The quality of the revised apps is limited. Only one app complied with the excellence criteria, and over 50% of the apps did not exceed minimum quality standards. The worst rated aspects were political advertising and logical security.

BACkgRound: Hepatitis C virus (HCV) infection affects more than 170 million people worldwide, and one-third of them have human immunodeficiency virus (HIV) coinfection. Multiple studies have been conducted in order to identify the factors that may explain different responses to treatment among patients. However, the reasons why HIV-HCV coinfected patients have lower responses to treatment are not clear. In addition, no studies have evaluated the influence of the complexity of the therapeutic regimen for hepatitis C infection on clinical outcomes.

Background As people with HIV infections age, comorbidities and complications have increased and could affect antiretroviral therapy (ART) adherence. Purpose To determine the comorbidities of patients with HIV infection, as well as to evaluate their contribution to ART adherence. Materials and methods A twelve-month retrospective observational study (from January 2012 to December 2012) was conducted in HIV-infected patients who were being treated with ART. ART adherence was the dependent variable. We collected the following independent variables: sex, age, HCV coinfection, transmission risk, CD4+ T-cell count, HIV viral load, ART-naive, type of ART and comorbidities. We defined polypathological patients as patients with two or more chronic conditions. Adherence was determined through dispensing pharmacy records (Total number of units dispensed/Total number of units needed×100) and the simplified medicines adherence questionnaire (SMAQ). Patients who took at least 90% of their prescribed ART were classified as good adherers. We performed a univariate logistic regression to determine the relationship between the comorbidities and ART adherence. Results We included 536 patients in the study (80.2% men, mean age 47 ± 7.1 years) of whom 49.2% were HIV-HCV co-infected. Injected drug use was the main mode of HIV transmission. The median CD4+ was 574.5 cells/mm3 (IQR: 353.8–776.3) and viral suppression (<20 copies/ml) was noted in 73.5% of the whole study population. 82.5% were ART-naive overall, antiretroviral regimens were mainly NNRTI-based (40.3%), and 31.5% were receiving a PI-based regimen. We identified 51.9% polypathological patients. The most common comorbidities were: dyslipidaemia (19.4%), neuropsychiatric disorders (14.7%), hypertension (13.2%), diabetes (5.6%) and cardiovascular disease (5.2%). The percentage of adherent patients was 86.2%. The variable polypathological patients (OR = 0.44; CI[0.26–.74]; p = 0.002) showed statistically significant relationships with ART adherence. Conclusions There is an important number of polypathological HIV-infected patients. Despite ART adherence being high, the presence of these comorbidities significantly reduces adherence. No conflict of interest.

BackgroundTreatment with tocilizumab has been associated with an increase in transaminase levels which may be related to treatment discontinuation.PurposeTo examine changes of transaminase levels (AST/ALT) in patients with rheumatic diseases treated with tocilizumab, as well as analyse the checking interventions.Material and methodsRetrospective observational study. Patients on treatment with tocilizumab between January 2007 and July 2014 were included. The data collected were: demographic, diagnosis, duration and dosage pattern of treatment, AST/ALT levels and concomitant treatment with methotrexate. The data were collected through outpatient electronic medical records.ResultsWe included 21 patients (86% male, 45.6 ± 13.8 years). 71% of patients had rheumatoid arthritis. The mean treatment duration was 24.4 ± 15.8 months. After the start of treatment with tocilizumab, 52% patients had values above the upper limit of normality (ULN, ALT > 50 U/L and AST > 40 U/L); 36% of them received methotrexate. In 9 patients (82%) the results reached values 1–3 times >ULN and in 2 patients (18%) values were observed 3–5 times >ULN. In 64% of patients the levels remained >ULN during treatment. Higher ALT/AST levels occurred in two patients who received doses of 8 mg/kg of tocilizumab. One of them was also on methotrexate treatment.The increase of AST/ALT levels occurred in 73% of patients between the first and third doses of treatment. In 3 patients a pharmacological intervention was made. The interventions were to decrease the tocilizumab dose (2 patients) and to decrease both the dose of tocilizumab and methotrexate.1 Two of them succeeded in normalising AST/ALT levels.ConclusionHalf of the patients treated with tocilizumab suffer an increase in AST/ALT levels, which in most cases is maintained over time. Concomitant treatment with methotrexate seems to predispose to an earlier increase of transaminase levels.Tocilizumab risk management should include continuous monitoring of transaminase levels so as to identify patients with a higher risk.ReferencesRheumatology (Oxford) 2012;51(Suppl 5):v38–47Reumatol Clin 2014;10(2):94–100Adherencia Paciente Prefiero 2013;7:653–66No conflict of interest.

Background Treatment modifications during the first year of starting antiretroviral treatment (ART) are extremely important. The first ART regimen should remain for years. First regimen toxicity can have a negative impact on adherence and virological efficacy. Purpose To identify patients who discontinued treatment with antiretroviral treatment within the first year in a HIV cohort and to analyse the factors that led to discontinuation of the treatment. Materials and methods Prospective multicentre study. Treatment-naive adult HIV patients who started treatment in 2011 were selected. Basic demographic characteristics (sex and age) and the pharmacotherapeutic variables initial ART, discontinuation of ART within the first year and reasons for this based on Swiss HIV Cohort (Elzi et al. Arch Intern Med. 2010) were collected. The main reasons for treatment modification were classified as treatment failure, intolerance and/or toxic effects, the patient’s choice, the physician’s decision, and other reasons. Results 108 patients started ART in 2011, 83% men. The mean age was 40 ± 11. The most frequent ART was emtricitabine/tenofovir/efavirenz (61%) followed by emtricitabine, tenofovir, atazanavir/ritonavir (16%), emtricitabine, tenofovir, darunavir/ritonavir (12%) and other combinations (11%). During the first year of ART, 28 individuals modified their treatment. The reasons for treatment discontinuation were: 60% intolerance or toxic effects, 18% treatment failure, 14% the physician’s decision and 8% other reasons. 17 patients modified their treatment because of drug intolerance and/or drug toxicity. Gastrointestinal tract intolerance was the most frequent toxic effect (29.4%), followed by rash (23.5%), hypersensitivity (17.6%), psychiatric events (11.7%), and others (17.8%). We emphasise that 28% of patients discontinued treatment more than once in the first year, especially those in the gastrointestinal tract intolerance group. Conclusions The main reasons for treatment discontinuation were intolerance or toxic effects. It is necessary to properly assess starting ART to reduce adverse events involving changes in the treatment. No conflict of interest.