RESUMO
To date, former research about the impact of HIV infection on mpox poor outcomes is still limited and controversial. Therefore, the aim of this study was to assess the impact of HIV on the clinical course of mpox, in a large population of patients from Spain. Nationwide case-series study. Patients from 18 Spanish hospitals, with PCR-confirmed mpox from April 27, 2022 to June 30, 2023 were included in this study. The main outcome was the development of long or complicated (LC) mpox, defined as: (i) duration of the clinical course ≥ 28 days, or; (ii) disseminated disease, or: (iii) emergence of severe complications. One thousand eight hundred twenty-three individuals were included. Seven hundred eighty-six (43%) were people living with HIV (PLWH), of whom 11 (1%) had a CD4 cell count < 200 cells/mm3 and 33 (3%) <350 cells/mm3 . HIV viral load ≥ 1000 cp/mL was found in 27 (3%) PLWH, none of them were on effective ART. Fifteen (60%) PLWH with HIV-RNA ≥ 1000 cp/mL showed LC versus 182 (29%) PLWH with plasma HIV-RNA load < 1000 copies/mL and 192 (24%) individuals without HIV infection (p < 0.001). In multivariate analysis, adjusted by age, sex, CD4 cell counts and HIV viral load at the time of mpox, only plasma HIV-RNA ≥ 1000 cp/mL was associated with a greater risk of developing LC mpox [adjusted OR = 4.06 (95% confidence interval 1.57-10.51), p = 0.004]. PLWH with uncontrolled HIV infection, due to lack of ART, are at a greater risk of developing LC mpox. Efforts should be made to ensure HIV testing is carried out in patients with mpox and to start ART without delay in those tested positive.
Assuntos
Infecções por HIV , Mpox , Humanos , Contagem de Linfócito CD4 , Progressão da Doença , RNARESUMO
OBJECTIVE: Multiple strategies have been utilised to reduce the incidence of HIV, including PrEP and rapid antiretroviral therapy initiation. The study objectives were to evaluate the efficacy, safety, satisfaction, treatment adherence, and system retention obtained with rapid initiation of bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) in naïve patients. METHODS: This phase IV, multicenter, open-label, single-arm, 48-week clinical trial enrolled patients between January 2020 and June 2022. Adherence to treatment was evaluated with the SMAQ questionnaire and patient satisfaction with the EQ-5D. RESULTS: Two hundred eight participants were enrolled with mean age of 35.6 years; 87.6% were males; mean CD4 count was 393.5 cells/uL (<200 cells/uL in 22.1%); viral load log was 5.6 (VL>100 000 cop/mL in 43.3%); 22.6% had AIDS, and 4.3% were coinfected with HBV. BIC/FTC/TAF was initiated on the day of their first visit to the HIV specialist in 98.6% of participants, and 9.6% were lost to follow-up. The efficacy at week 48 was 84.1 % by intention-to- treat (ITT), 94.6% by modified ITT, and 98.3% by per protocol analysis. The regimen was discontinued in two subjects (0.9%) during week 1 for grade 3 adverse events. Treatment adherence (weeks 4 [90%, IQR: 80-99%] vs. 48 [90%, IQR: 80-95%; P = 0.49]) and patient satisfaction (weeks 4 [90%, IQR: 80-99%] vs. 48 [90%, IQR: 80-95 P = 0.49]) rates were very high over the 48- week study period. CONCLUSIONS: BIC/FTC/TAF is an appropriate option for rapid ART initiation in naïve HIV patients, offering high efficacy, safety, durability, treatment adherence, retention in the healthcare system, and patient satisfaction. Number Clinical Trial registration: NCT06177574.
Assuntos
Alanina , Fármacos Anti-HIV , Emtricitabina , Infecções por HIV , Compostos Heterocíclicos de 4 ou mais Anéis , Piperazinas , Piridonas , Tenofovir , Humanos , Masculino , Feminino , Adulto , Infecções por HIV/tratamento farmacológico , Tenofovir/uso terapêutico , Tenofovir/análogos & derivados , Emtricitabina/uso terapêutico , Fármacos Anti-HIV/uso terapêutico , Compostos Heterocíclicos de 4 ou mais Anéis/uso terapêutico , Piridonas/uso terapêutico , Alanina/uso terapêutico , Alanina/análogos & derivados , Piperazinas/uso terapêutico , Combinação de Medicamentos , Carga Viral/efeitos dos fármacos , Pessoa de Meia-Idade , Adenina/análogos & derivados , Adenina/uso terapêutico , Adesão à Medicação , Amidas/uso terapêutico , Compostos Heterocíclicos com 3 Anéis/uso terapêutico , Satisfação do Paciente , Contagem de Linfócito CD4 , Resultado do Tratamento , Adulto JovemRESUMO
RESUMEN Lilian Harrison fue la primera persona en completar la travesía del Río de la Plata a nado, entre Colonia (Uruguay) y Punta Lara (Argentina) en 1923. La prensa argentina de la época coronó la victoria como un logro de toda la nación, a despecho de las apelaciones sexistas de los reportajes. Este artículo pretende analizar los discursos de la prensa uruguaya sobre la hazaña de la nadadora, utilizando las principales publicaciones periódicas de la época. El análisis de los reportajes permite concluir que, además de los artículos sexistas, que disminuían los logros de la atleta en comparación con sus compañeros masculinos, había cierto nivel de contrariedad en los reportajes, lo que indicaba el desagrado de la prensa hacia los propios nadadores del país.
