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1.
Rev. habanera cienc. méd ; 19(5): e2962, sept.-oct. 2020. tab
Article in Spanish | LILACS, CUMED | ID: biblio-1144688

ABSTRACT

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)


Subject(s)
Humans , Male , Female , Primary Health Care , HIV Infections/drug therapy , Acquired Immunodeficiency Syndrome/drug therapy , Antiretroviral Therapy, Highly Active/methods , Treatment Adherence and Compliance , Epidemiology, Descriptive
2.
Med. leg. Costa Rica ; 37(1): 101-113, ene.-mar. 2020. graf
Article in English | LILACS | ID: biblio-1098377

ABSTRACT

Abstract Forensic microbiology is a scientific area that has emerged with the need to investigate biocrimes, as in the case of intentional transmission of the Human Immunodeficiency Virus (HIV). The present exploratory work aimed to demonstrate how biomedical technology, such as phylogenetics and quantification of viral load and CD4+ T lymphocytes, can be used to produce technical evidence that brings more certainty in determining the authorship and materiality of these criminal behaviors.


Resumen La microbiología forense es un área científica que ha surgido con la necesidad de investigar los delitos biológicos, como en el caso de la transmisión intencional del virus de la inmunodeficiencia humana (VIH). Este trabajo exploratorio tuvo como objetivo demostrar cómo la tecnología biomédica, como la filogenética y la cuantificación de la carga viral y los linfocitos T CD4+, puede usarse para producir evidencia técnica que brinde más certeza para determinar la autoría y la materialidad de estas conductas criminales.


Subject(s)
Sex Offenses , HIV , Antiretroviral Therapy, Highly Active/methods , Microbiology , Acquired Immunodeficiency Syndrome/etiology , Coroners and Medical Examiners , DNA Transformation Competence , Forensic Medicine
3.
Rev. panam. salud pública ; 44: e27, 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1101761

ABSTRACT

RESUMEN Objetivo. Evaluar el impacto del programa de terapia antirretroviral de gran actividad (TARGA) en la disminución de casos estadio sida en Perú en el período 1983-2018. Métodos. Experimento natural con diseño de series de tiempo interrumpidas durante un período de 36 años. Se analizaron los casos de sida según el año de diagnóstico y la política de acceso universal a la terapia con antirretrovirales del año 2004. Se emplearon datos agregados del Centro Nacional de Epidemiología, Prevención y Control de Enfermedades de 1983 al 2018. Se utilizó la regresión logarítmica lineal y se evaluó el Programa TARGA con un modelo autorregresivo integrado de media móvil (ARIMA, por sus siglas en inglés), a fin de realizar un pronóstico del número esperado de casos anuales de sida, y mediante series de tiempo interrumpidas. Resultados. Entre 2004 y 2018 hubo un decremento anual de 2,60% de casos (intervalo de confianza del 95% [IC95%]: -3,9 - 1,2). El mejor modelo ARIMA identificado tuvo los componentes: (8, 3, 1). El pronóstico arrojó un total de 32 709 nuevos casos de sida para este período, con una prevención estimada de 10 280 casos. El análisis de series de tiempo arrojó una disminución anual de 134,21 (IC 95%: -160 - -108,60) casos. Conclusiones. Los hallazgos evidenciaron un aumento sustancial en los casos de sida durante el período 1983-2004, con una reducción significativa posterior a la implementación del Programa TARGA. El programa se confirma como una intervención efectiva para la prevención del número de casos de sida, permite el acceso universal a la terapia con antirretrovirales y otorga otros servicios como pruebas de monitoreo, consejería psicológica y el fomento de la adherencia al tratamiento en las personas que viven con VIH-sida.(AU)


ABSTRACT Objective. To evaluate the impact of the Highly Active Antiretroviral Therapy (HAART) Program in the reduction of AIDS stage cases in Peru between 1983-2018. Methods. Natural experiment with interrupted time series design considering a period of 36 years. Cases of AIDS were analyzed according to the year of diagnosis and the policy of universal access to antiretroviral therapy of 2004. Aggregated data from the National Center for Epidemiology, Prevention and Control of Diseases from 1983 to 2018 were used. Linear logarithmic regression was used and the effect of the HAART Program was evaluated with an autoregressive integrated moving average (ARIMA) model to make forecasting of the expected number of annual cases of AIDS, and through interrupted time series. Results. Between 2004-2018 there was an annual decrease of 2.60% (95% CI:-3.9-1.2) of cases. The best identified ARIMA model had the components: (8,3,1). The forecasting yielded a total of 32 709 new cases of AIDS for this period, indicating the estimated prevention of 10 280 cases. The time-series analysis showed an annual decrease of 134.21 (95% CI:-160- -108.60) cases. Conclusions. The findings showed a substantial increase in AIDS cases during the period 1983-2004, with a significant drop in cases after the implementation of the HAART Program. The Program is an effective intervention for the prevention of the number of AIDS cases, allowing universal access to antiretroviral therapy and providing other services such as monitoring tests, psychological counseling and the promotion of adherence to treatment in people living with HIV and AIDS.(AU)


RESUMO Objetivo. Avaliar o impacto do Programa de Terapia Antirretroviral Altamente Ativa (HAART) na redução de casos em fase de Aids no Peru de 1983 a 2018. Métodos. Experimento natural com desenho de séries temporais interrompidas considerando um período de 36 anos. Os casos de Aids foram analisados de acordo com o ano de diagnóstico e a política de acesso universal à terapia antirretroviral em 2004. Foram utilizados dados agregados do Centro Nacional de Epidemiologia, Prevenção e Controle de Doenças de 1983 a 2018. Utilizou-se regressão logarítmica linear. O efeito do HAART foi avaliado utilizando um modelo de autorregressão de média móvel integrada (ARIMA) para prever o número esperado de casos anuais de Aids; e através de séries temporais interrompidas. Resultados. De 2004 a 2018 houve uma diminuição anual de 2,60% (95%CI: -3,9 a 1,2) nos casos. Com base no melhor modelo ARIMA, que continha os componentes (8,3,1), foram previstos 32 709 casos novos de Aids para o período, indicando uma prevenção estimada de 10 280 casos. A análise da série temporal mostrou uma diminuição anual de 134,21 casos (95%CI: -160 a -108,60). Conclusões. Os resultados mostraram um aumento substancial de casos de Aids durante o período de 1983 a 2004, com queda significativa nos casos após a implementação do HAART. O HAART é uma intervenção eficaz para a prevenção de casos de Aids, permitindo o acesso universal à terapia antirretroviral e envolvendo outros serviços como testes de monitorização, aconselhamento psicológico e promoção da adesão ao tratamento em pessoas vivendo com HIV e Aids.(AU)


