A comprehensive overview on the role of phytocompounds in human immunodeficiency virus treatment / 中西医结合学报

Acquired immune deficiency syndrome (AIDS) is a worldwide epidemic caused by human immunodeficiency virus (HIV) infection. Newer medicines for eliminating the viral reservoir and eradicating the virus are urgently needed. Attempts to locate relatively safe and non-toxic medications from natural resources are ongoing now. Natural-product-based antiviral candidates have been exploited to a limited extent. However, antiviral research is inadequate to counteract for the resistant patterns. Plant-derived bioactive compounds hold promise as powerful pharmacophore scaffolds, which have shown anti-HIV potential. This review focuses on a consideration of the virus, various possible HIV-controlling methods and the recent progress in alternative natural compounds with anti-HIV activity, with a particular emphasis on recent results from natural sources of anti-HIV agents. Please cite this article as: Mandhata CP, Sahoo CR, Padhy RN. A comprehensive overview on the role of phytocompounds in human immunodeficiency virus treatment. J Integr Med. 2023; 21(4):332-353.

Religiosidade/espiritualidade e adesão à terapia antirretroviral em pessoas vivendo com HIV / Religiosity/spirituality and antiretroviral therapy adherence in people living with HIV / Religiosidad/espiritualidad y adhesión a la terapia antirretroviral en personas viviendo con VIH

Dentre os fatores associados à adesão à Terapia Antirretroviral (TARV) em pessoas vivendo com HIV, destaca-se a religiosidade/espiritualidade (R/E). O objetivo deste estudo foi apresentar as evidências disponíveis sobre a relação entre a dimensão da R/E e a adesão aos antirretrovirais. Realizou-se uma revisão integrativa de literatura com buscas nas bases/bibliotecas CINAHL, LILACS, PePSIC, PsycINFO, PubMed, SciELO, Scopus e Web of Science. Foram selecionados artigos empíricos publicados entre janeiro de 2008 e junho de 2019, sendo recuperados 49 estudos após a aplicação dos critérios de inclusão/exclusão. Encontraram-se associações positivas, negativas e neutras entre R/E e adesão à TARV, evidenciando que a R/E é uma dimensão psicossocial que pode ser preditora da adesão aos antirretrovirais. O sentido dessa influência, no entanto, ainda não é um consenso na literatura científica. Recomenda-se que essas influências sejam compreendidas a partir de elementos contextuais dessa população e não apenas de marcadores pessoais (AU).

Religiosity and spirituality (R/S) have stood out among factors associated with adherence to antiretroviral therapy (ART) in people living with HIV. This study aimed to identify evidence on the relationship between R/S and adherence to ART. An integrative literature review was conducted within the CINAHL, LILACS, PePSIC, PsycINFO, PubMed, SciELO, Scopus, and Web of Science databases. Empirical articles published between January 2008 and June 2019 were selected, and 49 studies were retrieved after applying the inclusion/exclusion criteria. Positive, negative, and neutral associations were found between R/S and adherence to ART, showing that R/S is a psychosocial dimension that can be a predictor of adherence to antiretrovirals. The meaning of this influence, however, is not yet a consensus in the scientific literature. It is recommended that these influences be understood from the contextual elements of this population and not just from personal markers (AU).

Entre los factores asociados a la adherencia a la Terapia Antirretroviral (TARV) en personas diagnosticadas con VIH, destaca la religiosidad/espiritualidad (R/E). El objetivo de este estudio fue presentar las evidencias disponibles sobre la relación entre la dimensión de la R/E y la adherencia a los antirretrovirales. Se realizó una revisión integradora de la literatura con búsquedas en las bases de datos/bibliotecas CINAHL, LILACS, PePSIC, PsycINFO, PubMed, SciELO, Scopus y Web of Science. Se seleccionaron artículos empíricos publicados entre enero de 2008 y junio de 2019, y se recuperaron 49 estudios tras aplicar los criterios de inclusión/exclusión. Fueron encontradas asociaciones positivas, negativas y neutras entre la R/E y la adherencia al TARV, lo que demuestra que la R/E es una dimensión psicosocial que puede ser un predictor de la adherencia a los medicamentos antirretrovirales. Sin embargo, el significado de esta influencia aún no está consensuado en la literatura científica. Se recomienda que estas influencias se entiendan a partir de los elementos contextuales de esta población y no solo de los marcadores personales (AU).

Glomeruloesclerosis focal segmentaria de variante colapsante asociada a VIH. Reporte de caso / Focal segmental glomerulosclerosis of collapsing variant associated with HIV: Clinical case

Resumen La afectación del virus de la inmunodeficiencia humana (VIH) ha cambiado tras el inicio del tratamiento antirretroviral de gran actividad, ya que este ha generado una mayor supervivencia y un menor número de comorbilidades en los pacientes. Es común que en las personas con VIH el fracaso renal agudo esté asociado a sepsis, toxicidad por fármacos o afección directa por el propio virus. La nefropatía en pacientes con VIH es variada y puede estar asociada al uso de medicamentos o directamente al efecto del virus. La prevalencia de esta patología en este tipo de pacientes es <10% y se caracteriza por un colapso glomerular. Las células del parénquima renal expresan los receptores de quimiocinas CCR5 y CXCR4, que son esenciales para la entrada de cepas de VIH-1 en las células. El presente caso es particularmente interesante ya que la insuficiencia renal aguda en el marco de un síndrome nefrótico fue la primera manifestación en un paciente con VIH/sida.

Abstract : Human immunodeficiency virus infection has changed after the start of highly active antiretroviral treatment, generating greater survival and fewer patient comorbidities. In these patients, the finding of acute renal failure is common, which may be associated with sepsis, drug toxicity, or direct involvement by the virus itself. Nephropathy in patients with HIV infection is varied, where it can be associated with the use of medications or directly due to the effect of the virus (HIVAN). The prevalence is less than 10 % and is characterized by glomerular collapse. Renal parenchyma cells express the chemokine receptors CCR5 and CXCR4 that are essential for the entry of HIV-1 strains into cells. The present case is interesting, since acute renal failure in the framework of a nephrotic syndrome was the first manifestation of a patient with HIV / AIDS.

