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1.
Rev. chil. infectol ; 41(2): 311-315, abr. 2024. ilus, tab
Article in Spanish | LILACS | ID: biblio-1559674

ABSTRACT

El alelo HLA B*57:01 es un marcador genético asociado con la hipersensibilidad al fármaco anti-retroviral abacavir (ABC) y su frecuencia en la población peruana todavía es desconocida. El objetivo fue identificar el alelo HLA B*57:01 en una población militar de Lima, Perú. Se reclutaron 43 personas viviendo con VIH (PVV) quienes aceptaron participar a través de un consentimiento informado. La detección del alelo HLA B*57:01 se realizó mediante RPC en tiempo real (RT-PCR). Asimismo, se determinó la carga viral (CV), el recuento de linfocitos CD4 y la genotipificación del VIH. Se identificaron dos casos positivos al alelo HLA B*57:01 (4,7%). Además, uno de ellos presentó múltiples mutaciones de resistencia a los anti-retrovirales (ARV), incluyendo ABC. Se demostró por primera vez en el Perú la presencia del alelo HLA B*57:01.


The HLA B*57:01 allele is a genetic marker associated with hypersensitivity to the antiretroviral Abacavir (ABC) and its frequency in the Peruvian population is still unknown. The objective was to identify the HLA B*57:01 allele in a military population from Lima, Peru. Forty three people living with HIV (PLWH) were recruited, who agreed to participate through informed consent. Detection of the HLA B*57:01 allele was performed by real-time PCR (RT-PCR). Likewise, viral load (VL), CD4 lymphocyte count and HIV genotyping were determined. Two cases positive for the HLA B*57:01 allele (4.7%) were identified. In addition, one of them had multiple resistance mutations to antiretrovirals (ARVs), including ABC. The presence of the HLA B*57:01 allele was demonstrated for the first time in Peru.


Subject(s)
Humans , Male , Middle Aged , HIV Infections/genetics , Anti-HIV Agents/adverse effects , Drug Hypersensitivity/genetics , Military Personnel , Peru , HLA-B Antigens/genetics , Genetic Markers , HIV Infections/drug therapy , HIV/genetics , CD4 Lymphocyte Count , Viral Load/genetics , Genetic Predisposition to Disease , Cyclopropanes/adverse effects , Drug Hypersensitivity/immunology , Alleles , Real-Time Polymerase Chain Reaction , Genotype
2.
Chinese Medical Journal ; (24): 2931-2937, 2023.
Article in English | WPRIM | ID: wpr-1007731

ABSTRACT

BACKGROUND@#This study aimed to determine the reasons for conversion and elucidate the safety and efficacy of transition to tenofovir alafenamide/emtricitabine/bictegravir sodium (TAF/FTC/BIC) in highly active antiretroviral therapy (HAART)-experienced HIV-infected patients in real-world settings.@*METHODS@#We conducted a retrospective cohort study. The treatment conversion rationales, safety, and effectiveness in 1684 HIV-infected patients with previous HAART experience who switched to TAF/FTC/BIC were evaluated at Beijing Ditan Hospital from September 2021 to Auguest 2022.@*RESULTS@#Regimen simplification (990/1684, 58.79%) was the most common reason for switching, followed by osteoporosis or osteopenia (375/1684, 22.27%), liver dysfunction (231/1684, 13.72%), decline in tenofovir alafenamide/emtricitabine/elvitegravir/cobicistat (TAF/FTC/EVG/c) with food restriction (215/1684, 12.77%), virological failure (116/1684, 6.89%), and renal dysfunction (90/1684, 5.34%). In patients receiving non-nucleotide reverse transcriptase inhibitors (NNRTI)-containing regimens, lipid panel changes 1 year after switching indicated a difference of 3.27 ± 1.10 mmol/L vs . 3.40 ± 1.59 mmol/L in triglyceride ( P  = 0.014), 4.82 ± 0.74 mmol/L vs . 4.88 ± 0.72 mmol/L in total cholesterol ( P  = 0.038), 3.09 ± 0.70 mmol/L vs . 3.18 ± 0.66 mmol/L in low-density lipoprotein ( P  <0.001), and 0.99 ± 0.11 mmol/L vs . 0.95 ± 0.10 mmol/L in high-density lipoprotein ( P  <0.001). Conversely, among patients receiving booster-containing regimens, including TAF/FTC/EVG/c and lopinavir/ritonavir (LPV/r), lipid panel changes presented decreased trends. We also observed an improved trend in viral load suppression, and alanine transaminase (ALT), aspartate transaminase (AST), estimated glomerular filtration rate (eGFR), and serum creatinine levels after the transition ( P  <0.001).@*CONCLUSION@#The transition to TAF/FTC/BIC demonstrated good treatment potency. Furthermore, this study elucidates the motivations behind the adoption of TAF/FTC/BIC in real-world scenarios, providing clinical evidence supporting the stable conversion to TAF/FTC/BIC for HAART-experienced patients.


Subject(s)
Humans , Antiretroviral Therapy, Highly Active/adverse effects , Anti-HIV Agents/adverse effects , HIV Infections/drug therapy , Tenofovir/therapeutic use , Retrospective Studies , Emtricitabine/pharmacology , Adenine/therapeutic use , Lipids
3.
Rev. chil. ortop. traumatol ; 62(1): 34-38, mar. 2021. ilus
Article in Spanish | LILACS | ID: biblio-1342663

ABSTRACT

Presentamos el primer reporte de caso en paciente adulto con virus de la inmunodeficiencia humana (VIH + ) con fractura por fragilidad en fémur proximal asociada al uso de terapia antirretroviral (TARV) con fumarato de disoproxilo de tenofovir (FDT) en Chile. Actualmente, los pacientes diagnosticados con VIH inician tratamiento precoz con TARV, lo que implica mayor cantidad de años de exposición a los fármacos de la terapia. El tiempo de exposición acumulado al FDT se ha asociado a disminución de la densidad mineral ósea y falla renal progresiva, pudiendo el paciente desarrollar síndrome de Fanconi adquirido y osteomalacia, con riesgo aumentado de fractura. Presentamos el caso de un hombre de 44 años, VIH+ , evaluado en urgencia tras caída a nivel que resultó en fractura patológica del fémur proximal. Los exámenes de ingreso destacaron hipocalemia, hipocalcemia, hipofosfatemia e hipovitaminosis D. Se realizó manejo multidisciplinario, con suspensión del FDT, un cambio en la TARV, y suplementación con calcio y carga de vitamina D. Se realizó reducción cerrada y fijación con clavo cefalomedular largo, que evolucionó favorablemente con rehabilitación motora precoz; el paciente recuperó su funcionalidad previa, y se observó consolidación ósea a las 12 semanas. La aparición de dolor osteomuscular en pacientes VIH+ en TARV debe levantar alta sospecha clínica de efecto adverso a medicamento; el seguimiento de estos pacientes debe incluir el control seriado de la función renal y de los niveles séricos de calcio y fósforo. La búsqueda y sospecha de estas complicaciones permitiría una intervención precoz, mejorando la condición de los pacientes y previniendo fracturas patológicas.


