RESUMO
OBJECTIVES: The aim of the study was to compare the effects on lipids, body composition and renal function of once-daily ritonavir-boosted saquinavir (SQV/r) or atazanavir (ATV/r) in combination with tenofovir/emtricitabine (TDF/FTC) over 48 weeks. METHODS: An investigator-initiated, randomized, open-label, multinational trial comparing SQV/r 2000/100 mg and ATV/r 300/100 mg once daily, both in combination with TDF/FTC, in 123 treatment-naïve HIV-1-infected adults was carried out. The primary endpoint was to demonstrate noninferiority of SQV/r compared with ATV/r with respect to the change in fasting cholesterol after 24 weeks. Secondary outcome measures were changes in metabolic abnormalities, body composition, renal function, and virological and immunological efficacy over 48 weeks. Patients who had used at least one dose of trial drug were included in the analysis. RESULTS: Data for 118 patients were analysed (57 patients on SQV/r and 61 on ATV/r). At week 24, changes in lipids were modest, without increases in triglycerides, including a significant rise in high-density lipoprotein (HDL) cholesterol and a nonsignificant decrease in the total:HDL cholesterol ratio in both arms with no significant difference between arms. Lipid changes at week 48 were similar to the changes observed up to week 24, with no significant change in the homeostasis model assessment (HOMA) index. Adipose tissue increased regardless of the regimen, particularly in the peripheral compartment and to a lesser extent in the central abdominal compartment, with an increase in adipose tissue reaching statistical significance in the ATV/r arm. A slight decline in the estimated glomerular filtration rate (eGFR) was observed in both arms during the first 24 weeks, with no progression thereafter. The immunological and virological responses were similar over the 48 weeks. CONCLUSIONS: Combined with TDF/FTC, both SQV/r 2000/100 mg and ATV/r 300/100 mg had comparable modest effects on lipids, had little effect on glucose metabolism, conserved adipose tissue, and similarly reduced eGFR. The virological efficacy was similar.
Assuntos
Adenina/análogos & derivados , Desoxicitidina/análogos & derivados , Dislipidemias/etiologia , Infecções por HIV/complicações , Infecções por HIV/metabolismo , Oligopeptídeos/farmacocinética , Organofosfonatos/farmacocinética , Piridinas/farmacocinética , Saquinavir/farmacocinética , Adenina/administração & dosagem , Adenina/farmacocinética , Adulto , Sulfato de Atazanavir , Desoxicitidina/administração & dosagem , Desoxicitidina/farmacocinética , Esquema de Medicação , Dislipidemias/induzido quimicamente , Dislipidemias/metabolismo , Emtricitabina , Feminino , Taxa de Filtração Glomerular , Infecções por HIV/tratamento farmacológico , Humanos , Nefropatias , Masculino , Oligopeptídeos/administração & dosagem , Organofosfonatos/administração & dosagem , Piridinas/administração & dosagem , Saquinavir/administração & dosagem , Tenofovir , Resultado do TratamentoRESUMO
BACKGROUND: The pathogenesis of HIV/hepatitis C virus (HCV) coinfection is poorly understood. We examined markers of oxidative stress, plasma antioxidants and liver disease in HIV/HCV-coinfected and HIV-monoinfected adults. METHODS: Demographics, medical history, and proof of infection with HIV, hepatitis A virus (HAV), hepatitis B virus (HBV) and HCV were obtained. HIV viral load, CD4 cell count, complete blood count (CBC), complete metabolic panel, lipid profile, and plasma concentrations of zinc, selenium, and vitamins A and E were determined. Malondialdehyde (MDA) and glutathione peroxidase concentrations were obtained as measures of oxidative stress. Aminotransferase to platelet ratio index (APRI) and fibrosis index (FIB-4) markers were calculated. RESULTS: Significant differences were found between HIV/HCV-coinfected and HIV-monoinfected participants in levels of alanine aminotransferase (ALT) (mean±standard deviation: 51.4±50.6 vs. 31.9±43.1 U/L, respectively; P=0.014), aspartate aminotransferase (AST) (56.2±40.9 vs. 34.4±30.2 U/L; P<0.001), APRI (0.52±0.37 vs. 0.255±0.145; P=0.0001), FIB-4 (1.64±.0.91 vs. 1.03±0.11; P=0.0015) and plasma albumin (3.74±0.65 vs. 3.94±0.52 g/dL; P=0.038). There were no significant differences in CD4 cell count, HIV viral load or antiretroviral therapy (ART) between groups. Mean MDA was significantly higher (1.897±0.835 vs. 1.344± 0.223 nmol/mL, respectively; P=0.006) and plasma antioxidant concentrations were significantly lower [vitamin A, 39.5 ± 14.1 vs. 52.4±16.2 µg/dL, respectively (P=0.0004); vitamin E, 8.29±2.1 vs. 9.89±4.5 µg/mL (P=0.043); zinc, 0.61±0.14 vs. 