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To describe breakthrough COVID-19 infection in patients who needed hospitalization and the factors associated with poor outcomes.We conducted a retrospective study on patients hospitalized with COVID-19 between December 27, 2020, and October 17, 2021, with either a complete vaccination (CV) scheme (diagnosed 2 weeks after the second dose of the Pfizer/Moderna/AstraZeneca or first dose of the Janssen vaccine was administered) or a partial vaccination (PV) scheme. The main outcomes were all-cause mortality and the need for invasive mechanical ventilation (IMV). The baseline factors associated with the outcomes were analyzed by multiple logistic regression to estimate the odds ratios (odds ratio [OR]; 95% confidence interval [CI]).A total of 145 (101 CV) patients were included. The CV subgroup was mainly composed of older males with high comorbidity (Charlson Index ≥3, 72%; immunosuppression, 20%) and with bilateral pneumonia in 63.4%. Limited therapeutic effort (LTE) was agreed upon for 28% of the patients. In the CV subgroup, endotracheal intubation was required in 10.9% of patients, reaching 15.3% when excluding LTE patients; the global mortality was 22.8%, reaching 41.4% in the subgroup with LTE. Although the patients with PV were younger and had fewer comorbidities, the main outcomes did not differ significantly between the CV and PV groups. The predictors of poor outcomes were age ≥ 65 years, confusion, ferritin500 mg/L, extensive lung infiltrates, and a Charlson Index ≥ 3.Patients with CV hospitalized because of breakthrough COVID-19 infection tend to be older persons, with comorbidities, and have a high mortality.

Background: Although the association between HIV infection and airways obstruction is well known, its etiopathogenesis is not clear. Objectives: Our aim was to analyze the association between biomarkers of systemic inflammation and bacterial translocation and pulmonary function tests in HIV infected patients and compare it between smokers and non-smokers. Methods: Cross-sectional, observational study. Inclusion criteria: people living with HIV with undetectable plasma viral load. Exclusion criteria: other comorbidities associated with systemic inflammation. Outcome variables: spirometry and diffusing capacity for carbon monoxide; explanatory variables: inflammatory biomarkers (interleukin-6, tumor necrosis factor-alpha), bacterial translocation (soluble CD14 [sCD14] and bacterial 16S rDNA), and variables related to HIV infection. Associations were tested using the Pearson/Spearman correlation tests, the student t test, and multivariable linear regression. Results: We included 71 patients (54.9% smokers). We did not observe significant differences in pulmonary function tests according to biomarkers of inflammation or bacterial translocation. In non-smokers (n=32), sCD14 was negatively correlated with forced expiratory volume in 1 second (R = -0.35, P = 0.048) and forced vital capacity (R= -0.40, P=0.023). Age, time since HIV diagnosis and CD4+ nadir were associated with alterations in PFTs. In smokers, the only association observed was between the pack-years and pulmonary obstruction. Conclusion: In non-smokers HIV patients, lung dysfunction can be, at least partially, related to bacterial translocation (sCD14), CD4+ nadir and time since HIV diagnosis.

BackgroundCarbohydrate antigen 125 (CA125) is an indicator of inflammation, immune response, and impaired cardiac function. The aim was to investigate whether CA125 behaves as a biomarker of severity and poor clinical outcomes in hospitalized patients with coronavirus disease 2019 (COVID-19).MethodsSerum CA125 [Elecsys CA125 II assay-(Roche Diagnostics GmbH)] was measured in stored biobank samples from COVID-19 hospitalized patients between 01 March 2020 and 17 October 2021. Multiple logistic regression models were built to explore the association between CA125 and clinical outcomes [in-hospital all-cause mortality, need for invasive mechanical ventilation (IMV), or non-invasive respiratory support (non-IRS)], estimating odds ratios (ORs; 95% CI). The gradient of risk of CA125 was evaluated by fractional polynomials.ResultsA total of 691 patients were included, median age of 63 years (50–76), men (57.2%), with high comorbidity. At admission, 85.8% had pneumonia. Median CA125 was 10.33 U/ml (7.48–15.50). The in-hospital mortality rate was 7.2%. After adjusting for confounding factors, CA125 ≥ 15.5 U/ml (75th percentile) showed an increased risk of death [OR 2.85(1.21–6.71)], as age ≥ 65 years, diabetes, and immunosuppression. Furthermore, CA125 as a continuous variable was positive and significantly associated with the risk of death after multivariate adjustment. The mean hospital stay of the patients with CA125 ≥ 15.5 U/ml was longer than the rest of the study population.ConclusionCA125 in the first 72 h of hospital admission seems a useful biomarker of mortality in hospitalized patients with moderate–severe COVID-19. If our findings are confirmed, the wide availability of this biomarker would make easy its widespread implementation in clinical practice.

OBJECTIVE There is scarce available evidence on the distribution over time of liver complications emergence in hepatitis C virus (HCV)-infected patients who achieve sustained virological response (SVR) with direct-acting antiviral (DAA)-based therapy. Therefore, we aimed at describing the kinetics of liver-related events appearance in this setting. DESIGN A multicentric prospective cohort study. METHODS HCV-monoinfected and HIV/HCV-coinfected patients from GEHEP-011 cohort, whose inclusion criteria were had achieved SVR with DAA-based therapy; liver stiffness prior to starting treatment at least 9.5 kPa; and available liver stiffness measurement at SVR. SVR was considered as the baseline time-point. RESULTS One thousand and thirty-five patients were included, 664 (64%) coinfected with HIV. Before DAA-based therapy, 63 (6.1%) individuals showed decompensated cirrhosis. After SVR, 51 (4.9%) patients developed liver complications. Median (Q1-Q3) time to the emergence of hepatic events was hepatic encephalopathy 11 (7-24) months, ascites 14 (6-29) months, hepatocellular carcinoma (HCC) 17 (11-42) months and portal hypertension gastrointestinal bleeding (PHGB) 28 (22-38) months (P = 0.152). We define two profiles of liver complications: those emerging earlier (encephalopathy and ascites) and, those occurring continuously during the follow-up (HCC, PHGB) [median (Q1-Q3) time to emergence 12.7 (6.6-28.2) months vs. 25.4 (12.5-41.53) months, respectively (P = 0.026)]. CONCLUSION The vast majority of HCV-infected patients who develop liver complications after reaching SVR with DAA do it within 3 years after SVR time-point. Specifically, hepatic encephalopathy and ascites do not usually emerge after this period. Conversely, HCC and PHGB may occur in longer term. It is critical to identify patients at risk of developing hepatic events to continue performing surveillance for them.

