Health-Related Quality of Life in People with Advanced HIV Disease, from 1996 to 2021: Systematic Review and Meta-analysis.

The purpose of the study was to assess the effects of advanced HIV disease (AHD) on health-related quality of life (HRQoL) in PLHIV, the changes in HRQoL outcomes over the last 25 years, and the differences between countries according to level of economic development. We conducted a systematic review and meta-analysis. The search was conducted in PubMed and Web of Science using the terms: "health-related quality of life", "HQRoL", "HIV", "AIDS", "advanced HIV disease" and "low CD4 cells". Studies inclusion criteria were: adult population; initiated after 1996 and published before July 2021; clinical trials, cross-sectional, cohort, and case-control studies; studies analyzing the relationship between AHD and HRQoL; English or Spanish language. Standardized mean differences (d+) were calculated to estimate the effect size for the meta-analyses. Summary statistics were calculated using a random-effects model, and analyses of effect moderators, using mixed-effects models. The meta-analysis included 38 studies. The results indicated that HRQoL is worse in patients with AHD compared to those without. The main HRQoL domains affected were overall health perception and concern and physical and functional health and symptoms. We found a moderate impact for age and gender on some HRQoL domains. There were no differences in relation to socioeconomic inequities, country of residence, or time period analyzed. In conclusion, advanced HIV disease has a negative impact on health and well-being in PLHIV. Our results show that despite all the advances in antiretroviral treatments over the last 25 years, AHD persists as a source of extreme vulnerability, regardless of where PLHIV live.

RESUMEN: El objetivo del estudio fue evaluar los efectos de la enfermedad avanzada de sida (EAS) en la calidad de vida relacionada con la salud (CVRS) en personas que viven con el VIH (PVVIH), los cambios experimentados en la CVRS en los últimos 25 años y las diferencias entre países. Realizamos una revisión sistemática y metaanálisis. La búsqueda se llevó a cabo en PubMed y Web of Science utilizando los términos: "calidad de vida relacionada con la salud", "CVRS", "VIH", "SIDA", "enfermedad avanzada por VIH" y "células CD4 bajas". Los criterios de inclusión de los estudios fueron: población adulta; iniciado después de 1996 y publicado antes de julio de 2021; ensayos clínicos, estudios transversales, de cohorte y de casos y controles; estudios que analizan la relación entre EAS y CVRS; idioma inglés o español. Se calcularon diferencias de medias estandarizadas (d+) para estimar el tamaño del efecto para los metaanálisis. Los efectos promedios se calcularon utilizando un modelo de efectos aleatorios, y el análisis de moderadores utilizando modelos de efectos mixtos. El metaanálisis incluyó 38 estudios. Los resultados indicaron que la CVRS es peor en pacientes con EAS en comparación con aquellos sin EAS. Los principales dominios de CVRS afectados son la percepción de salud general y su preocupación, y la función física y de salud y los síntomas asociados. Encontramos un impacto moderado por edad y género en algunos dominios de CVRS. No encontramos diferencias en cuanto a las desigualdades socioeconómicas, país de residencia o período de tiempo analizado. En conclusión, la enfermedad avanzada por VIH tiene un impacto negativo en la salud y el bienestar en las personas con VIH. Nuestros resultados muestran que, a pesar de todos los avances en los tratamientos antirretrovirales en los últimos 25 años, el EAS persiste como una fuente de extrema vulnerabilidad, independientemente de dónde vivan las personas con VIH.

Impact of circulating bacterial DNA in long-term glucose homeostasis in non-diabetic patients with HIV infection: cohort study.