0.67±0.15 mg/L (P=0.016)] in the HIV/HCV-coinfected participants than in the HIV-monoinfected participants, and these differences remained significant after adjusting for age, gender, CD4 cell count, HIV viral load, injecting drug use and race. There were no significant differences in glutathione peroxidase concentration, selenium concentration, body mass index (BMI), alcohol use or tobacco use between groups. Glutathione peroxidase concentration significantly increased as liver disease advanced, as measured by APRI (ß=0.00118; P=0.0082) and FIB-4 (ß=0.0029; P=0.0177). Vitamin A concentration significantly decreased (ß=-0.00581; P=0.0417) as APRI increased. CONCLUSION: HIV/HCV coinfection is associated with increased oxidative stress and decreased plasma antioxidant concentrations compared with HIV monoinfection. Research is needed to determine whether antioxidant supplementation delays liver disease in HIV/HCV coinfection.
Assuntos
Hepatite C/sangue , Hepatite C/complicações , Estresse Oxidativo/fisiologia , Abuso de Substâncias por Via Intravenosa/sangue , Abuso de Substâncias por Via Intravenosa/complicações , Adulto , Antioxidantes/metabolismo , Contagem de Linfócito CD4 , Feminino , Florida , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Hepatite C/tratamento farmacológico , Humanos , MasculinoRESUMO
BACKGROUND & AIMS: Human immunodeficiency virus (HIV) infection accelerates liver disease progression in patients with hepatitis C virus (HCV) and could shorten survival of those awaiting liver transplants. The Model for End-Stage Liver Disease (MELD) score predicts mortality in HIV-negative transplant candidates, but its reliability has not been established in HIV-positive candidates. METHODS: We evaluated predictors of pretransplantation mortality in HIV-positive liver transplant candidates enrolled in the Solid Organ Transplantation in HIV: Multi-Site Study (HIVTR) matched 1:5 by age, sex, race, and HCV infection with HIV-negative controls from the United Network for Organ Sharing. RESULTS: Of 167 HIVTR candidates, 24 died (14.4%); this mortality rate was similar to that of controls (88/792, 11.1%, P = .30) with no significant difference in causes of mortality. A significantly lower proportion of HIVTR candidates (34.7%) underwent liver transplantation, compared with controls (47.6%, P = .003). In the combined cohort, baseline MELD score predicted pretransplantation mortality (hazard ratio [HR], 1.27; P < .0001), whereas HIV infection did not (HR, 1.69; P = .20). After controlling for pretransplantation CD4(+) cell count and HIV RNA levels, the only significant predictor of mortality in the HIV-infected subjects was pretransplantation MELD score (HR, 1.2; P < .0001). CONCLUSIONS: Pretransplantation mortality characteristics are similar between HIV-positive and HIV-negative candidates. Although lower CD4(+) cell counts and detectable levels of HIV RNA might be associated with a higher rate of pretransplantation mortality, baseline MELD score was the only significant independent predictor of pretransplantation mortality in HIV-infected liver transplant candidates.
Assuntos
Infecções por HIV/mortalidade , Hepatite C Crônica/mortalidade , Falência Hepática/mortalidade , Transplante de Fígado , Cuidados Pré-Operatórios/estatística & dados numéricos , Índice de Gravidade de Doença , Adulto , Estudos de Coortes , Feminino , Humanos , Falência Hepática/cirurgia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Cuidados Pré-Operatórios/normas , Reprodutibilidade dos Testes , Fatores de Risco , Listas de EsperaRESUMO
Blood lipids and high-sensitivity C-reactive protein (hsCRP) are used to assess cardiovascular disease (CVD) risk. We evaluated in a cross-sectional design the relationship of hsCRP to markers of liver function (aspartate and alanine transaminases [AST and ALT, respectively]), CVD risk factors and HIV-disease progression markers in 226 HIV-1 sero-positive drug users. hsCRP showed a significant inverse relationship with ALT and high-density lipoprotein, independent of age, gender, viral load, CD4 cell-count and antiretroviral (ARV) use, and was not significantly associated with HIV-disease progression markers. Serum markers of liver damage, AST and ALT, were associated with lower hsCRP, total cholesterol, low-density lipoproteins and triglycerides. Elevated liver enzymes (> or =40 IU/L) were predictive of hsCRP levels that are considered a low risk for CVD. In conclusion, hsCRP may not be a reliable marker of CVD risk in populations with HIV at-risk for elevated liver enzymes due to high hepatitis B virus/hepatitis C virus prevalence and ARV use.