Subject(s)
Humans , Health Systems/organization & administration , Acquired Immunodeficiency Syndrome/prevention & control , Antiretroviral Therapy, Highly Active/methods , National Health Programs/organization & administration , Peru/epidemiology , Time Series Studies
4.
Rev. saúde pública (Online) ; 54: 108, 2020. tab, graf
Article in English | SES-SP, LILACS, BBO, SES-SP | ID: biblio-1139469

ABSTRACT

ABSTRACT OBJECTIVE: To estimate the prevalence of smoking and evaluate the factors associated with this outcome in people living with HIV (PLHIV). METHODS: This is a cross-sectional study of a prospective concurrent cohort of 462 individuals initiating antiretroviral therapy at three HIV/AIDS specialized services in Belo Horizonte between 2015 and 2017. The following smoking status were used: current smoker (CS), former smoker (FS) and non-smoker (NS). Multinomial logistic regression was performed with NS as the reference category. RESULTS: Most participants were men (81.4%), young (up to 34 years old; 57.2%) and non-white (75.7%). Of the total number of individuals, 27.7% were CS, 22.9% FS, and 49.4% NS. Most smokers were light smokers (65.1%), consumed up to 10 cigarettes per day and had been smoking for more than 10 years (63.3%), starting on average at 17.2 years of age (SD = 5.1). In the multivariate analysis, higher chances of being CS were associated with: being female, having up to 9 years of schooling, current or prior use of alcohol and illicit drugs (marijuana, cocaine and crack) and presenting signs and/or symptoms of anxiety or depression. Higher chances of being FS were associated with having up to 9 years of schooling and current or prior use of alcohol and illicit drugs (marijuana and crack). CONCLUSIONS: The results show that smoking is highly prevalent among PLHIV, indicating the need for HIV specialized services to prioritize smoking cessation interventions. These interventions should consider the use of alcohol and illicit drugs and be targeted especially to young people, those with low schooling and with signs and/or symptoms of anxiety or depression.


RESUMEN OBJETIVO: Estimar a prevalência do tabagismo e avaliar os fatores a ele associados em pessoas vivendo com HIV (PVHIV). MÉTODOS: Trata-se de estudo transversal de uma coorte prospectiva concorrente com 462 indivíduos em início de terapia antirretroviral atendidos em três serviços de assistência especializada ao HIV/aids em Belo Horizonte entre 2015 e 2017. Os status de tabagismo utilizados foram: fumante atual (FA), ex-fumante (EF) e não fumante (NF). Realizou-se regressão logística multinomial, sendo NF a categoria de referência. RESULTADOS: A maioria dos participantes eram homens (81,4%), jovens (de até 34 anos; 57,2%) e não brancos (75,7%). Do total de indivíduos, 27,7% eram FA, 22,9% EF, e 49,4% NF. A maioria dos tabagistas eram fumantes leves (65,1%), consumiam até 10 cigarros por dia e fumavam havia mais de 10 anos (63,3%), tendo começado em média aos 17,2 anos de idade (DP = 5,1). Na análise multivariada, maiores chances de ser FA se associaram a: ser do sexo feminino, ter até 9 anos de escolaridade, usar ou já ter usado álcool e drogas ilícitas (maconha, cocaína e crack) e apresentar sinais e/ou sintomas de ansiedade ou depressão. Maiores chances de ser EF se associaram a ter até 9 anos de escolaridade e usar ou já ter usado álcool e drogas e ilícitas (maconha e crack). CONCLUSÕES: Os resultados mostram que o tabagismo é altamente prevalente entre PVHIV, indicando a necessidade de os serviços de assistência especializada em HIV priorizarem intervenções a fim de cessá-lo, com abordagem sobre o uso de álcool e drogas ilícitas, especialmente voltadas para pessoas jovens, com baixa escolaridade e com sinais e/ou sintomas de ansiedade ou depressão.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Smoking/epidemiology , HIV Infections/psychology , HIV Infections/drug therapy , Anti-HIV Agents/therapeutic use , Antiretroviral Therapy, Highly Active/methods , Socioeconomic Factors , Brazil/epidemiology , HIV Infections/epidemiology , Prevalence , Cross-Sectional Studies , Prospective Studies
5.
Arq. bras. cardiol ; 113(4): 737-745, Oct. 2019. tab, graf
Article in English | LILACS | ID: biblio-1038572

ABSTRACT

Abstract Background: Most cardiovascular abnormalities in patients infected with the human immunodeficiency virus (HIV) have been associated with myocardial damage directly caused by the virus. Some cases, however, may be associated with adverse effects from antiretroviral therapy (ART). New ventricular function assessment techniques are capable of detecting early changes in the cardiac function of HIV-infected patients using or not using ART. The usefulness of these techniques has been little employed in these patients. Objectives: To investigate the potential influence of antiretroviral therapy (ART) on the occurrence of subclinical left ventricular systolic dysfunction evaluated by myocardial strain rate analysis using two-dimensional speckle tracking echocardiography (2-D Echo) in treated HIV patients compared to untreated patients and healthy individuals. Methods: Sixty-eight HIV-infected patients with no cardiovascular symptoms, normal left ventricular (LV) ejection fraction (> 0.55 on 2-D Echo) were divided into three groups: 11 patients not using antiretroviral therapy (NT), 24 using protease inhibitor (PI) and 33 using non-nucleoside reverse transcriptase inhibitor (NNRTI). We also studied 30 normal non-HIV infected individuals (Ctrl). Demographic, clinical, biochemical and anthropometric data were collected. Preliminary transthoracic echocardiography included study of myocardial strain using two-dimensional speckle tracking. We studied strain and strain rate in the seventeen left ventricular (LV) myocardial segments in the longitudinal, circumferential and radial axes. Statistical analysis of the data was done with IBM SPSS - version 20 for Windows. Upon analysis of the data, namely the normality of independent variables in the different groups and the homogeneity of the variances between the groups, Kruskal-Wallis' non-parametric test was done, followed by Dunn's multiple comparison tests to test the significance of the differences between the values measured in the study groups. A significance level of 5% was adopted for decision-making on statistical tests. Results: The mean age of HIV patients was 40 ± 8.65 years and the mean age of controls was 50 ± 11.6 years (p < 0.001). Median LV global longitudinal strain (GLS) of NT patients (-17.70%), PI patients (-18.27%) and NNRTIs (-18.47%) were significantly lower than that of the Ctrl group (-20.77%; p = 0.001). There was no significant difference in mean SLG between treated patients (PI, NNRTI) and untreated (NT) patients. No significant differences were observed in mean circumferential and radial strain, nor on circumferential and radial strain rates between the NT, PI, NNRTI and Ctrl groups. Conclusion: The data suggest that HIV patients present, on myocardial strain measured by speckle tracking, signs of early LV systolic dysfunction that seem to be unrelated to the presence of ART. The prognostic significance of this condition in these patients deserves further studies.