Acidose láctica associada à hipopotassemia grave em paciente sob uso de abacavir, atazanavir, lamivudina, lopinavir/ritonavir e tenofovir: Relato de caso / Lactic acidosis associated with severe hypopotasemia in patients under the use of abacavir, atazanavir, lamivudine, lopinavir / ritonavir and tenofovir: Case report

Os antirretrovirais (ARV) modificaram a evolução natural da síndrome da imunodeficiência adquirida de um quadro inicialmente com perspectiva fatal para doença de convivência crônica, com sobrevida que pode ser próxima daquela esperada para a pessoa hígida. A administração dos ARV, entretanto, requer vigilância médica, não só do especialista, mas de todos os envolvidos na Atenção Básica, na Unidade de Pronto Atendimento e na Terapia Intensiva, para que seus efeitos adversos sejam reconhecidos e abordados convenientemente, o que significará melhores condições de vida para os portadores do vírus da imunodeficiência humana (VIH). Este relato mostra os riscos de associação de ARV, e alerta para situações limites em que alterações metabólicas graves, como acidemia e hipopotassemia, podem colocar em risco a vida do paciente sob terapia ARV

Antirretrovirals (ARV) are medications that have modified the natural evolution of acquired immunodeficiency syndrome from a disease initially with fatal perspective to a chronic coexisting desease, with survival that may be close to that expected for the healthy person. Its administration, however, requires medical supervision, not only of the specialist, but of all those involved in basic care, in the emergency care unit and in the intensive care unit, so that its adverse effects are recognizeed and approached conveniently, which will mean better living conditions for human immunodeficiency vírus (HIV) carriers. This report shows the risk of ARV association, and alerts to limiting situations in whick serious metabolic changes, such as acidemia and hypokalemia, may endanger the lives of patients on ARV therapy.

Adherencia al tratamiento antirretroviral de personas con VIH/sida en la Atención Primaria de Salud / Adherence to antiretroviral treatment of people with HIV / AIDS in primary health care

RESUMEN Introducción: En el Tratamiento Antirretroviral de gran actividad (TARGA), la prevalencia de la adherencia terapéutica es un proceso complejo influido por múltiples factores relacionados con el paciente, la enfermedad, el fármaco, el entorno y el médico. Objetivo: Identificar el nivel de adherencia a la TARGA en personas con VIH/sida de un área de salud y algunas variables relacionadas. Material y Métodos: Estudio descriptivo realizado en 153 pacientes de 18 y más años, con diagnóstico de VIH/sida, del Policlínico "Marcos Manduley", municipio Centro Habana, de enero a diciembre de 2018. La fuente de datos fueron las historias clínicas individuales y se aplicó el cuestionario SMAQ para complementar la información. Se utilizó la prueba de Chi cuadrado ((2) con significación estadística, ɒ = 0,05, se identificaron variables cuyos coeficientes fueron significativamente diferentes de 0 (p < 0,05) y el grado de correlación entre variables utilizando el coeficiente tau-b de Kendall. Resultados: El 70,5 por ciento tuvo buena adherencia a la TARGA. Se encontró asociación estadística y moderada relación directa entre la adherencia terapéutica y la menor edad de los pacientes, débil relación directa con el mayor tiempo bajo tratamiento y ligera relación directa con la presencia de reacciones adversa. Conclusiones: El estudio permitió identificar que el nivel de adherencia terapéutica a la TARGA fue adecuado, usando el cuestionario SMAQ y se relaciona con algunas variables, resultados que concuerdan con otros estudios consultados(AU)

ABSTRACT Introduction: The prevalence of therapeutic adherence to highly active antiretroviral treatment (HAART) is a complex process influenced by multiple factors related to the patient, the disease, the drug, the environment and the doctor. Objective: To identify the level of adherence to HAART and some related variables in people with HIV / AIDS in a health area. Material and Methods: A descriptive study was carried out in 153 patients aged 18 and over with HIV / AIDS diagnosis that received medical assistance at "Marcios Manduley" Polyclinic in Centro Habana municipality from January to December 2018. Data were obtained from individual medical records; the simplified medication adherence questionnaire (SMAQ) was applied to complement the information. The Chi-square test ((2) was used with statistical significance, p = 0.05; variables whose coefficients were significantly different from 0 (p <0.05) were identified and the degree of correlation between variables was obtained using Kendall's correlation coefficient. Results: The results show that 70.5 percent of people had good adherence to HAART. There was statistical association and moderate direct relationship between therapeutic adherence and younger age patients, weak direct relationship with the longest duration of treatment and a slight direct relationship with the presence of adverse reactions. Conclusions: The study allowed us to identify that the level of therapeutic adherence to HAART was adequate using the SMAQ questionnaire. It is related to some variables, showing results that are consistent with other studies consulted(AU)

Hepatitis B viremia in HIV-coinfected individuals under antiretroviral therapy

ABSTRACT Background: Antiretroviral therapy (ART) has decreased AIDS incidence and mortality, rendering comorbidities, such as hepatitis B more relevant for people living with human immunodeficiency virus (HIV). Since antiretroviral drugs may also inhibit hepatitis B virus (HBV) replication, analyzing the impact of ART on management of hepatitis B in this population is important. Objective: To assess HBV viremia among HIV/HBV coinfected individuals on ART and its associated factors. Method: For this cross-sectional study, HIV/HBV-coinfected individuals, aged over 18 years, who were on ART for over six months and receiving care at an outpatient clinic in São Paulo were recruited. Sociodemographic characteristics, information about viral exposure, clinical and laboratory data, including evaluation of liver fibrosis were obtained. Plasma HBV DNA was measured by polymerase chain reaction. Viral genome sequencing was conducted for genotyping and identification of drug resistance-conferring mutations if viral load exceeded 900 IU/mL. Results: Out of 2,946 patients who attended the clinic in 2015, 83 were eligible and 56 evaluated. Plasma HBV DNA was detected in 16 (28.6%) (95% CI: 18.0-41.3%), all on lamivudine and tenofovir treatment. HBV DNA detection was associated with lower education (p = 0.015), higher international normalized ratios (p = 0.045), history of an AIDS-defining illness [OR: 3.43 (95% CI: 1.10-11.50)], and HBeAg detection [OR: 6.60 (95% CI: 1.84-23.6)]. In contrast, a last CD4+ count above 500 cells/mm3 in the year prior to inclusion [OR: 0.18 (95% CI: 0.04-0.71)] and detection of anti-HBe [OR: 0.21 (95% CI: 0.04-0.99)] were negatively associated. Patients with HBV DNA above 900 IU/mL were infected with subgenotypes A1 (n = 3) and D2 (n = 1), and exhibited viral mutations associated with total resistance to lamivudine and partial resistance to entecavir. Conclusions: Despite being on ART, a significant proportion of HIV/HBV-coinfected individuals present HBV viremia. Characterization of factors that are associated with this finding may help professionals provide better management to these patients.

