ABSTRACT
Long-term antiretroviral drug toxicity may exacerbate the impact of HAART-Cyperus esculentus (C. esculentus) interactions on testicular function in HIV-infected individuals. This study examined the ability of C. esculentus plants to treat testicular dysfunction, which is thought to be a probable side effect of antiretroviral toxicity. Adult Wistar male rats weighing 90-110 g were divided into six groups and administered the prescribed treatments. In addition to testicular histology and stereological parameters, testosterone levels, follicle-stimulating hormone levels, antioxidant markers, malondialdehyde (MDA), superoxide dismutase (SOD), and glutathione levels were also evaluated. The adverse consequences of highly active antiretroviral therapy (HAART) include considerable loss of germ cells, enlargement of the tubular lumen, widening of interstitial gaps, and severe hypocellularity. Compared to the other treatment groups, MDA levels dramatically increased, whereas GSH and antioxidant enzyme (SOD) levels significantly decreased. Testicular architecture was largely conserved after treatment with C. esculentus, with a notable increase in the cellular densities of germinal and interstitial cells and a notable decrease in the tubular lumen. Vacuolation, architectural malformations, and hypoplastic changes were reduced. Significant improvements were also observed in C. esculentus in terms of elevated antioxidant SOD and GSH levels and decreased MDA levels. C. esculentus reduced architectural distortions and testicular dysfunction caused by HAART, and improved testicular morphology. Further exploration of these pathways is required.
Subject(s)
Cyperus , Rats, Wistar , Testis , Animals , Male , Testis/drug effects , Testis/pathology , Testis/metabolism , Rats , Plant Extracts/pharmacology , Testosterone/blood , Superoxide Dismutase/metabolism , Antioxidants/pharmacology , Antioxidants/metabolism , Glutathione/metabolism , Antiretroviral Therapy, Highly Active , Malondialdehyde/metabolism , Oxidative Stress/drug effects , Anti-Retroviral Agents/toxicityABSTRACT
No disponible
Subject(s)
Humans , Male , Middle Aged , Colitis/chemically induced , Anti-Retroviral Agents/adverse effects , Fatty Liver/diagnostic imaging , Apoptosis/drug effects , Anti-Retroviral Agents/toxicity , Diarrhea/complications , Diarrhea/etiology , Fatty Liver/drug therapy , Loperamide/therapeutic use , Colonic Diseases/complications , Drug Substitution/methods , Darunavir/therapeutic useABSTRACT
Background: The incidence of antiretroviral therapy (ART)-induced lactic acidosis and its associated mortality may be reduced by appropriate dosing; risk stratification and early detection. Objectives: To describe the epidemiology of lactic acidosis; define the risk factors and identify predictive laboratory markers in the context of the roll-out of ART in South Africa. Design: A nested case control study. Risk factor analysis was adjusted for the established risk factors of weight and gender.Setting and subjects: Persons commenced on stavudine-containing therapy between 2004 and 2007 at Port Shepstone Hospital in KwaZulu-Natal were included. Persons with a body weight above 60 kg received Stavudine 40 mg twice daily; and those with a body weight below 60 kg; 30 mg twice daily.Outcome measures: Assessed risk factors included weight; gender; age; alanine transaminase (ALT); urea; creatinine; albumin; cholesterol; triglyceride (TG) levels; CD4 counts and viral loads.Results: Lactic acidosis occurred in 79 (17 per 1 000 person-years) of 1 762 people living with HIV on ART. Significant factors were being female [adjusted odds ratio (AOR) of 5.4] and increased body weight (adjusted OR of 1.1 per kg). The risk of lactic acidosis increased 6.6; 6.9 and 95 times (adjusted ORs) as weight increased from a baseline weight of 60 kg to 60-69 kg; 70-79 kg or 80 kg; respectively. Six months into therapy; predictors of developing lactic acidosis were an ALT 50 IU/l (adjusted OR of 11.1) and a higher TG (adjusted OR of 8.8 per mmol/l). No associations were found with regard to age; CD4 count; viral load; and creatinine or albumin levels.Conclusion: Obese females are at greatest risk of lactic acidosis; with an exponential increase in risk above 80 kg. The 30-mg dose may be preferable; given that a sharp increase in risk occurred at 60 kg; was most likely dose related; and that 30 mg has been shown to provide adequate virological suppression. Additional risk factors for lactic acidosis include a high ALT and TG levels at treatment