In HIV-infected patients, the damage in the gut mucosal immune system is not completely restored after antiretroviral therapy (ART). It results in microbial translocation, which could influence the immune and inflammatory response. We aimed at investigating the long-term impact of bacterial-DNA translocation (bactDNA) on glucose homeostasis in an HIV population. This was a cohort study in HIV-infected patients whereby inclusion criteria were: patients with age >18 years, ART-naïve or on effective ART (<50 HIV-1 RNA copies/mL) and without diabetes or chronic hepatitis C. Primary outcome was the change in HbA1c (%). Explanatory variables at baseline were: bactDNA (qualitatively detected in blood samples by PCR [broad-range PCR] and gene 16SrRNA - prokaryote), ART exposure, HOMA-R and a dynamic test HOMA-CIGMA [continuous infusion of glucose with model assessment], hepatic steatosis (hepatic triglyceride content - 1H-MRS), visceral fat / subcutaneous ratio and inflammatory markers. Fifty-four men (age 43.2 ± 8.3 years, BMI 24.9 ± 3 kg/m2, mean duration of HIV infection of 8.1 ± 5.3 years) were included. Baseline HbA1c was 4.4 ± 0.4% and baseline presence of BactDNA in six patients. After 8.5 ± 0.5 years of follow-up, change in HbA1c was 1.5 ± 0.47% in patients with BactDNA vs 0.87 ± 0.3% in the rest of the sample p < 0.001. The change in Hba1c was also influenced by protease inhibitors exposure, but not by baseline indices of insulin resistance, body composition, hepatic steatosis, inflammatory markers or anthropometric changes. In non-diabetic patients with HIV infection, baseline bacterial translocation and PI exposure time were the only factors associated with long-term impaired glucose homeostasis.

Impact of a stewardship program on bacteraemia in adult inpatients.

OBJECTIVE: Bloodstream infections (BSIs) are associated with considerable morbidity and mortality among inpatients. The aim of this study was to evaluate the impact of a stewardship program on clinical and antimicrobial therapy-related outcomes in patients with bacteraemia. METHODS: Single-centre, before-and-after quasi-experimental study in adult inpatients. Over 1 January 2013 to 31 June 2013 all patients aged 18 years or older with a bacteraemia (interven-tion group, N=200) were compared to a historical cohort (1 Janu-ary 2012 to 31 December 2012) (control group, N=200). RESULTS: Following blood culture results and adjusting for potential confounders, the stewardship program was associated with more changes to antibiotic regimens (adjusted odds ratio [ORa]: 4.6, 95% CI 2.9, 7.4), more adjustments to antimicrobial therapy (ORa: 2.4, 95% CI 1.5, 3.8), and better source control in the first five days (ORa 1.6, 95% CI: 1.0, 2.7). In the subgroup that initially received inappropriate empiric treatment (n=138), the intervention was associated with more antibiotic changes (OR: 3.9, 95% CI: 1.8, 8.5) and a better choice of definitive antimicrobial therapy (OR 2.3 95% CI: 1.2, 4.6). There were also more antibiotic changes in the subgroups with both Gram-negative (OR: 2.8, 95% CI: 1.6, 4.9; n=217) and Gram-positive (OR: 4.6, 95% CI: 1.8, 9.9; n=135) bacteraemia among those receiving the intervention, while the Gram-positive subgroup also received more appropriate definitive antimicrobial therapy (OR: 3.9, 95% CI: 1.8, 8.8). CONCLUSIONS: The stewardship program improved treatment of patients with bacteraemia and appropriateness of therapy.

Seasonal influenza in octogenarians and nonagenarians admitted to a general hospital: epidemiology, clinical presentation and prognostic factors.

