Gráfico con los estudios de buena calidad en el Análisis del ASAP Ecuador 2009

Análisis del ASAP 2009 Ecuador en los últimos 15 años

En los últimos 15 años , se han encontrado estudios que  han trabajado con las siguientes poblaciones y que según el análisi de calidad de los mismos es baja.

En la Población  HSH 9 estudios, TS (trabajadoras sexuales) 11 estudios , PPL 6 estudios, Jóvenes 11 estudios, P. General 8 estudios, PVVS 5 estudios, Otros 6 estudios , haciendo un total de  56  en los últimos 15 años.

Esto nos hace pensar en el desarrollo de la investigación de alta calidad metodológica en la linea de VIH-Sida e Its.

Dr. Carlos Erazo

Análisis del ASAP 2009 Ecuador

Criterios para evaluar la calidad de los estudios del ASAP Ecuador 2009

Los 8 aspectos metodológicos evaluados fueron:
1) Se definió claramente el objetivo del estudio.
2) Se definieron criterios de inclusión y exclusión.
3) Se calculó el tamaño de la muestra y se colectó el número de individuos propuesto.
4) Se realizó técnica de muestreo de tipo probabilística para evitar el sesgo de selección.
5) Se implementaron estrategias para disminuir el error de recolección de datos.
6) Se describió la técnica de análisis de los datos.
7) Se reconocieron las limitaciones impuestas por la metodología.
8) Se expresaron los hallazgos con intervalos de confianza y/o significación estadística.

Análisis del ASAP 2009 Ecuador / Población objetivo de estas investigaciones

Análisis del ASAP 2009 Ecuador - Diseños Epidemiológicos

Análisis del ASAP Ecuador 2009 - Estado de Publicación de los trabajos

Análisis del ASAP 2009 Ecuador

Vitamin D Insufficiency in HIV-Infected Patients

"Vitamin D insufficiency was slightly less common in HIV-infected patients than in the general U.S. population. The clinical significance of this insufficiency remains uncertain.

Vitamin D deficiency is associated with a broad range of disorders, many of which are also linked to HIV infection and its treatment. However, little is known about the prevalence or predictors of low vitamin D levels among HIV-infected adults.

To address this gap, researchers evaluated laboratory, clinical, and behavioral data from 672 HIV-infected patients who were part of a larger U.S. cohort study and were not receiving vitamin D supplementation. Vitamin D insufficiency was defined as a 25-hydroxyvitamin D level <30 ng/mL, and prevalence estimates were standardized by age, sex, and race.

Seventy percent of the HIV-infected population was estimated to have vitamin D insufficiency. By comparison, the estimated prevalence in the general U.S. population, based on NHANES data, was 79%. In a multivariate analysis, Hispanic or black race, lack of exercise, higher body-mass index, hypertension, and use of efavirenz were all independently associated with vitamin D insufficiency. A glomerular filtration rate <90 mL/minute/1.73 m², use of ritonavir, and greater exposure to ultraviolet light were independently associated with a lower likelihood of vitamin D insufficiency.

Comment: The finding of a slightly lower prevalence of vitamin D insufficiency in the HIV-infected population than in the general population is somewhat surprising, although the prevalence in both groups is high. Given that the clinical significance of this insufficiency (especially in its mildest form) is poorly defined in virtually all populations, the observed associations with various HIV treatments do not, at this point, warrant any changes in screening or management. HIV clinicians can simply join providers from other fields in wondering what to do about measurement of or supplementation with this "vitamin du jour."

— Eileen Scully, MD, PhD, and Paul E. Sax, MD

Dr. Scully is a Fellow in the Division of Infectious Diseases at Brigham and Women's Hospital in Boston. She reports no conflicts of interest.

Published in Journal Watch HIV/AIDS Clinical Care February 7, 2011

CITATION(S):

Dao CN et al. Low vitamin D among HIV-infected adults: Prevalence of and risk factors for low vitamin D levels in a cohort of HIV-infected adults and comparison to prevalence among adults in the US general population. Clin Infect Dis 2011 Feb 1; 52:396.

Short-Term Neuropsychiatric Side Effects: Etravirine vs. Efavirenz

"Efavirenz is a cornerstone of many antiretroviral regimens because of its efficacy, once-daily dosing, and tolerability, but in some patients, it can cause troublesome neuropsychiatric problems. To determine whether etravirine might lead to fewer such problems, researchers conducted a randomized, double-blind, placebo-controlled study among HIV-infected treatment-naive patients. The study was sponsored by the maker of etravirine.

