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1.
Rev. bras. ciênc. saúde ; 24(1): 57-62, 2020. ilus
Article in Portuguese | LILACS | ID: biblio-1087474

ABSTRACT

Objetivo: Avaliar a influência da terapia na morfologia da epiderme de pacientes com Síndrome da Imunodeficiência Adquirida - AIDS. Metodologia: Estudo transversal desenvolvido na Universidade Federal do Triângulo Mineiro, Brasil. Foram selecionados pacientes com AIDS de ambos os sexos, que foram agrupados de acordo com o tratamento com Terapia antir-retroviral de alta eficiência: pacientes em uso de HAART (n = 14) e pacientes sem uso de HAART (n = 14). Outras informações foram coletadas do prontuário clínico. Resultados: A idade média dos pacientes em tratamento foi de 49,07 ± 7,89 anos e dos pacientes sem TARV foi de 55,11 ± 10,17 anos. A maioria dos pacientes na terapia utilizada pertencia ao sexo feminino, 9 (64,28%). Estes apresentaram espessamento epidérmico (150,04 x 86,09µm), número de camadas celulares (8,0 x 5,5 camadas) e densidade de células de Langerhans superiores àquelas que não utilizaram a terapia, com diferença significativa. Conclusão: Nossos achados sugerem que o HAART propor-ciona a recuperação dos constituintes da epiderme alterados pela doença, melhorando sua função como barreira chave na proteção do corpo contra microorganismos ambientais. (AU)


Objective: To evaluate the influence of therapy in the morphology of the epidermis of patients with Acquired Immunodeficiency Syndrome. Methodology: Cross-sectional study developed at the Triangulo Mineiro Federal University, Brazil. This study has been approved by Triângulo Mineiro Federal University Research Ethics Committee on protocol number 1780/2010. Patients with AIDS, of both genders were selected and arranged according to treatment with Highly Active Antiretroviral Therapy: patients in use of HAART (n = 14), and patients without use of HAART (n = 14). Other information was collected from the clinical record. Results: The mean age of the patients undergoing therapy was 49.07±7.89 years, and of the patients without HAART was 55.11±10.17 years. The majority of the patients using the therapy, belonged to the female gender, 9 (64.28%). These showed epidermal thickness (150.04 x 86.09µm), number of cell layers (8.0 x 5.5 layers) and density of Langerhans cells higher than those who did not use the therapy, with a significant difference. Conclusion: Our findings suggest that the HAART provides recovery of epidermis constituents altered by the disease, improving its function as a key barrier in protecting the body against environmental microorganisms. (AU)


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Acquired Immunodeficiency Syndrome , Antiretroviral Therapy, Highly Active , Epidermal Cells , Aging
2.
Rev. chil. infectol ; 36(4): 490-495, ago. 2019. tab
Article in Spanish | LILACS | ID: biblio-1042666

ABSTRACT

Resumen Introducción: El impacto del cambio de terapia antiretroviral (TAR) para tratar la dislipidemia en pacientes infectados por VIH no ha sido reportado en Chile. Objetivo: Evaluar la efectividad y seguridad a 12 meses del cambio de TAR a esquema con raltegravir (RAL) para tratar la dislipidemia. Material y Métodos: Cohorte retrospectiva de pacientes con infección por VIH en TAR, atendidos en Fundación Arriarán, con dislipidemia y que cambiaron a esquema con RAL para tratarla. Resultados: Se incluyó 73 casos, en TAR con inhibidores no nucleosídicos de transcriptasa reversa (INNTR; 50,7%) o inhibidores de proteasa (IP; 49,3%), con dislipidemia mixta (42,5%) o hipertrigliceridemia aislada (57,5%). La mediana de colesterol total (CT) y triglicéridos (TG) basales era 228 mg/dl y 420 mg/dl, respectivamente. El 94,5% tenía carga viral (CV) indetectable. Se modificó TAR de base en 58,4%; 89,1% recibía hipolipemiantes. Las concentraciones plasmáticas de lípidos descendieron significativamente a 12 meses (TG= −43,6%; CT= −19,3%). Ningún paciente presentó fracaso virológico, aunque 10,9% tuvo viremia detectable a 12 meses, mayoritariamente transitoria. Conclusiones: El cambio de TAR a RAL en pacientes dislipidémicos tratados con INNTR o IP reduce significativamente las concentraciones plasmáticas de TG y CT a 12 meses. Es una estrategia segura, pero puede observarse viremia transitoria.


Background: The impact of switching antiretroviral therapy (ART) regimen for dyslipidemia management in HIV-infected (HIV+) patients has not been reported in Chile. Aim: To assess effectiveness and safety at 12 months after switching to raltegravir-based regimen for dyslipidemia management. Methods: Retrospective cohort of HIV+ patients receiving ART at Arriaran Foundation, with dyslipidemia switched to raltegravir-based regimen for lipid management. Results: 73 patients were included, receiving ART based in nonnucleoside reverse transcriptase inhibitor (NNRTI; 50,7%) or protease inhibitor (PI; 49,3%), with mixed dyslipidemia (42,5%) or isolated hypertriglyceridemia (57,5%). At baseline, median total cholesterol (TC) and triglycerides (TG) were 228 mg/dl and 420 mg/dl, respectively; undetectable viral load (VL) was present in 94,5% of patients. Backbone ART was switched in 58,4% and lipid-lowering therapy was used by 89,1% of them. At 12 months, there was a significant decrease in TG (-43,6%) and TC (-19,3%). No cases of virologic failure were observed, although 10,9% of patients had detectable VL at 12 months, mostly transient. Conclusions: Switching ART to raltegravir-based regimen in dyslipidemic patients receiving NNRTI or PI is associated with a significative decrease in TG and TC at 12 months. This strategy is safe, but VL can be increased temporarily.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , HIV Infections/drug therapy , HIV Protease Inhibitors/adverse effects , Anti-HIV Agents/administration & dosage , Antiretroviral Therapy, Highly Active/methods , Dyslipidemias/prevention & control , Raltegravir Potassium/administration & dosage , HIV Infections/blood , Retrospective Studies , Cohort Studies , Follow-Up Studies , CD4 Lymphocyte Count , Viral Load
3.
Rev. chil. infectol ; 35(3): 326-328, 2018. tab, graf
Article in Spanish | LILACS | ID: biblio-1042646

ABSTRACT

Resumen Introducción: La terapia anti-retroviral (TARV) en pacientes con infección por VIH ha causado una disminución de la morbimortalidad y del riesgo de transmisión. Las recomendaciones internacionales actuales sugieren un inicio precoz de TARV, independiente del recuento de linfocitos T CD4. Objetivo: Describir el impacto del inicio de TARV en el recuento de CD4 y carga viral (CV) al año de tratamiento en pacientes que ingresaron al Programa de VIH del HCVB en los años 2013 y 2015. Métodos: Estudio descriptivo que incluyó a todos los pacientes que iniciaron TARV durante los años mencionados. Resultados: 78 y 100 pacientes iniciaron TARV el año 2013 y 2015; respectivamente. El año 2013, 48 (61,5%) pacientes, y el año 2015, 55 (55%) pacientes iniciaron terapia con un recuento de CD4 > 200 céls/mm3. En el primer grupo, al año de seguimiento, 43 (55%) pacientes tuvieron una CV indetectable; mientras que en el segundo grupo, esta meta se logró en 72% de los casos (p = 0,001). Conclusiones: El inicio temprano de TARV aumentó la proporción de pacientes con CV indetectable. Sin embargo, debemos mejorar las estrategias para optimizar los resultados.


Introduction: Anti-retroviral therapy (ART) in HIV patients has shown reduction in morbidity and mortality, and decrease in contagious risk. International recommendations include early initiation of ART, irrespectively of CD4 cell count. Objective: To describe the impact of ART initiation in CD4 cell count and viral load at the end of the first year of HIV treatment, for patients who entered the program at 2013 and 2015. Methodology: Descriptive study. The sample comprehends all patients who started their ART treatment in the indicated years, at HCVB. Results: 78 and 100 patients initiated ART treatment in 2013 and 2015, respectively. In 2013, 48 out of 78 patients (61.5%), and in 2015, 55 (55%) patients started therapy with CD4 > 200 cell/mm3. The follow-up in the first group resulted on 43 (55%) patients with an undetectable CV at the end of first year of treatment, meanwhile in the second group 72% achieved this target (p = 0.001). Conclusions: Early ART initiation increased the proportion of patients with undetectable CV. However, we must improve strategies to optimize results.


