RESUMO
BACKGROUND: Central nervous system opportunistic infections can be the first presentation of an HIV infection. Our aim is to describe clinical and laboratory characteristics of HIV-associated Cryptococcal Meningitis (CM), in-hospital outcomes and analyze associations of these parameters with adverse outcomes. METHODS: Observational study of local cohort of HIV-associated cryptococcal meningitis in a high complexity tertiary urban hospital in Santiago, Chile. Descriptive analysis through chart review of all episodes of HIV-associated CM in adults, from 1995 to 2019. Inclusion criteria were confirmed CM with cerebrospinal fluid culture or India ink in the appropriate clinical context and HIV diagnosis. We selected relevant variables that have been described as predictors of adverse outcomes in the literature and explore associations in our cohort. RESULTS: There were 37 HIV associated CM cases, occurring from 2000 to 2019. Majority were men (86â¯%) with a median age of 35 years. CM was the first HIV manifestation in 32â¯%. Opening pressure was measured in 10â¯% of patients at admission. Most CSF parameters were mildly altered, and two patients presented with completely normal CSF findings. Most patients -94,4â¯%- suffered adverse events secondary to antifungal therapy. Despite of recommendations against their use, steroids were frequently prescribed. Mortality was 18,9â¯%, and was associated with older age, and more days of headache prior to admission. CONCLUSIONS: CM clinical presentation and CSF characteristics are variable at presentation, which can lead to delayed diagnosis. Inappropriate use of corticosteroids, antifungal toxicity and suboptimal management of elevated intracranial pressure are key aspects to improve.
Assuntos
Infecções por HIV , Meningite Criptocócica , Centros de Atenção Terciária , Humanos , Meningite Criptocócica/complicações , Masculino , Adulto , Feminino , Estudos Retrospectivos , Infecções por HIV/complicações , Pessoa de Meia-Idade , Chile/epidemiologia , Infecções Oportunistas Relacionadas com a AIDS , Antifúngicos/uso terapêuticoRESUMO
We present the case of a 22-year-old patient with no morbid history who developed a brain abscess secondary to endocarditis due to Eikenella corrodens. The diagnosis was established by detecting the microorganism by universal polymerase chain reaction in fluid from the brain collection. Trans-esophageal echocardiogram study confirmed vegetations in the mitral valve. External ventricular shunt placement was required due to emptying of abscess to brain ventricles and secondary hydrocephalus. He received 80 days of effective antibiotic treatment and his evolution was favorable with complete resolution of his infection verified with images and echocardiogram. Follow-up at seven months later due to ventricule-peritoneal drainage valve dysfunction did not confirmed infection.
Assuntos
Abscesso Encefálico , Infecções por Bactérias Gram-Negativas , Adulto , Antibacterianos/uso terapêutico , Sistema Nervoso Central , Drenagem , Eikenella corrodens , Infecções por Bactérias Gram-Negativas/diagnóstico , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Humanos , Masculino , Adulto JovemRESUMO
In this prospective, multicentric, observational study, we describe the clinical characteristics and outcomes of people living with HIV (PLHIV) requiring hospitalization due to COVID-19 in Chile and compare them with Chilean general population admitted with SARS-CoV-2. Consecutive PLHIV admitted with COVID-19 in 23 hospitals, between 16 April and 23 June 2020, were included. Data of a temporally matched-hospitalized general population were used to compare demography, comorbidities, COVID-19 symptoms, and major outcomes. In total, 36 PLHIV subjects were enrolled; 92% were male and mean age was 44 years. Most patients (83%) were on antiretroviral therapy; mean CD4 count was 557 cells/mm3. Suppressed HIV viremia was found in 68% and 56% had, at least, one comorbidity. Severe COVID-19 occurred in 44.4%, intensive care was required in 22.2%, and five patients died (13.9%). No differences were seen between recovered and deceased patients in CD4 count, HIV viral load, or time since HIV diagnosis. Hypertension and cardiovascular disease were associated with a higher risk of death (p = 0.02 and 0.006, respectively). Compared with general population, the HIV cohort had significantly more men (OR 0.15; IC 95% 0.07-0.31) and younger age (OR 8.68; IC 95% 2.66-28.31). In PLHIV, we found more intensive care unit admission (OR 2.31; IC 95% 1.05-5.07) but no differences in the need for mechanical ventilation or death. In this cohort of PLHIV hospitalized with COVID-19, hypertension and cardiovascular comorbidities, but not current HIV viro-immunologic status, were the most important risk factors for mortality. No differences were found between PLHIV and general population in the need for mechanical ventilation and death.