We present the first case report of a human immunodeficiency virus (HIV)-positive adult patient with a fragility fracture of the proximal femur associated with antiretroviral therapy (ART) with tenofovir disoproxil fumarate (TDF) in Chile. Currently, patients diagnosed with HIV start ART early, resulting in more years of exposure to these drugs. The accumulated exposure time to TDF has been associated with a decreased bone mineral density and progressive renal failure, potentially leading to acquired Fanconi syndrome, osteomalacia, and an increased risk of fracture. We present a case of a 44-year-old, HIV-positive man assessed at the emergency room after a fall from standing height which resulted in a proximal femoral pathological fracture. Laboratory findings at admission revealed hypokalemia, hypocalcemia, hypophosphatemia, and hypovitaminosis D. Multidisciplinary management was performed, with TDF discontinuation, ART change, and supplementation with calcium and vitamin D. Closed reduction and fixation with a long cephalomedullary nail was successful, with early motor rehabilitation, functional recovery, and bone consolidation at 12 weeks. Musculoskeletal pain in HIV-positive patients on ART must raise the clinical suspicion of an adverse drug effect; the follow-up of these subjects must include serial monitoring of renal function and serum calcium and phosphorus levels. Screening and suspicion of such complications would enable an early intervention, improving the patients' condition and preventing pathological fractures.


Subject(s)
Humans , Male , Adult , Anti-HIV Agents/adverse effects , Femoral Fractures/chemically induced , Femoral Fractures/therapy , Tenofovir/adverse effects , Vitamin D/therapeutic use , Bone Nails , Calcium/therapeutic use , Closed Fracture Reduction , Fracture Fixation, Intramedullary/instrumentation
4.
Chinese Medical Journal ; (24): 2850-2856, 2021.
Article in English | WPRIM | ID: wpr-921172

ABSTRACT

BACKGROUND@#Central nervous system (CNS) symptoms after efavirenz (EFV) treatment in people living with human immunodeficiency virus (HIV) could persist and impact their quality of life. We assessed the impact of EFV-based regimen replacement with elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide (E/C/F/TAF), which is considered an alternative option for subjects who do not tolerate EFV. Most specifically, we assessed the safety and the efficacy of E/C/F/TAF and its effects on the participants' neuropsychiatric toxicity symptoms in a real-life setting.@*METHODS@#A prospective cohort study was conducted among virologic suppressed HIV-positive participants receiving EFV-based regimens with ongoing CNS toxicity ≥ grade 2. The participants were switched to single-pill combination regimens E/C/F/TAF and followed up for 48 weeks. The neuropsychiatric toxicity symptoms were measured using a CNS side effects questionnaire, as well as the Hospital Anxiety and Depression Scale and the Pittsburgh Sleep Quality Index. The primary outcome measure was the proportion of participants experiencing grade 2 or higher CNS toxicity after EFV switch off at weeks 12, 24, and 48. Secondary endpoints included virologic and immunological responses and the effect on fasting lipids at week 48 after switch.@*RESULTS@#One hundred ninety-six participants (96.9% men, median age: 37.5 years, median: 3.7 years on prior EFV-containing regimens) were included in the study. Significant improvements in anxiety and sleep disturbance symptoms were observed at 12, 24, and 48 weeks after switching to E/C/F/TAF (P < 0.05). No significant change in depression symptom scores was observed. At 48 weeks after switch, HIV viral load <50 copies/mL was maintained in all of the participants, median fasting lipid levels were moderately increased (total cholesterol [TC]: 8.2 mg/dL, low-density lipoprotein cholesterol [LDL-C]: 8.5 mg/dL, high-density lipoprotein cholesterol [HDL-C]: 2.9 mg/dL, and triglyceride (TG): 1.6 mg/dL, and the TC:HDL-C ratio remained stable.@*CONCLUSIONS@#The single-pill combination regimens E/C/F/TAF is safe and well tolerated. This study reveals that switching from EFV to E/C/F/TAF significantly reduces neuropsychiatric toxicity symptoms in people living with HIV with grade 2 or higher CNS complaints.


Subject(s)
Adult , Female , Humans , Male , Adenine/therapeutic use , Alanine , Alkynes , Anti-HIV Agents/adverse effects , Benzoxazines , Central Nervous System , Cobicistat/therapeutic use , Cyclopropanes , Drug Combinations , Emtricitabine/therapeutic use , HIV Infections/drug therapy , Prospective Studies , Quality of Life , Quinolones , Sleep Quality , Tenofovir/analogs & derivatives
5.
Braz. j. infect. dis ; 24(2): 104-109, Mar.-Apr. 2020. tab
Article in English | LILACS, ColecionaSUS | ID: biblio-1132438

ABSTRACT

ABSTRACT HIV infection may be considered a chronic condition for people living with HIV with access to antiretrovirals and this has effectively increased survival. Moreover, this has also facilitated the emergence of other comorbidities increasing the risk for drug-drug interactions and polypharmacy. The profile of these interactions as well as their consequences for people living with HIV are still not completely elucidated. The objectives of this study were to describe the profile of these interactions, their prevalence and their classification according to the potential for significant or non-significant drug-drug interactions. From June 2015 to July 2016, people living with HIV on follow-up at an Infectious Diseases Referral Center in Belo Horizonte, Brazil have been investigated for the presence of drug-drug interactions. A total of 304 patients were included and the majority (75%) had less than 50 years of age, male (66.4%), and 37.8% self-defined as brown skinned. Approximately 24% were on five or more medications and half of them presented with drug-drug interactions. Patients older than 50 years had a higher frequency of antiretrovirals drug-drug interactions with other drugs compared to younger patients (p = 0.002). No relationship was found between the number of drug-drug interactions and the effectiveness of antiretrovirals. As expected, the higher the number of non-HIV medications used (OR = 1.129; 95%CI 1.004-1.209; p = 0.04) was associated with an increase in drug-drug interactions. The high prevalence of drug-drug interactions found and the data collected should be useful to establish measures of quaternary prevention and to increase the medication security for people living with HIV.


Subject(s)
Adult , Female , Humans , Male , Middle Aged , HIV Infections/drug therapy , Anti-HIV Agents/adverse effects , Antiretroviral Therapy, Highly Active/adverse effects , Drug Interactions , Risk Factors , Anti-HIV Agents/therapeutic use , Polypharmacy
6.
Braz. j. infect. dis ; 24(1): 65-72, Feb. 2020. tab, graf
Article in English | LILACS | ID: biblio-1089327

ABSTRACT

ABSTRACT Antiretroviral therapy (ART) has modified the outcome of patients with HIV infection, providing virological control and reducing mortality. However, there are several reasons as to why patients may discontinue their antiretroviral therapy, with adverse events being one of the main reasons reported in the literature. This is a case-control nested in a cohort of people living with HIV/AIDS, conducted to identify the incidence of ART modification due to adverse events and the associated factors, in two referral services in Recife, Brazil, between 2011 and 2014. Of the modifications occurred in the first year of ART, 25.7% were driven by adverse events. The median time elapsed between initiating ART and the first modification due to adverse events was 70.5 days (95% CI: 26-161 days). The main adverse events were dermatological, neuropsychiatric and gastrointestinal. Dermatological events were the earliest to appear after initiating ART. Efavirenz was the most prescribed and most modified drug during the study period. The group of participants who used zidovudine, lamivudine, and efavirenz had a 2-fold greater chance (adjusted OR: 2.16 95% CI: 1.28-3.65) of switching ART due to adverse events when compared to the group that used tenofovir with lamivudine and efavirenz.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Young Adult , Acquired Immunodeficiency Syndrome/drug therapy , Anti-HIV Agents/adverse effects , Time Factors , Brazil , Zidovudine/adverse effects , Logistic Models , Risk Factors , Acquired Immunodeficiency Syndrome/mortality , Ritonavir/adverse effects , Lamivudine/adverse effects , Antiretroviral Therapy, Highly Active/adverse effects , Benzoxazines/adverse effects , Drug Combinations , Kaplan-Meier Estimate , Lopinavir/adverse effects , Tenofovir/adverse effects
7.
Chinese Medical Journal ; (24): 2919-2927, 2020.
Article in English | WPRIM | ID: wpr-877929