Subject(s)
Humans , Male , Adult , HIV Infections/drug therapy , CD4 Lymphocyte Count , Anti-HIV Agents/therapeutic use , Viral Load , Antiretroviral Therapy, Highly Active , HIV Infections/immunology , HIV Infections/virology , Follow-Up Studies
4.
Rev. chil. infectol ; 34(4): 352-358, ago. 2017. tab, graf
Article in Spanish | LILACS | ID: biblio-899723

ABSTRACT

Resumen Introducción: La adecuada adherencia a la TARV tiene un alto impacto en la sobrevida en el SIDA. Existe poco consenso sobre las causas de la baja adherencia al tratamiento en mujeres, estando éstas en una situación de desigualdad en términos de prevención y cuidados relacionados. Objetivos: Explorar y describir los aspectos socioculturales vinculados a la adherencia de mujeres al tratamiento anti-retroviral para el VIH/SIDA. Material y Métodos: Estudio cualitativo, exploratorio-descriptivo. La población de estudio fueron mujeres chilenas de 18 de edad o más con infección por VIH/SIDA. El tamaño de la muestra se definió por saturación de información. Se realizaron entrevistas en profundidad a 16 mujeres contactadas en siete centros públicos de atención a personas con infección por VIH en cuatro regiones del país, atendiendo al criterio de saturación de la información. Resultados: Existen diversos factores socio-culturales que determinan el grado de adherencia que las mujeres adoptan en relación al TARV. Los más relevantes son la satisfacción vital, el imaginario sobre el VIH, la disposición de sus redes frente al diagnóstico y la disponibilidad de información. Discusión: Se hace necesario incursionar en intervenciones específicas considerando los aspectos socio-culturales y satisfaciendo las necesidades psicosociales de las mujeres. Se hace imprescindible que las políticas públicas y los equipos de salud consideren dichos aspectos para mejorar la adherencia a la TARV.


Background: Adequate adherence to HAART has a high impact on survival of AIDA patients. There is little consensus on the causes of low adherence to treatment in women, who are in a situation of inequality in terms of prevention and related care. Objectives: To explore and describe the socio-cultural aspects related to the adherence of women to antiretroviral treatment for HIV / AIDS. Material and Methods: Qualitative, exploratory-descriptive study. The study population was focused on Chilean women, who are 18 years of age or older, living with HIV/AIDS. The sample size was defined by information saturation. In-depth interviews were conducted with 16 women contacted in seven public care centers for people living with HIV (PLHIV) in 4 regions of the country, and it was take into account the saturation of the information. Results: There are several sociocultural factors that determine the level of adherence that women adopt in relation to HAART. The most relevant ones are the vital satisfaction, the imaginary about HIV, the availability of their networks in front of diagnosis and the availability of information are fundamental. Discussion: It is necessary to enter into specific interventions considering the sociocultural aspects and satisfying the psychosocial needs of women. It is imperative that public policies and health teams consider these aspects to improve adherence to HAART.


Subject(s)
Humans , Female , Adult , HIV Infections/drug therapy , Anti-HIV Agents/therapeutic use , Cultural Characteristics , Medication Adherence/statistics & numerical data , Socioeconomic Factors , Chile , Sex Factors , Qualitative Research , Medication Adherence/psychology
5.
Rev. chil. infectol ; 33(supl.1): 11-19, oct. 2016. ilus, graf
Article in Spanish | LILACS | ID: biblio-844431

ABSTRACT

The present document describes the Cohort of HIV/AIDS children detected in Chile from 1987 to August 2014 and the effectiveness of the Protocol for Prevention of Vertical Transmission (PPVT) of HIV infection. Of the 375 HIV infected children enrolled since 1987 to August 2014, 245 of them are still in pediatric control. From the analysis of the Cohort is inferred that: a) it has observed an improvement in the detection of the HIV infected child, in number and precocious time; b) the majority of these children continue to be detected by clinic symptoms and signs (mainly unspecific and infectious manifestations); c) the ARVT use has meant a clinic and immunologic improvement with diminution of the infections, principally opportunistic infections, with a better life quality, a prolongation of survival and a diminution of lethality; d) as more survival has been produced, cancer has begun to be detected, a very infrequent complication observed in them before the ARVT use. The PPVT started in 1995, and was reinforced in 2005 with the "Joint Norm of HIV and Syphilis Vertical Transmission Prevention" (MINSAL), both have meant a diminution of the HIV vertical transmission from > 35% (before 1995) to < 2% nowadays in the mother-child binomial; also have permitted a second generation of HIV exposed children born without infection. In spite this PPVT, still HIV infected child continue to be detected which imply failures in some points of the health system.


Se presentan datos de la cohorte de niños con infección por VIH/SIDA detectados en Chile desde el año 1987 a agosto de 2014 y datos de la transmisión vertical (TV) del VIH con uso de protocolos de prevención de TV (PPTV). De los 375 niños infectados con VIH en este período, siguen en control pediátrico 245. Del análisis de la cohorte se desprende que: a) ha habido una mejoría en la pesquisa de los niños infectados con VIH, tanto en número como en precocidad; b) estos niños siguen detectándose, en su mayoría, por hechos clínicos (manifestaciones inespecíficas e infecciosas principalmente); c) el uso de TARV ha significado una mejoría clínica e inmunológica con disminución de las infecciones, principalmente las oportunistas, con una mejor calidad de vida, prolongación de la sobrevida, y disminución de la letalidad; d) por su mayor sobrevida, se ha observado el desarrollo de cánceres, muy infrecuentes en ellos antes del uso de terapia anti-retroviral. La aplicación de Protocolos de Prevención de la TV desde 1995, reforzada el 2005 con la “Norma Conjunta de la Prevención de la Transmisión Vertical del VIH y Sífilis” (MINSAL), ha significado una disminución de la TV del VIH desde más de 35% (antes de 1995) a < 2% actualmente en los binomios en prevención; además ha permitido que una segunda generación de niños expuestos al VIH nazca no infectada. A pesar de estos PPTV, aún siguen naciendo niños infectados con VIH, lo que implica fallas en algunos puntos del sistema de salud.


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Acquired Immunodeficiency Syndrome/drug therapy , Acquired Immunodeficiency Syndrome/epidemiology , Antiretroviral Therapy, Highly Active/statistics & numerical data , Time Factors , HIV Infections , Chile/epidemiology , Cohort Studies , Cause of Death , Age Factors , AIDS-Related Opportunistic Infections , Age Distribution , Infectious Disease Transmission, Vertical
6.
Rev. chil. infectol ; 33(5): 531-536, oct. 2016. ilus, graf, tab
Article in English | LILACS | ID: biblio-844404

ABSTRACT

Introduction: Red Salud UC is an Academic health network where HIV-infected patients from the public and private health system are followed by a multidisplinary team. Aim: To determine virologic and immunologic response after 144 weeks of starting first antiretroviral therapy in these patients. Methods: A retrospective analysis of adult HIV patients attended between 1992 and 2011 was performed. Demographic and clinical characteristics, antiretroviral therapies data and immunologic and virologic outcomes were collected. CD4 count and HIV viral load changes up to 144 weeks after initiation of antiretroviral therapy were analyzed. Results: 860 patients were included in the analyses. Median age was 42 years, 93% were men. Median CD4+ count at baseline was 202 cells/mm³. The most used ART regimen was zidovudine/lamivudine plus efavirenz. First line anti-retroviral therapy was changed in 42% patients, being the most common cause, drug toxicity. At week 144, median CD4+ lymphocyte cell count was 449 cells/mm³. Ninety percent and 96% had undetectable viral load measured as < 50 copies/mL or < 400 copies/mL respectively. Discussion: First report of a university cohort, with CD4 and viral load follow up for 144 weeks, including Chilean patients from public and private system. After initiation of ART, an excellent immunologic and virologic response was observed in this cohort.


