Combination antiretroviral therapy reduces mortality of HIV-infected persons. In Spain, where this therapy is widely available, we aim to evaluate mortality trends and causes of death in HIV-infected adults, and to estimate the excess mortality compared to the general population. From 1999 to 2018 mortality by causes was analyzed in a population-based cohort of adults aged 25 to 74 years diagnosed with HIV infection in Spain. Observed deaths and expected deaths according mortality in the general population of the same sex and age were compared using standardized mortality ratios (SMRs). HIV-infected people increased from 839 in 1999–2003 to 1059 in 2014–2018, median age increased from 37 to 47 years, the annual mortality rate decreased from 33.5 to 20.7 per 1000 person-years and the proportion of HIV-related deaths declined from 64% to 35%. HIV-related mortality declined from 21.4 to 7.3 (p < 0.001), while non-HIV-related mortality remained stable: 12.1 and 13.4 per 1000, respectively. Mortality decreased principally in persons diagnosed with AIDS-defining events. In the last decade, 2009–2018, mortality was still 8.1 times higher among HIV-infected people than in the general population, and even after excluding HIV-related deaths, remained 4.8 times higher. Excess mortality was observed in non-AIDS cancer (SMR = 3.7), cardiovascular disease (SMR = 4.2), respiratory diseases (SMR = 7.9), liver diseases (SMR = 8.8), drug abuse (SMR = 47), suicide (SMR = 5.3) and other external causes (SMR = 6). In conclusion, HIV-related mortality continued to decline, while non-HIV-related mortality remained stable. HIV-infected people maintained important excess mortality. Prevention of HIV infections in the population and promotion of healthy life styles in HIV-infected people must be a priority.
Comorbidities and risk factors for chronic diseases are very common in HIV-infected patients aged ≥50 years and increase with age, so they should be early considered in the clinical management of these patients. It is important to encourage healthy lifestyles to prevent comorbidities and to control risk factors. Concomitant treatments with ART should be carefully monitored to prevent drug interactions, adverse effects, and patient adherence failures.
A possible case of sprue-like enteropathy (SLE) induced by the use of telmisartan is reported. Telmisartan is an angiotensin-receptor II blocker (type 1) used for the treatment of hypertension. Several cases of SLE associated with olmesartan and other drugs of the same group have been reported. In all cases, SLE resolved following therapy withdrawal. We describe the case of an 80-year-old woman who presented with diarrhoea and abdominal pain. In the past 5 years she had been treated with telmisartan 40 mg once a day for hypertension, so we hypothesised that symptoms might be caused by telmisartan. After treatment discontinuation, diarrhoea disappeared. Three causality algorithms were applied and revealed a possible or likely causal relationship. At present, the patient remains asymptomatic. There is a causal relationship between the use of telmisartan and SLE. This association should be taken into account by physicians when prescribing and reviewing drug therapies.
Purpose: Concomitant use of diuretics, renin-angiotensin-aldosterone system (RAAS) inhibitors, and non-steroidal anti-inflammatory drugs (NSAIDs) or metamizole, known as 'triple whammy' (TW), has been associated with an increased risk of acute kidney injury (AKI). Nevertheless, there is still uncertainty on its impact in hospitalisation and mortality. The aim of the study was to analyse the association between exposure to TW and the risk of hospitalisation for AKI, all-cause mortality and the need for renal replacement therapy (RRT).
BackgroundNivolumab is approved by the US Food and Drug Administration for the treatment of patients with melanoma, metastatic non-small cell lung cancer (NSCLC) and renal cell carcinoma (RCC), and has been included in our hospital’s formulary since 2015.PurposeTo evaluate the efficacy and safety of patients treated with nivolumab in our hospital in real world data.Material and methodsThis was a retrospective observational study of all patients included in the nivolumab early access programme (November 2015–February 2016). Measured variables included: age, sex, diagnosis, disease stage, ECOG, number of cycles, prior lines of treatment, objective response and adverse effects. Evaluation of the response was performed according to RECIST version 1.1, and toxicity as defined by the NCI-CTCAE, version 4.0.Results8 patients were included (7 men), median age 68.5 years (52–74) and ECOG 1–2. Nivolumab candidates were treated with 3 mg/kg intravenous infusions every 14 days. 6 patients were diagnosed with lung cancer (2 squamous histology, 4 adenocarcinomas) and 2 other patients had RCC. All patients had stage IV disease except one who had stage IIIA disease. They had previously received a median of two lines of treatment and the median number of cycles administered was 6. All patients with NSCLC had progressed after platinum based chemotherapy and 4 had been treated with docetaxel. Patients with RCC had received TKI therapy and everolimus previously. Regarding effectiveness, no patient obtained an objective response (complete response+partial response), 4 patients (50%) maintained stable disease (SD), 2 patients are in progression (25%) and 2 patients are awaiting evaluation by imaging but with clinical improvement. Treatment related adverse effects of any grade were reported in all patients. The most common were asthenia, respiratory infection, hyporexia, nausea and anorexia. One patient required hospitalisation with colitis grade 3.ConclusionThe effectiveness in terms of objective response rate was lower than that reported in the literature. The tumour response rate was limited to SD. Treatment related adverse effects were similar to those described in other studies, mostly grades 1–2. To evaluate efficacy and long term safety, a longer monitoring period is required. It is essential to measure the health outcomes of new and expensive drugs to rationalise their use and optimise efficiency in the oncology area.References and/or acknowledgementsBrahmer J, et al. Nivolumab versus docetaxel in advanced squamous-cell non-small-cell lung cancer. N Engl J Med2015;373:123–35.No conflict of interest
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