Human immunodeficiency virus (HIV) remains incurable due to latent viral reservoirs established in non-activated CD4 T cells that cannot be eliminated via antiretroviral therapy. Current efforts to ...cure HIV are focused on identifying drugs that will induce viral gene expression in latently infected cells, commonly known as latency reversing agents (LRAs). Some drugs have been shown to reactivate latent HIV but do not cause a reduction in reservoir size. Therefore, finding new LRAs or new combinations or increasing the round of stimulations is needed to cure HIV. However, the effects of these drugs on viral rebound after prolonged treatment have not been evaluated. In a previous clinical trial, antiretroviral therapy intensification with maraviroc for 48 weeks caused an increase in residual viremia and episomal two LTR-DNA circles suggesting that maraviroc could reactivate latent HIV. We amended the initial clinical trial to explore additional virologic parameters in stored samples and to evaluate the time to viral rebound during analytical treatment interruption in three patients. Maraviroc induced an increase in cell-associated HIV RNA during the administration of the drug. However, there was a rapid rebound of viremia after antiretroviral therapy discontinuation. HIV-specific T cell response was slightly enhanced. These results show that maraviroc can reactivate latent HIV in vivo but further studies are required to efficiently reduce the reservoir size.
We conducted a retrospective observational study to demonstrate that switching to insulin degludec from other long-acting insulins reduces the risk of hypoglycaemia events and improves glycaemic ...control in patients with type 2 diabetes and stage 2-3B chronic kidney disease.
To describe an unusual clinical presentation of visceral leishmaniasis affecting the colon.
We report the case of an HIV-positive patient with visceral leishmaniasis. We describe the clinical case, ...the procedures performed, the treatment provided and the patient's evolution. A comparative table of previously reported similar cases is shown.
Visceral leishmaniasis with intestinal involvement is an uncommon process. Nevertheless, this possibility should be taken into consideration in the differential diagnosis of immunosuppressed patients with symptoms of diarrhea, as a favorable prognosis depends on early diagnosis and appropriate treatment.
We describe an unusual clinical association of disseminated histoplasmosis with reactive hemophagocytic syndrome. We report the case of a new HIV-positive patient with reconstitution inflammatory ...syndrome like reactive hemophagocytic syndrome associated with disseminated histoplasmosis. We describe the clinical case, the procedures performed, the treatment provided and the patient’s evolution. A figure of liver biopsy Grocott’s silver methenamine stain that shows lots of uniform ovoid yeasts in portal spaces’ macrophages that supports the diagnosis of disseminated histoplasmosis in our case.
To compare coronavirus disease 2019 (COVID-19) hospitalization outcomes between persons with and without HIV.
Retrospective observational cohort study in 150 hospitals in Spain.
Patients admitted ...from 1 March to 8 October 2020 with COVID-19 diagnosis confirmed by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 positive) PCR test in respiratory tract samples. The primary data source was the COVID-19 Sociedad Española de Medicina Interna's registry (SEMI-COVID-19). Demographics, comorbidities, vital signs, laboratory parameters, and clinical severity as well as treatments received during admission, treatment duration, ICU admission, use of invasive mechanical ventilation, and death were recorded. Factors associated with mortality and the composite of ICU admission, invasive mechanical ventilation, and death, were analyzed.
Data from 16 563 admissions were collected, 98 (0.59%) of which were of persons with HIV infection. These patients were younger, the percentage of male patients was higher, and their Charlson comorbidity index was also higher. Rates of mortality and composite outcome of ICU admission, invasive mechanical ventilation or death were lower among patients with HIV infection. In the logistic regression analysis, HIV infection was associated with an adjusted odds ratio of 0.53 95% confidence interval (CI) 0.29-0.96 for the composite outcome.
HIV infection was associated with a lower probability of ICU admission, invasive mechanical ventilation, or death.
Summary
Background
Many Spanish hospitals converted scheduled in-person visits to telephone visits during the COVID-19 lockdown. There is scarce information about the performance of those visits.
Aim
...To compare telephone visits during the COVID-19 lockdown period with previous in-person visits.
Design
Retrospective descriptive study.