Introducción: La Red de Salud UC es una red académica de atención, donde pacientes portadores del VIH del área pública y privada de salud son atendidos por un equipo profesional multidisciplinario. Objetivo: Determinar las respuestas virológicas e inmunológicas a 144 semanas de iniciada la primera terapia antiretroviral en dichos pacientes. Métodos: Análisis retrospectivo de registros de pacientes adultos portadores de VIH atendidos entre 1992 y 2011. Se recolectaron datos demográficos, clínicos, terapia anti-retroviral, resultados inmunológicos y virológicos. Se analizaron los resultados de linfocitos T CD4+ y carga viral de VIH a las 144 semanas de iniciada la primera terapia anti-retroviral. Resultados: Fueron incluidos en el análisis 860 pacientes. El promedio de edad fue 42 años, 93% hombres. La mediana basal de LT CD4+ fue 202 céls/mm³. La terapia más utilizada fue zidovudina/lamivudina/efavirenz. En 42% de los pacientes se cambió la terapia de primera línea; la causa más común fue toxicidad a los anti-retrovirales. A la semana 144 de iniciada la terapia, la mediana de LT CD4+ fue de 449 céls/mm³. Alcanzaron cargas virales indetectables 90 y 96% con < 50 copias ARN/mL o < 400 copias ARN/mL respectivamente. Discusión: Primer reporte de pacientes tratados en un centro universitario, con seguimiento inmuno-virológico a 144 semanas, que incluye pacientes del área pública y privada de salud chilena. Después del inicio de la terapia, se observó una excelente respuesta inmuno-virológica.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , HIV Infections/drug therapy , Anti-HIV Agents/therapeutic use , Antiretroviral Therapy, Highly Active , Time Factors , RNA, Viral , HIV Infections/immunology , HIV Infections/virology , Chile , Retrospective Studies , CD4 Lymphocyte Count , Viral Load
7.
ACM arq. catarin. med ; 44(1): 93-105, jan. - mar. 2015. Tab
Article in Portuguese | LILACS | ID: biblio-1869

ABSTRACT

Objetivos: Identificar fatores associados ao uso do polimetilmetacrilato em pacientes HIV positivos sob tratamento antirretroviral em Santa Catarina e definir o perfil dos pacientes que buscam o tratamento para lipoatrofia facial. Métodos: Estudo transversal com 219 pacientes elaborado a partir de registros no SINAN (Sistema de Informação de Agravos de Notificação) e concomitantemente no serviço realizador da intervenção para lipoatrofia facial no âmbito do Sistema Único de Saúde no Estado de Santa Catarina, no período de 2008 a 2011, em que foram avaliados possíveis fatores de risco em variáveis sóciodemográficas e clínicas relacionadas à doença e à intervenção. Resultados: Os pacientes tinham em média 48 anos variando de 30 a 74 anos, sendo predominantemente do sexo masculino (70,8%). Foi encontrada associação significativa entre hipertensão arterial sistêmica (p=0,0006), sexo masculino (p=0,0010), realização de transfusão sanguínea (p=0,013), pacientes não etilistas (p=0,014) e portadores de HIV há mais de 5 anos (p=0,049) e a maior aplicação de polimetilmetacrilato. Em média, o grupo homossexual necessitou de quase 0,6 intervenções a mais do que o grupo heterossexual para uso de metacrilato, assim como maior volume (6,16mL). Conclusão: Pacientes do sexo masculino, homossexuais, hipertensos, que realizaram transfusão sanguínea, não etilistas e que possuem diagnóstico da doença há mais de 5 anos fizeram aplicação de maior volume de polimetilmetacrilato.


Objectives: Identify factors associated with use of polymethylmetacrylate HIV-infected patients in with treatment on antiretroviral in Santa Catarina and define the profile of patients seeking treatment for lipoatrophy. Methods: Cross-sectional study with 219 patients compiled from records in SINAN (Information System for Notifiable Diseases) and concurrently director of the service intervention for facial lipoatrophy in the SUS in the state of Santa Catarina, from 2008 to 2011, where they were assessed possible risk factors in clinical and sociodemographic variables related to illness and intervention. Results: Patients had an mean of 48 years ranging from 30 to 74 years, predominantly male (70.8%). There was use of higher volume of polymethyl methacrylate in the face of patients with hypertension (p = 0.0006), male gender (p = 0.0010), performance of blood transfusion (p = 0.013), non-alcoholic patients (p = 0.014) and HIV for over 5 years (p = 0.049). On mean, the homosexual group interventions needed almost 0.6 more than the heterosexual group for use methacrylate as well as higher volume (6.16 mL). Conclusion: Homossexual men, hypertensive, patients who underwent blood transfusion, nondrinkers as well as who have a diagnosis of the disease for more than 5 years showed increased risk for higher volume of polymethyl methacrylate in the face male patients.

8.
Rev. chil. infectol ; 32(supl.1): 44-56, feb. 2015. ilus, tab
Article in Spanish | LILACS | ID: lil-742525

ABSTRACT

In this article, the following topics about pediatric HIV infection and AIDS are summarized: a description of pathogenic and clinical aspects of HIV infection in children, the clues for its suspicion, the preventive strategies to avoid the vertical transmission of HIV, the study to certify or to rule out the HIV infection in infants and children, the main recommendations of antiretroviral treatment and how to prevent and treat manifestations of HIV infection. Besides, the evolution in Chile of the pediatric HIV infection is described with details, since the first child detected with AIDS in 1987, infected by transfusion and the first infants (twin) diagnosed in 1989, infected by vertical twins transmission, to 2014, with the progress obtained, snags, hopes and challenges addressed.


En este artículo se describe en forma resumida la patogénesis y aspectos clínicos de la infección por VIH en niños, las claves para su sospecha, las medidas preventivas para evitar su transmisión vertical, el estudio necesario para certificar o descartar la infección en lactantes y niños mayores, y las principales recomendaciones para la terapia anti-retroviral y cómo tratar y prevenir las manifestaciones de la infección por VIH. Se relata a continuación, en forma detallada, la evolución que ha experimentado en Chile la infección por VIH en pediatría, desde el primer caso pesquisado en el año 1987, producto de una transfusión sanguínea, y los primeros lactantes (mellizos) detectados en 1989, que fueran infectados en forma vertical, hasta el año 2014, con el progreso obtenido, las trabas, esperanzas y desafíos enfrentados.


Subject(s)
Adolescent , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Pregnancy , AIDS-Related Opportunistic Infections/epidemiology , HIV Infections/epidemiology , Infectious Disease Transmission, Vertical/prevention & control , Acquired Immunodeficiency Syndrome/drug therapy , Acquired Immunodeficiency Syndrome/epidemiology , Anti-Retroviral Agents/therapeutic use , Chile/epidemiology , Disease Progression , HIV , HIV Infections/drug therapy , HIV Infections/transmission , Infectious Disease Transmission, Vertical/legislation & jurisprudence
9.
Rev. chil. infectol ; 30(5): 507-512, oct. 2013. graf, tab
Article in Spanish | LILACS | ID: lil-691156

ABSTRACT

In the Chilean AIDS Cohort, the 15.9% of the patients change the first scheme of HAART because of toxicity, which is also the cause of 47% suspensions of treatment occurred in the first months of therapy. Aim: To analyze the incidence and causality of adverse drug reactions in patients initiating or changing antiretroviral therapy. Materials andMethods: 92 patients who started or changed antiretroviral treatment in a period from May to July 2011 were followed to detect adverse drug reactions. Results: 75% (n: 69) of patients had at least one adverse event. From a total of 76 adverse drug reactions detected the most frequent ones were diarrhea (21.1%, n: 16) and hyperbilirubinemia (19.7% n: 15). 85.9% of the adverse events where grade depending on its seriousness, 34.1% had grade 1 toxicity, 32.9% grade 2, 9.4% grade 3 and only 3.5% grade 4. Only 22 patients (31.8%) required a treatment change. The most frequent causes for changing treatment were because of anaemia by AZT (45.4%, n: 10) and diarrhea associated with the use of LPV/r (27.3%, n: 6). Conclusion: Knowing the real incidence rate of adverse drug reactions may help the health team giving proper management and monitoring of these reactions in the patient, in order to avoid an early change of HAART. Defining a multidisciplinary team which includes a pharmacist is essential for proper pharmacosurveillance.