Subject(s)
Acidosis , Anti-Retroviral Agents/toxicity , Biomarkers , Risk Factors , StavudineABSTRACT
Highly active antiretroviral therapy (HAART)-associated toxicity has been the most important limiting factor of the doubtless efficacy of this treatment. HAART-associated toxicity can have two kinds of temporal profiles; early toxicity, also known as tolerability, and long-term or chronic toxicity. Both types of toxicity are of foremost importance, not only because they represent an added co-morbidity, but also because the patient often associates the starting of HAART with toxic effects. This fact has often been linked to a decrease in patient adherence to the treatment, which may eventually lead to virological failure. The appearance of long-term toxic effects is usually due to continuous, even indefinite, exposure to antiretroviral drugs. When antiretroviral drug toxicity develops, the caregiver usually has two choices; to decrease and/or reverse such toxicity. On the one hand, withdrawal of the offending agent and its substitution for another agent with a different toxicity profile, and on the other, pharmacological or non-pharmacological interventions directed at correcting the toxicity-associated problems. However, it should be kept in mind that pharmacological interventions always have the possibility of giving rise to interactions with antiretroviral drugs, eventually leading to new toxic effects. Fortunately, in the last few years, new drugs and drug families have been added to the antiretroviral (AU)
Desde el inicio de la era del tratamiento antirretroviral de gran actividad (TARGA), existe la evidencia de que el factor más importante que ha limitado la indudable eficacia del TARGA ha sido la toxicidad secundaria al tratamiento. Dicha toxicidad puede adoptar dos perfiles temporales: la toxicidad precoz, acorto plazo o tolerabilidad, y la toxicidad a largo plazo o toxicidad crónica. Ambos tipos de toxicidades son importantes no sólo por la carga adicional de comorbilidad que suponen, sino también por el hecho de que frecuentemente el paciente establece la relación entre la toma de medicamentos y la aparición de síntomas o signos de toxicidad. Este hecho puede suponer, en muchos casos, un menoscabo de la adherencia del paciente al TARGA y precipitar un fracaso virológico. En el caso de la toxicidad crónica, su aparición se verá favorecida por la exposición continuada a los fármacos de forma indefinida. Las actuaciones a realizar frente a la aparición de toxicidad por antirretrovirales pueden resumirse en dos; por un lado, la retirada del fármaco implicado en la aparición de la toxicidad y su sustitución por un congénere que no la presente y, por otro, la implementación de intervenciones farmacológicas o no dirigidas a la corrección de los trastornos secundarios a dicha toxicidad. Debe tenerse en cuenta que si dicha intervención es farmacológica, los fármacos utilizados para dicho fin pueden interactuar con los antirretrovirales y, a resultas de ello, causar toxicidad adicional. En los últimos años se han incorporado nuevos fármacos e incluso nuevas familias al arsenal antirretroviral, cuya toxicidad tanto a corto como a largo plazo es mucho menor que la de (..) (AU)
Subject(s)
Humans , Anti-Retroviral Agents/toxicity , /therapy , HIV Infections/drug therapy , /adverse effects , Toxicogenetics , Treatment RefusalABSTRACT
