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    Humanising and optimising HIV health care for refugees and asylum seekers
    (2024)
    Claudia P Cortes
    ;
    Omar Sued
    ;
    William C W Wong
    ;
    Annick Borquez
    ;
    Charles Ssonko
    Scopus© Citations 13  1
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      9Scopus© Citations 8
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    Highly active antiretroviral therapy discontinuation time is associated with therapeutic failure among human immunodeficiency virus (<scp>HIV</scp>)‐infected immigrant adults: A cohort study from a Peruvian referral hospital during the Venezuelan exodus
    (2023)
    Kirbeliz Rebolledo‐Ponietsky
    ;
    Ali Al‐kassab‐Córdova
    ;
    Aldo Lucchetti‐Rodríguez
    ;
    ;
    Alfonso J. Rodriguez‐Morales
    <jats:title>Abstract</jats:title><jats:sec><jats:title>Objective</jats:title><jats:p>To evaluate the association between Highly Active Antiretroviral Therapy (HAART) discontinuation time and therapeutic failure (TF) in Venezuelan immigrants with HIV that restart HAART.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>We carried out a retrospective cohort study in a large hospital in Peru. We included Venezuelan immigrants who restarted HAART and were followed over at least 6 months. The primary outcome was TF. Secondary outcomes were immunologic (IF), virologic (VF) and clinical (CF) failures. The exposure variable was HAART discontinuation, categorised as no discontinuation, less than 6 months, and 6 months or more. We applied generalised linear models Poisson family with robust standard errors to calculate crude (cRR) and adjusted (aRR) relative risks by statistical and epidemiological criteria.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>We included 294 patients, 97.2% were males, and the median age was 32 years. Out of all the patients, 32.7% discontinued HAART for less than 6 months, 15.0% discontinued for more than 6 months and the remaining 52.3% did not discontinue. The cumulative incidence of TF was 27.9%, 24.5% in VF, 6.0% in IF and 6.0% in CF. Compared with non‐discontinued HAART patients, the discontinuation for less than 6 months (aRR = 1.98 [95% CI: 1.27<jats:bold>–</jats:bold>3.09]) and from 6 months to more (aRR = 3.17 [95% CI: 2.02<jats:bold>–</jats:bold>4.95]) increased the risk of TF. Likewise, treatment discontinuation of up to 6 months (aRR = 2.32 [95% CI: 1.40<jats:bold>–</jats:bold>3.84]) and from 6 months to more (aRR = 3.93 [95% CI: 2.39<jats:bold>–</jats:bold>6.45]) increased the risk of VF.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>HAART discontinuation increases the probability of TF and VF in Venezuelan immigrants.</jats:p></jats:sec>
      10Scopus© Citations 2
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    NPC1 as a Modulator of Disease Severity and Viral Entry of SARSCoV- 2
    <jats:sec> <jats:title /> <jats:p>The COVID-19 plague is hitting mankind. Several viruses, including SARS-CoV-1, MERS-CoV, EBOV, and SARS-CoV-2, use the endocytic machinery to enter the cell. Genomic variants in NPC1, which encodes for the endo-lysosomal Niemann-Pick type C1 protein, restricts the host-range of viruses in bats and susceptibility to infections in humans. Lack of NPC1 and its pharmacological suppression inhibits many viral infections including SARS-CoV-1 and Type I Feline Coronavirus Infection. Antiviral effects of NPC1-inhibiting drugs for COVID-19 treatment should be explored.</jats:p> </jats:sec>
    Scopus© Citations 10  2
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    Scopus© Citations 18  5
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    Latin American Youths’ Migration Journeys and Settlement in the Tarapacá Region in Chile: Implications for Sexual and Reproductive Health