En la Cohorte Chilena de SIDA, 15,9% de los pacientes requiere cambio de su primer esquema de TARV por toxicidad, siendo además la causa de 47% de las suspensiones de tratamiento ocurrida en los primeros meses de terapia. Objetivo: Analizar la incidencia y causalidad de las reacciones adversas a medicamentos en pacientes que inician o cambian terapia anti-retroviral. Material y Métodos: Se realizó un seguimiento para la detección de reacciones adversas a medicamentos a 92 pacientes que iniciaron o cambiaron tratamiento anti-retroviral en un período comprendido entre mayo y julio del 2011. Resultados: 75% (n: 69) de los pacientes presentó al menos un evento adverso. De las 76 reacciones adversas a medicamentos detectadas, las más frecuentes fueron: diarrea (21,1%; n: 16) e hiperbilirrubinemia (19,7% n: 15). El 85,9% de las notificaciones se calificó según su gravedad; obtuvo una toxicidad grado 1 en 34,1%; 32,9% grado 2; 9,4% grado 3 y 3,5% grado 4. Sólo 22 pacientes (31,8%) requirieron un cambio de tratamiento, las causas más frecuentes de cambio fueron: anemia por AZT (45,4%; n: 10) y diarrea asociada al uso de LPV/r (27,3%; n: 6). Conclusión: El conocimiento de la real incidencia de estas reacciones adversas a medicamentos puede ayudar a los equipos tratantes para un adecuado control y manejo de éstos en el paciente, con el fin de evitar un cambio anticipado de TARV. Es fundamental conformar un equipo multidisciplinario que incluya al químico farmacéutico para una adecuada farmacovigilancia.


Subject(s)
Adult , Female , Humans , Male , Middle Aged , Anti-HIV Agents/adverse effects , HIV Infections/drug therapy , Anti-HIV Agents/therapeutic use , Chile/epidemiology , Incidence
10.
Motriz rev. educ. fís. (Impr.) ; 19(2): 313-324, abr.-jun. 2013. graf, tab
Article in Portuguese | LILACS | ID: lil-678308

ABSTRACT

O presente estudo investigou o efeito de 24 semanas de treinamento resistido (TR) sobre a força e hipertrofia muscular de pacientes HIV-soropositivos. Participaram deste estudo 45 voluntários submetidos à terapia antirretroviral fortemente ativa (HAART), destes, 23 realizaram 3 sessões semanais, com 10 repetições a 80% 1RM. O teste de 1RM foi realizado de acordo com a metodologia proposta por Kraemer e Fry (1995), para estimativa da hipertrofia muscular adotou-se as equações de Frisancho (1984). Em comparação aos valores, o TR melhorou a força de 1RM nos exercícios de agachamento em 49% (21,0±4,9 vs. 31,2±5,1; P=0,001), supino reto em 13% (34,3±8,1 vs. 39,8±9,4; P=0,04), cadeira extensora em 34,1% (26,3±7,1 vs. 37,1±6,6; P=0,01), tríceps em 51% (22,9±4,0 vs. 38,3±4,9; P=0,001), pulley costas em 31,5% (31,7±3,9 vs. 41,7±4,4; P=0,01), cadeira flexora em 37,2% (18,9±3,4 vs. 27,3±3,2; P=0,01) e rosca bíceps em 60% (27,9±6,9 vs. 40,4±4,5; P=0,001). Não foram observadas diferenças (P<0,05) entre os valores basais e finais para o grupo controle. Observou-se aumento significativo (P<0,05) na área muscular do braço isenta de massa óssea, no grupo TR (52,8±14,5 cm²) em relação ao controle (39,5±12,4 cm²). Ademais, o TR resultou em significativa (P<0,05) redução da glicemia sanguínea de jejum (96,5±18,3 vs. 90,5±12,6), pressão arterial sistólica (126,3±14,3 vs. 120,0±10,0) e circunferência de cintura (83,0±12,5 vs. 80,6±10,2). Conclui-se que seis meses de TR resultaram em melhora na força e hipertrofia, ademais, o treinamento aplicado contribuiu para a regulação das variáveis metabólicas dos pacientes. Uma vez que a HAART é inevitável ao HIV-soropositivo, recomenda-se que o exercício físico seja realizado no intuito de dirimir os efeitos colaterais advindos desta terapia.


The aim of this study was to investigate the effect of 24 weeks of resistance training (RT) on the strength and muscle hypertrophy in patients with HIV-seropositive. Participated in the study 45 subjects undergoing highly active antiretroviral therapy (HAART). They were divided into two groups: control (n=22) and RT (n=23). The RT group realized three sessions, with 10 repetitions at 80% of 1MR. The MR tests were performed pre and post 24 weeks according to Kraemer and Fry (1995) and the equations proposed by Frisancho (1984) were adopted to estimate bone-free upper arm muscle area. Compared to baseline, the RT improved the strength of 1MR in the squat exercise at 49% (21.0±4.9 vs. 31.2±5.1; P=0.001), bench press by 13% (34.3±8.1 vs. 39.8±9.4, P=0.04), leg extension in 34.1% (26.3±7.1 vs. 37.1±6.6, P=0.01), triceps in 51% (22.9±4.0 vs. 38.3±4.9, P=0.001), pulley in 31.5% (31.7±3.9 vs. 41.7±4.4, P=0.01), leg curl in 37.2% (18.9±3.4 vs. 27.3±3.2, P=0.01) and biceps in 60% (27.9±6.9 vs. 40.4±4.5, P=0.001); there were no significant differences between baseline and final at control. The Bone-free upper arm muscle area at RT group (52.8±14.5 cm²) was significant increased (P<0.05) comparing to control (39.5±12.4 cm²). Moreover, the RT resulted in significant reduction (P<0.05) in fasting blood glucose (96.5±18.3 vs. 90.5±12.6, P<0.05), systolic blood pressure (126.3±14.3 mmHg vs. 120.0±10.0 mmHg) and waist circumference (83.0±12.5 cm vs. 80.6±10.2 cm). We conclude that six months of RT resulted in improvement in strength and hypertrophy; in addition, this training contributed to regulate the metabolic variables from these patients. Since the HAART is inevitable to HIV-seropositive, It's recommended that physical exercise be realized to minimize the side effects from this therapy.


Subject(s)
Humans , Male , Female , Anthropometry , Antiretroviral Therapy, Highly Active , Exercise Therapy , HIV-Associated Lipodystrophy Syndrome
11.
Audiol., Commun. res ; 18(1): 10-16, jan.-mar. 2013. tab
Article in Portuguese | LILACS | ID: lil-676859

ABSTRACT

OBJETIVO: Caracterizar as manifestações audiológicas em indivíduos com HIV/AIDS (Vírus da Imunodeficiência Humana/Síndrome da Imunodeficiência Adquirida) submetidos e não submetidos à terapia antirretroviral. MÉTODOS: A avaliação audiológica foi realizada em 28 indivíduos do Grupo Pesquisa I (GPI) com HIV/AIDS, submetidos à terapia antirretroviral; 24 indivíduos do Grupo Pesquisa II (GPII) com HIV/AIDS, não submetidos à terapia antirretroviral e 45 indivíduos saudáveis do Grupo Controle (GC). Os exames audiológicos que compuseram esta pesquisa foram: Audiometria Tonal Convencional, Logoaudiometria e Audiometria em Altas Frequências. RESULTADOS: Houve diferença nos grupos GPI e GPII, para os resultados obtidos tanto na avaliação audiológica convencional, como na avaliação em altas frequências, observando-se limiares auditivos mais elevados quando comparados aos indivíduos do GC, porém sem diferença significativa entre GPI e GPII. CONCLUSÃO: Indivíduos com HIV/AIDS apresentam mais alteração na Audiometria Tonal Convencional e na Audiometria em Altas Frequências quando comparados a indivíduos saudáveis (GC) sugerindo comprometimento do sistema auditivo, sendo observada maior ocorrência de perda auditiva na Audiometria em Altas Frequências quando comparada à Audiometria Tonal Convencional nos grupos GPI e GPII. Não houve diferença entre indivíduos com HIV/AIDS submetidos (GPI) e não submetidos (GPII) à terapia antirretroviral para a Audiometria Tonal Convencional e Audiometria em Altas Frequências.


