Tocilizumab for COVID-19 treatment. An Argentine report.

Recently it has been demonstrated the clinical effectiveness of tocilizumab (TCZ) associated with systemic steroids for the treatment of severe SARS-CoV-2 pneumonia with rapid progression. The objective of this work was to describe the epidemiological, clinical, laboratory and evolution characteristics of the patients who received this treatment. Between March and June 2021, TCZ was administered in a cohort study of adults with severe SARS-CoV-2 pneumonia, in a private hospital in the City of Buenos Aires; 30 patients were included, 63% men, middle age 55 years. Obesity (33%), arterial hypertension (26%) and diabetes (25%) were the most frequent comorbidities. We found associated infections during hospitalization in half of the cohort, within them, pneumonia associated with mechanical ventilation was the most frequent and methicillin-sensitive Staphylococcus aureus, the most prevalent germ. Patients with secondary infections had a higher requirement for invasive mechanical ventilation (IMV) (100% vs. 19% p < 0.001) and more days of hospitalization (median 23 vs. 15 p = 0.009). Of the entire cohort, seven who died during hospitalization had the highest requirement for IMV (100% vs. 43% p = 0.010) and secondary infections (100% vs. 35%, p = 0.006). In this relatively young cohort of patients with severe or critical SARS-CoV-2 pneumonia, obesity does not appear to be a predisposing factor for superinfection or death. The presence of secondary infections, organ failure and shock are presented as probable factors of worse evolution, as well as the requirement of IMV.

Recientemente se demostró la efectividad clínica del tocilizumab (TCZ) asociado a esteroides sistémicos para el tratamiento de la neumonía grave por SARS-CoV-2 con rápida progresión. El objetivo de este trabajo fue describir las características epidemiológicas, clínicas, de laboratorio y evolución de los pacientes que recibieron este tratamiento. Entre marzo y junio, 2021, se realizó un estudio de cohorte en un sanatorio privado de la Ciudad de Buenos Aires en adultos con neumonía grave por SARS-CoV-2 que recibieron TCZ. Se incluyeron 30 pacientes, hombres 63%, mediana edad 55 años, obesidad (33%), hipertensión arterial (26%) y diabetes (25%) fueron las comorbilidades más frecuentes. Encontramos infecciones asociadas durante la hospitalización en la mitad de la cohorte, dentro de ellas, la neumonía asociada a la ventilación mecánica fue la más frecuente y el Staphylococcus aureus meticilino sensible, el germen más prevalente. Los enfermos con infecciones secundarias tuvieron un mayor requerimiento de ventilación mecánica invasiva (VMI) (100% vs. 19% p < 0.001) y más días de internación (mediana 23 vs. 15 p = 0.009). De la totalidad de la cohorte, siete que fallecieron durante la internación tuvieron el mayor requerimiento de VMI (100% vs. 43% p = 0.010) e infecciones secundarias (100% vs. 35%, p = 0.006). En esta cohorte relativamente joven de pacientes con neumonía grave o crítica por SARS-CoV-2, la obesidad no parece ser un factor predisponente para sobreinfección o muerte. La presencia de infecciones secundarias, falla orgánica y shock se presentan como probables factores de peor evolución, como así también el requerimiento de VMI.

From publications to every day clinical practice: tocilizumab in patients with severe COVID-19.

INTRODUCTION: there is evidence on the effectiveness and safety of tocilizumab (TZC) used in combination with systemic corticosteroids for severe SARS-CoV-2 pneumonia treatment. The purpose of this study was to describe epidemiological, clinical, and laboratory features as well as clinical outcome of patients receiving this combination therapy compared with those receiving only corticosteroids. METHODS: a retrospective cohort study, which included adults with severe SARS-CoV-2 pneumonia, was conducted between March and August 2021. Enrolment included 101 patients, 46 with corticosteroids and 55 with corticosteroids plus tocilizumab. RESULTS: median age was 58 years old and 63.9% were females. High blood pressure was present in 36.1% and obesity in 54.6%. Survival in the cohort was 81.4%, with a median hospital stay of 19.0 days. Secondary infections were present in 47.4% of the cohort. Patients in the TZC group had a lower C reactive protein (CRP) at discharge, lower rate of multiple organ failure, better functional status at discharge and shorter hospital stay. In a bivariate analysis, no differences were found in mortality rate and secondary infections occurrence. When assessing clinical status as per WHO Ordinal Scale there was a significant difference in its variability from worsening to discharge (or 14 days), evidencing a better functional status in patients receiving TCZ. DISCUSSION: we were able to demonstrate its efficacy in reducing inflammatory biomarkers and a trend towards fewer days of hospitalization, with no impact on mortality.

