (DTG)-related neurotoxicity, which may be more common when combined with abacavir (ABC), its reversibility has not been explored in a clinical trial. METHODS: We conducted a randomized, multicenter, open-label, pilot trial to evaluate the reversibility of patient-reported neuropsychiatric symptoms, developed or worsened on DTG/ABC/lamivudine (DTG/ABC/3TC), in virologically suppressed patients switched to cobicistat-boosted-elvitegravir/emtricitabine/tenofovir-alafenamide (EVG/COBI/FTC/TAF). Participants were randomized to immediate switch (baseline) or to defer switch (week 4), and then all completed 24 weeks of follow up on EVG/COBI/FTC/TAF. At each visit, participants completed Pittsburgh Sleep Quality Index (PSQI) and Hospital Anxiety and Depression (HAD) scales and were interviewed about 11 neuropsychiatric symptoms potentially related with DTG through a questionnaire. At baseline and at the end of follow up, they also performed neurocognitive testing. Our primary objective was to compare changes in neuropsychiatric symptoms and PSQI and HAD scales between arms at week 4. Secondary objectives were to evaluate changes in neuropsychiatric symptoms and PSQI and HAD scales at weeks 4, 12, and 24 after switching to EVG/COBI/FTC/TAF and in neurocognitive performance and magnetic resonance imaging biomarkers at end of follow up. RESULTS: Thirty-eight participants were included. Study arms were similar at baseline. At week 4, neuropsychiatric symptoms and PSQI and HAD scores remained unchanged in participants receiving DTG/ABC/3TC and improved significantly in participants receiving EVG/COBI/FTC/TAF. These significant improvements were also observed at weeks 4, 12, and 24 after all participants switched to EVG/COBI/FTC/TAF. In addition, global neurocognitive performance improved (NPZ-7) after switching to EVG/COBI/FTC/TAF. CONCLUSIONS: Neuropsychiatric symptoms in patients on DTG/ABC/3TC could resolve or improve after switching to EVG/COBI/FTC/TAF.

[Prevalences of hepatitis virus coinfection and indications for chronic hepatitis C virus treatment and liver transplantation in Spanish HIV-infected patients. The GESIDA 29/02 and FIPSE 12185/01 Multicenter Study]. / Estudio multicéntrico sobre prevalencia de las coinfecciones por virus de hepatitis, indicación de tratamiento de hepatitis crónica C y necesidad de trasplante hepático en pacientes infectados por el VIH en España. Estudio GESIDA 29/02-FIPSE 12185/01.

INTRODUCTION: The aims of this study were to estimate the prevalence of HIV and hepatitis virus coinfection in the Spanish population and to determine the percentage of patients who are candidates for chronic hepatitis C virus (HCV) treatment and liver transplantation within this population. METHODS: A cross-sectional study was performed in 2002 in two Spanish populations of HIV-infected patients: 1,260 patients from 39 centers throughout Spain (P1) and 1,560 patients from three tertiary teaching hospitals in Madrid (P2). RESULTS: The following hepatitis A virus (HAV), hepatitis B virus (HBV) and HCV serological prevalence were found in the P1 and P2 groups, respectively: HAV-IgG antibodies: 74% and 78%; HBsAg1: 4.9% and 4.8%; HBsAg-, anti-HBc1, anti-HBs1: 39% and 39%; HBsAg-, anti-HBc1, anti-HBs-: 25% and 31%; HBsAg-, anti-HBc-, anti-HBs1: 7% and 8%; HBsAg-, anti-HBc-, anti-HBs-: 22% and 16%. Anti-HCV1: 61% and 65%, respectively. Of the patients with positive HCV serology, 88.8% and 84.6% of each group were positive for HCV-RNA by polymerase chain reaction. Multiple coinfections with hepatitis viruses were found in 3.2% and 2.8%, respectively; of these, 70% and 78% had coinfection with HBV, HCV and HDV. Liver cirrhosis was found in 5.8% and 9.6% of the patients coinfected with HIV and HCV, respectively. Liver transplant was indicated in approximately one out of every six coinfected patients with liver cirrhosis. The 43 and 37% of the HCV coinfected patients were good candidates for anti-HCV treatment, but only 14% and 15% of patients had initiated it. CONCLUSIONS: A high percentage of HIV-infected patients in Spain were coinfected with hepatitis viruses, especially HCV. The number of possible candidates for liver transplantation is rising and could increase in the next few years. In the future, greater efforts to treat HIV-and hepatitis virus-coinfected patients will be required.

