High Prevalence of Sequences Included in Transmission Clusters Within Newly Diagnosed HIV-1 Patients in Southern Spain (2004-2015).

The presence of transmission clusters (TCs) and their epidemiological characteristics in a treatment-naive cohort of HIV-1 patients in southern Spain over a decade (2004-2015) were evaluated. Protease and reverse transcriptase sequences provided by each genotype test were used in the phylogenetic study, performed first by the neighbor-joining method and then confirmed by Bayesian analysis. We collected clinical, immunovirological, and demographic data for all patients included. Our cohort comprised 757 patients, 428 (56.5%) belonging to a TC. Overall, we found 123 TCs, 21 of them comprising five or more individuals and three with ≥10 sequences. Forty-three TCs (35.0%) remained active. The clustered patients were mainly men (92.8%) who had sex with men (MSM) (81.5%), Spanish (80.6%), and young adults (median age at diagnosis of 32.6 years). They had lower percentages of late diagnosis and AIDS cases (42.1% and 13.6%, respectively), whereas the presence of recent seroconverters (31.1%), HIV-1 B subtypes (79.4%), and transmission drug resistance (20.3%) increased within TCs, with regard to not-clustered individuals. Among the TCs of non-B variants, circulating recombinant forms (CRF) were predominant (87.5%), with the highest frequencies for CRF19_cpx (17.0% of non-B subtype sequences in TCs); CRF02_AG (15.9%); and CRF01_AE (9.1%). In conclusion, over half of our cohort was included within a TC. More than a third of TCs found could be considered active transmission events. Belonging to a TC was related to MSM, Spanish origin, recent seroconversion, high prevalence of resistance mutations, and B HIV subtype. Among the non-B genetic forms in TCs, we found a high prevalence of CRF19_cpx, CRF02_AG, and CRF01_AE variants.

Symtuza® (DRV/c/FTC/TAF) in the management of treatment-naive HIV-patients. / Symtuza® (DRV/c/FTC/TAF) en el tratamiento de inicio.

The management of HIV infection is based on the administration of lifelong antiretroviral therapy (ART). Single-tablet regimens (STR) reduce pill burden and maximise long-term adherence. Cobicistat-boosted darunavir with emtricitabine and tenofovir alafenamide co-formulation (DRV/c/FTC/TAF), with trade name Symtuza®, is the first STR based on a protease inhibitor (PI). Symtuza® exhibits the efficacy, potency and high genetic barrier of DRV/c, positioning it as the drug of choice even in patients at risk of developing resistance mutations, in addition to the good safety profile of TAF and the advantages of an STR. Early ART initiation is also possible as baseline genotype and HLA-B5701 are not needed. It therefore represents a very good regimen for naive patients, in particular those at risk of poor adherence, and those with low potential risk for drug-drug interactions. Supplement information: This article is part of a supplement entitled "Co-formulated cobicistat-boosted darunavir, emtricitabine, and tenofovir alafenamide for the treatment of HIV infection", which is sponsored by Janssen.

Symtuza(R) (DRV/c/FTC/TAF) en el tratamiento inicial / Symtuza(R) (DRV/c/FTC/TAF) in the management of treatment-naive HIV-patients

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Artritis gonocócica en pacientes con infección por el virus de la inmunodeficiencia humana. Revisión de la literatura / Gonococcal arthritis in human immunodeficiency virus-infected patients. Review of the literature

Presentamos un caso de artritis gonocócica en un paciente con infección por el virus de inmunodeficiencia humana (VIH) y revisamos los 17 casos previamente publicados en sujetos con infección por este virus; solo un paciente presentó uretritis y los hemocultivos fueron positivos en un caso. La artritis gonocócica es infrecuente en pacientes con infección por el VIH y suele presentarse de forma aislada. Debe incluirse en el diagnóstico diferencial de las artritis agudas en pacientes con infección por el VIH (AU)

We report a case of gonococcal arthritis in a patient with human immunodeficiency virus (HIV) infection and review 17 previously published cases; only one patient presented urethritis, and blood cultures were positive in one case. Gonococcal arthritis is rare in HIV-infected patients and is not usually associated with other symptoms. It should be considered in the differential diagnosis of acute arthritis in patients with HIV infection (AU)

Gonococcal arthritis in human immunodeficiency virus-infected patients. Review of the literature. / Artritis gonocócica en pacientes con infección por el virus de la inmunodeficiencia humana. Revisión de la literatura.

We report a case of gonococcal arthritis in a patient with human immunodeficiency virus (HIV) infection and review 17 previously published cases; only one patient presented urethritis, and blood cultures were positive in one case. Gonococcal arthritis is rare in HIV-infected patients and is not usually associated with other symptoms. It should be considered in the differential diagnosis of acute arthritis in patients with HIV infection.