Resumo Fundamento: A maior parte das alterações cardiovasculares dos pacientes infectados pelo vírus da imunodeficiência humana (HIV) tem sido associada ao dano miocárdico causado diretamente pelo vírus. Alguns casos, porém, podem estar associados a efeitos adversos da terapia antirretroviral (TARV). Novas técnicas de avaliação da função ventricular são capazes de detectar modificações precoces na função cardíaca do paciente infectado pelo HIV em uso ou não de TARV. A utilidade dessas técnicas tem sido pouco empregada nesses pacientes. Objetivos: Investigar possível influência da terapia antirretroviral (TARV) na ocorrência de disfunção sistólica ventricular esquerda subclínica avaliada pela análise da taxa de deformação miocárdica (strain) por meio do speckle tracking ao ecocardiograma bidimensional (E2D) em pacientes portadores do HIV tratados, comparados com pacientes não tratados e indivíduos saudáveis. Métodos: Sessenta e oito pacientes infectados pelo HIV assintomáticos do ponto de vista cardiovascular, com fração de ejeção do ventrículo esquerdo (VE) normal (>0,55 pelo E2D) foram divididos em três grupos: 11 pacientes sem tratamento antirretroviral (ST), 24 em uso de inibidor de protease (IP) e 33 em uso de inibidor de transcriptase reversa não nucleosídeo (ITRNN). Foram estudados também 30 indivíduos normais não infectados pelo HIV (Ctrl). Foram coletados dados demográficos, clínicos, bioquímicos e antropométricos. A ecocardiografia transtorácica foi realizada incluindo no estudo inicial o estudo da deformação miocárdica pela técnica bidimensional (speckle tracking). Estudamos o strain e a sua taxa de deformação (strain rate) nos dezessete segmentos miocárdicos do ventrículo esquerdo (VE) nos eixos longitudinal, circunferencial e radial. A análise estatística dos dados foi feita com o programa IBM SPSS - versão 20 para Windows. Depois de analisados os dados, nomeadamente a normalidade das variáveis independentes nos diferentes grupos e a homogeneidade das variâncias entre os grupos, decidiu-se utilizar o teste não paramétrico de Kruskal-Wallis seguido dos testes de comparações múltiplas pelo procedimento de Dunn, para testar a significância das diferenças entre os valores medidos nos grupos em estudo. Foi considerado o nível de significância de 5% para a tomada de decisão nos testes estatísticos realizados. Resultados: A média das idades dos pacientes com HIV foi de 40 ± 8,65 anos e a idade média dos controles foi de 50 ± 11,6 anos (p < 0,001). Os valores medianos do strain longitudinal global do VE (SLG) dos pacientes ST (-17.70%), dos pacientes IP (-18.27%) e ITRNN (-18.47%) foram significativamente menores do que o grupo Ctrl (-20,77%; p = 0,001). Não houve diferença significante nos valores médios do SLGentre os pacientes tratados (IP, ITRNN) e não tratados (ST). Não foram observadas diferenças significantes nos valores médios do strain circunferencial e radial, nem nas taxas de deformação circunferencial e radial entre os grupos ST, IP, ITRNN e Ctrl. Conclusão: Os dados sugerem que pacientes com HIV apresentam, à análise da deformação miocárdica ao speckle tracking, sinais de disfunção sistólica incipiente do VE que parece não ter relação com a presença de TARV. O significado prognóstico dessa alteração nesses pacientes merece estudos futuros.


Subject(s)
Humans , Male , Female , Pregnancy , Adult , Middle Aged , Aged , Aged, 80 and over , HIV Infections/physiopathology , HIV Infections/drug therapy , Ventricular Dysfunction, Left/physiopathology , Ventricular Dysfunction, Left/diagnostic imaging , Antiretroviral Therapy, Highly Active/methods , Reference Values , Stroke Volume/physiology , Echocardiography/methods , Case-Control Studies , Cross-Sectional Studies , Reproducibility of Results , Statistics, Nonparametric
6.
Rev. chil. infectol ; 36(4): 490-495, ago. 2019. tab
Article in Spanish | LILACS | ID: biblio-1042666

ABSTRACT

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


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


Subject(s)
Humans , Male , Female , Adult , Middle Aged , HIV Infections/drug therapy , HIV Protease Inhibitors/adverse effects , Anti-HIV Agents/administration & dosage , Antiretroviral Therapy, Highly Active/methods , Dyslipidemias/prevention & control , Raltegravir Potassium/administration & dosage , HIV Infections/blood , Retrospective Studies , Cohort Studies , Follow-Up Studies , CD4 Lymphocyte Count , Viral Load
7.
Braz. j. infect. dis ; 23(4): 211-217, July-Aug. 2019. tab
Article in English | LILACS | ID: biblio-1039228

ABSTRACT

Abstract Background: Several tools have been developed to evaluate HIV health-related quality of life (HRQoL) during and after antiretroviral therapy (ART). Few longitudinal studies evaluated the effect of ART on the quality of life of HIV patients. Objective: To evaluate changes in HRQoL in HIV-infected individuals one year after initiating ART. Methods: A prospective study was conducted from May 2016 to July 2018. Data on clinical and sociodemographic characteristics of 91 HIV-infected patients were collected prior to initiation of ART and one year thereafter. Demographic and clinical data were collected and the questionnaires 36-item Short Form Health Survey (SF-36) and HIV/AIDS-targeted quality of life (HAT-QoL) were administered in both periods. Asymptomatic individuals, aged ≥18 years, were included in the study. Patients who discontinued treatment were excluded. The association between predictors of physical and mental HRQoL was analyzed by multiple linear regression analysis. Results: Patients were predominantly male (78.0%), mean age 35.3 ± 10.7 years, with no stable relationship (80.2%), and no comorbidities (73.6%). Most of the SF-36 domains improved after one year, particularly Physical Function (p = 0.0001), General Health (p = 0.0001), Social Functioning (p = 0.0001), Mental Health (p = 0.001), and Mental Component Summary (p = 0.004). HAT-QoL domains improved in the Overall Function (p = 0.0001), Life Satisfaction (p = 0.0001), Provider Trust (p = 0.001), and Sexual Function (p = 0.0001) domains. Sex (p = 0.032), age (p = 0.001), income (p = 0.007), and stable relationship (p = 0.004) were good predictors of the Physical Component Summary. Sex (p = 0.002) and stable relationship (p = 0.038) were good predictors of the Mental Component Summary. SF-36 and HAT-QoL scales presented strong correlations, except for Medication Concerns (0.15-0.37), HIV Mastery (0.18-0.38), Disclosure Worries (−0.15 to 0.07), and Provider Trust (−0.07 to 0.15). Conclusions: ART improved HRQoL after one year of use. The HAT-QoL and SF-36 correlated well and are good tools to evaluate HRQoL in HIV-infected patients on ART.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Quality of Life , HIV Infections/drug therapy , Antiretroviral Therapy, Highly Active/methods , Socioeconomic Factors , HIV Infections/physiopathology , HIV Infections/psychology , Prospective Studies , Surveys and Questionnaires , Longitudinal Studies , Treatment Outcome , Viral Load
8.
Ciênc. Saúde Colet ; 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
9.
Rev. cuba. med. trop ; 71(1): e311, ene.-abr. 2019. graf
Article in Spanish | LILACS, CUMED | ID: biblio-1093547