Methods
Telephone visits from 15 March to 31 May 2020 were compared with in-person visits during the same period in 2019.
Main measures
The proportions of both groups were compared in term of failure to contact patient, requested diagnostic tests/referrals, discharges, admissions and emergency visits within 30–60 days. A sample of patients, and all participating physicians completed surveys. Z-score test was used (statistical significance P<0.05).
Results
A total of 5602 telephone visits were conducted. In comparison to in-person visits, telephone visits showed higher rates of visit compliance (95.9% vs. 85.2%, P<0.001) and discharges (22.12% vs. 11.82%; P<0.001), and lower number of ancillary tests and referrals. During the 30- and 60-day periods following the telephone visit, a reduction of 52% and 47% in the combined number of emergency department visits and hospital admissions was observed compared to in-person visits (P<0.01). Of the 120 patients surveyed, 95% were satisfied/very satisfied with the telephone visits. Of the 26 physicians, 84.6% considered telephone visits were useful to prioritize patients.
Conclusions
During health emergencies, previously scheduled outpatient in-person visits can be converted to telephone visits, reducing absenteeism, increasing the rate of discharges and reducing ancillary tests and referrals without increasing the rate of hospital admissions or emergency department visits.
Objective: The primary endpoint of the study was to determine the proportion of patients with HIV RNA < 50 copies/mL at 48 weeks. Design: Phase IV, multicentric, open-label, single-arm clinical trial ...of participants recruited in 2018−2019 to evaluate the efficacy and safety of tenofovir alafenamide/emtricitabine/elvitegravir-cobicistat (TAF/FTC/EVG-c) as first-line treatment in HIV-1 infected naïve participants with advanced disease. Methods: Adverse events were graded according to the Division of AIDS scale version 2.0. Quantitative variables were recorded as median and interquartile range, and qualitative variables as absolute number and percentage. T-Student or Wilcoxon tests were used to analyze intragroup differences of the continuous variables. Results: Fifty participants were recruited with a baseline median CD4 lymphocyte count of 116 cells/µL and a viral load of 218,938 copies/mL. The proportion of patients with viral load <50 copies/mL at week 48 was 94% in the per-protocol analysis, with a median time of 1.9 months to achieve it. Three adverse events attributed to the study drug caused trial discontinuation. Conclusions: the use of TAF/FTC/EVG-c in patients with advanced HIV disease in our study demonstrated efficacy comparable to data from pivotal clinical trials with a good safety profile.
Background: The impact of COVID-19 pandemic on post-hospital mortality of polypathological patients is unknown. Methods: We compared two cohorts of polypathological patients: patients discharged ...during the first quarter of the years 2017-2019 (pre-pandemic cohort), and patients discharged in the first quarter of 2020 (pandemic cohort). Demographic characteristics, prognostic PROFUND score, use of hospital services after discharge, and vital status at 1, 3, 6, and 12 months were compared. The influence of the pandemic on 3, 6, and 12-month mortality was analyzed with a multivariant model, including gender, age, and prognostic PROFUND score. Results: The pre-pandemic (512 patients) and pandemic (132 patients) cohorts were similar in age (mean 78.8 vs. 79.1-year-old, respectively) and PROFUND prognostic index > 10 (31.9% vs. 37.4%, respectively). There were more men in the prepandemic cohort (59% vs. 49.6%, respectively, p = 0.06). The accumulated 6-month mortality was higher in the pandemic cohort (39.4% vs. 28.7%; p = 0.02), but not at 1, 3, and 12 months. A significant higher risk of accumulated mortality at 6 months in the pandemic cohort remained in multivariant analysis (Odds ratios: 1.63; IC95%: 1.07-2.48). Significant reduction in specialized healthcare utilization during the 12-month period after discharge was found in the pandemic cohort: 42% less emergency visits (p = 0.001), 30% less external office visits (p = 0.023), and 58% less hospitalizations (p = 0.001). Conclusions: Risk of 6-month accumulated mortality of polypathological patients discharged around the onset of the COVID-19 pandemic was 63% higher than historic controls. These differences disappeared 12 months after discharge.
PDF
