RESUMEN
BACKGROUND: Antiretroviral drugs with a lower potential to induce hepatic steatosis in human immunodeficiency virus (HIV) infection need to be identified. We compared the effect of switching efavirenz (EFV) to raltegravir (RAL) on hepatic steatosis among HIV-infected patients with nonalcoholic fatty liver disease (NAFLD) receiving EFV plus 2 nucleoside analogues. METHODS: HIV-infected patients on EFV plus tenofovir/emtricitabine or abacavir/lamivudine with NAFLD were randomized 1:1 to switch from EFV to RAL (400 mg twice daily), maintaining nucleoside analogues unchanged, or to continue with EFV plus 2 nucleoside analogues. At baseline, eligible patients should show controlled attenuation parameter (CAP) values ≥238 dB/m. Changes in hepatic steatosis at 48 weeks of follow-up over baseline levels were measured by CAP. RESULTS: Overall, 39 patients were included, and 19 of them were randomized to switch to RAL. At week 48, median CAP for the RAL group was 250 (Q1-Q3, 221-277) dB/m and 286 (Q1-Q3, 269-314) dB/m for the EFV group (P = .035). The median decrease in CAP values was -20 (Q1-Q3, -67 to 15) dB/m for the RAL arm and 30 (Q1-Q3, -17 to 49) dB/m for the EFV group (P = .011). CAP values <238 dB/m at week 48 were observed in 9 (47%) patients on RAL and 3 (15%) individuals on EFV (P = .029). CONCLUSIONS: After 48 weeks, HIV-infected individuals switching EFV to RAL showed decreases in the degree of hepatic steatosis, as measured by CAP, compared with those continuing with EFV. In addition, the proportion of patients without significant hepatic steatosis after 48 weeks was greater for those who switched to RAL. CLINICAL TRIALS REGISTRATION: NCT01900015.
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Fármacos Anti-VIH/efectos adversos , Benzoxazinas/efectos adversos , Infecciones por VIH/tratamiento farmacológico , Enfermedad del Hígado Graso no Alcohólico/inducido químicamente , Enfermedad del Hígado Graso no Alcohólico/diagnóstico por imagen , Raltegravir Potásico/efectos adversos , Alquinos , Fármacos Anti-VIH/uso terapéutico , Benzoxazinas/uso terapéutico , Índice de Masa Corporal , Peso Corporal/efectos de los fármacos , Ciclopropanos , Didesoxinucleósidos/uso terapéutico , Sustitución de Medicamentos , Quimioterapia Combinada , Diagnóstico por Imagen de Elasticidad , Emtricitabina/uso terapéutico , Femenino , Humanos , Lamivudine/uso terapéutico , Masculino , Persona de Mediana Edad , Raltegravir Potásico/uso terapéutico , Tenofovir/uso terapéutico , Triglicéridos/sangre , Relación Cintura-CaderaRESUMEN
We assessed the effect of different hepatic conditions such as fibrosis, steatosis and necroinflammatory activity on liver stiffness as measured by transient elastography in HIV/HCV-coinfected patients. We studied all consecutive HIV/HCV-coinfected patients who underwent liver biopsy and elastography between January 2007 and December 2008. Liver fibrosis was staged following METAVIR Cooperative Study Group criteria. Steatosis was categorized according to the percentage of affected hepatocytes as low (≤10%), moderate (<25%) and severe (≥25%). A total of 110 patients were included. Fibrosis was distributed by stage as follows: F0, n = 13; F1, n = 47; F2, n = 29; F3, n = 18; and F4, n = 3. Liver biopsy revealed the presence of hepatic steatosis in 68 patients (low to moderate, n = 53; and severe n = 15). By univariate regression analysis, fibrosis, necroinflammatory activity, and the degree of steatosis were correlated with liver stiffness. However, in a multiple regression analysis, steatosis and fibrosis were the only independent variables significantly associated with liver stiffness. With a cut-off of 9.5 kPa to distinguish patients with F ≤ 2 from F ≥ 3, elastography led to a significantly higher number of misclassification errors (25%vs 5%; P = 0.014), most of which were false positives for F ≥ 3. Our study suggests that the correlation between liver stiffness and fibrosis as estimated by transient elastography may be affected by the presence of hepatic steatosis in HIV/HCV-coinfected patients.