Assuntos
COVID-19/diagnóstico , Coinfecção/imunologia , Coinfecção/virologia , Infecções por HIV/complicações , Hospitalização/estatística & dados numéricos , SARS-CoV-2 , Adulto , Negro ou Afro-Americano , Idoso , Fármacos Anti-HIV/uso terapêutico , Contagem de Linfócito CD4 , COVID-19/terapia , Teste Sorológico para COVID-19 , Chile/epidemiologia , Cuidados Críticos , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Pandemias , Estudos ProspectivosRESUMO
Resumen Se presenta el caso de un paciente de 22 años sin antecedentes mórbidos que desarrolló un absceso cerebral secundario a una endocarditis por Eikenella corrodens. El diagnóstico se estableció mediante la detección por reacción de polimerasa en cadena universal en el líquido de la colección cerebral. La ecocardiografía transesofágica confirmó vegetaciones en la válvula mitral. Requirió la colocación de una derivación ventricular externa por vaciamiento del absceso a ventrículos cerebrales e hidrocefalia secundaria. Recibió 80 días de tratamiento antibacteriano efectivo. Su evolución fue favorable, con resolución completa de la infección verificada con imágenes y ecocardiografía de control. El seguimiento a los siete meses por una disfunción de válvula de drenaje ventrículo-peritoneal no demostró infección.
Abstract We present the case of a 22-year-old patient with no morbid history who developed a brain abscess secondary to endocarditis due to Eikenella corrodens. The diagnosis was established by detecting the microorganism by universal polymerase chain reaction in fluid from the brain collection. Trans-esophageal echocardiogram study confirmed vegetations in the mitral valve. External ventricular shunt placement was required due to emptying of abscess to brain ventricles and secondary hydrocephalus. He received 80 days of effective antibiotic treatment and his evolution was favorable with complete resolution of his infection verified with images and echocardiogram. Follow-up at seven months later due to ventricule-peritoneal drainage valve dysfunction did not confirmed infection.
Assuntos
Humanos , Masculino , Adulto , Adulto Jovem , Abscesso Encefálico , Infecções por Bactérias Gram-Negativas , Sistema Nervoso Central , Drenagem , Eikenella corrodens , Infecções por Bactérias Gram-Negativas/diagnóstico , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Antibacterianos/uso terapêuticoRESUMO
CASE PRESENTATION: A previously healthy 45-year-old man was admitted to our ED with a 3-week history of progressive dyspnea on exertion. He also presented with orthopnea, paroxysmal nocturnal dyspnea, and mild ankle swelling, but he showed no fever, wheezing, coughing, or sputum production. Outpatient laboratory studies, performed 1 week after symptom onset, revealed hypereosinophilia (4.100/µL). He was diagnosed with asthma and prescribed inhaled corticosteroids and low-dose prednisone, but he showed no symptomatic improvement. Over the last 48 h, he experienced rapid progression of dyspnea that made it difficult to speak with accompanying resting, substernal, nonradiating chest pain that became worse on inspiration. He had no allergies and reported no recent travels. Before symptom onset, he had not been taking any medication. He denied eating raw fish or meat and had not been exposed to mildew. His only exposure to animals was from his two indoor cats.
Assuntos
Albendazol/uso terapêutico , Asma/diagnóstico , Síndrome Hipereosinofílica/diagnóstico , Toxocaríase/diagnóstico , Corticosteroides/uso terapêutico , Animais , Asma/tratamento farmacológico , Gatos , Dor no Peito/diagnóstico , Dor no Peito/etiologia , Diagnóstico Diferencial , Progressão da Doença , Dispneia/diagnóstico , Dispneia/etiologia , Ecocardiografia/métodos , Eletrocardiografia/métodos , Serviço Hospitalar de Emergência , Eosinofilia/diagnóstico , Eosinofilia/etiologia , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia Torácica/métodos , Medição de Risco , Resultado do TratamentoRESUMO
Antiretroviral therapy (ART) has shown to be an effective measure in decreasing HIV vertical transmission (VT). Nevertheless, it is not free from adverse effects in the newborn: risk of prematurity, low birth weight, metabolic disorders, among others. Despite the importance of the subject, there are few national data that analyze the problem. We performed a retrospective analysis of a cohort of HIV positive mother/child binomial, followed between 1995 and 2010. Ninety-four pregnancies and 96 children (2 twin pregnancies) were analyzed. The rate of VT was 2.1%. Adverse effects attributed to ART were found on 85.4% of the newborn; highlighting the presence of anemia (70.8%) and several metabolic disorders [elevated lactate without acidosis (29.2%), lactic acidosis (12.5%), hyperkalemia (14.6%), metabolic acidosis (9.4%)]. Maternal exposure to protease inhibitors proved to be an independent risk factor for the development of metabolic disorders in newborns (OR 0.15 [0.04-0.48], p < 0.01). In our series, ART was effective in reducing the VT, however exposed newborns showed a high frequency of adverse effects, so it is advisable to implement programs for monitoring these patients to prevent sequelae.