A total of 157 patients received etravirine (dosed at 400 mg once daily) or efavirenz, each together with two nucleosides; 60% received tenofovir/FTC, 26% received abacavir/3TC, and 14% received AZT/3TC. The study population was 81% men and 85% white. Median age was 36; median baseline CD4 count, 302 cells/mm³; and median baseline viral load, 4.8 log copies/mL.

During 12 weeks of treatment, 93% of the efavirenz group and 88% of the etravirine group achieved viral loads <400 copies/mL; median CD4-count increases were 121 and 146 cells/mm³, respectively. Neuropsychiatric adverse reactions occurred in 46% of efavirenz recipients versus 17% of etravirine recipients; serious neuropsychiatric reactions (grades 2–4) occurred in 17% versus 5%. The prevalence of neuropsychiatric problems peaked at week 2 (44% for efavirenz vs. 22% for etravirine), but the difference between groups remained significant at week 12 (30% vs. 12%). The most common nervous system side effect was dizziness, and the most common psychiatric effect involved sleep disorders. Overall, 10 patients discontinued etravirine, and 8 discontinued efavirenz (4 in each group because of skin rash); neuropsychiatric problems contributed to five of the efavirenz discontinuations and one of the etravirine discontinuations.

Comment: The authors state that the lower neuropsychiatric event rate observed with etravirine could lead to better long-term adherence, but the difference in discontinuation rates for the two drugs was modest. Furthermore, the study was relatively short and focused on the period of treatment when adverse effects from efavirenz are generally most troublesome. Drawing long-term conclusions from this study is therefore difficult".

— Keith Henry, MD

Published in Journal Watch HIV/AIDS Clinical Care February 7, 2011

CITATION(S):

Nelson M et al. A comparison of neuropsychiatric adverse events during 12 weeks of treatment with etravirine and efavirenz in a treatment-naive, HIV-1-infected population. AIDS 2011 Jan 28; 25:335.

Race, Sex, and Clinical Outcomes in Early HIV Infection

Este es un interesante estudio, espero que lo disfruten.

Saludos 

Dr. Carlos Erazo

"Previous studies have shown that, in established HIV infection, women have lower viral loads and higher CD4-cell counts than men, and nonwhites have lower viral loads than whites. Do these differences by race and sex influence clinical presentations and outcomes during early HIV infection?

To find out, researchers evaluated longitudinal data from 2277 individuals who were diagnosed with acute or recent HIV infection between 1997 and 2007. Women made up only 5% of the cohort, and 55% of them were nonwhite. In contrast, only 23% of the men were nonwhite. Most participants were from the western or midwestern U.S., but 45% of the nonwhite women were from southern states. No information was available on hepatitis coinfection, insurance coverage, income, education, or mental health. Mean follow-up time was approximately 4 years.

As expected, women had lower baseline viral loads and higher baseline CD4-cell counts than men. However, these differences disappeared within 2 years among individuals who had not yet initiated antiretroviral therapy (ART). The proportion of patients who started ART during the study period was similar between men and women (69% and 64%), as was the proportion who achieved virologic suppression within 6 months of ART initiation (81% and 77%). However, rates of ART initiation differed significantly by race and geographic location: Nonwhite men and women were less likely to start ART than white men, who were, in turn, less likely to start ART than white women. Patients from the South were less likely to start ART than those from other regions.

Women were more likely than men to report HIV-associated non–AIDS-related conditions (persistent generalized lymphadenopathy, diarrhea, peripheral neuropathy) and certain AIDS-defining illnesses (recurrent bacterial pneumonia). Of all the groups analyzed, nonwhite women in the South had the highest rate of HIV/AIDS-related events (81%).

Comment: The data presented in this paper open the door for further investigation into the influence of biology on the course of HIV infection. However, removing sociodemographic barriers to optimal care will likely have a much greater impact on outcomes than understanding biological determinants of progression and response to treatment."

— Sonia Nagy Chimienti, MD

Published in Journal Watch HIV/AIDS Clinical Care February 7, 2011

CITATION(S):

Meditz AL et al. Sex, race, and geographic region influence clinical outcomes following primary HIV-1 infection. J Infect Dis2011 Feb 15; 203:442.

