RESUMO
OBJECTIVE: To update the 2010 recommendations on the evaluation and management of renal disease in HIV-infected patients. METHODS: This document was approved by a panel of experts from the AIDS Working Group (GESIDA) of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), the Spanish Society of Nephrology (S.E.N.), and the Spanish Society of Clinical Chemistry and Molecular Pathology (SEQC). The quality of evidence and the level of recommendation were evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. RESULTS: The basic renal work-up should include measurements of serum creatinine, estimated glomerular filtration rate by CKD-EPI, Urine protein-to-creatinine ratio, and urinary sediment. Tubular function tests should include determination of serum phosphate levels and urine dipstick for glucosuria. In the absence of abnormal values, renal screening should be performed annually. In patients treated with tenofovir or with risk factors for chronic kidney disease (CKD), more frequent renal screening is recommended. In order to prevent disease progression, potentially nephrotoxic antiretroviral drugs are not recommended in patients with CKD or risk factors for CKD. The document advises on the optimal time for referral of a patient to the nephrologist and provides indications for renal biopsy. The indications for and evaluation and management of dialysis and renal transplantation are also addressed. CONCLUSIONS: Renal function should be monitored in all HIV-infected patients. The information provided in this document should enable clinicians to optimize the evaluation and management of HIV-infected patients with renal disease.
Assuntos
Infecções por HIV/complicações , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/terapia , Algoritmos , Humanos , Testes de Função Renal , Encaminhamento e Consulta , Insuficiência Renal Crônica/classificação , Insuficiência Renal Crônica/complicações , Fatores de RiscoRESUMO
The aim of this article is to update the 2010 recommendations on the evaluation and management of renal disease in HIV-infected patients. Renal function should be monitored in all HIV-infected patients. The basic renal work-up should include measurements of serum creatinine, estimated glomerular filtration rate by CKD-EPI, urine protein-to-creatinine ratio, and urinary sediment. Tubular function tests should include determination of serum phosphate levels and urine dipstick for glucosuria. In the absence of abnormal values, renal screening should be performed annually. In patients treated with tenofovir or with risk factors for chronic kidney disease (CKD), more frequent renal screening is recommended. In order to prevent disease progression, potentially nephrotoxic antiretroviral drugs are not recommended in patients with CKD or risk factors for CKD. The document provides indications for renal biopsy and advises on the optimal time for referral of a patient to the nephrologist. The indications for and evaluation and management of dialysis and renal transplantation are also addressed.
Assuntos
Infecções por HIV/complicações , Insuficiência Renal Crônica/terapia , Anemia/etiologia , Anemia/terapia , Fármacos Anti-HIV/efeitos adversos , Fármacos Anti-HIV/farmacocinética , Fármacos Anti-HIV/uso terapêutico , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/terapia , Comorbidade , Complicações do Diabetes/epidemiologia , Complicações do Diabetes/terapia , Gerenciamento Clínico , Progressão da Doença , Interações Medicamentosas , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Hepatite Viral Humana/epidemiologia , Humanos , Hiperlipidemias/tratamento farmacológico , Hiperlipidemias/epidemiologia , Hipertensão/tratamento farmacológico , Hipertensão/epidemiologia , Imunossupressores/efeitos adversos , Imunossupressores/farmacocinética , Imunossupressores/uso terapêutico , Testes de Função Renal , Transplante de Rim , Nefrologia , Sobrepeso/epidemiologia , Transplante de Pâncreas , Encaminhamento e Consulta , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/epidemiologia , Terapia de Substituição Renal , UrináliseRESUMO
The aim of this article is to update the 2010 recommendations on the evaluation and management of renal disease in human immunodeficiency virus (HIV)-infected patients. Renal function should be monitored in all HIV-infected patients. The basic renal work-up should include measurements of serum creatinine, estimated glomerular filtration rate by CKD-EPI, urine protein-to-creatinine ratio, and urinary sediment. Tubular function tests should include determination of serum phosphate levels and urine dipstick for glycosuria. In the absence of abnormal values, renal screening should be performed annually. In patients treated with tenofovir, or with risk factors for chronic kidney disease (CKD), more frequent renal screening is recommended. In order to prevent disease progression, potentially nephrotoxic antiretroviral drugs are not recommended in patients with CKD or risk factors for CKD. The document provides indications for renal biopsy and advises on the optimal time for referral of a patient to the nephrologist. The indications for and evaluation and management of dialysis and renal transplantation are also addressed.