Relevancia clínica de las interacciones medicamentosas en pacientes infectados con el virus de la inmunodeficiencia humana: actualización 2015-2017 / The clinical relevance of drug interactions in patients with human immunodeficiency virus infection: update 2015-2017

Resumen Introducción: La farmacocinética de los anti-retrovirales (ARVs) puede ser modificada por otros medicamentos de uso concomitante. Es oportuno actualizar las interacciones entre nuevos ARVs y fármacos de uso crónico para mantener un éxito terapéutico. Objetivo: Actualizar información sobre interacciones medicamentosas en pacientes con infección por VIH/SIDA en terapia antiretroviral. Método: Revisión estructurada en MEDLINE/ PubMed utilizando los términos Mesh: Anti-retroviral agents and drug interactions or herb-drug interactions or food-drug interactions, entre enero de 2015 y junio de 2017. Fueron seleccionadas publicaciones sobre interacciones medicamentosas en humanos, en inglés o español y con acceso a texto completo. Además, se incluyeron referencias de artículos considerados relevantes. La inclusión de los artículos fue evaluada por tres investigadores independientes y, en caso de requerirlo, por consenso entre ellos. La relevancia clínica se estableció, acorde con la gravedad y probabilidad de ocurrencia de la interacción. Resultados: Se identificaron 466 artículos, se accedió a texto completo a 444. De éstos, 164 aportaron interacciones, lo que permitió identificar un total de 534 parejas de interacciones medicamentosas. Las interacciones que presentaron un mayor riesgo de generar problemas de seguridad y efectividad fueron 308 (57,7%) de nivel 2 y 35 (6,6%) de nivel 1. Conclusiones: Se identifican 534 parejas nuevas de interacciones medicamentosas, de ellas 308 (64,2%) de mayor relevancia clínica.

Background: The pharmacokinetics of anti-retrovirals (ARVs) can be modified by other concomitant medicinal products. It is timely to update the interactions between new ARVs and drugs of chronic use to maintain therapeutic success. Aim: To update information about drug interactions in patients with HIV/AIDS on antiretroviral therapy. Methods: Comprehensive literature review in MEDLINE/PubMed database from January of 2015 to June of 2017, using the Mesh terms: Anti-retroviral agents and drug interactions or herb-drug interactions or food-drug interactions. Publications with drug interactions in humans, in English or Spanish, and with full text were retrieved. Additionally, citation lists from identified articles were reviewed. The study inclusion was assessed by three independent researchers and by consensus among them when was necessary. Clinical relevance of drug interaction was grouped into levels according to seriously and probability of occurrence. Results: 466 articles were identified; full text was accessed in 444. Of these, 164 provided interactions, which allowed the identification of a total of 534 pairs of drug interactions. The interactions that presented a higher risk of generating safety and effectiveness problems were 308 (57.7%) of level 2 and 35 (6.6%) of level 1. Conclusions: We identify 534 new pairs of drug interactions, of which 308 (64.2%) are the most clinically relevant.

Efeitos adversos da profilaxia antirretroviral após exposição ocupacional ao HIV / Adverse effects of antiretroviral prophylaxis after occupational exposure to HIV

A exposição ocupacional a material biológico com risco de transmissão do vírus da imunodeficiência humana (HIV) constitui uma emergência médica. A profilaxia pós-exposição (PEP) deve ser iniciada precocemente e mantida por 28 dias. Desde julho de 2015, o Ministério da Saúde passou a recomendar o uso combinado de três drogas antirretrovirais para a PEP, menos tóxicas e melhor toleradas do que as usadas anteriormente. Apesar disso, quase metade dos expostos em uso da PEP apresenta efeitos adversos. Geralmente, eles são leves e autolimitados. Os mais comuns são alterações gastrointestinais, astenia, cefaleia e tontura. Entretanto, eventos mais graves já foram observados e a taxa de interrupção da profilaxia permanece elevada. Em 2017, o Ministério da Saúde modificou o esquema de primeira linha da PEP, substituindo o terceiro antirretroviral. Esse artigo relata um caso de toxicidade associada ao uso da PEP após exposição ocupacional a material biológico contaminado pelo HIV, traz a revisão dos potenciais efeitos adversos das drogas antirretrovirais que compõem o esquema profilático preconizado pelo Ministério da Saúde e discute a conduta do médico do trabalho diante dessas complicações.

Occupational exposure to biological materials involving risk of human immunodeficiency virus (HIV) transmission is a medical emergency. Post-exposure prophylaxis (PEP) should be started early and administered for 28 days. Since July 2015, the Brazilian Ministry of Health recommends the combined use of three antiretroviral drugs for PEP, which are less toxic and better tolerated than the ones previously used. Nevertheless, almost half of the exposed individuals under PEP exhibit adverse effects, which are usually mild and self-limited. The most frequent adverse events are gastrointestinal disorders, asthenia, headache and dizziness. However, more severe events have been reported, and the rate of non-completion of prophylaxis remains high. In 2017, the Brazilian Ministry of Health modified the first-line PEP regimen involving replacement of the third antiretroviral drug. The present article reports a case of toxicity associated with PEP following an occupational accident involving exposure to HIV infected biological material. In addition, we review the potential adverse effects of antiretroviral drugs included in the prophylactic regimens recommended by the Brazilian Ministry of Health and discuss measures occupational physicians should adopt vis-à-vis these complications

Evaluación de la densidad mineral ósea en niños con infección vertical por VIH / Evaluation of bone mineral density in children with vertical infection by HIV

Resumen Los cambios en la densidad mineral ósea (DMO) son comunes en adultos infectados con virus de la inmunodeficiencia humana (VIH). Existen pocos estudios que evalúen el compromiso óseo en niños. Objetivo: Evaluar la DMO en niños infectados verticalmente por VIH. Métodos: Se estudiaron 53 niños infectados (8-18) de cinco hospitales. Se registró severidad de enfermedad, evaluación nutricional, vitamina D (25-OHD) y estado inmunológico. La DMO se midió mediante densitometría. Se utilizó análisis descriptivo, comparación de medias y regresión lineal simple y múltiple. Resultados: El 88,7% estaban en estadio B y C, 57% eran eutróficos y 18,9% tenían talla baja. El 33,3% presentaba niveles de 25-OHD < 20 ng/ml. El 11%, 6% y 4% de los niños tenían DMO < 2DE en cadera, columna y cuerpo entero, respectivamente. La DMO se correlacionó con IMC, talla, severidad de enfermedad y años de tratamiento. Sólo inhibidores de las proteasas (IP) mantuvieron su significancia al ajustar por otras variables. Conclusión: Los niños infectados con VIH tuvieron DMO más baja por edad comparados con datos de NHANES III. La severidad de la enfermedad, talla, zIMC, los años de tratamiento con anti-retrovirales, principalmente IP, están relacionados con la reducción de la masa ósea.

