Purpose: To assess the effect of hepatitis A virus (HAV) infection on HIV viral load (VL) and the... more Purpose: To assess the effect of hepatitis A virus (HAV) infection on HIV viral load (VL) and the influence of HIV on the clinical expression of HAV infection. Methods: Single-center study of 23 HIV-positive patients and 41 HIV-negative patients diagnosed with acute HAV infection during 2008-2009. The impact of HAV on HIV VL was defined as an increase of >0.5 log10 during the event, or a detectable VL for those previously suppressed patients. Results: The impact of acute HAV on VL was observed in 37.5% patients. HIV-negative patients were younger (27 vs 34 years, P < .0001), and serum transaminases levels normalized earlier than in the HIV-positive patients (121 vs 178 days, P < .05). Conclusions: Acute HAV infection may have an impact on HIV VL. The interactions between the 2 viruses may not only prolong the HAV viremia, with a potential increase in the transmission of infection, but the impact on HIV may increase the risk of HIV transmission. Studies with higher sample size are needed to confirm our results.
Journal of the International Association of Physicians in AIDS Care (Chicago, Ill. : 2002)
HIV infection is considered yet another cardiovascular risk factor (CVRF), particularly associate... more HIV infection is considered yet another cardiovascular risk factor (CVRF), particularly associated with immunosuppression. 1 In addition, HIV-infected patients have a higher prevalence of CVRF than in the general population. 2 The clinical importance of all this is the result of increase in the incidence of cardiovascular events in these patients. 3 However, few data are available in Spain relating to coronary events (CEs) in patients with HIV infection. The aim, therefore, of this study was to estimate the incidence of CEs in HIV-infected patients on outpatient followup and to determine the associated characteristics. We undertook a cross-sectional, multicenter study involving outpatients seen between March 2007 and August 2007 at 5 hospitals. All the patients completed a questionnaire about CVRF and were asked about any prior cardiovascular event. Information was checked from the clinical histories of the patients. Coronary events included any acute coronary syndrome, acute myocardial infarction, placement of a coronary stent, or coronary surgery. The statistical analysis was done with SPSS 17.0 (SPSS, Chicago, Illinois). Continuous variables are expressed as medians (interquartile range [IQR]) and the categorical variables as numbers (percentages). A multivariate analysis was done to seek factors potentially associated with CEs. The study was designed and carried out in accordance with the principles of the Declaration of Helsinki and approved by the Research Ethics Committee of the Hospital Virgen de la Victoria, Málaga. The study included 1155 patients, with a mean follow-up of 11 422 patient-years. Of the 40 cardiovascular events recorded, 29 were CEs, representing an incidence of 2.53 events per 1000 patient-years. Table 1 shows the patients with and without CEs. The CEs were associated with older age (odds ratio [OR] 1.8; 95% confidence interval [CI], 1.78-1.96; P < .009), hypertension (OR 4.9; 95% CI, 1.7-4.9; P < .005), and a family history of ischemic heart disease (OR 4.7; 95% CI, 1.7-13; P < .006). The estimated incidence of CEs in our study was higher than the estimates reported for the general population in the meta-analysis of Medrano, 4 which found an incidence of CEs of 1.3 to 2.1 per 1000 patient-years for men aged 25 to 74 and 0.29 to 0.61 for women of the same age. However, it is lower than that found in such cohort studies as Manresa (5 events per 1000 person-years) 5 or ZACARIS-I (Zaragoza Cardiovascular Risk factors Study-I; 6.4 and 4.0 events per 1000 person-years
To determine the prevalence of CRF and MS in an HIVinfected population, to analyse the risk facto... more To determine the prevalence of CRF and MS in an HIVinfected population, to analyse the risk factors for the development of MS, and to estimate the cardiovascular risk (CVR) at 10 years.
