Browsing by Author "Miro, Jose M."

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    Acute meningoencephalitis due to human immunodeficiency virus type 1 infection in 13 patients: Clinical description and follow-up
    (2008) Villar del Saz, Sergi; Sued, Omar; Falcó, Vicenç; Agüero, Francisco; Crespo, Manuel; Pumarola, Teresa; Curran, Andrea; Gatell, Jose; Pahissa, Alberto; Miro, Jose M.; Ribera, Esteban
    The objective of this study is to describe a series of cases of severe meningitis caused by human immunodeficiency virus type 1 (HIV-1) occurring during primary infection or after antiretroviral treatment interruption. In an observational cohort study, 13 patients with clinical diagnosis of meningitis or meningoencephalitis were reviewed. Ten cases occurred during primary HIV-1 infection and 3 after antiretroviral therapy (ART) withdrawal. Demographic parameters, clinical presentation and outcome, and laboratory and cerebrospinal fluid (CSF) parameters were recorded. The risk factor for HIV-1 infection acquisition was sexual transmission in all cases. The most frequent systemic symptoms were fever (12/13) and headeache (9/13). Among neurologic symptoms, focal signs appeared in seven patients (53.8%), confusion in six (46.2%), and agitation in five (38.5%). The median CD4 cell count was 434 cells/mm3. In all cases, CSF was a clear lymphocytaire fluid with normal glucose levels. Cranial computerized tomography was performed in seven patients, with a normal result in all of them; brain magnetic resonance in eight patients was normal in five cases and showing cortical atrophy, limbic encephalitis, and leptomeningeal enhancement in one patient each. The electroencephalographs (EEG) just showed diffuse dysfunction in three cases. ART was started in 11 patients. HIV RNA load at 12 months was <50 copies/ml in all treated patients. The 13 patients recovered without neurologic sequela. Meningitis or meningoencephalitis during primary HIV-1 infection or after ART cessation are unusual but sometimes a life-threatening manifestation. Although all patients tend to recover and the necessity of ART is not well established, some data suggest its potential benefit in these patients.
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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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    Behçet's disease in an HIV-1-infected patient treated with highly active antiretroviral therapy
    (2006) Gómez-Puerta, Jose A.; Espinosa, Gerard; Miro, Jose M.; Sued, Omar; Llibre, Josep M.; Cervera, Ricard; Font, Joan
    Behcet’s disease is a systemic vasculitis of unknown etiology, characterized by recurrent oral and genital ulcers and uveitis. In addition, cutaneous, articular, neurologic, intestinal, pulmonary, urogenit tal and vascular manifestations have been observed in these patients [1]. Since the introduction of protease inhibitor-based antiretroviral therapy in 1996, the natural history of human immunodeficiency virus infection changed dramatically, with a decrease in disease progression and mortality. Simultaneously, a wide variety of autoimmune diseases emerged in this group of patients although the number of reports of HIV patients with Behcet’s disease seems to remain stable [2]. The diagnosis of Behcet’s disease in HIV pat tients may be difficult to establish, mainly because some clinical manifestations of infections related or not with HIV may mimic the clinical features of Behcet’s. We describe here an HIV-infected patient who developed Behcet’s disease 10 years after contracting HIV infection. In addition, we review the literature and describe the clinical characteristics of patients with this association
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    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.