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Coinfección , Hígado Graso/patología , Infecciones por VIH/complicaciones , Hepatitis C/complicaciones , Cirrosis Hepática/patología , Adulto , Elasticidad , Diagnóstico por Imagen de Elasticidad , Hígado Graso/complicaciones , Femenino , Humanos , Cirrosis Hepática/complicaciones , Masculino , Persona de Mediana EdadRESUMEN
Transient elastography (FibroScan) is a novel, rapid and noninvasive technique to assess liver fibrosis. Our objective was to compare transient elastography (TE) and other noninvasive serum indexes as alternatives to liver biopsy in HIV/hepatitis C virus (HCV)-coinfected patients. The fibrosis stage (METAVIR Score), TE, the aspartate aminotransferase-to-platelet ratio index, the Forns fibrosis index, FIB-4 and HGM-2 indexes were assessed in 100 patients between January 2007 and January 2008. The diagnostic values were compared by calculating the area under the receiver operating characteristic curves (AUROCs). Using TE, the AUROC (95% CI) of liver stiffness was 0.80 (0.72-0.89) when discriminating between F
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Biopsia , Diagnóstico por Imagen de Elasticidad , Infecciones por VIH/complicaciones , Hepatitis C Crónica/complicaciones , Hepatitis C Crónica/patología , Cirrosis Hepática/diagnóstico , Adulto , Biomarcadores , Humanos , Cirrosis Hepática/patología , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Curva ROC , Estadística como AsuntoRESUMEN
IntroducciónEl porcentaje de gestantes infectadas por VIH que demandan embarazo ha aumentado en los países desarrollados debido a la estabilidad de la infección y la disminución de la transmisión vertical por los tratamientos antirretrovirales (TAR) y las medidas preventivas. Sin embargo, existe poca información respecto al efecto del TAR sobre el embarazo.MétodosEstudio retrospectivo de las gestantes infectadas por VIH con TAR controladas en el Hospital La Paz entre los años 2000-2017. Se estudiaron las complicaciones maternofetales.ResultadosSe recogieron 141 gestaciones en 112 mujeres infectadas por VIH. El TAR más utilizado fue la combinación de 2 inhibidores de la transcriptasa inversa análogos nucleosídicos+1 inhibidor de la proteasa (58,1%), con diferencias significativas entre los distintos tratamientos en cuanto a la carga viral plasmática, siendo indetectable en mayor medida con 2 inhibidores de la transcriptasa inversa análogos nucleosídicos +1 inhibidor de la transcriptasa inversa no nucleosídico, segunda pauta más utilizada. Las tasas de neonatos a término de bajo peso (<2.500g) (11,3%), partos pretérmino (11,1%) y rotura prematura de membranas pretérmino (5,6%) fueron mayores que en la población general. Aunque no hubo asociación, estas complicaciones fueron más frecuentes en gestantes con un inhibidor de la proteasa/ritonavir. No se relacionaron con la carga viral plasmática. No se encontró aumento en la tasa de interrupciones gestacionales, malformaciones ni diabetes gestacional.ConclusiónEn las gestantes infectadas por VIH con TAR está aumentada la tasa de neonatos a término de bajo peso, prematuridad y rotura prematura de membranas pretérmino en comparación con la población general, relacionándose especialmente con el tratamiento con un inhibidor de la proteasa, aunque sin asociación significativa.
