Clinical impact of COVID-19 on people with substance use disorders.

BACKGROUND: People with substance use disorders are considered at increased risk of COVID-19 and its more serious complications, however data on the impact of COVID-19 are lacking. The study aimed to describe the clinical characteristics and outcomes of COVID-19 on people with substance use disorders. METHODS: an observational study was carried out including patients aged ≥ years with COVID-19 pneumonia admitted to an urban hospital during March 12 to June 21,2020. RESULTS: Among 2078 patients admitted, 27 (1.3%) were people with substance use disorders: 23(85.2%) were men with a median age of 56.1 + 10.3 years and. The main SUD were alcohol in 18(66.7%) patients, heroine in 6(22.2%) and cocaine in 3(11.1%) and 24(88.8%) patients were on ongoing substance use disorder treatment. One or more comorbidities associated to COVID-19 risk were observed in 18(66.6%) of patients. During a median length of stay of 10 days (IQR:7-19), severe pneumonia developed in 7(25.9%) patients, acute respiratory distress syndrome in 5 (18.5%) and none died. CONCLUSION: Larger sample sizes and sero-epidemiological studies are needed to confirm the low incidence of severe COVID-19 on patients with SUD.

Trends in AIDS Mortality, Retention in Opioid Agonist Therapy, and HIV RNA Suppression in HIV-Infected People Who Injected Drugs from 2000 to 2015.

AIDS is a major cause of preventable mortality in HIV-infected people who inject drugs (HIV-PWID). An observational study was conducted to examine trends in AIDS mortality and related factors among HIV-infected individuals who died between 2000 and 2015 at an urban hospital. Overall HIV-mortality was 6.5% (413/6307) with no changes over time (p 0.76). AIDS mortality dropped in HIV-PWID (p 0.02) although it represented 26.4% at the end of study period. Age (per one-year increase) [odds ratio (OR) 0.95], third study period (2010-2015) (OR 0.54), HIV-PWID on opioid agonist therapy (OAT) (OR 0.39), and HIV RNA suppression (OR 0.15) were associated with AIDS mortality. OAT was reported in 58.3% (161/276) and RNA suppression in 30.9% (85/276) of HIV-PWID. OAT non-retention was due to drop-outs [85.2% (98/115)] and rejection [14.8% (17/115)] in HIV-PWID. Therefore, additional strategies are required to improve OAT retention and HIV RNA suppression to continue reducing AIDS mortality.

Use of highly active antiretroviral therapy is increasing in HIV positive severe drug users.

BACKGROUND: Substance abuse greatly impacts the effectiveness of highly active antiretroviral therapy (HAART). We analyzed antiretroviral use in drug users positive for human immunodeficiency virus (HIV) that sought substance abuse treatment. METHODS: This cross-sectional study recruited 705 patients HIV positive (74.6% men) between 1997 and 2007. Patients were grouped by calendar periods when different HAART regimens were available in Spain (p1: 1997-1999, n=299; p2: 2000-2003, n=249; and p3: 2004-2007, n=157). RESULTS: The mean age at admission was 34 years; 94.7% had a past history of injection drug use (IDU) and 67.7% were current IDUs. The average CD4 cell count was 399 cells/µL [interquartile range:203-632 cells/µL]. Lifetime prevalence of antiretroviral use was 59.4% (416/705; p1: 48.1%; p2: 64.6%; p3: 72.6%; p<0.05). The overall prevalence of antiretroviral use at admission was 40.7% (p1: 31.4%; p2: 41.0%; p3: 58.0%; p<0.05). In multivariate logistic regression analysis, age, calendar period, and non-IDU were predictors of antiretroviral use at admission. Among those taking antiretrovirals, 21.6% were on suboptimal HAART, mostly in the p1 group. Overall, 44.6% of patients were taking protease inhibitor and non-nucleoside reverse transcriptase inhibitor (PI-NNRTI), 21.9% were taking NRTI-NNRTI, and 9.4% were taking three NRTIs. Although not significant, the three-NRTI regimen was associated with CD4 >350 cells/µL and HIV RNA <400 copies/mL. CONCLUSIONS: HAART use is steadily increasing in HIV positive heavy drug users. However, part of this population remains antiretroviral therapy-naïve despite advanced immunodeficiency. Interventions that focus on integrating substance abuse with HIV/AIDS treatments are needed.

[Treatment of osteoporosis with calcium and vitamin D. Systematic review]. / Tratamiento de la osteoporosis con calcio y vitamina D. Revisión sistemática.

BACKGROUND: Systematic review of the efficacy of calcium and vitamin D for the treatment of osteoporosis. MATERIAL AND METHOD: Review of the database MEDLINE between 1996 and may 1998, by the key words: osteoporosis, calcium, vitamin D (and related terms) and randomized clinical trial. Review of the electronic versions of Best Evidence, The Cochrane Library, congress abstracts and references from two main textbooks. Ascending review of the literature. All the reviews were performed independently by two of the authors. Design parameters and main results of the primary publications of the identified trials were tabulated. Two independent observers carried out methodological scoring of the studies. Results were tabulated and a judgement made for the results. RESULTS: Eleven studies on calcium, 8 of vitamin D and 12 about calcitriol and other hormone derivatives were included. Studies with calcium were mainly performed on non-clinical populations and in three anti-fracture efficacy was analyzed. Results were positive in population with low baseline intake and substantial supplementation. Trials on vitamin D were done in non-clinical and on institutionalized populations. Trials with calcitriol were developed mainly in osteoporotic fracture populations and reached poorer methodological validity scores. Heterogeneity of the studies precluded a meta-analysis of the different treatments. Studies on calcium showed clinical efficacy in a more consistent way. Inter-observer score was good (kappa = 0.81) and there were no significant correlations between sample size and effect in the different studies. CONCLUSIONS: Calcium treatment is efficacious in populations with low intake receiving substantial supplementation. Vitamin D is efficacious associated with calcium mainly in deficient populations. Efficacy of calcitriol and other derivatives is more controversial.