Utilidad de la ecografía de la arteria femoral complementaria a la exploración carotídea para la detección de ateromatosis subclínica en pacientes con infección por el virus de la inmunodeficiencia humana / Usefulness of artery femoral ultrasound complementary to carotid exploration for the detection of subclinical atheromatosis in patients with human immunodeficiency virus infection

Introducción La detección de la enfermedad ateromatosa subclínica (EAS) en los pacientes con el virus de la inmunodeficiencia humana (VIH) se basa habitualmente en la ecografía carotídea. Sin embargo, estudios en otras enfermedades muestran una infraestimación de la EAS cuando se explora exclusivamente la región carotídea. Este estudio evalúa el impacto de la exploración combinada carotídea y femoral en la detección de la EAS. Métodos Estudio transversal y prospectivo de pacientes con VIH, diagnosticados entre 2008 y 2017. Se realizó ecografía carotídea y femoral. La EAS fue definida según los criterios de Mannheim. Resultados Se incluyeron 102 pacientes (edad media: 40 años, el 73,5% varones). La prevalencia de la EAS por exploración carotídea fue del 15,7% (n=16), y por exploración femoral fue del 18,6% (n=19). La proporción de pacientes con criterios de EAS global (afectación carotídea o femoral) fue del 23,5% (n=24) lo que implica un aumento absoluto de la detección de EAS del 7,84% (IC 95%: 2,63-13,06%). Conclusiones La detección de la EAS aumenta de forma importante con el uso combinado de la ecografía carotídea y femoral en la población con VIH. (AU)

Introduction Detection of subclinical atheromatosis disease (SAD) in patients with human immunodeficiency virus (HIV) infection is usually based on carotid ultrasound. However, studies in other pathologies have shown a probable underestimation of SAD when its detection is exclusively based on carotid exploration. This study evaluates the impact on detection of SAD in patients with HIV through combined carotid and femoral exploration. Methods Cross-sectional and prospective study of patients with HIV, diagnosed between 2008-2017. Carotid and femoral ultrasound examination was performed in all patients. EAS was defined according to Mannheim criteria. Results One hundred two patients were included (mean age: 40 years, 73.5% being male). The prevalence of carotid SAD in the total sample was 15.7% (n=16), and the prevalence of femoral SAD was 18.6% (n=19). The proportion of patients with global SAD criteria (carotid or femoral) was 23.5% (n=24), which implies an absolute increase in SAD detection of 7.84% (95% CI; 2.63-13.06%) at the total sample. Conclusions Detection of SAD is significantly increased by the combined use of carotid and femoral arterial ultrasound in the population affected by HIV infection. (AU)

[Usefulness of artery femoral ultrasound complementary to carotid exploration for the detection of subclinical atheromatosis in patients with human immunodeficiency virus infection]. / Utilidad de la ecografía de la arteria femoral complementaria a la exploración carotídea para la detección de ateromatosis subclínica en pacientes con infección por el virus de la inmunodeficiencia humana.

INTRODUCTION: Detection of subclinical atheromatosis disease (SAD) in patients with human immunodeficiency virus (HIV) infection is usually based on carotid ultrasound. However, studies in other pathologies have shown a probable underestimation of SAD when its detection is exclusively based on carotid exploration. This study evaluates the impact on detection of SAD in patients with HIV through combined carotid and femoral exploration. METHODS: Cross-sectional and prospective study of patients with HIV, diagnosed between 2008-2017. Carotid and femoral ultrasound examination was performed in all patients. EAS was defined according to Mannheim criteria. RESULTS: One hundred two patients were included (mean age: 40 years, 73.5% being male). The prevalence of carotid SAD in the total sample was 15.7% (n=16), and the prevalence of femoral SAD was 18.6% (n=19). The proportion of patients with global SAD criteria (carotid or femoral) was 23.5% (n=24), which implies an absolute increase in SAD detection of 7.84% (95% CI; 2.63-13.06%) at the total sample. CONCLUSIONS: Detection of SAD is significantly increased by the combined use of carotid and femoral arterial ultrasound in the population affected by HIV infection.

