Suchergebnisse

IntroductionIn general, HIV co‐infected patients included in clinical trials evaluating the hepatitis C virus (HCV) therapy with telaprevir (TVR) or boceprevir (BOC) with advanced fibrosis, are scarce. We analyze data concerning the use of these drugs in a real‐life clinical setting with patients affected by a more advanced degree of fibrosis in a Spanish cohort.MethodsWe evaluated safety and efficacy in an interim analysis encompassing the first 24 weeks of triple therapy with peginterferon (alfa‐2a or alfa‐2b), ribavirin and TVR or BOC in an observational, multicentre study. HIV/HCV genotype 1 co‐infected patients beginning therapy from January 2012 to July 2013 were included.ResultsEnrolled patients were 155 (144 patients on TVR and 11 on BOC), average age was 47 years, 83% were male. With respect to HCV treatment, 44% were naïve, 13% relapsers, 17% partial responders, 21% null responders, and in seven patients, the previous response was unknown. All but three (98%) were under antiretroviral therapy (ART) (other than reverse transcriptase inhibitors, the backbone was raltegravir 43%, atazanavir 35%, and etravirine 28%). Median HCV‐RNA at baseline was 6.1 log10, 54% were cirrhotic and 38% F3. At week 4, 93% of patients continued on therapy, 81% at w12, and 73% at w24. Virological failure was observed more frequently in: cirrhotic patients (19% [95% CI, 11–27]) vs F3 (12% [CI, 4–20]); patients with TT allele of the IL28B polymorphism (40% [CI, 18–61]) vs CT (21% [CI, 12–31]), or CC (2,2% [CI, −2–6]); previous null responders (37.5% [CI, 21–54]) vs partial responders (15.4% [CI, 1–29]), naïve (13% [CI, 5–21]) or relapsers (0% [CI, 0–0]); and in patients with a genotype subtype 1a (23.6% [CI, 57–76]) vs 1b (8.1% [CI, −1–17]). Overall, 17% had virological failure and in 8% treatment was discontinued due to adverse events. Severe adverse events occurred in 30 patients (19%). Haematologic disorders were the most common type including severe anaemia in 12 (7.7%) patients. Erythropoietin was employed in 41 patients (26.4%) and 11 (7.1%) received blood transfusions. Nineteen patients (12.2%) were treated with G‐CSF, and 17 (11%) with thrombopoietin‐receptor agonists. Five patients died (3.2%), three due to hepatic decompensation, one due to pneumonia and one due to pulmonary hypertension.ConclusionsIn a real‐life setting, therapy against HCV in co‐infected patients with advanced liver fibrosis shows high virologic success at 24 weeks. However, frequent haematologic disorders are observed and a close monitoring and an intensive therapy are needed to optimize the results.

IntroductionTraditional screening system focus on classic risk factors "lost" a substantial proportion of HIV‐infected patients. Several organizations such as CDC or USPS Task Force favour universal screening for HIV infection for good cost‐effectiveness profile. In a previous study prevalence of HIV infection in patients attending our infectious diseases department was high (5.4%).ObjectiveTo determine prevalence of HIV infection in patients aged 20–55 years in primary care (PC).Material and MethodsA propsective observational study was undertaken between February and June 2013. We performed a screening of HIV infection type "Opt‐out" (offering voluntary rejection) in 4 PC centers (32 Physicians) in San Juan‐Alicante. Sample size (n=318) for a prevalence of 1% and a confidence level of 97% was calculated. Nevertheless, other PC physician not recruiting patients performed HIV testing according clinical risk factors.ResultsHIV testing was offered to 508 patients. Mean age 38.9±10 years (58.5% female). Overall, 430 (83.8%) agreed to participate. Finally, 368 patients (71.7% of total) were tested for HIV. No patient had a positive result (100% ELISA HIV negative). However, following clinical practice, 3 patients were diagnosed of HIV in the same period by non‐recruiting physicians. In 2 cases, serology was performed at the patient's request and in one case by constitutional syndrome. The 3 patients were MSM.Conclusions1) In our study, we detected no new cases of HIV infection through universal screening. 2) Our screened population could be lower‐risk because of high percentage of women included (58.5%). 3) Performing HIV opt‐in screening (clinical practice), we detected 3 cases in the same period, all having HIV risk factors (MSM). 4) These results suggest that opt‐out screening should be developed in high‐risk populations. It is still to be determined what is the best screening strategy in low‐risk populations such as ours.