Conocer la prevalencia de factores de riesgo cardiovascular (FRCV) y síndrome metabólico (SM) en ... more Conocer la prevalencia de factores de riesgo cardiovascular (FRCV) y síndrome metabólico (SM) en pacientes con infección por el virus de la inmunodeficiencia humana (VIH). Métodos. Estudio observacional, multicéntrico y transversal de todos los pacientes con infección por el VIH atendidos de forma ambulatoria en 5 hospitales de la provincia de Málaga entre marzo y agosto de 2007. A todos los pacientes se realizó un cuestionario sobre FRCV, examen físico y analítica en ayunas. El riesgo cardiovascular (RCV) a 10 años se realizó mediante la ecuación de Framingham y el diagnóstico de SM se hizo en función de los criterios del National Cholesterol Education Program. Resultados. Se incluyó a 1.155 pacientes. El 76,9% eran varones y la edad media fue de 44,3 años. El 86,1% de los pacientes estaba en tratamiento antirretroviral. La prevalencia de FRCV fue la siguiente: tabaco 59%, hipertrigliceridemia 38,2%, cHDL bajo 40,6%, hipertensión arterial 10,6% y diabetes mellitus 9,4%. El 14,3% de los pacientes cumplía criterios de SM y los componentes más frecuentes fueron hipertrigliceridemia (88,3%) y colesterol unido a lipoproteínas de alta densidad bajo (78,7%). Los pacientes con SM tenían mayor RCV a 10 años (el 10,9 frente al 5,6%; p < 0,0001). El único factor asociado al SM fue la edad (odds ratio = 4,7; intervalo de confianza del 95%, 4,6-4,8). Conclusiones. Los FRCV en pacientes con infección por el VIH de nuestro medio son muy frecuentes, entre los cuales destaca el consumo de tabaco. La prevalencia de SM es similar a la de la población general española y se asocia a un mayor RCV. El único factor asociado al desarrollo de SM fue la edad.
To analyse the prevalence of HIV-infected patients who do not reach their target LDL-cholesterol ... more To analyse the prevalence of HIV-infected patients who do not reach their target LDL-cholesterol (LDL-C) levels. Multicenter, cross-sectional study of all HIV-infected patients on regular follow-up in 5 hospitals in the province of Malaga (March-August/07). They were classified depending on their target LDL-C levels (NCEP): group A:<160mg/dl, if </=1 cardiovascular risk factor (CVRF); group B: <130mg/dl, if >/=2 CVRF; group C: <100mg/dl, if cardiovascular disease or equivalents or CVR at 10 years >20%). A comparison between patients reaching their target LDL-C levels and those not reaching them was done. Statistic program: SPSS. Of 1019 included patients, 232 (22.8%) did not reach their target LDL-C levels. There were 693 patients in Group A, 163 in Group B, and 153 in Group C (6.6%, 53.3 % and 65.0% respectively (p<0.05)) who did not reach their target LDL-C. Factors associated with LDL-C levels higher than target were: obesity (OR=1.98; 95%CI: 1.14-3.46; p=0.0...
Purpose: To assess the effect of hepatitis A virus (HAV) infection on HIV viral load (VL) and the... more Purpose: To assess the effect of hepatitis A virus (HAV) infection on HIV viral load (VL) and the influence of HIV on the clinical expression of HAV infection. Methods: Single-center study of 23 HIV-positive patients and 41 HIV-negative patients diagnosed with acute HAV infection during 2008-2009. The impact of HAV on HIV VL was defined as an increase of &amp;gt;0.5 log10 during the event, or a detectable VL for those previously suppressed patients. Results: The impact of acute HAV on VL was observed in 37.5% patients. HIV-negative patients were younger (27 vs 34 years, P &amp;lt; .0001), and serum transaminases levels normalized earlier than in the HIV-positive patients (121 vs 178 days, P &amp;lt; .05). Conclusions: Acute HAV infection may have an impact on HIV VL. The interactions between the 2 viruses may not only prolong the HAV viremia, with a potential increase in the transmission of infection, but the impact on HIV may increase the risk of HIV transmission. Studies with higher sample size are needed to confirm our results.