[Capillaroscopy, microangiopathy, and HIV. Descriptive study of capillaroscopy findings in HIV positive patients].

BACKGROUND: In this study, we aim to evaluate microangiopathy in HIV positive patients by using capillaroscopy. To date, few studies have been published on the topic. Capillaroscopy may be a tool for early diagnosis of cardiovascular involvement in this patient population. METHODOLOGY: Cross-sectional study with HIV positive patients >18 years. The enrolment period was set from January to June 2018. The following data were collected: demographic (sex, age), laboratory tests (duration of infection, CD4 cell count, CD4:CD8 ratio, coinfection with other viruses), antiretroviral treatment, dyslipidemia, and comorbidities (active smoking, alcoholism, high blood pressure, dyslipidaemia, diabetes, cardiopathy). The capillaroscopy and blood tests were performed simultaneously. The following alterations were evaluated in the capillaroscopy: congestion, tortuosity, haemorrhage, dilations, capillary loss, and presence of megacapillaries. RESULTS: One hundred and two patients were included; 73.5% were male, mean age was 40 years (SD: 10), and mean duration of infection 4.5 years (SD: 3.1). At diagnosis, mean CD4 cell count was 408/mm3 and CD4/CD8 ratio 0.4. A number of patients (14.7%) were coinfected with the hepatitis B virus; 31.3% were active smokers and 13.7% alcoholics. Capillaroscopy alterations were found in most study patients (93.1%): congestion (78.5%), tortuosity (77.5%), haemorrhage (13.8%), dilations (11.8%), capillary loss (5%), and megacapillaries (1%). Capillary tortuosity was associated with age and smoking; and haemorrhage with age, CD4, antiretroviral treatment, and hypertension. CONCLUSION: Prevalence of capillaroscopy alterations is high in HIV positive patients, particularly tortuosity and congestion. To the best of our knowledge, the later alteration has not been previously reported in this group of patients.

Capilaroscopia, microangiopatía y VIH. Estudio descriptivo de hallazgos capilaroscópicos en pacientes con VIH / Capillaroscopy, microangiopathy, and HIV. Descriptive study of capillaroscopy findings in HIV positive patients

Fundamento: El objetivo de este estudio fue valorar la afectación microangiopática mediante capilaroscopia en pacientes infectados por el virus de la inmunodeficiencia humana (VIH). Apenas ha sido estudiada y podría constituir una herramienta de diagnóstico precoz de afectación cardiovascular en estos pacientes. Material y métodos: Estudio transversal que incluyó pacientes mayores de 18 años, diagnosticados de infección por VIH entre 2008 y 2018. Se recogieron variables demográficas (sexo, edad), analíticas (tiempo de infección, CD4, CD4/CD8, coinfección por otros virus), tratamiento antirretroviral y comorbilidades (tabaquismo, enolismo, hipertensión arterial, dislipemia, diabetes, cardiopatía). Se realizó una capilaroscopia y un análisis de sangre en el mismo acto. Las alteraciones capilaroscópicas evaluadas fueron: congestión, tortuosidades, hemorragias, dilataciones, pérdida capilar y megacapilares. Resultados: Se incluyeron 102 pacientes, 73,5% hombres, edad media 40 años (DE: 10) y tiempo medio de infección 4,5 años (DE: 3,1). Al diagnóstico, la media de CD4 fue 408 células/mm3 y la razón CD4/CD8 fue 0,4. El 14,7% presentaban coinfección por el virus de la hepatitis B, el 31,3% tabaquismo y el 13,7% enolismo. El 93,1% de pacientes mostró alguna alteración capilaroscópica. Se observaron, por orden de frecuencia, congestión (78,5%), tortuosidades (77,5%), hemorragias (13,8%), dilataciones (11,8%), pérdida capilar (5%) y megacapilares (1%). Las torutuosidades se asociaron a edad y tabaquismo, y las hemorragias a edad, CD4, tratamiento antirretroviral, e hipertensión. Conclusiones: Los pacientes con infección por VIH presentan una prevalencia importante de alteraciones capilaroscópicas, principalmente tortuosidades y congestión. Es la primera descripción de áreas de congestión como hallazgo capilaroscópico en este grupo de pacientes.(AU)