ABSTRACT Lilian Harrison was the first person to complete the crossing of the River Plate by swimming between Colonia (Uruguay) and Punta Lara (Argentina) in 1923. The Argentine press of the time crowned the victory as an achievement of the whole nation, despite the sexist appeals of the reports. This article aims to analyse the discourses of the Uruguayan press about the swimmer's achievement, using the main periodicals published at the time. An analysis of the reports allows us to conclude that, in addition to the sexist articles, which also diminished the athlete's achievements compared to her male companions, there was some level of contrariness in the reports, signalling the displeasure of the press towards the country's swimmers.
RESUMO Lilian Harrison foi a primeira pessoa a completar a Travessia do Rio da Prata à nado, entre Colônia (Uruguay) e Punta Lara (Argentina) no ano de 1923. A imprensa argentina da época coroou a vitória como uma conquista de toda a nação, em que pesem os apelos sexistas das reportagens. Esse artigo tem como objetivo analisar os discursos da imprensa Uruguaya sobre o feito da nadadora, utilizando os principais periódicos publicados na época. Uma análise das reportagens permite concluir que, para além das matérias sexistas, que também diminuíram os feitos da atleta frente aos companheiros do gênero masculino, houve algum nível de contrariedade nas reportagens, sinalizando o desagrado da imprensa em relação aos próprios nadadores do país.
RESUMO
Introducción: La infección por Listeria monocytogenes es una enfermedad grave que afecta mayoritariamente a personas de edad avanzada e inmunodeprimidos y cuya incidencia está aumentando. En este estudio se analizan los casos de listeriosis en dos hospitales con el fin de estudiar cambios en su incidencia, formas de presentación clínica y posibles factores asociados a mortalidad. Material y métodos: Estudio retrospectivo multicéntrico de pacientes con listeriosis diagnosticada por aislamiento microbiológico entre 1977 y 2021 en dos hospitales universitarios de Madrid. Se recogen variables epidemiológicas, clínicas, estado de inmunodepresión, pruebas complementarias y tratamiento. Se analizan factores asociados a mortalidad. Resultados: Se analizaron 194 casos de listeriosis. La incidencia de listeriosis por ingresos aumentó a lo largo del estudio, con una importante caída del número de casos en 2020. La bacteriemia aislada (37,1%) y la afectación del sistema nervioso central (SNC) (36,6%) fueron las presentaciones más frecuentes. El 21% de los casos tuvo síntomas de gastroenteritis. El 16,5% presentó otras infecciones focales, siendo las más frecuentes peritonitis bacteriana espontánea (8,2%), colecistitis (2,1%), infección respiratoria (1,5%) e infección de prótesis vascular (1,5%). La mortalidad intrahospitalaria fue del 24,7%. Fueron factores independientes asociados a mortalidad al ingreso la edad (odds ratio [OR] 1.027, intervalo de confianza [IC] 95% 1.003-1.056) y la presencia de tumor sólido (OR 3.525, IC 95% 1.652-7.524). Conclusiones: En este estudio se constata un aumento de la incidencia de listeriosis en nuestro medio. Las presentaciones más frecuentes fueron la bacteriemia aislada y la afectación del SNC. La mortalidad intrahospitalaria se asoció a la edad y al diagnóstico de tumor sólido.(AU)
Introduction: Listeria monocytogenes infection is a severe disease affecting mainly aged people and patients with immune depression. The incidence of listeriosis seems to be increasing. In the present study cases of listeriosis from two hospitals are analyzed with the aims of studying changes in its incidence, clinical forms of presentation and possible factors associated with mortality. Methods: Retrospective multicentric study of patients with culture-proven listeriosis in two university hospitals in Madrid between 1977 and 2021. Epidemiological and clinical variables, as well as factors for immune depression, complementary studies and treatments were registered. Factors associated with mortality were analyzed. Results: A total of 194 cases of listeriosis were analyzed. The incidence of listeriosis among in-patients increased through the study period, with a significant drop in the number of cases in 2020. The most common clinical presentations were isolated bacteriemia (37.1%) and central nervous system involvement (CNS) (36.6%). Symptoms of gastroenteritis occurred in 21% of cases. Other focal infections were present in 16.5% of patients, the most frequent were spontaneous bacterial peritonitis (8.2%), cholecystitis (2.1%), respiratory infection (1.5%) and vascular prothesis infection (1.5%). In-hospital mortality was 24.7%. Independent factors associated with mortality at admission were age (odds ratio [OR] 1.027, 95% confidence interval [95% CI]1.0031.056) and a diagnosis of a solid tumor (OR 3.525, 95% CI1.6527.524). Conclusions: This study confirms an increasing incidence of listeriosis in our millieu. The most common clinical presentations were isolated bacteriemia and central nervous system involvement. In-hospital mortality was associated with age and the diagnosis of a solid tumor.(AU)
