C. Tural

Hospital Universitario La Paz

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Bonaventura Clotet

Universitat Autònoma de Barcelona

B Clotet

Poznan University of Medical Sciences

Antonella d’Arminio Monforte

Center for Outcomes Research and Clinical Epidemiology

Rainer Weber

University of Cologne

H Trocha

Gdańsk Medical University

G Scullard

Imperial College London

Ladislav Machala

Fakultní nemocnice Bulovka

J. Perdios

General Hospital of Athens G. Genimatas

M. Pynka

Pomeranian Medical University

Antonio Chirianni

Ospedale D. Cotugno

Cooperative Institutions

Inserm

143

Assistance Publique – Hôpitaux de Paris

101

Université Paris Cité

Universitat Autònoma de Barcelona

University of Amsterdam

Hospital Universitari Germans Trias i Pujol

Istituto Nazionale per le Malattie Infettive Lazzaro Spallanzani

University College London

University of Milan

Sorbonne Université

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Identification of recent HIV-1 infection among newly diagnosed cases in Catalonia, Spain (2006-08)

European Journal of Public Health (2011)

Anabel Romero Victoria González Anna Esteve Elisa Martró Lurdes Matas

Background: Quantification and description of patients recently infected by HIV can provide an accurate estimate of the dynamics of HIV transmission. Between 2006 and 2008 in Catalonia, we estimated the prevalence of recent HIV infection among newly diagnosed cases, described the epidemiological characteristics of the infection according to whether it was recent, long-standing or advanced, and identified factors associated with recent infection. Methods: A Test for Recent Infection (TRI) was performed in serum samples from patients newly diagnosed with HIV. Two different TRI were used: the Vironostika-LS assay (January 2006–May 2007) and the BED-CEIA CEIA (June 2007 onwards). Samples were obtained within the first 6 months of diagnosis. Patients whose samples tested positive in the TRI were considered recently infected. Results: Of 1125 newly diagnosed patients, 79.9% were men (median age, 35.4 years), 38.7% were born outside Spain, 48.9% were men who have sex with men (MSM) and 10.6% presented other sexually transmitted infections. The overall percentage of recent infection was 23.0%, which increased significantly, from 18.1% in 2006 to 26.2% in 2008. This percentage was higher for patients from South America (27.6%). Factors associated with recent infection were acquiring infection through sexual contact between MSM [odds ratio (OR) 2.0; 95% confidence interval (95% CI) 1.1–3.9], compared with acquiring infection through heterosexual relations and being under 30 years of age (OR 5.9; 95% CI 1.9–17.4), compared with being over 50 years of age. Conclusion: The highest percentage of recent infection was identified in MSM, suggesting either a higher incidence or a greater frequency of HIV testing. Information regarding testing patterns is necessary to correctly interpret data from recently infected individuals. Systems to monitor the HIV epidemic should include both parameters.

Identification

10.1093/eurpub/ckr179

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Citations (18)

Transient Elastography for Predicting Liver-Related Events in Cirrhotic HIV-Infected Patients

Journal of AIDS & Clinical Research (2017)

Montes ML Juan Berenguer Miró Jm Carmen Quereda Asunción Hernando

Aim:We assessed liver stiffness measurement (LSM) for the prediction of mortality and decompensation in HIVinfected patients with compensated liver cirrhosis. Method:A prospective cohort study of HIV-infected patients with confirmed liver cirrhosis from 9 hospitals in Spain.LSM was undertaken for each patient; clinical events were collected prospectively after the baseline visit, and patients were followed until death or the censoring date.We used univariate/multivariate Cox proportional hazard models to evaluate the utility of LSM for predicting the first hepatic decompensation or overall mortality.The sensitivity (SEN), specificity (SPE), positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+) and negative likelihood ratio (LR-) were calculated.The LSM cutoff was selected using ROC curves. Results:We included 102 patients with compensated liver cirrhosis; median [interquartile, (IQR)] follow-up was 36 (21-46) months, median (IQR) CD4+ cell count was 415 cells/μL (307-624) and 94% were receiving antiretroviral therapy.The median (IQR) LSM was 17 kPa (11.7-26).Nineteen events were recorded during follow-up.Multivariate analysis showed that time to hepatic decompensation was associated with CD4+ <200 cells/μL (HR, 26; 95% CI, 1.8-377; p<0.02) and LSM ≥ 25 kPa (HR, 7.2; 95% CI, 1.1-47; p=0.04) and that time to overall mortality was associated with LSM ≥ 25 kPa (HR, 14.3; 95% CI, p=0.02).The predictive values for decompensation (LSM ≥ 25 kPa) were as follows: SEN, 67%; SPE, 78%; NPV, 96%; PPV, 23%; LR+, 3; LR-, 0.4.The predictive values for overall mortality with this LSM cutoff were as follows: SEN, 86%; SPE, 79%; NPV, 99%; PPV, 23%; LR+, 4; LR-, 0.2. Conclusion:Our data suggest that LSM is an accurate method for the prediction of mortality and decompensation in HIV-infected patients with liver cirrhosis.

