RESUMO
OBJECTIVES: HIV infection has been associated with lower rates of sustained viral response (SVR) with direct-acting antivirals (DAAs). There are few data on glecaprevir/pibrentasvir (G/P) in HIV/HCV coinfection outside clinical trials. METHODS: The HEPAVIR-DAA cohort, which recruits HIV/HCV-coinfected patients (NCT02057003) and the GEHEP-MONO cohort (NCT02333292), including HCV-monoinfected individuals, are two concurrent ongoing multicentre cohorts of patients receiving anti-HCV treatment. Patients starting G/P included in those cohorts were analysed. Overall SVR (ITT), discontinuations due to adverse effects, and dropouts were evaluated and compared between both cohorts. RESULTS: Of the 644 patients who started G/P with evaluable SVR, 132 were HIV/HCV coinfected. Overall SVR rates were 487/512 (95.1%) in HCV-monoinfected patients versus 126/132 (95.5%) in HIV/HCV-coinfected patients (Pâ=â1.000). One patient (0.8%) relapsed, and another (0.8%) discontinued treatment due to side effects. SVR to 8 or 12 weeks of treatment with G/P was similar in HIV/HCV-coinfected versus HCV-monoinfected patients. The main reason for not reaching SVR among HIV/HCV-coinfected patients was premature dropout linked to active drug use. CONCLUSIONS: G/P in HIV/HCV coinfection was highly effective and tolerable in clinical practice. SVR to 8 or 12 weeks of treatment with G/P was similar in HIV/HCV-coinfected compared with HCV-monoinfected patients but active drug use is still a barrier to reach HCV microelimination.
Assuntos
Coinfecção , Infecções por HIV , Hepatite C Crônica , Humanos , Antivirais/farmacologia , Coinfecção/tratamento farmacológico , Coinfecção/complicações , Hepatite C Crônica/complicações , Hepatite C Crônica/tratamento farmacológico , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Ensaios Clínicos como Assunto , Estudos Multicêntricos como AssuntoAssuntos
Humanos , Masculino , Adulto , Dor nas Costas/diagnóstico , Dor nas Costas/tratamento farmacológico , Dor nas Costas/terapia , Infecções por HIV , Cooperação e Adesão ao Tratamento , Hepatite A , Hepatite B , Equinococose , Antiparasitários , Echinococcus granulosus/microbiologia , Microbiologia , Doenças Transmissíveis , Albendazol , PraziquantelRESUMO
Treatment with interferon-free direct-acting antivirals (DAA) has become the gold standard in chronic hepatitis C virus (HCV) infection. Nevertheless, little research about the metabolic impact of achieving sustained virological response (SVR) is available in HCV/HIV co-infected patients. This research aimed to evaluate early anthropometric, lipid and liver parameters changes after achieving SVR 12 weeks after treatment (SVR12). A real-life retrospective descriptive before-after study assessed 128 DAA treatment episodes from 2015 to 2019 in HCV/HIV co-infected patients. Anthropometric parameters (weight, body mass index), lipid profile, genotype (GT) and viral load, liver data (basics laboratory necroinflammatory parameters and transient elastography (TE)) were collected before treatment with DAA (baseline), and when SVR12 was achieved. Significant increases (p < 0.01) were found in the early lipid profile, measured by LDLc (84.6 ± 35.0 vs. 108.6 ± 35.1 mg/dL) and total cholesterol (161.3 ± 41.0 vs. 183.3 ± 41.6 mg/dL). Significant changes (p < 0.05) were found in liver parameters, measured by ALT (58.2 ± 34.0 vs. 22.0 ± 16.0 U/L), bilirubin (0.8 ± 0.6 vs. 0.6 ± 0.5 mg/dL), albumin (4.2 ± 0.4 vs. 4.3 ± 0.3 g/dL) and liver stiffness (LS) (13.7 ± 13.3 vs. 11.8 ± 12.1 kPa). The main conclusions were that the use of DAA has an early negative impact on lipid metabolism. Achieving SVR12 against HCV leads to an early improvement in liver function and LS in HCV/HIV co-infected patients without interference with antiretroviral treatment (ART) and DAA. Short-term close lipid monitoring may be necessary when combining protease inhibitors. HCV-GT-3/HIV co-infected patients might require further close monitoring for residual fibrosis. These findings can be relevant for actual clinical practice.