Assuntos
Infecções por HIV/complicações , Nefropatias/terapia , Adenina/efeitos adversos , Adenina/análogos & derivados , Adenina/uso terapêutico , Algoritmos , Fármacos Anti-HIV/efeitos adversos , Fármacos Anti-HIV/uso terapêutico , Biópsia , Doenças Cardiovasculares/complicações , Gerenciamento Clínico , Medicina Baseada em Evidências , Infecções por HIV/tratamento farmacológico , Hepatite Viral Humana/complicações , Hepatite Viral Humana/cirurgia , Humanos , Rim/patologia , Nefropatias/induzido quimicamente , Nefropatias/complicações , Nefropatias/diagnóstico , Testes de Função Renal , Transplante de Rim , Transplante de Fígado , Ácidos Fosforosos/efeitos adversos , Ácidos Fosforosos/uso terapêutico , Complicações Pós-Operatórias/prevenção & controle , Encaminhamento e Consulta , Terapia de Substituição Renal , Fatores de RiscoAssuntos
Infecções por Actinomycetales/microbiologia , Ponte de Artéria Coronária , Bactéria Gordonia/isolamento & purificação , Osteomielite/microbiologia , Esternotomia/efeitos adversos , Esterno/microbiologia , Infecção da Ferida Cirúrgica/microbiologia , Infecções por Actinomycetales/diagnóstico , Infecções por Actinomycetales/tratamento farmacológico , Infecções por Actinomycetales/cirurgia , Idoso , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Fístula Cutânea/etiologia , Desbridamento , Diagnóstico Diferencial , Exsudatos e Transudatos/microbiologia , Feminino , Bactéria Gordonia/efeitos dos fármacos , Humanos , Testes de Sensibilidade Microbiana , Nocardiose/diagnóstico , Osteomielite/tratamento farmacológico , Osteomielite/cirurgia , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz , Esterno/cirurgia , Infecção da Ferida Cirúrgica/tratamento farmacológico , Infecção da Ferida Cirúrgica/cirurgiaAssuntos
Linfoma de Burkitt/virologia , Herpesvirus Humano 4/isolamento & purificação , Linfoma Relacionado a AIDS/virologia , Neoplasias Meníngeas/virologia , Compressão da Medula Espinal/etiologia , Neoplasias da Coluna Vertebral/virologia , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Terapia Antirretroviral de Alta Atividade , Linfoma de Burkitt/complicações , Linfoma de Burkitt/tratamento farmacológico , Ciclofosfamida/administração & dosagem , Doxorrubicina/administração & dosagem , Evolução Fatal , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/virologia , Humanos , Região Lombossacral , Linfoma Relacionado a AIDS/complicações , Linfoma Relacionado a AIDS/tratamento farmacológico , Neoplasias Meníngeas/complicações , Pessoa de Meia-Idade , Paraparesia/etiologia , Prednisolona/administração & dosagem , Neoplasias da Coluna Vertebral/complicações , Vincristina/administração & dosagemRESUMO
The response to pegylated interferon (pegIFN) plus ribavirin (RBV) as treatment of chronic hepatitis C virus (HCV) infection is lower in HIV-coinfected than in HCV-monoinfected patients and could be due to suboptimal RBV dosing and/or insufficient duration of therapy in prior trials. In a prospective, multicenter, open, comparative trial, HCV/HIV-coinfected patients received pegIFN plus weight-based RBV for 48 or 72 weeks (HCV genotypes 1 and 4) and 24 or 48 weeks (HCV genotypes 2 and 3). Use of didanosine was not allowed. Out of 389 patients included in the trial, 61% were infected by HCV-1/4 and 67% had serum HCV-RNA >500,000 IU/ml. Sustained virological response (SVR) was achieved by 49.6%, significantly higher in HCV-2/3 than HCV-1/4 (72.4% vs. 35%; p < 0.0001). A high drop-out rate in the longer treatment arms precluded obtaining definitive conclusions about the efficacy of prolonging therapy. Premature treatment discontinuations due to serious adverse events occurred in 8.2%. Infection with HCV-2/3, lower baseline HCV-RNA, and negative HCV-RNA at week 12 were all independent predictors of SVR in the multivariate analysis. The use of RBV 1000-1200 mg/day plus pegIFN is relatively safe and provides SVR in nearly half of coinfected patients, twice as high in HCV-2/3 than HCV-1/4.