Browsing by Author "Navarro, Gemma"

Now showing 1 - 4 of 4
  • Thumbnail Image
    Item
    Características clinicoepidemiológicas y tendencias en el tratamiento antirretroviral de una cohorte de pacientes con infección por el virus de la inmunodeficiencia humana. Cohorte PISCIS
    (2005-04) Jaén, Ángeles; Casabona, Jordi; Esteve, Anna; Miró, Jose M; Tural, Cristina; Ferrer, Elena; Riera, Melchor; Segura, Ferran; Force, Lluís; Sued, Omar; Vilaró, Josep; Masabeu, Àngels; García, Isabel; Dorca, Esther; Altès, Jordi; Navarro, Gemma; Podzamczer, Daniel; Villalonga, Concepción; Clotet, Bonaventura; Gatell, Jose
    Fundamento y objetivo: Los objetivos de este estudio fueron describir el proceso de implementación de la cohorte PISCIS y las características clinicoepidemiológicas y las tendencias en el tratamiento antirretroviral (TARV) de los pacientes con infección por el virus de la inmunodeficiencia humana (VIH) incluidos desde 1998 hasta 2003. Pacientes y método: Estudio de cohorte prospectivo de pacientes con infección por el VIH de 16 años de edad o mayores atendidos en primera visita en 10 hospitales de Cataluña y uno de las Baleares. El análisis estadístico de las tendencias se realizó mediante el test de la *2 de Mantel. Resultados: Se incluyó a un total de 5.968 pacientes (edad media: 39,5 años; 75% varones) con un tiempo medio de seguimiento de 26,4 meses (13.130 personas-año). Del total, 2.763 fueron nuevos diagnósticos, en los que la vía de transmisión más frecuente fue la heterosexual (43%), seguida de la homosexual (31%). Se observó una tendencia significativamente creciente en la proporción de sujetos de edad inferior a 35 años e inmigrantes. Un 43% tenían una cifra de linfocitos CD4 inferior a 200 células/µl en la determinación más cercana al diagnóstico de la infección por el VIH. Del total, un 87% estaban en TARV en el año 2003. Entre los pacientes no tratados previamente que iniciaron pautas de TARV con 3 o más fármacos, se observó una disminución de las pautas que incluían inhibidores de la proteasa (del 85% en 1998 al 25% en 2003; p < 0,001), mientras que aumentaron otras que contenían inhibidores de la transcriptasa inversa no análogos y análogos de los nucleósidos. Conclusiones: Las cohortes de pacientes con infección por el VIH son viables en nuestro medio y tienen gran utilidad clínica y en salud pública. La vía de transmisión más frecuente entre los nuevos diagnósticos es la heterosexual, el retraso en el diagnóstico es elevado y las pautas de TARV han ido cambiando para adaptarse a las recomendadas por las guías.
  • Thumbnail Image
    Item
    Determinants of HIV Progression and Assessment of the Optimal Time to Initiate Highly Active Antiretroviral Therapy
    (2008-02-01) Jaén, Ángeles; Esteve, Anna; Miró, Josep M; Tural, Cristina; Montoliu, Alexandra; Ferrer, Elena; Riera, Melcior; Segura, Ferran; Force, Lluis; Sued, Omar; Vilaró, Josep; Garcia, Isabel; Masabeu, Angels; Altès, Jordi; Clotet, Bonaventura; Podzamczer, Daniel; Murillas, Javier; Navarro, Gemma; Gatell, Jose; Casabona, Jordi; the PISCIS Study Group
    Objective: We analyze the factors related to progression to AIDS or death in HIV-infected patients from the Proyecto para la Informatización del Seguimiento Clínico epidemiológico de los pacientes con Infección por VIH/SIDA (PISCIS) Cohort and we assess the optimal time to initiate highly active antiretroviral therapy (HAART) taking lead time into account. Methods: We selected naive patients who were AIDS-free and initiated HAART after January 1998. Statistical analyses were performed using Cox proportional hazards models. Lead time was defined as the time it took the deferred group with an early disease stage to reach the later stage. The analysis accounting for lead time was performed using multiple imputation methods based on estimates from the pre-HAART period as described elsewhere. Results: Multivariate analysis on 2035 patients (median follow-up = 34.3 months) showed significantly higher hazard ratios (HRs) for a CD4 count <200 cells/μL (HR = 3.79, 95% confidence interval [CI]: 2.18 to 6.57), HIV-1 RNA level >100,000 copies/mL (HR = 1.84, 95% CI: 1.26 to 2.69), and hepatitis C virus (HCV) coinfection (HR = 2.40, 95% CI: 1.65 to 3.49), whereas a lower risk was found for those who started HAART between January 2001 and June 2004 (HR = 0.55, 95% CI: 0.30 to 0.90). When lead time and unseen events were included, we found a higher risk of progression to AIDS among patients who deferred treatment when the CD4 count reached <200 cells/μL (HR = 2.97, 95% CI: 1.91 to 4.63) and 200 to 350 cells/μL (HR = 1.85, 95% CI: 1.03 to 3.33) compared with those who started treatment with CD4 counts from 200 to 350 cells/μL and >350 cells/μL, respectively. Conclusions: Advanced HIV disease, HCV coinfection, and early HAART period were determinants of AIDS progression or death. Lead-time analysis in asymptomatic HIV-infected patients suggests that the best time to start HAART is before the CD4 count falls to lower than 350 cells/μL.
  • Thumbnail Image
    Item
    HIV-1 infected patients older than 50 years. PISCIS cohort study
    (2008) Navarro, Gemma; Nogueras, Maria M.; Segura, Ferran; Casabona, Jordi; Miro, Jose M.; Murillas, Javier; Tural, Cecilio; Ferrer, Enrique; Jaén, Amelia; Force, Laura; Vilaró, Laura; García, Iván; Masabeu, Antoni; Altés, José; Esteve, Albert; Sued, Omar; Riera, Maria; Clotet, Bonaventura; Podzamczer, Daniel; Gatell, Jose; PISCIS Study Group
    Objective: The aim of this study is to characterize the ways in which older HIV-infected people differ from younger HIV-infected people. Methods: Prospective cohort study. PISCIS cohort includes newly attended HIV-infected subjects since January 1, 1998. Naive patients were selected. Two groups were defined: G1 (>or=50 years at time of diagnosis, n=493) and G2 (18-49 years, n=4511). Statistical analysis was performed using chi(2), Student's t test, Cox regression and linear mixed models. Results: G1 had different features: males (G1: 84% vs. G2: 75%, p<0.001), sexual transmission (52% vs. 32%, p<0.001), AIDS at first visit (38% vs. 22%, p<0.001). The follow-up was 6 years. Ninety-five percent of patients in G1 and 92% in G2 presented a detectable viral load (>or=500 copies/mm(3)) at the first visit (p=0.016). G1 presented lower CD4 levels with respect to G2 throughout the period but the increase of CD4 in G1 at the end of the study period was 254 cells/mm(3) whereas for G2 it was 196 cells/mm(3) (p<0.001). Mortality was 9% for G1 and 4% for G2 (p<0.001). Conclusions: HIV-infected people diagnosed at the age of 50 years or older showed different features. They showed good viral and immunological response to HAART.
  • Thumbnail Image
    Item
    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.