Estudio multicéntrico sobre prevalencia de las coinfecciones por virus de hepatitis, indicación de tratamiento de hepatitis crónica C y necesidad de trasplante hepático en pacientes infectados por el VIH en España. Estudio GESIDA 29/02-FIPSE 12185/01 / Prevalences of hepatitis virus coinfection and indications for chronic hepatitis C virus treatment and liver transplantation in Spanish HIV-infected patients. The GESIDA 29/02 and FIPSE 12185/01 Multicenter Study

Introducción. Los objetivos del estudio son estimar la prevalencia de las coinfecciones por virus de la hepatitis en la población española infectada por el VIH y determinar el porcentaje de pacientes candidatos a tratamiento de la hepatitis C crónica (HCC) y a trasplante hepático dentro de esta población. Métodos. Estudio transversal de dos poblaciones de pacientes infectados por el VIH realizado en el año 2002: 1.260 pacientes de la población de 39 centros de toda la geografía española (P1) y 1.560 pacientes de la de tres hospitales de tercer nivel de Madrid (P2). Resultados. La prevalencia sérica de virus de las hepatitis A (VHA), B (VHB) y HCC encontrada respectivamente en P1 y P2. IgG anti-VHA1: 74% y 78%. HBsAg1: 4,9 y 4,8%. HBsAg­, anti-HBc1, anti-HBs1: 39 y 39%. HBsAg­, anti-HBc1, anti-HBs­: 25 y 31%. HBsAg­, anti-HBc­, anti-HBs1: 7 y 8%. HBsAg­, anti-HBc­, anti-HBs­: 22 y 16%. Anti-VHC1: 61 y 65%. Entre estos 88,8 y 84,6% tenían una PCR VHC1. Coinfección múltiple por virus de la hepatitis 3,2 y 2,8% y de estos, 70 y 78% con coinfección por el VHB, el VHC y el VHD. Cirrosis hepática el 5,8 y 9,6% de los pacientes coinfectados por el VIH y el VHC, con indicación de considerar trasplante hepático aproximadamente en uno de cada seis. El 43 y 37% de los coinfectados por el VHC eran buenos candidatos a tratamiento de HCC, pero sólo el 14 y el 15% lo habían iniciado. Conclusiones. Un elevado porcentaje de pacientes infectados por el VIH en España están coinfectados por virus de hepatitis, especialmente por el tipo C (VHC). El número de posibles candidatos a trasplante hepático es elevado y puede aumentar en los próximos años. En el futuro será necesario un mayor esfuerzo de tratamiento en los pacientes coinfectados por el VIH y virus de hepatitis (AU)

Introduction. The aims of this study were to estimate the prevalence of HIV and hepatitis virus coinfection in the Spanish population and to determine the percentage of patients who are candidates for chronic hepatitis C virus (HCV) treatment and liver transplantation within this population. Methods. A cross-sectional study was performed in 2002 in two Spanish populations of HIV-infected patients: 1,260 patients from 39 centers throughout Spain (P1) and 1,560 patients from three tertiary teaching hospitals in Madrid (P2).Results. The following hepatitis A virus (HAV), hepatitis B virus (HBV) and HCV serological prevalence were found in the P1 and P2 groups, respectively: HAV-IgG antibodies: 74% and 78%; HBsAg1: 4.9% and 4.8%; HBsAg­, anti-HBc1, anti-HBs1: 39% and 39%; HBsAg­, anti-HBc1, anti-HBs­: 25% and 31%; HBsAg­, anti-HBc­, anti-HBs1: 7% and 8%; HBsAg­, anti-HBc­, anti-HBs­: 22% and 16%. Anti-HCV1: 61% and 65%, respectively. Of the patients with positive HCV serology, 88.8% and 84.6% of each group were positive for HCV-RNA by polymerase chain reaction. Multiple coinfections with hepatitis viruses were found in 3.2% and 2.8%, respectively; of these, 70% and 78% had coinfection with HBV, HCV and HDV. Liver cirrhosis was found in 5.8% and 9.6% of the patients coinfected with HIV and HCV, respectively. Liver transplant was indicated in approximately one out of every six coinfected patients with liver cirrhosis. The 43 and 37% of the HCV coinfected patients were good candidates for anti-HCV treatment, but only 14% and 15% of patients had initiated it. Conclusions. A high percentage of HIV-infected patients in Spain were coinfected with hepatitis viruses, especially HCV. The number of possible candidates for liver transplantation is rising and could increase in the next few years. In the future, greater efforts to treat HIV-and hepatitis virus-coinfected patients will be required (AU)

Preguntas y respuestas sobre la meningitis por criptococo asociada a la infección por el virus de la inmunodeficiencia humana / Questions and answers concerning meningitis by cryptococcus associated with human immunodeficiency virus infection

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