ABSTRACT

BACKGROUND@#Albuvirtide is a once-weekly injectable human immunodeficiency virus (HIV)-1 fusion inhibitor. We present interim data for a phase 3 trial assessing the safety and efficacy of albuvirtide plus lopinavir-ritonavir in HIV-1-infected adults already treated with antiretroviral drugs.@*METHODS@#We carried out a 48-week, randomized, controlled, open-label non-inferiority trial at 12 sites in China. Adults on the World Health Organization (WHO)-recommended first-line treatment for >6 months with a plasma viral load >1000 copies/mL were enrolled and randomly assigned (1:1) to receive albuvirtide (once weekly) plus ritonavir-boosted lopinavir (ABT group) or the WHO-recommended second-line treatment (NRTI group). The primary endpoint was the proportion of patients with a plasma viral load below 50 copies/mL at 48 weeks. Non-inferiority was prespecified with a margin of 12%.@*RESULTS@#At the time of analysis, week 24 data were available for 83 and 92 patients, and week 48 data were available for 46 and 50 patients in the albuvirtide and NRTI groups, respectively. At 48 weeks, 80.4% of patients in the ABT group and 66.0% of those in the NRTI group had HIV-1 RNA levels below 50 copies/mL, meeting the criteria for non-inferiority. For the per-protocol population, the superiority of albuvirtide over NRTI was demonstrated. The frequency of grade 3 to 4 adverse events was similar in the two groups; the most common adverse events were diarrhea, upper respiratory tract infections, and grade 3 to 4 increases in triglyceride concentration. Renal function was significantly more impaired at 12 weeks in the patients of the NRTI group who received tenofovir disoproxil fumarate than in those of the ABT group.@*CONCLUSIONS@#The TALENT study is the first phase 3 trial of an injectable long-acting HIV drug. This interim analysis indicates that once-weekly albuvirtide in combination with ritonavir-boosted lopinavir is well tolerated and non-inferior to the WHO-recommended second-line regimen in patients with first-line treatment failure.@*TRIAL REGISTRATION@#ClinicalTrials.gov Identifier: NCT02369965; https://www.clinicaltrials.gov.Chinese Clinical Trial Registry No. ChiCTR-TRC-14004276; http://www.chictr.org.cn/enindex.aspx.


Subject(s)
Adult , Humans , Anti-HIV Agents/adverse effects , Antiretroviral Therapy, Highly Active , China , Drug Therapy, Combination , HIV Infections/drug therapy , HIV-1 , Maleimides , Peptides , Ritonavir/therapeutic use , Treatment Outcome , Viral Load
8.
Chinese Medical Journal ; (24): 2808-2815, 2020.
Article in English | WPRIM | ID: wpr-877936

ABSTRACT

BACKGROUND@#Lipid abnormalities are prevalent among people living with human immunodeficiency virus (HIV) (PLWH) and contribute to increasing risk of cardiovascular events. This study aims to investigate the incidence of dyslipidemia and its risk factors in PLWH after receiving different first-line free antiretroviral regimens.@*METHODS@#PLWH who sought care at the Third People's Hospital of Shenzhen from January 2014 to December 2018 were included, and the baseline characteristics and clinical data during the follow-up were collected, including total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C). The risk factors of dyslipidemia after antiretroviral therapy were analyzed with the generalized estimating equation model.@*RESULTS@#Among the 7623 PLWH included, the mean levels of TC, HDL-C and LDL-C were 4.23 ± 0.85 mmol/L, 1.27 ± 0.29 mmol/L and 2.54 ± 0.65 mmol/L, respectively, and the median TG was 1.17 (IQR: 0.85-1.68) mmol/L. Compared with that in PLWH receiving tenofovir disoproxil fumarate (TDF) + lamivudine (3TC) + ritonavir-boosted lopinavir (LPV/r), zidovudine (AZT) + 3TC + efavirenz (EFV), and AZT + 3TC + LPV/r, the incidence of dyslipidemia was lower in PLWH receiving TDF + 3TC + EFV. In multivariate analysis, we found that the risks of elevations of TG, TC, and LDL-C were higher with TDF + 3TC + LPV/r (TG: odds ratio [OR] = 2.82, 95% confidence interval [CI]: 2.55-3.11, P < 0.001; TC: OR = 1.24, 95% CI: 1.14-1.35, P < 0.001; LDL: OR = 1.06, 95% CI: 1.00-1.12, P = 0.041), AZT + 3TC + EFV (TG: OR = 1.41, 95% CI: 1.28-1.55, P < 0.001; TC: OR = 1.43, 95% CI: 1.31-1.56, P < 0.001; LDL: OR = 1.18, 95% CI: 1.12-1.25, P < 0.001), and AZT + 3TC + LPV/r (TG: OR = 3.08, 95% CI: 2.65-3.59, P < 0.001; TC: OR = 2.40, 95% CI: 1.96-2.94, P < 0.001; LDL: OR = 1.52, 95% CI: 1.37-1.69, P < 0.001) than with TDF + 3TC + EFV, while treatment with TDF + 3TC + LPV/r was less likely to restore HDL-C levels compared with TDF + 3TC + EFV (OR = 0.95, 95% CI: 0.92-0.97, P < 0.001). In addition to antiretroviral regimens, antiretroviral therapy duration, older age, overweight, obesity and other traditional factors were also important risk factors for dyslipidemia.@*CONCLUSION@#The incidence of dyslipidemia varies with different antiretroviral regimens, with TDF + 3TC + EFV having lower risk for dyslipidemia than the other first-line free antiretroviral regimens in China.


Subject(s)
Aged , Humans , Anti-HIV Agents/adverse effects , China/epidemiology , Dyslipidemias/epidemiology , HIV , HIV Infections/drug therapy , Lamivudine/therapeutic use , Lipids , Risk Factors
9.
Rev. Assoc. Med. Bras. (1992, Impr.) ; 66(supl.1): s75-s81, 2020. graf
Article in English | LILACS | ID: biblio-1057102

ABSTRACT

SUMMARY The scenario of infection by the human immunodeficiency virus (HIV) has been undergoing changes in recent years, both in relation to the understanding of HIV infection and regarding the treatments available. As a result, the disease, which before was associated with high morbidity and mortality, is now seen as a chronic disease that can be controlled, regarding both transmission and symptoms. However, even when the virus replication is well controlled, the infected patient remains at high risk of developing renal involvement, either by acute kidney injury not associated with HIV, nephrotoxicity due to antiretroviral drugs, chronic diseases associated with increased survival, or glomerular disease associated to HIV. This review will cover the main aspects of kidney failure associated with HIV.