Highlights • There is a high prevalence of hypokalemia among patients with COVID-19 pneumonia. • This suggests the presence of a disorder in the renin-angiotensin system activity. • Hypokalemia is associated with requiring invasive mechanical ventilation. • Hypokalemia seems to be a sensitive biomarker of severity-progression of COVID-19. • Serum levels of potassium should be closely monitored in these patients., Objectives Serum levels of potassium (K+) seem significantly lower in severe SARS-CoV-2 infection, with an unknown clinical translation. The objective was to investigate whether hypokalemia acts as a biomarker of severity in COVID-19 pneumonia, and associates with major clinical outcomes. Methods Retrospective cohort study of inpatients with COVID-19 pneumonia (March 3 - May 2, 2020). Patients were categorized according to nadir levels of K + in the first 72 hours of admission: hypokalemia (K+ ≤3.5 mmol/L) and normokalemia (>3.5 mmol/L). Main outcomes were all-cause mortality and need of invasive mechanical ventilation (IMV), analyzed by multiple logistic regression (OR; 95%CI). Results 306 patients were enrolled. Ninety-four patients (30.7%) had hypokalemia, showing at baseline significantly higher comorbidity (Charlson index ≥3, 30.0% vs. 16.3%)(p = 0.02), CURB65 scores (1.5(0.0-3.0) vs. 1.0(0.0-2.0))(p = 0.04), and some inflammatory parameters. After adjustment for confounders, hypokalemia was independently associated with requiring IMV during the admission (OR 8.98; 95%CI 2.54-31.74). Mortality was 15.0% (n = 46) and was not influenced by low K + . Hypokalemia was associated with longer hospital and ICU stay. Conclusions Hypokalemia is prevalent in patients with COVID-19 pneumonia. Hypokalemia is an independent predictor of IMV requirement and seems to be a sensitive biomarker of severe progression of COVID-19.

BackgroundTransmission of resistance mutations to integrase strand transfer inhibitors (INSTIs) in HIV-infected patients may compromise the efficacy of first-line antiretroviral regimens currently recommended worldwide. Continued surveillance of transmitted drug resistance (TDR) is thus warranted.ObjectivesWe evaluated the rates and effects on virological outcomes of TDR in a 96 week prospective multicentre cohort study of ART-naive HIV-1-infected subjects initiating INSTI-based ART in Spain between April 2015 and December 2016.MethodsPre-ART plasma samples were genotyped for integrase, protease and reverse transcriptase resistance using Sanger population sequencing or MiSeq™ using a ≥ 20% mutant sensitivity cut-off. Those present at 1%–19% of the virus population were considered to be low-frequency variants.ResultsFrom a total of 214 available samples, 173 (80.8%), 210 (98.1%) and 214 (100.0%) were successfully amplified for integrase, reverse transcriptase and protease genes, respectively. Using a Sanger-like cut-off, the overall prevalence of any TDR, INSTI-, NRTI-, NNRTI- and protease inhibitor (PI)-associated mutations was 13.1%, 1.7%, 3.8%, 7.1% and 0.9%, respectively. Only three (1.7%) subjects had INSTI TDR (R263K, E138K and G163R), while minority variants with integrase TDR were detected in 9.6% of subjects. There were no virological failures during 96 weeks of follow-up in subjects harbouring TDR as majority variants.ConclusionsTransmitted INSTI resistance remains rare in Spain and, to date, is not associated with virological failure to first-line INSTI-based regimens.

Exploring differences in clinical outcomes based on race and origin among patients hospitalized for COVID-19 is a controversial issue. The ALC COVID-19 Registry includes all confirmed COVID-19 patients admitted to hospital from 3 March 2020 to 17 December 2020. The data were obtained from electronic health records in order to evaluate the differences in the clinical features and outcomes among European and Latin American patients. The follow-ups occurred after 156 days. A propensity score weighting (PSW) logistic regression model was used to estimate the odds ratio (OR, 95% CI) for Latin American origin and outcome associations. Of the 696 patients included, 46.7% were women, with a median age of 65 (IQR 53–67) years, 614 (88.2%) were European, and 82 (11.8%) were Latin American. Latin American patients were younger, with fewer comorbidities, and a higher incidence of extensive pneumonia. After adjusting for residual confounders, Latin American origin was not associated with an increased risk of death (PSW OR 0.85 (0.23–3.14)) or with the need for invasive mechanical ventilation (PSW OR 0.35 (0.12–1.03)). Latin American origin was associated with a shorter hospital stay, but without differences in how long the patient remained on mechanical ventilation. In a public healthcare system, the rates of death or mechanical ventilation in severe COVID-19 cases were found to be comparable between patients of European and Latin American origins.

Objectives Frailty can be used as a predictor of adverse outcomes in people with coronavirus disease 2019 (COVID‐19). The aim of the study was to analyse the prognostic value of two different frailty scores in patients hospitalised for COVID‐19. Material and Methods This retrospective cohort study included adult (≥18 years) inpatients with COVID‐19 and took place from 3 March to 2 May 2020. Patients were categorised by Clinical Frailty Score (CFS) and Hospital Frailty Risk Score (HFRS). The primary outcome was in‐hospital mortality, and secondary outcomes were tocilizumab treatment, length of hospital stay, admission in intensive care unit (ICU) and need for invasive mechanical ventilation. Results were analysed by multivariable logistic regression and expressed as odds ratios (ORs), adjusting for age, sex, kidney function and comorbidity. Results Of the 290 included patients, 54 were frail according to the CFS (≥5 points; prevalence 18.6%, 95% confidence interval [CI]: 14.4‐23.7) vs 65 by HFRS (≥5 points; prevalence: 22.4%, 95% CI 17.8‐27.7). Prevalence of frailty increased with age according to both measures: 50‐64 years, CFS 1.9% vs HFRS 12.3%; 65‐79 years, CFS 31.5% vs HFRS 40.0%; and ≥80 years, CFS 66.7% vs HFRS 40.0% (P

Objective: To investigate the long-term impact of plasma VL elevations between 50 and 199 copies/ml (VLE50-199) on virological failure and development of AIDS, death or non-AIDS events (NAE) in patients receiving ART. Methods: We analyzed ART-naïve adults from the cohort of the Spanish AIDS Research Network (CoRIS) who initiated ART from 2012 to 2017 and achieved VL50% of the measurements). Multivariate Cox models were used.Results: Of 4121 patients included, 3881 (94.2%) patients VLE50-199 was uncommon or was not present. VLE50-199 was frequent in 185 (4.5%) and very frequent in 55 (1.3%) patients. 169 had virological failure (4.1%), 57 (1.38%) patients died or developed an AIDS event and 107 (2.6%) developed NAE. Frequent VLE50-199 (aHR, 11.83; 95% CI, 6.42–21.84; pConclusion: Persistent mild elevations between 50 and 199 copies/ml were strongly associated with an increased risk of virological failure and with higher rates of NAE. Therefore, closer monitoring of these patients may be warranted.

