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1.
Int J Tuberc Lung Dis ; 18(9): 1080-4, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-25189556

RESUMO

BACKGROUND: It is unclear whether optimal immunological recovery reduces the risk of tuberculosis (TB) in human immunodeficiency virus (HIV) infected patients receiving antiretroviral therapy (ART), in whom it is still significantly higher than in the general population. METHODS: Retrospective cohort study in ART-treated patients without a previous diagnosis of TB. TB was microbiologically proven. Multivariate analyses were performed to identify risk factors associated with TB. RESULTS: This study included 1824 patients; the median follow-up was 473 days. The median CD4 count was 207 cells/µl (90-363.8); 339 (18.6%) were tuberculin skin test positive. Increased CD4 count gain after ART initiation was a protective factor against active TB (per each 100 cells/µl increase, OR 0.683, 95%CI 0.522-0.894). Maximal protection was observed in patients reaching increments ⩾150 cells/µl after 12 months of ART (OR 0.29, 95%CI 0.11-0.8) or ⩾300 cells/µl after 24 months (OR 0.73, 95%CI 0.71-0.75). There was no association between achieving HIV RNA <50 copies/ml and risk of active TB (OR 1.43, 95%CI 0.68-2.49). CONCLUSIONS: The risk of TB in patients starting ART is reduced among those with better immunological response, and is unrelated to the virological response. Our results emphasise the need for adjunctive strategies in immunological non-responders to minimise any residual risk of TB.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/prevenção & controle , Fármacos Anti-HIV/uso terapêutico , Coinfecção , Infecções por HIV/tratamento farmacológico , Tuberculose/prevenção & controle , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Infecções Oportunistas Relacionadas com a AIDS/imunologia , Infecções Oportunistas Relacionadas com a AIDS/microbiologia , Adulto , Contagem de Linfócito CD4 , Distribuição de Qui-Quadrado , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Infecções por HIV/imunologia , Humanos , Hospedeiro Imunocomprometido , Incidência , Modelos Logísticos , Masculino , Análise Multivariada , Razão de Chances , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco , Espanha/epidemiologia , Fatores de Tempo , Resultado do Tratamento , Teste Tuberculínico , Tuberculose/diagnóstico , Tuberculose/epidemiologia , Tuberculose/imunologia , Tuberculose/microbiologia , Carga Viral
2.
Int J Tuberc Lung Dis ; 15(10): 1347-52, 2011 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-22283893

RESUMO

BACKGROUND: There may be an interaction between the CD4 count and the tuberculin skin test (TST) for the development of tuberculosis (TB) in human immunodeficiency virus (HIV) infected patients receiving highly active antiretroviral therapy (HAART). METHODS: Observational, cohort study of patients treated with HAART during the course of HIV infection in whom TB was confirmed by a positive culture result. Patients were stratified by TST and CD4 count. Univariate and multivariate analyses were performed to identify risk factors associated with the development of TB. RESULTS: The study included 1824 patients starting HAART, 339 (18.6%) of whom were TST-positive. After a median 473 days, 45 cases of TB had developed (1.9 cases per 100 person-years, 95%CI 1.38-2.54). The risk of developing TB increased significantly among patients with a positive TST (2.81, 95%CI 1.11-7.15), and in individuals with > or < 200 cells/µ l (1.37, 95%CI 0.44-4.21). By contrast, in the TST-negative group, the risk was significantly higher in patients with < 200 cells/µ l (16.64, 95%CI 2.16-127.6). CONCLUSIONS: TST-positive patients are at high risk of developing TB, irrespective of CD4 count. However, among TST-negative patients only those with a CD4 count < 200 cells/µ l have an appreciable risk of developing the disease.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Fármacos Anti-HIV/uso terapêutico , Contagem de Linfócito CD4 , Coinfecção , Infecções por HIV/tratamento farmacológico , Teste Tuberculínico , Tuberculose/diagnóstico , Tuberculose/epidemiologia , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/imunologia , Infecções Oportunistas Relacionadas com a AIDS/microbiologia , Adulto , Terapia Antirretroviral de Alta Atividade , Distribuição de Qui-Quadrado , Intervalo Livre de Doença , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Infecções por HIV/imunologia , Humanos , Incidência , Estimativa de Kaplan-Meier , Masculino , Análise Multivariada , Razão de Chances , Valor Preditivo dos Testes , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Espanha/epidemiologia , Fatores de Tempo , Tuberculose/imunologia , Tuberculose/microbiologia
3.
Rev Esp Enferm Dig ; 100(2): 76-81, 2008 Feb.
Artigo em Espanhol | MEDLINE | ID: mdl-18366264