Assuntos
Alanina Transaminase/sangue , Fármacos Anti-HIV/uso terapêutico , Proteína C-Reativa/análise , Doenças Cardiovasculares/sangue , Infecções por HIV/complicações , Fármacos Anti-HIV/farmacologia , Biomarcadores/sangue , Proteína C-Reativa/metabolismo , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/fisiopatologia , Estudos Transversais , Infecções por HIV/patologia , Soropositividade para HIV , Prevalência , Fatores de RiscoRESUMO
OBJECTIVES: To determine the safety and effectiveness of a once-daily highly active antiretroviral therapy (HAART) regimen in patients at risk for poor adherence using directly observed therapy (DOT) for 24 weeks followed by weekly phone contact for another 24 weeks. METHODS: A prospective, open-label pilot study was carried out. Antiretroviral-naïve patients with advanced HIV disease were treated with once-daily amprenavir 1200 mg, ritonavir 200 mg, didanosine 400 mg and lamivudine 300 mg. After 24 weeks, DOT was substituted by weekly phone contact. Measurements of viral load and CD4 cell count, and safety laboratory measurements, were taken regularly for 48 weeks. RESULTS: Twenty-two patients were enrolled in the study, of whom 19 completed at least 4 weeks of treatment. Seventeen patients completed 24 weeks and 13 completed 48 weeks. None discontinued treatment as a result of adverse events. The median baseline HIV viral load was 5.29 log(10) HIV-1 RNA copies/mL and the median CD4 cell count was 20 cells/microL. At weeks 24 and 48, 74% of the patients had viral loads <400 copies/mL. At 48 weeks, the median decrease in viral load from baseline was 3.06 log(10) copies/mL, and the median increase in CD4 cell count was 118 cells/microL. The median trough plasma amprenavir concentrations at weeks 1 and 24 were 1.87 and 1.42 microg/mL, respectively. CONCLUSIONS: This study suggests that DOT followed by weekly patient contact results in good treatment outcome in this challenging population. The median trough plasma amprenavir concentrations were above the effective concentration of drug that resulted in 90% inhibition of viral load in vivo (EC(90)) for wild-type HIV.
Assuntos
Fármacos Anti-HIV/uso terapêutico , Terapia Diretamente Observada , Infecções por HIV/tratamento farmacológico , Ritonavir/uso terapêutico , Sulfonamidas/uso terapêutico , Adulto , Fármacos Anti-HIV/sangue , Terapia Antirretroviral de Alta Atividade , Carbamatos , Esquema de Medicação , Feminino , Furanos , Infecções por HIV/sangue , Infecções por HIV/virologia , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Ritonavir/sangue , Estatísticas não Paramétricas , Sulfonamidas/sangue , Resultado do Tratamento , Carga ViralRESUMO
We evaluated the safety and efficacy of indinavir 400 mg and ritonavir 400 mg twice daily (RIT/IND 400/400) in HIV-1-infected individuals, using an open label, proof of concept study. All patients received indinavir 400 mg and ritonavir 400 mg twice daily. Patients were followed up to 48 weeks. Nineteen subjects were enrolled, 11 (58%) men and eight (42%) women. The majority were American Black (nine; 47%) or Haitian (eight; 42%). The median baseline plasma HIV-1 viral load (VL) was 5.13 log10 copies/mL and the median CD4 cell count was 112 cells/mm(3). The proportion of compliant patients with VL <400 copies/mL at week 24 was 60% compared with 0% for non-compliant patients (P=0.011 [intent-to-treat] or P=0.085 [on-treatment]). VL at week 4 predicted week 24 VL response. Compliant patients had a median average CD4 cell count increase of 83.2 cells/mm(3) compared with 42.0 cells/mm(3) for non-compliant patients (P=0.010). The median average changes in triglycerides and cholesterol were significantly higher in compliant patients. This is a potent, safe combination for the treatment of HIV-1. VL at week 4 is predictive of viral outcome at week 24. Fasting serum cholesterol and triglycerides were significantly elevated during the study.