Introducción: existe evidencia sobre la efectividad y seguridad de tocilizumab (TZC) utilizado en combinación con corticosteroides sistémicos para el tratamiento de la neumonía grave por SARS-CoV-2. El propósito de este estudio fue describir las características epidemiológicas, clínicas y de laboratorio, así como el resultado clínico de los pacientes que recibieron esta terapia combinada en comparación con los que recibieron solo corticosteroides. Métodos: se realizó un estudio de cohorte retrospectivo, que incluyó adultos con neumonía grave por SARS-CoV-2, entre marzo y agosto de 2021. Se incluyeron 101 pacientes, 46 con corticosteroides y 55 con corticosteroides más tocilizumab. Resultados: la mediana de edad fue de 58 años y el 63.9% eran mujeres. La hipertensión arterial estuvo presente en el 36.1% y la obesidad en el 54.6%. La supervivencia en la cohorte fue del 81.4%, con una mediana de estancia hospitalaria de 19.0 días. Las infecciones secundarias estuvieron presentes en el 47.4% de la cohorte. Los pacientes del grupo TZC tenían valores menores de proteína C reactiva (PCR) al alta, una tasa más baja de insuficiencia multiorgánica, un mejor estado funcional al alta y una estancia hospitalaria más corta. En un análisis bivariado, no se encontraron diferencias en la tasa de mortalidad y la ocurrencia de infecciones secundarias. Al evaluar el estado clínico según la Escala Ordinal de la OMS hubo una diferencia significativa en su variabilidad desde el empeoramiento hasta el alta (o 14 días), evidenciando un mejor estado funcional en los que recibieron TCZ. Discusión: pudimos demostrar su eficacia en la reducción de biomarcadores inflamatorios y una tendencia a menos días de hospitalización, sin impacto en la mortalidad.

SARS-CoV-2 and Dengue virus Co-infection. A Case Report.

Coinfection of SARS-CoV-2 and dengue virus has not been previously reported. We report a confirmed case with favourable outcome, but whether the occurrence of simultaneous infections may alter the usual clinical course of each infection is still unknown.

Tocilizumab for COVID-19 treatment. an argentine report / Tocilizumab en el tratamiento de COVID-19. Informe argentino

Abstract Recently it has been demonstrated the clinical effectiveness of tocilizumab (TCZ) associated with systemic steroids for the treatment of severe SARS-CoV-2 pneumonia with rapid progression. The objective of this work was to describe the epidemiological, clinical, laboratory and evolution characteristics of the patients who received this treatment. Between March and June 2021, TCZ was administered in a cohort study of adults with severe SARS-CoV-2 pneumonia, in a private hospital in the City of Buenos Aires; 30 patients were included, 63% men, middle age 55 years. Obesity (33%), arterial hypertension (26%) and diabetes (25%) were the most frequent comorbidities. We found associated infections during hospitalization in half of the cohort, within them, pneumonia associated with mechanical ventilation was the most frequent and methicillin-sensitive Staphylococcus aureus, the most prevalent germ. Patients with secondary infections had a higher requirement for invasive mechanical ventilation (IMV) (100% vs. 19% p < 0.001) and more days of hospitalization (median 23 vs. 15 p = 0.009). Of the entire cohort, seven who died during hospitalization had the highest requirement for IMV (100% vs. 43% p = 0.010) and secondary infections (100% vs. 35%, p = 0.006). In this relatively young cohort of patients with severe or critical SARS-CoV-2 pneumonia, obesity does not appear to be a predisposing factor for superinfection or death. The presence of secondary infections, organ failure and shock are presented as probable factors of worse evolution, as well as the requirement of IMV.

Resumen Recientemente se demostró la efectividad clínica del tocilizumab (TCZ) asociado a esteroides sistémicos para el tratamiento de la neumonía grave por SARS-CoV-2 con rápida progresión. El objetivo de este trabajo fue describir las caracterís ticas epidemiológicas, clínicas, de laboratorio y evolución de los pacientes que recibieron este tratamiento. Entre marzo y junio, 2021, se realizó un estudio de cohorte en un sanatorio privado de la Ciudad de Buenos Aires en adultos con neumonía grave por SARS-CoV-2 que recibieron TCZ. Se incluyeron 30 pacientes, hombres 63%, mediana edad 55 años, obesidad (33%), hipertensión arterial (26%) y diabetes (25%) fueron las comorbilidades más frecuentes. Encontramos infecciones asociadas durante la hospitalización en la mitad de la cohorte, den tro de ellas, la neumonía asociada a la ventilación mecánica fue la más frecuente y el Staphylococcus aureus meticilino sensible, el germen más prevalente. Los enfermos con infecciones secundarias tuvieron un mayor requerimiento de ventilación mecánica invasiva (VMI) (100% vs. 19% p < 0.001) y más días de internación (me diana 23 vs. 15 p = 0.009). De la totalidad de la cohorte, siete que fallecieron durante la internación tuvieron el mayor requerimiento de VMI (100% vs. 43% p = 0.010) e infecciones secundarias (100% vs. 35%, p = 0.006). En esta cohorte relativamente joven de pacientes con neumonía grave o crítica por SARS-CoV-2, la obesidad no parece ser un factor predisponente para sobreinfección o muerte. La presencia de infecciones secundarias, falla orgánica y shock se presentan como probables factores de peor evolución, como así también el requerimiento de VMI.

