ABSTRACT
BACKGROUND: The prolonged current survival of human immunodeficiency virus (HIV) patients exposes them to new problems arising from the comorbidities they face. OBJECTIVES: To describe the situation of comorbidities, polypharmacy, therapeutic complexity and adherence in people living with HIV over 65 years of age and to assess the presence of potentially inappropriate prescriptions (PIP) by applying deprescription criteria. METHODS: Observational study including HIV people (> 65 years) from a university tertiary level hospital. Demographic, clinical and pharmacotherapeutic characteristics of the patients and their treatments were studied. The prevalence of polypharmacy (> 5 medications) and the pharmacotherapy complexity, quantified by the Medication Regimen Complexity Index (MRCI), were calculated. Therapeutic adherence was assessed by the Simplified Medication Adherence Questionnaire (SMAQ) and the medication possession ratio, according to prescription dispensing records. The Screening Tool of Older People's Prescriptions (STOPP) and List of Evidence-baSed depreScribing for CHRONic patients (LESS-CHRON) criteria were applied to identify PIP. MAIN OUTCOME MEASURE: PIP in elderly people living with HIV. RESULTS: Thirty patients were included, 73% of whom were men, with a median age of 71 years (IQR 67 - 76) and a median duration of infection of 17 years (IQR, 9 - 21). Seventy percent of the patients suffered from dyslipemia, 66.7% from hypertension, 43.3% from diabetes and 26.7% from mental health disorders. Seventy percent of the patients took more than 5 medications and 30% more than 10. The MRCI of concomitant medications was higher (18.3 points) than the MRCI of antiretroviral therapy (5.1 points), 66.7% of the studied population was classified as adherent. Finally, 70% of the patients present some PIP according to the STOPP or LESS-CHRON criteria. The polypharmacy was significantly associated (p = 0.008) with meeting deprescription criteria. CONCLUSION: The elderly people living with HIV present numerous comorbidities and met the criteria for polypharmacy. Their pharmacotherapy complexity is mainly determined by the concomitant treatments. There is a high prevalence of meeting deprescription criteria in people living with HIV over the age of 65 and a clear relationship between polypharmacy and deprescription. The optimization of pharmacotherapy is necessary in this population.
Subject(s)
HIV Infections , Inappropriate Prescribing , Aged , Comorbidity , Cross-Sectional Studies , Female , HIV Infections/drug therapy , HIV Infections/epidemiology , Humans , Male , Polypharmacy , Potentially Inappropriate Medication ListABSTRACT
ANTECEDENTES Y OBJETIVO: Tras la introducción del tratamiento antirretroviral se objetiva una disminución de los tumores definitorios de sida (TDS), mientras que los tumores no definitorios de sida (TNDS) han aumentado en pacientes infectados por VIH (PIV). Disponemos de poca información sobre el pronóstico y factores de riesgo asociados. Hemos estudiado la supervivencia y su relación con la inmunodeficiencia tras el diagnóstico de TDS o TNDS. MATERIALES Y MÉTODOS: Estudio observacional, retrospectivo, sobre 788 PIV de los que 133 desarrollaron una neoplasia maligna entre 2000-2016. Las neoplasias se dividieron en TDS o TNDS y el grado de inmunodeficiencia según el recuento de linfocitos T CD4 >o
BACKGROUND AND OBJECTIVE: After the introduction of antiretroviral therapy, a decrease in AIDS defining cancers (ADCs) is observed, while non-AIDS-defining cancers (NADCs) have increased in HIV-infected patients (HIP). We have little information about the prognosis and associated risk factors. We studied survival and its relationship with immunodeficiency after the diagnosis of ADC or NADC. MATERIAL AND METHODS: Observational, retrospective study of 788 HIP of whom 133 developed a malignancy between 2000-2016. Malignancies were divided into ADCs or NADCs and degree of immunodeficiency according to the CD4 T lymphocyte count> or
Subject(s)
Humans , Male , Female , Adult , Middle Aged , HIV Infections/drug therapy , HIV Infections/mortality , Neoplasms/drug therapy , Neoplasms/mortality , Survival Analysis , HIV Infections/pathology , Neoplasms/pathology , Prognosis , Risk Factors , Retrospective Studies , Kaplan-Meier Estimate , Regression AnalysisABSTRACT
BACKGROUND AND OBJECTIVE: After the introduction of antiretroviral therapy, a decrease in AIDS defining cancers (ADCs) is observed, while non-AIDS-defining cancers (NADCs) have increased in HIV-infected patients (HIP). We have little information about the prognosis and associated risk factors. We studied survival and its relationship with immunodeficiency after the diagnosis of ADC or NADC. MATERIAL AND METHODS: Observational, retrospective study of 788 HIP of whom 133 developed a malignancy between 2000-2016. Malignancies were divided into ADCs or NADCs and degree of immunodeficiency according to the CD4 T lymphocyte count> or
Subject(s)
Acquired Immunodeficiency Syndrome , HIV Infections , Neoplasms , CD4 Lymphocyte Count , HIV Infections/complications , HIV Infections/drug therapy , HIV Infections/epidemiology , Humans , Neoplasms/epidemiology , Retrospective Studies , Risk FactorsABSTRACT
No disponible
Subject(s)
Humans , Female , Middle Aged , Dengue/epidemiology , Chromatography, Affinity , Flaviviridae Infections/epidemiology , Flaviviridae/pathogenicityABSTRACT
CONTEXT: Tuberculosis of the prostate has mainly been described in immunocompromised patients. However, it can exceptionally be found as an isolated lesion in immunocompetent patients. CASE REPORT: We report a case of prostatic tuberculosis in a young, healthy and immunocompetent patient with unremarkable findings from intravenous urographic examination. Computed tomography showed an abscess in the prostate and Mycobacterium tuberculosis was isolated in a urine culture. Treatment with isoniazid, rifampin and pyrazinamide was successful.