OBJECTIVE: Seasonal influenza is responsible for high annual morbidity and mortality worldwide, especially in elderly patients. The aim of the study was to analyse the epidemiological, clinical and prognostic features of influenza in octogenarians and nonagenarians admitted to a general hospital, as well as risk factors associated with mortality. METHODS: Retrospective, cross-sectional, descriptive study in patients admitted and diagnosed with influenza by molecular biology in the General University Hospital of Alicante from 1 January to 31 April 2015. RESULTS: A total of 219 patients were diagnosed with influenza in the study period: 55 (25.1%) were ≤64 years-old; 77 (35.2%) were aged 65-79; 67 (30.6%) were aged 80-89 years; and 20 (9.1%) were aged ≥90 years. Most flu episodes were caused by influenza A (n=181, 82.6%). Patients aged 80 years or older had lower glomerular filtration rate (mean: 49.7 mL/min vs. 62.2 mL/min; p=0.006), a greater need for non-invasive mechanical ventilation (22% vs 9.3%; p=0.02), greater co-morbidity due to cardiac insufficiency (40.5% vs. 16.4%; p<0.001) and chronic renal disease (32.9 vs. 20%, p=0.03), and greater mortality (19% vs. 2.9%; p<0.001). In a multivariate analysis, mortality was higher in those aged 80 or over (adjusted odds ratio [ORa] 9.2, 95% confidence interval [CI] 1.65-51.1), those who had acquired the flu in a long-term care facility (ORa 11.9, 95% CI 1.06-134), and those with hyperlactataemia (ORa 1.89, 95% CI 1.20-3.00). CONCLUSIONS: Seasonal influenza is a serious problem leading to elevated mortality in octogenarian and nonagenarian patients admitted to a general hospital.

Biological markers of fertility (inhibin-B) in HIV-infected men: influence of HIV infection and antiretroviral therapy.

OBJECTIVES: Inhibin B (IB) levels and the IB: follicle-stimulating hormone (FSH) ratio (IFR), biomarkers of global Sertoli cell function, show a strong relationship with male fertility. The aim of the study was to examine the prevalence of impaired fertility potential in HIV-infected men and the influence of antiretroviral therapy (ART) on fertility biomarkers. METHODS: A cross-sectional study with sequential sampling was carried out. A total of 169 clinically stable patients in a cohort of HIV-infected men undergoing regular ambulatory assessment in a tertiary hospital were included. The mean [± standard deviation (SD)] age of the patients was 42.6 ± 8.1 years, all were clinically stable, 61.5% had disease classified as Centers for Disease Control and Prevention (CDC) stage A, and were na?ve to ART or had not had any changes to ART for 6 months (91.1%). Morning baseline IB and FSH concentrations were measured using an enzyme-linked immunosorbent assay (ELISA) and an electrochemiluminescent immunoassay (ECLIA), respectively. A multivariate logistic regression model was used to identify factors associated with impaired fertility, defined as IB < 119 pg/mL or IFR < 23.5. RESULTS: The mean (± SD) IB level was 250 ± 103 pg/mL, the median [interquartile range (IQR)] FSH concentration was 5.1 (3.3-7.8) UI/L and the median (IQR) IFR was 46.1 (26.3-83.7). The prevalence of impaired fertility was 21.9% [95% confidence interval (CI) 16.3-20.7%]. Negative correlations of body mass index and waist: hip ratio with FSH and IB levels were observed (P < 0.01), while a sedentary lifestyle and previous nevirapine exposure were associated with a decreased risk of IB levels ≤ 25th percentile in multivariate analysis. Only older age, as a risk factor, and sedentary lifestyle, with a protective effect, were independently associated with impaired fertility in multivariate analysis. CONCLUSIONS: Global testicular Sertoli cell function and fertility potential, assessed indirectly through serum IB levels and IB: FSH ratio, appear to be well maintained in HIV-infected men and not damaged by ART.

Impact of vitamin D insufficiency on insulin homeostasis and beta cell function in nondiabetic male HIV-infected patients.