From publications to every day clinical practice: tocilizumab in patients with severe COVID-19 / De las publicaciones a la práctica cotidiana: tocilizumab en pacientes con COVID-19 grave

Abstract Introduction: there is evidence on the effectiveness and safety of tocilizumab (TZC) used in combination with systemic corticosteroids for severe SARS-CoV-2 pneumonia treatment. The purpose of this study was to describe epidemiological, clinical, and laboratory features as well as clinical outcome of patients receiving this combination therapy compared with those receiving only corticosteroids. Methods: a retrospective cohort study, which included adults with severe SARS-CoV-2 pneumonia, was conducted between March and August 2021. Enrolment included 101 patients, 46 with corticosteroids and 55 with corticosteroids plus tocilizumab. Results: median age was 58 years old and 63.9% were females. High blood pressure was present in 36.1% and obesity in 54.6%. Survival in the cohort was 81.4%, with a median hospital stay of 19.0 days. Secondary infections were present in 47.4% of the cohort. Patients in the TZC group had a lower C reactive protein (CRP) at discharge, lower rate of multiple organ failure, better functional status at discharge and shorter hospital stay. In a bivariate analysis, no differences were found in mortality rate and secondary infections occurrence. When assessing clinical status as per WHO Ordinal Scale there was a significant difference in its variability from wors ening to discharge (or 14 days), evidencing a better functional status in patients receiving TCZ. Discussion: we were able to demonstrate its efficacy in reducing inflammatory biomarkers and a trend towards fewer days of hospitalization, with no impact on mortality.

Resumen Introducción: existe evidencia sobre la efectividad y seguridad de tocilizumab (TZC) utilizado en combinación con corticosteroides sistémicos para el tratamiento de la neumonía grave por SARS-CoV-2. El propósito de este estudio fue describir las características epidemiológicas, clínicas y de laboratorio, así como el resultado clínico de los pacientes que recibieron esta terapia combinada en comparación con los que recibieron solo corticosteroides. Métodos: se realizó un estudio de cohorte retrospectivo, que incluyó adultos con neumonía grave por SARS-CoV-2, entre marzo y agosto de 2021. Se incluyeron 101 pacientes, 46 con corticosteroides y 55 con corticosteroides más tocilizumab. Resultados: la mediana de edad fue de 58 años y el 63.9% eran mujeres. La hipertensión arterial estuvo presente en el 36.1% y la obesidad en el 54.6%. La supervivencia en la cohorte fue del 81.4%, con una mediana de estancia hospitalaria de 19.0 días. Las infecciones secundarias estuvieron presentes en el 47.4% de la cohorte. Los pacientes del grupo TZC tenían valores menores de pro teína C reactiva (PCR) al alta, una tasa más baja de insuficiencia multiorgánica, un mejor estado funcional al alta y una estancia hospitalaria más corta. En un análisis bivariado, no se encontraron diferencias en la tasa de mortalidad y la ocurrencia de infecciones secundarias. Al evaluar el estado clínico según la Escala Ordinal de la OMS hubo una diferencia significativa en su variabilidad desde el empeoramiento hasta el alta (o 14 días), evidenciando un mejor estado funcional en los que recibieron TCZ. Discusión: pudimos demostrar su eficacia en la reducción de biomarcadores inflamatorios y una tendencia a menos días de hospitalización, sin impacto en la mortalidad.

Treatment as prevention in resource-limited settings: is it feasible to maintain HIV viral load suppression over time?

