Incidence of Diabetes Mellitus and Associated Factors in the Era of Antiretroviral Drugs With a Low Metabolic Toxicity Profile.

Objective: The incidence of type 2 diabetes mellitus (T2DM) has risen dramatically. Among people living with HIV (PLHIV), chronic disease (now >15 cases/1000 in the general population worldwide) and long-term exposure to antiretroviral therapy (ART) can alter metabolic processes early, favoring insulin resistance and T2DM. We retrospectively studied the incidence of T2DM and associated factors in the Cohort of the Spanish AIDS Research Network, a prospective cohort of PLHIV enrolled at diagnosis and before initiation of ART. Methods: PLHIV were aged >18 years and ART naive at inclusion. The incidence of new diagnoses of T2DM after initiation of ART (per 1000 person-years) was calculated. Predictors of a diagnosis of T2DM were identified by a Cox proportional hazards model adjusted for statistically significant and clinically relevant variables. Results: Cumulative incidence was 5.9 (95% CI, 5.1-6.7) per 1000 person-years, increasing significantly in persons aged >50 years to 14.4 (95% CI, 10.4-19.3). Median time to diagnosis of T2DM was 27 months. Only age and higher education were significant. Interestingly, higher education was associated with a 33% reduction in the incidence of T2DM. Having received tenofovir disoproxil fumarate + (lamivudine or emtricitabine) + rilpivirine was almost significant as a protective factor (hazard ratio, 0.49; 95% CI, .24-1.01; P = .05). Conclusions: The incidence of T2DM in PLHIV in Spain was high, especially in persons aged >50 years. Age was the factor most closely associated with onset, and educational level was the factor most associated with reduced risk. We highlight the lack of association between HIV-related factors and T2DM and show that, within nonnucleoside reverse transcriptase inhibitors, rilpivirine could prove more benign for metabolic comorbidities.

Drug-related and psychopathological symptoms in HIV-positive men who have sex with men who inject drugs during sex (slamsex): Data from the U-SEX GESIDA 9416 Study.

OBJECTIVES: Sexualized intravenous drug use, also known as slamsex, seems to be increasing among HIV-positive men who have sex with men (MSM). Physical and psychopathological symptoms have previously been reported in this population, although research on the subject of slamsex is scarce. The objectives of our study were to describe the psychopathological background of a sample of HIV-positive MSM who engaged in slamsex during the previous year and to compare physical, psychopathological, and drug-related symptoms between these participants and those who engaged in non-injecting sexualized drug use. DESIGN AND METHODS: Participants (HIV-positive MSM) were recruited from the U-Sex study in 22 HIV clinics in Madrid during 2016-17. All participants completed an anonymous cross-sectional online survey on sexual behavior and recreational drug use. When participants met the inclusion criteria, physicians offered them the opportunity to participate and gave them a card with a unique code and a link to access the online survey. The present analysis is based on HIV-positive MSM who had engaged in slamsex and non-injecting sexualized drug use. RESULTS: The survey sample comprised 742 participants. Of all the participants who completed the survey, 216 (29.1%) had engaged in chemsex, and of these, 34 (15.7%) had engaged in slamsex. Participants who engaged in slamsex were more likely to have current psychopathology (depression, anxiety, and drug-related disorders) than participants who engaged in non-injecting sexualized drug use. In addition, participants who engaged in slamsex more frequently reported high-risk sexual behaviors and polydrug use and were more often diagnosed with sexually transmitted infections (STIs) and hepatitis C than those who did not inject drugs. Compared with participants who did not inject drugs, participants who engaged in slamsex experienced more severe drug-related symptoms (withdrawal and dependence), symptoms of severe intoxication (loss of consciousness), and severe psychopathological symptoms during or after slamsex (eg, paranoid thoughts and suicidal behaviors). CONCLUSION: Slamsex is closely associated with current psychiatric disorders and severe drug-related and psychiatric symptoms.

[Immigration and HIV: pulmonary, cutaneous and genitourinary syndromes. Eosinophilia]. / Inmigración y VIH: síndromes pulmonar, cutáneo y genitourinario. Eosinofilia.

Infectious diseases are the leading cause of mortality in less developed countries, many of which are located in tropical areas. These diseases have particular features than can hamper diagnosis unless clinicians are familiar with their characteristics. The present article describes the clinical pattern of pulmonary, cutaneous and genitourinary tropical diseases and the main principles of their diagnosis. Emphasis is placed on their geographical distribution and the influence of HIV infection.

Inmigración y VIH: síndromes pulmonar, cutáneo y genitourinario. Eosinofilia / Immigration and HIV: pulmonary, cutaneous and genitourinary syndromes. Eosinophilia

Las enfermedades infecciosas constituyen la principal causa de mortalidad en los países en vías de desarrollo, muchos de los cuales están localizados en regiones tropicales. Algunas de estas enfermedades tienen características particulares que pueden dificultar su diagnóstico, si no se está familiarizado con ellas. En este artículo se describen los patrones clínicos de las enfermedades pulmonares, dermatológicas y genitourinarias en el trópico y los principios básicos de su diagnóstico, haciendo hincapié en la distribución geográfica y la influencia de la infección por el virus de la inmunodeficiencia humana

Infectious diseases are the leading cause of mortality in less developed countries, many of which are located in tropical areas. These diseases have particular features than can hamper diagnosis unless clinicians are familiar with their characteristics. The present article describes the clinical pattern of pulmonary, cutaneous and genitourinary tropical diseases and the main principles of their diagnosis. Emphasis is placed on their geographical distribution and the influence of HIV infection

[Factors predicting the failure of interruption of highly active antiretroviral treatment (HAART) in HIV-infected patients]. / Factores que predicen el fracaso de las interrupciones del tratamiento antirretroviral (TAR) en los pacientes con infección por el VIH.