OBJECTIVES: Vitamin D is thought to play a role in glucose homeostasis and beta cell function. Our aim was to examine the impact of plasma 25-hydroxyvitamin D [25(OH)D] upon in vivo insulin sensitivity and beta cell function in HIV-infected male patients without diabetes. METHODS: A cross-sectional study was carried out involving a cohort of HIV-infected patients undergoing regular assessment in a tertiary hospital. Eighty-nine patients [mean (± standard deviation) age 42 ± 8 years] were included in the study: 14 patients were antiretroviral therapy (ART)-naïve, while 75 were on ART. Vitamin D insufficiency (VDI) was defined as 25(OH)D < 75 nmol/L; insulin sensitivity was determined using a 2-h continuous infusion of glucose model assessment with homeostasis (CIGMA-HOMA), using the trapezoidal model to calculate the incremental insulin and glucose areas under the curve (AUCins and AUGglu, respectively). Beta cell function was assessed using the disposition index (DI). Abdominal visceral adipose tissue (VAT) and hepatic triglyceride content (HTGC) were measured by magnetic resonance imaging (MRI) and 1-H magnetic resonance spectroscopy. Multivariate linear regression analysis was performed. RESULTS: VDI was associated with insulin resistance (IR), as indicated by a higher CIGMA-HOMA index (odds ratio 1.1) [1.01-1.2]. This association was independent of the main confounders, such as age, Centers for Disease Control and Prevention (CDC) stage, ART, lipodystrophy, body mass index, VAT:subcutaneous adipose tissue ratio and HTGC, as confirmed by multivariate analysis (B = 12.3; P = 0.01; r² = 0.7). IR in patients with VDI was compensated by an increase in insulin response. However, beta cell function was lower in the VDI subpopulation (33% decrease in DI). CONCLUSIONS: VDI in nondiabetic HIV-positive male patients is associated with impaired insulin sensitivity and a decrease in pancreatic beta cell function.

Pruritus in HIV-infected patients in the era of combination antiretroviral therapy: a study of its prevalence and causes.

Pruritus is a common symptom in HIV-infected patients. However, there is a lack of studies examining this symptom. We investigated the prevalence of pruritus and its causes in this population by offering the possibility of participating in a skin health programme to all HIV-infected patients who attended our service in Alicante, Spain. Those who accepted (n = 303) underwent an interview and a detailed physical examination by specialists from the Dermatology Department. Between May 2003 and October 2003, 94 patients (31%) reported pruritus: xerosis, seborrhoeic eczema and interdigital tinea pedis were the most frequent dermatological entities responsible for this symptom. Patients with pruritus had higher viral loads (P = 0.006). We conclude that pruritus is still a frequent symptom in HIV-infected patients. To the best of our knowledge this is the first prevalence study of pruritus in an HIV population in the combination antiretroviral therapy (cART) era.

Evaluación de un modelo multidisciplinar de hospitalización alternativa a la hospitalización convencional en la neumonía adquirida en la comunidad / Evaluation of a multidisciplinar y alternative hospitalization model in comparison with conventional hospitalization for patients with community-acquired pneumonia

Objetivo: Evaluar la estancia hospitalaria y la mortalidad de un modelo multidisciplinar de hospitalización alternativa (HA) frente a un sistema de hospitalización convencional(HC) en pacientes con neumonía adquirida en la comunidad (NAC). Método: Estudio observacional prospectivo, en el que se incluyó a todos los pacientes con NAC atendidos en el servicio de urgencias (SU) de un hospital general durante un año. Se recogieron las variables sociodemográficas, de comorbilidad, clínicas y de laboratorio. Se calcularon el Pneumonia Severity Index (PSI) y el índice de Barthel en el momento del ingreso. A su ingreso se asignaron de forma no aleatoria a un modelo de HC o al modelo de HA, consistente en ingreso en la unidad de corta estancia de urgencias y alta con seguimiento en el hospital de día de la unidad de enfermedades infecciosas o seguimiento a través de la unidad de hospitalización a domicilio. Se evaluó la estancia hospitalaria y la mortalidad a los 30 días. Resultados: Ingresaron 425 (77,2%) pacientes, 130 en HA y 252 en HC. Los asignados a HA eran de mayor edad (69 frente a 62,7 años; p < 0,001), con mayor deterioro funcional (47 % frente a 23,8 %; p < 0,001), con mayor puntuación PSI (PSI IV 61,5 %frente al 36,9 %; p < 0,001), con menor estancia media hospitalaria (2,5 frente a 9,6días; p < 0,001) y menor mortalidad a los 30 días (3,9 % frente a 11,2 %; p < 0,05,riesgo relativo 0,3, intervalo de confianza del 95% 0,1-0,8). Conclusiones: Un modelo multidisciplinar de HA alternativo de hospitalización en el manejo de la NAC permite reducir la estancia hospitalaria y la mortalidad asociada (AU)

