[Lopinavir/ritonavir in new simplification strategies in antiretroviral therapy]. / Lopinavir/ritonavir en nuevas estrategias de simplificación del tratamiento antirretroviral.

Interest in simplification arises from the need to dispense with nucleoside analogs due to their long-term toxicity. Since the first trials analyzing the safety and effectiveness of the strategy with lopinavir/ritonavir (LPV/r) emerged more than 10 years ago, simplification continues to arouse scientific, clinical and economic interest. At present, there is no consensus on recommendations; interpretations of results are discordant: while some emphasize the greater risk of loss of virologic control, others indicate that the possible virological rebound with this strategy is unrelated to a loss of therapeutic options or to the emergence of resistance to ritonavir-boosted protease inhibitors. This scenario governs the recommendations that can be made in clinical practice; almost all groups agree that candidates should be selected for a simplification strategy with fewer drugs.

[HIV infection in immigrants: clinical and epidemiological differences as compared to the native population in a Health Area in Madrid (2002-2004)]. / Infección por el VIH en inmigrantes: diferencias clínico-epidemiológicas con la población autóctona en un área de salud de la Comunidad de Madrid (2001-2004).

OBJECTIVE: To describe the incidence and characteristics of immigrant patients attended in a dedicated HIV Unit in Madrid (Spain). METHODS: Cross-sectional study including all patients whose first visit to our HIV Unit took place between January 2001 and December 2004. RESULTS: Among a total of 516 new patients seen during the study period, 101 (19.6%) were immigrants (59% from Latin America, 27% from sub-Saharan Africa). Considering only patients who had not received previous clinical care in other centers (n = 298), 25.5% were immigrants. As compared to Spanish patients, there was a higher proportion of women among the immigrant population (40% vs. 26%: P = 0.008), age was lower (35 vs. 38 years; P = 0.003), and educational level was higher (39% vs. 13% secondary or higher education; P < 0.0001), with no statistical differences regarding employment (37% vs. 27% were unemployed; P = 0.07). Sexual transmission was more frequent among immigrants (85% vs. 37%; P < 0.0001), but the main sexual route of infection in both groups was heterosexual contact (71% and 66%). There were no differences in the baseline clinical, immunological, or virological status. CONCLUSION: A large number of new patients attended for the first time in a dedicated HIV Clinic in Madrid were immigrants. Although these patients showed some differences in demographic characteristics and the mechanism of HIV transmission, no significant differences were found in their clinical or immunological characteristics as compared to Spanish patients.