RESUMEN
Two adult patients living with AIDS presented with severe bone pain associated with tenofovir (TDF) use. Both were unable to walk without assistance and were severely restricted in their movement due to the bone pain. Both had mild renal impairment, Fanconi syndrome, and bone mineral density (BMD) loss. Bone pain and inability to walk were reversible with the cessation of TDF and supplementation with Vitamin D(3), calcium, and phosphate. These cases appear to be examples of the severity of BMD loss associated with TDF use and suggest not only attention to renal function with TDF use, but also monitoring of alkaline phosphatase (bone fraction) and plasma phosphorus as indicators of BMD loss.
Asunto(s)
Adenina/análogos & derivados , Fármacos Anti-VIH/efectos adversos , Infecciones por VIH/tratamiento farmacológico , VIH-1 , Limitación de la Movilidad , Organofosfonatos/efectos adversos , Osteoporosis/inducido químicamente , Dolor/inducido químicamente , Absorciometría de Fotón , Adenina/efectos adversos , Adulto , Fosfatasa Alcalina/sangre , Terapia Antirretroviral Altamente Activa/métodos , Bicarbonatos/sangre , Conservadores de la Densidad Ósea/uso terapéutico , Síndrome de Fanconi/inducido químicamente , Humanos , Masculino , Persona de Mediana Edad , Osteoporosis/diagnóstico , Osteoporosis/tratamiento farmacológico , Osteoporosis/prevención & control , Dolor/diagnóstico , Dolor/tratamiento farmacológico , Dolor/prevención & control , TenofovirRESUMEN
Although established in controlled studies that there is no advantage to 4-drug highly active antiretroviral therapy (HAART) or regimens with or without protease inhibitors (PIs), we questioned this finding in a clinical setting (ie, no inclusion criteria). Ours is a single clinic retrospective study including all participants >18 years of age during their first year of HAART. A total of 190 participants were reviewed, with 168 (88%) attaining a viral load <400 copies/mL at the end of a year of HAART; 144 of 164 (88%) succeeded with 3 drugs and 24 of 26 (92%) with 4 drugs (P = .51). In all, 59 of 71 (83%) succeeded using a PI versus 109 of 119 (92%) without a PI (P = .08). Male gender and exposure time to HAART were significant variables for a successful outcome. Failures were due to side effects (50%), nonadherence (45%), and drug allergy (5%). Our results support current guidelines recommending 3-drug HAART.
Asunto(s)
Terapia Antirretroviral Altamente Activa/métodos , Infecciones por VIH/tratamiento farmacológico , Inhibidores de Proteasas/uso terapéutico , Adenina/análogos & derivados , Adenina/uso terapéutico , Adolescente , Adulto , Alquinos , Sulfato de Atazanavir , Benzoxazinas/uso terapéutico , Estudios de Cohortes , Ciclopropanos , Desoxicitidina/análogos & derivados , Desoxicitidina/uso terapéutico , Combinación de Medicamentos , Hipersensibilidad a las Drogas/complicaciones , Combinación Efavirenz, Emtricitabina y Fumarato de Tenofovir Disoproxil , Combinación Emtricitabina y Fumarato de Tenofovir Disoproxil , Femenino , Infecciones por VIH/sangre , Humanos , Kentucky , Lamivudine/uso terapéutico , Masculino , Cumplimiento de la Medicación , Persona de Mediana Edad , Nevirapina/uso terapéutico , Oligopéptidos/uso terapéutico , Organofosfonatos/uso terapéutico , Compuestos Organofosforados/uso terapéutico , Oxazinas/uso terapéutico , Piridinas/uso terapéutico , Estudios Retrospectivos , Factores Sexuales , Carga Viral , Adulto Joven , Zidovudina/uso terapéuticoRESUMEN
OBJECTIVES: To determine the efficacy and compare the side-effects of cevimeline and pilocarpine in the secretion of saliva in patients with xerostomia. METHODS: A randomized, cross-over, double blind study was designed. Fifteen patients with diagnosis of xerostomia were assigned to take either 5 mg of pilocarpine or 30 mg of cevimeline three times a day for four weeks. Salivary flow rates were measured during the initial baseline, first and second month appointments. Statistical analysis was carried out with ANOVA and post hoc t-tests. RESULTS: Twelve patients completed both medication treatments. Although both medications proved to increase salivary secretion, there was no significant difference between pilocarpine and cevimeline. Also, the perceived side-effects between the two medications were similar. CONCLUSION: Both medications increased the secretion of saliva at the end of four weeks. However, there was a slightly higher increment in saliva with pilocarpine. However, the difference was not statistically significant.