Objective: To compare duration of hospital stay and mortality between conventional hospitalization and an alternative hospital care model for patients with community-acquired pneumonia (CAP).Patients and methods: Prospective, non randomized study including all patients with CAP treated in our hospital’semergency department (ED) in 1 year. We recorded information on sociodemographic variables, comorbidity, clinical condition, and laboratory findings. The Pneumonia Severity Index (PSI) and the Barthel score were also recorded onadmission to the ED. A care model (alternative or conventional hospitalization) was assigned without randamization on admission. The alternative model consisted of admission to a short-stay unit in the ED, and follow-up on discharge in the day hospital of the infectious diseases department or at home by the home hospitalization staff. Outcome measures were duration of hospital stay and 30-day mortality. Results: Of a total of 550 patients, 425 (77.2%) were admitted; 252 received conventional hospital care and 130 were treated under the alternative model. Those assigned to the alternative model were older (mean age of 69 years vs. 62.7years, P<.001), had greater functional deficits (47% vs 23.8%; P<.001), and a higher PSI (PSI of IV or higher, 61.5% vs36.9%; P<.001). The duration of hospital stay was shorter under the alternative model (2.5 days vs 9.6 days, P<.001) and 30-day mortality was lower (3.9% vs 11.2%, P<.05; relative risk, 0.3 [95% confidence interval, 0.1-0.8]). Conclusions: This alternative model of hospital care for the management of CAP allows hospital stay to be shortened and it is associated with lower mortality (AU)

Infección por gripe nueva A(H1N1) en personal sanitariode un hospital terciario / Clinical and epidemiologic characteristics of the new influenza virus A(H1N1)v in staff at a tertiary care hospital

Objetivo: Describir la organización que se estableció en el hospital para la atención a sus profesionales sanitarios (PS) con sospecha de infección por gripe nueva A(H1N1) y las características de los casos confirmados. Método: Todos los PS con sospecha de enfermedad eran remitidos a urgencias para su evaluación clínica y el establecimiento de las medidas de control de infecciones. Se les recogió edad, sexo, lugar de trabajo, antecedentes vacunales, factores riesgo, características clínicas, forma probable de contagio, utilización de métodos de barrera en la atención a pacientes con enfermedad respiratoria febril, transmisión a pacientes y tiempos de resolución y hasta la incorporación al trabajo. Resultados: Se han atendido a 34 PS con sospecha de gripe nueva A(H1N1), y en 11se confirmó el diagnóstico. De éstos, 2 trabajaban en urgencias, lo que supone una OR de 3,3 (IC95%: 0,7 a 15,5) respecto a los PS del resto del hospital. Todos los pacientes fueron dados de alta desde urgencias, a dos se les administró oseltamivir, y no se registraron ni complicaciones ni transmisiones a pacientes u otros profesionales. Conclusiones: El programa de atención a los PS enfermos presta una asistencia sanitaria adecuada y mejora los programas de prevención y control de infecciones en el centro. Los PS que trabajan en urgencias parecen estar sujetos a un mayor riesgo de contagio de la gripe nueva A(H1N1) (AU)

Objectives: To describe the organization of care for staff suspected of new influenza virus A(H1N1)v infection at atertiary care hospital and to record the characteristics of confirmed cases. Methods: All personnel suspected of being infected were sent to the emergency department for evaluation and implementation of infection control measures. An epidemiologic questionnaire was used to record age, sex, workplace, vaccination history, risk factors, symptoms, probable means of contagion, use of barriers when caring for patients with respiratory symptoms and fever, transmission to patients, time elapsed until resolution of symptoms, and time elapsed until return to work. Results: Thirty-four staff members were suspected of having the new influenza virus. The diagnosis was confirmed in 11.Two worked in the emergency department (odds ratio, 3.3; 95% confidence interval, 0.7-15.5 in comparison with other hospital locations). All were discharged home from the emergency department. Two were prescribed oseltamivir. No complications or cases of transmission to other patients or staff were detected. Conclusions: The procedure for attending staff who were infected with the virus was adequate to the situation and improved infection prevention and control within the hospital. Staff who work in the emergency department seem to beat greater risk of contagion by the new influenza virus A (H1N1) (AU)