PURPOSE: To characterize the audiologic manifestations in individuals with HIV/AIDS (Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome) submitted and not submitted to antiretroviral therapy. METHODS: The audiologic evaluation was carried out in 28 individuals in Research Group I (RGI) with HIV/AIDS submitted to antiretroviral therapy; 24 individuals in Research Group II (RGII) with HIV/AIDS not submitted to antiretroviral therapy, and 45 healthy individuals in the Control Group (CG). The audiologic tests that comprised this study were: Conventional Pure Tone Audiometry, Speech Audiometry and High Frequency Audiometry. RESULTS: There were differences between groups RGI and RGII regarding conventional audiologic evaluation and high frequency audiometry. There were higher thresholds for both Conventional and High Frequency Audiometries when compared with CG subjects, however without significant difference among RGI and RGII. CONCLUSION: Individuals with HIV/AIDS present more abnormal results in Conventional Pure Tone Audiometry and High Frequency Audiometry than healthy individuals (CG), which indicates impairment in the hearing system. Individuals with HIV/AIDS present more abnormal findings in High Frequency Audiometry when compared to Conventional Pure Tone Audiometry. There was no difference between individuals with HIV/AIDS submitted (RGI) and not submitted (RGII) to antiretroviral therapy regarding Conventional Pure Tone Audiometry and High Frequency Audiometry.


Subject(s)
Humans , Acquired Immunodeficiency Syndrome/complications , Antiretroviral Therapy, Highly Active/adverse effects , Audiology , Hearing Tests , Hearing Loss , Pitch Perception , Speech Reception Threshold Test
12.
São Paulo med. j ; 131(3): 145-152, 2013. tab
Article in English | LILACS | ID: lil-679560

ABSTRACT

CONTEXT AND OBJECTIVE The number of people living with HIV (PLHIV) in Brazil is between 600,000 and 890,000. Assessing the diet is important in planning healthcare actions and improving PLHIV's quality of life. This study aimed to estimate the prevalence of inappropriate protein, total fat, saturated fat, carbohydrate, fiber, sodium, calcium and cholesterol intake among PVHIV on highly-active antiretroviral therapy (HAART). DESIGN AND SETTING Cross-sectional study in nine Specialized STD/AIDS Healthcare Centers in São Paulo. METHODS Men and women aged 20 to 59 years, on HAART for at least three months, were included. Nutrient intake was assessed using 24-hour food recall applied in person and repeated among 30% of the population by telephone. The between and within-person variances were corrected. RESULTS 507 individuals were evaluated: 58% male, mean age 41.7 years (standard deviation, SD = 7.8). The mean time since HIV diagnosis was 6.6 years (SD = 4.1), and since HAART onset, 5.1 years (SD = 3.3). More than 20% of the population presented intake above the recommendations for saturated fat, cholesterol and/or sodium, and below the recommendations for fiber. The recommended maximum tolerable sodium level was exceeded by 99% of the sample, and 86% of men and 94% of women did not reach the daily recommendations for calcium. Protein, carbohydrate and total fat intakes were adequate for the majority of the population. CONCLUSIONS A significant portion of the population presented inappropriate intake of saturated fat, sodium, fiber and calcium. Interventions aimed at improving PLHIV's dietary quality are needed. .


CONTEXTO E OBJETIVO O número de pessoas vivendo com HIV (PVH) no Brasil oscila entre 600.000 e 890.000. A avaliação de dietas é relevante para o planejamento de ações de saúde e melhoria da qualidade de vida desses indivíduos. Este estudo visa estimar a prevalência de inadequação do consumo de proteínas, lipídios totais, lipídios saturados, carboidratos, fibras, sódio, cálcio e colesterol em PVH em terapia antirretroviral de alta atividade (TARV). TIPO DE ESTUDO E LOCAL Estudo transversal em nove Centros de Assistência Especializados em DST/Aids localizados em São Paulo. MÉTODOS Homens e mulheres com idade entre 20 e 59 anos, em TARV por no mínimo 3 meses, foram incluídos. O consumo de nutrientes foi avaliado com um recordatório alimentar de 24 horas aplicado pes-soalmente e repetido em 30% da população por telefone. A variabilidade intra e interpessoal foi corrigida. RESULTADOS Foram avaliados 507 indivíduos, 58% homens e idade média de 41,7 anos (desvio padrão, DP = 7,8). O tempo médio de infecção por HIV foi de 6,6 anos (DP = 4,1), e de TARV, de 5,1 anos (DP = 3,3). Mais que 20% da população apresentou consumo acima das recomendações para lipídios saturados, colesterol e/ou sódio, e abaixo para fibras. Excederam a recomendação máxima tolerada para sódio 99% da amostra, enquanto 86% dos homens e 94% das mulheres não atingiram as recomendações diárias para o cálcio. O consumo de proteínas, carboidratos e lipídios totais mostrou-se adequado para a maioria da população. CONCLUSÕES Uma importante parcela da população apresentou consumo inadequado para lipídios saturados, sódio, fibras ...


Subject(s)
Adult , Female , Humans , Male , Middle Aged , Young Adult , Calcium, Dietary/administration & dosage , Dietary Fats/administration & dosage , Dietary Fiber/administration & dosage , Dietary Proteins/administration & dosage , HIV Infections , Nutritional Status/physiology , Sodium, Dietary/administration & dosage , Antiretroviral Therapy, Highly Active , Chi-Square Distribution , Cross-Sectional Studies , Diet Surveys/methods , HIV Infections/drug therapy , Reference Values
13.
Rev. latinoam. enferm ; 20(5): 847-853, Sept.-Oct. 2012. tab
Article in English | LILACS, BDENF | ID: lil-656185

ABSTRACT

OBJECTIVE: to identify the different types of morphological alterations from lipodystrophy syndrome (LS) in outpatients and relate them to the therapeutic regimen used. METHOD: a cross-sectional study which recruited 60 patients with HIV and LS and 79 without LS, who consented to interview and data collection from their medical notes. RESULTS: the region most affected by lipoatrophy was the face; by lipohypertrophy, the abdomen, and by the mixed form, the alterations to the abdomen, face, and upper and lower limbs. CONCLUSION: among the therapeutic regimens, that comprised of zidovudine, lamivudine and efavirenz seemed to protect against LS. Nursing can act in the early identification of the changes, as well as providing guidance and support for patients affected by the changes in their body image.


OBJETIVO: identificar os diferentes tipos de alterações morfológicas da síndrome da lipodistrofia (SL) em pacientes dos atendimentos ambulatoriais e relacioná-las ao esquema terapêutico utilizado. MÉTODO: estudo transversal, para o qual foram recrutados 60 pacientes com HIV e SL e 79 sem a SL, que consentiram entrevista e coleta de dados em prontuário. RESULTADOS: a região mais acometida pela lipoatrofia foi a face; pela lipo-hipertrofia o abdome e pela forma mista as alterações em abdome, face, membros superiores e inferiores. CONCLUSÃO: dentre os esquemas terapêuticos, o composto pela zidovudina, lamivudina e efavirenz pareceu proteger contra a SL. A enfermagem pode atuar na identificação precoce das alterações, além de fornecer orientações e apoio aos pacientes acometidos pelas mudanças na imagem corporal.


OBJETIVO: identificar los diferentes tipos de alteraciones morfológicas del Síndrome de la lipodistrofia (SL) en pacientes de los servicios de ambulatorio y relacionarlas al esquema terapéutico utilizado. MÉTODO: estudio transversal en lo que fueron reclutados 60 pacientes con VIH y la SL y 79 sin la SL, que consintieron entrevista y recogida de datos en prontuario. RESULTADOS: la región más acometida por la lipoatrofia fue la cara; por la lipohipertrofia el Abdomen y por la forma mixta las alteraciones en Abdomen, cara, miembros superiores e inferiores. CONCLUSIÓN: entre los esquemas terapéuticos, el compuesto por la zidovudina, lamivudina y efavirenz pareció proteger contra la SL. La enfermería puede actuar en la identificación precoz de las alteraciones, además de suministrar orientaciones y apoyo a los pacientes acometidos por los cambios en la imagen corporal.