RESUMO O panorama da infecção pelo vírus da imunodeficiência humana (HIV) vem sofrendo alterações nos últimos anos, tanto em relação ao entendimento da infecção pelo HIV quanto aos tratamentos disponíveis. Como resultado, a doença, que antes estava associada a alta morbimortalidade, é agora considerada uma doença crônica que pode ser controlada, tanto em relação à transmissão quanto aos sintomas. No entanto, mesmo quando a replicação viral é bem controlada, o paciente infectado tem um alto risco de desenvolver complicações renais, seja através de lesão renal aguda não relacionada ao HIV, por nefrotoxicidade causada por drogas antirretrovirais, por doenças crônicas associadas com o aumento da sobrevida ou por doença glomerular associada ao HIV. Esta revisão abordará os principais aspectos da insuficiência renal associada ao HIV.


Subject(s)
Humans , HIV Infections/complications , AIDS-Associated Nephropathy/etiology , Acute Kidney Injury/etiology , HIV Infections/drug therapy , Chronic Disease , Risk Factors , AIDS-Associated Nephropathy/pathology , Anti-HIV Agents/adverse effects , Antiretroviral Therapy, Highly Active/adverse effects , Acute Kidney Injury/pathology , Tenofovir/adverse effects , Atazanavir Sulfate/adverse effects , Kidney/pathology
11.
Biomédica (Bogotá) ; 39(3): 561-575, jul.-set. 2019. tab, graf
Article in Spanish | LILACS | ID: biblio-1038815

ABSTRACT

Resumen Introducción. El tratamiento antirretroviral de la infección por el virus de la inmunodeficiencia humana (HIV) se ha relacionado con diversos problemas de los medicamentos que causan o pueden causar la aparición de resultados negativos. En este contexto, es importante determinar su incidencia, caracterizarlos y clasificarlos para diseñar estrategias que minimicen su impacto. Objetivo. Estimar la incidencia global y de cada uno de los problemas relacionados con los medicamentos antirretrovirales utilizados en el tratamiento del HIV en una cohorte de pacientes hospitalizados en una institución de tercer nivel de Bogotá. Materiales y métodos. Se hizo un estudio descriptivo y retrospectivo de cohorte en pacientes de 18 años o más de edad con diagnóstico de infección por el HIV y en tratamiento antirretroviral, hospitalizados entre el 1° enero de 2015 y el 31 de diciembre de 2016 en el Hospital Santa Clara de Bogotá. Resultados. La incidencia global de los problemas relacionados con los medicamentos antirretrovirales fue de 0,90 (IC95% 0,85-0,93). La incidencia de las interacciones medicamentosas fue de 0,85 (IC95% 0,80-0,90), la de las reacciones adversas de 0,28 (IC95% 0,22-0,35) y la del error de prescripción de 0,12 (IC95% 0,08-0,17). Conclusión. Los problemas relacionados con los medicamentos deben estudiarse, diagnosticarse, prevenirse y tratarse para que el personal de salud pueda anticiparse a su aparición, disminuir su incidencia, implementar planes de manejo del riesgo y optimizar el cumplimiento del tratamiento antirretroviral.


Abstract Introduction: The antiretroviral therapy for the treatment of the human immunodeficiency virus (HIV) is a therapeutic strategy linked to drug-related problems that cause or can cause the appearance of negative results associated with the medication. It is important, therefore, to identify their incidence, characterize them, and classify them to design strategies to minimize their impact. Objective: To estimate the overall incidence and the incidence of each one of the antiretroviral drugs-related problems in the treatment of the HIV infection in a cohort of hospitalized patients in Bogotá, Colombia. Materials and methods: We conducted a descriptive, retrospective cohort study in patients aged 18 years or more diagnosed with HIV infection and under antiretroviral treatment hospitalized between January 1st, 2015, and December 31st, 2016, in the Hospital Santa Clara, Bogotá. Results: The overall incidence of antiretroviral drug-related problems was 0.90 (95% CI: 0.85-0.93). The incidence of drug-drug interactions was 0.85 (95% CI: 0.80-0.90), 0.28 (95% CI: 0.22-0.35) for adverse reactions, and 0.12 (CI 95%: 0.08-0.17) for prescription errors. Conclusion: Drug-related problems should be studied, diagnosed, prevented, and treated. Their knowledge can enable health care professionals to anticipate their emergence, reduce their incidence, implement risk management plans, and optimize adherence to antiretroviral treatment.


Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Young Adult , HIV Infections/drug therapy , Anti-HIV Agents/adverse effects , Medication Errors/statistics & numerical data , Incidence , Retrospective Studies , Colombia/epidemiology , Drug Interactions , Drug-Related Side Effects and Adverse Reactions/epidemiology , Tertiary Care Centers , Hospitals, Public , Inpatients
12.
Braz. j. infect. dis ; 23(4): 268-270, July-Aug. 2019. tab
Article in English | LILACS | ID: biblio-1039233

ABSTRACT

Abstract Abacavir can cause a multi-systemic hypersensitivity reaction (HSR) in 5-8% of the patients, which is related to HLA-B*57-01 allele. In Brazil, the HLA-B*57-01 screening test became available only in March 2018, several years after abacavir was in use. In this retrospective study we reviewed medical charts of all patients receiving an abacavir-containing regimen to evaluate the frequency of HSR in patients followed at a referral center in Salvador, Brazil. A total of 192 patients who received abacavir were identified, most male (67.1%), black or racially mixed (77.8%), and having diagnosis of a previous AIDS defining conditions (83.7%). Only one patient developed HSR (incidence: 0.52%). The main reasons for abacavir-containing antiretroviral therapy discontinuation were virological failure (28%), adverse effects to other components of the regimen (25%), and simplification of therapy (16%). The low incidence of HSR to abacavir does not support the use of HLA-B*57-01 screening test, in Salvador, Brazil.


Subject(s)
Humans , Male , Female , Adult , Dideoxynucleosides/adverse effects , HIV Infections/drug therapy , Anti-HIV Agents/adverse effects , Drug Hypersensitivity/etiology , Drug Hypersensitivity/epidemiology , Brazil/epidemiology , Incidence , Retrospective Studies
13.
Ciênc. Saúde Colet. (Impr.) ; 24(5): 1903-1914, Mai. 2019. tab
Article in English | LILACS | ID: biblio-1001806

ABSTRACT

Abstract The aim of this study was to describe metabolic changes in HIV/AIDS patients according to the treatment regimen. It was a retrospective cohort conducted from 2002 to 2014. Researchers surveyed clinical variables and treatment regimen of 538 individuals. They used measures of central tendency and marginal logistic regression to determine the influence of the treatment regimen on clinical variables over time; survival was estimated using Kaplan-Meier curves. 56.2% of patients were male, 82.2% white, 33.8% had 4 to 7 years of study, 49.2% were married, 98.5% had sexual transmission, and 89.0% were heterosexuals. During the study period, 24.4% had hypertension, 18.2% changed cholesterol, 39.7% low HDL, 51.3% high triglycerides and 33.3% hyperglycemia. Treatment regimens with nucleotide reverse transcriptase inhibitors associated with protease inhibitors, and the association of different classes of antiretrovirals have been associated with greater lipid changes. Higher metabolic changes were observed in patients with longer treatment time. It is concluded that preventive measures, as well as early treatment, can contribute to minimize the risks of developing cardiovascular diseases.


