Background and importanceThe effectiveness of current antiretroviral treatments has prolonged the survival of HIV patients, and with age, the prevalence of comorbidities increases. The new clinical ...conditions of these patients may cause potentially inappropriate prescriptions.Aim and objectivesThe aim of this study was to identify potentially inappropriate prescriptions in a HIV population over 65 years of age and to verify differences between physicians’ prescriptions and actual patient receipt of medications.Material and methodsThis was an observational study of elderly HIV patients (≥65 years) who collected antiretroviral treatment (ART) at the pharmacy of a third level hospital between June and November 2018. The electronic prescription was checked against what the patient reported taking, to be sure of the real treatment taken by the patient. The confirmed treatments were evaluated with STOPP and LESS-CHRON criteria.ResultsThirty patients met the inclusion criteria. Based on the STOPP criteria, de-prescription of one medication was detected in 63.3% of patients, and in 60.0% of patients with the LESS-CHRON model. The most frequent type of drug affected by both criteria were benzodiazepines, followed by antidepressants in the case of STOPP and antiaggregants in the case of LESS-CHRON. The total number of patients who may be candidates for de-prescription by meeting the criteria with one or the other method was 70%. The total number of drugs prescribed was significantly associated (p=0.008) with meeting de-prescription criteria. Discrepancies between physicians` prescriptions and real patient takings were found in 23% of patients.Conclusion and relevanceThere was a high prevalence of meeting de-prescription criteria in elderly HIV patients and a clear relationship between polypharmacy and de-prescription. Benzodiazepines were the most frequent drugs meeting the conditions of de-prescription. To obtain a complete record of a patient‘s treatment, it is necessary to complement the electronic medical record with a suitable clinical interview. It is important to periodically re-evaluate the need for treatment in chronic patients, with special interest in high risk drugs in the elderly.References and/or acknowledgementshttp://dx.doi.org/10.1136/ejhpharm-2017-001251No conflict of interest.
•Most tuberculosis (TB) units reported changes in their TB team operations.•TB patients diagnosed during COVID-19 showed more extended pulmonary forms.•Latent TB infections in children household ...contacts were higher in 2020.•Active TB in children household contacts were higher in 2020.
The impact of COVID-19 on the diagnosis and management of tuberculosis (TB) patients is unknown.
Participating centres completed a structured web-based survey regarding changes to TB patient management during the COVID-19 pandemic. The study also included data from participating centres on patients aged ≥18 diagnosed with TB in 2 periods: March 15 to June 30, 2020 and March 15 to June 30, 2019. Clinical variables and information about patient household contacts were retrospectively collected.
A total of 7 (70%) TB units reported changes in their usual TB team operations. Across both periods of study, 169 patients were diagnosed with active TB (90 in 2019, 79 in 2020). Patients diagnosed in 2020 showed more frequent bilateral lesions in chest X-ray than patients diagnosed in 2019 (P = 0.004). There was a higher percentage of latent TB infection and active TB among children in households of patients diagnosed in 2020, compared with 2019 (P = 0.001).
The COVID-19 pandemic has caused substantial changes in TB care. TB patients diagnosed during the COVID-19 pandemic showed more extended pulmonary forms. The increase in latent TB infection and active TB in children of patient households could reflect increased household transmission due to anti-COVID-19 measures.
Choriocarcinoma is an aggressive tumour. Uncommonly, it spreads distantly, and rarely results in pulmonary and brain metastases. Its prognosis is generally good when treated. We report a 33-year-old ...woman with fever, haemoptysis and asthenia. One month after the appearance of metrorrhagia, she was diagnosed to have choriocarcinoma with pulmonary metastasis. After chemotherapy, pulmonary images disappeared and human chorionic gonadotropin returned to normal. She was re-admitted with neurological signs ten months later, confirming recurrence of the disease with brain metastasis. She was treated with surgery and polychemotherapy, with a favourable outcome and disappearance of the disease.