Changes in bone mineral density (BMD) are common in adults infected with human immunodeficiency virus (HIV). There are few studies evaluating bone involvement in children infected. Objective: To evaluate BMD in vertically HIV-infected children. Methods: We studied 53 infected children (8-18 years) from five hospitals. Disease status, nutritional assessment, vitamin D (25-OHD) levels and immunological status were recorded. BMD was measured by densitometry. Descriptive analysis, comparison of means and simple and multiple linear regression were used. Results: 88.7% children were in stage B and C, 57% were eutrophic and 18.9% had short stature. 33.3% had 25-OHD levels < 20 ng / ml. 11%, 6% and 4% of the children had BMD <-2DE in hip, spine and whole body respectively. BMD was correlated with BMI, height, disease stage and years of treatment. Only protease inhibitors (PIs) maintained their significance when adjusted for other variables. Conclusion: children infected with HIV had lower BMD by age compared to NHANES III data. The severity of the disease, height, zBMI, years of treatment with antiretrovirals, mainly IP, are related to the reduction of bone mass.

Antiviral activity of animal venom peptides and related compounds

Abstract Viruses exhibit rapid mutational capacity to trick and infect host cells, sometimes assisted through virus-coded peptides that counteract host cellular immune defense. Although a large number of compounds have been identified as inhibiting various viral infections and disease progression, it is urgent to achieve the discovery of more effective agents. Furthermore, proportionally to the great variety of diseases caused by viruses, very few viral vaccines are available, and not all are efficient. Thus, new antiviral substances obtained from natural products have been prospected, including those derived from venomous animals. Venoms are complex mixtures of hundreds of molecules, mostly peptides, that present a large array of biological activities and evolved to putatively target the biochemical machinery of different pathogens or host cellular structures. In addition, non-venomous compounds, such as some body fluids of invertebrate organisms, exhibit antiviral activity. This review provides a panorama of peptides described from animal venoms that present antiviral activity, thereby reinforcing them as important tools for the development of new therapeutic drugs.

Antiviral activity of animal venom peptides and related compounds

Viruses exhibit rapid mutational capacity to trick and infect host cells, sometimes assisted through virus-coded peptides that counteract host cellular immune defense. Although a large number of compounds have been identified as inhibiting various viral infections and disease progression, it is urgent to achieve the discovery of more effective agents. Furthermore, proportionally to the great variety of diseases caused by viruses, very few viral vaccines are available, and not all are efficient. Thus, new antiviral substances obtained from natural products have been prospected, including those derived from venomous animals. Venoms are complex mixtures of hundreds of molecules, mostly peptides, that present a large array of biological activities and evolved to putatively target the biochemical machinery of different pathogens or host cellular structures. In addition, non-venomous compounds, such as some body fluids of invertebrate organisms, exhibit antiviral activity. This review provides a panorama of peptides described from animal venoms that present antiviral activity, thereby reinforcing them as important tools for the development of new therapeutic drugs.(AU)

Prevalência de dislipidemias em pacientes em terapia antirretroviral atendidos em um serviço de assistência especializada em Cuiabá (MT) / Prevalence of dyslipidemias in antiretroviral therapy patients served in a specialized care service in Cuiabá (MT)

Embora associada à melhoria da qualidade de vida dos portadores do vírus da imunodeficiência humana (HIV), a terapia antirretroviral (TARV) trouxe alterações nas manifestações cardiovasculares. A TARV tem sido relacionada à dislipidemia, à resistência à insulina e ao diabetes mellitus , que se constituem como fatores de risco para doença cardiovascular. Objetivo: Determinar a prevalência de dislipidemia em pacientes com HIV/síndrome de imunodeficiência adquirida (AIDS) atendidos no serviço de assistência especializada (SAE) de Cuiabá (MT), de acordo com o tempo de tratamento, o grau da doença e a droga utilizada no tratamento. Métodos: Trata-se de um estudo retrospectivo, por meio de dados coletados em prontuários de pacientes adultos, de ambos os sexos, portadores do HIV, acompanhados pelo SAE. Para coleta de dados informados, foi utilizado um instrumento composto de dados demográficos, pessoais, antropométricos e bioquímicos. Com base nos exames bioquímicos, foi analisada a presença de alterações de colesterol total (CT), triglicerídeos totais (TG) e lipoproteína de baixa densidade (LDL). O estágio da doença foi considerado conforme a contagem de células CD4. Resultados: Foram avaliados 124 indivíduos, sendo 54,8% do sexo masculino. A faixa etária mais prevalente (50,8%) esteve entre 40 e 60 anos. No tocante à escolaridade, 36,8% relataram ter ensino superior incompleto. Quanto ao estado civil, 40,2% declararam-se casados. Com relação ao tempo de exposição ao tratamento antirretroviral, observou-se 44,2% de prevalência de dislipidemia nos pacientes com 1,0 a 4,9 anos de tratamento. Quanto ao estágio da doença, foi verificada prevalência de 53,4% de dislipidemia nos pacientes no estágio inicial (CD4≥500 cells/µL), porém houve piora progressiva do perfil lipídico com o avançar da doença. Concernente ao tipo de droga utilizada, 29,3% dos pacientes de nosso estudo utilizam o esquema "ITRNN + 2ITRN". Conclusão: O risco de dislipidemias pode aumentar com o tempo de tratamento, com a gravidade da doença e com o tipo de droga utilizada na terapia.