Resumo O objetivo deste estudo foi descrever os fatores de risco cardiovascular em pacientes HIV/AIDS de acordo com o esquema terapêutico utilizado. Estudo de Coorte retrospectiva no período de 2002 a 2014. Foram levantadas variáveis clínicas e esquema de tratamento de 538 indivíduos. Utilizaram-se medidas de tendência central, e regressão marginal logística para verificar a influência do esquema de tratamento sobre variáveis clinicas ao longo do tempo. Dos pacientes, 56,2% eram homens, 82,2% brancos, 33,8% tinham entre 4 a 7 anos de estudo, 49,2% eram casados, 98,5% tiveram transmissão sexual e 89,0% eram heterossexuais. A idade média no diagnóstico foi de 36,3 anos. Durante o período de estudo, 24,4% hipertensão arterial, 18,2% colesterol alterado, 39,7% HDL baixo, 51,3% triglicerídeos elevados e 33,3% hiperglicemia. Os esquemas de tratamento com Inibidores da transcriptase reversa nucleotídeos associados a inibidores da protease, e a associação de diferentes classes de antirretrovirais estiveram associados a maiores alterações lipídicas e maiores alterações metabólicas com maior tempo de tratamento. Conclui-se que medidas preventivas, bem como tratamento precoce pode contribuir para minimizar os riscos de desenvolvimento de doenças cardiovasculares.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Aged , Young Adult , Cardiovascular Diseases/epidemiology , HIV Infections/drug therapy , Anti-HIV Agents/administration & dosage , Lipids/blood , Brazil/epidemiology , Cardiovascular Diseases/etiology , Retrospective Studies , Risk Factors , Cohort Studies , Anti-HIV Agents/adverse effects , Antiretroviral Therapy, Highly Active/adverse effects , Antiretroviral Therapy, Highly Active/methods , Middle Aged
14.
J. bras. nefrol ; 41(1): 48-54, Jan.-Mar. 2019. tab
Article in English | LILACS | ID: biblio-1002416

ABSTRACT

ABSTRACT Aim: To determine the prevalence of chronic kidney disease (CKD) and the epidemiological, clinical, and laboratory factors associated with CKD in Mexican HIV-infected patients. Methods: Cross-sectional study. We included 274 patients with HIV/AIDS. CKD was defined by the estimated glomerular filtration rate (eGFR < 60 mL/min/1.73 m2 assessed by CKD-EPI) and albuminuria criteria from KDIGO guidelines. Clinical, epidemiological, and laboratory characteristics were compared between patients with and without CKD. The factors associated with CKD were assessed by logistic regression analysis. Results: The mean age was 41±11 years, and 72.3% of the patients were men. The global prevalence of CKD was 11.7% (n = 32); 7.2% (n = 20) were defined by eGFR criterion; 7.6% (n = 21), by the albuminuria criterion; and 3.2% (n = 9), by both CKD criteria. The most frequently observed stages of CKD were KDIGO G3A1 stage with 4.7% (n = 13), KDIGO G1A2 stage with 3.6% (n = 10) and KDIGO G3A2 stage with 1.7% (n = 5). The factors associated with CKD were use of abacavir/lamivudine (OR 3.2; 95% CI 1.1-8.9; p = 0.03), a CD4 lymphocyte count < 400 cells/µL (OR 2.6; 95% 1.03-6.4, p = 0.04), age (OR 1.1; 95% CI 1.04-1.2, p = 0.001) and albuminuria (OR 19.98; 95% CI: 5.5-72.2; p < 0.001). Conclusions: CKD was a frequent complication in HIV-infected patients. These findings confirm the importance of screening and the early detection of CKD, as well as the importance of identifying and treating traditional and non-traditional risk factors associated with CKD.


RESUMO Objetivo: Determinar a prevalência de doença renal crônica (DRC) e os fatores epidemiológicos, clínicos e laboratoriais associados à DRC em pacientes mexicanos infectados pelo HIV. Métodos: Estudo transversal. Incluímos 274 pacientes com HIV/AIDS. A DRC foi definida pela taxa de filtração glomerular estimada (TFGe < 60 mL/min/1,73 m2, avaliada pelo CKD-EPI) e pelos critérios de albuminúria das diretrizes do KDIGO. As características clínicas, epidemiológicas e laboratoriais foram comparadas entre pacientes com e sem DRC. Os fatores associados à DRC foram avaliados por análise de regressão logística. Resultados: A média da idade foi de 41 ± 11 anos e 72,3% dos pacientes eram homens. A prevalência global de DRC foi de 11,7% (n = 32); 7,2% (n = 20) foram definidos pelo critério TFGe; 7,6% (n = 21), pelo critério da albuminúria; e 3,2% (n = 9), pelos dois critérios para DRC. Os estágios mais frequentemente observados da DRC foram o estágio KDIGO G3A1 com 4,7% (n = 13); estágio KDIGO G1A2 com 3,6% (n = 10) e estágio KDIGO G3A2 com 1,7% (n = 5). Os fatores associados à DRC foram o uso de abacavir/lamivudina (OR 3,2; IC95% 1,1-8,9; p = 0,03), contagem de linfócitos CD4 < 400 células/µL (OR 2,6; 95% 1,03-6,4, p = 0,04), idade (OR 1,1; IC95% 1,04-1,2, p = 0,001) e albuminúria (OR 19,98; IC95%: 5,5-72,2; p < 0,001). Conclusões: A DRC foi uma complicação frequente em pacientes infectados pelo HIV. Esses achados confirmam a importância do rastreamento e da detecção precoce da DRC, bem como a importância de identificar e tratar os fatores de risco tradicionais e não tradicionais associados à DRC.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , HIV Infections/complications , Renal Insufficiency, Chronic/etiology , Renal Insufficiency, Chronic/epidemiology , Dideoxynucleosides/adverse effects , Logistic Models , Prevalence , Cross-Sectional Studies , Retrospective Studies , Risk Factors , Age Factors , CD4 Lymphocyte Count , Lamivudine/adverse effects , Anti-HIV Agents/adverse effects , Diabetes Complications , Albuminuria , Glomerular Filtration Rate , Hypertension/complications , Mexico/epidemiology
15.
Belo Horizonte; s.n; 2019. 88 p. tab, ilus.
Thesis in Portuguese | BDENF, LILACS | ID: biblio-1007621

