ABSTRACT
Background: Three-drug antiretroviral therapy (ART-3) has reduced complications and improved survival in HIV+ patients. The Chilean Public Health System began dual therapy (ART-2) in 1997, covering approximately 40 percent of patients in need. Aim: To report the results of a follow-up of patients with and without access to ART in a Chilean public hospital. Patient and Methods: Prospective follow-up of patients with ART-2 and 3 (cases) and patients with no access to ART (controls). All patients needed ART but it was available to a minority of them. Selection for ART was at random. Follow-up was between 6-24 months (11/96 to 3/99). Basal and periodic clinical and laboratory parameters were determined. Mortality and occurrence of new AIDS-defining events (ADE) were compared statistically using chi square. Results: One hundred and fifty cases (106 ART2, 28 ART3 and 16 ART2 expanded to ART3) and 166 controls were studied. Basal parameters were similar except prior ART (32.7 and 18.7 percent in cases and controls respectively). Close to 1/3 patients had AIDS. Cases had a mean follow up of 527 days; controls, 478. Six cases (4 percent) (5 in ART-2) and 17 controls (10 percent) died. Mortality x 100/pts/yr was 2.7 in cases and 7.7 in controls, p <0.05. ADE per 100/pts/yr was 21 in cases (24.4 in ART2, 15.1 in TAR3) and 54.5 in controls, p <0.05. Cases had a reduction of: esophageal candidiasis (84 percent), tuberculosis (75 percent), cryptococcosis and toxoplasmosis (66 percent), P carinii pneumonia (55 percent) and bacterial pneumonia (46 percent) and they had fewer hospitalizations (73 percent). Late assessment: 70 of 101 ART-2 patients had changed to ART-3 (1 death); 22 of 101 kept original ART-2 (12 dead, 10 alive), 39 of 43 ART-3 patients were alive and 1 died. Conclusions: Short-term ART-2 and 3 significantly reduced mortality (60 percent and 73 percent) ADE (65 percent and 76 percent respectively) and hospitalizations. Benefits of ART-2 were short lived. Resource-constrained countries cannot depend on weaker than standard ART for proper care of people with HIV disease
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Zidovudine , Lamivudine , Acquired Immunodeficiency Syndrome/drug therapy , Case-Control Studies , Prospective Studies , AIDS-Related Opportunistic Infections , Anti-HIV Agents , Hospitalization , Acquired Immunodeficiency Syndrome/complications , Acquired Immunodeficiency Syndrome/mortalityABSTRACT
Background: Combined antiretroviral therapy (AVR) has shown a protective effect (PE) on morbidity and survival in HIV (+) patients of industrialised countries where triple-drug therapy (ARV-3) is standard. In Chile the public health system began providing double-drug therapy in 1997 (ARV-2) with 2 reverse transcriptase inhibitors. Aim: To assess the impact of ARV in morbimortality of HIV (+) patients in Chile after a year of follow up. Patients and methods: Retrospective case-control (1:1) study. Cases were 97 patients followed during 1997 for 6 or more months and dying during that period. Each case had a control of the same gender and CDC stage, similar age and CD4 count, but surviving a same period of follow up. A comparison of ARV before and during follow up (rate and type) was done. P carinii prophylaxis, pneumococcal immunization at baseline or follow up, frequency of hospital admissions and occurrence of opportunistic infections in both groups were assessed. Odds ratio (OR) for mortality, hospitalisation and opportunistic infections in ARV user, as well as treatment PE were calculated. Results: Twenty four (24.7 percent) cases and sixty six (68 percent) controls received ARV during follow up (p< 0.001), OR was 0.15 (CI 95 percent 0.08-0.3), p < 0.001, the PE was 6.6 for ARV users versus non users, among cases 19 patients received ARV-2 and five received ARV-3. Among controls, 41 patients received ARV-2 and 25 received ARV-3. These differences established an OR of 0.20 (CI 95 percent 0.09-0.04) and a PE of 5 for ARV-2 versus no ARV. For ARV-3 compared with no ARV the OR was 0.08 (CI 95 percent 0.003-0.26), and the PE 12.5. Fifty three (54.6 percent) cases and 13 (13.4 percent) controls required hospital