Currently, AIDS or severe immunodeficiency remains as a challenge for people with HIV (PWHIV) and healthcare providers. Our purpose was to analyze the impact of advanced HIV disease (AHD) on mortality, life expectancy and health-related quality of life (HRQoL). We reviewed cohort studies and meta-analyses conducted in middle- and high-income countries. To analyze HRQoL, we selected studies that reported overall health and/or physical/mental health scores on a validated HRQoL instrument. AIDS diagnosis supposes a higher risk of mortality during the first six months, remaining higher for 48 months. It has been reported that cancer and cardiovascular disease persist as frequent causes of mortality in PWHIV, especially those with previous or current AHD. PWHIV who initiate combination antiretroviral therapy (cART) with CD4 < 200 cells/µL have significantly lower estimated life expectancy than those with higher counts. AHD is associated with lower HRQoL, and a worse physical health or mental health status. AIDS and non-AIDS defining events are significant predictors of a lower HRQoL, especially physical health status. AHD survivors are in risk of mortality and serious comorbidities, needing special clinical attention and preventive programs for associated comorbidities. Their specific needs should be reflected in HIV guidelines.

GAMES Investigators., [Background] Enterococcal endocarditis (EE) is a growing entity in Western countries. However, quality data from large studies is lacking., [Objectives] The purpose of this study was to describe the characteristics and analyze the prognostic factors of EE in the GAMES cohort., [Methods] This was a post hoc analysis of a prospectively collected cohort of patients from 35 Spanish centers from 2008 to 2016. Characteristics and outcomes of 516 cases of EE were compared with those of 3,308 cases of nonenterococcal endocarditis (NEE). Logistic regression and Cox proportional hazards regression analysis were performed to investigate risk factors for in-hospital and 1-year mortality, as well as relapses., [Results] Patients with EE were significantly older; more frequently presented chronic lung disease, chronic heart failure, prior endocarditis, and degenerative valve disease; and had higher median age-adjusted Charlson score. EE more frequently involved the aortic valve and prosthesis (64.3% vs. 46.7%; p < 0.001; and 35.9% vs. 28.9%; p = 0.002, respectively) but less frequently pacemakers/defibrillators (1.5% vs. 10.5%; p < 0.001), and showed higher rates of acute heart failure (45% vs. 38.3%; p = 0.005). Cardiac surgery was less frequently performed in EE (40.7% vs. 45.9%; p = 0.024). No differences in in-hospital and 1-year mortality were found, whereas relapses were significantly higher in EE (3.5% vs. 1.7%; p = 0.035). Increasing Charlson score, LogEuroSCORE, acute heart failure, septic shock, and paravalvular complications were risk factors for mortality, whereas prior endocarditis was protective and persistent bacteremia constituted the sole risk factor for relapse., [Conclusions] Besides other baseline and clinical differences, EE more frequently affects prosthetic valves and less frequently pacemakers/defibrillators. EE presents higher rates of relapse than NEE.

Purpose: To analyze the influence of adding gentamicin to a regimen consisting of β-lactam or vancomycin plus rifampicin on survival in patients suffering from Staphylococcal prosthetic valve endocarditis (SPVE). Methods: From January 2008 to September 2016, 334 patients with definite SPVE were attended in the participating hospitals. Ninety-four patients (28.1%) received treatment based on β-lactam or vancomycin plus rifampicin and were included in the study. Variables were analyzed which related to patient survival during admission, including having received treatment with gentamicin. Results: Seventy-seven (81.9%) were treated with cloxacillin (or vancomycin) plus rifampicin plus gentamicin, and 17 patients (18.1%) received the same regimen without gentamicin. The causative microorganism was Staphylococcus aureus in 40 cases (42.6%) and coagulase-negative staphylococci in 54 cases (57.4%). Overall, 40 patients (42.6%) died during hospital admission, 33 patients (42.9%) in the group receiving gentamicin and 7 patients in the group that did not (41.2%, P = 0.899). Worsening renal function was observed in 42 patients (54.5%) who received gentamicin and in 9 patients (52.9%) who did not (p = 0.904). Heart failure as a complication of endocarditis (OR: 4.58; CI 95%: 1.84–11.42) and not performing surgery when indicated (OR: 2.68; CI 95%: 1.03–6.94) increased mortality. Gentamicin administration remained unrelated to mortality (OR: 1.001; CI 95%: 0.29–3.38) in the multivariable analysis. Conclusions: The addition of gentamicin to a regimen containing vancomycin or cloxacillin plus rifampicin in SPVE was not associated to better outcome.

Objective: To investigate the rate of colorectal neoplasms (CRNs) in patients who have Enterococcus faecalis infective endocarditis (EFIE) with available colonoscopies and to assess whether this is associated with the identification of a focus the infection. Patients and Methods: Retrospective analysis of data from a prospective multicenter study involving 35 centers who are members of the Grupo de Apoyo para el Manejo de la Endocarditis en Espana [Support Group for the Management of Infective Endocarditis in Spain] cohort. A specific set of queries regarding information on colonoscopy and histopathology of colorectal diseases was sent to each participating center. Four-hundred sixty-seven patients with EFIE were included from January 1, 2008, to December 31, 2017, from whom data on colonoscopy performance and results were available in 411 patients. Results: One hundred forty-two (34.5%) patients had a colonoscopy close to the EFIE episode. The overall rate of colorectal diseases was 70.4% (100 of 142), whereas the prevalence of CRN (advanced adenomas and colorectal carcinoma) was 14.8% (21 of 142), with no significant differences between the group of EFIE of unknown focus and that with an identified focus. Conclusion: Our study adds to prior evidence suggesting a much higher rate of CRN among patients with EFIE than in the general population of the same age and sex. In addition, our findings suggest that this phenomenon might take place both in EFIE with an unknown and an identified source of infection.

To compare the clinical and epidemiological characteristics and the evolution of infective endocarditis in adults aged under 65 years, 65–79 years, and 80 years or older. An observational retrospective cohort study in patients with infective endocarditis was performed in a public hospital in Spain from January 2013 to December 2017. Seventy-two patients were treated: 26 (36.1%) were under 65 years old, 28 (38.9%) were 65–79 years old, and 18 (25%) were aged 80 or older. Prosthetic valve endocarditis was less common in patients aged 65–79 years (3.6%) than in younger (23.1%; p = 0.047) or older (38.9%; p = 0.004) patients. In contrast, degenerative heart disease was more prevalent in the 65–79 year age group [64.3% compared to 15.4% (p