Subject(s)
Adult , Female , Humans , Male , Anti-HIV Agents/adverse effects , HIV Infections/drug therapy , Lipodystrophy/chemically induced , Acquired Immunodeficiency Syndrome/drug therapy , Anti-HIV Agents/therapeutic use , Cross-Sectional Studies
14.
Rev. APS ; 15(3)set. 2012.
Article in Portuguese | LILACS | ID: lil-676067

ABSTRACT

O sucesso da terapia antirretroviral depende da manutenção de altas taxas de adesão ao tratamento. O presente artigo tem por objetivo avaliar a percepção dos usuários da terapia antirretroviral de alta atividade com relação ao acolhimento propiciado pelos profissionais de saúde, procurando verificar as dificuldades na adesão entre pacientes com histórico de abandono da mesma. A metodologia utilizada é o estudo qualitativo em uma amostra aleatória de treze indivíduos. Os dados foram analisados a partir dos discursos coletados por meio de entrevistas, utilizando-se a análise de conteúdo. Os resultados indicam que os fatores contribuintes para a interrupção do tratamento foram: a ausência de estrutura para o atendimento em saúde, voltada para a adesão e o acolhimento dos pacientes, deficiências de apoio social aos pacientes e familiares, atitudes de preconceito relacionadas à doença, intolerância gastrointestinal e condições socioeconômicas. A conclusão a que se chega é a de que a organização da assistência e o atendimento acolhedor podem contribuir para a melhoria da adesão ao tratamento de pessoas vivendo com Aids.


The success of antiretroviral therapy depends on maintaining high rates of adherence to treatment. This article aims to assess the perception of users in high activity antiretroviral therapy in relation to the partnership afforded by health professionals, seeking to ascertain the difficulties in adherence among patients with a history of abandoning it. The methodology used is the qualitative study on a random sample of thirteen individuals. Data were analyzed from the discourse collected through interviews, using content analysis. The results indicate that the factors contributing to discontinuing treatment were the lack of healthcare infrastructure focused on adherence and care for patients, deficiencies in social support to patients and family members, prejudiced attitudes toward the disease, gastrointestinal intolerance, and socioeconomic conditions. The conclusion obtained is that the organization of care and service in partnership with the patient can help improve adherence to treatment for people living with AIDS.


Subject(s)
Acquired Immunodeficiency Syndrome , Antiretroviral Therapy, Highly Active , User Embracement , Medication Adherence , Treatment Adherence and Compliance
15.
Rev. saúde pública ; 46(4): 737-746, Aug. 2012. tab
Article in English, Portuguese | LILACS | ID: lil-646476

ABSTRACT

OBJETIVO: Analisar o efeito do tratamento nutricional sobre as alterações metabólicas provocadas pelo uso da terapia antirretroviral em adultos vivendo com HIV/aids. MÉTODOS: Revisão sistemática de literatura no PubMed, Lilacs e Cochrane, entre 1996 e 2010, do tipo ensaio clínico, controlado, randomizado, crossover, adultos, vivendo com HIV/aids em uso de terapia antirretroviral e sem doenças oportunistas. A intervenção de interesse foi suplementação nutricional via oral e/ou mudança de estilo de vida por tratamento dietoterápico específico: dislipidemia, resistência insulínica, lipodistrofia e hipertensão arterial sistêmica. A escala de Jadad foi utilizada para classificação qualitativa dos artigos. RESULTADOS: Foram localizados 385 artigos e sete foram incluídos. As intervenções utilizadas nesses estudos foram: dieta, dieta mais exercício físico, dieta mais suplemento e somente suplementos. Dislipidemia foi desfecho avaliado em todos os estudos. Os estudos que avaliaram suplementação com ômega 3 encontraram redução significativa dos triglicérides. Dieta específica mais suplementação de ômega 3 mostrou aumento de HDL-colesterol. Suplementação com nicotinato de cromo não teve efeito sobre a dislipidemia. Modificação de estilo de vida, incluindo dieta e atividade física, reduziu significativamente a circunferência da cintura, lipodistrofia e pressão arterial sistólica. CONCLUSÕES: A redução de triglicérides pela suplementação com ômega 3 foi a intervenção nutricional com maiores evidências científicas. A prescrição de dieta específica parece ser a intervenção mais adequada para aumentar HDL-colesterol. Não é possível fazer inferências sobre o tratamento nutricional do colesterol total, LDL-colesterol e resistência insulínica. Modificações no estilo de vida podem promover melhora da lipodistrofia e pressão arterial.


OBJECTIVE: To analyze the effect of nutritional treatment on metabolic changes caused by the use of antiretroviral therapy in adults with HIV/AIDS. METHODS: A systematic review of literature was conducted in the PubMed, Lilacs and Cochrane databases, between 1996 and 2010, including crossover and randomized controlled clinical trials performed in adults with HIV/AIDS using antiretroviral therapy and without opportunistic diseases. The intervention of interest was oral nutritional supplementation and/or a change in lifestyle due to specific dietary treatment: dyslipidemia, insulin resistance, lipodystrophy and systemic arterial hypertension. The Jadad scale was used for a qualitative classification of articles. RESULTS: A total of 385 articles were found, of which seven were included. The interventions used in these studies were as follows: diet, diet and physical exercises, diet and supplementation, and only supplementation. Dyslipidemia was the outcome assessed in all studies. Studies that assessed omega-3 supplementation found a significant reduction in triglycerides. The specific diet with omega-3 supplementation showed an increase in HDL-cholesterol. Chrome nicotinate supplementation did not have an effect on dyslipidemia. Changing one's lifestyle, including diet and physical activity, significantly reduced waist circumference, lipodystrophy and systolic blood pressure. CONCLUSIONS: Reduction in tryglicerides with omega-3 supplementation was the nutritional intervention with the strongest scientific evidence. Prescribing a specific diet appeared to be the most adequate intervention to increase HDL-cholesterol. Inferences could not be made about the nutritional treatment of total cholesterol, LDL-cholesterol and insulin resistance. Changes in lifestyle can promote an improvement in lipodystrophy and blood pressure.


Subject(s)
Humans , Male , Female , Adult , Dietary Supplements , Dyslipidemias/diet therapy , HIV-Associated Lipodystrophy Syndrome/diet therapy , Antiretroviral Therapy, Highly Active/adverse effects , Cholesterol/blood , Clinical Trials as Topic , Exercise , /therapeutic use , Insulin Resistance , Life Style , Triglycerides/blood
16.
Rev. chil. infectol ; 29(3): 337-343, jun. 2012. tab
Article in Spanish | LILACS | ID: lil-645601

ABSTRACT

Introduction: Highly effective antiretroviral triple therapy (TAR3) has led to a significant increase in survival of patients (pts) infected with human immunodeficiency virus. In 1999 it was started in the Chilean public health system, including Arriarán Foundation (FA) access to TAR, reaching full coverage since 2003. By October 31, 2009 124 pts had reached 10 years of uninterrupted TAR3 in FA. Objective: To describe and analyze the profile of pts, their therapeutic regimen (s) and clinical outcomes during 10 years of TAR3. Methods: Retrospective descriptive study. We reviewed the records of pts who had reached 10 years of uninterrupted TAR3 in FA. Demographic data, baseline and virological staging at start of TAR3, comorbidities and complications were recorded. Drug regimens used were analyzed, as well as toxicity, virological and immunological outcomes, frequency and reasons for change in therapy. Complications were classified as opportunistic and not opportunistic during this evolution and the latest known clinical and laboratory data were registered. A database program based on Excel was used. Results: 121/124 pts were available for analysis, 76.8% male, male-female ratio was 3.3:1. Baseline median age: 36 years (20-69); CD4 cells 176/ mm³ (8-1,224) with 65.3% < 200; median viral load (STL): 60,078 copies/ml (1,100- 7,900,000); 36.3% were in clinical AIDS stage. Patients received an average of 3.5 therapies regimens during the decade (range, 1 [14 pts, 11.5%] to 7 [3 pts, 2.4%]), with average duration of 42 months each and a median of 36 months. As initial TAR3 regimen 2 backbone nucleoside analogues (ITRN) was the most frequent, with a protease inhibitor (PI) in 51.2% and non-nucleoside RTIs (NNRTIs) in 38.8%. Adverse reactions were the main reason for change of therapy (24.7%), followed by virological failure (24.2%) and treatment simplification (16.6%). At the latest assessment, all with > 10 years of TAR3 median CD4 was 602 cells/mm³, 11 pts (9%) had CD4 < 200/mm³; 85.2% had undetectable VL (< 80 copies/mL); the remaining 14.8% had a median of 1,800 copies/mL. Only 2 pts (1.7%) were in AIDS clinical stage. Current regimens were 2 NRTI plus 1 NNRTI in 61 pts (50.4%), 2 or more NRTI plus 1 PI in 46 (38%). Seventy two pts (60.3%) had chronic comorbidities at latest follow up. Dyslipidemia, hypertension, diabetes mellitus and renal failure were the most frequent conditions; 17 pts (14%) had clinical lipodystrophy secondary to TAR. Conclusion: Achieving a decade of TAR is already a reality and in the short term will be routine. This is rarely achieved with the initial therapeutic regimen. The major obstacles to prolonged maintenance of a single therapeutic regimen have been adverse effects and virological failure, although current drugs with better efficacy and safety profile may allow longer use for each regimen. Despite the difficulty of treating these pts, they can achieve long-term survival with good virologic control, immune recovery and absence of opportunistic complications associated with HIV infection. Nonetheless, the high frequency of non opportunistic chronic comorbidities and antiretroviral therapy side effects after prolonged or life-long use is becoming a major issue.