Assuntos
Humanos , Masculino , Feminino , Listeriose , Prognóstico , Listeria monocytogenes , Mortalidade , Infecções do Sistema Nervoso Central , Bacteriemia , Estudos Retrospectivos , Incidência , Microbiologia , Técnicas MicrobiológicasRESUMO
Introducción En España, la proporción de inmigrantes en los servicios clínicos de infección por virus de la inmunodeficiencia humana (VIH) es creciente. El objetivo del presente artículo es describir las características sociodemográficas, epidemiológicas y clínicas de una cohorte de personas con infección por VIH de la Red de Investigación en Sida (CoRIS) según su lugar de origen. Métodos CoRIS es una cohorte abierta, prospectiva y multicéntrica de adultos con infección por VIH sin tratamiento antirretrovírico previo, que se atendieron en 19 hospitales de 9 Comunidades Autónomas españolas entre enero de 2004 y octubre de 2006. Se describen las características por región de origen y se comparan con los casos españoles Resultados Se incluyeron 2.507 pacientes: el 76,3% fueron varones, con una mediana de edad de 36 años. Por el lugar de origen, el 71,5% fueron españoles; el 16,0% fueron latinoamericanos; el 5,8% fueron de África Subsahariana; el 3,7% fueron de Europa occidental; el 1,7% fueron de Europa del este, y el 1,4% fueron de África del norte. En comparación con los españoles, hubo diferencias significativas en sexo, edad y categoría de transmisión. La mediana de linfocitos CD4 al ingreso a la cohorte fue de 352×106/l, sin que hubiera diferencias según el origen. La mediana de carga vírica fue de 48,962 copias/ml, significativamente menor en el grupo de África subsahariana. Tras 11,4 meses de seguimiento, el 57,9% había iniciado tratamiento, sin que hubiera diferencias por origen. La prevalencia de coinfección con hepatitis C fue del 29,9% en españoles, del 7,3% en latinoamericanos, del 11,7% en los sujetos de África subsahariana y del 45,7% en los sujetos de Europa del este (p-60;0,05). El 13,4% tuvo prueba de tuberculina positiva; el 28,6% en los sujetos del África subsahariana y el 30,8% en los sujetos de África del norte. La tuberculosis fue más frecuente entre los sujetos de Europa del este (9,5%) y del África subsahariana (8,3%) que en españoles (4,8%) (p-60;0,05). Conclusiones Casi un tercio de las personas con infección por VIH que se atendieron recientemente en España fueron extranjeros. Sus características sociodemográficas, epidemiológicas y clínicas reflejan la epidemia en sus lugares de origen. Sin embargo, su situación inmunológica cuando acceden al hospital y en el inicio del tratamiento no difiere de la de los pacientes españoles (AU)
Introduction A growing number of immigrants are using the public health services for HIV in Spain. We describe the sociodemographic, epidemiological, and clinical characteristics of a cohort of naïve HIV-infected subjects (CoRIS cohort) according to their place of origin. Methods CoRIS is an open, hospital-based cohort of naïve, HIV-infected persons attended in 19 hospitals from 9 of the 19 autonomous regions in Spain. We describe the characteristics of the cohort members by place of origin, and compare them with the Spanish cases identified from January 2004 to October 2006, using the chi-square and Fisher exact tests. Results Of 2507 patients, 76.3% were men and median age was 36 years. By origin, 71.5% were Spanish, 16.0% Latin Americans (LA), 5.8% sub-Saharan Africans (SSA), 3.7% Western Europeans (WE), 1.7% Eastern Europeans (EE) and 1.4% North Africans (NA). Compared to Spaniards, there were significant differences by origin in sex, age, and transmission category. Median CD4 count at cohort entry was 352 cell/μL, with no differences according to origin. Median viral load was 48 962 copies/mL and was significantly lower for SSA. Over 11.4 months of follow-up, 57.9% initiated HAART with no differences by origin. Hepatitis C prevalence was 29.9% in Spaniards, 7.3% in Latin Americans, 11.7% in SSA, and 45.7% in EE (P-60;0.05). Overall, 13.4% were Mantoux-positive (28.6% in SSA and 30.8% in NA). Tuberculosis was more common among cases from EE (9.5%) and SSA (8.3%) compared to Spaniards (4.8%) (P-60;0.05).ConclusionsAlmost one third of naïve HIV-infected patients in CoRIS are foreign-born. Their sociodemographic, epidemiological and clinical characteristics reflect the epidemic in their places of origin. However, their immunological status at cohort entry and initiation of HAART is no different from that of Spaniards(AU)