Transient elastography

Transient (computer programming)

Omics

10.4172/2155-6113.1000675

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660 HIV/HCV-COINFECTED PATIENTS WHO ACHIEVED SVR ARE STILL AT RISK OF DEVELOPING HEPATOCELLULAR CARCINOMA

Journal of Hepatology (2013)

Nicolás Merchante E Merino C. Tural António Rivero‐Juarez Francisco Jover

10.1016/s0168-8278(13)60662-5

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Estimating prevalence of accumulated HIV-1 drug resistance in a cohort of patients on antiretroviral therapy

Journal of Antimicrobial Chemotherapy (2011)

WP Bannister Alessandro Cozzi‐Lepri Jesper Kjær B Clotet Adriano Lazzarin

Estimating the prevalence of accumulated HIV drug resistance in patients receiving antiretroviral therapy (ART) is difficult due to lack of resistance testing at all occasions of virological failure and in patients with undetectable viral load. A method to estimate this for 6498 EuroSIDA patients who were under follow-up on ART at 1 July 2008 was therefore developed by imputing data on patients with no prior resistance test results, based on the probability of detecting resistance in tested patients with similar profiles.Using all resistance test results available, predicted intermediate/high-level resistance to specific drug classes [nucleoside reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs) and protease inhibitors (PIs)] was derived using the Stanford algorithm v5.1.2. Logistic regression models were then employed to estimate predicted probability of resistance to each drug class for given values of current viral load, history of virological failure and previous virological suppression. Based on these predicted probabilities and patients' covariate profiles, estimates of prevalence in 5355 patients with no prior test results were obtained. Overall prevalence of resistance was estimated by pooling these data with those observed in the remaining 1143 tested patients.Prevalence of NRTI, NNRTI and PI resistance was estimated as 43% (95% confidence interval: 39%-46%), 15% (13%-18%) and 25% (22%-28%), respectively.This method provides estimates for the proportion of treated patients in a cohort who harbour resistance on a given date, which are less likely to be affected by selection bias due to missing resistance data and will allow us to estimate prevalence of resistance to different drug classes at specific timepoints in HIV-infected populations on ART.

HIV drug resistance

10.1093/jac/dkr006

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Citations (16)

Progression of liver fibrosis in HIV/hepatitis C virus‐coinfected individuals on antiretroviral therapy with early stages of liver fibrosis at baseline

HIV Medicine (2013)

Ramon Sanmartin Jordi Tor Arantza Sanvisens J.L. García López Antoni Jou

The aim of the study was to assess the progression of liver fibrosis in HIV/hepatitis C virus (HCV)-coinfected patients with no or mild-to-moderate fibrosis (stages F0-F2).Liver fibrosis was reassessed by transient elastometry (TE) between January 2009 and November 2011 in HIV/HCV-coinfected patients with stage F0-F2 fibrosis in a liver biopsy performed between January 1997 and December 2007. Patients with liver stiffness at the end of follow-up < 7.1 kPa were defined as nonprogressors, and those with values ≥ 9.5 kPa or who died from liver disease were defined as progressors. Cirrhosis was defined as a cut-off of 14.6 kPa. The follow-up period was the time between liver biopsy and TE. Cox regression models adjusted for age, gender and liver fibrosis stage at baseline were applied.The median follow-up time was 7.8 years [interquartile range (IQR) 5.5-10 years]. The study population comprised 162 patients [115 (71%) nonprogressors and 47 (29%) progressors; 19 patients (11.7%) had cirrhosis]. The median time from the diagnosis of HCV infection to the end of follow-up was 20 years (IQR 16.3-23.1 years). Three progressors died from liver disease (1.8%). The variables associated with a lower risk of progression were age ≤ 38 years (hazard ratio (HR) 0.32; 95% confidence interval (CI) 0.16-0.62; P = 0.001], having received interferon (HR 2.18; 95% CI 1.14-4.15; P = 0.017), being hepatitis B virus surface antigen (HBsAg) negative (HR 0.20; 95% CI 0.04-0.92; P = 0.039), and baseline F0-F1 (HR 0.43; 95% CI 0.28-0.86; P = 0.017).A high proportion of patients with stage F0-F2 fibrosis progress to advanced liver fibrosis. Advanced liver fibrosis must be included in the list of diseases associated with aging. Our results support the recommendation to offer HCV antiviral therapy to HIV/HCV-coinfected patients at early stages of liver fibrosis.