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    Pneumocystis jirovecii pneumonia in Spanish HIV-infected patients in the combined antiretroviral therapy era: prevalence of dihydropteroate synthase mutations and prognostic factors of mortality
    (2008) Alvarez-Martínez, Miriam J.; Moreno, Asunción; Miro, Jose M.; Valls, Maria Eugenia; Rivas, Paula V.; Lazzari, Elisa de; Sued, Omar; Benito, Natividad; Domingo, Pere; Ribera, Esteban; Santín, Miguel; Sirera, Guillermo; Segura, Ferràn; Vidal, Francesc; Rodríguez, Francisco; Riera, Melchor; Cordero, Maria Elisa; Arribas, Jose; Anta, Maria Teresa Jiménez de; Gatell, Jose; Wilson, Paul E.; Meshnick, Steven R.; Spanish PCP Working Group
    The incidence of Pneumocystis jirovecii pneumonia (PCP) in HIV-infected patients has decreased thanks to sulfa prophylaxis and combined antiretroviral therapy. The influence of P. jirovecii dihydropteroate synthase (DHPS) gene mutations on survival is controversial and has not been reported in Spain. This prospective multicenter study enrolled 207 HIV-infected patients with PCP from 2000 to 2004. Molecular genotyping was performed on stored specimens. Risk factors for intensive care unit (ICU) admission and mortality were identified using a logistic regression model. Seven patients (3.7%; 95% confidence interval [CI], 1.5-7.5%) had DHPS mutations. Overall mortality was 15% (95% CI, 10-21%), rising to 80% (95% CI, 61-92%) in patients requiring mechanical ventilation. None of the patients with DHPS mutants died, nor did they need ICU admission or mechanical ventilation. PaO(2) <60 mm Hg at admission was a predictor of ICU admission (P = 0.01), and previous antiretroviral therapy predicted non-ICU admission (P = 0.009). PaO(2) <60 mm Hg at admission and ICU admission during the 1st week were predictors of mortality (P = 0.03 and P < 0.001, respectively). The prevalence of DHPS mutants in Spain is low and is not associated with a worse outcome. Severe respiratory failure at admission is the strongest predictor of PCP outcome.
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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.
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    Tratamiento antirretroviral en pacientes con Infección Primaria por VIH
    (2006) Sued, Omar; Iribarren, Jose A.; Arrizabalaga, Javier; Miro, Jose M.
    Carata al editor sobre "Barreiro y Soriano han publicado en esta revista una revisión de la situación actual del tratamiento antirretroviral (TAR). En el artículo, los autores recomiendan que «todo paciente diagnosticado en la fase aguda de la infección, o en los 6 meses posteriores, debe ría recibir TAR». Queremos comentar que esta afirmación tan taxativa contrasta claramente con todas las guías de TAR vigentes basadas en la evidencia..."
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    Trends in Transmission of Drug Resistance and Prevalence of Non-B Subtypes in Patients with Acute or Recent HIV-1 Infection in Barcelona in the Last 16 Years (1997-2012)
    (2015-6) Ambrosioni, Juan; Sued, Omar; Nicolas, David; Parera, Marta; López-Diéguez, María; Romero, Anabel; Agüero, Fernando; Marcos, María Ángeles; Manzardo, Christian; Zamora, Laura; Gómez-Carrillo, Manuel; Gatell, Jose; Pumarola, Tomás; Miro, Jose M.
    Objectives: To evaluate the prevalence of transmitted drug resistance (TDR) and non-B subtypes in patients with acute/recent HIV-1 infection in Barcelona during the period 1997-2012. Methods: Patients from the "Hospital Clínic Primary HIV-1 Infection Cohort" with a genotyping test performed within 180 days of infection were included. The 2009 WHO List of Mutations for Surveillance of Transmitted HIV-1 Drug Resistance was used for estimating the prevalence of TDR and phylogenetic analysis for subtype determination. Results: 189 patients with acute/recent HIV-1 infection were analyzed in 4 time periods (1997-2000, n=28; 2001-4, n=42; 2005-8, n=55 and 2009-12, n=64). The proportion of patients with acute/recent HIV-1 infection with respect to the total of newly HIV-diagnosed patients in our center increased over the time and was 2.18%, 3.82%, 4.15% and 4.55% for the 4 periods, respectively (p=0.005). The global prevalence of TDR was 9%, or 17.9%, 9.5%, 3.6% and 9.4% by study period (p=0.2). The increase in the last period was driven by protease-inhibitor and nucleoside-reverse-transcriptase-inhibitor resistance mutations while non-nucleoside-reverse-transcriptase inhibitor TDR and TDR of more than one family decreased. The overall prevalence of non-B subtypes was 11.1%, or 0%, 4.8%, 9.1% and 20.3 by study period (p=0.01). B/F recombinants, B/G recombinants and subtype F emerged in the last period. We also noticed an increase in the number of immigrant patients (p=0.052). The proportion of men-who-have-sex-with-men (MSM) among patients with acute/recent HIV-1 infection increased over the time (p=0.04). Conclusions: The overall prevalence of TDR in patients with acute/recent HIV-1 infection in Barcelona was 9%, and it has stayed relatively stable in recent years. Non-B subtypes and immigrants proportions progressively increased.