ABSTRACT

Introdução: A Profilaxia Pós-Exposição sexual (PEP sexual) ao HIV decorrente de relações sexuais consentidas é parte de um plano preventivo de ações combinadas contra o HIV/aids. É indicada para situações de falha, rompimento ou não uso do preservativo. No Programa Brasileiro esta ação compreende o uso de antirretrovirais (ARV) por 28 dias, iniciados até 72 horas da exposição e o follow-up (seguimento) da pessoa assistida, realizado em três etapas. Apesar de consagrada em diversos países, estudos sinalizam para a necessidade de investimento em pesquisas que busquem elucidar fatores que intervêm na adesão à profilaxia. No Brasil, o uso da PEP sexual é ainda recente, sendo escassas as publicações nacionais nesta área. Objetivo: Analisar a adesão à profilaxia e ao cumprimento das etapas de seguimento das pessoas assistidas no Programa Brasileiro de Profilaxia Pós-Exposição sexual ao HIV, decorrente de relação consentida. Método: Estudo observacional, de coorte retrospectivo, realizado de fevereiro de 2011 a dezembro de 2017 com as PEP dispensadas em um serviço de referência, responsável pelo o maior número de atendimentos no município de Belo Horizonte, Minas Gerais ­ Brasil. Dados secundários, coletados por meio de um instrumento composto por 68 variáveis, armazenados no Programa EPI-DATA 3.1 e analisados pelo software estatístico SPSS 21.0. Amostra caracterizada pelo cálculo de freqüência, medidas de tendência central e variabilidade. Para avaliar os fatores associados à adesão à profilaxia e ao seguimento foi utilizado o teste qui-quadrado de Pearson, teste de Mann-whitney e o modelo de regressão logística binária, com estimativa do valor de Odds Ratio e intervalo de confiança de 95%. Todas as análises consideraram nível de significância de 5%. Resultados: Da amostra de 1996 pessoas a maioria eram homens, idade média de 30 anos, raça/cor parda, escolaridade de nível superior e residentes em Belo Horizonte. Foram predominantes as exposições por rompimento ou falhas no uso do preservativo (53,8%), decorrentes de relações anais (56,3%), ocorridas com parceria de sorologia desconhecida, mas pertencentes à população de alta prevalência ao HIV (57,4%). Mais da metade (68,1%) recebeu o esquema ARV composto pelos medicamentos Tenofovir, Lamivudina, Atazanavir e Ritonavir. Tiveram efeitos colaterais 84,9%. Aderiram aos 28 dias de medicação 33,6%. Na adesão parcial, o principal motivo da interrupção foi o efeito colateral (56,1%). Quanto ao seguimento 50,4% retornaram para pelo menos uma das etapas - exames basais (32,0%); 1º exame de HIV (36,6%) e 2º exame (15,1%). Concluíram as etapas do seguimento 6,8%. Foram fatores associados à maior chance de adesão à PEP: ter mais idade, residir em Belo Horizonte e região metropolitana, ser bissexual, ter se exposto com parceria sabidamente soropositiva para HIV e não ter utilizado esquema ARV com Tenofovir, Zidovudina e Lamivudina. Os fatores associados à maior chance de conclusão do seguimento foram ter mais idade, ter se exposto com parceria sabidamente soropositiva e o não uso do mesmo esquema ARV explicitado acima. Houve duas soroconversões ao HIV, uma devido à interrupção precoce da profilaxia e outra pela continuidade de exposições de risco. Conclusão: Observou-se baixos índices de adesão à PEP e ao seguimento sinalizando que a efetividade deste Programa depende de uma conjunção de estratégias, tendo por base os fatores preditores de adesão e medidas públicas que respondam aos perfis e especificidades da população. A ampliação do acesso ao serviço, a incorporação do uso de tecnologias de comunicação; a disponibilização de material educativo, a ampliação dos locais de atendimento, a escolha de esquemas ARVde melhor tolerabilidade, ações mais direcionadas para as mulheres e para a população com menor idade, além do acompanhamento e da orientação das pessoas assistidas são alguns caminhos a serem seguidos. O aprofundamento investigativo em outros serviços e regiões do Brasil representa um somatório para a visibilidade da experiência brasileira, tanto para a PEP sexual quanto para as demais estratégias de prevenção combinada ao HIV.(AU)


Resumo em língua estrangeira Introduction: The HIV post-exposure prophylaxis (PEP) is part of a multiple-action prevention plan against HIV/AIDS. It is recommended for situations involving failure or the non-use of condoms. In the Brazilian program, this plan involves taking antiretroviral medicines (ART) for 28 days, starting up to 72 hours of potential exposure to HIV, and a three-stage follow-up with the assisted individual. Although this technique is renowned in several countries, studies indicate the need for investment in research that seeks to elucidate factors involved in the adherence to prophylaxis. The use of PEP is still recent and national publications in this area are scarce. Objective: To analyse adherence to prophylaxis and compliance with follow-up stages for the individuals assisted by the Programa Brasileiro de Profilaxia Pós-Exposição sexual ao HIV, as a result of consensual intercourse. Method: Observational study, retrospective, carried out between February 2011 and December 2017, with PEPs dispensed at a reference health centre, which is responsible for the largest number of treatments in the city of Belo Horizonte, Minas Gerais ­ Brazil. Secondary data collection carried out with a 68-variable instrument. The data was stored in the EPI-3.1 DATE software and analyzed by the statistical software SPSS 21.0. The sample was characterised through frequency calculation, measures of central tendency and variability. To assess the factors associated with adherence to prophylaxis and to the follow-up, the following have been used: the Pearson Chi-square test, the Mann-Whitney test and the binary logistic regression model, with estimates of the Odds Ratio value and confidence interval of 95%. All the analysis considered a significance level of 5%. Results: Out of the 1996-user sample, the majority were men, 30 years old on average, brown-coloured, with a higher education degree, and residents of the city of Belo Horizonte. Exposures were predominantly due to condom breakage or failure (53.8%) arising from anal intercourse (56.3%), intercourse with unknown serology partners, but belonging to the population of high prevalence of HIV (57.4%). More than half of them (68.1%) received the antiretroviral drugs composed of Tenofovir, Lamivudine, Atazanavir and Ritonavir. Side effects were observed in 84.9%. 33.6% adhered to medications for 28 days. In cases of partial adherence, the side effect was the main reason for an interruption for 56.1%. Regarding the follow-up cases, 50.4% returned for at least one of the stages - basal exams (32.0%); 1st HIV test (36.6%) and 2nd test (15.1%). A total of 6.8% have completed all the stages. Higher adherence to PEP was associated with the following factors: advanced age, residence in Belo Horizonte or its metropolitan region, being bisexual, having had intercourse with a partner known to be HIV positive and not taking Tenofovir, Zidovudine and Lamivudine antiretrovirals. The factors associated with the highest chances of follow-up completion were advanced age and having had intercourse with a partner known to be HIV positive and not taking the aforementioned antiretrovirals. There have been two cases of seroconversion to HIV ­ one of them due to early interruption of the prophylaxis, and the other due to continuing risk exposure. Conclusion: Low rates of adherence to PEP and follow-up procedures were observed, signposting that the effectiveness of this program is dependent on a combination of strategies, based on the predictors of adherence and public measures that respond to the profiles and the specificities of population. Possible solutions involve increased access to treatment, incorporation of communication technologies; the provision of educational material, expansion of treatment centres, choosing better tolerability antiretroviral drugs, campaigns targeting women and younger population, as well as monitoring and offering guidance to assisted individuals. Further research into this area in other treatment centres and regions in Brazil may increase visibility of the Brazilian experience for both the PEP and other combined HIV prevention strategies. Keywords: Post-exposure prophylaxis. HIV. Adherence.(AU)


Subject(s)
Humans , Male , Female , Adult , Acquired Immunodeficiency Syndrome/prevention & control , HIV/drug effects , Post-Exposure Prophylaxis , Treatment Adherence and Compliance/statistics & numerical data , Socioeconomic Factors , Surveys and Questionnaires , Retrospective Studies , Anti-HIV Agents/adverse effects , Academic Dissertation
16.
J. pediatr. (Rio J.) ; 95(supl.1): S95-S101, 2019.
Article in English | LILACS | ID: biblio-1002484

ABSTRACT

Abstract Objective: Weight and height growth impairment is one of the most frequent manifestations in HIV-infected children and may be the first sign of disease, being considered a marker of disease progression and an independent risk factor for death. The aim of this review is to evaluate the influence of antiretroviral therapy on the growth pattern of children and adolescents living with HIV/AIDS. Source of data: A non-systematic review was carried out in the PubMed database, with the terms "HIV", "Weight and height growth", "ART" and "children". The most relevant publications were selected. Data Synthesis: Antiretroviral therapy has significantly reduced morbidity and mortality in HIV-infected children and is clearly associated with recovery of weight and height-for-age Z-scores, especially when started early, in the asymptomatic child still without weight-height impairment. Therapeutic strategies involving the GH/IGF-1 axis, especially for children with growth impairment, are still being studied. Conclusions: HIV-infected children show early weight-height impairment; antiretroviral therapy improves the anthropometric profile of these children.