Background and Aim: The circulating recombinant form 02_AG (CRF02_AG) is the predominant clade among the human immunodeficiency virus type-1 (HIV-1) non-Bs with a prevalence of 5.97% (95% Confidence Interval-CI: 5.41-6.57%) across Spain. Our aim was to estimate the levels of regional clustering for CRF02_AG and the spatiotemporal characteristics of the largest CRF02_AG subepidemic in Spain. Methods: We studied 396 CRF02_AG sequences obtained from HIV-1 diagnosed patients during 2000-2014 from 10 autonomous communities of Spain. Phylogenetic analysis was performed on the 391 CRF02_AG sequences along with all globally sampled CRF02_AG sequences (N = 3,302) as references. Phylodynamic and phylogeographic analysis was performed to the largest CRF02_AG monophyletic cluster by a Bayesian method in BEAST v1.8.0 and by reconstructing ancestral states using the criterion of parsimony in Mesquite v3.4, respectively. Results: The HIV-1 CRF02_AG prevalence differed across Spanish autonomous communities we sampled from (p < 0.001). Phylogenetic analysis revealed that 52.7% of the CRF02_AG sequences formed 56 monophyletic clusters, with a range of 279 sequences. The CRF02_AG regional dispersal differed across Spain (p = 0.003), as suggested by monophyletic clustering. For the largest monophyletic cluster (subepidemic) (N = 79), 49.4% of the clustered sequences originated from Madrid, while most sequences (51.9%) had been obtained from men having sex with men (MSM). Molecular clock analysis suggested that the origin (t(MRCA)) of the CRF02_AG subepidemic was in 2002 (median estimate; 95% Highest Posterior Density-HPD interval: 1999-2004). Additionally, we found significant clustering within the CRF02_AG subepidemic according to the ethnic origin. Conclusion: CRF02_AG has been introduced as a result of multiple introductions in Spain, following regional dispersal in several cases. We showed that CRF02_AG transmissions were mostly due to regional dispersal in Spain. The hot-spot for the largest CRF02_AG regional subepidemic in Spain was in Madrid associated with MSM transmission risk group. The existence of subepidemics suggest that several spillovers occurred from Madrid to other areas. CRF02_AG sequences from Hispanics were clustered in a separate subclade suggesting no linkage between the local and Hispanic subepidemics., This work was supported by Plan Nacional de I + D + I and Fondo Europeo de Desarrollo Regional-FEDER (RD16/0025/0040 and PI18/00819) and Fundacion Progreso y Salud, Junta de Andalucia (PI-0550-2017). The study was in part funded by the Hellenic Scientific Society for the Study of AIDS and Sexually Transmitted Diseases.

The reported prevalence of HIV-associated neurocognitive disorders in HIV people depends on the population studied and the methodology used. We analyze the prevalence of neurocognitive impairment (NCI) and associated factors in patients on successful antiretroviral therapy (ART), without comorbidities. Cross-sectional observational study in HIV subjects, =18 years old, on stable ART, and HIV viral load of

ObjectivesInhibin B (IB) levels and the IB: follicle-stimulating hormone (FSH) ratio (IFR), biomarkers of global Sertoli cell function, show a strong relationship with male fertility. The aim of the study was to examine the prevalence of impaired fertility potential in HIV-infected men and the influence of antiretroviral therapy (ART) on fertility biomarkers. MethodsA cross-sectional study with sequential sampling was carried out. A total of 169 clinically stable patients in a cohort of HIV-infected men undergoing regular ambulatory assessment in a tertiary hospital were included. The mean [ standard deviation (SD)] age of the patients was 42.6 8.1 years, all were clinically stable, 61.5% had disease classified as Centers for Disease Control and Prevention (CDC) stage A, and were na?ve to ART or had not had any changes to ART for 6 months (91.1%). Morning baseline IB and FSH concentrations were measured using an enzyme-linked immunosorbent assay (ELISA) and an electrochemiluminescent immunoassay (ECLIA), respectively. A multivariate logistic regression model was used to identify factors associated with impaired fertility, defined as IB < 119 pg/mL or IFR < 23.5. ResultsThe mean (+/- SD) IB level was 250 +/- 103 pg/mL, the median [interquartile range (IQR)] FSH concentration was 5.1 (3.3-7.8) UI/L and the median (IQR) IFR was 46.1 (26.3-83.7). The prevalence of impaired fertility was 21.9% [95% confidence interval (CI) 16.3-20.7%]. Negative correlations of body mass index and waist: hip ratio with FSH and IB levels were observed (P < 0.01), while a sedentary lifestyle and previous nevirapine exposure were associated with a decreased risk of IB levels 25th percentile in multivariate analysis. Only older age, as a risk factor, and sedentary lifestyle, with a protective effect, were independently associated with impaired fertility in multivariate analysis. ConclusionsGlobal testicular Sertoli cell function and fertility potential, assessed indirectly through serum IB levels and IB: FSH ratio, appear to be well maintained in HIV-infected men and not damaged by ART.

To evaluate the course of left-sided infective endocarditis (LsIE) in patients with liver cirrhosis (LC) analyzing its influence on mortality and the impact of surgery.Prospective cohort study, conducted from 1984 to 2013 in 26 Spanish hospitals.A total of 3.136 patients with LsIE were enrolled and 308 had LC: 151 Child-Pugh A, 103 B, 34 C and 20 were excluded because of unknown stage. Mortality was significantly higher in the patients with LsIE and LC (42.5% vs. 28.4%; p0.01) and this condition was in general an independent worse factor for outcome (HR 1.51, 95% CI: 1.23-1.85; p0.001). However, patients in stage A had similar mortality to patients without cirrhosis (31.8% vs. 28.4% p = NS) and in this stage heart surgery had a protective effect (28% in operated patients vs. 60% in non-operated when it was indicated). Mortality was significantly higher in stages B (52.4%) and C (52.9%) and the prognosis was better for patients in stage B who underwent surgery immediately (mortality 50%) compared to those where surgery was delayed (58%) or not performed (74%). Only one patient in stage C underwent surgery.Patients with liver cirrhosis and infective endocarditis have a poorer prognosis only in stages B and C. Early surgery must be performed in stages A and although in selected patients in stage B when indicated.

Background: There is little information concerning infective endocarditis (IE) in patients with bicuspid aortic valve (BAV) or mitral valve prolapse (MVP). Currently, IE antibiotic prophylaxis (IEAP) is not recommended for these conditions. Objectives: This study sought to describe the clinical and microbiological features of IE in patients with BAV and MVP and compare them with those of IE patients with and without IEAP indication, to determine the potential benefit of IEAP in these conditions. Methods: This analysis involved 3,208 consecutive IE patients prospectively included in the GAMES (Grupo de Apoyo al Manejo de la Endocarditis infecciosa en España) registry at 31 Spanish hospitals. Patients were classified as high-risk IE with IEAP indication (high-risk group; n = 1,226), low- and moderate-risk IE without IEAP indication (low/moderate-risk group; n = 1,839), and IE with BAV (n = 54) or MVP (n = 89). Results: BAV and MVP patients had a higher incidence of viridans group streptococci IE than did high-risk group and low/moderate-risk group patients (35.2% and 39.3% vs. 12.1% and 15.0%, respectively; all p < 0.01). A similar pattern was seen for IE from suspected odontologic origin (14.8% and 18.0% vs. 5.8% and 6.0%; all p < 0.01). BAV and MVP patients had more intracardiac complications than did low/moderate-risk group (50% and 47.2% vs. 30.6%, both p < 0.01) patients and were similar to high-risk group patients. Conclusions: IE in patients with BAV and MVP have higher rates of viridans group streptococci IE and IE from suspected odontologic origin than in other IE patients, with a clinical profile similar to that of high-risk IE patients. Our findings suggest that BAV and MVP should be classified as high-risk IE conditions and the case for IEAP should be reconsidered. Sin financiación 18.639 JCR (2018) Q1, 3/136 Cardiac & Cardiovascular Systems 9.280 SJR (2018) Q1, 1/365 Cardiology and Cardiovascular Medicine No data IDR 2018 UEM