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REPORTS
National Black HIV/AIDS Awareness Day February 7, 2011
full text
Disparities in Diagnoses of HIV Infection Between Blacks/African Americans and Other Racial/Ethnic Populations 37 States, 2005--2008
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Increase in Newly Diagnosed HIV Infections Among Young Black Men Who Have Sex with Men Milwaukee County, Wisconsin, 1999--2008
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Vital Signs: Prevalence, Treatment, and Control of Hypertension United States, 1999--2002 and 2005--2008
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Vital Signs: Prevalence, Treatment, and Control of High Levels of Low-Density Lipoprotein Cholesterol United States, 1999--2002 and 2005--2008
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Announcement: Congenital Heart Defect Awareness Week February 7--14, 2011
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Errata: Vol. 59, No. 46
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Errata: Vol. 59, No. 49
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QuickStats: Percentage of Persons with Current Asthma Who Reported Receiving an Asthma Management Plan from a Health Professional, by Race/Ethnicity and Age Group National Health Interview Survey, United States, 2008
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Recommended Adult Immunization Schedule United States, 2011
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Notifiable Diseases and Mortality Tables
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Association of ongoing drug and alcohol use with non-adherence to antiretroviral therapy and higher risk of AIDS and death: results from ACTG 362

 

  http://www.informaworld.com/smpp/content~content=a933017317~db=all~jumptype=rss

 

Authors: Susan E. Cohn^ab; Hongyu Jiang^c; J. Allen McCutchan^d; Susan L. Koletar^e; Robert L. Murphy^b; Kevin R. Robertson^f; Annabelle M. de St. Maurice^g; Judith S. Currier^h; Paige L. Williams^c

Abstract Drug and alcohol use have been associated with a worse prognosis in short-term and cross-sectional analyses of HIV-infected populations, but longitudinal effects on adherence to antiretroviral therapy (ART) and clinical outcomes in advanced AIDS are less well characterized. We assessed self-reported drug and alcohol use in AIDS patients, and examined their association with non-adherence and death or disease progression in a multicenter observational study. We defined non-adherence as reporting missed ART doses in the 48 hours before study visits. The association between drug use and ART non-adherence was evaluated using repeated measures generalized estimating equation (GEE) models. The association between drug and alcohol use and time to new AIDS diagnosis or death was evaluated via Cox regression models, controlling for covariates including ART adherence. Of 643 participants enrolled between 1997 and 1999 and followed through 2007, at entry 39% reported ever using cocaine, 24% amphetamines, and 10% heroin. Ongoing drug use during study follow-up was reported by 9% using cocaine, 4% amphetamines, and 1% heroin. Hard drug (cocaine, amphetamines, or heroin) users had 2.1 times higher odds (p=0.001) of ART non-adherence in GEE models and 2.5 times higher risk (p=0.04) of AIDS progression or death in Cox models. Use of hard drugs was attenuated as a risk factor for AIDS progression or death after controlling for non-adherence during follow-up (HR = 2.11, p=0.08), but was still suggestive of a possible adherence-independent mechanism of harm. This study highlights the need to continuously screen and treat patients for drug use as a part of ongoing HIV care.
Keywords: substance use; drug use; alcohol use; HIV/AIDS; outcomes; adherence; antiretroviral therapy; mortality

Influenza A H1N1 in HIV-infected adults(*).

Martínez E, Marcos M, Hoyo-Ulloa I, Antón A, Sánchez M, Vilella A, Larrousse M, Pérez I, Moreno A, Trilla A, Pumarola T, Gatell J.

Infectious Diseases Unit, Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain Microbiology Unit, Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain HIV Unit, National Institute of Medical Sciences and Nutrition "Salvador Zubiran", Mexico City, Mexico Emergency Unit, Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain Preventive Medicine and Epidemiology Unit, Hospital Clínic-IDIBAPS, University of Barcelona, Barcelona, Spain.

