RESUMO
The continuous pharmacological advances in antiretroviral treatment (ART) and the increasing understanding of HIV drug resistance has led to a change in the paradigm of ART optimization in the setting of the viral suppression of treatment-experienced patients with the emerging evidence of the effectiveness and safety of dual therapies. The aim of this study is to determine the antiviral efficacy and safety of switching to Dolutegravir + Lamivudine in people living with HIV, and to analyze the rate of patients with virologic failure (VF). A total of 200 patients were included with a median age of 51 years, 189 cells/µL of nadir CD4+, 13 years on ART and four previous ART regimens. Among the 168 patients who completed a follow-up at 48 weeks, a total of five VFs occurred, resulting in a 2.98% (5/168) VF rate. The results of the intention-to-treat analysis were a VF rate of 2.54% (5/197), and the rate of patients/year with viral suppression was 98.3% (298/303) in the observed data analysis. We observed a significant improvement in mean CD4 lymphocytes, the CD4/CD8 ratio and lipid profiles. The optimization of ART to DTG plus 3TC is a cost-effective switch option for treatment-experienced HIV patients, and also improves their lipid profiles.
Assuntos
Fármacos Anti-HIV , Infecções por HIV , Soropositividade para HIV , HIV-1 , Oxazinas , Piperazinas , Piridonas , Humanos , Pessoa de Meia-Idade , Lamivudina/efeitos adversos , Infecções por HIV/tratamento farmacológico , Fármacos Anti-HIV/efeitos adversos , Espanha , Compostos Heterocíclicos com 3 Anéis/efeitos adversos , Antirretrovirais/uso terapêutico , LipídeosRESUMO
Sarcoidosis is included within the multisystemic granulomatous diseases with autoimmune character. The case of a 51-year-old man with hemoptysis, cholestasis and bone lesions is presented. After ruling out infectious, inflammatory and neoplastic entities, a diagnosis of sarcoidosis and autoimmune hepatitis with primary biliary cholangitis was established.
Assuntos
Colangite , Colestase , Hepatite Autoimune , Cirrose Hepática Biliar , Sarcoidose , Masculino , Humanos , Pessoa de Meia-Idade , Cirrose Hepática Biliar/complicações , Cirrose Hepática Biliar/diagnóstico , Sarcoidose/complicações , Sarcoidose/diagnóstico por imagem , Colestase/complicações , Hepatite Autoimune/complicações , Granuloma , Colangite/complicaçõesAssuntos
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
Kidney development is a complex process that begins during the fifth to ninth weeks of life. Different types of renal congenital anomalies exist; however, they are rare and usually asymptomatic. Renal ectopia is a rare malformation that affects 0.01-0.05% of patients. Of all the locations, the most frequent is the pelvic (55%). We present a case of a 21-year-old man with bilateral renal ectopia.
Assuntos
Nefropatias , Sistema Urinário , Anormalidades Urogenitais , Adulto , Humanos , Rim/anormalidades , Masculino , Pelve , Adulto JovemRESUMO
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.
RESUMO
Kidney development is a complex process that begins during the fifth to ninth weeks of life. Different types of renal congenitalanomalies exist; however, they are rare and usually asymptomatic. Renal ectopia is a rare malformation that affects 0.01-0.05%of patients. Of all the locations, the most frequent is the pelvic (55%). We present a case of a 21-year-old man with bilateral renalectopia. (AU)
Assuntos
Humanos , Masculino , Adulto Jovem , Coristoma/diagnóstico por imagem , Rim/diagnóstico por imagem , Rim/anormalidades , Tomografia Computadorizada por Raios XAssuntos
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 TratamentoAssuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Instituições Residenciais , Instituição de Longa Permanência para Idosos , Infecções por Coronavirus , Coronavírus Relacionado à Síndrome Respiratória Aguda Grave , Perfil de Saúde , Grupos de Risco , Evolução Clínica , Pandemias , Atenção Primária à Saúde , Espanha/epidemiologia , Epidemiologia DescritivaRESUMO
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