Análisis de la duración y los motivos de cambio de la primera combinación de tratamiento antirretroviral / Analysis of the duration of and reasons for changing the first combination of antiretroviral therapy

Objetivo Conocer la duración y los motivos de cambio de las distintas combinaciones de fármacos utilizadas como inicio del tratamiento antirretroviral en pacientes naive. Métodos Estudio observacional y retrospectivo en el que se incluyeron todos los pacientes con infección por VIH que iniciaron tratamiento antirretroviral en un hospital universitario de referencia de alta tecnología durante el periodo comprendido entre el 1 de enero de 2003 y el 31 de diciembre de 2005. El seguimiento se realizó hasta el 31 de diciembre de 2008. Para estimar la probabilidad acumulada de interrupción del tratamiento se utilizó el método de Kaplan-Meier. Resultados Se incluyeron un total de 441 pacientes. La mediana de duración del primer tratamiento fue de 384 (intervalo intercuartil 84–1.290) días. Los regímenes basados en inhibidores de la transcriptasa inversa no análogos de nucleósidos y aquellos que incluían como análogos de nucleósidos abacavir o tenofovir en combinación con lamivudina o emtricitabina presentaron una duración significativamente mayor que el resto. Los principales motivos de finalización fueron las reacciones adversas aunque en un porcentaje menor que el obtenido en estudios anteriores. No se hallaron asociaciones entre el resto de características de los pacientes o del tratamiento y el riesgo de interrupción. Discusión Aunque la duración del primer tratamiento antirretroviral sigue siendo corta, actualmente se producen menos cambios por reacciones adversas y por pérdidas de seguimiento. Los motivos podrían ser una mejor tolerancia y una menor complejidad. No obstante, son necesarios más estudios para determinar el beneficio de un régimen frente a otro y poder generalizar estos resultados (AU)

Objective To determine the duration of and reasons behind changing the various combinations of drugs used for the initiation of antiretroviral treatment in naïve patients. Methods A retrospective observational study that included all patients with HIV infection who started antiretroviral therapy in a high-tech university reference hospital during the period from 1 January 2003 and 31 December 2005. Patients were followed until 31 December 2008. To estimate the cumulative probability of discontinuation the Kaplan-Meier method was used. Results A total of 441 patients were included. The average duration of the first treatment was 384 (interquartile interval 84–1290) days. The regimen based on non-nucleoside reverse transcriptase inhibitors and those that included as nucleosides abacavir or tenofovir in combination with lamivudine or emtricitabine showed a significantly longer duration than the rest. The main reasons for termination were the side effects, although in a lesser percentage than that obtained in previous studies. No associations were found between the rest of the characteristics of the patients or of the treatment and the risk of termination. Discussion Although the duration of the first antiretroviral treatment remains short, currently fewer changes are made due to side effects and due to loss to follow-up. The reasons may be better tolerance and less complexity. However, more studies are needed to determine the benefits of one regimen or another, and to be able to generalise the results (AU)

[Analysis of the duration of and reasons for changing the first combination of antiretroviral therapy]. / Análisis de la duración y los motivos de cambio de la primera combinación de tratamiento antirretroviral.

OBJECTIVE: To determine the duration of and reasons behind changing the various combinations of drugs used for the initiation of antiretroviral treatment in naïve patients. METHODS: A retrospective observational study that included all patients with HIV infection who started antiretroviral therapy in a high-tech university reference hospital during the period from 1 January 2003 and 31 December 2005. Patients were followed until 31 December 2008. To estimate the cumulative probability of discontinuation the Kaplan-Meier method was used. RESULTS: A total of 441 patients were included. The average duration of the first treatment was 384 (interquartile interval 84-1290) days. The regimen based on non-nucleoside reverse transcriptase inhibitors and those that included as nucleosides abacavir or tenofovir in combination with lamivudine or emtricitabine showed a significantly longer duration than the rest. The main reasons for termination were the side effects, although in a lesser percentage than that obtained in previous studies. No associations were found between the rest of the characteristics of the patients or of the treatment and the risk of termination. DISCUSSION: Although the duration of the first antiretroviral treatment remains short, currently fewer changes are made due to side effects and due to loss to follow-up. The reasons may be better tolerance and less complexity. However, more studies are needed to determine the benefits of one regimen or another, and to be able to generalise the results.

Congenital smooth muscle hamartoma presenting as a linear atrophic plaque: case report and review of the literature.

Congenital smooth muscle hamartoma usually manifests as a well-circumscribed, hyperpigmented plaque, frequently hypertrichotic, on the trunk or extremities. We report such a lesion in a 7-month-old girl that presented as a linear, mottled, purplish red plaque appearing in areas to be atrophic, involving her right buttock, posterior thigh and leg, and fifth toe. Although the clinical appearance suggested linear morphea, a biopsy specimen had numerous haphazardly oriented bundles of smooth muscle in the reticular dermis. Masson trichrome staining, smooth muscle specific actin, and electron microscopic studies confirmed the smooth muscle nature of the cells. A diagnosis of smooth muscle hamartoma was made. To our knowledge, this linear clinical presentation has not been described previously.

Multiple cutaneous myxomas. Report of a case without other elements of Carney's complex.

An 11-year-old hispanic female was referred for evaluation of multiple asymptomatic papules which had slowly developed since age two. The patient had no significant medical history and no family members, including an older sibling, were similarly affected. Physical examination revealed multiple 2-6 mm flesh-colored to erythematous papules over the posterior scalp, trunk, and extremities, predominantly in a midline distribution. No lentigines, blue nevi, or evidence of endocrine ab-normalities were noted. Echocardiogram was normal with no evidence of myxoma. Six cutaneous biopsies showed myxomas, as evidenced by well-circumscribed dermal tumors composed of stellate, dendritic cells embedded in a mucinous stroma. Special stains and electron microscopy confirmed the H&E finding. Immunoperoxidase staining for Factor XIIIa was positive in the dendritic tumor cells, suggesting a relationship with dermal dendrocytes. This patient represents a case of multiple cutaneous myxomas without other components of Carney's complex of myxomas, spotty pigmentation, endocrine overactivity, and a variety of uncommon tumors. A long-term follow-up is indicated since some of the above cited elements of the syndrome could appear over time.

Occupational contact dermatitis from rhodium and cobalt.

We report a case of occupational allergic contact dermatitis from rhodium sulphate and cobalt chloride in a 29-year-old woman working in a goldsmith's workshop. The relevance and source of sensitization to these metals in our patient is described, and the literature on the subject reviewed.