Assuntos
Infecções por HIV/tratamento farmacológico , Inibidores da Protease de HIV/uso terapêutico , HIV-1/efeitos dos fármacos , Indinavir/uso terapêutico , Cooperação do Paciente/estatística & dados numéricos , Ritonavir/uso terapêutico , População Negra/estatística & dados numéricos , Relação Dose-Resposta a Droga , Quimioterapia Combinada , Feminino , Infecções por HIV/sangue , Infecções por HIV/etnologia , Inibidores da Protease de HIV/efeitos adversos , Haiti/etnologia , Humanos , Modelos Logísticos , Masculino , Projetos Piloto , Valor Preditivo dos Testes , Ritonavir/efeitos adversos , Estados Unidos , População Urbana , Carga ViralRESUMO
In this international, noncomparative, randomized phase II trial, we evaluated the effectiveness and tolerance of atovaquone suspension (1500 mg orally twice daily) plus either pyrimethamine (75 mg per day after a 200-mg loading dose) or sulfadiazine (1500 mg 4 times daily) as treatment for acute disease (for 6 weeks) and as maintenance therapy (for 42 weeks) for toxoplasmic encephalitis (TE) in patients infected with human immunodeficiency virus. Twenty-one (75%) of 28 patients receiving pyrimethamine (95% lower confidence interval [CI], 58%) and 9 (82%) of 11 patients receiving sulfadiazine (95% lower CI, 53%) responded to treatment for acute disease. Of 20 patients in the maintenance phase, only 1 experienced relapse. Eleven (28%) of 40 eligible patients discontinued treatment as a result of adverse events, 9 because of nausea and vomiting or intolerance of the taste of the atovaquone suspension. Although gastrointestinal side effects were frequent, atovaquone-containing regimens are otherwise well tolerated and safe and may be useful for patients intolerant of standard regimens for toxoplasmic encephalitis.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Síndrome da Imunodeficiência Adquirida/parasitologia , Antiprotozoários/uso terapêutico , Encefalite/tratamento farmacológico , Toxoplasma , Infecções Oportunistas Relacionadas com a AIDS/parasitologia , Síndrome da Imunodeficiência Adquirida/complicações , Doença Aguda , Adulto , Animais , Antiprotozoários/efeitos adversos , Atovaquona , Quimioterapia Combinada , Encefalite/parasitologia , Feminino , Seguimentos , Humanos , Masculino , Naftoquinonas/efeitos adversos , Naftoquinonas/uso terapêutico , Pirimetamina/efeitos adversos , Pirimetamina/uso terapêutico , Sulfadiazina/efeitos adversos , Sulfadiazina/uso terapêutico , Fatores de Tempo , Toxoplasma/efeitos dos fármacos , Resultado do TratamentoRESUMO
OBJECTIVE: To assess the safety, tolerance and activity of increasing doses of azithromycin in combination with pyrimethamine for the treatment of toxoplasmic encephalitis (TE) in patients with AIDS. DESIGN: A phase I/II dose-escalation study of oral azithromycin in combination with pyrimethamine. SETTING: Eight clinical sites in the United States. PATIENTS: Forty-two adult HIV-infected patients with confirmed or presumed acute TE. METHODS: Patients were enrolled into three successive cohorts receiving azithromycin 900, 1200 and 1500 mg a day with pyrimethamine as induction therapy. The induction period was 6 weeks followed by 24 weeks of maintenance therapy. MAIN OUTCOME MEASURES: Patient response was evaluated clinically and radiologically. RESULTS: Of the 30 evaluable patients, 20 (67%) responded to therapy during the induction period. Ten experienced disease progression. Of the 15 patients who received maintenance therapy, seven (47%) relapsed. Six patients discontinued treatment during the induction period as a result of reversible toxicities. Treatment-terminating adverse events occurred most frequently among the patients receiving the 1500 mg dose. CONCLUSION: The combination of azithromycin (900-1200 mg a day) and pyrimethamine may be useful as an alternative therapy for TE among patients intolerant of sulfonamides and clindamycin, but maintenance therapy with this combination was associated with a high relapse rate. The combination was safe, but low-grade adverse events were common.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Antibacterianos/uso terapêutico , Antiprotozoários/uso terapêutico , Azitromicina/uso terapêutico , Encefalite/tratamento farmacológico , Pirimetamina/uso terapêutico , Toxoplasmose/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico por imagem , Adulto , Animais , Antibacterianos/efeitos adversos , Antiprotozoários/efeitos adversos , Azitromicina/efeitos adversos , Estudos de Coortes , Relação Dose-Resposta a Droga , Quimioterapia Combinada , Encefalite/diagnóstico por imagem , Feminino , Humanos , Masculino , Pirimetamina/efeitos adversos , Radiografia , Toxoplasma , Toxoplasmose/diagnóstico por imagem , Resultado do Tratamento , Estados UnidosRESUMO