La introducción de la triterapia anti-retroviral de alta efectividad (TAR3) ha llevado a un significativo aumento en la sobrevida de los pacientes infectados por virus de inmunodeficiencia humana. En 1999 se inició en el sistema público de salud chileno, incluida la Fundación Arriarán (FA) el acceso progresivo a TAR3, que alcanzó cobertura completa desde 2003. En FA al 31 de octubre de 2009 se compatibilizaban 124 pacientes (pts) que habían alcanzado 10 años de TAR3 ininterrumpida. Objetivo: Describir y analizar el perfil de los pts, sus terapias y la evolución clínica durante el período de 10 años de TAR3. Material y Método: estudio descriptivo y retrospectivo. Se revisaron las fichas de los pts que alcanzaron 10 años de TAR3 en FA. Se registraron datos demográficos, clínicos y clasificación por etapas, co-morbilidades y complicaciones al inicio de tratamiento. Se analizaron los esquemas terapéuticos recibidos, toxicidades y desenlaces virológicos e inmunológicos, así como la frecuencia y razones de cambio de terapias, las complicaciones oportunistas y no oportunistas durante esta evolución y el último estado clínico y de laboratorio conocido. Se empleó una base de datos en base al programa Excel. Resultados: se lograron analizar 121/124 pts, 76,8% hombres, relación hombre:mujer 3,3:1. Mediana basal: edad, 36 años (20-69); recuento de linfocitos CD4 de 176 céls/mm³ (8-1.224), con 65,3% < de 200 céls/mm³; carga viral (CV): 60.078 copias/ml (1.100 -7.900.000); 44/121 (36,3%) en etapa SIDA clínica inicial. Los pacientes recibieron un promedio de 3,5 esquemas de terapias durante el decenio (rango, 1 [14 pts, 11,5 %] a 7 [3 pts, 2,4 %]), con duración promedio de 42 meses en cada uno y una mediana de 36. TAR3 inicial con dos análogos nucleosídicos (ITRN) fue lo más frecuente, con un inhibidor de la proteasa (IP) en 51,2% o con ITR no nucleosídico (ITRnN) en 38,8%. Las reacciones adversas fueron el principal motivo de cambio de esquemas (24,7%), seguido de fracaso virológico (24,2%) y simplificación terapéutica (16,6%). En su última evaluación y con > 10 años de TAR3 la mediana de linfocitos CD4 era de 602 céls/mm³; había 11 pts (9 %) con CD4 < 200/ mm³; 85,2% estaba con CV indetectable (< 80 copias/ mL), 14 (14,8%) con detectabilidad viral, y éstos con una mediana de 1.800 copias/mL. Sólo 2 pts (1,7%) estaban en etapa clínica de SIDA. El esquema de TAR3 actual más frecuente era de dos ITRN más un ITRnN, en 61 pts (50,4%) y luego dos ITRN más un IP en 46 (38%). En 72 pts (60,3%) se pesquisaron co-morbilidades crónicas: dislipidemias, hipertensión arterial, diabetes mellitus y/o insuficiencia renal; 17 pts (14%) presentaban lipodistrofia clínica secundaria a TAR3 Conclusión: Alcanzar una década de TAR3 ya está siendo una realidad y a corto plazo será rutinario. Esto rara vez se logra con la primera terapia, aunque esquemas contemporáneos más efectivos y seguros pueden hacerlo posible a futuro. Los principales obstáculos para lograr mantención prolongada de un solo esquema terapéutico son los efectos adversos y el fracaso virológico. A pesar de las dificultades terapéuticas estos pts pueden alcanzar sobrevida a largo plazo con buen control virológico, recuperación inmune y control de las complicaciones oportunistas asociadas a la infección por VIH. Destaca la alta frecuente de co-morbilidades crónicas no oportunistas y secuelas de la terapia anti-retroviral.


Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Acquired Immunodeficiency Syndrome/drug therapy , Acquired Immunodeficiency Syndrome/epidemiology , Anti-HIV Agents/administration & dosage , Antiretroviral Therapy, Highly Active/adverse effects , HIV Long-Term Survivors/statistics & numerical data , AIDS-Related Opportunistic Infections/epidemiology , AIDS-Related Opportunistic Infections/etiology , Anti-HIV Agents/adverse effects , Antiretroviral Therapy, Highly Active/methods , Chronic Disease , Comorbidity , Chile/epidemiology , Drug Administration Schedule , Dyslipidemias/etiology , Hypertriglyceridemia/etiology , Lipodystrophy/etiology , Patient Outcome Assessment , Sex Ratio
17.
Rev. chil. infectol ; 29(2): 217-220, abr. 2012. ilus, tab
Article in Spanish | LILACS | ID: lil-627235

ABSTRACT

We report a 43 years old HIV-1 infected male who developed a severe subacute neurological damage because of a progressive multifocal leukoencephalopathy confirmed by PCR for JC virus. The patient was treated with antiretroviral therapy in adequate doses for CNS penetration and mirtazapine, an antidepressant inhibitor of serotonin receptors. His evolution during one year follow up has been favorable in both, clinically and images.


Se presenta el caso clínico de un paciente de sexo masculino, de 43 años portador de VIH que desarrolló un grave daño neurológico subagudo debido a una leucoencefalopatía multifocal progresiva diagnosticada mediante reacción de polimerasa en cadena de virus JC. El paciente fue tratado con terapia anti-retroviral de penetración eficiente al SNC y con mirtazapina, un antidepresivo inhibidor de los receptores de serotonina. Su evolución durante un año de seguimiento ha sido favorable tanto del punto de vista clínico como de imágenes.


Subject(s)
Adult , Humans , Male , AIDS Dementia Complex/drug therapy , Antiretroviral Therapy, Highly Active , Antidepressive Agents, Tricyclic/therapeutic use , Leukoencephalopathy, Progressive Multifocal/drug therapy , Mianserin/analogs & derivatives , Drug Therapy, Combination/methods , Mianserin/therapeutic use , Treatment Outcome
18.
João Pessoa; s.n; 2012. 89 p. ilus, tab.
Thesis in Portuguese | LILACS, BDENF | ID: biblio-1037612

ABSTRACT

A Síndrome da Imunodeficiência Adquirida (AIDS) transmitida pelo Human Immunodeficiency Vírus (HIV) ataca o sistema imunológico, podendo causar repercussões sobre o estado geral de saúde e, de modo particular, à saúde auditiva. Objetivou-se avaliar a audição de crianças com HIV/AIDS e analisar a associação dos achados audiológicos em crianças com HIV/AIDS, relacionando-os à carga viral, às doenças oportunistas e ao tratamento antirretroviral (TARV) instituído. Foram analisadas 23 crianças com HIV/AIDS que estavam em acompanhamento em dois serviços de atendimento especializado (SAE). Os responsáveis pelas crianças responderam um questionário que continha dados sobre a situação clínica e a saúde auditiva das crianças, o qual foi posteriormente complementado por informações contidas em prontuário. Em seguida, foi realizada a inspeção do meato acústico externo e, quando necessário, as crianças foram encaminhadas ao otorrinolarigologista para propiciar a realização dos exames audiológicos. A avaliação audiológica foi composta pelo exame de audiometria tonal e imitanciometria (timpanometria e reflexos estapedianos). Para análise descritiva dos dados foi utilizada a técnica de estatística inferencial, através do teste Exato de Fisher, quando as condições para utilização do teste Qui-quadrado não foram verificadas. Foram respeitadas as orientações para pesquisa em seres humanos contidas na Resolução CNE N° 196/1996. Observou-se uma ocorrência de perdas auditivas por orelha em 84,8% das crianças analisadas, prevalecendo um percentual de 76,9% de perdas auditivas discretas e 67,4% para timpanometria de curva tipo B. As manifestações otológicas foram observadas em 65,2% das crianças, sendo a otalgia a de maior ocorrência (66,7%), havendo associação significativa desta com a perda auditiva (p=0,001).