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Infecções por Coronavirus , Febre , Zona Tropical , Diagnóstico Diferencial , Mali , Espanha , Doenças TransmissíveisAssuntos
Humanos , Masculino , Adolescente , Coronavírus Relacionado à Síndrome Respiratória Aguda Grave , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Pandemias , Exame Físico , Síndrome de Resposta Inflamatória Sistêmica/diagnóstico , Infecções por Coronavirus/prevenção & controle , Atenção Primária à Saúde , Espanha , Sintomas GeraisAssuntos
Fármacos Anti-HIV , Infecções por HIV , Fármacos Anti-HIV/efeitos adversos , Feminino , Infecções por HIV/tratamento farmacológico , Compostos Heterocíclicos com 3 Anéis/efeitos adversos , Humanos , Lamivudina/efeitos adversos , Oxazinas/uso terapêutico , Piperazinas , Gravidez , Piridonas/uso terapêuticoAssuntos
Humanos , Feminino , Gravidez , Adulto , Lamivudina/efeitos adversos , Lamivudina/toxicidade , Lamivudina/uso terapêutico , Antirretrovirais/efeitos adversos , Antirretrovirais/farmacologia , Transmissão Vertical de Doenças Infecciosas , Transmissão de Doença Infecciosa , Infecções por HIV/tratamento farmacológico , Infecções por HIV/transmissão , Terapia Combinada , HIV , Doenças Transmissíveis , Microbiologia , Cooperação e Adesão ao TratamentoRESUMO
No disponible
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Malária Falciparum/diagnóstico , Febre/etiologia , Infecções por Coronavirus/diagnóstico , Diagnóstico Diferencial , Pandemias , Plasmodium falciparum/isolamento & purificação , CoinfecçãoRESUMO
Invasive fungal infections have increased progressively in the last decades, producing elevated morbidity and mortality. In recent years, there have been numerous advances in the treatment of these diseases, with the introduction of new drugs in clinical practice and the information derived from several types of studies. This has improved the prognosis of some invasive fungal infections and increased the therapeutic options in various clinical situations. This new knowledge must be assessed to determine its application in clinical practice, taking into account available scientific evidence and clinical experience. With this aim, the Andalusian Society of Infectious Diseases has developed this consensus document containing recommendations for the treatment of the invasive fungal infections.
Assuntos
Micoses/terapia , Antifúngicos/administração & dosagem , Antifúngicos/uso terapêutico , Aspergilose/tratamento farmacológico , Aspergilose/epidemiologia , Aspergilose/cirurgia , Candidíase/tratamento farmacológico , Candidíase/epidemiologia , Criptococose/tratamento farmacológico , Criptococose/epidemiologia , Humanos , Estudos Multicêntricos como Assunto , Micoses/tratamento farmacológico , Micoses/epidemiologia , Micoses/microbiologia , Micoses/cirurgia , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
Las infecciones fúngicas invasoras (IFI) son un grupo de enfermedades en aumento progresivo en las dos últimas décadas, con morbilidad y mortalidad elevadas. En los últimos años han aparecido avances en el tratamiento de estas enfermedades, como consecuencia de la aparición de nuevos medicamentos y de nuevos conocimientos derivados de diferentes tipos de estudios, los cuales mejoran el pronóstico de algunas de las IFI y aumentan las opciones terapéuticas en diversos tipos de situaciones clínicas. Estos conocimientos necesitan valorarse para su aplicación a la práctica clínica, en base a la evidencia científica disponible y a la experiencia clínica. Por ello, la Sociedad Andaluza de Enfermedades Infecciosas ha desarrollado este documento de consenso sobre las recomendaciones para el tratamiento de las IFI (AU)
Invasive fungal infections have increased progressively in the last decades, producing elevated morbidity and mortality. In recent years, there have been numerous advances in the treatment of these diseases, with the introduction of new drugs in clinical practice and the information derived from several types of studies. This has improved the prognosis of some invasive fungal infections and increased the therapeutic options in various clinical situations. This new knowledge must be assessed to determine its application in clinical practice, taking into account available scientific evidence and clinical experience. With this aim, the Andalusian Society of Infectious Diseases has developed this consensus document containing recommendations for the treatment of the invasive fungal infections (AU)