Aplicación de una técnica de lavado seminal en pacientes infectados por VHC y coinfectados con VIH / Application of a technique of seminal washing in patients infected by VHC and co-infected with HIV

Objetivo Estudiar el aclaramiento de la carga viral en muestras de semen en pacientes con VHC y coinfectados con VIH tras realizar dos lavados seguidos de swim-up. Diseño experimental Estudio longitudinal prospectivo Pacientes Once pacientes con serología VHC positiva, seis de ellos coinfectados por VIH. Métodos Las muestras de semen se recogieron por masturbación, extrayéndose el mismo día muestras sanguíneas a los pacientes para la determinación de carga viral plasmática (CVP), genotipaje VHC, poblaciones linfocitarias CD4/CD8, anticuerpos anti-VHC y serología VIH: En una alícuota inicial se hizo el seminograma y al resto del semen se le realizaron dos lavados con medio de cultivo, seguidos de un swim-up determinándose CV seminal en todas las fracciones plasmáticas y celulares en el Cobas Amplicor HIV monitor 1.5 y Cobas TaqMan HCV. Resultados Grupo VHC (edad 37,2 años; 60% genotipo 3; anticuerpos anti VHC: 35,3; CVP-VHC: 1xl06 copias ARN/ml. Grupo coinfección (edad 34,5 años; 80% genotipo 3; media anticuerpos anti-VHC: 34,8, CVP-VHC: 4xlOS copias ARN/ml. No se detectó CV seminal- VHC en ninguna de las muestras de semen detectándose CV seminal- VIH en el 85% de las muestras, siendo sus medias en las distintas fracciones seminales: Sedimento celular inicial: 1,8xl03 copias ARN+ADN/ml; Plasma seminal inicial: 8,9xl03 copias ARN/ml; Primer lavado: 4, 7xl 04 copias ARN/ml; Segundo lavado: 876 copias ARN/ml; Swim-up: Indetectable en todos los pacientes. Conclusiones El protocolo de dos lavados seguido de swim-up nos permite eliminar hasta límites indetectables la CV seminal en los pacientes a estudio. Los resultados del estudio deben ser completados con una casuística mayor

Objective To study the clearance of the viralload in samples of semen in patients with VHC and co-infected with HIV alter two washings followed by swim-up. Experimental design Prospective longitudinal study. Patients Eleven patients with positive serology VHC, six of them co-infected by HIV: Methods The samples of semen were laten by masturbation. The same day, blood samples were extracted from patients for the determination of plasmatic viral load (CVP), genotype VHC, linfocyte populations CD4/CD8, antibodies anti-VHC and HIV serology. In an initial sample a seminograme was carried out.To the rest of the semen samples the following was carried out: two washings to culture medium followed by a swim-up finding out the seminal CV in all the plasmatic and cellular fractions in the Cobas Amplicor HIV 1,5 monitor and Cobas TaqMan HCV: Results Group VHC (age 37,2 years; 60% genotype 3; antibodies anti VHC: 35.3,. CVP-VHC: lxl06 copiesRNA/mililiter: Group co-infection (age 34,5 years; 80% genotype 3; average antibodies anti VHC:34.8, CVP-VHC: 4xl05 copies RNA/mililiter: lt was not detected CV seminal- VHC in any of the samples of semen detecting itself CV seminal- VIH in 85% of the samples being its averages in the different seminal fractions: lnitial cellular sediment: 1.8xl03 copies RNA+DNAmililiter; lnitial seminal plasma: 8.9xl03 copies RNA/mililiter; First washing: 4.7xl04 copies RNA/mililiter; Second washing: 876 copies RNA/mililiter; Swim-up: Indetectable in all the patients. Conclusions The protocol of the two washings followed by a swim-up allows us to reduce below detectable levels the seminal CV in the population of the study. The result must be completed with a greater number of patients