ABSTRACT

El sarcoma de Kaposi se ha convertido en uno de los tumores más prevalentes en África tras la epidemia de VIH, que afecta de una manera similar a hombres y mujeres. El retraso diagnóstico y el limitado acceso a tratamiento antirretroviral o quimioterapia condicionan el pronóstico de los pacientes que lo padecen. En este artículo se realiza una revisión sobre la referida enfermedad, con el objetivo de describir sus aspectos más relevantes en los últimos años en África, como son su epidemiología, caractéristicas clínicas y opciones terapéuticas existentes. Este tumor es provocado por la infección por virus herpes humano tipo 8, que resulta más prevalente en las zonas rurales del continente africano. Se postula la transmisión a través de la saliva como la vía más importante de contagio en África. La inmunodepresión que causa el VIH favorece el efecto oncogénico del virus. La forma epidémica de SK se manifiesta inicialmente como lesiones hiperpigmentadas o violáceas en la piel, que pueden extenderse a linfáticos o mucosas y a nivel sistémico, principalmente a pulmón o aparato digestivo. El síndrome de reconstitución inmune sistémica puede complicar la evolución del paciente. El inicio temprano de la terapia antirretroviral resulta imprescindible. Además, el pronóstico de los pacientes mejora con la suma de tratamiento quimioterápico con doxorrubicina, vincristina, etopóxido o bleomicina principalmente(AU)


Kaposi sarcoma (KS) has become one of the most prevalent tumors in Africa after the HIV epidemic. KS affects both men and women. Diagnostic delay and limited access to antiretroviral treatment or chemotherapy have an impact on the prognosis of KS patients. A review was conducted about KS with the purpose of describing its most outstanding characteristics in recent years in Africa, such as its epidemiology, clinical features, and existing therapeutic options. This tumor is caused by infection with human herpesvirus 8, which is more prevalent in rural areas of the African continent. Transmission via saliva was found to be the most important transmission route in Africa. HIV-related immunosuppression fosters the oncogenic effect of the virus. The epidemic form of KS initially presents as hyperpigmented or violet-colored skin lesions which may extend to lymph nodes or mucosae, or systemically, mainly to the lungs or the digestive tract. Systemic immune reconstitution syndrome may complicate the patient's evolution. Early start of antiretroviral therapy is indispensable. Additionally, prognosis improves with chemotherapy with doxorubicin, vincristine, etoposide or bleomycin, mainly(AU)


Subject(s)
Humans , Sarcoma, Kaposi/drug therapy , Sarcoma, Kaposi/epidemiology , Skin Neoplasms/complications , Africa South of the Sahara/epidemiology , Herpesvirus 8, Human/pathogenicity , Antiretroviral Therapy, Highly Active/methods
10.
Rev. cuba. reumatol ; 20(3): e650, sept.-dic. 2018.
Article in Spanish | LILACS, CUMED | ID: biblio-1093790

ABSTRACT

Introducción: La infección por VIH/SIDA constituye uno de los principales problemas de salud en el mundo con elevadas tasas de morbilidad y mortalidad demostradas. En diferentes estudios epidemiológicos ha quedado confirmado que 36,3 millones de personas vivían con el VIH hasta el año 2015 en todo el mundo. Hasta este momento 78 millones han sido infectados desde 1981, año en que comenzó la epidemia, y el 25 por ciento de los pacientes desconocen que están infectados, lo cual propicia el contagio. Objetivo: Realizar una revisión bibliográfica relacionada con la infección por el VIH/SIDA, sus complicaciones en las enfermedades reumáticas y metabólicas y su respuesta al tratamiento antirretroviral de alta eficiencia. Método: Se realizó una búsqueda bibliográfica en bases de datos nacionales e internacionales y en diferentes fuentes de información para recuperar los artículos relacionados con el tema sobre el VIH-SIDA, las complicaciones reumáticas y metabólicas y su respuesta al tratamiento antirretroviral de alta eficiencia, tema escogido para este trabajo. Resultados: Se recuperaron 78 artículos y nueve textos que trataban temas relacionados con la infección por VIH-SIDA; de ellos fueron útiles para nuestros objetivos 55 documentos que forman parte de nuestras referencias bibliográficas, los cuales agrupamos de acuerdo con los diferentes temas planteados para este estudio y se llegó a conclusiones útiles para nuestra comunidad científica. Conclusiones: Las enfermedades reumáticas y autoinmunes han sido diagnosticadas con mucha frecuencia en los pacientes infectados con el VIH-SIDA en Cuba y en el mundo antes del tratamiento antirretroviral de alta eficiencia, mediante el cual ha aumentado la expectativa de supervivencia de estos enfermos y disminuido la aparición de síntomas clínicos y afecciones, así como infecciones oportunistas, después de su inclusión en el enfoque terapéutico(AU)