IntroductionThe percentage of HIV-infected pregnant women seeking pregnancy has increased in developed countries due to the stability of the infection and the decrease in vertical transmission due to antiretroviral treatment (ART) and preventive measures. However, there is little information regarding the effect of ART on pregnancy.MethodsRetrospective study of HIV-infected pregnant women on ART monitored at Hospital La Paz between 2000-2017. Maternal-foetal complications were studied.ResultsOne hundred and forty-one gestations were collected in 112 HIV-infected women. The most commonly used ART was the combination of 2 nucleoside reverse transcriptase inhibitor analogues+1 protease inhibitor (58.1%), with significant differences between the different treatments in terms of plasma viral load being undetectable to a greater extent with 2 nucleoside reverse transcriptase inhibitor analogues+1 non-nucleoside reverse transcriptase inhibitor, the second most used regimen. The rates of low birth weight (<2,500g) term neonates (11.3%), preterm delivery (11.1%) and preterm premature rupture of membranes (5.6%) were higher than in the general population. Although there was no association, these complications were more frequent in pregnant women with a protease inhibitor/ritonavir. They were not related to plasma viral load. No increase in the rate of gestational terminations, malformations or gestational diabetes was found.ConclusionHIV-infected pregnant women on ART have an increased rate of low birth weight, prematurity, and preterm premature rupture of membranes at term compared to the general population, especially related to treatment with protease inhibitor, although without significant association.
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Femenino , Embarazo , Ciencias de la Salud , Terapia Antirretroviral Altamente Activa , VIH , Mujeres Embarazadas , Ginecología , EmbarazoRESUMEN
The emotional processing in human immunodeficiency virus-seropositive individuals (HIV+) has been scarcely studied. We included HIV+ individuals (n = 107) on antiretroviral therapy (≥2 years) who completed 6 facial processing tasks and neurocognitive testing. We compared HIV+ and healthy adult (HA) participants (n = 40) in overall performance of each facial processing task. Multiple logistic regressions were conducted to explore predictors of poorer accuracy in those measures in which HIV+ individuals performed poorer than HA participants. We separately explored the impact of neurocognitive status, antiretroviral regimen, and hepatitis C virus (HCV) coinfection on the tasks performance. We found similar performance in overall facial emotion discrimination, recognition, and recall between HIV+ and HA participants. The HIV+ group had poorer recognition of particular negative emotions. Lower WAIS-III Vocabulary scores and active HCV predicted poorer accuracy in recognition of particular emotions. Our results suggest that permanent damage of emotion-related brain systems might persist despite long-term effective antiretroviral therapy.
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Trastornos del Conocimiento/etiología , Emociones/fisiología , Expresión Facial , Infecciones por VIH/complicaciones , Reconocimiento en Psicología , Adulto , Análisis de Varianza , Antirretrovirales/farmacología , Antirretrovirales/uso terapéutico , Trastornos del Conocimiento/virología , Emociones/efectos de los fármacos , Femenino , VIH/genética , Infecciones por VIH/sangre , Infecciones por VIH/tratamiento farmacológico , Humanos , Receptores de Lipopolisacáridos/sangre , Masculino , Recuerdo Mental/efectos de los fármacos , Persona de Mediana Edad , Pruebas Neuropsicológicas , Estimulación Luminosa , Valor Predictivo de las Pruebas , Reconocimiento en Psicología/efectos de los fármacos , Reconocimiento en Psicología/fisiologíaRESUMEN
BACKGROUND AND OBJECTIVE: To know the durability of consecutive regimens of antiretroviral treatment is important to design a long-term therapy, but there is not much information about this subject. PATIENTS AND METHOD: Retrospective epidemiological study of a sample of 401 patients who began antiretroviral treatment between January 1997 and April 2000 at ten Spanish hospitals. The duration of each consecutive antiretroviral regimen was calculated and the reasons for modification and discontinuation were described. RESULTS: In the 3 years and 3 months covered by the study, 48.6% of the patients received more than one regimen of therapy. Seventy five of the initial prescribed combinations included protease inhibitors. Median duration of consecutive lines of therapy was decreasing: 560, 360, 330 and 202 days for the first, second, third and fourth regimens, respectively. The main reason to modification was intolerance or toxicity (46.2, 49.1 and 47.1% for the first, second and third modification). A fifth of changes was originated by difficulties to follow the therapy. Virological failure was the reason for modification in 21.8, 24.5 and 26.5% of first, second and third changes. CONCLUSIONS: Duration of consecutive antiretroviral regimens progressively decreases. Intolerance or drug toxicity were the main reasons conditioning the change of treatment.