La monoterapia con lopinavir/ritonavir como estrategia de simplificación tiene el potencial de minimizar la toxicidad del tratamiento antirretroviral sin perder eficacia en casos seleccionados según estudios realizados en adultos; sin embargo, existen pocos datos en niños. Describimos una serie de 5 casos pediátricos tratados con este régimen durante una mediana de 112 semanas. Un niño con problemas de adhesión requirió intensificación de tratamiento por fallo virológico, presentando nuevamente carga viral indetectable. Ensayos clínicos aleatorizados controlados son necesarios para evaluar la eficacia de esta estrategia en niños y establecerlas recomendaciones apropiadas (AU)
Lopinavir/ritonavir monotherapy as a simplification strategy has the potential to minimize antiretroviral treatment toxicity without losing efficacy in selected cases, according to studies in adults, but little is known in paediatric patients. We report 5 children on this regimen for a median time of 112 weeks. One child with suboptimal adherence required intensification therapy to re-suppress viral load. Randomised controlled trials are needed to evaluate the efficacy of this strategy in children in order to make appropriate recommendations (AU)
Subject(s)
Humans , Male , Female , Child , HIV/pathogenicity , Ritonavir/therapeutic use , Anti-Retroviral Agents/toxicity , Anti-Retroviral Agents/therapeutic use , Ritonavir/administration & dosageSubject(s)
Humans , Male , Female , Anti-Retroviral Agents/toxicity , Anti-Retroviral Agents/therapeutic use , HIV Infections/complications , HIV Infections/drug therapy , Emigrants and Immigrants/statistics & numerical data , Retrospective Studies , Emigration and Immigration/trends , Epidemiological Monitoring/organization & administration , Epidemiological Monitoring/statistics & numerical data , Epidemiological Monitoring/standardsABSTRACT
Introducción: En el presente trabajo, pretendemos definir el porcentaje de lactantes, hijos de madre VIH−+, pertenecientes a la cohorte prospectiva madrileña Fundación para la Investigación y la Prevención del SIDA en España y expuestos a tratamiento antirretroviral intraútero y perinatal, que presentan hiperlactacidemia u otros marcadores de posible daño mitocondrial, como hipertransaminasemia, o hiperamilasemia, durante los 3 primeros meses de vida, así como establecer una correlación entre los fármacos usados y el porcentaje de lactantes con dichos efectos adversos. Métodos: Se realizó el análisis de las analíticas disponibles de 623 niños no infectados nacidos en el periodo 20002005, fijándose los límites para hiperlactacidemia, hipertransaminasemia e hiperamilasemia de las tablas de toxicidad pediátrica para ensayos relativos al VIH (tablas ACTG), de manera global y para cada fármaco usado durante la gestación. Resultados: Los porcentajes de niños con hiperlactacidemia a los 0,5, 1,5 y 3 meses fueron del 48, 51,4 y 43%, de entre los lactantes con analítica disponible el porcentaje de niños con elevación de GOT a los 0,5, 1,5 y 3 meses fue del 13,2, 10,4 y de 17,2%. Respectivamente, la proporción de lactantes con elevación de GPT fue del 3,3, 3,4 y 5%. No se encontró hiperamilasemia en ningún niño en el análisis de los 15 días de vida. La proporción de niños con hiperamilasemia a las 6 semanas y a los 3 meses fue de 0,6 y 2,6%. No hubo diferencias significativas al realizar la comparación de los porcentajes de hiperlactacidemia, hipertransaminasemia o hiperamilasemia según el fármaco usado intraútero. Conclusiones: Hemos encontrado un alto porcentaje de lactantes expuestos a tratamiento antirretroviral intraútero con hiperlactacidemia, acorde con los resultados de otras series, sin que se haya comunicado morbimortalidad asociada a este fenómeno y no hemos podido asociar mayor prevalencia de hiperlactacidemia, hipertransaminasemia o hiperamilasemia a ninguno de los fármacos usados en la gestación (AU)