Introduction: HIV/AIDS infection is one of the main health problems worldwide, with high morbidity and mortality. Different epidemiological studies have confirmed that 36.3 million people worldwide were living with HIV until 2015. So far, 78 million have been infected since 1981, the year in which the epidemic began, and 25 percent of patients do not know they are infected, which spreads infection. Objective: To carry out a literature review about HIV/AIDS infection, its complications in rheumatic metabolic manifestations, and its response to highly efficient antiretroviral treatment. Method: A literature search was carried out in the databases PudMed/MEDLINE, Cumed and Lilac, as well as in the regional information sources SciELO and ScienceDirect, using the key phrases manifestaciones reumáticas y VIH-SIDA [rheumatic manifestations and HIV-AIDS], complicaciones metabólicas y VIH-SIDA [metabolic complications and HIV-AIDS], tratamiento antirretroviral de alta eficiencia y VIH-SIDA [high-efficiency antiretroviral treatment and HIV-AIDS], in order to recover the articles about HIV-AIDS and rheumatic and metabolic complications and their response to highly efficient antiretroviral treatment. Results: 78 articles and nine texts dealing about the aforementioned topics were recovered; of them, 55 documents that are part of our bibliographical references were useful for our purposes, which were grouped according to the different topics proposed for this study. We reached useful conclusions for our scientific community. Conclusions: Rheumatic and autoimmune diseases have been diagnosed very frequently in patients infected with HIV/AIDS in Cuba and worldwide during the era prior to highly efficient antiretroviral treatment. Its incorporation into the therapeutic approach has increased the survival expectations of these patients, in addition to the substantial decrease in the appearance of clinical symptoms and conditions, especially the inflammatory arthritic conditions, seronegative spondyloarthropathies, psoriasis and opportunistic infections(AU)


Subject(s)
Humans , Autoimmune Diseases , Rheumatic Diseases/complications , Acquired Immunodeficiency Syndrome/complications , HIV/metabolism , Spondylarthropathies , Epidemiologic Studies , Antiretroviral Therapy, Highly Active/methods
11.
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
12.
Ciênc. Saúde Colet ; 23(8): 2533-2542, Aug. 2018. tab, graf
Article in Portuguese | LILACS | ID: biblio-952741

ABSTRACT

Resumo O presente estudo analisou o consumo alimentar e a presença de fatores de risco cardiovasculares em pessoas vivendo com HIV/AIDS (PVHA) em uso regular de antirretrovirais. O consumo alimentar foi avaliado por meio de questionário de frequência alimentar anual, dividido em alimentos protetores e não protetores para doença cardiovascular (DCV). Os dados foram calculados pelo Teste t de Student para amostras independentes, pelo Teste U de Mann-Whitney e pelo teste exato de Fischer, considerando significativo p < 0,05. A amostra consistiu de 45 PVHA (60% do sexo feminino). O consumo de alimentos não protetores para o risco cardiovascular foi maior do que o de alimentos protetores nos homens (3,91 ± 0,26 vs. 2,79 ± 0,32 p = 0,01) e nas mulheres (3,40 ± 0,23 vs. 2,60 ± 0,29 p = 0,04). A prevalência de síndrome metabólica foi 33,3% nos homens e 37% nas mulheres. Os homens apresentaram hipertrigliceridemia (50%) e baixas concentrações de HDL-c (44%), enquanto que as mulheres apresentaram hipertrigliceridemia (46%), hipercolesterolemia (66,7%, p < 0,02 vs. homens) e obesidade central (54%, p < 0,05 vs. homens). Os resultados deste estudo indicam a presença de padrão de consumo alimentar inadequado e elevada prevalência de fatores de risco relacionados às DCV nos indivíduos avaliados.


Abstract This cross-sectional study evaluated the food intake patterns related to cardiovascular risk disease among people living with HIV/AIDS (PLWHA) with viral suppression and receiving highly active antiretroviral therapy (HAART). Food intake was obtained by the annual food frequency questionnaire, separated into two groups, healthy and unhealthy food related intake and cardiovascular disease. Data were analyzed using Student's t Test for independent samples or the Mann-Whitney U Test and Fisher's exact test, with a significance level of p < 0.05. The sample consisted of 45 individuals with HIV/AIDS (60% female). The intake of unhealthy foods for cardiovascular risk was greater compared to the intake of healthy foods, both in men (3.91 ± 0.26 vs. 2.79 ± 0.32 p = 0.01) and women (3.40 ± 0.23 vs. 2.60 ± 0.29 p = 0.04). Metabolic syndrome prevalence was 33.3% in men and 37% in women. Men presented hypertriglyceridemia (50%) and low HDL (44%) and women presented central obesity (54%, p = 0.05 vs. men) hypercholesterolemia (66.7% p = 0.02 vs. men) and hypertriglyceridemia (46%). Study results indicate the presence of unhealthy food intake patterns and a high prevalence of cardiovascular risk factors in the evaluated subjects.


Subject(s)
Humans , Male , Female , Adult , Cardiovascular Diseases/epidemiology , HIV Infections/epidemiology , Diet/statistics & numerical data , Feeding Behavior , Cardiovascular Diseases/etiology , HIV Infections/drug therapy , Prevalence , Cross-Sectional Studies , Surveys and Questionnaires , Risk Factors , Antiretroviral Therapy, Highly Active/methods , Metabolic Syndrome/epidemiology , Dyslipidemias/epidemiology , Diet, Healthy/statistics & numerical data , Middle Aged , Obesity/epidemiology
13.
Int. j. odontostomatol. (Print) ; 12(1): 93-98, Mar. 2018. graf
Article in Spanish | LILACS | ID: biblio-893307

ABSTRACT

RESUMEN: El objetivo de este estudio fue reportar un caso clínico donde se realizó el manejo quirúrgico de múltiples condilomas de la mucosa oral en un paciente infectado por Virus de Inmunodeficiencia Humana (VIH) bajo Terapia Antirretroviral de Gran Actividad (TARGA). Hombre de 58 años en tratamiento por infección con VIH en TARGA hace 17 años, que acude al Servicio de Cirugía Maxilofacial del Hospital Barros Luco-Trudeau con múltiples lesiones verruciformes ubicadas en margen y cara dorsal de lengua, cara interna de ambas mejillas y labio inferior. Se realizó escisión quirúrgica de las lesiones de labio, cara dorsal de lengua y cara interna de mejilla del lado derecho, obteniéndose el diagnóstico histopatológico de condiloma. Tras 2 meses de realizar la cirugía se obtuvo recurrencia. La recurrencia de las lesiones puede originarse por la recrudescencia del virus latente adyacente al lecho quirúrgico y, por ello, deben considerarse otras alternativas de tratamiento. Por el impacto en la función, estética, potencial de contagio y malignización, es necesario su tratamiento.


ABSTRACT: The objective of this study was to report a clinical case in which surgical management of multiple condylomas in the oral mucosa was performed in a patient infected by Human Immunodeficiency Virus (HIV) who is under highly active antiretroviral therapy (HAART). A 58-yearold man, under HAART for 17 years for HIV infection, was admitted at the Maxillofacial Surgery Service at the Hospital Barros Luco-Trudeau as he was experiencing multiple verrucous lesions located on the lateral margin and dorsum of the tongue, as well as on the inner face of both cheeks and the lower lip. A surgical excision of the lesions on the lip, dorsum of the tongue and inner face of the right cheek was performed, where the histopathological diagnosis of condyloma was obtained. There was a recurrence two months after surgery. Recurrence of the lesions may be due to the recrudescence of the latent virus adjacent to the surgical bed and, therefore, other treatment alternatives should be considered. Treatment is necessary due to the impact on the function, aesthetics, and the potential to become contagious and malignant.