Although associated with improved quality of life for people with human immunodeficiency virus (HIV), the antiretroviral therapy (ART) has brought changes in cardiovascular manifestations. Antiretroviral therapy has been related with dyslipidemia, insulin resistance and diabetes mellitus, which constitute risk factors for cardiovascular disease. Objective: This study aimed at determining the prevalence of dyslipidemia in patients with HIV/ acquired immunodeficiency syndrome (AIDS) treated at the specialized care center in Cuiabá (MT), according to the duration of treatment, the stage of the disease and the drug used for treatment. Methods: This is a retrospective study using data collected from medical records of adult patients of both sexes, positive for HIV/AIDS treated at the specialized care center in Cuiabá. To collect the data, we used an instrument consisting of demographic, personal, anthropometric and biochemical data. The biochemical tests analyzed the presence of abnormal total cholesterol (TC), total triglycerides (TG) and low- density lipoprotein (LDL). The stage of the disease was found in accordance with CD4. Results: A total of 124 patients were evaluated, of which 54.8% were male. The most prevalent age group (50.8%) was between 40 and 60 years old. Regarding education, 36.8% reported having incomplete higher education. In terms of marital status, 40.2% declared to be married. With respect to the time of exposure to antiretroviral therapy, there was a 44.2% prevalence of dyslipidemia in patients with 1.0 to 4.9 years of treatment. Concerning the stage of the disease, the prevalence of dyslipidemia was found in 53.4% of patients in the early stage (CD4≥500 cells/uL). However, there was progressive worsening of lipid profile with the advance of the disease. About the type of drug used, 29.3% of the patients in our study used the scheme "NNRTI + 2ITRN." Conclusion: The risk of dyslipidemia may increase with the time of treatment, the severity of the disease and the type of drug used in therapy .

Relevancia clínica de las interacciones medicamentosas en pacientes infectados con el virus de la inmunodeficiencia humana: actualización 2009-2014 / The clinical relevance of drug interactions in patients with human immunodeficiency virus infection: update 2009-2014

Objective: To update information about drug interactions in patients with HIV/AIDS. Methods: Comprehensive literature review in MEDLINE/PubMed database from May of 2009 to December of 2014, using the Mesh terms: Anti-retroviral agents and drug interactions or herb-drug interactions or food-drug interactions. Publications with drug interactions in humans, in English or Spanish, and with full text were retrieved. Additionally, citation lists from identified articles were reviewed. The study inclusion was assessed by three independent researchers and by consensus among them when was necessary. Clinical relevance of drug interaction was grouped into four levels according to seriously and probability of occurrence. Results: Global, 546 different references were retrieved and 243 were selected. In addition 11 further manuscripts were identified in the references of the included articles. Overall, 935 pairs of drug interactions were identified, 95.7% pharmacokinetic (823 by enzyme induction or inhibition and 67 by changes in bioavailability). Of the 935 pairs of drug interactions, 402(43%) were classified as levels 1 or 2. Conclusions: The most clinically relevant antiretroviral drug interactions are due to pharmacokinetic mechanism, mainly induction or enzyme inhibition, according to previous reviews, the protease inhibitors remain as the antiretrovirals with the highest number of clinical relevant interactions.

Objetivo: Actualizar información sobre interacciones medicamentosas en pacientes con VIH/SIDA. Métodos: Revisión estructurada en MEDLINE/PubMed utilizando los términos Mesh: Anti-retroviral agents and drug interactions or herb-drug interactions or food-drug interactions, entre mayo de 2009 y diciembre de 2014. Publicaciones sobre interacciones medicamentosas, en humanos, en inglés o español y con acceso a texto completo fueron seleccionadas. Además, se incluyeron referencias de artículos considerados relevantes. La inclusión de los artículos fue evaluada por tres investigadores independientes y, en caso de requerirlo, por consenso entre ellos. La relevancia clínica se estableció en cuatro niveles, acorde con la gravedad y probabilidad de ocurrencia de la interacción. Resultados: Se identificaron 546 artículos, de los cuales se seleccionaron 273; además, se incluyeron 11 referencias relevantes. Se identificaron 935 parejas de interacciones medicamentosas, 95,7% farmacocinéticas. De este grupo, 823 mediadas por inducción o inhibición enzimática y 67 por cambios en la biodisponibilidad. De las 935 parejas de interacciones, 402 (43%) fueron relevantes clínicamente (niveles 1 o 2). Conclusiones: Las interacciones medicamentosas con anti-retrovirales de mayor relevancia clínica se deben a mecanismos farmacocinéticos, principalmente inducción o inhibición enzimática. Acorde con revisiones previas, los inhibidores de proteasa continúan siendo los anti-retrovirales con mayor número de interacciones relevantes.

The Incidence and Clinical Characteristics of Acute Serum Creatinine Elevation more than 1.5 mg/dL among the Patients Treated with Tenofovir/Emtricitabine-containing HAART Regimens

BACKGROUND: The combination of tenofovir disoproxil fumarate (TDF) and emtricitabine (FTC) has been the first choice nucleoside reverse transcriptase inhibitor (NRTI) according to many reliable antiretroviral treatment (ART) guidelines because of its high efficacy. However, TDF-related renal toxicity reported in Western countries is a challenging issue regarding clinical use. We conducted this study to evaluate the incidence and characteristics of an acute increase in serum creatinine (Cr) level > 1.5 mg/dL among TDF/FTC-based highly active antiretroviral treatment (HAART)-treated patients. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 205 HIV-infected patients treated with TDF/FTC-containing regimens between 1 February 2010 and 30 April 2014. Three groups of TDF/FTC + ritonavir-boosted protease inhibitor (PI/r), TDF/FTC + non-nucleoside reverse transcriptase inhibitor (NNRTI), and TDF/FTC + integrase strand transfer inhibitor (INSTI), and three PI/r subgroups of TDF/FTC + lopinavir (LPV)/r, TDF/FTC + atazanavir (ATV)/r, TDF/FTC + darunavir (DRV)/r were evaluated. RESULTS: A total 136 patients (91 in the TDF/FTC + PI/r group, 20 in the TDF/FTC + NNRTI group and 25 in the TDF/FTC + INSTI group) were included in the statistical analysis. Four cases (4.9%; all in the TDF/FTC + PI/r group) among 136 patients showed an acute increase in serum Cr more than 1.5 mg/dL, so the overall incidence was 2.8 cases per 100 patient-years. One case was a patient treated with TDF/FTC + LPV/r, and the others were treated with TDF/FTC + ATV/r. No case of an acute increase in serum Cr was observed in the TDF/FTC + DRV/r group. The incidence of serum Cr increase more than 1.5 mg/dL in TDF/FTC + PI/r group was 4.0 cases per 100 patient-years. CONCLUSION: Although only a small number of patients were evaluated retrospectively from a single center, the TDF/FTC + PI/r regimen may have been related with relatively higher tendency of increment of serum Cr level. These findings reinforce the importance of close follow-ups of HIV-infected patients treated with the TDF/FTC + PI/r regimens.