We undertook a study to compare the safety of intravenous (i.v.) versus oral hydration to prevent nephrotoxicity associated with the use of foscarnet for induction therapy of cytomegalovirus (CMV) infection in HIV-infected persons. Patients, given foscarnet at a dose of 90 mg/kg every 12 h, were randomized to receive either i.v. or oral hydration. Thirty-seven patients were given i.v. hydration and 44 were given oral hydration. Median duration of therapy for both groups was 17 days. There was no difference between the 2 groups in either serious adverse events or rise of creatinine to > or = 2.0 mg/dl. However, serum creatinine, while generally remained within normal limits, increased more in patients who received oral hydration after 10 days of therapy (significant only by slope analysis, P < 0.05). Although i.v. hydration provided better protection against nephrotoxicity, oral hydration was relatively safe and convenient provided that creatinine clearance (CrCl) is monitored closely.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/complicações , Síndrome da Imunodeficiência Adquirida/tratamento farmacológico , Antivirais/uso terapêutico , Infecções por Citomegalovirus/complicações , Foscarnet/uso terapêutico , Infecções Oportunistas Relacionadas com a AIDS/sangue , Infecções Oportunistas Relacionadas com a AIDS/terapia , Síndrome da Imunodeficiência Adquirida/sangue , Síndrome da Imunodeficiência Adquirida/complicações , Administração Oral , Adulto , Creatinina/sangue , Infecções por Citomegalovirus/sangue , Infecções por Citomegalovirus/terapia , Feminino , Hidratação , Foscarnet/administração & dosagem , Humanos , Infusões Intravenosas , Masculino , Cloreto de Sódio/administração & dosagemRESUMO
To evaluate the efficacy of ganciclovir, foscarnet, or the combination of both for the treatment of cytomegalovirus polyradiculomyelopathy (CMV-PRAM), we reviewed the records of seven patients with AIDS, diagnosed with CMV-PRAM. Muscle strength was graded according to the Medical Research Council (MRC) scale. Response to treatment was also classified according to MRC scale, based on the degree of improvement in muscle strength. Six of 7 patients had a good response to treatment, reaching the MRC scale of 4, or improving at least 3 degrees in the same scale. CMV-PRAM may be treated with ganciclovir alone or in combination with foscarnet.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/complicações , Antivirais/uso terapêutico , Infecções por Citomegalovirus/complicações , Foscarnet/uso terapêutico , Ganciclovir/uso terapêutico , Polirradiculopatia/tratamento farmacológico , Polirradiculopatia/virologia , Doenças da Medula Espinal/tratamento farmacológico , Doenças da Medula Espinal/virologia , Adulto , Infecções por Citomegalovirus/tratamento farmacológico , Quimioterapia Combinada , Eletromiografia , Feminino , Humanos , Masculino , Tono Muscular/efeitos dos fármacos , Resultado do Tratamento , Retenção Urinária/tratamento farmacológico , Retenção Urinária/virologiaRESUMO
This article suggests ways to manage the dose-limiting adverse reactions caused by foscarnet so that this agent may be used with confidence as first-line therapy in patients with cytomegalovirus (CMV) disease. Foscarnet (trisodium phosphonoformate) has been used for the treatment of CMV disease in patients who are infected with HIV. Some physicians who treat patients with CMV infection are reluctant to use foscarnet because of the serious adverse effects that may occur, especially during the induction period. The most frequently reported serious adverse effects are nephrotoxicity, electrolyte disturbances, nausea, penile ulcerations and seizures. The nephrotoxicity associated with foscarnet is attributable to renal tubular damage, and may be minimised by calculating and infusing the appropriate dose after hydrating the patient. Monitoring serum electrolyte levels and replacing electrolytes before symptoms occur may limit the development of dosage-limiting toxicities. Nausea occurring during foscarnet infusions may be ameliorated by using antiemetics and slowing the infusion rate. Seizures associated with the use of this agent are mostly a result of the simultaneous presence of other CNS pathologies. Penile ulcers are best managed by stopping the infusion until the ulcers heal; they may be prevented by paying careful attention to personal hygiene.