La terapia anti-retroviral (TARV) es efectiva en disminuir la transmisión vertical (TV) del VIH, pero no está exenta de efectos adversos en los recién nacidos: riesgo de prematurez, bajo peso al nacer, alteraciones metabólicas y otros. Pese a lo relevante del tema, existen pocos datos nacionales que analicen el problema. Realizamos un estudio observacional, retrospectivo, de una serie de binomios madre infectada por VIH/hijo atendidos entre los años 1995 y 2010. Se analizaron 94 embarazos y 96 hijos (2 embarazos gemelares). La tasa de TV fue 2,1%. De los recién nacidos, 85,4% presentó efectos adversos atribuibles a la exposición a TARV destacando la presencia de anemia (70,8%) y alteraciones metabólicas varias [hiperlactacidemia sin acidosis (29,2%), acidosis láctica (12,5%), hiperkalemia (14,6%) y acidosis metabólica (9,4%). La exposición materna al uso de IP demostró ser un factor de riesgo independiente para el desarrollo de alteraciones metabólicas en los recién nacidos (OR 4 [1,58-10,12], p 0,003). En nuestra serie, la TARV demostró ser efectiva en reducir la TV. Sin embargo, los recién nacidos expuestos presentaron alta frecuencia de efectos adversos, por lo que es recomendable la implementación de programas de seguimiento de estos pacientes para prevenir secuelas.
Assuntos
Feminino , Humanos , Recém-Nascido , Gravidez , Fármacos Anti-HIV/efeitos adversos , Infecções por HIV/transmissão , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Complicações Infecciosas na Gravidez/tratamento farmacológico , Chile/epidemiologia , Infecções por HIV/epidemiologia , Transmissão Vertical de Doenças Infecciosas/estatística & dados numéricos , Complicações Infecciosas na Gravidez/epidemiologia , Estudos Retrospectivos , Fatores de RiscoRESUMO
Antiretroviral therapy (ART) has shown to be an effective measure in decreasing HIV vertical transmission (VT). Nevertheless, it is not free from adverse effects in the newborn: risk of prematurity, low birth weight, metabolic disorders, among others. Despite the importance of the subject, there are few national data that analyze the problem. We performed a retrospective analysis of a cohort of HIV positive mother/child binomial, followed between 1995 and 2010. Ninety-four pregnancies and 96 children (2 twin pregnancies) were analyzed. The rate of VT was 2.1%. Adverse effects attributed to ART were found on 85.4% of the newborn; highlighting the presence of anemia (70.8%) and several metabolic disorders [elevated lactate without acidosis (29.2%), lactic acidosis (12.5%), hyperkalemia (14.6%), metabolic acidosis (9.4%)]. Maternal exposure to protease inhibitors proved to be an independent risk factor for the development of metabolic disorders in newborns (OR 0.15 [0.04-0.48], p < 0.01). In our series, ART was effective in reducing the VT, however exposed newborns showed a high frequency of adverse effects, so it is advisable to implement programs for monitoring these patients to prevent sequelae.
Assuntos
Fármacos Anti-HIV/efeitos adversos , Infecções por HIV/transmissão , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Complicações Infecciosas na Gravidez/tratamento farmacológico , Chile/epidemiologia , Feminino , Infecções por HIV/epidemiologia , Humanos , Recém-Nascido , Transmissão Vertical de Doenças Infecciosas/estatística & dados numéricos , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Estudos Retrospectivos , Fatores de RiscoRESUMO
We report a 43 years old HIV-1 infected male who developed a severe subacute neurological damage because of a progressive multifocal leukoencephalopathy confirmed by PCR for JC virus. The patient was treated with antiretroviral therapy in adequate doses for CNS penetration and mirtazapine, an antidepressant inhibitor of serotonin receptors. His evolution during one year follow up has been favorable in both, clinically and images.