INTRODUCTION: Recently, there has been increasing interest in the role of "treatment as prevention" (TasP). Some of the questions regarding TasP strategies arise from the perceived difficulties in achieving and maintaining viral load (VL) suppression over time and the risk of emergence of viral resistance that could compromise future treatment options. This study was conducted to assess these questions in a resource-limited setting. METHODOLOGY: We performed a retrospective observational study of HIV-infected patients diagnosed in the pre-HAART era on follow-up at a private center from Buenos Aires, Argentina. Socio-demographic, clinical, and laboratory data were extracted from clinical charts. Analyses were performed to test for potential associations of selected variables with current virologic failure or use of third-line drugs. RESULTS: Of 619 patients on follow-up, 82 (13.2%) were diagnosed in the pre-HAART era. At the time of our study, 79 (96.3%) patients were on HAART, with a median duration of 14 years (IQR 12-15) of therapy, and exposure to mono or dual nucleoside reverse transcriptase inhibitors regimens in 47.8% of cases. Sixty-nine patients (87.3%) had undetectable VL, 37 (46.8%) never presented virologic failure, and 19 (24.1%) experienced only one failure. Thirteen patients (16.5%) were receiving third-line ART regimens, with an average of 2.7-fold more virologic failures than those on first- or second-line regimens (p = 0.007). CONCLUSIONS: Maintaining viral load suppression over time in resource-limited-settings is feasible.

Prospective multicenter study of community-associated skin and skin structure infections due to methicillin-resistant Staphylococcus aureus in Buenos Aires, Argentina.

BACKGROUND: Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) is now the most common cause of skin and skin structure infections (SSSI) in several world regions. In Argentina prospective, multicenter clinical studies have only been conducted in pediatric populations. OBJECTIVE: PRIMARY: describe the prevalence, clinical and demographic characteristics of adult patients with community acquired SSSI due to MRSA; secondary: molecular evaluation of CA-MRSA strains. Patients with MRSA were compared to those without MRSA. MATERIALS AND METHODS: Prospective, observational, multicenter, epidemiologic study, with molecular analysis, conducted at 19 sites in Argentina (18 in Buenos Aires) between March 2010 and October 2011. Patients were included if they were ≥ 14 years, were diagnosed with SSSI, a culture was obtained, and there had no significant healthcare contact identified. A logistic regression model was used to identify factors associated with CA-MRSA. Pulse field types, SCCmec, and PVL status were also determined. RESULTS: A total of 311 patients were included. CA-MRSA was isolated in 70% (218/311) of patients. Clinical variables independently associated with CA-MRSA were: presence of purulent lesion (OR 3.29; 95%CI 1.67, 6.49) and age <50 years (OR 2.39; 95%CI 1.22, 4.70). The vast majority of CA-MRSA strains causing SSSI carried PVL genes (95%) and were SCCmec type IV. The sequence type CA-MRSA ST30 spa t019 was the predominant clone. CONCLUSIONS: CA-MRSA is now the most common cause of SSSI in our adult patients without healthcare contact. ST30, SCCmec IV, PVL+, spa t019 is the predominant clone in Buenos Aires, Argentina.

Update on primary HIV-1 resistance in Argentina: emergence of mutations conferring high-level resistance to nonnucleoside reverse transcriptase inhibitors in drug-naive patients.

Here we present a survey including 52 drug-naive recently HIV-1-infected subjects from Buenos Aires City and province (79%) and 3 other regions in Argentina (21%). Recent infections were established from previous negative serology (32/52), indeterminate Western blot (12/52), or acute retroviral syndrome after high-risk HIV exposure (8/52) within 9 months before genotyping (median time, 4.2 months). Genotyping was performed from plasma by sequencing both protease and reverse transcriptase. Phylogenetic analysis combined with bootscanning resulted in 21 subtype B sequences and 31 B/F recombinants (RecBF). On protease, minor resistance-related mutations were found in both subtype B and RecBF with low frequencies. The substitution L89M, recently suggested as a resistance-related mutation in some subtype F viruses, was observed in 1 RecBF. On reverse transcriptase, major resistance-related mutations were found in 4 of 52 (7.7%) patients from different health centers: M41L (subtype B) and K103N+/-P225H (1 RecBF and 2 subtype B). The greater than 5% resistance threshold found indicates a need for sentinel resistance surveillances calling for an update in the current resistance testing guidelines in Argentina.

Incidencia de enfermedades de transmisión sexual en personas que viven con VIH / Incidence of diseases of sexual transmission in people who live with VIH

Estudio sobre la incidencia de nuevas enfermedades de trasmisión sexual posteriores al diagnóstico de VIH, cuyo objetivo es evidenciar la frecuencia de conductas sexuales de riesgo en personas que viven con SIDA; y para el que se tomaron datos de las historias clínicas de pacientes con seguimiento regular entre Diciembre de 1998 y Diciembre de 2003, evaluados como adherentes al tratamiento