RESUMO
We report the use of efavirenz 600 mg/emtricitabine 200 mg/tenofovir disoproxil fumarate 300 mg, once daily in a 47-year-old black man with a solitary kidney and human immunodeficiency virus (HIV). In 1990, he underwent radiation, chemotherapy, and ultimately, a unilateral nephrectomy for Wilms' tumor. Because of previous reports of tenofovir disoproxil fumarate-induced nephrotoxicity, our objective was to evaluate and monitor our patient's renal function over the course of 19 months based on serum creatinine, estimated creatinine clearance using the Cockroft-Gault equation, estimated glomerular filtration rate using the modification of diet in renal disease formula and urinalyses. After experiencing gastrointestinal side effects from other antiretroviral agents, our patient was switched to efavirenz/emtricitabine/tenofovir disoproxil fumarate in June 2013. At baseline, his serum creatinine was 1.35 mg/dL, estimated creatinine clearance 68.7 mL/min (based on actual body weight of 71.8 kg), estimated glomerular filtration rate 72.9 mL/min/1.73 m(2), with a CD4 cell count of 119 cells/mm(3) (5%) and an undetectable HIV viral load. In March 2015, his weight was 73.2 kg, serum creatinine 1.42 mg/dL, estimated creatinine clearance 65.2 mL/min, estimated glomerular filtration rate 68.1 mL/min/1.73 m(2), with a CD4 cell count of 120 cells/mm(3) (10%) and an undetectable HIV viral load. Other authors have reported tenofovir-induced nephrotoxicity in patients with a solitary kidney. Our patient had no evidence of nephrotoxicity over the course of 19 months on tenofovir disoproxil fumarate-based antiretroviral therapy (ART). He maintained adequate renal function, comparable to his baseline renal function. Our case report suggests that a tenofovir disoproxil fumurate-based ART may be a viable option for some patients with a solitary kidney. Additional studies and data are needed considering this is a small and relatively unstudied population.
Assuntos
Fármacos Anti-HIV/efeitos adversos , Fármacos Anti-HIV/uso terapêutico , Taxa de Filtração Glomerular/efeitos dos fármacos , Infecções por HIV/tratamento farmacológico , Rim/efeitos dos fármacos , Tenofovir/uso terapêutico , Adenina/efeitos adversos , HIV-1/efeitos dos fármacos , Humanos , Masculino , Pessoa de Meia-Idade , Nefrectomia , Resultado do TratamentoAssuntos
Controle de Doenças Transmissíveis/organização & administração , Ética Médica , Política de Saúde/legislação & jurisprudência , Acessibilidade aos Serviços de Saúde/organização & administração , Prisioneiros/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Idoso , Atenção à Saúde/organização & administração , Feminino , Nível de Saúde , Humanos , Masculino , Medicina , Pessoa de Meia-Idade , Avaliação das Necessidades , Formulação de Políticas , Prisões , Saúde Pública , Fatores de Risco , Fatores Sexuais , Estados Unidos , Adulto JovemAssuntos
Atenção à Saúde/organização & administração , Acessibilidade aos Serviços de Saúde/organização & administração , Prisioneiros/estatística & dados numéricos , Prisões/métodos , Controle de Doenças Transmissíveis/organização & administração , Feminino , Humanos , Comunicação Interdisciplinar , Masculino , Medicina , Transtornos Mentais/diagnóstico , Transtornos Mentais/epidemiologia , Transtornos Mentais/terapia , Avaliação das Necessidades , Estados UnidosRESUMO
Correctional populations have an elevated human immunodeficiency virus (HIV) prevalence, yet many individuals lack access to subspecialty care. Our study showed that HIV-infected inmates had significantly greater virologic suppression and higher CD4 T-lymphocyte counts when managed by a multidisciplinary team of subspecialists conducting clinics via telemedicine. In other studies, these outcomes have been associated with reductions on HIV-related morbidity and mortality, as well as HIV transmission.
Assuntos
Antirretrovirais/uso terapêutico , Infecções por HIV/tratamento farmacológico , Infecções por HIV/virologia , HIV/isolamento & purificação , Prisões , Telemedicina/métodos , Carga Viral , Adolescente , Adulto , Contagem de Linfócito CD4 , Estudos de Coortes , Infecções por HIV/imunologia , Humanos , Pessoa de Meia-Idade , Resultado do Tratamento , Adulto JovemRESUMO
OBJECTIVE: This study estimated the seroprevalence of hepatitis C virus in a public-sector psychiatric hospital. METHOD: Patients admitted between Jan. 1, 1998, and Dec. 30, 2000, were routinely screened for hepatitis C virus antibody on admission. RESULTS: A total of 133 (8.5%) of 1,556 patients admitted were positive for the hepatitis C virus. Aminotransferase levels were elevated but rarely abnormal among patients positive for the hepatitis C virus. Hepatitis B surface antibody was found in 27.8% of the patients positive for the hepatitis C virus. These patients were more likely to receive a diagnosis of psychoactive substance use disorder but no other psychiatric diagnoses. CONCLUSIONS: The prevalence of hepatitis C virus is high among psychiatric patients in the public sector. Much needs to be learned about the role of universal screening and effective techniques for primary prevention and antiviral treatment in this population.