Subject(s)
Humans , Male , Middle Aged , Tongue Diseases/virology , Condylomata Acuminata/virology , Antiretroviral Therapy, Highly Active/methods , Photomicrography , Condylomata Acuminata/surgery , Condylomata Acuminata/diagnosis , HIV Infections/virology , Mouth Mucosa/virology
14.
Ciênc. Saúde Colet ; 23(1): 115-122, Jan. 2018. tab
Article in Portuguese | LILACS | ID: biblio-890487

ABSTRACT

Resumo Esta revisão integrativa da literatura tem por objetivo identificar as principais lesões bucais que afetam pacientes pediátricos com HIV, bem como descrever o efeito da terapia antirretroviral altamente ativa (HAART) sobre essas lesões, comparando-a com a terapia antirretroviral (ART). Foi feita uma busca nas bases de dados PubMed e Scielo, seguindo critérios de inclusão e exclusão pré-determinados. Foram selecionados dezenove artigos científicos e extraídas as informações principais sobre prevalência e a frequência das manifestações bucais em pacientes pediátricos HIV positivos e o efeito da terapêutica aplicada. As lesões mais frequentes foram candidíase oral, gengivite, aumento das parótidas e eritema gengival linear. O uso da HAART mostrou diminuir a prevalência das manifestações bucais nos pacientes pediátricos com HIV e ser mais eficaz que a ART. Os achados deste estudo sugerem que a manifestação bucal mais frequente em pacientes pediátricos com HIV é a candidíase oral, seguida de alterações como gengivite e aumento das glândulas parótidas. O uso de HAART parece reduzir a prevalência dessas lesões orais, apresentando resultados mais eficazes que os da ART.


Abstract This integrative literature review aims to identify the main oral lesions affecting pediatric patients with HIV, and describe the effect of highly active antiretroviral therapy (HAART) on these injuries, comparing it to antiretroviral therapy (ART). A search was conducted in PubMed and Scielo databases, following predetermined inclusion and exclusion criteria. 19 papers were selected and the main information on the prevalence and frequency of oral manifestations in HIV-positive pediatric patients and effect of therapy applied were extracted. The most frequent injuries were oral candidiasis, gingivitis, parotid gland enlargement and linear gingival erythema. The use of HAART shown to reduce the prevalence of oral manifestations in pediatric patients with HIV and be more effective than ART. The findings of this study suggest that the most frequent oral manifestation in HIV-infected children is oral candidiasis, followed by changes such as gingivitis and enlargement parotid glands. The use of HAART appears to reduce the prevalence of these oral lesions, showing more effective results than ART.


Subject(s)
Humans , Child , HIV Infections/complications , Anti-HIV Agents/administration & dosage , Mouth Diseases/etiology , Parotid Gland/pathology , Candidiasis, Oral/etiology , Candidiasis, Oral/prevention & control , Candidiasis, Oral/epidemiology , HIV Infections/drug therapy , HIV Infections/epidemiology , Prevalence , AIDS-Related Opportunistic Infections/prevention & control , AIDS-Related Opportunistic Infections/epidemiology , Antiretroviral Therapy, Highly Active/methods , Gingivitis/etiology , Gingivitis/prevention & control , Gingivitis/epidemiology , Mouth Diseases/prevention & control
15.
Rev. chil. infectol ; 35(1): 49-61, 2018. tab, graf
Article in Spanish | LILACS | ID: biblio-899777

ABSTRACT

Resumen Introducción Las recomendaciones internacionales de tratamiento anti-retroviral incluyen pruebas de resistencia para orientar el régimen de tratamiento en cada paciente, lo que no está disponible de forma estable en Ecuador. Objetivo Describir las mutaciones que confieren resistencia a anti-retrovirales en una población de pacientes ecuatorianos. Metodología A partir de muestras de plasma de 101 pacientes con VIH-1 con fallo a la terapia anti-retroviral, 15 niños y 86 adultos, se realizó pirosecuenciación con el GS Junior (Roche) y se analizaron las secuencias con el programa DeepChek. Resultados Las mutaciones más frecuentes fueron M184V/I, K101E/P/H, K103N/S, D30N, M46L/I, I54L/M, V82T/F/A/S/L y L90M en adultos, y F77L, K103N/S, M46L/I, V82T/F/A/S/L y L90M en niños. Se encontró una elevada resistencia a los inhibidores de la transcriptasa reversa (TR) no análogos de nucleósidos en poblaciones minoritarias virales de adultos y niños (34,9 y 70%, respectivamente), en los niños, tanto las poblaciones virales mayoritarias como minoritarias, fueron resistente a inhibidores de proteasa (> 45%). Los pacientes que tuvieron un mayor número de esquemas terapéuticos presentaron mayores niveles de resistencia a los anti-retrovirales. La mayoría de las muestras fueron del subtipo B en la región de la TR y proteasa, y CRF25_cpx en integrasa. Conclusiones Se muestran las mutaciones y la resistencia a antiretrovirales en una población de pacientes ecuatorianos con infección por VIH-1, que permitirán realizar un llamado de alerta a las autoridades de salud sobre la necesidad de realizar estudios de resistencia.


Background The international recommendations of antiretroviral treatment include resistance tests to guide the treatment regimen in each patient, which is not available on a regular basis in Ecuador. Aim To describe mutations that confer resistance to antiretrovirals in a population of Ecuadorian patients. Methods Plasma samples from 101 HIV-1 patients with failure to antiretroviral therapy, divided into 15 children and 86 adults, were studied with the GS Junior (Roche) and the sequences were analyzed with the DeepChek program. Results The most frequent mutations were M184V/I, K101E/P/H, K103N/S, D30N, M46L/I, I54L/M, V82T/F/A/S/L and L90M in adults and F77L, K103N/S, M46L/I, V82T/F/A/S/L and L90M in children. High resistance to non-nucleoside reverse transcriptase (RT) inhibitors in minority viral populations of adults and children (34.9% and 70%) was detected; in children both viral populations (majority and minority viral populations) (> 45%) were protease inhibitor resistant. Patients who had a greater number of therapeutic regimens had higher levels of resistance to antiretrovirals. Most of the samples were subtype B in the TR and protease region, and CRF25_cpx in integrase. Conclusions Mutations and resistance to antiretrovirals are shown in a population of Ecuadorian patients with HIV-1. These results will make it possible to issue a warning to health authorities about the need for resistance studies.