Introduction: In this study, we attempt to find out the percentage of uninfected infants born to HIV-infected women and exposed in-utero and perinatally to Antiretroviral Treatment (ART) that show high lactate levels, or any other mitochondrial damage markers (such as hypertransaminasaemia or hyperamylasaemia), during the first three months of age. We shall also establish whether certain drugs used in-utero are associated with higher lactate, transaminase or amylase levels. Methods: We analysed the available data from 623 uninfected infants born in the Spanish FIPSE cohort that were born in the period 20002005. The normal values for lactate, transaminases and amylase were set according to AIDS Clinical Groups Trials toxicity tables for infants. Results: The percentages of children with high lactate levels at 0.5; 1.5 and 3 months of age were 48%, 51.4% and 43% among those infants with available data. Respectively, the percentages of children with high AST values were 13.2; 10.4 and 17.2%. The values for high ALT were 3.3%; 3.4% and 5%. The percentages for hyperamylasaemia were 0%; 0.6% and 2.6%. We found no significant difference among the drugs used in utero for the four analysed biochemical markers along the first three months of age. Conclusions: We have found a high proportion of hyperlactataemia among infants exposed in-utero to ART, as shown in other cohorts of similar characteristics. No morbidity or mortality was communicated to the cohort analysis group. No ART drug among those used in-utero was statistically associated with a higher proportion of high lactate levels in these infants (AU)
Subject(s)
Humans , Male , Female , Infant , HIV Seropositivity/complications , HIV Seropositivity/diagnosis , HIV Seropositivity/epidemiology , Infectious Disease Transmission, Vertical/classification , Infectious Disease Transmission, Vertical/prevention & control , Anti-Retroviral Agents/adverse effects , Anti-Retroviral Agents/pharmacology , Anti-Retroviral Agents/toxicity , Data Interpretation, Statistical , 28599 , Transaminases , Transaminases/metabolism , Transaminases/toxicity , Lactic Acid/adverse effects , Lactic Acid/chemical synthesis , Lactic Acid/toxicityABSTRACT
Objetivo Actualizar información sobre interacciones medicamentosas en pacientes con VIH/sida. Método Se realizó una revisión en PubMed de artículos publicados en inglés y español entre el 1 de julio de 2007 y el 30 de abril de 2009 sobre interacciones de antirretrovirales en humanos. La búsqueda fue complementada con la revisión de interacciones de medicamentos utilizados frecuentemente en pacientes con VIH/sida y de referencias de artículos considerados relevantes. Resultados Se encontraron 52 nuevas interacciones relacionadas con el metabolismo por el CYP3A4 y la competencia por la absorción intestinal, también se encontraron nuevas interacciones de tipo farmacocinético para medicamentos que ya estaban en el mercado, y se reportaron interacciones para medicamentos recientemente comercializados: tipranavir, fosamprenavir, darunavir, raltegravir, maraviroc y etravirina. Conclusiones Hay evidencia de 52 nuevas interacciones, encontrándose medicamentos que utilizan vías metabólicas en el sistema enzimático CYP450, y se aclaran otras del proceso de absorción intestinal (AU)
Objective To update information on drug interactions in patients with HIV/AIDS. Method PubMed was used to review English and Spanish articles published between 1 July 2007 and 30 April 2009 on antiretroviral drug interactions in humans. The search included a review of interactions between commonly-used medications in patients with HIV/AIDS and references from articles considered to be relevant.Results52 new interactions were identified having to do with CYP3A4 metabolism and competition for intestinal absorption. New pharmacokinetic interactions were identified for medications that were already on the market, and we report interactions for drugs that were recently introduced: Tipranavir, Fosamprenavir, Darunavir, Raltegravir, Maraviroc and Etravirine. Conclusions There is evidence of 52 new interactions between medications using metabolic routes in the CYP450 enzymatic system, and an explanation is given for others in the intestinal absorption process (AU)
