Browsing by Author "Domingo, Pere"

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    Discontinuation of maintenance therapy for cryptococcal meningitis in patients with AIDS treated with highly active antiretroviral therapy: an international observational study
    (2004-02-15) Mussini, Cristina; Pezzotti, Patrizio; Miró, José M; Martinez, Esteban; de Quiros, Juan Carlos Lopez Bernaldo; Cinque, Paola; Borghi, Vanni; Bedini, Andrea; Domingo, Pere; Cahn, Pedro; Bossi, Philippe; de Luca, Andrea; d'Arminio Monforte, Antonella; Nelson, Mark; Nwokolo, Nneka; Helou, Silvia; Negroni, Ricardo; Jacchetti, Gaia; Spinello, Antinori; Lazzarin, Adriano; Cossarizza, Andrea; Esposito, Roberto; Antinori, Andrea; Aberg, Judith A; International Working Group on Cryptococcosis
    We conducted a retrospective, multicenter study evaluating the safety of discontinuing maintenance therapy for cryptococcal meningitis after immune reconstitution. Inclusion criteria were a previous definitive diagnosis of cryptococcal meningitis, a CD4 cell count of >100 cells/µL while receiving highly active antiretroviral therapy (HAART), and the subsequent discontinuation of maintenance therapy for cryptococcal meningitis. The primary end point was relapse of cryptococcal disease. As of July 2002, 100 patients were enrolled. When maintenance therapy was discontinued, the median CD4 cell count was 259 cells/µL and the median plasma virus load was <2.30 log10 copies/mL, and serum cryptococcal antigen was undetectable in 56 patients. During a median follow-up period of 28.4 months (range, 6.7–64.5; 262 person-years), 4 events were observed (incidence, 1.53 events per 100 person-years; 95% confidence interval, 0.42–3.92). Three of these patients had a CD4 cell count of >100 cells/µL and a positive serum cryptococcal antigen test result during the recurrent episode. In conclusion, discontinuation of maintenance therapy for cryptococcal meningitis is safe if the CD4 cell count increases to >100 cells/µL while receiving HAART. Recurrent cryptococcal infection should be suspected in patients whose serum cryptococcal antigen test results revert back to positive after discontinuation of maintenance therapy.
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    Pneumocystis jirovecii pneumonia in Spanish HIV-infected patients in the combined antiretroviral therapy era: prevalence of dihydropteroate synthase mutations and prognostic factors of mortality
    (2008) Alvarez-Martínez, Miriam J.; Moreno, Asunción; Miro, Jose M.; Valls, Maria Eugenia; Rivas, Paula V.; Lazzari, Elisa de; Sued, Omar; Benito, Natividad; Domingo, Pere; Ribera, Esteban; Santín, Miguel; Sirera, Guillermo; Segura, Ferràn; Vidal, Francesc; Rodríguez, Francisco; Riera, Melchor; Cordero, Maria Elisa; Arribas, Jose; Anta, Maria Teresa Jiménez de; Gatell, Jose; Wilson, Paul E.; Meshnick, Steven R.; Spanish PCP Working Group
    The incidence of Pneumocystis jirovecii pneumonia (PCP) in HIV-infected patients has decreased thanks to sulfa prophylaxis and combined antiretroviral therapy. The influence of P. jirovecii dihydropteroate synthase (DHPS) gene mutations on survival is controversial and has not been reported in Spain. This prospective multicenter study enrolled 207 HIV-infected patients with PCP from 2000 to 2004. Molecular genotyping was performed on stored specimens. Risk factors for intensive care unit (ICU) admission and mortality were identified using a logistic regression model. Seven patients (3.7%; 95% confidence interval [CI], 1.5-7.5%) had DHPS mutations. Overall mortality was 15% (95% CI, 10-21%), rising to 80% (95% CI, 61-92%) in patients requiring mechanical ventilation. None of the patients with DHPS mutants died, nor did they need ICU admission or mechanical ventilation. PaO(2) <60 mm Hg at admission was a predictor of ICU admission (P = 0.01), and previous antiretroviral therapy predicted non-ICU admission (P = 0.009). PaO(2) <60 mm Hg at admission and ICU admission during the 1st week were predictors of mortality (P = 0.03 and P < 0.001, respectively). The prevalence of DHPS mutants in Spain is low and is not associated with a worse outcome. Severe respiratory failure at admission is the strongest predictor of PCP outcome.
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    Prevalence of Transmitted Antiretroviral Resistance and Distribution of HIV-1 Subtypes Among Patients with Recent Infection in Catalonia (Spain) between 2003 and 2005
    (2011) Romero, Alejandra; Sued, Omar; Puig, Teresa; Esteve, Anna; Pumarola, Tomas; Casabona, Jordi; González, Victoria; Matas, Lurdes; Tural, Cristina; Rodrigo, Isabel; Margall, Núria; Domingo, Pere; Casanova, Aurora; Ferrer, Elena; Caballero, Estrella; Ribera, Esteve; Farré, Joan; Puig, Teresa; Amengual, Maria José; Navarro, Gemma; Prat, Josep M.; Masabeu, Angels; Simó, Josep M.; Villaverde, Carlos A.; Barrufet, Pilar; Goretti, Sauca M.; Orti, Xavier; Amat, Orti; Navarro, Rosa; Euras, Josep M.; Vilarós, Josep; Villà, M. Carme; Montull, Santiago; Vilanova, Conrad; Pujol, Ferran; Díaz, Olga; Miro, Jose M
    Objectives: The objectives of this study were to assess the prevalence of transmitted HIV-1 drug resistances (TDR) and HIV-1 subtypes in recently infected patients in Catalonia between 2003 and 2005 and to describe the characteristics of these patients according to the presence or absence of TDR and HIV-1 subtype. Methods: After application of the Serological Testing Algorithm for Recent HIV Seroconversion (STARHS), residual aliquots of serum samples from recently infected antiretroviral-naïve individuals were genotyped. FASTA sequences were analyzed using the HIVDB Program. The World Health Organization 2009 List of Mutations for Surveillance of Transmitted HIV-1 Drug Resistant HIV Strains was used to estimate the prevalence of TDR. Results: Of 182 recently infected patients, 14 (7.7%) presented TDR. Seven (3.8%) had genotypic evidence of TDR against non-nucleoside reverse transcriptase inhibitors, 6 (3.3%) against nucleoside reverse transcriptase inhibitors, 3 (1.6%) against protease inhibitors (PIs), and only 2 individuals (1.1%) presented TDR against more than one class of drugs. Thirty-five (19.2%) patients were infected with a non-B HIV-1 subtype. Conclusion: This is the first study to estimate the prevalence of TDR in recently infected patients in Catalonia. The results are similar to those of studies performed in other Spanish regions. Correct monitoring of these parameters requires systematic epidemiologic surveillance of transmitted resistance.