Subject(s)
Humans , Male , Female , Child, Preschool , Child , Adult , HIV Infections/genetics , HIV Infections/drug therapy , HIV-1/drug effects , HIV-1/genetics , Drug Resistance, Multiple, Viral/genetics , Anti-Retroviral Agents/pharmacology , Mutation/drug effects , HIV Infections/blood , Logistic Models , Polymerase Chain Reaction , Cross-Sectional Studies , Age Factors , CD4 Lymphocyte Count , Viral Load , Antiretroviral Therapy, Highly Active/methods , Anti-Retroviral Agents/therapeutic use , Ecuador , HIV Reverse Transcriptase/drug effects
16.
Ciênc. Saúde Colet ; 23(11): 3649-3662, Oct. 2018. tab, graf
Article in Portuguese | LILACS | ID: biblio-974742

ABSTRACT

Resumo O tratamento da aids implica a utilização de diversos medicamentos que compõem a terapia antirretroviral, sendo o controle logístico monitorado por um sistema nacional informatizado de dispensação, o Sistema de Controle Logístico de Medicamentos (SICLOM). O objetivo foi investigar a utilização da terapia antirretroviral de pacientes de dois hospitais universitários no Estado do Rio de Janeiro a partir do SICLOM. Foi realizado um estudo seccional com coleta de dados sociodemográficos e de dispensação, a partir do SICLOM. A avaliação da posse para estimativa de pacientes não aderidos foi realizada através do indicador de proporção de dias cobertos (PDC). Foram incluídos 538 pacientes com cadastro ativo no SICLOM, maiores de 18 anos de ambos os sexos. O ARV mais utilizado em ambos os hospitais foi lamivudina, dentre 58 esquemas diferentes identificados. A maior parte dos pacientes utilizava esquemas classificados como de primeira linha de tratamento. Em média, a proporção de dias cobertos (posse) pelo tratamento foi 88% (± 0,16). A linha de tratamento mostrou associação estatística com a posse, sendo observado melhor PDC 91% (p < 0,001) para os esquemas resgate. Este estudo corroborou o SICLOM como uma boa fonte para conhecimento do perfil de utilização de ARV.


Abstract Treatment of AIDS involves the use of the cocktail of drugs that make up the antiretroviral therapy. Its logistic control is monitored by a computerized national system of dispensation, the Logistic Control System of Medication (SICLOM). This study aimed to investigate, by means of SICLOM data, the use of antiretroviral therapy in patients treated at two University Hospitals in the state of Rio de Janeiro. A cross-sectional study was conducted with sociodemographic and dispensation data collected from SICLOM. The evaluation of drug ownership was done by calculating the Proportion of Days Covered (PDC). Five hundred and thirty-eight patients of both genders with active registration in SICLOM and over 18 years of age were included. The ART most used in both hospitals was lamivudine, considering the total of 58 different schemes identified. The mean of possession of groups was 88% (± 0,16). The factor associated with possession of drugs was the ART scheme, with PDC of 91% (p<0,001) for rescue schemes. This study confirmed that SICLOM was a reliable source to establish the profile of the population assisted.


Subject(s)
Humans , Male , Female , Adult , HIV Infections/drug therapy , Acquired Immunodeficiency Syndrome/drug therapy , Anti-HIV Agents/therapeutic use , Brazil , Cross-Sectional Studies , Anti-HIV Agents/administration & dosage , Antiretroviral Therapy, Highly Active/methods , Drug Therapy, Combination , Hospitals, University , Middle Aged
18.
Int. j. cardiovasc. sci. (Impr.) ; 30(2): f:171-l:176, mar.-abr. 2017. tab, graf
Article in Portuguese | LILACS | ID: biblio-833937

ABSTRACT

Crianças e adolescentes infectados pelo HIV através da transmissão mãe-filho têm alto risco de desenvolver doenças cardiovasculares precoces devido à dislipidemia, resistência à insulina e inflamação crônica de baixo grau. O objetivo do estudo piloto foi analisar o efeito de um programa de exercícios físicos lúdicos sobre os desfechos cardiovasculares, morfológicos, metabólicos, de aptidão e qualidade de vida. Um ensaio clínico não-randomizado composto por 24 sessões de exercícios aeróbicos e resistidos foi aplicado a 10 crianças e adolescentes vivendo com o HIV, oriundos de Florianópolis, SC, Brasil. As seguintes variáveis foram obtidas antes e após o programa: colesterol total, HDL-c, LDL-c, triglicerídeos, glicose, proteína-C reativa em jejum, pressão arterial, espessura íntima-média da artéria carótida comum (EIM-ACC), resistência muscular, aptidão aeróbia, antropometria e qualidade de vida medida. Após a intervenção, observou-se diminuição da pressão arterial sistólica (-6,8mmHg, 6,6%, p = 0,019) e EIM-ACC (-60,0µm, 12,2%; p = 0,002) após 24 sessões. Observou-se aumento na resistência muscular dos membros superiores (+3,3 rep.min-1, 63,5%, p = 0,002), flexibilidade (+5,7 cm, 26,0%; p = 0,001) e qualidade de vida (+10,4 pontos, 27,5%, p = 0,003). Em nossa amostra de crianças e adolescentes vivendo com o HIV, um programa de exercícios de curta duração foi associado com melhora no risco cardiovascular, aptidão física e qualidade de vida


Subject(s)
Humans , Male , Female , Child , Adolescent , Acquired Immunodeficiency Syndrome , Adolescent , Cardiovascular Diseases/physiopathology , Child , Exercise , Physical Fitness/physiology , Quality of Life , Antiretroviral Therapy, Highly Active/methods , Dyslipidemias/complications , Insulin Resistance , Pragmatic Clinical Trials as Topic , Risk Factors , Statistical Analysis , Treatment Outcome
19.
J. pediatr. (Rio J.) ; 92(6): 631-637, Nov.-Dec. 2016. tab
Article in English | LILACS | ID: biblio-829119

ABSTRACT

Abstract Objective: To assess clinical and laboratory data, and acute kidney injury (AKI) in HIV-infected children using and not using highly active antiretroviral therapy (HAART) prior to admission. Methods: A retrospective study was conducted with HIV-infected pediatric patients (<16 years). Children who were using and not using HAART prior to admission were compared. Results: Sixty-three patients were included. Mean age was 5.3 ± 4.27 years; 55.6% were females. AKI was observed in 33 (52.3%) children. Patients on HAART presented lower levels of potassium (3.9 ± 0.8 vs. 4.5 ± 0.7 mEq/L, p = 0.019) and bicarbonate (19.1 ± 4.9 vs. 23.5 ± 2.2 mEq/L, p = 0.013) and had a higher estimated glomerular filtration rate (102.2 ± 36.7 vs. 77.0 ± 32.8 mL/min/1.73 m2, p = 0.011) than those not on HAART. In the multivariate analysis, the use of HAART prior to the admission was a protective factor for AKI (p = 0.036; OR = 0.30; 95% CI = 0.097-0.926). Conclusion: AKI is a common complication of pediatric HIV infection. Use of HAART prior to the admission preserved glomerular filtration and was a protective factor for AKI, but increased medication side effects, such as hypokalemia and renal metabolic acidosis.