Subject(s)
Humans , Drug Interactions , HIV Infections/drug therapy , /adverse effects , Anti-Retroviral Agents/toxicity , Risk FactorsABSTRACT
En la actualidad, la infección por el virus de la inmunodeficiencia humana (VIH) en niños es una enfermedad crónica con un excelente pronóstico a largo plazo, pero que precisa tratamiento combinado con fármacos antirretrovirales de por vida. Sin embargo, la mejoría en la calidad de vida está limitada por los efectos secundarios de los fármacos; el más importante es la predisposición a un síndrome de toxicidad metabólica más o menos completo con: hiperlipidemia, lipodistrofia, resistencia a la insulina, acidosis láctica, osteopenia, hipertensión arterial y toxicidad específica de órganos como riñón, hígado, sistema nervioso central (SNC) y médula ósea. El riesgo de enfermedad cardiovascular en la vida adulta y la previsible alteración en la masa ósea definitiva son el coste metabólico más importante que hay que pagar por la supervivencia a largo plazo. Aunque muchas de estas alteraciones pueden tratarse adecuadamente, las interacciones farmacológicas, las intolerancias y el elevado número de pastillas ponen en riesgo el correcto cumplimiento, esencial para asegurar la eficacia terapéutica. Presentamos en este artículo a cuatro pacientes pediátricos que describen un abanico de posibilidades de toxicidad metabólica en niños infectados por el VIH, así como un enfoque práctico del tratamiento terapéutico (AU)
Paediatric Human Immunodeficiency Virus infection (HIV) nowadays is a chronic disease with an excellent long term prognosis, but lifelong combined antiretroviral treatment is required. However, an improved quality of life in this population is limited by adverse drug effects. The highest risk of treatment toxicity is developing a complete metabolic syndrome including: Hyperlipemia, lipodystrophy, insulin resistance, lactic acidosis, osteopenia, hypertension, and specific system and organ toxicity, such as the kidney, liver, CNS or bone marrow. The risk of cardiovascular disease adult life and also definitive bone mass damage are the most significant metabolic costs that have to paid for increased survival. Most of these toxicities were able to be adequately treated but, pharmacological interferences, patient intolerance and the high number of drugs are the problems that limit the adherence to treatment, which is essential for a good therapeutical efficacy. In this article, we present four HIV paediatric patients who presented with almost the whole range of metabolic toxicities, and a practical overview of therapeutical management (AU)
Subject(s)
Humans , Male , Female , Child, Preschool , Child , Adolescent , Anti-Retroviral Agents/toxicity , Anti-Retroviral Agents/therapeutic use , HIV Infections/therapy , Quality of Life , Hypolipidemic Agents/administration & dosage , Hypolipidemic Agents/adverse effects , Hypolipidemic Agents , Survival Rate , Risk Factors , Acquired Immunodeficiency Syndrome/complications , HipABSTRACT
Objetivo: Evaluar el impacto del sexo en la presencia del síndrome de lipodistrofia en una población de pacientes infectados por el VIH y su asociación con los factores de riesgo cardiovascular. Pacientes y método: Estudio transversal que incluyó a los pacientes de 20 años de edad o mayores, con infección por el VIH atendidos en la consulta externa del Servicio de Medicina Interna y Enfermedades Infecciosas del Hospital del Mar de Barcelona durante el año 2.003. Se evaluaron las características clínico-epidemiológicas de la infección por el VIH, la presencia de lipodistrofía y los factores de riesgo cardiovascular. Resultados: De los 710 pacientes incluidos en el estudio, las mujeres representaban el 28% de la serie. Los varones con lipodistrofia presentaron una mayor prevalencia de hipertensión arterial, hipercolesterolemia, hipoalfalipoproteinemia e hipertrigliceridemia comparado con los que no presentaban lipodistrofia (22,8 vs. 11,2%, p = 0,000; 20,6 vs. 9,3%, p = 0,001; 39,7 vs. 30%, p = 