Documento de consenso sobre el diagnóstico y tratamiento de la hepatitis C crónica en el medio penitenciario / Spanish consensus guideline about chronically hepatitis C diagnostic and treatment in the prison environment

La proporción elevada de internos con HCC en los CP españoles, sumado al alto porcentaje de coinfección por el VIH y el aumento progresivo de la esperanza de vida en los pacientes con infección por el VIH, hacen pensar que la incidencia de enfermedad hepática grave (EHG) asociada a VHC aumentará de forma progresiva en los próximos años en el medio penitenciario. Por ello hemos planteado este documento de consenso para el diagnóstico y tratamiento de la hepatitis C en las prisiones españolas, con la colaboración de expertos de diferentes sociedades científicas, siguiendo la metodología del NIH Consensus Statements(http://consensus.nih.gov/about/process.htm)

In Spanish prisons the incidence of serious liver illness associate to HCV, will increase in the next years because the high proportion of Hepatitis C in inmates, the high percentage of co-infected people by the HIV, and the progressive growth of life expectancy in patients with HIV infection. This consensus document for diagnosis and management of the hepatitis C, is presented with the experts contribution of different medical scientific Spanish societies using the methodology of the NIH Consensus Statements. (http://consensus.nih.gov/about/process.htm)

A prospective study of the clarithromycin-digoxin interaction in elderly patients.

The study was a prospective observational trial carried out to assess the clarithromycin-digoxin interaction in elderly patients chronically taking digoxin. Digoxin concentrations were determined before and after concomitant treatment with clarithromycin. A Bayesian approach was used to calculate digoxin pharmacokinetics. In the seven patients who were studied there was a significant increase in digoxin concentration after 4-7 days of clarithromycin treatment; digoxin clearance and elimination rate constant were 56-60% lower and elimination half-life was 82% longer. The pharmacokinetic clarithromycin-digoxin interaction in the elderly may be much more frequent than has been assumed up to now.

Varón de 66 años con fiebre, cefalea y síndrome meníngeo / Sixty-six-year old man with fever, headache and meningeal syndrome

No disponible

Progressive multifocal leukoencephalopathy treated with cidofovir in HIV-infected patients receiving highly active anti-retroviral therapy.

Progressive multifocal leukoencephalopathy (PML) has been a devastating disease for HIV-1-infected patients since the beginning of the AIDS pandemic. Currently, highly active antiretroviral therapy (HAART) seems to improve the outcome of PML in many patients. We describe two cases of PML whose course worsened in spite of HAART, but had a good response to cidofovir.

[Lipodystrophy and hyperglycemia produced by protease inhibitors]. / Lipodistrofia e hiperglucemia producidas por inhibidores de la proteasa.

BACKGROUND: HIV-1 protease inhibitors (PI) have been recently associated with a syndrome of anomalous body fat distribution or lipodystrophy (LD), which sometimes is associated to hyperglycemia. Many aspects of this syndrome remain obscure. The objective of the study is to describe the prevalence, clinical patterns, derangement of glucose metabolism associated and follow-up. METHODS: Patients taking at least one PI during January 1998 were asked a questionnaire about any body change, and a physical exam looking for fat changes was performed. In patients found to have LD, basal plasma glucose, cholesterol, triglycerides and cortisol were studied, and an oral glucose tolerance test (OGTT) was performed. In those cases with breast enlargement, prolactin and estradiol were measured. RESULTS: Among 272 patients, five cases (1.8%) of LD were detected. The syndrome appeared associated with all the IP available at the time of the study, a medium of 4.2 months after the introduction of the drug. The most common pattern was fat accumulation in abdomen and breast, and fat loss in arms, legs and face. Basal glycemia was normal in all 5 patients, but OGTT showed carbohydrate intolerance in two (both of them had family antecedents of type 2 diabetes mellitus). Only one patient need treatment withdrawal because of progressive deforming changes. CONCLUSIONS: The LD can appear in patients taking any IP. Body changes are usually self limited and in many patients PI don't need to be stopped.