Impacto de la implantación de un protocolo de actuación de neumonía adquirida en la comunidad / Impact of the implementation of an intervention protocol in community-acquired pneumonia

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Response to combined antiretroviral therapy according to gender and origin in a cohort of naïve HIV-infected patients: GESIDA-5808 study.

BACKGROUND: We analyzed differences in response to combined antiretroviral therapy (cART) according to sex and geographic origin in a retrospective comparative study of Spanish-born and immigrant patients initiating cART. METHODS: The primary endpoint was time to treatment failure (TTF), defined as virological failure, death, opportunistic infection, interruption of cART, or loss to follow-up. Late diagnosis was defined as a CD4+ cell count ≤ 200 cells/mm3 and/or AIDS at initiation of cART. Survival was analyzed using Kaplan-Meier analysis and Cox regression. RESULTS: We followed 1,090 patients, of whom 318 were women (45.6% immigrant women [IW]). At initiation of treatment, women had a higher CD4+ count than men (217 vs 190 cells/mm3), a lower viral load (4.7 vs 5 log), and fewer were late starters (49% vs 59%). The adjusted risk of TTF between women and men was not significantly different (hazard ratio [HR], 1.10; 95% CI, 0.79-1.53). TTF was shorter among IW than Spanish-born women (124 weeks [95% CI, 64-183] vs 151 [95% CI, 127-174]) and loss to follow-up was double that of Spanish-born women (25.5% vs 11.6%). CONCLUSIONS: Although response to cART was similar for both sexes, men started treatment later. IW were more frequently lost to follow-up and switched treatment. Measures to improve medical follow-up after initiation of cART should be promoted among this minority group.

Síndrome de Budd Chiari agudo / Acute Budd Chiari Syndrome

El Síndrome de Budd Chiari se caracteriza por la obstrucción del retorno venoso de los venas hepáticas, la vena cava inferior o la aurícula derecha. El presente caso ilustra el índice de sospecha clínica necesario para el diagnóstico precoz del Síndrome de Budd Chiari cuando las pruebas complementarias iniciales (transaminasasas y ECO Abdominal) no son concluyentes (AU)

Budd Chiari Syndrome is characterised by the obstruction of venous return of the hepatic veins, the inferior vena cava and the right atrium. This case illustrates the index of clinical suspicion necessary for early diagnosis of Budd Chari Syndrome when initial complementary tests (transaminases and abdominal ultrasound) are not conclusive (AU)

Uso de bupropión en la deshabituación tabáquica en pacientes infectados por el VIH en tratamiento antirretroviral / Bupropion use for smoking cessation in HIV-infected patients receiving antiretroviral therapy

El tabaquismo es el factor de riesgo cardiovascular modificable más importante. El bupropión es el método de deshabituación tabáquica (DT) más eficaz, pero se metaboliza por el citocromo P-450 y podría provocar interacciones con los antirretrovirales. Presentamos un estudio prospectivo de DT con bupropión en pacientes VIH1 en tratamiento antirretroviral. Se incluyeron 21 pacientes. El 38% seguían sin fumar al año. No se encontraron interacciones clínicamente significativas. La DT con bupropión es efectiva y no ha provocado interacciones clínicamente significativas con los antirretrovirales (AU)

Smoking is the most important modifiable cardiovascular risk factor. Bupropion administration is an effective method to achieve smoking cessation (SC), but the drug is metabolized by the cytochrome P450 enzyme system and this might cause interactions with antiretroviral drugs. We present a prospective study of bupropion SC therapy in HIV-positive patients under antiretroviral treatment. A total of 21 patients were studied; 38% of them stopped smoking for more than one year. No clinically significant drug interactions were found. Bupropion SC therapy was effective in HIV-positive patients and did not cause significant clinical interactions with antiretroviral drugs (AU)

[Bupropion use for smoking cessation in HIV-infected patients receiving antiretroviral therapy]. / Uso de bupropión en la deshabituación tabáquica en pacientes infectados por el VIH en tratamiento antirretroviral.

Smoking is the most important modifiable cardiovascular risk factor. Bupropion administration is an effective method to achieve smoking cessation (SC), but the drug is metabolized by the cytochrome P450 enzyme system and this might cause interactions with antiretroviral drugs. We present a prospective study of bupropion SC therapy in HIV-positive patients under antiretroviral treatment. A total of 21 patients were studied; 38% of them stopped smoking for more than one year. No clinically significant drug interactions were found. Bupropion SC therapy was effective in HIV-positive patients and did not cause significant clinical interactions with antiretroviral drugs.

Tratamiento antirretroviral con nelfinavir en un paciente infectado por el VIH y diabetes mellitus secundaria a indinavir / Antiretroviral therapy with nellfinavir for patient infected, by HIV and secondary diabetes mellitus due to indinavir

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