Sífilis e infección por el virus de la inmunodeficiencia humana: una endemia en hombres que tienen sexo con hombres / Syphilis and human immunodeficiency virus infection: an endemic infection in men who have sex with men

OBJETIVO: Describir las características epidemiológicas, clínicas y analíticas de los hombres que tienen sexo con hombres (HSH) con infección por el VIH diagnosticados de sífilis en la Unidad de Gestión Clínica de Enfermedades Infecciosas del Hospital Virgen de la Victoria de Málaga durante el período 2004-2013. Pacientes y método: Estudio descriptivo de 196 episodios de sífilis en 167 HSH infectados por el VIH (2004-2013). Se recogieron datos epidemiológicos, clínicos y analíticos de todos los pacientes. La incidencia anual de sífilis en HSH con infección por el VIH corresponde al cociente entre el número de episodios de sífilis en HSH en un año dividido por el número de HSH en seguimiento en ese año. RESULTADOS: La incidencia anual osciló entre el 1,2% (2007) y el 7,8% (2012). Presentación asintomática en el 42,8% y diagnóstico coincidente de sífilis e infección por el VIH en el 28,5%. CONCLUSIONES: La incidencia anual de sífilis ha aumentado en los HSH con infección por el VIH. Un tercio de los diagnósticos de infección por el VIH coincidió con el de sífilis y casi la mitad eran cuadros asintomáticos

OBJECTIVE: to analyse epidemiological, clinical, and analytical features of HIV-infected men who have sex with men (MSM) diagnosed with syphilis in the Infectious Diseases Unit (Hospital Virgen de la Victoria, Málaga, Spain) during 2004-2013. PATIENTS AND METHODS: An observational study was conducted on 196 syphilis episodes in 167 MSM infected with HIV (2004-2013). Epidemiological, clinical, and analytical data were collected. Annual syphilis incidence among HIV-MSM is calculated as the number of syphilis episodes among MSM in one year divided by the number of MSM followed up in that year. RESULTS: Incidence ranged from 1.2% (2007) to 7.8% (2012). There were asymptomatic episodes in 42.8% cases, and an HIV-syphilis coincident diagnosis in 28.5%. CONCLUSIONS: The annual incidence of syphilis has increased within HIV infected MSM. One third of the syphilis episodes were simultaneous to HIV diagnosis and near half of them were asymptomatic

[Syphilis and human immunodeficiency virus infection: an endemic infection in men who have sex with men]. / Sífilis e infección por el virus de la inmunodeficiencia humana: una endemia en hombres que tienen sexo con hombres.

OBJECTIVE: to analyse epidemiological, clinical, and analytical features of HIV-infected men who have sex with men (MSM) diagnosed with syphilis in the Infectious Diseases Unit (Hospital Virgen de la Victoria, Málaga, Spain) during 2004-2013. PATIENTS AND METHODS: An observational study was conducted on 196 syphilis episodes in 167 MSM infected with HIV (2004-2013). Epidemiological, clinical, and analytical data were collected. Annual syphilis incidence among HIV-MSM is calculated as the number of syphilis episodes among MSM in one year divided by the number of MSM followed up in that year. RESULTS: Incidence ranged from 1.2% (2007) to 7.8% (2012). There were asymptomatic episodes in 42.8% cases, and an HIV-syphilis coincident diagnosis in 28.5%. CONCLUSIONS: The annual incidence of syphilis has increased within HIV infected MSM. One third of the syphilis episodes were simultaneous to HIV diagnosis and near half of them were asymptomatic.

Eficacia y seguridad de asociar ezetimiba a dosis bajas de atorvastatina en la hipercolesterolemia asociada al tratamiento antirretroviral en pacientes con el virus de la inmunodeficiencia humana / Efficacy and safety of adding ezetimibe to low-doses atorvastatin for highly active antiretroviral therapy-related hypercholesterolaemia

Estudio prospectivo, abierto, de pacientes con el virus de la inmunodeficiencia humana (VIH) con dislipemia asociada al tratamiento antirretroviral (TAR) para analizar la eficacia y la seguridad de la ezetimiba junto a dosis bajas de atorvastatina en pacientes que no alcanzan el objetivo de colesterol unido a lipoproteínas de baja densidad (cLDL) con atorvastatina. Se analizaron las modificaciones en el perfil lipídico, riesgo cardiovascular (RCV) a 10 años (ecuación de Framingham), parámetros inmunovirológicos y concentraciones de creatincinasa y transaminasa glutámico pirúvica a las 24 semanas de añadir ezetimiba al tratamiento. Se incluyeron a 27 pacientes, 13 (48%) alcanzaron el objetivo de cLDL y hubo una reducción del colesterol total, cLDL y del porcentaje de pacientes con un RCV a 10 años > 10%. El recuento de linfocitos CD4 aumentó y todos mantuvieron la carga viral del VIH indetectable. No se observaron efectos adversos. El uso de ezetimiba junto a dosis bajas de atorvastatina es eficaz y seguro para el tratamiento de la hipercolesterolemia asociada al TAR (AU)