Journal of the International Association of Physicians in AIDS Care (Chicago, Ill. : 2002)
HIV infection is considered yet another cardiovascular risk factor (CVRF), particularly associate... more HIV infection is considered yet another cardiovascular risk factor (CVRF), particularly associated with immunosuppression. 1 In addition, HIV-infected patients have a higher prevalence of CVRF than in the general population. 2 The clinical importance of all this is the result of increase in the incidence of cardiovascular events in these patients. 3 However, few data are available in Spain relating to coronary events (CEs) in patients with HIV infection. The aim, therefore, of this study was to estimate the incidence of CEs in HIV-infected patients on outpatient followup and to determine the associated characteristics. We undertook a cross-sectional, multicenter study involving outpatients seen between March 2007 and August 2007 at 5 hospitals. All the patients completed a questionnaire about CVRF and were asked about any prior cardiovascular event. Information was checked from the clinical histories of the patients. Coronary events included any acute coronary syndrome, acute myocardial infarction, placement of a coronary stent, or coronary surgery. The statistical analysis was done with SPSS 17.0 (SPSS, Chicago, Illinois). Continuous variables are expressed as medians (interquartile range [IQR]) and the categorical variables as numbers (percentages). A multivariate analysis was done to seek factors potentially associated with CEs. The study was designed and carried out in accordance with the principles of the Declaration of Helsinki and approved by the Research Ethics Committee of the Hospital Virgen de la Victoria, Málaga. The study included 1155 patients, with a mean follow-up of 11 422 patient-years. Of the 40 cardiovascular events recorded, 29 were CEs, representing an incidence of 2.53 events per 1000 patient-years. Table 1 shows the patients with and without CEs. The CEs were associated with older age (odds ratio [OR] 1.8; 95% confidence interval [CI], 1.78-1.96; P < .009), hypertension (OR 4.9; 95% CI, 1.7-4.9; P < .005), and a family history of ischemic heart disease (OR 4.7; 95% CI, 1.7-13; P < .006). The estimated incidence of CEs in our study was higher than the estimates reported for the general population in the meta-analysis of Medrano, 4 which found an incidence of CEs of 1.3 to 2.1 per 1000 patient-years for men aged 25 to 74 and 0.29 to 0.61 for women of the same age. However, it is lower than that found in such cohort studies as Manresa (5 events per 1000 person-years) 5 or ZACARIS-I (Zaragoza Cardiovascular Risk factors Study-I; 6.4 and 4.0 events per 1000 person-years
To determine the prevalence of CRF and MS in an HIVinfected population, to analyse the risk facto... more To determine the prevalence of CRF and MS in an HIVinfected population, to analyse the risk factors for the development of MS, and to estimate the cardiovascular risk (CVR) at 10 years.
Conocer la prevalencia de factores de riesgo cardiovascular (FRCV) y síndrome metabólico (SM) en ... more Conocer la prevalencia de factores de riesgo cardiovascular (FRCV) y síndrome metabólico (SM) en pacientes con infección por el virus de la inmunodeficiencia humana (VIH). Métodos. Estudio observacional, multicéntrico y transversal de todos los pacientes con infección por el VIH atendidos de forma ambulatoria en 5 hospitales de la provincia de Málaga entre marzo y agosto de 2007. A todos los pacientes se realizó un cuestionario sobre FRCV, examen físico y analítica en ayunas. El riesgo cardiovascular (RCV) a 10 años se realizó mediante la ecuación de Framingham y el diagnóstico de SM se hizo en función de los criterios del National Cholesterol Education Program. Resultados. Se incluyó a 1.155 pacientes. El 76,9% eran varones y la edad media fue de 44,3 años. El 86,1% de los pacientes estaba en tratamiento antirretroviral. La prevalencia de FRCV fue la siguiente: tabaco 59%, hipertrigliceridemia 38,2%, cHDL bajo 40,6%, hipertensión arterial 10,6% y diabetes mellitus 9,4%. El 14,3% de los pacientes cumplía criterios de SM y los componentes más frecuentes fueron hipertrigliceridemia (88,3%) y colesterol unido a lipoproteínas de alta densidad bajo (78,7%). Los pacientes con SM tenían mayor RCV a 10 años (el 10,9 frente al 5,6%; p < 0,0001). El único factor asociado al SM fue la edad (odds ratio = 4,7; intervalo de confianza del 95%, 4,6-4,8). Conclusiones. Los FRCV en pacientes con infección por el VIH de nuestro medio son muy frecuentes, entre los cuales destaca el consumo de tabaco. La prevalencia de SM es similar a la de la población general española y se asocia a un mayor RCV. El único factor asociado al desarrollo de SM fue la edad.
To analyse the prevalence of HIV-infected patients who do not reach their target LDL-cholesterol ... more To analyse the prevalence of HIV-infected patients who do not reach their target LDL-cholesterol (LDL-C) levels. Multicenter, cross-sectional study of all HIV-infected patients on regular follow-up in 5 hospitals in the province of Malaga (March-August/07). They were classified depending on their target LDL-C levels (NCEP): group A:<160mg/dl, if </=1 cardiovascular risk factor (CVRF); group B: <130mg/dl, if >/=2 CVRF; group C: <100mg/dl, if cardiovascular disease or equivalents or CVR at 10 years >20%). A comparison between patients reaching their target LDL-C levels and those not reaching them was done. Statistic program: SPSS. Of 1019 included patients, 232 (22.8%) did not reach their target LDL-C levels. There were 693 patients in Group A, 163 in Group B, and 153 in Group C (6.6%, 53.3 % and 65.0% respectively (p<0.05)) who did not reach their target LDL-C. Factors associated with LDL-C levels higher than target were: obesity (OR=1.98; 95%CI: 1.14-3.46; p=0.0...
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