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Fármacos Anti-VIH/uso terapéutico , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/epidemiología , Adulto , Femenino , Humanos , Masculino , Estudios Retrospectivos , España , Factores de TiempoAsunto(s)
Educación Médica Continua , Informática Médica , Narración , Adolescente , Adulto , Femenino , Humanos , MasculinoRESUMEN
To evaluate the safety and efficacy of an induction dose of pegylated interferon alpha 2a (IFN-alpha2a) on the 12-week hepatitis C virus (HCV) kinetics in human immunodeficiency virus (HIV) patients co-infected with HCV. One hundred sixteen HIV/HCV co-infected patients from nine hospitals in Spain were randomized to receive 270 microg/week of pegylated IFN-alpha2a for 4 weeks followed by 180 microg/week for 8 weeks or 180 microg/week for 12 weeks. Ribavirin was given at a daily dose of 1000 or 1200 mg. The main outcome measure was the percentage of patients achieving an HCV-RNA below 50 IU/mL or a decrease of 2 or more log(10) at week 12 (early virologic response, EVR). HCV-RNA was measured at baseline, weekly, for the first 4 weeks and monthly thereafter. We observed no difference in the percentage of patients achieving an EVR between arms (on-treatment, 74% in both arms; intention-to-treat, 70% in the induction arm and 67% in the control arm), nor were there differences in the percentage achieving an undetectable HCV qualitative polymerase chain reaction at any time points or in the decrease in HCV-RNA from baseline. No differences were found between arms in the percentage of dropouts (8% in the whole study population). Our study failed to find a benefit of an induction dose of 270 microg/week of pegylated IFN-alpha2a for 4 weeks on the EVR in co-infected patients who are treatment naive. Despite the lack of benefit with this regimen, induction therapy with this schedule was safe and well tolerated in co-infected patients.
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Antivirales/uso terapéutico , Infecciones por VIH/complicaciones , VIH-1 , Hepacivirus/aislamiento & purificación , Hepatitis C Crónica/complicaciones , Hepatitis C Crónica/tratamiento farmacológico , Interferón-alfa/uso terapéutico , Polietilenglicoles/uso terapéutico , Adulto , Esquema de Medicación , Quimioterapia Combinada , Femenino , Infecciones por VIH/tratamiento farmacológico , Hepacivirus/genética , Hepatitis C Crónica/virología , Humanos , Interferón alfa-2 , Interferón-alfa/administración & dosificación , Masculino , Proyectos Piloto , Polietilenglicoles/administración & dosificación , Reacción en Cadena de la Polimerasa , ARN Viral/sangre , Proteínas Recombinantes , Ribavirina/administración & dosificación , Ribavirina/uso terapéutico , Seguridad , España , Resultado del Tratamiento , Carga ViralRESUMEN
The hepatitis C infection is highly prevalent among HIV-infected patients. As a direct consequence of the increased survival of these patients in the HAART era, liver disease and its long-term complications have became a genuine health problem in these patients. The treatment of chronic HCV hepatitis is associated with several secondary effects, hiperlactacidemiae/lactic acidosis is one of the most dangerous. It appears to be related with the association of ribavirin and ddI, d4T or AZT. These are three cases of hiperlactacidemiae/lactic acidosis collected during the first twelve months of treatment with pegylated interferon and ribavirin in University Hospital of Guadalajara.