Prospective, open-label study of HIV-patients with HAART-related dyslipidaemia to analyse the efficacy and safety of ezetimibe plus low-dose atorvastatin in HIV-patients on HAART who do not reach LDL-C goals with atorvastatin. Changes in plasma levels of lipids, cardiovascular risk (CVR) at 10 years (Frahmingam equation), immunovirological parameters, CK and ALT levels were analysed. Twenty seven patients were included, thirteen (48%) achieved LDL-C goals, and a reduction was observed in total cholesterol, LDL-C, and the percentage of patients with a 10 year CVR > 10%. mean CD4 cells count increased, and all patients maintained undetectable HIV viral load. No adverse events were observed. Adding ezetimibe to low-dose atorvastatin is safe and effective for HAART-related hypercholesterolaemia (AU)

[Cost of nucleoside analogue reverse transcriptase inhibitor-related toxicity in HIV-1-infected patients]. / Costes de la toxicidad asociada a los análogos de nucleósidos inhibidores de la transcriptasa inversa en pacientes con infección por el VIH-1.

OBJECTIVE: To estimate the impact of toxicity related to nucleoside analogue reverse transcriptase inhibitors (NRTI) on the total cost of medical care in HIV-1-infected patients. METHODS: . A pharmacoeconomic model was developed from the data obtained by a prospective, observational, multicenter study performed in Spain (Recover). The study patients had developed one NRTI-associated adverse event (AE) that justified discontinuation of treatment with the drug. All costs derived from NRTI-associated AEs in the HAART regimens of HIV-1-infected patients over a period of one year were assessed. The cost assessment (2005 values) included direct medical costs (drugs and AE management) and indirect costs (loss of productivity). The healthcare resources used in AE management were estimated by an expert panel of clinicians. RESULTS: The use and cost of resources rose with increasing severity of all the AE. The average total cost per patient was estimated to be 4012 euro, which included 1789 euro in drug costs (NRTI associated with therapy discontinuation due to AE), and 2223 euro in direct and indirect costs of AE management (45% and 55% of total cost, respectively). Seventy-three per cent of AE-associated costs per patient came from lipoatrophy (560 euro), lipodystropy (535 euro) and peripheral neuropathy (533 euro). CONCLUSION: Management of NRTI-related toxicities is more costly than NRTI acquisition and produces a significant increase in the overall healthcare expenditure for HIV-1-infected patients. This fact should be taken into account when designing the most efficient antiretroviral treatment strategies.

Costes de la toxicidad asociada a los análogos de nucleósidos inhibidores de la transcriptasa inversa en pacientes con infección por el VIH-1 / Cost of nucleoside analogue reverse transcriptase inhibitor-related toxicity in HIV-1-infected patients

Objetivo. Estimar el impacto de la toxicidad asociada a los inhibidores de la transcriptasa inversa análogos de nucleósidos (ITIAN) en el coste total del tratamiento de pacientes con infección por el virus de la inmunodeficiencia humana tipo 1 (VIH-1). Métodos. Se ha diseñado un modelo farmacoeconómico a partir de datos obtenidos de un estudio prospectivo, multicéntrico, observacional realizado en España (Estudio Recover). Los pacientes del estudio habían desarrollado un acontecimiento adverso (AA) asociado a un ITIAN que motivaba su suspensión. En el análisis se incluyen todos los costes derivados de la toxicidad inducida por los ITIAN en los tratamientos antirretrovirales durante un año. Los costes (valores del año 2005) incluidos han sido: médicos directos (fármacos y manejo de AA) e indirectos (pérdidas de productividad). La estimación de los recursos relacionados con el manejo de los AA se ha realizado a través de un panel de consenso de expertos clínicos. Resultados. El incremento en el uso y coste de recursos sanitarios se correlaciona con la gravedad de todos los AA evaluados. El coste promedio total estimado por paciente ha sido de 4.012 €: 1.789 € por costes farmacológicos (ITIAN asociados con la discontinuación de la terapia por AA) y 2.223 € por costes directos e indirectos del manejo de los AA (45 y 55%, respectivamente, de los costes totales). El 73% de los costes por paciente asociados a AA se deben a la lipoatrofia (560 €), lipodistrofia mixta (535 €) y neuropatía periférica (533 €). Conclusión. En pacientes que desarrollan toxicidades asociadas a ITIAN, el coste económico de su manejo es superior al coste de adquisición de los ITIAN y produce un incremento significativo en los costes totales del tratamiento de la infección por VIH-1. El coste del manejo de estas toxicidades debería tenerse en cuenta en el diseño de estrategias de tratamiento antirretroviral más eficientes (AU)