Background: In this study, we aim to evaluate microangiopathy in HIV positive patients by using capillaroscopy. To date, few studies have been published on the topic. Capillaroscopy may be a tool for early diagnosis of cardiovascular involvement in this patient population. Methodology: Cross-sectional study with HIV positive patients >18 years. The enrolment period was set from January to June 2018. The following data were collected: demographic (sex, age), laboratory tests (duration of infection, CD4 cell count, CD4:CD8 ratio, coinfection with other viruses), antiretroviral treatment, dyslipidemia, and comorbidities (active smoking, alcoholism, high blood pressure, dyslipidaemia, diabetes, cardiopathy). The capillaroscopy and blood tests were performed simultaneously. The following alterations were evaluated in the capillaroscopy: congestion, tortuosity, haemorrhage, dilations, capillary loss, and presence of megacapillaries. Results: One hundred and two patients were included; 73.5% were male, mean age was 40 years (SD: 10), and mean duration of infection 4.5 years (SD 3.1). At diagnosis, mean CD4 cell count was 408/mm3 and CD4/CD8 ratio 0.4. A number of patients (14.7%) were coinfected with the hepatitis B virus; 31.3% were active smokers and 13.7% alcoholics. Capillaroscopy alterations were found in most study patients (93.1%): congestion (78.5%), tortuosity (77.5%), haemorrhage (13.8%), dilations (11.8%), capillary loss (5%), and megacapillaries (1%). Capillary tortuosity was associated with age and smoking; and haemorrhage with age, CD4, antiretroviral treatment, and hypertension. Conclusion. Prevalence of capillaroscopy alterations is high in HIV positive patients, particularly tortuosity and congestion. To the best of our knowledge, the later alteration has not been previously reported in this group of patients.(AU)

Potentially inappropriate prescriptions and therapeutic complexity in older HIV patients with comorbidities.

BACKGROUND: The prolonged current survival of human immunodeficiency virus (HIV) patients exposes them to new problems arising from the comorbidities they face. OBJECTIVES: To describe the situation of comorbidities, polypharmacy, therapeutic complexity and adherence in people living with HIV over 65 years of age and to assess the presence of potentially inappropriate prescriptions (PIP) by applying deprescription criteria. METHODS: Observational study including HIV people (> 65 years) from a university tertiary level hospital. Demographic, clinical and pharmacotherapeutic characteristics of the patients and their treatments were studied. The prevalence of polypharmacy (> 5 medications) and the pharmacotherapy complexity, quantified by the Medication Regimen Complexity Index (MRCI), were calculated. Therapeutic adherence was assessed by the Simplified Medication Adherence Questionnaire (SMAQ) and the medication possession ratio, according to prescription dispensing records. The Screening Tool of Older People's Prescriptions (STOPP) and List of Evidence-baSed depreScribing for CHRONic patients (LESS-CHRON) criteria were applied to identify PIP. MAIN OUTCOME MEASURE: PIP in elderly people living with HIV. RESULTS: Thirty patients were included, 73% of whom were men, with a median age of 71 years (IQR 67 - 76) and a median duration of infection of 17 years (IQR, 9 - 21). Seventy percent of the patients suffered from dyslipemia, 66.7% from hypertension, 43.3% from diabetes and 26.7% from mental health disorders. Seventy percent of the patients took more than 5 medications and 30% more than 10. The MRCI of concomitant medications was higher (18.3 points) than the MRCI of antiretroviral therapy (5.1 points), 66.7% of the studied population was classified as adherent. Finally, 70% of the patients present some PIP according to the STOPP or LESS-CHRON criteria. The polypharmacy was significantly associated (p = 0.008) with meeting deprescription criteria. CONCLUSION: The elderly people living with HIV present numerous comorbidities and met the criteria for polypharmacy. Their pharmacotherapy complexity is mainly determined by the concomitant treatments. There is a high prevalence of meeting deprescription criteria in people living with HIV over the age of 65 and a clear relationship between polypharmacy and deprescription. The optimization of pharmacotherapy is necessary in this population.