Assuntos
Complexo AIDS Demência/tratamento farmacológico , Antidepressivos Tricíclicos/uso terapêutico , Terapia Antirretroviral de Alta Atividade , Leucoencefalopatia Multifocal Progressiva/tratamento farmacológico , Mianserina/análogos & derivados , Adulto , Quimioterapia Combinada/métodos , Humanos , Masculino , Mianserina/uso terapêutico , Mirtazapina , Resultado do TratamentoRESUMO
We report a 43 years old HIV-1 infected male who developed a severe subacute neurological damage because of a progressive multifocal leukoencephalopathy confirmed by PCR for JC virus. The patient was treated with antiretroviral therapy in adequate doses for CNS penetration and mirtazapine, an antidepressant inhibitor of serotonin receptors. His evolution during one year follow up has been favorable in both, clinically and images.
Se presenta el caso clínico de un paciente de sexo masculino, de 43 años portador de VIH que desarrolló un grave daño neurológico subagudo debido a una leucoencefalopatía multifocal progresiva diagnosticada mediante reacción de polimerasa en cadena de virus JC. El paciente fue tratado con terapia anti-retroviral de penetración eficiente al SNC y con mirtazapina, un antidepresivo inhibidor de los receptores de serotonina. Su evolución durante un año de seguimiento ha sido favorable tanto del punto de vista clínico como de imágenes.
Assuntos
Adulto , Humanos , Masculino , Complexo AIDS Demência/tratamento farmacológico , Terapia Antirretroviral de Alta Atividade , Antidepressivos Tricíclicos/uso terapêutico , Leucoencefalopatia Multifocal Progressiva/tratamento farmacológico , Mianserina/análogos & derivados , Quimioterapia Combinada/métodos , Mianserina/uso terapêutico , Resultado do TratamentoRESUMO
Infections due to non-typhi salmonellae (NTS) generally cause a mild and self-limited gastrointestinal disease. However, there have been reports of atypical and severe presentations in immunocompromised patients. We report the case of a male patient who consulted with a cervical mass. He was found to be HIV-positive and Salmonella Typhimurium was isolated in one blood culture and cervical mass tissue culture. We discuss the relevance of infections by NTS in immunodeficient patients because they present with more severe illness than normal population. We emphasize the importance of NTS bacteremia as a marker of underlying immunodeficiency. We present some localized infection sites reported in the literature and their relation with particular diseases. We discuss the future relevance that an early start of antiretroviral therapy (ART) may have in HIV patients with NTS acute bacteremia or focal infections. Because infections by NTS can be severe and highly lethal they must be considered in the differential diagnosis of causative organisms of localized infections and bacteremia in HIV patients.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/microbiologia , Abscesso/microbiologia , Soropositividade para HIV/microbiologia , Infecções por Salmonella/microbiologia , Salmonella typhimurium/isolamento & purificação , Adulto , Humanos , Masculino , PescoçoRESUMO
OBJECTIVE: To characterize the clinical presentation, course and mortality of pandemic influenza in HIV-1-infected patients in Santiago, Chile. METHODS: Prospective observational study. RESULTS: Thirty patients were included (three hospitalized), 93% were on HAART, mean CD4(+) cell count was 423 cells/µl and viral load was undetectable in 77% of patients. All patients had fever, 90% had cough, 80% had myalgias, 70% had pharyngeal congestion, 47% had coryza, 47% had odynophagia, 37% had headache and 23% had vomiting. Four patients developed pneumonia. All patients received antiviral therapy and no patient died. CONCLUSIONS: HIV patients infected by the new influenza A pandemic (H1N1) virus behave similarly to the general population.