INTRODUCTION: Treatment interruptions may be an alternative to HAART in the management of chronically infected HIV-patients. We designed this study in an attempt to assess the predictability of this strategy. METHODS: We recruited HIV-infected patients whose treatment had been suspended. Interruption was due to the patient's own decision, or toxicity, or because the patient had started the treatment with more than 350 CD41 cells/microL (immunologic criteria). RESULTS: Forty-one consecutive patients were included, with a median follow-up of 13 months. Failure was associated with the reason for interruption (p 5 0.0063). Failure occurred in 14.3% of those who interrupted treatment due to immunological criteria and in 40% of those who interrupted treatment due to their own decision or toxicity. The reasons for interruption were: toxicity in 11 patients (26.8%), personal decision in 9 (21.9%) and immunological criteria in 21 (51.2%). In the univariate analysis, the nadir CD41 cell count < 350 cél./microL [OR 16 (p = 0.054)] was statistically significant in the patients who stopped treatment due to immunological criteria, while treatment with protease inhibitors [OR 14 (p = 0.032)] was statistically significant in the remaining patients. In the multivariable analysis only nadir CD41 < 350 cél./microL was independently related with failure. CONCLUSIONS: Failure was related to interruption criteria and was greater in patients who stopped due their own decision or toxicity. When interruption was due to immunological criteria, the factor predicting failure was nadir CD41 cell count < 350 cél./microL. In the remaining patients, none of the variables was related to failure.

Factores que predicen el fracaso de las interrupciones del tratamiento antirretroviral (TAR) en los pacientes con infección por el VIH / Factors predicting the failure of interruption of highly active antiretroviral treatment (HAART) in HIV-infected patients

INTRODUCCIÓN. La interrupción del tratamiento puede ser una alternativa terapéutica al tratamiento antirretroviral en el manejo de la infección crónica por el virus de la inmunodeficiencia humana. Para estudiar esta opción, se ha diseñado un estudio de predicibilidad. MÉTODOS. Se incluyeron a pacientes que pararon el tratamiento por abandono de la medicación, toxicidad o por haber iniciado el tratamiento con una cifra de CD4+ > 350 cél./ml (criterio inmunológico).RESULTADOS. Se seleccionaron de forma prospectiva41 pacientes y la mediana de seguimiento fue de 13 meses. El fracaso se relacionó con el criterio de suspensión(p = 0,0063). En aquellos que abandonaron el tratamiento por criterio inmunológico el fracaso fue del 14,3% y en los que pararon por toxicidad o por abandono, el 40%. Las causas que motivaron la suspensión fueron: 11 (26,8%) por toxicidad; 9 (21,9%) por abandono y 21 (51,2%) por criterio inmunológico. Aunque en el análisis univariado, en el grupo que paró el tratamiento por “criterio inmunológico” la variable CD4+ nadir inferior a 350 cél./ml (odds ratio[OR] 16; p = 0,054) fue estadísticamente significativa, y en los otros pacientes lo fue el tratamiento con inhibidores de proteasa (OR 14; p = 0,032), en el análisis multivariable sólo CD4+ nadir inferior a 350 cél./ml se asoció de forma independiente con el fracaso. CONCLUSIONES. El fracaso se relacionó con el criterio de suspensión, y fue mayor cuando se suspendió por toxicidad o por abandono. El factor que predijo el fracaso en los pacientes que pararon por “criterio inmunológico ”fue una cifra de CD4+ nadir inferior a 350 cél./ml. En el otro grupo de pacientes, ninguna variable se relacionó con el fracaso (AU)

INTRODUCTION. Treatment interruptions may be an alternative to HAART in the management of chronically infected HIV-patients. We designed this study in an attempt to assess the predictability of this strategy. METHODS. We recruited HIV-infected patients whose treatment had been suspended. Interruption was due to the patient’s own decision, or toxicity, or because the patient had started the treatment with more than 350 CD4+ cells/mL (immunologic criteria).RESULTS. Forty-one consecutive patients were included, with a median follow-up of 13 months. Failure was associated with the reason for interruption (p = 0.0063).Failure occurred in 14.3% of those who interrupted treatment due to immunological criteria and in 40% of those who interrupted treatment due to their own decision or toxicity. The reasons for interruption were: toxicity in 11 patients (26.8%), personal decision in 9 (21.9%) and immunological criteria in 21 (51.2%). In the univariate analysis, the nadir CD4+ cell count < 350 cél./mL[OR 16 (p = 0.054)] was statistically significant in the patients who stopped treatment due to immunological criteria, while treatment with protease inhibitors [OR14 (p = 0.032)] was statistically significant in there maining patients. In the multivariable analysis only nadir CD4+ < 350 cél./mL was independently related with failure. CONCLUSIONS. Failure was related to interruption criteria and was greater in patients who stopped due their own decision or toxicity. When interruption was due to immunological criteria, the factor predicting failure was nadir CD4+ cell count < 350 cél./mL. In the remaining patients, none of the variables was related to failure (AU)