BACKGROUND/AIMS Data regarding the use of all-oral direct-acting antivirals in HIV/hepatitis C virus (HCV)-coinfected patients with advanced liver fibrosis are required, because they are generally under-represented in clinical trials. This study sought to evaluate the use of these drugs in a cohort of coinfected patients, mostly with factors that have previously been recognized as predictors of treatment failure. METHODS COINFECOVA-2 is an observational, multicenter study conducted in Eastern Spain. Data of all HIV/HCV-coinfected patients treated with direct-acting antiviral under real-life conditions were retrospectively collected, and factors associated with treatment success or safety were analysed. RESULTS Among 515 included patients, 96% were on antiretroviral therapy and 89.5% had an HIV-RNA less than 50 copies/ml. HCV genotype (G) distribution was 47% G-1a, 20% G-4, 14.4% G-1b, and 12.8% G-3. Patients with cirrhosis were 54.2%, and 46% failed to prior HCV-therapies. Overall, 92.8% patients (95% confidence interval: 90.2-94.9) achieved sustained virologic response (SVR12). Cirrhosis was the only factor associated with treatment failure, and SVR12 rate was significantly lower in patients with liver stiffness at least 21 kPa. Adverse events were reported in 36.7%, but only two patients (0.4%) discontinued treatment because of adverse events. The bivariate analysis showed an association between ribavirin use and an increased risk of adverse events (odds ratio 2.84; 95% confidence interval: 1.95-4.1; P ≤ 0.0001). CONCLUSION This heterogeneous cohort of coinfected patients showed a high rate of SVR12. Among cirrhotic patients, those with a liver stiffness at least 21 kPa had a higher probability of treatment failure. Ribavirin use seems to increase the appearance of adverse events.

In HIV-infected patients, the damage in the gut mucosal immune system is not completely restored after antiretroviral therapy (ART). It results in microbial translocation, which could influence the immune and inflammatory response. We aimed at investigating the long-term impact of bacterial-DNA translocation (bactDNA) on glucose homeostasis in an HIV population. This was a cohort study in HIV-infected patients whereby inclusion criteria were: patients with age > 18 years, ART-na < ve or on effective ART (< 50 HIV-1 RNA copies/mL) and without diabetes or chronic hepatitis C. Primary outcome was the change in HbA1c (%). Explanatory variables at baseline were: bactDNA (qualitatively detected in blood samples by PCR [broad-range PCR] and gene 16SrRNA - prokaryote), ART exposure, HOMA-R and a dynamic test HOMA-CIGMA [continuous infusion of glucose with model assessment], hepatic steatosis (hepatic triglyceride content - 1H-MRS), visceral fat / subcutaneous ratio and inflammatory markers. Fifty-four men (age 43.2 +/- 8.3 years, BMI 24.9 +/- 3 kg/m(2), mean duration of HIV infection of 8.1 +/- 5.3 years) were included. Baseline HbA1c was 4.4 +/- 0.4% and baseline presence of BactDNA in six patients. After 8.5 +/- 0.5 years of follow-up, change in HbA1c was 1.5 +/- 0.47% in patients with BactDNA vs 0.87 +/- 0.3% in the rest of the sample p < 0.001. The change in Hba1c was also influenced by protease inhibitors exposure, but not by baseline indices of insulin resistance, body composition, hepatic steatosis, inflammatory markers or anthropometric changes. In non-diabetic patients with HIV infection, baseline bacterial translocation and PI exposure time were the only factors associated with long-term impaired glucose homeostasis.

ObjectiveHIV infection is associated with an increased risk of cardiovascular disease. Irisin is a miokyne secreted by skeletal muscle, which may influence insulin homeostasis, nonalcoholic fatty liver disease (NAFLD) and atherosclerosis. Our objective was to evaluate the relationships between serum irisin, insulin homeostasis, NAFLD and subclinical atherosclerosis in HIV-infected males. DesignCross-sectional study in a cohort of HIV-infected patients. PatientsInclusion criteria: men older than 18years; antiretroviral therapy (ART) -naive or on effective ART (

Background To analyse the clinical, epidemiological, microbiological and prognostic differences of pyogenic liver abscess (PLA) in older (≥ 65 years of age) versus younger patients (< 65 years). Methods Multicentre, retrospective cohort study in all patients with PLA admitted to two Spanish hospitals from January 2000 to January 2014. Cases were divided into two age groups (< 65 years and ≥65 years) for comparison of clinical, epidemiological and microbiological characteristics as well as treatment. Results Of 98 patients analysed, 40 patients were younger than 65, and 58 were aged 65 or older. Significant associations in the older group were found with female sex (adjusted odds ratio [ORa] 9.0; 95% CI 1.4, 56), non-cryptogenic origin (ORa 14.5; 95% CI 1.6, 129), absence of chronic liver disease (ORa 14; 95% CI 1.3, 155), Escherichia coli infection (ORa 7.7; 95% CI 1.03, 58), and incidence of complications (ORa 2.3; 95% CI 1.04, 5.4). Mortality was 8.2% overall, although all deaths occurred in the older group (8/58; 13.8%) (p = 0.02). Discussion Our results are in consonance with other published studies. Older patients with PLA tend to present more anomalies in the biliary tract (Kai et. al, World J Gastroenterol 18: 2948-295, 2012, Rahimian et. al, Clin Infect Dis 39:1654-9, 2004, Seeto, Medicine (Baltimore) 75:99-113, 1996, Kao et.al, Aliment Pharmacol Ther 36:467-76, 2012, Lai et. al, Gastroenterology 146:129-37, 2014), while younger patients are more often male and present more commonly with previous liver disease (especially related to alcohol) and cryptogenic PLA. Conclusion In patients aged 65 or older, PLA was more common in women and in those with a history of biliary disease, and E. coli was the most frequent bacterium. Mortality was also higher in the older group.

Objective: HIV/HCV-coinfected patients and hepatitis C virus (HCV) monoinfected subjects are thought to respond equally to direct-acting antiviral (DAA)-based therapy despite the lack of data derived from clinical trials. This study is aimed to evaluate the impact of HIV coinfection on the response to DAA-based treatment against HCV infection in the clinical practice. Patients and Methods: In a prospective multicohort study, patients who initiated DAA-based therapy at the Infectious Disease Units of 33 hospitals throughout Spain were included. The primary efficacy outcome variables were the achievement of sustained virologic response 12 weeks after the scheduled end of therapy date (SVR12). Results: A total of 908 individuals had reached the SVR12 evaluation time-point, 426 (46.9%) were HIV/HCV-coinfected, and 472 (52%) received interferon (IFN)-free therapy. In an intention-to-treat analysis, SVR12 rates in subjects with and without HIV-coinfection were 55.3% (94/170 patients) versus 67.3% (179/266 subjects; p = 0.012) for IFN-based treatment and 86.3% (221/256 subjects) versus 94.9% (205/216 patients, p = 0.002) for IFN-free regimens. Relapse after end-of-treatment response to IFN-free therapy was observed in 3/208 (1.4%) HCV-monoinfected subjects and 10/231 (4.4%) HIV/HCV-coinfected individuals (p = 0.075). In a multivariate analysis adjusted for age, sex, transmission route, body-mass index, HCV genotype, and cirrhosis, the absence of HIV-coinfection (adjusted odds ratio: 3.367; 95% confidence interval: 1.15-9.854; p = 0.027) was independently associated with SVR12 to IFN-free therapy. Conclusions: HIV-coinfection is associated with worse response to DAA-based therapy against HCV infection. In patients receiving IFN-free therapy, this fact seems to be mainly driven by a higher rate of relapses among HIV-coinfected subjects.