0,03 y 56,6 vs. 40,9%, p = 0,0001, respectivamente). En las mujeres, la presencia de lipodistrofia se acompañó de una mayor prevalencia de obesidad central e hipertrigliceridemia con respecto a la ausencia de lipodistrofia. En los varones predominó el patrón de lipoatrofia (24,9 vs. 12,6%, p = 0,0001), y en las mujeres el lipoacúmulo (12,3 vs. 22,6%, p = 0,0001). Además, las mujeres eran más jóvenes, tenían una mayor prevalencia de tabaquismo, antecedentes familiares de cardiopatía isquémica prematura y de obesidad central, y una menor prevalencia de hipertensión arterial y de hipoalfalipoproteinemia que los varones con lipodistrofia (42,1 ± 8 años vs. 44,8 ± 9,9 años, p = 0,03; 77,5 vs. 64%, p = 0,04; 22,5 vs. 9%, p = 0,003; 31 vs. 8,5%, p = 0,0001; 9,9 vs. 22,8%, p = 0,01; 25,4 vs. 39,7%, p = 0,03, respectivamente). Conclusiones: El presente estudio demuestra que el impacto del sexo en la lipodistrofia de los pacientes con infección por el VIH no sólo afecta al patrón de lipodistrofia, sino también al perfil de riesgo cardiovascular
Objective: To evaluate the influence of sex in human immunodeficiency virus (HIV)-infected patients with lipodystrophy and its association with cardiovascular risk factors. Patients and method: A cross-sectional study was conducted in HIVinfected patients aged 20 or over managed at the outpatient Infectious Disease Unit in 2003. Clinical and epidemiological characteristics of HIV infection, lipodystrophy and cardiovascular risk factors were evaluated. Results: Of the 760 patients included in the study, women comprised 28%. Men with lipodystrophy had a higher prevalence of hypertension, hypercholesterolemia, hypoalphalipoproteinemia and hypertriglyceridemia than those without lipodystrophy. Women with lipodystrophy had a higher prevalence of central obesity and hypertriglyceridemia compared with those without lipodystrophy (22.8 vs. 11.2%, p = 0.000; 20.6 vs. 9.3%, p = 0.001; 39.7 vs. 30%, p = 0.03 y 56.6 vs. 40.9%, p = 0.0001, respectively). The lipoatrophy pattern was predominant in men (24.9 vs. 12.6%, p = 0.0001) and lipoaccumulation forms in women (12.3 vs. 22.6%, p = 0.0001). Furthermore, women were younger, had a higher prevalence of smoking, family history of premature coronary heart disease and central obesity, and a lower prevalence of hypertension and hypoalphalipoproteinemia than men with lipodystrophy (42.1 ± 8 years vs. 44.8 ± 9.9 years, p = 0.03; 77.5 vs. 64%, p = 0.04; 22.5 vs. 9%, p = 0.003; 31 vs. 8.5%, p = 0.0001; 9.9 vs. 22.8%, p = 0.01; 25.4 vs. 39.7%, p = 0.03). Conclusions: This study demonstrated that the influence of sex in lipodystrophy in HIV-infected patients affects not only the lipodystrophy pattern, but also the cardiovascular risk profile
Subject(s)
Male , Adult , Female , Humans , Lipodystrophy/complications , Lipodystrophy/diagnosis , HIV Infections/complications , HIV Infections/diagnosis , Hypertriglyceridemia/complications , Anti-Retroviral Agents/toxicity , Anti-Retroviral Agents/therapeutic use , Risk Factors , Sex , Cross-Sectional Studies , Hypertension/complications , Hypercholesterolemia/complications , Tangier Disease/complications , Tobacco Use Disorder/physiopathology , Blood Glucose/analysisABSTRACT
La coinfección por el VHC es un importante factor de riesgo para el desarrollo de hepatotoxicidad inducida por los antirretrovirales, la cual constituye uno de los efectos adversos más comunes y uno de los principales motivos para la suspensión de éstos. Aunque casi todos los fármacos de este grupo terapéutico pueden resultar lesivos para el hígado, ritonavir (a dosis plenas) y nevirapinason los que con mayor frecuencia se asocian con esta circunstancia. Así, entre los no-análogos denucleósidos en concreto, diversos estudios han puesto de manifiesto una menor incidencia de hepatotoxicidad con efavirenz que con nevirapina, hecho que también se ha objetivado en el subgrupo de pacientes que han desarrollado cirrosis hepática. Respecto al impacto de los antirretrovirales sobre la progresión de la fibrosis hepática inducida por el VHC, sin duda otro aspecto muy importante de la coinfección por VIH/VHC, se ha observado que los inhibidores de la proteasa ejercen un efecto protector antela misma, el cual, aunque de menor intensidad, presenta también efavirenz, pero no nevirapina (AU)