Acquired immunodeficiency syndrome (AIDS), transmitted by Human Immunodeficiency Vírus (HIV) it attacks the immune system, which may cause adverse effects on the general state of health, and in particular, the hearing health. The objective of this study was to evaluate the hearing of children with HIV/AIDS and to assess the association of audiological findings in children with HIV/AIDS, relating them to the viral load, the opportunistic diseases and to antiretroviral treatment (TARV) instituted. We analyzed 23 children with HIV/AIDS that were followed at two specialized care services (SCS). Those responsible for the children responded to a questionnaire that included data on the clinical situation and the hearing health of children, which was subsequently complemented by information contained in medical records. Then, the external acoustic meatus was inspected and where necessary, the children were referred to the ent propitiate the realization of the audiological exams. The audiological evaluation was composed by examination of audiometry and immitanciometry (tympanometry and stapedial reflexes). For descriptive analysis of the data was used to the technique of inferential statistics, using Fisher's exact test, when the conditions for use of the test thur-square has not been verified. They were complied with the guidelines for research involving human beings contained in Resolution CNS N° 196/1996. There was an occurrence of hearing loss by ear in 84.8 % of the children analyzed, prevailing a percentage of 76.9 % of hearing loss discrete and 67.4 % for tympanometry curve type B. The otologic manifestations were observed in 65.2 % of the children, with the ear pain to the highest occurrence (66.7 %), there was no significant association with hearing loss (p=0.001).


Subject(s)
Humans , Child , HIV Infections , Otitis , Hearing Loss
19.
Rev. bras. ginecol. obstet ; 33(4): 170-175, abr. 2011. graf, tab
Article in Portuguese | LILACS | ID: lil-596280

ABSTRACT

OBJETIVO: avaliar a frequência de testes anti-HIV realizados no pré-natal e de testes rápidos solicitados para estantes internadas para o parto. MÉTODO: trata-se de um estudo de corte transversal com 711 gestantes atendidas no momento do parto no período de janeiro a julho de 2010. Excluíram-se do estudo aquelas admitidas para controle clínico e as que não permitiram que seus dados fossem incluídos na pesquisa. Utilizou-se o teste do χ² ou o teste de Fisher para comparação de proporções na análise univariada. Foram incluídas no modelo de regressão logística todas as variáveis com valor p<0,25, chamado de modelo inicial. Utilizou-se o pacote estatístico SPSS e adotou-se o nível de significância estatística de 5 por cento. RESULTADOS: a idade média das pacientes foi de 25,77±6,7 anos, sendo a idade máxima e mínima de 44 e 12 anos, respectivamente. A média da idade gestacional no momento do atendimento foi de 38,41±6,7 semanas. Destas pacientes, 96,3 por cento (n=685) tinham acompanhamento pré-natal, sendo que 11,1 por cento (n=79) fizeram pré-natal na Maternidade Therezinha de Jesus, da Faculdade de Medicina da Universidade Federal de Juiz de Fora (UFJF), em Juiz de Fora, Minas Gerais. A média de consultas no pré-natal foi de 6,85±2,88, mas 28,1 por cento tiveram menos de 6 consultas. Identificaram-se 10 gestantes soropositivas para o HIV (1,4 por cento), sendo 2 pacientes sabidamente soropositivas. As demais (n=8) foram rastreadas no momento do parto e, por isso, não receberam a profilaxia ARV no pré-natal. Três pacientes foram admitidas em período expulsivo e também não receberam a profilaxia intraparto. Entretanto, todos os recém-nascidos foram avaliados e foi realizada a supressão da lactação e iniciada a formulação láctea...


PURPOSE: to evaluate the frequency of HIV tests performed during prenatal care and rapid tests ordered for pregnant women admitted at the time of delivery. METHOD: this was a cross-sectional study with 711 pregnant women at delivery during the period from January to July 2010. Women admitted for clinical control and those that did not allow their clinical data to be included in the study were excluded. The χ² test or the Fisher's Exact test was used for comparison of the proportion in univariate analysis. All the variables with p<0.25 were included in the logistic regression model, called initial model. The analyses were carried out using the SPSS software, with the level of significance set at 5 percent. RESULTS: the mean age of the patients was 25.77±6.7 years and the maximum and minimum age was 44 and 12 years, respectively. The average gestational age at the time of attendance was 38.41±6.7 weeks. Of these patients, 96.3 percent (n=685) had prenatal care and 11.1 percent (n=79) received prenatal care at our facility. The average number of prenatal care visits was 6.85±2.88, but 28.1 percent had less than six visits. We identified 10 HIV-positive pregnant women (1.4 percent) and two patients were known to be HIV positive. The others (n=8) were screened at birth and therefore did not receive ARV prophylaxis during the prenatal period. Three patients were admitted during the expulsion period and also did not receive intrapartum antibiotic prophylaxis. However, all newborns were evaluated, with lactation being suppressed and artificial milk being used...


Subject(s)
Humans , Female , Pregnancy , Antiretroviral Therapy, Highly Active , Health Services Research , HIV Infections , Infectious Disease Transmission, Vertical , Prenatal Care
20.
Medicina (Ribeiräo Preto) ; 44(1): 87-93, jan.-mar. 2011.
Article in English | LILACS | ID: lil-644428

ABSTRACT

Objective: To evaluate the clinical and metabolic profile of HIV-seropositive patients on HAART with a diagnosis of associated lipodystrophy. Methods: We analyzed data computed in a protocol attached to the records of patients treated at the University Hospital of the Medical School of Ribeirão Preto. Results: 69.7% of the participants were male. Mean ± standard deviation body mass index was 24.7 ± 3.6 kg/m2and 26.7 ± 5.98 kg/m2, and average weight 72.78 ± 12.7 kg and 65.94 ± 15.4 kg for males and females, respectively. The percentage of lean mass was greater in men (p = 0.0008) and body fat was greater in women (p = 0.0006)...


Objetivo: Avaliar o perfil clínico e metabólico dos pacientes soropositivo para HIV, em uso de terapia antiretroviral fortemente ativa (Highly Active Antiretroviral Therapy - HAART) e com diagnóstico de lipodistrofia associada. Métodos: A pesquisa foi realizada a partir da análise de dados computados em um protocolo anexado ao prontuário de pacientes atendidos na Unidade Especial de Tratamento para Doenças Infecciosas (UETDI), no Ambulatório de Dislipidemia (ADIS) do Hospital das Clínicas da Faculdade deMedicina de Ribeirão Preto (HC-FMRP). Resultados: 69,7% dos participantes eram do sexo masculino. As médias (DP) de IMC foram 24,7 ± 3.6 Kg/m2 e 26,7 ± 5.98 Kg/m2 e média de peso 72,78 ±12.7 Kg e 65,94 ± 15.4 Kg para o sexo masculino e feminino, respectivamente. A porcentagem de massa magra foi maior nos homens (p=0,0008) e de gordura corporal, maior no sexo oposto (p=0,0006)...


Subject(s)
Humans , Male , Female , Antiretroviral Therapy, Highly Active , Cardiovascular Diseases , HIV-Associated Lipodystrophy Syndrome
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