A Novel Acute Retroviral Syndrome Severity Score Predicts the Key Surrogate Markers for HIV-1 Disease Progression.

OBJECTIVE: Best long-term practice in primary HIV-1 infection (PHI) remains unknown for the individual. A risk-based scoring system associated with surrogate markers of HIV-1 disease progression could be helpful to stratify patients with PHI at highest risk for HIV-1 disease progression. METHODS: We prospectively enrolled 290 individuals with well-documented PHI in the Zurich Primary HIV-1 Infection Study, an open-label, non-randomized, observational, single-center study. Patients could choose to undergo early antiretroviral treatment (eART) and stop it after one year of undetectable viremia, to go on with treatment indefinitely, or to defer treatment. For each patient we calculated an a priori defined "Acute Retroviral Syndrome Severity Score" (ARSSS), consisting of clinical and basic laboratory variables, ranging from zero to ten points. We used linear regression models to assess the association between ARSSS and log baseline viral load (VL), baseline CD4+ cell count, and log viral setpoint (sVL) (i.e. VL measured ≥90 days after infection or treatment interruption). RESULTS: Mean ARSSS was 2.89. CD4+ cell count at baseline was negatively correlated with ARSSS (p = 0.03, n = 289), whereas HIV-RNA levels at baseline showed a strong positive correlation with ARSSS (p<0.001, n = 290). In the regression models, a 1-point increase in the score corresponded to a 0.10 log increase in baseline VL and a CD4+cell count decline of 12/µl, respectively. In patients with PHI and not undergoing eART, higher ARSSS were significantly associated with higher sVL (p = 0.029, n = 64). In contrast, in patients undergoing eART with subsequent structured treatment interruption, no correlation was found between sVL and ARSSS (p = 0.28, n = 40). CONCLUSION: The ARSSS is a simple clinical score that correlates with the best-validated surrogate markers of HIV-1 disease progression. In regions where ART is not universally available and eART is not standard this score may help identifying patients who will profit the most from early antiretroviral therapy.

Principio de unidad familiar y cambio de vecindad civil por residencia. Comentario a la STS, 1ª, 14.9.2009

En la línea apuntada por la mayoría de la doctrina, la STS de 14.9.2009 considera que desde la entrada en vigor de la Constitución española (1978) debía entenderse derogada la regla de propagación a la esposa de la vecindad civil del marido prevista en el art. 14.4 CCe [redacción de 1974]; ello supone que desde entonces la mujer casada pudo cambiar autónomamente de vecindad civil. Partiendo de ello, en el caso enjuiciado, la mujer cambió de vecindad civil por residencia continuada en Cataluña durante más de diez años sin declaración en contrario (art. 14.3.2.o CCe [1974] y 14.5.2.o CCe [1990]), vecindad civil catalana que mantenía en el momento de su fallecimiento, pese a haber realizado distintas manifestaciones ¿que resultan ineficaces? en el sentido de ostentar o de querer conservar la vecindad civil navarra.

Treatment-Naive Individuals Are the Major Source of Transmitted HIV-1 Drug Resistance in Men Who Have Sex With Men in the Swiss HIV Cohort Study.

Background.195;Human immunodeficiency virus type 1 (HIV-1) transmitted drug resistance (TDR) can compromise antiretroviral therapy (ART) and thus represents an important public health concern. Typically, sources of TDR remain unknown, but they can be characterized with molecular epidemiologic approaches. We used the highly representative Swiss HIV Cohort Study (SHCS) and linked drug resistance database (SHCS-DRDB) to analyze sources of TDR. Methods.195;ART-naive men who have sex with men with infection date estimates between 1996 and 2009 were chosen for surveillance of TDR in HIV-1 subtype B (N = 1674), as the SHCS-DRDB contains pre-ART genotypic resistance tests for >69% of this surveillance population. A phylogeny was inferred using pol sequences from surveillance patients and all subtype B sequences from the SHCS-DRDB (6934 additional patients). Potential sources of TDR were identified based on phylogenetic clustering, shared resistance mutations, genetic distance, and estimated infection dates. Results.195;One hundred forty of 1674 (8.4%) surveillance patients carried virus with TDR; 86 of 140 (61.4%) were assigned to clusters. Potential sources of TDR were found for 50 of 86 (58.1%) of these patients. ART-naive patients constitute 56 of 66 (84.8%) potential sources and were significantly overrepresented among sources (odds ratio, 6.43 [95% confidence interval, 3.22-12.82]; P < .001). Particularly large transmission clusters were observed for the L90M mutation, and the spread of L90M continued even after the near cessation of antiretroviral use selecting for that mutation. Three clusters showed evidence of reversion of K103N or T215Y/F. Conclusions.195;Many individuals harboring viral TDR belonged to transmission clusters with other Swiss patients, indicating substantial domestic transmission of TDR in Switzerland. Most TDR in clusters could be linked to sources, indicating good surveillance of TDR in the SHCS-DRDB. Most TDR sources were ART naive. This, and the presence of long TDR transmission chains, suggests that resistance mutations are frequently transmitted among untreated individuals, highlighting the importance of early diagnosis and treatment.