Assuntos
Infecções por HIV/virologia , Vírus da Influenza A Subtipo H1N1/patogenicidade , Influenza Humana/virologia , Adulto , Idoso , Terapia Antirretroviral de Alta Atividade , Chile , Infecções por HIV/tratamento farmacológico , Humanos , Vírus da Influenza A Subtipo H1N1/efeitos dos fármacos , Influenza Humana/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Pandemias , Estudos Prospectivos , Carga ViralRESUMO
Neurosyphilis follows a more aggressive and different clinical course in HIV-infected patients compared to patients with normal immunity. Two historical series of patients with a diagnosis of neurosyphilis between 1995 and 2008 were compared: they included a group of 15 patients with y and 28 patients without HIV infection. Probability of neurosyphilis in patients with positive serum VDRL was increased in patients infected with HIV compared to HIV negative patients (OR: 62.37 IC:95% (32.1-119.1) p value:< 0,001). Predominant clinical manifestations in neurosyphilis in the HIV negative group were ocular abnormality, vascular encephalic and spinal cord lesions. In the HIV positive group, they were fever, ocular abnormalities and headache. There were no differences in cerebrospinal fluid characteristics between both groups. Neurosyphilis was diagnosed even in patients with blood VDRL of < 1:32, that happened in 17.8% of the HIV positive patients with blood and in 60% of t he HIV negative patients. Penicillin sodium given at dose >or= than 18.000.000 IU/day IV during 14 days was the most common treatment. In patients with clinical neurosyphilis, 93% of HIV negative group, and 54.2% of HIV positive group had persistent neurological after-effects. Three HIV positive patients died due to causes not related to neurosyphilis.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Soronegatividade para HIV , Neurossífilis/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/complicações , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Adulto , Idoso , Antibacterianos , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neurossífilis/complicações , Neurossífilis/tratamento farmacológico , Penicilina G Benzatina/uso terapêutico , Estudos Retrospectivos , Sorodiagnóstico da Sífilis , Adulto JovemRESUMO
OBJECTIVE: To compare the performance of two tests for diagnosing latent tuberculosis (TB) infection in the HIV-positive population in Chile, in order to better identify the subjects who might benefit from TB chemoprophylaxis. DESIGN: This was a cross-sectional study among individuals attending three HIV outpatient clinics in Santiago, tested with a 2-TU purified protein derivative, QuantiFERON((R))-TB Gold 'in-tube' (QFT-G), and a chest X-ray. RESULTS: A total of 116 subjects were enrolled in the study, having a mean CD4 count of 393cells/microl (range 100-977). The tuberculin skin text (TST; 5mm cutoff) and QFT-G results were positive in 10.9% and 14.8% of the individuals, respectively, with moderate agreement between both tests (kappa=0.59). A history of both known TB exposure (odds ratio (OR) 3.46, 95% confidence interval (CI) 1.02-11.22) and past TB (OR 4.31, 95% CI 1.13-15.5) were associated with a positive QFT-G result. Only past TB was significantly associated with a positive TST result (OR 6.63, 95% CI 1.62-26.3). Among the subjects with TST<5mm, 8.2% were positive by QFT-G test. These individuals had a lower mean CD4 cell count than those detected positive by both tests (328cells/microl and 560cells/microl, respectively, p=0.03). CONCLUSIONS: In this population of HIV-infected individuals, QFT-G and TST showed an acceptable level of agreement, although QFT-G appears less affected by more advanced immunosuppression.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Infecções por HIV/complicações , Interferon gama/sangue , Mycobacterium tuberculosis , Teste Tuberculínico , Tuberculose Pulmonar/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Infecções Oportunistas Relacionadas com a AIDS/microbiologia , Adulto , Idoso , Contagem de Linfócito CD4 , Chile/epidemiologia , Feminino , Infecções por HIV/imunologia , Humanos , Masculino , Pessoa de Meia-Idade , Kit de Reagentes para Diagnóstico , Reprodutibilidade dos Testes , Tuberculose Pulmonar/epidemiologia , Tuberculose Pulmonar/microbiologia , Adulto JovemRESUMO
OBJECTIVES: Caspofungin has demonstrated efficacy in invasive candidiasis. However, in a comparative study, most patients (>83%) had candidaemia. Therefore, we performed a study in patients with non-fungaemic invasive candidiasis. PATIENTS AND METHODS: Adults with proven non-fungaemic invasive candidiasis or probable chronic disseminated candidiasis (CDC) received caspofungin primary or salvage monotherapy. Most patients received 50 mg daily following a 70 mg loading dose. Patients with endocarditis, osteomyelitis or septic arthritis received caspofungin at 100 mg daily and were allowed dose escalation up to 150 mg. Primary efficacy endpoint was the overall response at end of caspofungin therapy. A favourable overall response required complete resolution of symptoms and either eradication of Candida or radiographic resolution. RESULTS: All 48 patients enrolled had confirmed infection and received>or=1 dose of caspofungin. At study entry, 8% were neutropenic. The mean APACHE II score was 14.3. Most infections were due to Candida albicans (60%) or Candida glabrata (14%). The overall success at end of caspofungin therapy was 81%. Success by site of infection was as follows: peritonitis 77% (10/13), abdominal abscess 89% (8/9), CDC 88% (7/8), osteomyelitis/septic arthritis 100% (4/4), endocarditis 33% (1/3) and multiple sites 75% (6/8). Outcomes were similar across Candida spp. None of the patients had a serious drug-related adverse event or discontinued caspofungin due to toxicity. Overall mortality until 12 week follow-up was 23%. CONCLUSIONS: In deep-seated invasive candidiasis, including peritonitis, abdominal abscesses, CDC and arthritis, caspofungin was effective and safe at regular doses and up to 100 mg daily.