Subject(s)
Prostatic Diseases/diagnosis , Tuberculosis, Male Genital/diagnosis , Adult , Antitubercular Agents/therapeutic use , Humans , Immunocompetence , Isoniazid/therapeutic use , Male , Mycobacterium tuberculosis/isolation & purification , Prostatic Diseases/drug therapy , Prostatic Diseases/microbiology , Pyrazinamide/therapeutic use , Rifampin/therapeutic use , Tomography, X-Ray Computed , Tuberculosis, Male Genital/drug therapyABSTRACT
CONTEXT: Tuberculosis of the prostate has mainly been described in immunocompromised patients. However, it can exceptionally be found as an isolated lesion in immunocompetent patients. CASE REPORT: We report a case of prostatic tuberculosis in a young, healthy and immunocompetent patient with unremarkable findings from intravenous urographic examination. Computed tomography showed an abscess in the prostate and Mycobacterium tuberculosis was isolated in a urine culture. Treatment with isoniazid, rifampin and pyrazinamide was successful.
CONTEXTO: La tuberculosis prostática ha sido principalmente descrita en pacientes inmunodeprimidos. Sin embargo, es excepcional como lesión aislada en pacientes inmunocompetentes. CASO CLINICO: Describimos el caso de un varón sano e inmunocompetente con tuberculosis prostática y hallazgos irrelevantes en la urografía de eliminación realizada. La tomografía computerizada (TC) mostró un absceso en próstata, aislándose en el urocultivo Mycobacterium tuberculosis. El tratamiento con isoniazida, rifampicina y pirazinamida fue exitoso.
Subject(s)
Adult , Humans , Male , Prostatic Diseases/diagnosis , Tuberculosis, Male Genital/diagnosis , Antitubercular Agents/therapeutic use , Immunocompetence , Isoniazid/therapeutic use , Mycobacterium tuberculosis/isolation & purification , Prostatic Diseases/drug therapy , Prostatic Diseases/microbiology , Pyrazinamide/therapeutic use , Rifampin/therapeutic use , Tomography, X-Ray Computed , Tuberculosis, Male Genital/drug therapySubject(s)
HIV Infections/complications , HIV-1 , Meningoencephalitis/virology , Myocarditis/virology , Adult , HIV Infections/diagnosis , Humans , MaleSubject(s)
Anti-Retroviral Agents/adverse effects , Anticonvulsants/adverse effects , Carbamazepine/adverse effects , Drug Interactions , Vertigo/chemically induced , Acquired Immunodeficiency Syndrome/complications , Acquired Immunodeficiency Syndrome/drug therapy , Adult , Anticonvulsants/blood , Antiretroviral Therapy, Highly Active/adverse effects , Carbamazepine/blood , Epilepsy/complications , Epilepsy/drug therapy , Female , Humans , Treatment Outcome , Vertigo/diagnosis , Vertigo/therapyABSTRACT
No disponible
Subject(s)
Female , Adult , Humans , Carbamazepine/poisoning , Drug Interactions , HIV Infections/drug therapy , Epilepsy/drug therapy , Protease Inhibitors/pharmacokineticsABSTRACT
Deflazacort is a relatively new glucocorticoid with significant immunosuppressant activity and presumably fewer side effects. The present study was designed to compare the effects of deflazacort on the proliferative activity of thymus cells and thymolysis with the growth inhibition. We treated Long-Evans rats for nine days with cortisone (CORT, 5.0 mg/day), deflazacort (DFZ, 0.15 mg/day), and control vehicle (CTRL). Animals were sacrificed 1 hour after injection of bromodeoxyuridine (BrdUrd) on day 10. BrdUrd-labeled thymic cells were quantified without knowledge of treatment. A Labeling Index (LI), expressed as the number of BrdUrd BrdUrd-labeled cells per 100 total cells and the Numerical Density (ND), expressed as the total number of cells per 100 microm(2) were calculated. Treatment with either glucocorticoid resulted in a significant and equal decrease of thymus weight, indicating a marked reduction in total immunogenic tissue. A general alteration of thymic histological structure occurred in the CORT group. The LI was not different between CTRL and DFZ groups, 6.9 and 7.9% of cells were labeled respectively. In the CORT group, the LI was 2.5%. With respect to Numerical Density, the CTRL group had the greatest value (14.6 +/- 0.4 cells/100 microm(2)), with the DFZ (12.3 +/- 0.06 cells/100 microm(2)) and CORT groups being significantly lower (10.4 +/- 0.5 cells/100 microm(2)). Although regression analysis of thymus weight pointed to bioequivalence of the glucocorticoid dosages used, BrdUrd-labeling raised the possibility that the cells still present in the thymus of DFZ-treated animals retained, at least partially, their normal capacities for proliferation.