Avaliação da efetividade de uma intervenção psicossocial para melhorar a adesão do paciente à terapia antirretroviral da Aids: ensaio controlado aleatório utilizando monitoramento eletrônico

INTRODUÇÃO: O sucesso da terapia antirretroviral de alta potência depende da manutenção de altas taxas de adesão do paciente ao tratamento, o que provocou a implementação de intervenções para melhorar a adesão nos programas de Aids em todo o mundo. No Brasil há poucos estudos sobre a efetividade destas intervenções e apenas um foi aleatório e controlado. Este estudo objetiva avaliar a efetividade de uma intervenção psicossocial para melhorar a adesão de pessoas vivendo com HIV e Aids à terapia antirretroviral. MÉTODOS: Consentiram em participar do estudo 121 dos 363 pacientes com carga viral >50 cópias/ml e com mesmo esquema antirretroviral por no mínimo seis meses, em acompanhamento no Centro de Referência e Treinamento em DST e Aids - São Paulo/Brasil. Todos os participantes utilizaram monitoramento eletrônico de medicação por 60 dias sendo então aleatorizados na proporção de 1:1 para os grupos de intervenção (GI) e controle (GC). O GI recebeu o cuidado usual do serviço e participou de quatro encontros individuais de uma hora com profissional de saúde previamente capacitado a intervalos de 15 dias. O GC recebeu apenas o cuidado usual. O desfecho primário foi a adesão medida pelo monitoramento eletrônico no momento da alocação nos grupos (início da intervenção), após 30, 60, 90 e 120 dias. A medida secundária foi a carga viral no início e no final do estudo. A análise foi feita por intenção de tratamento. RESULTADOS: Não houve diferença estatística significativa nas medidas de adesão segundo percentual de doses tomadas, de doses tomadas no horário e proporção de pacientes com adesão >= 95%, entre os grupos GI e GC durante o período da intervenção (medidas de 30 e 60 dias). Entretanto, a evolução da proporção de pacientes com adesão >= 95% entre o início da intervenção e o primeiro seguimento pós intervenção (medida de 90 dias)...

INTRODUCTION: The success of the antiretroviral therapy depends on high patient adherence to treatment, which has led to the implementation of interventions aimed at enhancing adherence in AIDS programs worldwide. Few studies have been performed in Brazil investigating the effectiveness of these interventions, and only one randomized controlled study is available. The aim of this study is to assess the effectiveness of a psychosocial intervention in improving adherence to antiretroviral treatment among individuals living with HIV and AIDS. METHOD: A total of 121 out of 363 patients with viral load > 50 copies/ml and in use of the same antiretroviral scheme for at least six months were recruited from the Reference and Training Center for STD and AIDS - São Paulo/Brazil. All participants used electronic monitoring of medication for 60 days and were randomized in a 1:1 ratio for the intervention group (IG) and control (CG) The IG, in addition to receiving standard care, took part in four 1-hour meetings, held every fortnight by a trained-health professional. The CG received standard care only. The study was run for six month. The primary outcome was adherence measured by electronic monitoring at the time of allocation groups (commencement of intervention), after 30, 60, 90 and 120 days. The secondary measure was the viral load at baseline and end-point of the study. The analysis was done by intention to treat. RESULTS: Comparison between IG and CG during the intervention period revealed no statistically significant difference in adherence in terms of percentage of doses taken, percentage of doses taken on time, or proportion of patients with adherence >= 95%. However, the evolution of the proportion of patients with adherence >= 95% between the commencement of intervention and follow-up after first intervention (as of 90 days) showed increased adherence in the GI and a tendency for reduced...

Avaliação da efetividade de uma intervenção psicossocial para melhorar a adesão do paciente à terapia antirretroviral da Aids: ensaio controlado aleatório utilizando monitoramento eletrônico / Evaluation of the effectiveness of a psychosocial intervention to improve patient adherence to antiretroviral therapy of AIDS: randomized clinical trial using electronic monitoring

INTRODUÇÃO: O sucesso da terapia antirretroviral de alta potência depende da manutenção de altas taxas de adesão do paciente ao tratamento, o que provocou a implementação de intervenções para melhorar a adesão nos programas de Aids em todo o mundo. No Brasil há poucos estudos sobre a efetividade destas intervenções e apenas um foi aleatório e controlado. Este estudo objetiva avaliar a efetividade de uma intervenção psicossocial para melhorar a adesão de pessoas vivendo com HIV e Aids à terapia antirretroviral. MÉTODOS: Consentiram em participar do estudo 121 dos 363 pacientes com carga viral >50 cópias/ml e com mesmo esquema antirretroviral por no mínimo seis meses, em acompanhamento no Centro de Referência e Treinamento em DST e Aids - São Paulo/Brasil. Todos os participantes utilizaram monitoramento eletrônico de medicação por 60 dias sendo então aleatorizados na proporção de 1:1 para os grupos de intervenção (GI) e controle (GC). O GI recebeu o cuidado usual do serviço e participou de quatro encontros individuais de uma hora com profissional de saúde previamente capacitado a intervalos de 15 dias. O GC recebeu apenas o cuidado usual. O desfecho primário foi a adesão medida pelo monitoramento eletrônico no momento da alocação nos grupos (início da intervenção), após 30, 60, 90 e 120 dias. A medida secundária foi a carga viral no início e no final do estudo. A análise foi feita por intenção de tratamento. RESULTADOS: Não houve diferença estatística significativa nas medidas de adesão segundo percentual de doses tomadas, de doses tomadas no horário e proporção de pacientes com adesão >= 95%, entre os grupos GI e GC durante o período da intervenção (medidas de 30 e 60 dias). Entretanto, a evolução da proporção de pacientes com adesão >= 95% entre o início da intervenção e o primeiro seguimento pós intervenção (medida de 90 dias)...