Resumo Objetivo: O acometimento do desenvolvimento pondero-estatural é uma das manifestações mais frequentes nas crianças infectadas pelo HIV e pode ser o primeiro sinal de doença, é considerado um marcador de progressão para doença e um fator de risco independente para morte. O objetivo desta revisão é avaliar a influência da terapia antirretroviral no padrão de crescimento em crianças e adolescentes vivendo com HIV/Aids. Fonte dos dados: Foi feita uma revisão não sistemática na base de dados PubMed, com os termos "HIV", "desenvolvimento pondero estatural", "TARV" e "crianças". Foram selecionadas as publicações mais relevantes. Síntese dos dados: A terapia antirretroviral reduziu substancialmente a morbimortalidade em crianças infectadas pelo HIV e está claramente associada à recuperação do escore-z de peso e de estatura para idade, principalmente quando iniciada precocemente, na criança assintomática e ainda sem comprometimento pondero-estatural. Estratégias terapêuticas que envolvem o eixo GH/IGF-1, principalmente para crianças com comprometimento do crescimento, ainda estão em estudo. Conclusões: As crianças infectadas pelo HIV apresentam comprometimento pondero-estatural precoce e a terapia antirretroviral melhora o perfil antropométrico dessas crianças.


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Body Height/drug effects , HIV Infections/drug therapy , Child Development/physiology , Anti-HIV Agents/therapeutic use , Growth and Development/drug effects , Growth Disorders/physiopathology , HIV Infections/physiopathology , Child Development/drug effects , Disease Progression , Anti-HIV Agents/adverse effects , Antiretroviral Therapy, Highly Active , Growth and Development/physiology , Growth Disorders/chemically induced
17.
Medisan ; 22(8)set.-oct. 2018. tab
Article in Spanish | LILACS | ID: biblio-976151

ABSTRACT

Se efectuó un estudio descriptivo y transversal de 40 pacientes con VIH pertenecientes al Policlínico Docente Frank País García de Santiago de Cuba, con vistas a identificar las reacciones adversas a medicamentos antirretrovirales durante el primer semestre de 2018. En la casuística, la mayoría de las notificaciones las realizaron los especialistas en Medicina General Integral (61,4 por ciento), seguidos por los de Medicina Interna y los licenciados en Enfermería (8,8 y 17,6 por ciento, respectivamente); asimismo, entre los efectos adversos predominantes figuraron las náuseas, la cefalea y los mareos, fundamentalmente con los esquemas terapéuticos constituidos por lamivudina-zidovudina-nevirapina y zidovudina-nevirapina-efavirenz. Se concluye que durante el tratamiento antirretroviral la mayoría de dichas reacciones fueron clasificadas como definitivas, independientemente del esquema terapéutico prescrito y las enfermedades concomitantes.


A descriptive and cross sectional study of 40 patients with HIV belonging to the Teaching Polyclinic Frank País García in Santiago de Cuba was carried out with the aim of identifying the adverse reactions to antirretroviral drugs during the first semester of 2018. Most of the notifications were carried out by specialists in Comprehensive General Medicine (61,4 percent) in the case material, followed by those of Internal Medicine and Licentiate in Nursing (8,8 and 17,6 percent, respectively); also, among the predominant adverse effects there were nauseas, migraine and sickness, fundamentally with the therapeutic schemes constituted by lamivudina-zidovudina-nevirapina and zidovudina-nevirapina-efavirenz. It is concluded that during antirretroviral treatment most of these reactions were classified as definitive, independently of the prescribed therapeutic scheme and the concomitant diseases.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Young Adult , Acquired Immunodeficiency Syndrome/therapy , Acquired Immunodeficiency Syndrome/epidemiology , Anti-Retroviral Agents/adverse effects , Primary Health Care , Anti-HIV Agents/adverse effects , Pharmacovigilance
18.
Cad. Saúde Pública (Online) ; 34(10): e00009618, oct. 2018. tab, graf
Article in English | LILACS | ID: biblio-974575

ABSTRACT

Abstract: The latest Brazilian guideline recommended the reduction of routine CD4+ T cell counts for the monitoring of patients with human immunodeficiency virus type 1 (HIV-1) under combination antiretroviral therapy (cART). The aim of this study was to evaluate the safety of monitoring response to cART in HIV-1 infection using routine viral load at shorter intervals and CD4+ T cell count at longer intervals. CD4+ T cell counts and HIV-1 viral load were evaluated in 1,906 HIV-1-infected patients under cART during a three-year follow-up. Patients were stratified as sustained, non-sustained and non-responders. The proportion of patients who showed a CD4+ T > 350cells/µL at study entry among those with sustained, non-sustained and non-responders to cART and who remained with values above this threshold during follow-up was 94.1%, 81.8% and 71.9%, respectively. HIV-1-infected patients who are sustained virologic responders and have initial CD4+ T cell counts > 350cells/µL showed a higher chance of maintaining the counts of these cells above this threshold during follow-up than those presenting CD4+ T ≤ 350cells/µL (OR = 39.9; 95%CI: 26.5-60.2; p < 0.001). This study showed that HIV-1-infected patients who had sustained virologic response and initial CD4+ T > 350cells/µL were more likely to maintain CD4+ T cell counts above this threshold during the next three-year follow-up. This result underscores that the evaluation of CD4+ T cell counts in longer intervals does not impair the safety of monitoring cART response when routine viral load assessment is performed in HIV-1-infected patients with sustained virologic response.


Resumo: O último consenso brasileiro recomenda reduzir a rotina de contagem de linfócitos T CD4+ para monitorar os pacientes com HIV-1 sob terapia antirretroviral combinada (TARV). O estudo teve como objetivo avaliar a segurança do monitoramento à TARV na infecção pelo HIV-1, realizando a carga viral a intervalos mais curtos e a contagem de linfócitos T CD4+ a intervalos mais longos. Foram avaliadas a contagem de linfócitos T CD4+ e a carga viral do HIV-1 em 1.906 pacientes com HIV-1 em uso de TARV durante um seguimento de três anos. Os pacientes foram estratificados em: resposta sustentada, não sustentada e não respondedores. As proporções de pacientes com linfócitos T CD4+ > 350células/µL na linha de base do estudo entre de resposta sustentada, não sustentada e não respondedores à TARV e que permaneceram com valores acima desse limiar ao longo do seguimento foram 94,1%, 81,8% e 71,9%, respectivamente. Os pacientes com resposta virológica sustentada e que tinham contagem de T CD4+ > 350células/µL mostraram maior probabilidade de manter a contagem acima desse limiar durante o seguimento, quando comparados àqueles com T CD4+ ≤ 350células/µL (OR = 39,9; 95%CI: 26,5-60,2; p < 0,001). O estudo mostrou que pacientes HIV-1+ com resposta virológica sustentada e contagem de linfócitos T CD4+ > 350células/µL tinham maior probabilidade de manter a contagem de células T CD4+ acima desse limiar durante o seguimento de três anos subsequentes. O resultado corrobora que a contagem de linfócitos T CD4+ com intervalos mais longos não compromete a segurança do monitoramento da resposta à TARV quando a avaliação da carga viral é feita de rotina em pacientes HIV-1+ com resposta virológica sustentada.


