[A study of initial antiretroviral therapy effectiveness, survival and safety in HIV+ patients]. / Estudio de la efectividad, supervivencia y seguridad de las terapias antirretrovirales de inicio en pacientes VIH+.

OBJECTIVE: To study initial antiretroviral therapies indicated for HIV-infected patients during the 2001-2003 period regarding effectiveness, survival and safety. METHOD: A descriptive, retrospective study of clinical and drug-related variables of naïve HIV-infected patients through pharmacotherapeutic history. RESULTS: Mean CD4+ lymphocytes counts were 209.6 cells/mm3. Pneumonia by Pneumocystis carinii was the most commonly found condition at antiretroviral treatment onset. Most commonly used therapies included those based on a non-nucleoside reverse transcriptase inhibitor (NNRTI) combined with two nucleoside reverse transcriptase inhibitors (NRTIs). The longest mean survival was achieved by using combinations of three nucleoside reverse transcriptase inhibitors. The primary reason for initial antiretroviral therapy discontinuation were adverse effects, with stavudine exhibiting the poorest tolerability. CONCLUSIONS: Therapies based on non-nucleoside reverse transcriptase inhibitors and protease inhibitors (PIs) have shown similar effectiveness to increase CD4+ cell counts. Regarding viral load decreases, protease inhibitors were most effective. Therapies using three nucleoside reverse transcriptase inhibitors resulted in peak survival.

Estudio de la efectividad, supervivencia y seguridad de las terapias antirretrovirales de inicio en pacientes VIH+ / A study of initial antiretroviral therapy effectiveness, survival and safety in HIV+ patients

Objetivo: Estudiar los tratamientos antirretrovirales de inicioindicados en pacientes VIH durante el periodo 2001-2003, suefectividad, supervivencia y seguridad.Método: Estudio descriptivo retrospectivo de las variables clínicasy farmacológicas de los pacientes VIH naïve a través de lahistoria farmacoterapéutica.Resultados: La media de linfocitos CD4+ ha sido 209,6 células/mm3. La neumonía por Pneumocystis carinii ha sido la principalenfermedad presente al iniciar tratamiento antirretroviral.Las terapias más utilizadas han sido las basadas en la utilización deun inhibidor de la transcriptasa inversa no análogo de los nucleósidos(ITINN) combinado con dos inhibidores análogos (ITIAN). Lascombinaciones de tres inhibidores de la transcriptasa inversa análogosde los nucleósidos presentaron la mayor supervivenciamedia. El principal motivo de suspensión de terapia inicial hansido los efectos adversos, siendo la estavudina el peor tolerado.Conclusiones: Las terapias basadas en inhibidores de la transcriptasainversa no análogos de los nucleósidos e inhibidores de laproteasa (IPs) han demostrado una efectividad similar en el incrementode células CD4+. En la disminución de los niveles de cargaviral los inhibidores de la proteasa han resultado más efectivos. Lasterapias con tres inhibidores de la transcriptasa inversa análogos delos nucleósidos han presentado la mayor supervivencia

Objective: To study initial antiretroviral therapies indicatedfor HIV-infected patients during the 2001-2003 period regardingeffectiveness, survival and safety.Method: A descriptive, retrospective study of clinical anddrug-related variables of naïve HIV-infected patients throughpharmacotherapeutic history.Results: Mean CD4+ lymphocytes counts were 209.6cells/mm3. Pneumonia by Pneumocystis carinii was the mostcommonly found condition at antiretroviral treatment onset. Mostcommonly used therapies included those based on a non-nucleosidereverse transcriptase inhibitor (NNRTI) combined with twonucleoside reverse transcriptase inhibitors (NRTIs). The longestmean survival was achieved by using combinations of three nucleosidereverse transcriptase inhibitors. The primary reason for initialantiretroviral therapy discontinuation were adverse effects,with stavudine exhibiting the poorest tolerability.Conclusions: Therapies based on non-nucleoside reversetranscriptase inhibitors and protease inhibitors (PIs) have shownsimilar effectiveness to increase CD4+ cell counts. Regarding viralload decreases, protease inhibitors were most effective. Therapiesusing three nucleoside reverse transcriptase inhibitors resulted inpeak survival

[Cross-hypersensitivity syndrome between antiepileptic drugs: report of a case]. / Síndrome de hipersensibilidad cruzado entre antiepilépticos: a propósito de un caso.

Antiepileptic hypersensitivity syndrome (SHA) is a rare (1/1.000 to 1/10.000 in new exposures) but potentially life-threatening syndrome that occurs after exposure to an anticonvulsant, most commonly the aromatic ones such as phenytoin, carbamazepine or phenobarbital. Clinical features of this syndrome include cutaneous reactions, fever, lymphadenopaties, eosinophilia and internal organ involvement (mainly liver, but also kidney, CNS, heart or lung). We present a case report of a 61-year-old woman treated with phenobarbital who developed a cutaneous eruption attributed to this drug. Treatment was changed to phenytoin and after 17 days the patient developed cutaneous rash, eosinophilia and an increase in transaminase levels. The high rate of cross-sensitivity between aromatic anticonvulsants (40-80%) suggests a link between a hypersensitivity reaction to phenytoin and the previous reaction to phenobarbital.

Teratogénesis: clasificaciones / Teratogenesis: classifications

La prevalencia de malformaciones debidas a fármacos es baja pero también evitable. Esto hace necesario la información precisa y actualizada sobre el potencial teratogénico de los fármacos ya que la prescripción de fármacos durante el embarazo es elevada. Se han desarrollado múltiples clasificaciones de fármacos en función de su riesgo teratogénico entre las cuales la más usada es la de la Food and Drug Administration en la que los fármacos se dividen en cinco grupos (A, B, C, D, X). Existen clasificaciones similares desarrolladas en otros países (Australia, Suecia o Alemania). Otras clasificaciones de fármacos aluden a la probabilidad o frecuencia de teratogenia. La ausencia de una clasificación única, la inespecificidad de las definiciones y la falta de estudios, no nos permiten muchas veces poder valorar adecuadamente el posible riesgo para el feto. (AU)