Nefrologia: uma especialidade pouco atrativa para os medicos peruanos? / Nephrology: is a medical specialty unattractive to Peruvian doctors?

Embora a Comissão Nacional de Especialização Médica (CONAREME) tenha aumentado o número de vagas para Nefrologia no Peru, não houve um aumento proporcional do número de participantes para esta especialidade, o que é preocupante em um contexto no qual são necessários mais nefrologistas no país. A Sociedade Peruana de Nefrologia (SPN) deve tomar medidas para tornar a nossa especialidade mais atraente para os médicos peruanos.

Although the National Committee of Medical Residency (CONAREME) has increased the number of nephrology residency positions in Peru, the increase has not been proportional to the number of applicants. This is worrisome in an environment lacking of nephrologists, like our country. The Peruvian Society of Nephrology (SPN) should take the measures to make this specialty more attractive to Peruvian physicians.

High rate of virologic suppression with darunavir/ritonavir plus optimized background therapy among highly antiretroviral-experienced HIV-infected patients: results of a prospective cohort study in São Paulo, Brazil

OBJECTIVES: To assess the virologic and immunological response of darunavir/ritonavir plus optimized background therapy in highly antiretroviral-experienced HIV-infected patients in Brazil. METHODS: Prospective cohort study carried out in a tertiary center in Sao Paulo, Brazil. Three-class antiretroviral-experienced patients with confirmed virologic failure began darunavir/ritonavir plus optimized background therapy (nucleoside/tide reverse transcriptase inhibitors ± raltegravir ± enfuvirtide ± maraviroc) after performing a genotypic resistance assay. Clinical evaluation and laboratory tests were collected at baseline and at weeks 12, 24, and 48. Multivariate analysis was performed to identify predictors of virologic response at 48 weeks. RESULTS: Ninety-two patients were included. The median of darunavir resistant mutation was 1 (range 0-6). The median genotypic sensitivity score in the optimized background therapy was 2 (interquartile range 1-2). At week 48, 83% (95% CI: 75-90%) had an HIV RNA level <50 copies/mL and the median CD4 cell count was 301 (interquartile range 224-445) cells/mm³. Baseline HIV RNA >100 000 copies/mL was inversely associated with virologic success at week 48 (HR: 0.22, 95% CI: 0.06-0.85, p = 0.028). CONCLUSIONS: Darunavir/ritonavir plus optimized background therapy was a highly effective salvage regimen under clinical routine conditions in a referral center in Brazil, which is similar to the reported in high-income countries.