ABSTRACT
El objetivo del presente trabajo es evaluar si existe relación entre los niveles plasmáticos de efavirenz y la aparición de dislipemia como hipercolesterolemia, hipretrigliceridemia o aumento de LDL-c.Se realizaron niveles plasmáticos de efavirenz a los pacientes en tratamiento con este fármaco desde septiembre de 2012 hasta junio de 2015. Se registraron los parámetros lipídicos correspondientes a cada analítica. Las determinaciones de efavirenz se realizaron mediante cromatografía líquida de alta eficacia. Los datos se manejaron mediante el programa Quick Statistics Calculator y Excel 2007.Los niveles plasmáticos de efavirenz superiores a 4.000 ng/ml se asocian en nuestro estudio con una mayor frecuencia de niveles de colesterol superiores a 200 mg/dl.Este estudio puede ser de utilidad para aquellas zonas en las que usen pautas de tratamiento con este fármaco de manera frecuente. (AU)
The aim of this study is to evaluate if there is a relationship between plasma levels of efavirenz and the occurrence of dyslipidemia such as hypercholesterolemia, hypretrigiceridemia or increased LDL-c.Plasma levels of efavirenz were performed to patients under treatment with this drug during the period from September 2012 to June 2015. Lipid parameters corresponding to each analytical were recorded. Determinations of efavirenz were analyzed by high performance liquid chromatography. Data were managed using the Quick Statistics Calculator and Excel 2007 program.Plasma levels of efavirenz higher than 4,000 ng/ml were associated, in our study, with a higher frequency of cholesterol levels higher than 200 mg/dl.This study may be useful to those areas where treatment guidelines with this drug are used on a frequent basis. (AU)
Subject(s)
Humans , Efavirenz, Emtricitabine, Tenofovir Disoproxil Fumarate Drug Combination , Hyperlipidemias , Chromatography , 34628 , Pharmaceutical PreparationsABSTRACT
PURPOSE: To describe a divergence insufficiency in a young woman. METHODS: Case report. RESULTS: A 38-year-old woman presented with a episode of homonymus horizontal diplopia at distance. She was orthophoric at near but had esotropia at distance. Neurological evaluation was normal but multiple demyelinating lesions were shown in the magnetic resonance scan, with increased intrathecal Ig G production. Double vision improved after corticosteroid mega-doses. CONCLUSIONS: An acute onset of diplopia due to divergence insufficiency in a young adult may be associated with a demyelinating disorder.
Subject(s)
Brain/pathology , Demyelinating Diseases/complications , Diplopia/etiology , Esotropia/etiology , Adult , Demyelinating Diseases/diagnosis , Demyelinating Diseases/drug therapy , Diplopia/diagnosis , Diplopia/drug therapy , Esotropia/diagnosis , Esotropia/drug therapy , Female , Glucocorticoids/therapeutic use , Humans , Magnetic Resonance Imaging , Methylprednisolone/therapeutic use , Multiple Sclerosis/complications , Multiple Sclerosis/diagnosis , Multiple Sclerosis/drug therapyABSTRACT
BACKGROUND: Prospective study of survival and AIDS or death progression in a cohort of 251 HIV infected patients whose seroconversion time is unknown, with 1 main objective: To analyse CD4+ lymphocytes count, p24 antigen plasmatic levels and viral load as surrogate markers. PATIENTS AND METHODS: 251 patients were included, most of them undergoing antiretroviral therapy, followed consecutively in the HIV/AIDS Unity of Internal Medicine Service of the Hospital Universitario Arnau de Vilanova in Lleida. We made clinical and analytical baseline studies and every 3 months thereafter. In relation to CD4+ lymphocytes, 3 groups were established: group I, 500 or more cells/mL; group II, 200-499 cells/mL and group III, < 200 cells/mL. In the same way, with p24 antigen we established 3 group: group I, < 20 pg/mL, group II, 20-39 