Abstract

OBJECTIVES: HIV-infected adults are considered to be at higher risk for influenza A H1N1 complications but data supporting this belief are lacking. We aimed to compare epidemiological data, clinical characteristics, and outcomes of influenza A H1N1 infection between HIV-infected and -uninfected adults.
METHODS: From 26 April to 6 December 2009, each adult presenting with acute respiratory illness at the emergency department of our institution was considered for an influenza A H1N1 diagnosis by specific multiplex real-time polymerase chain reaction. For every HIV-infected adult diagnosed, three consecutive adults not known to be HIV-infected diagnosed in the same calendar week were randomly chosen as controls.
RESULTS: Among 2106 adults tested, 623 (30%) had influenza A H1N1 infection confirmed. Fifty-six (9%) were HIV-positive and were compared with 168 HIV-negative controls. Relative to HIV-negative controls, HIV-positive patients were older, more frequently male, and more frequently smokers (P≤0.02). In the HIV-positive group, prior or current AIDS-defining events were reported for 30% of patients, 9% and 30% had CD4 counts of <200 and 200-500 cells/μL, respectively, and 95% had HIV-1 RNA <50 copies/mL. Pneumonia (9%vs. 25%, respectively, in the HIV-positive and HIV-negative groups; P=0.01) and respiratory failure (9%vs. 21%, respectively; P=0.04) were less common in the HIV-positive group. Oseltamivir (95%vs. 71% in the HIV-positive and HIV-negative groups, respectively; P=0.003) was administered more often in HIV-positive patients. Three patients (all HIV-negative) died. In the HIV-positive group, CD4 cell count and plasma HIV-1 RNA did not differ before and 4-6 weeks after influenza A H1N1 diagnosis (P>0.05).
CONCLUSIONS: HIV infection did not increase the severity of influenza A H1N1 infection, and influenza A H1N1 infection did not have a major effect on HIV infection.

http://www.ncbi.nlm.nih.gov/pubmed/21255221

Sala Situacional definición

Swine flu and pregnant women: Advice, prevention and management

British Journal of Midwifery, Vol. 19, Iss. 2, 01 Feb 2011, pp 76 - 80 

 

Since mid-December 2010, there has been an increase in the number of reported cases of severe H1N1A, or 'swine flu'. Maternity units across the UK have also seen a rapid rise in the number of hospital and intensive care unit admissions due to H1N1A infection among pregnant women. Hospitalization, critical illness and mortality rates in pregnant women with H1N1A infection are significantly higher than those of non-pregnant women of the same age. For this reason, key public health messages, including respiratory and hand hygiene, should be emphasized. Midwives and doctors should also promote influenza vaccine uptake among all pregnant women who have not previously been vaccinated against H1N1A. All those who care for pregnant women should also seek vaccination themselves.

http://www.britishjournalofmidwifery.com/cgi-bin/go.pl/library/article.html?uid=81698;article=BJM_19_2_76

Fibromyalgia Criteria and Severity Scales for Clinical and Epidemiological Studies: A Modification of the ACR Preliminary Diagnostic Criteria for Fibromyalgia

Abstract

Objective To develop a fibromyalgia (FM) survey questionnaire for epidemiologic and clinical studies using a modification of the 2010 American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia (ACR 2010). We also created a new FM symptom scale to further characterize FM severity.

Methods The ACR 2010 consists of 2 scales, the Widespread Pain Index (WPI) and the Symptom Severity (SS) scale. We modified these ACR 2010 criteria by eliminating the physician’s estimate of the extent of somatic symptoms and substituting the sum of 3 specific self-reported symptoms. We also created a 0–31 FM Symptom scale (FS) by adding the WPI to the modified SS scale. We administered the questionnaire to 729 patients previously diagnosed with FM, 845 with osteoarthritis (OA) or with other noninflammatory rheumatic conditions, 439 with systemic lupus erythematosus (SLE), and 5210 with rheumatoid arthritis (RA).

Results The modified ACR 2010 criteria were satisfied by 60% with a prior diagnosis of FM, 21.1% with RA, 16.8% with OA, and 36.7% with SLE. The criteria properly identified diagnostic groups based on FM severity variables. An FS score ≥ 13 best separated criteria+ and criteria– patients, classifying 93.0% correctly, with a sensitivity of 96.6% and a specificity of 91.8% in the study population.

Conclusion A modification to the ACR 2010 criteria will allow their use in epidemiologic and clinical studies without the requirement for an examiner. The criteria are simple to use and administer, but they are not to be used for self-diagnosis. The FS may have wide utility beyond the bounds of FM, including substitution for widespread pain in epidemiological studies. 

Link: http://jrheum.org/content/early/2011/01/27/jrheum.100594.abstract