Resumen: Las últimas directrices brasileñas recomendaron la reducción de la rutina en el recuento celular CD4+ T para pacientes con el virus de inmunodeficiencia humano tipo 1 (VIH-1), con terapia de combinación antirretroviral (cART por sus siglas en inglês). El objetivo de este estudio fue evaluar la seguridad de la monitorización de la respuesta a la cART en una infección por VIH-1, usando rutinas de carga viral en intervalos más cortos y recuento celular CD4+ T en intervalos más largos. Se evaluaron el recuento celular CD4+ T y la carga viral VIH-1 en 1.906 pacientes infectados con VIH-1 y con cART durante un seguimiento que duró tres años. Los pacientes fueron estratificados como constantes, inconstantes y sin respuesta. La proporción de pacientes que mostraron CD4+ T > 350células/µL en el estudio entran dentro del grupo de los constantes, inconstantes y sin respuesta al cART, y quienes permanecieron con valores por encima de este umbral durante los seguimientos fueron 94,1%, 81,8% y 71,9%, respectivamente. Los pacientes infectados por VIH-1 que cuentan con la respuesta virológica constante y tienen un recuento inicial CD4+ T > 350células/µL mostraron una oportunidad más alta de mantener el recuento de estas células por encima del umbral durante los seguimientos, respecto a quienes presentaban CD4+ T células ≤ 350células/µL (OR = 39,9; IC95%: 26,5-60,2; p < 0,001). Este estudio expuso que los pacientes infectados por VIH-1, que habían tenido una respuesta virológica constante e inicial CD4+ T > 350células/µL, eran más propensos a mantener el recuento de células CD4+ T por encima de este umbral durante los tres años posteriores de seguimiento. Este resultado destaca que la evaluación del cómputo de células CD4+ T en intervalos más largos no obstaculiza la seguridad al realizar una monitorización en la respuesta a cART, cuando la evaluación de la carga viral rutinaria se realiza en pacientes infectados por VIH-1 con una respuesta virológica constante.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Young Adult , HIV Infections/drug therapy , HIV-1/immunology , CD4 Lymphocyte Count/methods , Anti-HIV Agents/administration & dosage , Antiretroviral Therapy, Highly Active/methods , Socioeconomic Factors , Time Factors , Follow-Up Studies , Longitudinal Studies , HIV-1/drug effects , Anti-HIV Agents/adverse effects , Viral Load/drug effects , Viral Load/immunology , Antiretroviral Therapy, Highly Active/adverse effects , Middle Aged
19.
Rev. Soc. Bras. Med. Trop ; 51(4): 436-444, July-Aug. 2018. tab, graf
Article in English | LILACS | ID: biblio-957440

ABSTRACT

Abstract INTRODUCTION: Acquired immunodeficiency syndrome is an advanced stage of a human immunodeficiency virus infection. The antiretroviral therapy aims to improve the life quality of HIV patients and a good adherence is essential for a better prognosis. This study aimed to evaluate the adherence of human immunodeficiency virus/acquired immunodeficiency syndrome patients to antiretroviral therapy recommended by the Brazilian health system in Anápolis/Goiás, and correlate the level of adherence with sociodemographic data and clinical-laboratory variables. METHODS Adherence to antiretroviral therapy was assessed using the Questionnaire for Evaluation of Adherence to Antiretroviral Therapy. The sociodemographic data were collected using a standardized questionnaire and the clinical-laboratory records were reviewed. RESULTS: Among 220 patients included, 59% (129/220) were men and the average age was 41 years. Infection was acquired primarily through sexual contact (92%, 202/220), and 69% (152/220) of the patients were heterosexual. Approximately 86% (188/220) of the patients had good or strict adherence to antiretroviral therapy. In our study, the use of illicit drugs was associated with low adherence to antiretroviral therapy (p=0.0004), and no significant association was observed between adherence levels and other sociodemographic data (p>0.05). The logistic regression indicated that adverse effects (p=0.0018) and sexual orientation (p=0.0152) were associated with the level of adherence to antiretroviral therapy. Patients with good or strict adherence had higher CD4+T lymphocyte count (p<0.0001) and undetectable viral load (p<0.0001). Patients with low adherence (14%, 32/220) had higher frequency of adverse events (p=0.0009). The frequency of coinfections was 25% (55/220), with syphilis and tuberculosis being the most common coinfections. CONCLUSIONS: Adherence was related to use of illicit drugs, adverse effects, and sexual orientation.


Subject(s)
Humans , Male , Female , Adult , Aged , Young Adult , HIV Infections/drug therapy , Anti-HIV Agents/therapeutic use , Medication Adherence/statistics & numerical data , Socioeconomic Factors , Cross-Sectional Studies , Surveys and Questionnaires , CD4 Lymphocyte Count , Anti-HIV Agents/adverse effects , Viral Load , Coinfection , Middle Aged
20.
Braz. j. infect. dis ; 22(3): 193-201, May-June 2018. tab, graf
Article in English | LILACS | ID: biblio-974216

ABSTRACT

ABSTRACT Background In people living with HIV, much is known about chronic kidney disease, defined as a glomerular filtration rate under 60 mL/min. However, there is scarce data about prevalence and risk factors for milder impairment (60-89 mL/min). Objective The present study aims to assess the influence of sex, antiretroviral therapy, and classical risk factors on the occurrence of mild decreased renal function in a large Spanish cohort of HIV-infected patients. Methods Cross-sectional, single center study, including all adult HIV-1-infected patients under antiretroviral treatment with at least two serum creatinine measures during 2014, describing the occurrence of and the risk factors for mildly decreased renal function (eGFR by CKD-EPI creatinine equation of 60-89 mL/min). Results Among the 4337 patients included, the prevalence rate of mildly reduced renal function was 25%. Independent risk factors for this outcome were age older than 50 years (OR 3.03, 95% CI 2.58-3.55), female sex (OR 1.23, 95% CI 1.02-1.48), baseline hypertension (OR 1.57, 95% CI 1.25-1.97) or dyslipidemia (OR 1.48, 95% CI 1.17-1.87), virologic suppression (OR 1.88, 95% CI 1.39-2.53), and exposure to tenofovir disoproxil-fumarate (OR 1.67, 95% CI 1.33-2.08) or ritonavir-boosted protease-inhibitors (OR 1.19, 95% CI 1.03-1.39). Conclusions Females and patients over 50 seem to be more vulnerable to renal impairment. Potentially modifiable risk factors and exposure to tenofovir disoproxil-fumarate or ritonavir-boosted protease-inhibitors are present even in earlier stages of chronic kidney dysfunction. It remains to be determined whether early interventions including antiretroviral therapy changes (tenofovir alafenamide, cobicistat) or improving comorbidities management will improve the course of chronic kidney disease.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , HIV Infections/complications , HIV Infections/drug therapy , HIV Infections/epidemiology , Anti-HIV Agents/adverse effects , Kidney Failure, Chronic/etiology , Kidney Failure, Chronic/epidemiology , Spain/epidemiology , Comorbidity , Sex Factors , Prevalence , Cross-Sectional Studies , Risk Factors , Age Factors , Treatment Outcome , Statistics, Nonparametric , Risk Assessment , Viral Load , Antiretroviral Therapy, Highly Active/adverse effects , Glomerular Filtration Rate
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