pg/mL, group III 40 or more pg/mL. We studied survival in relation to baseline levels and stability, the latter being understood as persistent levels in the initial group, or better, over 3 year period. Survival analysis was made by Kaplan-Meier estimation. Relative risk was calculated by Cox's proportional hazards model. RESULTS: During the 36 months of follow-up 53 patients died. AIDS progression risk or death was 4.8 times higher for the p24 antigen > = 40 pg/mL group than for the p24 antigen < 20 pg/mL one; patients with p24 antigen between 20-39 pg/mL relative risk was 2.5 times higher than those included in p24 antigen < 20 pg/mL group. These results emphasize that if we take into account the p24 antigen stability during these 36 months. In relation to progression study, 36 patients progressed. AIDS progression risk or death for p24 antigen > = 40 pg/mL group was 7.69 times higher in relation to that with p24 antigen levels between 20-39 pg/mL. The bivariable study shows that CD4 lymphocytes counts and p24 antigen level have quite an independent value. The comparison with viral load by PCR determination makes manifest discrepancy, difficult to explain. CONCLUSIONS: p24 antigen plasma level is a good survival and AIDS progress or death surrogate markers in HIV infected patients, and it is useful for 3 years or more. An isolated value < 20 pg/mL and, furthermore, the stability in successive controls under this concentration is a sign of good prognosis. Its value is emphasized with CD4+ lymphocytes count. It seem necessary that more comparative studies with viral load are required.
Subject(s)
CD4-Positive T-Lymphocytes/immunology , HIV Core Protein p24/blood , HIV Infections/mortality , HIV-1 , Viral Load/statistics & numerical data , Adult , Anti-HIV Agents/therapeutic use , Biomarkers/blood , Cohort Studies , Disease Progression , Drug Therapy, Combination , HIV Infections/blood , HIV Infections/drug therapy , Humans , Prognosis , Risk , Survival Analysis , Time FactorsABSTRACT
Fundamento: Analizar el valor del recuento de linfocitos CD4+, los niveles plasmáticos de antígeno p24 y la carga viral (RNA, PCR), como marcadores pronóstico en una cohorte de pacientes infectados por el VIH-1, cuyo tiempo de seroconversión es desconocido. Pacientes y métodos: Se incluyeron 251 pacientes, la mayoría con terapia antirretroviral, que fueron asistidos de forma consecutiva en la Unidad VIH/SIDA del Servicio de Medicina Interna del Hospital Universitario Arnau de Vilanova de Lleida. Se hicieron estudios clínico-analíticos en el momento de inclusión (basal) y luego, cada 3 meses. En relación con los linfocitos CD4+, se establecieron 3 grupos: Grupo I, 500 ó más células/ml; grupo II, 200-499 células/ml; grupo III, 40 pg/ml fue 4,8 veces mayor que para el grupo con antígeno 40 pg/ml fue 7,69 veces superior en relación al grupo con antígeno p24 < 20 pg/ml y 6 veces superior que el grupo con antígeno p24 entre 20 y 39 pg/ml. El estudio bivariable muestra cierta independencia entre la cifra de linfocitos CD4+ y el valor del antígeno p24. La comparación con la determinación de carga viral por PCR pone de manifiesto una discrepancia de difícil explicación. Conclusiones: El nivel plasmático del antígeno p24 es un buen marcador pronóstico de supervivencia y de progresión a SIDA o muerte en enfermos infectados por el VIH-1 y su validez se prolonga por lo menos 3 años (AU)
Subject(s)
Adult , Humans , Anti-HIV Agents/therapeutic use , Biomarkers/blood , CD4-Positive T-Lymphocytes , Cohort Studies , Disease Progression , Drug Therapy, Combination , HIV Core Protein p24 , HIV Infections/blood , HIV Infections/drug therapy , Prognosis , Risk , Survival Analysis , Time Factors , Viral Load , CD4-Positive T-Lymphocytes/immunology , HIV Core Protein p24/blood , HIV Infections/mortality , HIV-1 , Viral Load/statistics & numerical dataABSTRACT