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Acidosis Láctica/inducido químicamente , Antivirales/efectos adversos , Infecciones por VIH/tratamiento farmacológico , Hepatitis C/tratamiento farmacológico , Interferón-alfa/efectos adversos , Polietilenglicoles , Ribavirina/efectos adversos , Adulto , Femenino , Infecciones por VIH/complicaciones , Hepatitis C/complicaciones , Humanos , Interferón alfa-2 , Masculino , Proteínas RecombinantesAsunto(s)
Antivirales/efectos adversos , Interferón-alfa/efectos adversos , Enfermedades de la Retina/inducido químicamente , Adulto , Antivirales/uso terapéutico , Hepatitis C Crónica/complicaciones , Hepatitis C Crónica/tratamiento farmacológico , Humanos , Interferón alfa-2 , Interferón-alfa/uso terapéutico , Masculino , Polietilenglicoles , Proteínas Recombinantes , Trastornos de la Visión/inducido químicamenteRESUMEN
No disponible
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Masculino , Adulto , Humanos , Antivirales/efectos adversos , Interferón-alfa/efectos adversos , Enfermedades de la Retina/inducido químicamente , Antivirales/uso terapéutico , Hepatitis C Crónica/complicaciones , Hepatitis C Crónica/tratamiento farmacológico , Interferón-alfa/uso terapéutico , Trastornos de la Visión/inducido químicamenteRESUMEN
No disponible
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Masculino , Anciano , Humanos , Enfermedades Musculares/microbiología , Clostridium/patogenicidad , Infecciones por Clostridium/complicaciones , Mordeduras y Picaduras/complicaciones , Aves de Corral , Diagnóstico Diferencial , Necrosis/complicaciones , Antibacterianos/uso terapéuticoRESUMEN
La infección por virus de la hepatitis C tiene una alta prevalencia entre las personas infectadas por VIH. Por su elevada tasa de evolución a la cronicidad, pudiendo progresar a cirrosis y carcinoma hepatocelular, y el incremento en la esperanza de vida de estos pacientes es necesario afrontar el tratamiento de esta coinfección.La asociación del TARGA con el interferón y la ribavirina produce interacciones y efectos adversos no bien documentados hasta el momento actual. La hiperlactacidemia/acidosis láctica es uno de los más potencialmente graves que parece asociado a la combinación de ribavirina con ddI, d4T o AZT.Se describen tres casos de hiperlactacidemia/ acidosis láctica recogidos en el Hospital Universitario de Guadalajara durante el tratamiento de la hepatitis C crónica en pacientes con infección por VIH. (AU)
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Adulto , Masculino , Femenino , Humanos , Ribavirina , Infecciones por VIH , Interferón-alfa , Antivirales , Acidosis Láctica , Hepatitis CRESUMEN
No disponible
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Adolescente , Adulto , Masculino , Femenino , Humanos , Narración , Informática Médica , Educación Médica Continua , España , Transexualidad , Atención a la SaludRESUMEN
OBJETIVO: Valorar la adecuación de ingresos y altas hospitalarias de un área de urgencias analizando su relación con diversas variables. MATERIAL Y MÉTODOS: Se evaluó la adecuación del ingreso y alta, aplicando el Appropriateness Evaluation Protocol (AEP) retrospectivamente a una muestra representativa de pacientes atendidos en urgencias en Junio/1998. RESULTADOS: En las altas, el acuerdo encontrado entre el AEP y el juicio médico fue del 96,43 por ciento. El 2,4 por ciento de las altas fueron inadecuadas. Los pacientes a los que se les solicitó alguna prueba, presentaron una inadecuación significativamente mayor (p=0,01). La inadecuación de solicitud de pruebas complementarias actúa como factor independiente de protección para el ingreso inadecuado. CONCLUSIONES: Los resultados obtenidos son aceptables, si bien, deben realizarse estudios de evaluación para identificar problemas y adoptar las correspondientes estrategias de mejora (AU)