Objective. To estimate the impact of toxicity related to nucleoside analogue reverse transcriptase inhibitors (NRTI) on the total cost of medical care in HIV-1-infected patients. Methods. A pharmacoeconomic model was developed from the data obtained by a prospective, observational, multicenter study performed in Spain (Recover). The study patients had developed one NRTI-associated adverse event (AE) that justified discontinuation of treatment with the drug. All costs derived from NRTI-associated AEs in the HAART regimens of HIV-1-infected patients over a period of one year were assessed. The cost assessment (2005 values) included direct medical costs (drugs and AE management) and indirect costs (loss of productivity). The healthcare resources used in AE management were estimated by an expert panel of clinicians. Results. The use and cost of resources rose with increasing severity of all the AE. The average total cost per patient was estimated to be 4012 €, which included 1789 € in drug costs (NRTI associated with therapy discontinuation due to AE), and 2223 € in direct and indirect costs of AE management (45% and 55% of total cost, respectively). Seventy-three per cent of AE-associated costs per patient came from lipoatrophy (560 €), lipodystrophy (535 €) and peripheral neuropathy (533 €). Conclusion. Management of NRTI-related toxicities is more costly than NRTI acquisition and produces a significant increase in the overall healthcare expenditure for HIV-1-infected patients. This fact should be taken into account when designing the most efficient antiretroviral treatment strategies (AU)

Sífilis e infección por el virus de la inmunodeficiencia humana / Syphilis and HIV infection

La sífilis y la infección por el virus de la inmunodeficiencia humana (VIH) son enfermedades de transmisión sexual (ETS) que afectan a colectivos con prácticas de riesgo similares, por lo que la coinfección no es rara. Recientemente se han documentado brotes de sífilis en varones jóvenes homosexuales con infección por el VIH, lo que tiene trascendencia clínica y epidemiológica. Al igual que ocurre con otras ETS, la sífilis facilita la transmisión del VIH, por lo que los brotes referidos podrían conducir a un incremento de la incidencia de infección por el VIH. La presentación clínica, el diagnóstico serológico y el tratamiento de la sífilis tienen una serie de peculiaridades en los pacientes VIH positivos. Otro aspecto importante a tener en cuenta es el posible impacto que la sífilis puede ejercer en la infección por el VIH; además, se ha descrito un descenso de los linfocitos CD4 y un incremento de la carga viral en estos pacientes

Because syphilis and HIV infections are both sexually transmitted diseases (STD) that affect collectives with similar risk behaviors, coinfection is not unusual. Recent outbreaks of syphilis among HIV-infected men who have sex with men have been reported, with epidemiological and clinical importance. Like other STD, syphilis facilitates HIV transmission, and therefore these syphilis epidemics have generated concerns about potential increases in the incidence of HIV. Clinical features, serological diagnosis, and the therapeutic management of syphilis present certain peculiarities in HIV-infected individuals. Another important issue is the possible impact of syphilis on HIV infection; recent reports have described a decrease in CD4 cell count and an increase in HIV viral load in coinfected patients

Infección por el virus de la inmunodeficiencia humana: de Pneumocystis a estatinas / HIV infection: from Pneumocystis to statins

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[Retrospective epidemiological study on the durability of the treatment of HIV infection or AIDS in Spain]. / Estudio epidemiológico retrospectivo sobre la duración del tratamiento de la infección por el virus de la inmunodeficiencia humana en España.

BACKGROUND AND OBJECTIVE: To know the durability of consecutive regimens of antiretroviral treatment is important to design a long-term therapy, but there is not much information about this subject. PATIENTS AND METHOD: Retrospective epidemiological study of a sample of 401 patients who began antiretroviral treatment between January 1997 and April 2000 at ten Spanish hospitals. The duration of each consecutive antiretroviral regimen was calculated and the reasons for modification and discontinuation were described. RESULTS: In the 3 years and 3 months covered by the study, 48.6% of the patients received more than one regimen of therapy. Seventy five of the initial prescribed combinations included protease inhibitors. Median duration of consecutive lines of therapy was decreasing: 560, 360, 330 and 202 days for the first, second, third and fourth regimens, respectively. The main reason to modification was intolerance or toxicity (46.2, 49.1 and 47.1% for the first, second and third modification). A fifth of changes was originated by difficulties to follow the therapy. Virological failure was the reason for modification in 21.8, 24.5 and 26.5% of first, second and third changes. CONCLUSIONS: Duration of consecutive antiretroviral regimens progressively decreases. Intolerance or drug toxicity were the main reasons conditioning the change of treatment.