BACKGROUND: Prospective study of AIDS or death progression in a cohort of 251 HIV infected patients whose time of seroconversion is unknown, with 2 main objectives: 1. To analyse plasma level p24 antigen as a marker of progression. 2. To evaluate stability of plasma levels of p24 antigen as a marker of progression. PATIENTS AND METHODS: 251 patients were studied, most on antiretroviral therapy, who were attended at HIV/AIDS Unit of Internal Medicine Service of the Hospital Universitario Arnau de Vilanova de Lleida. Mean initial CD4 cell count were 376 x 10(6)/L (range: 0.8-1350) 51 cases had been diagnosed previously with AIDS, their were therefore excluded. Analysis of survival, according to initial plasma p24 antigen and Cd4 cell count as well as the stability of plasma level p24 antigen was performed by Kaplan-Meier test. Relative risk were calculate by Cox's proportional hazard model. RESULTS: During a follow-up period of 24 months, 38 patients progressed to AIDS or died. Relative risk (RR) of progression to AIDS or death related to the group with p24 antigen < 40 pg/ml was 5.48 when p24 antigen => 40 pg/ml (p < 0.0005). Relative risk of progression to AIDS or death for the patients with unstable plasmatic level of p24 antigen related to the group with stable plasmatic level was 4.25 (p < 0.0005). CONCLUSIONS: Plasma level and stability of p24 antigen are useful as a markers of risk of AIDS progression or death and they behaves as an independent prognostic markers in our patients. p24 antigen < 40 pg/ml is associated with a better prognosis.
Subject(s)
HIV Core Protein p24/blood , HIV Infections/immunology , HIV-1 , Acquired Immunodeficiency Syndrome/immunology , Acquired Immunodeficiency Syndrome/mortality , Biomarkers/blood , CD4-Positive T-Lymphocytes/immunology , Cohort Studies , Disease Progression , HIV Infections/mortality , Humans , Multivariate Analysis , Prognosis , Prospective Studies , Time Factors , Viral LoadABSTRACT
Fundamento: Estudio prospectivo de la progresión a SIDA o muerte en una cohorte de 251 pacientes infectados por el VIH, cuyo tiempo de seroconversión es desconocido, con dos objetivos primordiales: 1º. Analizar los niveles plasmáticos del antígeno p24 como marcador de progresión 2º. Valorar la estabilidad de los niveles plasmáticos del antígeno p24 como marcador de progresión. Pacientes y métodos: Se incluyeron inicialmente 251 pacientes, la mayoría con terapia antirretroviral, que fueron asistidos de forma consecutiva en la Unidad VIH/SIDA del Servicio de Medicina Interna del Hospital Universitario Arnau de Vilanova de Lleida. La media del recuento inicial de linfocitos CD4 fue de 376,283 x 106/L (rango 1,5 - 1350). 51 casos habían sido diagnosticados previamente de SIDA, por lo que fueron excluidos del estudio de progresión. Las comparaciones de las curvas de supervivencia, de acuerdo con las cifras iniciales de antígeno p24 y de linfocitos CD4, así como con la estabilidad o no de la antigenemia, se realizaron con la prueba de Kaplan-Meier. El cálculo del riesgo relativo se realizó mediante el modelo de riesgo proporcional de Cox. Resultados: Durante los 24 meses de seguimiento progresaron a SIDA o fallecieron 38 pacientes. El riesgo de progresión a SIDA o muerte para el grupo con antígeno p24 = ó > 40 pg / ml fue 5,48 veces superior al grupo con antígeno p24 < 40 pg/ml (p<0,0005). El riesgo de progresión a SIDA o muerte para el grupo con antígeno p24 inestable fue 4,25 veces superior al grupo con antígeno p24 estable (p<0,0005). Conclusiones: El nivel de antigenemia p24 y su estabilidad son unos buenos marcadores del riesgo de progresión a SIDA o muerte y se comporta como un factor pronóstico independiente en nuestro grupo de pacientes. Una cifra < 40 pg/ml aislada o mantenida se asocia con un mejor pronóstico (AU)