Diferencias en supervivencia según el tipo de cáncer y el grado de inmunodeficiencia en pacientes con infección VIH / Differences in survival according to malignancy type and degree of immunodeficiency in HIV-infected patients

ANTECEDENTES Y OBJETIVO: Tras la introducción del tratamiento antirretroviral se objetiva una disminución de los tumores definitorios de sida (TDS), mientras que los tumores no definitorios de sida (TNDS) han aumentado en pacientes infectados por VIH (PIV). Disponemos de poca información sobre el pronóstico y factores de riesgo asociados. Hemos estudiado la supervivencia y su relación con la inmunodeficiencia tras el diagnóstico de TDS o TNDS. MATERIALES Y MÉTODOS: Estudio observacional, retrospectivo, sobre 788 PIV de los que 133 desarrollaron una neoplasia maligna entre 2000-2016. Las neoplasias se dividieron en TDS o TNDS y el grado de inmunodeficiencia según el recuento de linfocitos T CD4 >o

BACKGROUND AND OBJECTIVE: After the introduction of antiretroviral therapy, a decrease in AIDS defining cancers (ADCs) is observed, while non-AIDS-defining cancers (NADCs) have increased in HIV-infected patients (HIP). We have little information about the prognosis and associated risk factors. We studied survival and its relationship with immunodeficiency after the diagnosis of ADC or NADC. MATERIAL AND METHODS: Observational, retrospective study of 788 HIP of whom 133 developed a malignancy between 2000-2016. Malignancies were divided into ADCs or NADCs and degree of immunodeficiency according to the CD4 T lymphocyte count> or

Differences in survival according to malignancy type and degree of immunodeficiency in HIV-infected patients. / Diferencias en supervivencia según el tipo de cáncer y el grado de inmunodeficiencia en pacientes con infección VIH.

BACKGROUND AND OBJECTIVE: After the introduction of antiretroviral therapy, a decrease in AIDS defining cancers (ADCs) is observed, while non-AIDS-defining cancers (NADCs) have increased in HIV-infected patients (HIP). We have little information about the prognosis and associated risk factors. We studied survival and its relationship with immunodeficiency after the diagnosis of ADC or NADC. MATERIAL AND METHODS: Observational, retrospective study of 788 HIP of whom 133 developed a malignancy between 2000-2016. Malignancies were divided into ADCs or NADCs and degree of immunodeficiency according to the CD4 T lymphocyte count> or

Strongyloides stercoralis: a rare and severe presentation in a pregnant woman.

Strongyloides stercoralis is a parasitic nematode with a worldwide distribution. It can go from an asymptomatic infection to a life-threatening hyperinfection syndrome. Here, we report a case of intestinal obstruction due to S. stercoralis in a pregnant woman. This condition, as well as severe strongyloidiasis in pregnant women, is seldomly reported. In this case, Human T-lymphotropic Virus 1 (HTLV-1) coinfection was confirmed, a well-known risk factor for a more severe presentation of strongyloidiasis. We suggest that HTLV status should be screened in every severe S. stercoralis infection, or when, despite a correct treatment, a relapse is observed.

Acute Myopericarditis Associated with Tickborne Rickettsia sibirica mongolitimonae.

We report an unusual case of myopericarditis caused by Rickettsia sibirica mongolitimonae. Because of increasing reports of Rickettsia spp. as etiologic agents of acute myopericarditis and the ease and success with which it was treated in the patient reported here, rickettsial infection should be included in the differential diagnosis for myopericarditis.

Miocarditis y meningoencefalitis como forma de presentación de una primoinfección por el virus de la inmunodeficiencia humana-1 / No disponible

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