RESUMO
Integrase strand transfer inhibitors (INSTI) are associated with neuropsychiatric adverse events (NPAEs). The aim of this study was to evaluate improvements in NPAEs after switching an INSTI-based regimen to darunavir/cobicistat (DRV/c) or doravirine (DOR). Methods: A prospective cohort study was conducted to evaluate the reversibility of NPAEs via the Patient Health Questionnaire (PHQ-9), the Insomnia Severity Index (ISI), and the Hospital Anxiety and Depression Scale (HADS-A and D) in patients who started antiretroviral therapy with dolutegravir (DTG) or bictegravir (BIC). These patients were switched to DRV/c or DOR. Scales were compared at the moment of the switch and 12 weeks later. Results: We included 1153 treatment-naïve men, 676 (58.7%) with BIC and 477 (41.3%) with DTG. A total of 32 (2.7%) experienced NPAEs that led to discontinuation. Insomnia was found in 20 patients; depression via PHQ-9 in 21 patients, via HADS-D in 5 patients, and anxiety via HADS-A in 12 patients. All of them were evaluated by a psychiatrist at the moment of the symptoms; 7 (21.8%) started psychotropic drugs. After 12 weeks of follow-up, PHQ-9, ISI, HADS-A, and HADS-D decreased, with a p-value ≤ 0.05. Conclusions: NPAEs seem to improve after switching to a DRV/c- or DOR-based regimen after the first 4 and 12 weeks.
Assuntos
Cobicistat , Darunavir , Infecções por HIV , Piridonas , Humanos , Masculino , Darunavir/efeitos adversos , Darunavir/uso terapêutico , Darunavir/administração & dosagem , Infecções por HIV/tratamento farmacológico , Pessoa de Meia-Idade , Estudos Prospectivos , Adulto , Cobicistat/efeitos adversos , Cobicistat/uso terapêutico , Cobicistat/administração & dosagem , Piridonas/efeitos adversos , Inibidores de Integrase de HIV/efeitos adversos , Inibidores de Integrase de HIV/uso terapêutico , Inibidores de Integrase de HIV/administração & dosagem , Compostos Heterocíclicos com 3 Anéis/efeitos adversos , Compostos Heterocíclicos com 3 Anéis/uso terapêutico , Compostos Heterocíclicos com 3 Anéis/administração & dosagem , Distúrbios do Início e da Manutenção do Sono/induzido quimicamente , Substituição de Medicamentos/efeitos adversos , Fármacos Anti-HIV/efeitos adversos , Fármacos Anti-HIV/uso terapêutico , Piperazinas/efeitos adversos , TriazóisRESUMO
Abstract: Chikungunya fever is a tropical vector-borne disease that has been spreading rapidly around the world during the last 10 years, and which has been usually misdiagnosed as dengue. Nowadays, this disease is increasing in Mexico, mainly in the southern and central zones of the country, being significantly more common in women, children and young adults (28% in < 20 years of age). The classical presentation includes fever, arthralgia, polyarthritis, back-pain, and skin rashes. Although symptoms and treatment are similar to those for dengue, there are key clinical features to differentiate these two diseases.
Resumen: La enfermedad por el virus chikungunya es una enfermedad tropical transmitida por vector, que en los últimos 10 años ha tenido una gran diseminación mundial y ha sido históricamente subdiagnosticada debido a las características en común con el dengue. Actualmente la incidencia en México ha ido en aumento, sobre todo en el centro-sur del país. Es más común en mujeres, adultos jóvenes y niños (28% son menores de 20 años). El cuadro clínico suele presentarse con fiebre, artralgia, poliartritis, dolor de espalda, cefalea y erupciones cutáneas. A pesar de que el tratamiento es sintomático y similar al del dengue, existen datos clínicos clave para diferenciarlas.