Hepatitis C

10.1111/hiv.12105

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Citations (26)

Baseline Resistance and Virological Outcome in Patients with Virological Failure who Start a Regimen Containing Abacavir: Eurosida Study

Antiviral Therapy (2004)

Cecilia Cabrera Alessandro Cozzi‐Lepri Andrew Phillips Clive Loveday Ole Kirk

Objectives To investigate the ability of several HIV-1 drug-resistance interpretation systems, as well as the number of pre-specified combinations of abacavir-related mutations, to predict virological response to abacavir-containing regimens in antiretroviral therapy-experienced, abacavir-naive patients starting an abacavir-containing regimen in the EuroSIDA cohort. Patients and methods A total of 100 HIV-infected patients with viral load (VL) >500 copies/ml who had a plasma sample available at the time of starting abacavir (baseline) were included. Resistance to abacavir was interpreted by using eight different commonly used systems that consisted of rules-based algorithms or tables of mutations. Correlation between baseline abacavir-resistance mutations and month 6 virological response was performed on this population using a multivariable linear regression model accounting for censored data. Results The baseline VL was 4.36 log 10 RNA copies/ml [interquartile range (IQR): 3.65–4.99 log 10 RNA copies/ml] and the median CD4 cell count was 210 cells/μl (IQR: 67–305 cells/μl). Our patients were pre-exposed to a median of seven antiretrovirals (2–12) before starting abacavir therapy. The median (range) number of abacavir mutations (according to the International AIDS Society-USA) detected at baseline was 3.5 (0–8). Overall, the Kaplan–Meier estimate of the median month 6 VL decline was 0.86 log 10 RNA copies/ml [95% confidence intervals (95% CI): 0.45–1.24]. The VL in those patients ( n=31) who intensified treatment by adding only abacavir decreased by a median 0.20 log 10 RNA copies/ml (95% CI: -0.18; +0.94). The proportion of patients who harboured viruses fully resistant to abacavir among the eight genotypic resistance interpretation algorithms ranged from 12% [Agence Nationale de Recherches sur le SIDA (ANRS)] to 79% [Stanford HIV RT and PR Sequence Database (HIVdb)]. Some interpretation systems showed statistically significant associations between the predicted resistance status and the virological response while others showed no consistent association. The number of active drugs in the regimen was associated with greater virological suppression (additional month 6 VL reduction per additional sensitive drug=0.51, 95% CI: 0.15–0.88, P=0.006); baseline VL was also weakly associated (additional month 6 VL reduction per log 10 higher=0.30, 95% CI: -0.02; +0.62, P=0.06). In contrast, the number of drugs previously received was associated with diminished viral reduction (additional month 6 VL reduction per additional drug=-0.14, 95% CI: -0.28; 0.00, P=0.05). Conclusions Our results revealed a high degree of variability among several genotypic resistance interpretation algorithms currently in use for abacavir. Therefore, the interpretation of genotypic resistance for predicting response to regimens containing abacavir remains a major challenge.

Abacavir

Interquartile range

Regimen

10.1177/135965350400900509

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Citations (10)

Spontaneous resolution of Candida esophagitis in a seroconverting patient for HIV antibodies.

PubMed (1988)

B Clotet Joan Romeu A Casals C. Tural J. Boix

Esophagitis

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Citations (9)

20 PERFORMANCE OF LIVER STIFFNESS COMPARED WITH LIVER BIOPSY TO PREDICT SURVIVAL AND DECOMPENSATIONS OF CIRRHOSIS AMONG HIV/HCV-COINFECTED PATIENTS

Journal of Hepatology (2013)

Juan Macı́as Ángela Camacho M. A. von Wichmann Luís F. López‐Cortés Enrique Ortega

10.1016/s0168-8278(13)60022-7

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Long‐Lasting Remission of Cytomegalovirus Retinitis without Maintenance Therapy in Human Immunodeficiency Virus‐Infected Patients

The Journal of Infectious Diseases (1998)

C. Tural Joan Romeu G. Sirera D. Andreu María Dolores Antón Conejero

Seven AIDS patients who were receiving suppressive therapy for previously diagnosed cytomegalovirus (CMV) retinitis were offered treatment with protease inhibitors (PIs). Secondary prophylaxis for CMV was discontinued after 3 months of therapy with PIs if patients had >150 CD4 cells/mm3 and a human immunodeficiency virus (HIV) load of <200 copies/mL and if they were negative for CMV as determined by qualitative CMV polymerase chain reaction (PCR). Ophthalmologic exams were done periodically. After a median follow-up of 9 months (range, 9-12), no new episodes of CMV retinitis were observed. CD4 cell counts were >150 cells/mm3 in all cases, HIV loads were <200 copies/mL, and results for qualitative CMV PCRs remained negative. These observations suggest that for selected patients with healed CMV retinitis who have immunologic and virologic evidence of a clinical response to potent combination antiretroviral therapy, temporary discontinuation of a chronic anti-CMV suppressive therapy may not result in further retinal necrosis. However, the long-term immunologic benefit of PIs and hence the safety of prolonged withdrawal of anti-CMV therapy is unknown.

Cytomegalovirus retinitis

Discontinuation

Cytomegalovirus

Betaherpesvirinae

Maintenance therapy

10.1086/517399

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Citations (199)

836 DIFFERENCES IN VIROLOGIC RESPONSE PATTERNS BETWEEN HIV/HCV CO-INFECTED AND HCV MONO-INFECTED PATIENTS TREATED WITH PEGINTERFERON AND RIBAVIRIN WITH DOSE ADJUSTED TO BODY WEIGHT (1000–1200 MG/DAY)

Journal of Hepatology (2008)

C. Tural J.A. Galeras Ramón Planas S. Coll Antoni Jou

10.1016/s0168-8278(08)60838-7

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Citations (0)