Background Pathogenesis of atherosclerosis is complex and differences between HIV-infected patients and general population cannot be completely explained by the higher prevalence of traditional cardiovascular risk factors. We aimed to analyse the association between inflammation and subclinical atherosclerosis in HIV patients with low Framingham risk score. Materials and methods Case-control study. Setting: outpatient Infectious Diseases clinic in a university hospital. Subjects: HIV-1 infected patients aged >35 years receiving antiretroviral treatment with viral load 5 cigarettes/day; diabetes; hypertension; vascular diseases. Main outcome: subclinical atherosclerosis determined by ultrasonography: common carotid intima-media thickness greater than 0.8mm or carotid plaque presence. Explanatory variables: ribosomal bacterial DNA (rDNA), sCD14, interleucin 6 (IL6) and TNF-α. Results Eighty four patients were included, 75% male, mean age 42 years and mean CD4+ cells 657+-215/mm3. Median Framingham risk score was 1% at 10 years (percentile 25-75: 0.5-4%). Eighteen patients (21%) had subclinical atherosclerosis, the associated factors were older age (p 0.001), waist-hip ratio (p 0.01), time from HIV diagnosis (p 0.02), rDNA (p 0.04) and IL6 (p 0.01). In multivariate analysis, OR for subclinical atherosclerosis was 7 (IC95% 1.3-40) and 9 (IC95% 1.0-85) for patients older than 44 years and IL6>6.6 pg/mL respectively. Conclusions Well controlled HIV patients with low Framingham risk score have a high prevalence of subclinical carotid atherosclerosis and the main risk factors are age and inflammation. These patients are not receiving primary prophylaxis for cardiovascular events according to currrent guidelines. This article is protected by copyright. All rights reserved.

Although visceral leishmaniasis (VL) can affect immunocompromised patients, data from the human immunodeficiency virus (HIV) infection context are limited, and the characteristics of VL in other immunosuppression scenarios are not well defined. A retrospective review of all cases of VL in immunocompromised patients from January 1997 to December 2014 in two Spanish hospitals on the Mediterranean coast was performed. We included 18 transplant recipients (kidney: 7, liver: 4, lung: 3, heart: 2, and blood marrow: 2), 12 patients with other causes of immunosuppression (myasthenia gravis: 3 and rheumatoid arthritis: 2), and 73 VL HIV-positive patients. Fever was more common in transplant patients (94.4%) and patients with other types of immunosuppression (100%) than in HIV-positive individuals (73.3%). Hepatomegaly was less common in transplant recipients (27.8%) and patients with other types of immunosuppression (41.7%) compared with HIV-positive patients (69.9%) (P = 0.01; P = 0.001, respectively). Patients with other types of immunosuppression had a median leukocyte count of 1.5 × 10(9)/L, significantly lower than HIV-positive patients (2.5 × 10(9)/L) (P = 0.04). Serology was more commonly positive in nontransplant immunosuppressed individuals (75%) and transplant recipients (78.6%) than in HIV-patients (13.8%) (P < 0.001). Antimonial therapy was rarely used in transplant recipients (1.9%) and never in patients with other immunosuppressive conditions, whereas 34.2% of HIV-positive patients received it (P = 0.05 and P = 0.01, respectively). Mortality was 16.7% in both transplant recipients and patients with other immunosuppressive conditions and 15.1% in HIV-positive patients. The features of VL may be different in immunosuppressed patients, with more fever and less hepatomegaly and leukopenia than in HIV-infected patients.

Resumen Fundamento y objetivo Ciertos marcadores inflamatorios estan elevados en pacientes con infeccion por el virus de la inmunodeficiencia humana (VIH). El tratamiento antirretroviral (TAR) mejora algunos de estos parametros, pero no suele normalizarlos. El objetivo de este estudio es determinar los factores, incluida la traslocacion bacteriana, asociados a una mayor actividad inflamatoria en pacientes con infeccion por VIH en tratamiento. Pacientes y metodos Estudio observacional transversal. Se incluyeron pacientes con infeccion por VIH que recibian TAR y tenian carga viral plasmatica del VIH (CVP-VIH) tumour necrosis factor α (TNF-α, «factor de necrosis tumoral α»). La variable explicativa principal fueron los marcadores de traslocacion bacteriana (ADN ribosomal 16S y sCD14). Los pacientes con valores de IL-6 o TNF-α por encima del percentil 75 (grupo 1) se compararon con el resto de pacientes (grupo 2), y se calcularon las odds ratio (OR) brutas y ajustadas (analisis multivariante). Resultados Se incluyeron 81 pacientes (73% varones, edad mediana 45 anos, 48% en estadio C). El 26% tenia hepatitis cronica C. La mediana de linfocitos CD4 era de 493 cel/mm 3 y el 30% tenia CVP-VIH detectable. Se detecto ADN ribosomal en el 21% de los pacientes. Los integrantes del grupo 1 presentaron con mayor frecuencia ADN ribosomal (OR 77, p Conclusiones En pacientes con infeccion por VIH en tratamiento, los mayores valores de marcadores inflamatorios se observan en aquellos casos con traslocacion bacteriana y antecedentes de enfermedad cardiovascular.

Objectives Vitamin D is thought to play a role in glucose homeostasis and beta cell function. Our aim was to examine the impact of plasma 25-hydroxyvitamin D [25(OH)D] upon in vivo insulin sensitivity and beta cell function in HIV-infected male patients without diabetes. Methods A cross-sectional study was carried out involving a cohort of HIV-infected patients undergoing regular assessment in a tertiary hospital. Eighty-nine patients [mean (± standard deviation) age 42 ± 8 years] were included in the study: 14 patients were antiretroviral therapy (ART)-naive, while 75 were on ART. Vitamin D insufficiency (VDI) was defined as 25(OH)D

BACKGROUND Decrease in HIV viral load (VL) is accompanied by decrease in microbial translocation (MT) and chronic inflammation, but the behavior of these markers in patients with HIV-VL

Measles is a viral infection that affects skin and other organs and systems. We collected retrospectively the characteristics of 147 consecutive adult patients with measles during an outbreak in Spain (January–June 2012). They complained of nausea, vomiting and diarrhea in 48.3, 39.5 and 27.2 %, respectively. The liver was involved in 67.5 % of patients. Thirty-eight patients (25.9 %) were admitted to the hospital. Associated with hospital admission were dyspnea [adjusted odds ratio (aOR): 49.8], abnormal alanine aminotransferase (aOR: 29), odynophagia (aOR: 12.5) and vomiting (aOR: 58). Gastrointestinal and liver involvement in adults with measles is common.