Background and importanceDarunavir/cobicitat/emtricitabine/tenofovir alafenamide (DRV/c/FTC/TAF) is a new single tablet regimen for HIV. Another advantage is its coformulation with tenofovir ...alafenamide, and a better safety profile.Aim and objectivesTo evaluate reasons for switching from one antiretroviral therapy (ART) to DRV/c/FTC/TAF, and to evaluate effectiveness, safety and patient satisfaction.Material and methodsThis was an observational, descriptive, retrospective study of patients who started treatment with DRV/c/FTC/TAF and had an analytical control after the start of treatment. Variables collected: demographic, pharmacotherapeutic (reason for change to DRV/c/FTC/TAF, previous ART, number of previous active ingredients and tablets) and clinical (CD4 and CD8 lymphocytes, CD4/CD8 quotient, viral load and glomerular filtrate prior to and a median of 105 days after starting treatment). Satisfaction with ART was measured at 5 months using the ESTAR questionnaire (developed in Spanish based on the English language version of the HIV treatment satisfaction questionnaire (HIVTSQ)), with scores ranging from 0 to 60 points.ResultsThere were 38 patients (median age 50.5 years; 66.7% women) who initiated DRV/c/FTC/TAF. Three patients were not included: two naive and one who discontinued after a month due to intolerance. The previous ART was protease inhibitor/potentiator (PI/p) with two nucleotide analogue reverse transcriptase inhibitors (2NRTI) in 54.3% of patients, PI/p in 11.4%, integrase inhibitor (INSTI) with NRTI in 11.4% and 22.9% other. Patients switched from tenofovir diproxyl fumarate (TDF) to TAF (45.7%). Patients changed from an average of 2.57 active principles daily to 3, and from 1.78 tablets to 1.Reasons for change were renal in 40%, CD4 decrease I 8.6%, renal and bone in 8.6%, simplification and lack of adherence in 8.6% and other in 34.2%. Median CD4 changed from 505 to 684; median CD8 from 692 to 764; and median CD4/CD8 from 0.66 to 0.69. Undetectable viral load remained stable in 97.7% of patients and glomerular filtrate in 94.3%. Scores in the ESTAR questionnaire were higher than 50 in 80% of patients.Conclusion and relevanceIn daily practice, DRV/c/FTC/TAF was used in most cases to prevent damage to renal function. DRV/c/FTC/TAF is an effective and safe treatment which maintains viral load and glomerular filtrate. Patient satisfaction with the treatment was excellent.References and/or acknowledgementsNo conflict of interest.
The main objective of our investigation was to know the incidence and epidemiology of non-tuberculous mycobacteria (NTM) in our area and the prevalence of comorbidities in patients with MNT ...infection. As secondary objectives, we studied the distribution by species of MNT, the forms of disease and the type of sample used for its diagnosis.
A retrospective study was carried out in which all the isolates of mycobacteria carried out by the microbiology laboratory of the Hospital Clínico Universitario Lozano Blesa of Zaragoza during the period between January 1, 2011 and December 31, 2018 were included.
A total of 533 mycobacteria were isolated, of which 295 (55.35%) were tuberculosis (MTB) and 238 (44.65%) were MNT. Of the whole MNT isolates, only 15.54% were considered clinically significant. Twenty-one species were identified being the most frequent: M. gordonae (26.89%), M. fortuitum (19.75%) and M. avium (16.39%). 32.72% of the MNT isolates were found in people over 70 years of age.
We can confirm that the reported number of MNT isolates in our area is higher than in previous periods. MNT infection is more common in men and those older than 70 years. The epidemiology, especially the risk factors, of MNT disease is changing.
Background: Administration of antiretroviral therapy (ART) once daily is creating extraordinary interest among the members of the scientific community and also among those who receive the therapy. ...However, in clinical practice, some doubts remains about its use. Objectives: This document examines the characteristics and possibilities of treatment administered once daily. Methods: Consensus of 248 Spanish experts in the field. Results: Once-daily dosing is considered an added value which could favour adherence and, therefore, efficacy, as well as the quality of life of certain patients, however, the objective of adequate adherence in the long term is often difficult to achieve regardless of the treatment used. In theory, any patient can receive once-daily therapy, although some patients could particularly benefit from it, e.g. those with unfavourable social or personal circumstances, including drug users, patients whose treatment must be supervised, patients receiving multiple medications, or those who need rescue therapy after multiple treatment failures. At present, it is possible to design once-daily ART using some of the combinations of drugs considered as first-choice in national and international recommendations for antiretroviral therapy, but the options are still limited. The marketing of new drugs with this characteristic could allow us to increase the number and types of patient who can benefit from once-daily regimens, including those patients who need rescue therapy. Conclusions: Once-daily ART is a good alternative to regimens administered several times each day when a potent combination of active drugs is available.
It is well-known that gastrointestinal adverse events related to cART, such as diarrhoea, are strongly associated with a lower quality of life in HIV-infected patients. At the same time, these AEs ...can have a negative impact on adherence to the cART. In fact, gastrointestinal AEs are one of the most frequent reasons for discontinuation of cART. Our aim was to determine the incidence of chronic diarrhoea (CD; > or=4 weeks) in a group of HIV outpatients on cART, the factors related to its presence and its impact in their quality of life. CD is present in 8.8% of our patients. Nearly 50% of the patients did not refer the CD to their doctor although it had a negative impact in their life. Current smoking and LPV have a negative impact in CD; however, an undetectable VL had a protective effect.