Assuntos
Antifúngicos/uso terapêutico , Candidíase/tratamento farmacológico , Equinocandinas/uso terapêutico , APACHE , Adulto , Idoso , Antifúngicos/efeitos adversos , Candidíase/microbiologia , Candidíase/mortalidade , Caspofungina , Relação Dose-Resposta a Droga , Equinocandinas/efeitos adversos , Feminino , Seguimentos , Humanos , Lipopeptídeos , Masculino , Pessoa de Meia-Idade , Recidiva , Resultado do TratamentoRESUMO
OBJECTIVE: The objective was to compare the safety and efficacy of intravenous labetalol and intravenous hydralazine for acutely lowering blood pressure in pregnancy. STUDY DESIGN: Two hundred women with severe hypertension in pregnancy were randomized to receive hydralazine (5 mg as a slow bolus dose given intravenously, and repeated every 20 min up to a maximum of five doses) or labetalol (20-mg intravenous bolus dose followed by 40 mg if not effective within 20 min, followed by 80 mg every 20 min up to a maximum dose of 300 mg). The primary end point was successful lowering of blood pressure and maternal hypotension. RESULTS: Women were similar with respect to characteristics at randomization. No significant differences were observed for maternal hypotension or persistent severe hypertension; only two patients in the hydralazine group presented with hypotension. Palpitations (p=0.01) and maternal tachycardia (p=0.05) occurred significantly more often in patients treated with hydralazine. The main neonatal outcomes were very similar per group; however, hypotension and bradycardia were significantly more frequent in the labetalol group. There were two neonatal deaths per antihypertensive drug group. CONCLUSIONS: This randomized clinical trial shows that labetalol and hydralazine fulfill the criteria required for an antihypertensive drug to treat severe hypertension in pregnancy.
Assuntos
Antagonistas Adrenérgicos/uso terapêutico , Anti-Hipertensivos/uso terapêutico , Hidralazina/uso terapêutico , Hipertensão/tratamento farmacológico , Labetalol/uso terapêutico , Vasodilatadores/uso terapêutico , Antagonistas Adrenérgicos/administração & dosagem , Anti-Hipertensivos/administração & dosagem , Feminino , Humanos , Hidralazina/administração & dosagem , Hipotensão/induzido quimicamente , Labetalol/administração & dosagem , Pré-Eclâmpsia/prevenção & controle , Gravidez , Resultado da Gravidez , Taquicardia/induzido quimicamente , Vasodilatadores/administração & dosagemRESUMO
BACKGROUND: Kaposi sarcoma is the most common tumor in HIV infected patients. AIM: To describe a cohort of patients with Kaposi sarcoma. MATERIAL AND METHODS: Retrospective review of HIV patients with Kaposi sarcoma seen at a public hospital and at a HIV clinic. Detailed description of patients subjected to antiretroviral treatment and chemotherapy. RESULTS: Between 1995 and 2002, 1127 HIV infected patients were seen. Of these, 78 had Kaposi sarcoma, 15 were treated with high activity antiretroviral therapy (HAART) and 17 with HAART and chemotherapy. These 32 patients were male, and their mean age was 33 +/- 6 years. The initial CD4 count in 27 of these was 95 +/- 105 cells/ml. The initial viral load in 18 of these was 370,246 +/- 768,693 RNA copies/ml. Of the 15 patients treated with HAART, eight had a complete remission, one had a partial response, one remained stationary and five died. Of the 17 patients treated with HAART and chemotherapy, seven had complete remission, five had a partial response, 2 remained stationary and three died. The lapse of complete remission was 272 days for those treated with HAART and 292 days for those treated with HAART and chemotherapy. CONCLUSIONS: In HIV patients with Kaposi sarcoma, high activity antiretroviral therapy, associated or not to chemotherapy, induces complete remission in 46% of patients and partial remission in 16%.