Evolución virológica de pacientes con infección por VIH que inician terapia antirretroviral con carga viral basales muy alta / Virological evolution of patients with HIV infection that start antiretroviral therapy with a very high baseline viral load

INTRODUCCIÓN: Se desconoce el grado de supresión viral en pacientes con infección por VIH que inician terapia antirretroviral (TAR) con cargas virales (CV) muy altas. OBJETIVO: Conocer el porcentaje de supresión viral en pacientes con VIH que inician TAR con CV ≥ 500.000 copias/mL a 96 semanas. PACIENTES Y MÉTODO: Estudio retrospectivo. Se incluyeron pacientes que iniciaron TAR con CV ≥ 500.000 copias/mL, entre los años 2008 y 2018, estratificándose en base a escala logarítmica. Se determinó el porcentaje de supresión viral, y las variables asociadas a este desenlace. RESULTADOS: Se incluyeron 221 pacientes. La mediana de edad y CV era de 43 años y 6,0 log, respectivamente, estando la mayoría (37%) en estadio C3 al inicio de TAR. El 48,8 y 87,7% de los pacientes logró la supresión viral al año y dos años de seguimiento, respectivamente. Se observó que, a mayor edad, a mayor inmunosupresión, y a mayor CV, mayor el tiempo para lograr la indetectabilidad. Sólo se demostró fracaso virológico en tres pacientes. DISCUSIÓN: Los pacientes con infección por VIH que inician TAR con CV muy altas demoran más tiempo en lograr la supresión viral, lo cual es proporcional a la magnitud de ésta y al grado de inmunosupresión, sin que esto conlleve mayor riesgo de fracaso virológico.

BACKGROUND: The degree of viral suppression in HIV patients who start antiretroviral therapy (ART) with very high viral loads (CV) is unknown. AIM: To know the percentage of viral suppression in HIV patients who start ART with CV ≥ 500,000 copies/mL at 96 weeks. METHOD: Retrospective study. Patients who started ART with a CV ≥ 500,000 copies/mL between 2008 and 2018 were included, stratifying on the basis of a logarithmic scale. The percentage of viral suppression and the variables associated with this outcome were determined. RESULTS: 221 patients were included. The median age and CV were 43 years and 6.0 log, respectively, with the majority (37%) being in stage C3 at the start of ART. 48.8 and 87.7% of the patients achieved viral suppression at one year and two years of follow-up, respectively. It was observed that the older the immunosuppression, and the higher CV, the longer the time to achieve undetectability. Virological failure was only demonstrated in three patients. DISCUSSION: Patients with HIV infection who start ART with very high CVs take longer to achieve viral suppression, which is proportional to the magnitude of this and the degree of immunosuppression, without this entailing a greater risk of virological failure.

Adaptación cultural y validación del cuestionario Ocular Surface Disease Index en una población chilena / Validation of the Ocular Surface Disease Index Questionnaire for Chilean patients

Background: Ocular Surface Disease Index (OSDI) is the most commonly used questionnaire worldwide to detect dry eye disease. Although it is massively used in clinical practice in Chile, its use has not been validated yet in the country. Aim: To develop a cultural adaptation and to validate the OSDI questionnaire for the Chilean population. Material and Methods: For cultural adaptation, a translation, retro-translation and an expert panel review was carried out. The resulting questionnaire was applied to a pilot group of twelve participants and their comments were considered for the final questionnaire version. The final questionnaire was applied to a non-random sample of 200 patients aged 53 ± 17 years (75% women). Internal consistency and construct validity were evaluated by Cronbach's alpha and exploratory factor analysis respectively. Results: According to the OSDI score, 81% of respondents had dry eye (55% severe). Reliability was 0.91 and factor analysis resulted in three factors explaining 75.4% of the total variance. Conclusions: The OSDI questionnaire version obtained in this study demonstrated excellent internal consistency values and adequate construct validity making it applicable to clinical practice and dry eye research.