[Illustrations de L'art du fabricant de velours de coton] / Bernard, grav.; Fossier, dess. ; Jean-Marie Roland de la Platière, aut. du texte

Comprend : [Bandeau folio Aij : allégorie de la Justice. Homme écrivant, singe. Ornements à la Bérin.] [Cote : Res Atlas V 117/Microfilm R 101257] ; [Pl.1 : de la mécanique à carder le coton. Vues et développements de la machine à carder le coton.] L'art du fabricant de velours de coton. [Cote : Res Atlas V 117/Microfilm R 101257] ; [Pl.2 : de la mécanique à carder le coton. Machine à carder le coton.] L'art du fabricant de velours de coton. [Cote : Res Atlas V 117/Microfilm R 101257] ; [Pl.3 : de la mécanique à carder le coton. Machine à carder le coton. Fig.4 : petits cadres en fer, implantés sur la charpente de la mécanique, sur lesquels s'appuie et tourne l'axe des cylindres.] L'art du fabricant de velours de coton. [Cote : Res Atlas V 117/Microfilm R 101257] ; [Pl.4 : de la mécanique à filer le coton et de la manière de s'en servir.] L'art du fabricant de velours de coton. [Cote : Res Atlas V 117/Microfilm R 101257] ; [Pl.5 : de la mécanique à filer le coton et de la manière de s'en servir.] L'art du fabricant de velours de coton. [Cote : Res Atlas V 117/Microfilm R 101257] ; [Pl.6 : fabrication du velours. Fig.1 : moulins à retordre les fils de coton, doublés pour la châine des velours] L'art du fabricant de velours de coton. [Cote : Res Atlas V 117/Microfilm R 101257] ; [Pl.7 : fabrication du velours. Fig.1 : vue perspective du métier monté et en travail.] L'art du fabricant de velours de coton. [Cote : Res Atlas V 117/Microfilm R 101257] ; [Pl.8 : fabrication du velours. Armure de piqué pour un carreau quatre points simple ou double, velours velvet-ret, croisé, piqué ou cannelé. Fig.8 : fabrication d'une toile sans lisière.] L'art du fabricant de velours de coton. [Cote : Res Atlas V 117/Microfilm R 101257] ; [Pl.9 : fabrication du velours. Le fourneau à brûler, griller ou raser les velours de coton et de la manière de faire cette opération.] L'art du fabricant de velours de coton. [Cote : Res Atlas V 117/Microfilm R 101257] ; [Pl.10 avec 3 vignettes : vignette 1, fabrication du velours. Des couleurs en bon teint. Atelier de teinture pour les coulers ordinaires, les garançages etc. Vignette 2 : atelier de teinture pour les cuves de bleu. Vignette 3 : atelier de teinture pour les tones de noir.] L'art du fabricant de velours de coton. [Cote : Res Atlas V 117/Microfilm R 101257] ; [Pl.11 : fabrication du velours. Des couleurs en bon teint. De la cuve du bleu à chaud. Mécanique à imprimer au cylindre les toiles, croisés, satinettes, velours de coton etc. Mécanique à découper les velours cannelés et le velvet-ret avec l'ouvrier vu en travail. ] L'art du fabricant de velours de coton. [Cote : Res Atlas V 117/Microfilm R 101257]