Assuntos
Antivirais/efeitos adversos , Foscarnet/efeitos adversos , Inibidores da Transcriptase Reversa/efeitos adversos , Animais , Antivirais/administração & dosagem , Antivirais/uso terapêutico , Infecções por Citomegalovirus/tratamento farmacológico , Relação Dose-Resposta a Droga , Feminino , Foscarnet/administração & dosagem , Foscarnet/uso terapêutico , Doenças dos Genitais Femininos/induzido quimicamente , Doenças dos Genitais Femininos/prevenção & controle , Doenças dos Genitais Masculinos/induzido quimicamente , Doenças dos Genitais Masculinos/prevenção & controle , Infecções por HIV/complicações , Humanos , Hipocalcemia/induzido quimicamente , Hipocalcemia/prevenção & controle , Rim/efeitos dos fármacos , Masculino , Náusea/induzido quimicamente , Náusea/prevenção & controle , Inibidores da Transcriptase Reversa/administração & dosagem , Inibidores da Transcriptase Reversa/uso terapêutico , Convulsões/induzido quimicamente , Úlcera/induzido quimicamente , Úlcera/prevenção & controle , Equilíbrio Hidroeletrolítico/efeitos dos fármacosRESUMO
OBJECTIVE: To determine the prevalence of hepatitis B virus (HBV) infection in heterosexual patients attending two genitourinary medicine (GUM) clinics in the West Midlands and to examine whether heterosexual activity is a risk factor for acquiring HBV infection with the view to extend HBV vaccination policies to cover this group. DESIGN: HBV markers were determined in the GUM study group and compared with that of the control groups. Responses to a questionnaire were used to examine sexual behaviour patterns that may be related to heterosexual acquisition of HBV infection. SETTING: The West Midlands, UK April 1992-January 1993. SUBJECTS: 788 male patients and 688 female patients attending GUM clinics were compared with 498 male blood donors and 563 females attending antenatal clinics for the seroprevalence of HBV markers. Potential risk factors related to heterosexual activity were assessed in 1436 patients in the study group. MAIN OUTCOME MEASURES: Prevalence of HBV markers in the GUM study group and the controls. The possible use of the risk factors examined as predictors for acquiring HBV infection. RESULTS: The seroprevalence of hepatitis B core antibody (anti-HBc) in GUM patients was 1.9% and 0.5% in the control group. In the study groups the prevalence of anti-HBc from Birmingham was 3.2% while that from Coventry was 0.8%. The low seroprevalence of HBV prevented a multiple logistic analysis. A limited regression analysis showed that being non-white (p < 0.001) and duration of sexual activity (p = 0.013) were risk factors for HBV infection. However, these two factors were poor predictors of the risk to exposure to HBV infection. CONCLUSION: The prevalence of HBV infection in heterosexual patients in the West Midlands is very low and does not provide any indications to broaden HBV vaccination into heterosexual patients attending GUM clinics. Risk factors were poor predictors of the exposure to HBV infection. This is partially due to the low prevalence of HBV infection in this study. Further studies are required before definitive conclusions are made regarding the potential predictive value of risk factors.
Assuntos
Hepatite B/epidemiologia , Sexualidade , Adulto , Estudos Transversais , Inglaterra/epidemiologia , Feminino , Hepatite B/etnologia , Anticorpos Anti-Hepatite B/sangue , Antígenos do Núcleo do Vírus da Hepatite B/sangue , Antígenos de Superfície da Hepatite B/sangue , Antígenos de Superfície da Hepatite B/imunologia , Antígenos E da Hepatite B/sangue , Antígenos E da Hepatite B/imunologia , Humanos , Masculino , Prevalência , Estudos Prospectivos , Análise de Regressão , Fatores de Risco , Estudos Soroepidemiológicos , Comportamento SexualRESUMO
A review of all the patients diagnosed to have Pediculosis pubis (P pubis) during a 2 year period 1989-1991 was carried out. They constituted the index group and were compared with 140 consecutive patients seen during the month of June 1990, who served as controls. Both groups were comparable with respect to age and use of modern contraception. Coexisting sexually transmitted diseases (STDs) were found in 37% of the index group. Incidence of STDs was 51% among the controls. In the preceding 3 months, patients in the index group had significantly more sexual partners p < 0.005. These findings emphasize the need to offer full STD screening and health education to sexually active people who present with P pubis.