INTRODUCTION: The success of the antiretroviral therapy depends on high patient adherence to treatment, which has led to the implementation of interventions aimed at enhancing adherence in AIDS programs worldwide. Few studies have been performed in Brazil investigating the effectiveness of these interventions, and only one randomized controlled study is available. The aim of this study is to assess the effectiveness of a psychosocial intervention in improving adherence to antiretroviral treatment among individuals living with HIV and AIDS. METHOD: A total of 121 out of 363 patients with viral load > 50 copies/ml and in use of the same antiretroviral scheme for at least six months were recruited from the Reference and Training Center for STD and AIDS - São Paulo/Brazil. All participants used electronic monitoring of medication for 60 days and were randomized in a 1:1 ratio for the intervention group (IG) and control (CG) The IG, in addition to receiving standard care, took part in four 1-hour meetings, held every fortnight by a trained-health professional. The CG received standard care only. The study was run for six month. The primary outcome was adherence measured by electronic monitoring at the time of allocation groups (commencement of intervention), after 30, 60, 90 and 120 days. The secondary measure was the viral load at baseline and end-point of the study. The analysis was done by intention to treat. RESULTS: Comparison between IG and CG during the intervention period revealed no statistically significant difference in adherence in terms of percentage of doses taken, percentage of doses taken on time, or proportion of patients with adherence >= 95%. However, the evolution of the proportion of patients with adherence >= 95% between the commencement of intervention and follow-up after first intervention (as of 90 days) showed increased adherence in the GI and a tendency for reduced...

Lipodistrofia em crianças e adolescentes com síndrome da imunodeficiência adquirida e sua relação com a terapia antirretroviral empregada / Lipodystrophy in children and adolescents with acquired immunodeficiency syndrome and its relationship with the antiretroviral therapy employed

OBJETIVO: Avaliar a presença de lipodistrofia clínica em crianças com síndrome da imunodeficiência adquirida e relacioná-la com o esquema antirretroviral utilizado, alterações do perfil lipídico e resistência insulínica. MÉTODOS: Por meio de estudo transversal, foram avaliadas 30 crianças e adolescentes (mediana de idade = 9,1 anos) com síndrome da imunodeficiência adquirida, no período entre 2004 e 2005. As avaliações clínico-laboratoriais incluíram: classificação da infecção pelo HIV, medidas antropométricas (peso e estatura), glicemia e insulina séricas e perfil lipídico (LDL-c, HDL-c, triglicérides). A lipodistrofia foi definida por parâmetros clínicos. O teste do qui-quadrado foi utilizado na análise estatística. RESULTADOS: Todos os pacientes recebiam terapia antirretroviral regularmente (mediana de tempo de uso = 28,4 meses), 80 por cento utilizavam três drogas em associação (terapia fortemente ativa) e 30 por cento usavam inibidores de protease. Lipodistrofia e dislipidemia foram observadas em 53,3 e 60 por cento dos pacientes, respectivamente. Crianças que utilizavam terapia fortemente ativa com inibidor de protease apresentaram maior percentual de lipodistrofia mista, com diferença estatisticamente significante em relação ao grupo com terapia fortemente ativa sem inibidor de protease e ao grupo sem terapia fortemente ativa (44,4 versus 16,7 por cento; p = 0,004). Não se observou diferença estatisticamente significante entre presença de lipodistrofia e gênero, idade (> 10 anos), alterações do perfil lipídico e resistência insulínica. CONCLUSÕES: A elevada prevalência de dislipidemia e lipodistrofia verificada nas crianças com síndrome da imunodeficiência adquirida, mostrando relação com o esquema antirretroviral empregado, pode significar um risco elevado para o desenvolvimento futuro de complicações, especialmente as cardiovasculares.

OBJECTIVE: To evaluate the presence of clinical lipodystrophy in children with the acquired immunodeficiency syndrome and to relate it to the antiretroviral regimen employed, to changes in lipid profile and to insulin resistance. METHODS: This was a cross-sectional study that evaluated 30 children and adolescents (median age = 9.1 years) with the acquired immunodeficiency syndrome during 2004 and 2005. The following clinical and laboratory evaluations were performed: classification of HIV infection, anthropometric measurements (weight and height), serum glycemia, serum insulin and lipid profile (LDL-c, HDL-c, triglycerides). Lipodystrophy was diagnosed using clinical parameters. The chi-square test was used for statistical analysis. RESULTS: All of the patients were taking antiretroviral therapy regularly (median duration of 28.4 months); 80 percent were on three drugs in combination (highly active therapy) and 30 percent were on protease inhibitors. Lipodystrophy and dyslipidemia were observed in 53.3 and 60 percent of the patients, respectively. Children on a highly active therapy regimen with protease inhibitors exhibited a higher percentage of mixed lipodystrophy; the difference between these children and the group on highly active therapy without protease inhibitors and the group not on a highly active therapy was statistically significant (44.4 vs. 16.7 percent; p = 0.004). There was no statistically significant association between the presence of lipodystrophy and sex, age (> 10 years), changes to the lipid profile or insulin resistance. CONCLUSIONS: The elevated prevalence of dyslipidemia and lipodystrophy observed among children with acquired immunodeficiency syndrome, which exhibited a relationship with the antiretroviral regimen employed, may represent an increased risk for future complications, in particular cardiovascular problems.

Dislipidemia em pacientes HIV/AIDS em uso de anti-retrovirais num hospital universitário, Rio de Janeiro, Brasil / Dyslipidemia in HIV/AIDS patients in antiretroviral therapy in a university hospital, Rio de Janeiro, Brazil

INTRODUÇÃO: O uso contínuo da terapêutica anti-retroviral (TARV) está associado à ocorrência de diversos distúrbios metabólicos. OBJETIVO: O principal objetivo deste estudo foi determinar a prevalência de dislipidemia em pacientes com vírus da imunodeficiência humana/síndrome de imunodeficiência adquirida (HIV/AIDS) atendidos no ambulatório de doenças infecciosas do Hospital Universitário Pedro Ernesto da Universidade do Estado do Rio de Janeiro (HUPE/UERJ). MATERIAL E MÉTODOS: No período de 1/10/2004 a 30/5/2005, os participantes do estudo responderam a uma entrevista sobre dados demográficos e relativos à saúde. Após a entrevista foram verificadas as seguintes medidas: peso, altura, cintura e quadril. Foi coletado sangue para realização de dosagem plasmática de colesterol total (CT), colesterol da lipoproteína de alta densidade (HDL-C) e triglicerídeos (TG). Dos 268 pacientes que compareceram à consulta no período de estudo, 23 não se apresentaram para a coleta de sangue e 10 não quiseram participar. O modelo de regressão de Poisson foi empregado para encontrar variáveis associadas à dislipidemia. RESULTADOS: Foram incluídos 235 pacientes, dos quais 182 (77,5 por cento) tinham dislipidemia; houve prevalência maior no sexo masculino (69,8 por cento) do que no feminino (30,2 por cento); e 26,9 por cento tinham antecedentes familiares de dislipidemia contra 15,1 por cento sem este antecedente. Para o tempo de uso de TARV, tanto a média quanto a mediana foram maiores no grupo de pacientes com dislipidemia. CONCLUSÃO: Em nosso estudo, a prevalência de dislipidemia em portadores de HIV/AIDS foi alta (77,5 por cento) e foram identificados sexo masculino, história familiar de dislipidemia e tempo de uso de TARV como fatores associados.