RESUMO

INTRODUCTION: proton pump inhibitors (PPIs) block the H+/K+ ATPase enzyme in gastric wall cells, leading to an inhibition of both baseline and stimulated acid secretion. Appropriate indications include: Gastroesophageal reflux, acute upper gastrointestinal bleeding, erosive gastritis or esophagitis, dyspepsia, NSAID-related gastropathy, and stress ulcer prophylaxis in high risk patients. The aims of this study were to review the current indications of PPIs, and to evaluate their use in Guadalajara s University Hospital. MATERIAL AND METHODS: a transversal, analytic, randomized study was carried out during 2003 in our internal medicine department. A total of 208 medical records for 832 patients receiving PPIs were reviewed (25%). Mean age was 67 years (range: 16-92), 46.2% were females, and most frequent conditions were HBP, COPD, and DM. RESULTS: 34.6% of patients took PPIs before admission, their use being inappropriate in 68.1% of them. Among hospitalized patients 73.03% used PPIs inappropriately, and most of them had no such indication at discharge. CONCLUSIONS: results are in accordance with the literature, with a high frequency of incorrect PPI use; a more accurate use of PPIs is to be recommended to avoid side effects and drug interactions, and to provide a more efficient medical care.


Assuntos
Inibidores da Bomba de Prótons/uso terapêutico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Uso de Medicamentos/normas , Uso de Medicamentos/estatística & dados numéricos , Feminino , Hospitalização , Humanos , Medicina Interna , Masculino , Pessoa de Meia-Idade , Alta do Paciente
4.
Rev. esp. enferm. dig ; 100(2): 76-81, feb. 2008. ilus, tab
Artigo em Es | IBECS | ID: ibc-71225

RESUMO

Introducción: los inhibidores de la bomba de protones (IBP)bloquean la enzima H+/K+ ATPasa en las células parietales gástricas,logrando la inhibición de la secreción de ácido clorhídrico deforma basal como tras estimulación. Las indicaciones apropiadaspara su uso son: enfermedad por reflujo gastroesofágico, hemorragiadigestiva aguda, úlceras activas, gastritis o esofagitis erosiva,dispepsia, gastropatía por AINE, profilaxis de úlcera de estrésen pacientes de riesgo.El objetivo del estudio fue la revisión de las indicaciones de losIBP en nuestro medio y la evaluación de su utilización en el HospitalUniversitario de Guadalajara.Material y métodos: se realizó un estudio de corte transversalanalítico con selección aleatoria de los pacientes atendidos enel Servicio de Medicina Interna durante todo el año 2003. Se revisaronun total de 208 historias de 832 pacientes (un 25%) a losque se administraron IBP. La edad media fue de 67 años (rango16-92), el 46,2% fueron mujeres y las enfermedades subyacentesmás frecuentes fueron: HTA, EPOC y DM.Resultados: un 34,6% de los pacientes tomaban IBP antesdel ingreso. De estos, el 68,1% no tenía indicación. Durante el ingresose prescribió de forma inadecuada el IBP al 73,07% y alalta, se mantenía el IBP sin indicación correcta.Conclusiones: los resultados están en concordancia con losanteriormente publicados, manteniéndose una alta frecuencia deuso incorrecto de los IBP y siendo recomendable una utilizaciónmás racional para evitar los efectos secundarios, las interaccionescon otros fármacos y aportar una atención médica más eficiente


Introduction: proton pump inhibitors (PPIs) block the H+/K+ ATPase enzyme in gastric wall cells, leading to an inhibition of both baseline and stimulated acid secretion. Appropriate indications include: Gastroesophageal reflux, acute upper gastrointestinalbleeding, erosive gastritis or esophagitis, dyspepsia,NSAID-related gastropathy, and stress ulcer prophylaxis in high risk patients. The aims of this study were to review the current indications of PPIs, and to evaluate their use in Guadalajara’s University Hospital.Material and methods: a transversal, analytic, randomizedstudy was carried out during 2003 in our internal medicine department. A total of 208 medical records for 832 patients receiving PPIs were reviewed (25%). Mean age was 67 years (range: 16-92), 46.2% were females, and most frequent conditions were HBP, COPD, and DM. Results: 34.6% of patients took PPIs before admission, theiruse being inappropriate in 68.1% of them. Among hospitalized patients 73.03% used PPIs inappropriately, and most of them had no such indication at discharge.Conclusions: results are in accordance with the literature, with a high frequency of incorrect PPI use; a more accurate use of PPIs is to be recommended to avoid side effects and drug interactions, and to provide a more efficient medical care (AU)


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Uso de Medicamentos , Bombas de Próton/antagonistas & inibidores , Estudos Transversais , Hospitalização , Alta do Paciente
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