admission, OR 0.49 (CI 95 percent 0.25-0.94), p=0.03, and PE of 2.04 of ARV versus no ARV; 82 (85.3 percent) cases and 50 (51 percent) controls had opportunistic infections, OR 0.5 (CI 95 percent 0.26-0.96), p=0.03 and PE of 2 for ARV versus no ARV. There were no significant differences in prior ARV, prophylaxis and immunisation between cases and controls. Conclusions: This study showed the high impact of ARV in short term morbimortality of HIV(+) patients and the need to implement antiretroviral therapy to all patients as an official health policy. This study did not answer the question of the role, if any, of weaker-than standard antiretroviral therapy
Subject(s)
Humans , Female , Male , Adult , Middle Aged , Protease Inhibitors/pharmacology , Zidovudine/pharmacology , Reverse Transcriptase Inhibitors/pharmacology , Acquired Immunodeficiency Syndrome/drug therapy , Case-Control Studies , Retrospective Studies , AIDS-Related Opportunistic Infections/drug therapy , AIDS-Related Opportunistic Infections/epidemiology , Anti-HIV Agents/pharmacology , Drug Therapy, Combination , Hospitalization/statistics & numerical data , Acquired Immunodeficiency Syndrome/mortalityABSTRACT
La etiología de la uretitis no gonocóccica trasciende las infecciones por chlamydia trachomatis y ureaplasma urealyticum. otros agentes etiológicos comunes son responsables de aproximadamente 20 por ciento de los casos y en un tercio no se precisa una etiología. Por esta situación se requiere de una nueva terminología para caracterizar mejor esta entidad. Test de amplificación genómica aplicados a la secreción uretral u orina son nuevas herramientas para un diagnóstico precoz de chlamydia trachomatis. El diagnóstico precoz es muy importante para evitar complicaciones y secuelas, especialmente infertilidad en mujeres, mediante un tratamiento oportuno y adecuado. Azitromicina, 1g oral, en dosis única es un avance significativo en el tratamiento de la uretritis causada por clamidias
Subject(s)
Humans , Chlamydia trachomatis/isolation & purification , Ureaplasma urealyticum/isolation & purification , Urethritis/diagnosis , Azithromycin/therapeutic use , Chlamydia trachomatis/drug effects , Chlamydia trachomatis/pathogenicity , Gene Amplification , Ureaplasma urealyticum/drug effects , Ureaplasma urealyticum/pathogenicity , Urethritis/drug therapy , Urethritis/etiology , Urine/microbiologySubject(s)
Humans , Female , Pregnancy , Adult , Infant, Newborn , Malaria/diagnosis , Pregnancy Complications, Infectious/diagnosis , Malaria, Cerebral/etiology , Malaria, Falciparum , Malaria/complications , Malaria/drug therapy , Malaria/etiology , Plasmodium falciparum/drug effects , Plasmodium falciparum/pathogenicity , Pregnancy Complications, Infectious/drug therapy , Quinine/therapeutic useABSTRACT
Se presenta la experiencia con 50 pacientes VIH positivos tratados en un período de 4 años por patología anorrectal. Se trata de 49 hombres y una mujer con un promedio etario de 35 años (extremos 20-59), 52 por ciento homosexuales, 28 por ciento bisexuales y 20 por ciento heterosexuales. El 94 por ciento presentaba enfermedades asociadas, destacando las ETS en el 70 por ciento y la tuberculosis en el 18 por ciento. El 64 por ciento de los casos corresponde a SIDA según la clasificación del CDC de 1993, cifra que alcanza al 17 por ciento en los 23 pacientes (46 por ciento) sometidos a tratamiento quirúrgico. La principal indicación de cirugía fue la sepsis perianal, seguida de los condilomas y la enfermedad ulcerativa anorrectal. La cicatrización se logró en todos los pacientes entre 20 y 60 días, con control sintomático satisfactorio en el 60 por ciento de los tratados en forma conservadora. El seguimiento es completo en el 70 por ciento de los casos con un promedio de 14 meses (extremos 3-29), falleciendo 15 pacientes por la enfermedad de base. Los resultados de la cirugía son alentadores aunque se reconoce un sesgo en la selección de los candidatos a cirugía, con exclusión de los pacientes con enfermedad más avanzada. La mayor sobrevida actual de los pacientes VIH nos plantea un desafío en cuanto al manejo de la patología proctológica, ya sea con fines curativos o paliativos