To determine the prevalence of erectile dysfunction in a cohort of HIV-infected men in a stable clinical state, the effect of exposure to antiretroviral therapy on sexual dysfunction and to identify the risk factors.This is a cross-sectional, observational study.HIV-infected men without hepatitis C virus coinfection were included if they were antiretroviral therapy-naive (naive group), on current treatment with an enhanced protease inhibitor (protease inhibitor group) or on current treatment with two to three nucleoside reverse transcriptase inhibitors along with one nonnucleoside reverse transcriptase inhibitor and never having received treatment with protease inhibitor (nonnucleoside reverse transcriptase inhibitor group). Erectile dysfunction was defined as an ejection fraction of 25 or less (International Index of Erectile Function-15).Ninety patients were included, with an age of 42 +/- 8.2 years and CD4 cell count of 465 cells/microl [P25-75 361-676]: 18.9% in Centers for Disease Control and Prevention class C and 72.2% with undetectable viral load. Seventy-six patients (84.4%) were receiving antiretroviral therapy, 39 (43.3%) in the protease inhibitor group. The prevalence of lipodystrophy was 31.5%. Forty-seven (53.4%) patients had an erectile dysfunction. Multivariate logistic regression analysis confirmed that there was an independent association between the patients' age (per decade; odds ratio 2.2, 95% confidence interval 1.04-4.5, P = 0.04) and greater duration of exposure to protease inhibitor (per year; odds ratio 1.6, 95% confidence interval 1.12-2.4, P = 0.01). Older age, depression and lipodystrophy, combined with the duration of exposure to protease inhibitor, determined a lower score on various sexual dysfunction domains (P0.05).There is a high prevalence of erectile dysfunction in HIV-infected men, with age and the duration of exposure to protease inhibitor being the only identifiable risk factors.

Resumen Objetivos el objetivo de este estudio fue determinar la prevalencia de la infeccion cronica por el virus de la hepatitis C (VHC) y sus genotipos en una poblacion penitenciaria, asi como tambien describir los hallazgos histologicos encontrados en una subpoblacion de sujetos a los que se les realizo biopsia hepatica y en los que se identificaron los posibles factores de riesgo asociados a la fibrosis y a la actividad inflamatoria. Metodos se seleccionaron 800 internos, de los cuales 730 aceptaron el cribado con serologia del VHC y confirmacion por PCR ( polymerase chain reaction 'reaccion en cadena de la polimerasa'). Se estudiaron las variables sociodemograficas, conductuales y relacionadas con la encarcelacion. A los sujetos con infeccion cronica por VHC se les ofrecio la realizacion de una biopsia hepatica. Se definio enfermedad hepatica avanzada como fibrosis (⩾3) y tambien en funcion de la actividad inflamatoria (indice de actividad inflamatoria [HAI] mayor o igual a 8). Resultados se encontraron anticuerpos frente al VHC en 279 internos. La PCR del VHC confirmo infeccion por VHC en 250 internos, prevalencia del 34,2% (intervalo de confianza [IC] del 95%: 30,8–37,8). El uso de drogas intravenosas se asocio de manera independiente con la infeccion cronica por VHC, odds ratio (OR) de 51,7 (IC del 95%: 31–86). La distribucion de los genotipos fue la siguiente: el genotipo 1a en el 32,9% de los sujetos, el genotipo 3 en el 29,7% de los sujetos, el genotipo 1b en el 18,4% de los sujetos y el genotipo 4 en el 17,1% de los sujetos. Se realizaron 51 biopsias hepaticas; se encontro enfermedad hepatica avanzada en funcion del grado de fibrosis en 7 sujetos (13,7%) y en funcion del HAI en 31 sujetos (60,7%). Las concentraciones elevadas de aspartato-transaminasa y alanina-aminotransferasa se asociaron a enfermedad hepatica avanzada tanto en funcion del grado de fibrosis como del HAI (p Conclusion la infeccion persistente por VHC tiene gran prevalencia en la poblacion penitenciaria y se asocia al uso de drogas intravenosas. Un grupo importante de presos con infeccion por VHC podria experimentar enfermedad hepatica avanzada, especialmente aquellos con un mayor tiempo total de consumo de estas sustancias. La variedad de los genotipos del VHC es mayor que en la poblacion general.

Virological failure of antiretroviral treatment increases the morbidity and mortality associated with AIDS. With currently available drugs it is possible to achieve an HIV - PVL 10% or cardiovascular disease.

La prevalencia de la infeccion por el virus de la hepatitis C (VHC) en las prisiones espanolas es muy elevada (38,5%). Las caracteristicas de los pacientes infectados, especialmente la elevada coinfeccion con el virus de la inmunodeficiencia humana (VIH), hacen probable que la morbilidad y mortalidad producida por enfermedad hepatica grave secundaria a esta infeccion aumente de forma considerable en los proximos anos. Un grupo de expertos multidisciplinar con experiencia con pacientes internados en prisiones espanolas ha sido invitado a establecer una serie de recomendaciones para el diagnostico y tratamiento de la hepatitis C en las prisiones espanolas.

Fundamento y objetivo La incidencia y los factores de riesgo para el desarrollo de sindrome postrombotico (SPT) no son bien conocidos. El objetivo del estudio fue determinar la relacion entre el SPT y determinadas variables clinicas, analiticas y terapeuticas. Pacientes y metodo Estudio prospectivo observacional. Se incluyo consecutivamente a pacientes con trombosis venosa profunda (TVP) proximal de miembros inferiores atendidos en medicina interna entre febrero de 2000 y julio de 2002. Se excluyo a aquellos con esperanza de vida inferior a 12 meses, imposibilidad de seguimiento, insuficiencia hepatica o renal, SPT o varices previos y recurrencia de la trombosis durante el seguimiento. La variable principal fue el desarrollo de SPT a los 12 meses y las variables explicativas, los factores de riesgo de TVP, el valor del dimero D, los estudios de hipercoagulabilidad, el tratamiento anticoagulante y el uso de medias elasticas compresivas. Resultados Se evaluo a 172 pacientes con TVP, de los cuales se excluyo a 69 y 16 se perdieron en el seguimiento. De los 87 pacientes que completaron el estudio, 47 (54%) desarrollaron SPT. La utilizacion de medias compresivas fue correcta en el 57% y se asocio a un descenso de la incidencia de SPT del 45% (p = 0,01). Ninguna otra variable se asocio a SPT. El analisis multivariante confirmo el efecto protector de las medias compresivas (riesgo relativo de 0,3; p Conclusiones Aproximadamente el 50% de los pacientes con TVP desarrolla SPT al ano. El riesgo es mayor en pacientes con TVP previa ipsolateral y disminuye a la mitad con la utilizacion de medias compresivas.