    <jats:p>The sexual and reproductive health of young migrants has not been sufficiently addressed in mobility studies. In this article, we dwell on some aspects of this issue in the migration process of Latin American youth. We conducted a qualitative study in the region of Tarapacá, Chile, carrying out in-depth interviews with key informants, health staff and young migrants between 18 and 25 years old. The results show some motivations to migrate related to sexual and reproductive health: young pregnant women, LGBTQI+ and HIV-positive people seeking access to health care and social contexts of reduced gender discrimination. During the migration process, young people are exposed to various kinds of sexual violence, and in their settlement in Chile, to situations of racism, stigma and discrimination in society as a whole and in access to and during sexual and reproductive health care. Health care for young migrants is mainly focused on maternal care and reproductive issues, while sexual health as a whole is disregarded. We argue that sexual health must be addressed as a central dimension of the lived experiences of young migrants, and that the social, cultural and structural factors that undermine their sexual and reproductive health must be addressed in order to provide culturally competent health services.</jats:p>
      8Scopus© Citations 5
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    High Flow Nasal Cannula as Support in Immunocompromised Patients with Acute Respiratory Failure: A Retrospective Study
    (2021)
    Claudia Giugliano-Jaramillo
    ;
    Josefina León
    ;
    Cristobal Enriquez
    ;
    Juan E. Keymer
    ;
    Rodrigo Pérez-Araos
    <jats:sec> <jats:title>Introduction:</jats:title> <jats:p>High Flow Nasal Cannula (HFNC) is a novel technique for respiratory support that improves oxygenation. In some patients, it may reduce the work of breathing. In immunocompromised patients with Acute Respiratory Failure (ARF), Non-Invasive Ventilation (NIV) is the main support recommended strategy, since invasive mechanical ventilation could increase mortality rates. NIV used for more than 48 hours may be associated with increased in-hospital mortality and hospital length of stay. Therefore HFNC seems like a respiratory support alternative.</jats:p> </jats:sec> <jats:sec> <jats:title>Objective:</jats:title> <jats:p>To describe clinical outcomes of immunocompromised patients with ARF HFNC-supported.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods:</jats:title> <jats:p>Retrospective study in patients admitted with ARF and HFNC-supported. 25 adult patients were included, 21 pharmacologically and 4 non- pharmacologically immunosuppressed. Median age of the patients was 64 [60-76] years, APACHE II 15 [11-19], and PaO2:FiO2 218 [165-248]. Demographic information, origin of immunosuppression, Respiratory Rate (RR), Heart Rate (HR), Mean Arterial Pressure (MAP), oxygen saturation (SpO<jats:sub>2</jats:sub>) and PaO<jats:sub>2</jats:sub>:FiO<jats:sub>2</jats:sub> ratio were extracted from clinical records of our HFNC local protocol. Data acquisition was performed before and after the first 24 hours of connection. In addition, the need for greater ventilatory support after HFNC, orotracheal intubation, in-hospital mortality and 90 days out-patients’ mortality was recorded.</jats:p> </jats:sec> <jats:sec> <jats:title>Results:</jats:title> <jats:p>Mean RR before the connection was 25±22 breaths/min and 22±4 breaths/min after the first 24 hours of HFNC use (95% CI; p=0.02). HR mean before connection to HFNC was 96±22 beats/min, and after, it was 86±15 beats/min (95%CI; p=0.008). Previous mean MAP was 86±15 mmHg, and after HFNC, it was 80±12 mmHg (95%CI; p=0.09); mean SpO<jats:sub>2</jats:sub> after was 93±5% and before it was 95±4% (95% CI; p=0.13); and previous PaO<jats:sub>2</jats:sub>:FiO<jats:sub>2</jats:sub> mean was 219±66, and after it was 324±110 (95%CI; p=0.52). In-hospital mortality was 28% and 90 days out-patients’ mortality was 32%.</jats:p> </jats:sec> <jats:sec> <jats:title>Conclusion:</jats:title> <jats:p>HFNC in immunosuppressed ARF subjects significantly decreases HR and RR, being apparently an effective alternative to decrease work of breathing. In-hospital mortality in ARF immunosuppressed patients was high even though respiratory support was used. Better studies are needed to define the role of HFNC-support in ARF.</jats:p> </jats:sec>
      11
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    CD4/CD8 ratio as a predictor of the response to HBV vaccination in HIV-positive patients: A prospective cohort study
    (2016)
    Francisco Fuster
    ;
    Jose Ignacio Vargas
    ;
    Daniela Jensen
    ;
    Valeska Sarmiento
    ;
    Pedro Acuña
      13Scopus© Citations 53
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      13Scopus© Citations 11
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    Item type:Publication,
      13Scopus© Citations 16