Browsing by Author "Pumarola, Tomas"

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    Avances en el diagnóstico y tratamiento de la infección aguda por el VIH-1
    (2004) Miro, Jose M.; Sued, Omar; Plana, Marta; Pumarola, Tomas; Gallart, Teresa
    Según la Organización Mundial de la Salud (OMS) cada día se infectan en el mundo unas 14.000 personas. Sin embargo, en pocos casos el diagnóstico se realizará durante la fase aguda de la infección por el virus de la inmunodeficiencia humana (VIH). La infección aguda por el VIH es el período comprendido entre la entrada del VIH en el organismo y la seroconversión completa, definida por una prueba de Western blot positiva. Este período dura aproximadamente 30 días y la mayoría de veces (40-90%) se acompaña de manifestaciones clínicas banales (fiebre, exantema, faringitis, úlceras en mucosas entre otras), de 2 semanas de duración, que se pueden confundir con otros procesos infecciosos comunitarios, entre ellos la mononucleosis infecciosa. El diagnóstico microbiológico se realiza por la ausencia de anticuerpos en plasma (prueba de análisis de inmunoabsorción ligado a enzimas [ELISA] negativa) y la presencia de una carga viral (CV) del VIH en plasma positiva (> 10.000 copias/ml). El diagnóstico de la infección aguda por el VIH es muy importante por varias razones: a) epidemiológicas, es el período con las mayores tasas de transmisión de la infección por el VIH y permite conocer el patrón de crecimiento de la epidemia y la tasa de transmisión de cepas resistentes a los antirretrovirales, que en España es del 10%; b) inmunopatológico, ya que es una oportunidad única para estudiar los mecanismos virológicos, inmunológicos, y genéticos implicados en la transmisión y patogenia de esta enfermedad; y c) terapéutico, ya que el inicio del tratamiento antirretroviral en esta fase podría modificar la historia natural de esta infección. Sin embargo, este es un tema controvertido y en la actualidad la mayoría de comités de expertos sólo recomiendan el tratamiento si se pueden incluir los pacientes en ensayos clínicos o si las manifestaciones clínicas son graves o duraderas.
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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.
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    Primary human immunodeficiency virus type 1 infection: clinical, virological and immunological characteristics of 75 patients (1997-2003)
    (2006) Sued, Omar; Miro, Jose M.; Alquezar, Antonio; Claramonte, Xavier; García, Francesc; Plana, Marta; Arnedo, Montserrat; de Lazzari, Emilia; Gil, Carlos; Manzardo, Christian; Blanco, Juan L.; Martínez, Esteban; Mallolas, Josep; Joseph, Jordi; Pumarola, Tomas; Gallart, Teresa; Gatell, Jose
    Objectives: To describe the epidemiological and clinical characteristics and the evolution of a cohort of patients with primary HIV-1 infection from the Barcelona area. Methods: Prospective cohort study of HIV-infected patients diagnosed with primary HIV infection in a tertiary hospital in Barcelona (Spain) from 1997 through 2003. Descriptive analysis of epidemiological and clinical characteristics and effect of highly active antiretroviral treatment (HAART) on outcome. Results: A total of 75 patients were diagnosed, accounting for 2.9% of the total of newly diagnosed HIV patients during the same time period. Eighty-one percent of the patients were males and the median age was 30 years (IQR 26-38). The most frequent transmission route was homosexual (72%), followed by heterosexual (17%) and intravenous drug abuse (11%). Seventy-seven percent of patients presented symptoms, the most frequent being fever (98%), asthenia (86%), arthralgia-myalgia (65%), lymphadenopathy (55%), night sweats (48%) and rash. Sixty-five percent started HAART, although the proportion of patients that received HAART decreased from 79% during the period 1997-2000 to 49% during the period 2001-2003 (p < 0.01). After a median follow-up of 37 months (IQR 26-66), one patient died and eight cases were lost to follow-up. The patients who did not receive HAART had a higher probability of immunological or clinical deterioration during the follow-up when compared to the group that received HAART (42.3% versus 12.3%; p < 0.001). In treated patients, dyslipidemia and lipodystrophy were diagnosed in 58% and 37% of cases, respectively. Conclusions: Primary HIV-1 infection was diagnosed more frequently in homosexual males, and its clinical characteristics were similar to those observed in previous studies. HAART given during primary HIV infection was effective, but was associated with a high percentage of adverse effects.