Eighty‐four HCV/HIV‐coinfected and 252‐matched HCV‐monoinfected liver transplant recipients were included in a prospective multicenter study. Thirty‐six (43%) HCV/HIV‐coinfected and 75 (30%) ...HCV‐monoinfected patients died, with a survival rate at 5 years of 54% (95% CI, 42–64) and 71% (95% CI, 66 to 77; p = 0.008), respectively. When both groups were considered together, HIV infection was an independent predictor of mortality (HR, 2.202; 95% CI, 1.420–3.413 p < 0.001). Multivariate analysis of only the HCV/HIV‐coinfected recipients, revealed HCV genotype 1 (HR, 2.98; 95% CI, 1.32–6.76), donor risk index (HR, 9.48; 95% CI, 2.75–32.73) and negative plasma HCV RNA (HR, 0.14; 95% CI, 0.03–0.62) to be associated with mortality. When this analysis was restricted to pretransplant variables, we identified three independent factors (HCV genotype 1, pretransplant MELD score and centers with <1 liver transplantation/year in HIV‐infected patients) that allowed us to identify a subset of 60 (71%) patients with a similar 5‐year prognosis (69%95% CI, 54–80) to that of HCV‐monoinfected recipients. In conclusion, 5‐year survival in HCV/HIV‐coinfected liver recipients was lower than in HCV‐monoinfected recipients, although an important subset with a favorable prognosis was identified in the former.
Taken as a whole, HCV/HIV‐coinfected liver transplant recipients have lower posttransplant survival than matched HCV‐monoinfected liver transplant recipients, although an important subset of coinfected patients with survival similar to that of HCV‐monoinfected patients can be identified retrospectively.
Purpose of the study
Efficacy, toxicity and complexity of antiretroviral (ARV) regimens may impact the quality of life (QoL). Since over the past years the simplification approach of ...lopinavir/ritonavir (LPV/r) as monotherapy (MT) has been shown to be non‐inferior to triple therapy (TT) in virological and immunological efficacy, the objective of this study was to compare several health‐ and treatment‐related outcomes between both ARV strategies with LPV/r.
Methods
A phase IV national, multicenter, controlled, randomized (2:1), open label, parallel‐group clinical trial to compare the QoL in patients on ARV TT containing any boosted protease inhibitor (PI), undetectable viral load (VL< 50 cop/mL) in the past 6 months and a CD4 nadir > 100 cells/µL, versus those who were simplified to LPV/r MT, for 24 weeks. QoL and health outcomes were evaluated by the Medical Outcomes Study HIV Health Survey (MOS‐HIV) and the five‐dimensional EuroQol questionnaire (EQ‐5D). Treatment satisfaction was assessed by the Spanish Questionnaire of Satisfaction with ARV Treatment (CESTA). Treatment adherence was assessed by the Spanish Multifactorial Adherence questionnaire (GEEMA) and a visual analog scale (VAS). Tolerability, safety and virological and immunological efficacy at week 24 were also analyzed.
Summary of results
225 patients from 29 sites were enrolled (MT: 146, 64.5%; TT: 79, 35.1%). Mean age (years) was 44.5 in MT and 45.2 in TT (p=0.745); mean duration (years) from HIV infection was 13.4 in MT and 12.8 in TT (p=0.587) and 71% were male in both arms. 87.6% of patients completed correctly the study (MT: 88.4%; TT: 86.1%; p=0.674). Health and treatment outcomes evaluated at final study visit are shown in figure 1 1. At study end, 84.1% in MT and 89.6% in TT had undetectable VL (p=0.313) and mean CD4 count were 742.8 cells/µL in MT and 646.5 cells/µL in TT (p=0.060). There were no significant differences in the percentage of patients with virological failure at week 24 as VL >50 cop/mL (MT: 8.2%; TT: 3.9%; p=0.271) and as VL >200 cop/mL (MT: 3.4%; TT: 0%; p=0.167).
‘Quality of life’ impact: monotherapy vs triple therapy.
Conclusions
The MT simplification strategy with LPV/r maintains comparable virological and immunological efficacy, as well as the tolerability profile, than the TT. The saving resulting from NRTIs withdrawal from the ARV regimen and the good results on QoL and patients treatment satisfaction make MT strategy with LPV/r be taken into account in clinical practice.
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