Introduccion Determinar los factores asociados a progresion y muerte de los pacientes con infeccion avanzada por el virus de la inmunodeficiencia humana (VIH) en la era del tratamiento antirretroviral de gran actividad (TARGA). Metodos Se incluyeron 146 pacientes con infeccion por el VIH, menos de 100 × 106/l linfocitos CD4+ y serologia positiva para citomegalovirus (CMV) fueron incluidos en el estudio entre diciembre de 1997 y octubre de 1998. Se realizo un seguimiento medio de 12,1 meses y se registro la progresion de la infeccion por el VIH (definida como aparicion de una nueva enfermedad definitoria de sida) y muerte. Las variables basales estudiadas fueron la carga viral plasmatica de VIH (CVP-VIH), los linfocitos CD4+ y CD8+, la administracion de TARGA y otras variables clinicas. Durante el seguimiento se determino la viremia por CMV (determinada por reaccion en cadena de la polimerasa [PCR]) y la eficacia de TARGA. Resultados El 40% de los pacientes progresaron y el 17% fallecieron. Los factores asociados a progresion o muerte fueron: los linfocitos CD4 Conclusiones Los linfocitos CD4+, CD8+ y el TARGA son los principales factores asociados a progresion de la infeccion avanzada por el VIH, pero el principal factor asociado a mortalidad es la viremia por CMV.

Pruritus is a common symptom in HIV-infected patients. However, there is a lack of studies examining this symptom. We investigated the prevalence of pruritus and its causes in this population by offering the possibility of participating in a skin health programme to all HIV-infected patients who attended our service in Alicante, Spain. Those who accepted ( n = 303) underwent an interview and a detailed physical examination by specialists from the Dermatology Department. Between May 2003 and October 2003, 94 patients (31%) reported pruritus: xerosis, seborrhoeic eczema and interdigital tinea pedis were the most frequent dermatological entities responsible for this symptom. Patients with pruritus had higher viral loads ( P = 0.006). We conclude that pruritus is still a frequent symptom in HIV-infected patients. To the best of our knowledge this is the first prevalence study of pruritus in an HIV population in the combination antiretroviral therapy (cART) era.

Carbapenem-resistant Acinetobacter baumannii (CRAb) is a major source of nosocomial infections in Spain associated with the production of OXA-58-like or OXA-24/40-like β-lactamase enzymes. We analysed the plasmids carrying the bla(OXA-24/40)-like gene in CRAb isolates obtained a decade apart.The presence of β-lactamases was screened for by PCR (metallo-β-lactamases, carbapenem-hydrolysing class D β-lactamases, GES and KPC) in 101 CRAb isolates obtained in two multicentre studies (GEIH/REIPI-Ab-2000 and GEIH/REIPI-Ab-2010; n = 493 Acinetobacter spp). We analysed the distribution and characterization of the plasmids carrying the bla(OXA-24/40)-like gene and sequenced two plasmids, AbATCC223p (2000) and AbATCC329p (2010) from A. baumannii ATCC 17978 transformants.Acquisition of the bla(OXA-24/40)-like gene was the main mechanism underlying resistance to carbapenems (48.7% in 2000 compared with 51.6% in 2010). This gene was mainly isolated in ST2 A. baumannii strains in both studies, although some novel STs (ST79 and ST80) appeared in 2010. The gene was located in plasmids (8-12 kbp) associated with the repAci2 or repAci2/repGR12 types. The sequences of AbATCC223p (8840 bp) and AbATCC329p (8842 bp) plasmids were similar, particularly regarding the presence of the genes encoding the AbkA/AbkB proteins associated with the toxin/antitoxin system. Moreover, the abkA/abkB gene sequences (96% identity) were also located in plasmids harbouring the bla(OXA-58)-like gene.The action of OXA-24/40 and OXA-58 β-lactamase-like enzymes represents the main mechanism underlying resistance to carbapenems in Spain in the last decade. AbkA/AbkB proteins in the toxin/antitoxin system may be involved in the successful dissemination of plasmids carrying the bla(OXA-24/40)-like gene, and probably also the bla(OXA-58)-like gene, thus contributing to the plasmid stability.

Introduction : Vitamin D insufficiency (VDI) has been associated with increased cardiovascular risk in the non-HIV population. This study evaluates the relationship among serum 25-hydroxyvitamin D [25(OH)D] levels, cardiovascular risk factors, adipokines, antiviral therapy (ART) and subclinical atherosclerosis in HIV-infected males. Methods : A cross-sectional study in ambulatory care was made in non-diabetic patients living with HIV. VDI was defined as 25(OH)D serum levels

We report the first case of human cryptococcosis due to Cryptococcus neoformans var. gattii described in our country, which was presented as brain cryptococcoma in an immunocompetent patient. An extensive sampling of the patient's environment was carried out to find the source of infection.

We herein describe a case of secondary syphilis in a patient with HIV infection that presented with an unusually diffuse polyostotic osteitis with skull involvement. Syphilis has to be added to the differential diagnosis of extensive inflammatory bone pain in patients at risk, especially if pain worsens at night.

Inflammatory biomarkers are increased in patients with human immunodeficiency virus (HIV) infection. Antiretroviral treatment (ART) improves some parameters but do not normalize them. The aim of this study is to determine those factors (including microbial translocation) associated with higher inflammation in HIV treated patients.Transversal observational study.HIV patients receiving ART with an HIV viral load (VL)400 copies/mL. Selection of patients: consecutively between November 2011 and January 2012. Main variable: plasma levels of interleukin 6 (IL-6) and tumour necrosis factor α (TNF-α). Main explanatory variable: microbial translocation markers (16S ribosomal DNA and sCD14). Patients with IL-6 or TNF-α levels above percentile 75 (group 1) were compared with the rest of patients (group 2). Odds ratio (OR) were determined.Eighty-one patients were included (73% male, median age 45 years, 48% stage C). Twenty-six percent had chronic hepatitis C. Median CD4 cell was 493/mm(3) and 30% had detectable HIV VL. 16S ribosomal DNA was detected in 21% of patients. Factors associated with the higher levels of inflammatory markers were 16S ribosomal DNA (OR 77, P.0001), sCD14 levels (P.0001) and history of cardiovascular disease (OR 15, P.01). In multivariate analysis, associations remained for 16S ribosomal DNA (OR 62, P.0001) and previous cardiovascular disease (OR 25, P.01).In patients with HIV infection receiving treatment, the higher levels of inflammatory markers are associated with microbial translocation and past cardiovascular events.

Coxiella burnetii myocarditis is a rare but severe clinical form of acute Q fever. We report the case of a 40-yearold man hospitalized for acute febrile syndrome. Fortyeight hours later, he presented dyspnea, orthopnea, and paroxysmal nocturnal dyspnea; cardiac auscultation revealed a third sound and echocardiography showed a diffusely hypokinetic and dilated left ventricle (30% ejection fraction). Serological studies showed antibodies against phase-II C. burnetii antigens (IgG titer 1:320 and IgM 1:50). The patient was treated with losartan, furosemide, and clarithromycin, resulting in rapid improvement. Six months after admission, the echocardiographic changes had completely disappeared.