ABSTRACT
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.
Subject(s)
Anti-HIV Agents/adverse effects , Benzoxazines/adverse effects , HIV Infections/drug therapy , Non-alcoholic Fatty Liver Disease/chemically induced , Non-alcoholic Fatty Liver Disease/diagnostic imaging , Raltegravir Potassium/adverse effects , Alkynes , Anti-HIV Agents/therapeutic use , Benzoxazines/therapeutic use , Body Mass Index , Body Weight/drug effects , Cyclopropanes , Dideoxynucleosides/therapeutic use , Drug Substitution , Drug Therapy, Combination , Elasticity Imaging Techniques , Emtricitabine/therapeutic use , Female , Humans , Lamivudine/therapeutic use , Male , Middle Aged , Raltegravir Potassium/therapeutic use , Tenofovir/therapeutic use , Triglycerides/blood , Waist-Hip RatioSubject(s)
Antiviral Agents/adverse effects , Interferon-alpha/adverse effects , Retinal Diseases/chemically induced , Adult , Antiviral Agents/therapeutic use , Hepatitis C, Chronic/complications , Hepatitis C, Chronic/drug therapy , Humans , Interferon alpha-2 , Interferon-alpha/therapeutic use , Male , Polyethylene Glycols , Recombinant Proteins , Vision Disorders/chemically inducedABSTRACT
No disponible
Subject(s)
Male , Adult , Humans , Antiviral Agents/adverse effects , Interferon-alpha/adverse effects , Retinal Diseases/chemically induced , Antiviral Agents/therapeutic use , Hepatitis C, Chronic/complications , Hepatitis C, Chronic/drug therapy , Interferon-alpha/therapeutic use , Vision Disorders/chemically inducedABSTRACT
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.
Subject(s)
Anti-HIV Agents/therapeutic use , HIV Infections/drug therapy , HIV Infections/epidemiology , Adult , Female , Humans , Male , Retrospective Studies , Spain , Time FactorsSubject(s)
Education, Medical, Continuing , Medical Informatics , Narration , Adolescent , Adult , Female , Humans , MaleABSTRACT
No disponible
Subject(s)
Adolescent , Adult , Male , Female , Humans , Narration , Medical Informatics , Education, Medical, Continuing , Spain , Transsexualism , Delivery of Health CareABSTRACT
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)