Resumo Objetivo: Avaliar dados clínicos e laboratoriais, bem como ocorrência de lesão renal aguda (LRA), em crianças HIV positivas com e sem uso de terapia antirretroviral altamente ativa (TARV) antes da admissão. Métodos: Estudo retrospectivo em pacientes pediátricos HIV positivos (< 16 anos). Foram comparadas as crianças que estavam em uso com aquelas sem uso de TARV prévia à internação. Resultados: Foram incluídos 63 pacientes, com média de 5,3 ± 4,27 anos, 55,6% do sexo feminino. LRA foi encontrada em 33 casos (52,3%). Os pacientes que usavam TARV apresentaram menores níveis de potássio (3,9 ± 0,8 vs. 4,5 ± 0,7 mEq/L, p = 0,019) e bicarbonato (19,1 ± 4,9 vs. 23,5 ± 2,2 mEq/L, p = 0,013), bem como maior taxa de filtração glomerular estimada (102,2 ± 36,7 vs. 77,0 ± 32,8 mL/min/1,73m2, p = 0,011), do que o pacientes sem TARV prévia. Na análise multivariada o uso de TARV prévia à internação foi fator protetor contra LRA (p = 0,036; RC = 0,30; IC de 95% = 0,097-0,926). Conclusão: A LRA é uma complicação comum da infecção pediátrica pelo HIV. O uso de TARV antes da internação foi associado a melhor taxa de filtração glomerular e foi fator de proteção contra LRA, porém desencadeou efeitos colaterais como hipocalemia e acidose metabólica.


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , HIV Infections/complications , Antiretroviral Therapy, Highly Active/methods , Acute Kidney Injury/complications , Potassium/blood , Bicarbonates/blood , HIV Infections/drug therapy , Retrospective Studies , Protective Agents/adverse effects , Antiretroviral Therapy, Highly Active/adverse effects , Glomerular Filtration Rate/drug effects
20.
Medicina (B.Aires) ; 76(6): 349-354, dic. 2016. tab
Article in Spanish | LILACS | ID: biblio-841608

ABSTRACT

Se determinó la frecuencia de mutaciones asociadas a resistencia de HIV-1 a antirretrovirales en embarazadas del área metropolitana de Buenos Aires, 2008-2014. Se incluyeron 136 mujeres con carga viral ≥ 500 copias/ml: 77 (56.6%) eran naïve; las otras 59 (43.4%) eran expuestas, ya sea con tratamiento en curso (n: 24) o previo (n: 35). Se realizó análisis de resistencia genotípica basal en plasma de pacientes naïve y con experiencia de tratamiento antirretroviral. Las mutaciones se identificaron según las listas de la Organización Mundial de la Salud y la International Antiviral Society, respectivamente. Se comparó la frecuencia de mutaciones detectadas en los subperíodos 2008-2011 vs. 2012-2014. Un total de 37 (27.2%) mujeres presentaron ≥ 1 mutación asociada a resistencia: 25/94 (26.5%) en 2008-2011 y 12/42 (28.5%) en 2012-2014 (p > 0.05). Entre las naïve, 15 (19.5%) tenían ≥ 1 mutación: 10/49 (20.4%) en el subperíodo 2008-2011 y 5/28 (17.8%) en 2012-2014 (p > 0.05). Las mutaciones encontradas en pacientes naïve estuvieron asociadas a inhibidores no nucleosídicos de la transcriptasa reversa, y, como en estudios anteriores, K103N fue la más frecuente a lo largo de todo el período. Entre las pacientes expuestas, 22/59 (37.3%) presentaron ≥ 1 mutación asociada a resistencia. Este estudio demuestra una alta frecuencia de mutaciones asociadas a resistencia que se mantuvo estable a lo largo del período. Los niveles detectados sugieren una mayor circulación en nuestro medio de cepas de HIV-1 resistentes a antirretrovirales con respecto a los niveles previamente observados en Argentina.


The study aimed to determine the prevalence of antiretroviral resistance associated mutations in HIV-1 infected pregnant woman treated in Buenos Aires metropolitan area (period 2008-2014). A total of 136 women with viral load ≥ 500 copies/ml were included: 77 (56.6%) were treatment-naïve and 59 (43.4%) were antiretroviral-experienced patients either with current (n: 24) or previous (n = 35) antiretroviral therapy. Genotypic baseline resistance was investigated in plasma of antiretroviral-naïve patients and antiretroviral-experienced patients. The resistance mutations were identified according to the lists of the World Health Organization and the International Antiviral Society, respectively. Frequencies of resistance associated mutations detected in 2008-2011 and 2012-2014 were compared. A total of 37 (27.2%) women presented at least one resistance associated mutation: 25/94 (26.5%) in 2008-2011 and 12/42 (28.5%) in 2012-2014 (p > 0.05). Among naïves, 15 (19.5%) had at least one mutation: 10/49 (20.4%) in the period 2008-2011 and 5/28 (17.8%) in 2012-2014 (p > 0.05). The resistance mutations detected in naïves were associated with non nucleoside reverse transcriptase inhibitors, being K103N the most common mutation in both periods. In antiretroviral experienced patients, 22/59 (37.3%) had at least one resistance mutation. This study demonstrates a high frequency of resistance associated mutations which remained stable in the period analyzed. These levels suggest an increased circulation of HIV-1 antiretroviral resistant strains in our setting compared to previous reports from Argentina.


Subject(s)
Humans , Female , Pregnancy , Adolescent , Adult , Young Adult , Pregnancy Complications, Infectious/drug therapy , HIV Infections/drug therapy , HIV-1/drug effects , Anti-HIV Agents/therapeutic use , Drug Resistance, Viral/drug effects , Argentina/epidemiology , Time Factors , HIV Infections/epidemiology , HIV Infections/virology , Age Factors , Gestational Age , HIV-1/genetics , Viral Load , Antiretroviral Therapy, Highly Active/methods , Drug Resistance, Viral/genetics , Genotype , Mutation
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