BACKGROUND: The continuous use of antiretroviral therapy (ART) is associated with several metabolic disturbances. OBJECTIVES: The main objective of this study was to determine the prevalence of dyslipidemia in human immunodeficiency virus/acquired immunological deficiency syndrome (HIV/AIDS) patients followed in the infectious diseases outpatient clinic of Hospital Universitário Pedro Ernesto, of Universidade do Estado do Rio de Janeiro (HUPE/UERJ). MATERIAL AND METHODS: From 10/1/2004 to 5/30/2005, the participants of this study answered a survey about demographic and health data. Afterwards, the following measurements were checked: weight, height, waist and hips. Blood samples were collected for total cholesterol, high-density lipoprotein cholesterol (HDL-C) and triglycerides tests. Out of 268 patients who came to the appointment during the study period, 23 did not attend the blood collection, and 10 did not want to participate. Poisson regression model was used to find the variables associated with dyslipidemia. RESULTS: Out of the 235 patients included in the study 182 (77.5 percent) had dyslipidemia, with prevalence of male (69.8 percent) over female ones (30.2 percent). Among the patients with dyslipidemia, 26.9 percent had family history of dyslipidemia against 15.1 percent who did not. Regarding ART duration, both mean and media were higher in the group of patients with dyslipidemia. CONCLUSION: In our study the prevalence of dyslipidemia in HIV/AIDS patients was high (77.5 percent), and the associated factors were male sex, family history of dyslipidemia and ART duration.

Antiretroviral drug taking among Myanmar migrants in central region of Thailand / การรับยาต้านไวรัสผู้อพยพชาวพม่าที่อยู่ในภาคกลางของประเทศไทย

Monitoring HIV treatment success includes a major portion in antiretroviral drug treatment. Antiretroviral drugs (ARV) do not eradicate the virus but they maintain viral replication at low levels. The study of ARV taking among migrants is an interesting issue. This study is aimed to identify factors which facilitate or constrain ARV taking among Myanmar migrant ARV users in the hospitals in central region of Thailand. It is expected to know factors affecting ARV taking in Myanmar migrants and to provide future specific intervention to increase and maintain high level of adherence. The qualitative study purposively selected 27 participants from 4 hospitals of Thailand (Sattahip Hospital, Photharam Hospital, Ratchburi Hospital, and Samut Sakhon Hospital). To develop the study, the participants were asked by in-depth interview. The number of participants regularly taking ARV and those having dose absence are nearly the same. Their incomes are not enough for long term ARV treatment taking. Therefore, free of charge treatment strongly improves their long term regular ARV taking. Their immigration registration highly affects to their free treatment. As regards the patients’ condition, the frequency of medical taking and opportunistic infection/clinical symptoms affected ARV taking. Social and family support and knowledge from hospitals result in improving their self awareness. Despite these factors, self awareness itself is more important for this Myanmar migrant group. In conclusion, economic concern, work related factors, immigration registration and self awareness are affected Myanmar migrants ARV taking.

Microbiota intestinal de indivíduos que sofreram acidente ocupacional com materiais biológicos e que realizaram profilaxia anti-retroviral / Intestinal microbiota of individuals who suffered occupational accidents with biological materials and underwent antiretroviral prophylaxis

Avaliar a microbiota intestinal de indivíduos que sofreram acidente ocupacional com materiais biológicos e receberam anti-retrovirais foi o objetivo deste estudo. O grupo de estudo constou de 23 indivíduos com idade entre 18-45 anos, sendo 13 doadores de sangue e 10 que sofreram acidente ocupacional. Foram avaliados a microbiota intestinal, antropometria e exames laboratoriais pré, pós e 30 dias após o término da medicação. Zidovudina mais lamivudina foi utilizada em 70 por cento dos indivíduos associado ao nelfinavir, 20 por cento ao efavirenz e 10 por cento ao ritonavir. As alterações nutricionais e dietéticas-laboratoriais e de microbiota intestinal foram analisadas em três momentos. M1: até dois dias do início da profilaxia; M2: no último dia da profilaxia e M3: 30 dias após o término da profilaxia. Náuseas, vômitos e diarréia estiveram presentes em 50 por cento no segundo momento do estudo. Sobrepeso em 70 por cento, desnutrição e eutrofia em 10 por cento, dos indivíduos, não se modificaram durante o estudo. Transaminases, triglicérides, LDL-colesterol se elevaram no segundo momento e normalizaram 30 dias após término da medicação. Houve redução significativa dos Lactobacillus, Bifidobacterium e Bacteróides nos três momentos. Uso de anti-retrovirais provocou impacto significativo na microbiota intestinal dos indivíduos, sem recuperação em 30 dias.

The aim of this study was to evaluate the intestinal microbiota of individuals who had suffered occupational accidents and had received antiretrovirals. The study group consisted of 23 individuals between 18 and 45 years old, of whom 13 were blood donors and 10 had suffered occupational accidents. Intestinal microflora, anthropometry and laboratory tests were evaluated before, after and 30 days after discontinuation of the medication. Zidovudine plus lamivudine was used in association with nelfinavir for 70 percent of the individuals, with efavirenz for 20 percent and with ritonavir for 10 percent. Nutritional, diet, laboratory and intestinal microbiota abnormalities were analyzed at three times: M1, not more than two days after starting prophylaxis; M2, on the last day of prophylaxis; and M3, 30 days after ending prophylaxis. Nausea, vomiting and diarrhea were present in 50 percent at M2. Overweight in 70 percent, malnutrition and eutrophy in 10 percent of the individuals remained unchanged during the study. Transaminases, triglycerides and LDL-cholesterol because elevated at M2 and normalized 30 days after discontinuation of the medication. There were significant reductions in Lactobacillus, Bifidobacterium and Bacteroides at the three times. The use of antiretrovirals caused a significant impact on the individuals’ intestinal microbiota, without recovery after 30 days.