HCV coinfection is an important risk factor for antiretroviral-associated hepatotoxicity, which is one of the most common adverse events of antiretroviral therapy and one of the main causes for its discontinuation. Although almost all drugs of this therapeutic group could be harmful for the liver, ritonavir (in therapeutic doses) and nevirapine are those which most frequently are associated with hepatotoxicity. Specifically, among non-nucleoside analogues, several studies have revealed a smaller hepatotoxicityi ncidence with efavirenz rather than with nevirapine. This fact has been also observed in patients who developed hepatic cirrhosis. Regarding antiretroviral impact over progression of HCV-induced hepaticfibrosis, another very important aspect of HIV/HCV coinfection, it has been reported that protease inhibitors have a protector effect over that progression. Efavirenz also presents this positive effect, but this one is not so intense. However, nevirapine doesnt have it (AU)
Subject(s)
Humans , Hepacivirus , HIV Infections/complications , Anti-Retroviral Agents/toxicity , Liver Diseases/chemically induced , Liver , Risk FactorsABSTRACT
La leucoencefalopatía multifocal progresiva (LMP) es un criterio diagnóstico de sida. Afecta al 1-8% de los pacientes con sida (según las series), con supervivencias de 4-6 meses antes de las terapias antirretrovirales de gran actividad (TARGA). Se observa sobre todo en pacientes usuarios a drogas por vía parenteral, con inmunodeficiencia avanzada (Carga vírica: log 5 copias/ ml y CD4 < 150/ mm3). Parece que sólo los pacientes bajo tratamiento con TARGA consiguen supervivencias más prolongadas. Las hepatitis víricas no son el único problema que se ha visto en pacientes con infección por VIH. Infecciones oportunistas y neoplasias, tales como el linfoma y sarcoma de Kaposi y problemas biliares han sido observados, si bien estos no son muy frecuentes, gracias a los nuevos tratamientos antirretrovirales. Sin embargo en pacientes con Hepatitis B o C el tratamiento antirretroviral puede causar mayor hepatotoxicidad
Progressive multifocal leukoencephalopathy (PML) develops in 1-8% of patients with AIDS, for which it is a disease-defining condition. PML presents mainly in severely immunocompromised male intravenous drug users, having viral loads greater than log5 RNA copies/mL and CD4 populations lower than 150 cells/mm3. Death of AIDS patients with PML occurred after only 4 to 6 months before the introduction of highly active antiretroviral therapies (HAART), the only ones that have shown to prolong survival. Viral hepatitis is not the only liver condition affecting patients with AIDS, opportunistic infections and neoplasms, such as lymphoma and Kaposis sarcoma, as well as biliary disease are also encountered but, fortunately, they are currently less frequent as a result of the new antiretroviral treatments. The risks of HAART hepatotoxicity in patients with hepatitis B or C have been studied by several groups
Subject(s)
Male , Adult , Humans , Leukoencephalopathy, Progressive Multifocal/complications , Leukoencephalopathy, Progressive Multifocal/diagnosis , Leukoencephalopathy, Progressive Multifocal/therapy , Acquired Immunodeficiency Syndrome/complications , Acquired Immunodeficiency Syndrome/diagnosis , Anti-Retroviral Agents/therapeutic use , Anti-Retroviral Agents/toxicity , Immunosuppression Therapy/methods , Toxoplasmosis/complications , Toxoplasmosis/diagnosis , Anti-Retroviral Agents/adverse effects , Hepatitis B/complications , Hepatitis B/diagnosis , Hepatitis C/complications , Hepatitis C/diagnosis , Sensitivity and Specificity , Doxycycline/therapeutic use , Gentamicins/therapeutic use , Vancomycin/therapeutic useABSTRACT
No disponible