RESUMEN
BACKGROUND: Recently, a platform of T-cell replete haploidentical hematopoietic stem cell transplantation (haplo-HSCT) using post-transplant cyclophosphamide (Cy) has shown high reproducibility and acceptable safety profile. METHOD: This prospective cohort analysis allowed us to collect data on infections among 70 consecutive recipients of haplo-HSCT affected by various hematologic malignancies. RESULTS: After a median follow-up of 23 months, cumulative incidence of viral infections was 70% (95% confidence interval [CI] 59-81) at 100 days and 77% (95% CI 67-87) at 1 year; 35 of 65 patients at risk had CMV reactivation (54%) and the rate of polyomavirus-virus-associated cystitis was 19% (13/70). Cumulative incidence of bacterial and fungal infections at 1 year were 63% (95% CI 51-75) and 12% (95% CI 4-19), respectively. Of note, only 1 invasive fungal infection occurred beyond 1 year after transplant (day +739). CONCLUSION: In conclusion, despite a high rate of viral infections in the early period, present data suggest a satisfactory infectious profile after T-cell replete haplo-HSCT using post-transplant Cy. These results may help clinicians to improve both prophylactic and therapeutic antimicrobial strategies in this emerging haploidentical setting.
Asunto(s)
Infecciones Bacterianas/epidemiología , Ciclofosfamida/administración & dosificación , Enfermedad Injerto contra Huésped/prevención & control , Neoplasias Hematológicas/terapia , Trasplante de Células Madre Hematopoyéticas/métodos , Huésped Inmunocomprometido , Inmunosupresores/administración & dosificación , Micosis/epidemiología , Virosis/epidemiología , Adulto , Anciano , Infecciones Bacterianas/etiología , Infecciones Bacterianas/inmunología , Estudios de Cohortes , Ciclofosfamida/efectos adversos , Cistitis/epidemiología , Cistitis/etiología , Cistitis/inmunología , Infecciones por Citomegalovirus/epidemiología , Infecciones por Citomegalovirus/etiología , Infecciones por Citomegalovirus/inmunología , Femenino , Haplotipos , Humanos , Inmunosupresores/efectos adversos , Incidencia , Masculino , Persona de Mediana Edad , Micosis/etiología , Micosis/inmunología , Infecciones por Polyomavirus/epidemiología , Infecciones por Polyomavirus/etiología , Infecciones por Polyomavirus/inmunología , Estudios Prospectivos , Acondicionamiento Pretrasplante , Virosis/etiología , Virosis/inmunología , Adulto JovenRESUMEN
BACKGROUND: The prevalence and factors associated with an increased risk of renal dysfunction in HIV-infected patients receiving or not receiving antiretroviral therapy (ART) have been poorly evaluated in observational settings. METHODS: Patients in the ICONA Foundation cohort with at least two creatinine values available while still ART-naïve were enrolled in the study. A logistic regression analysis was performed to identify predictors of an estimated glomerular filtration rate (eGFR)<90 mL/min/1.73 m(2) at baseline. The incidence and predictors of a >20% reduction in eGFR from pre-combination ART (cART) levels (or a decrease from ≥90 to <90 mL/min/1.73 m(2) ) were evaluated by Poisson regression. RESULTS: A total of 1505 patients were included in the study; 363 (24%) had eGFR<90 mL/min/1.73 m(2) at baseline. Older patients [odds ratio (OR) 1.58 per 10 years older; P<0.00001], female patients (OR 2.41 vs. male patients; P<0.00001), those who had diabetes and/or hypertension (OR 2.36 vs. neither; P<0.03) and patients with higher baseline CD4 count (OR 1.06 per 100 cells/µL higher; P<0.03) showed a greater risk of eGFR<90 mL/min/1.73 m(2) . Ninety-six patients experienced an eGFR decrease of >20% from pre-cART levels (6.8 per 100 person-years). Older age [relative risk (RR) 1.41 per 10 years older; P=0.005], female gender (RR 2.25 vs. male; P=0.003) and current exposure to didanosine (ddI), tenofovir and protease inhibitors were the major determinants. CONCLUSIONS: We observed a relatively high rate of mild renal dysfunction in the absence of ART. In addition to traditional risk factors such as older age and diabetes/hypertension, female gender and current use of ddI, tenofovir and protease inhibitors were associated with a greater risk of decreased renal function as measured by eGFR.
Asunto(s)
Tasa de Filtración Glomerular , Infecciones por VIH/epidemiología , Inhibidores de la Proteasa del VIH/efectos adversos , Insuficiencia Renal/epidemiología , Inhibidores de la Transcriptasa Inversa/efectos adversos , Adulto , Factores de Edad , Recuento de Linfocito CD4 , Creatinina/metabolismo , Diabetes Mellitus/epidemiología , Quimioterapia Combinada , Métodos Epidemiológicos , Femenino , Infecciones por VIH/complicaciones , Infecciones por VIH/tratamiento farmacológico , Hepatitis Viral Humana/complicaciones , Humanos , Hipertensión/epidemiología , Italia , Masculino , Insuficiencia Renal/etiología , Insuficiencia Renal/fisiopatología , Factores SexualesAsunto(s)
Aneurisma Falso/etiología , Arteria Femoral/patología , Infecciones por VIH/complicaciones , Aneurisma Falso/diagnóstico por imagen , Aneurisma Falso/cirugía , Terapia Antirretroviral Altamente Activa/efectos adversos , Sulfato de Atazanavir , Arteria Femoral/diagnóstico por imagen , Arteria Femoral/cirugía , Infecciones por VIH/tratamiento farmacológico , Inhibidores de la Proteasa del VIH/efectos adversos , Humanos , Hiperlipidemias/inducido químicamente , Indinavir/efectos adversos , Masculino , Persona de Mediana Edad , Oligopéptidos/efectos adversos , Hemorragia Posoperatoria/etiología , Piridinas/efectos adversos , Infecciones Estreptocócicas/complicaciones , Infecciones Estreptocócicas/tratamiento farmacológico , Ultrasonografía Doppler en Color , Procedimientos Quirúrgicos VascularesRESUMEN
The use of tenofovir as part of a HAART regimen has been widely used in HIV-multi-experienced-patients because of its favourable resistance profile. Tenofovir is mainly eliminated by the kidneys and renal toxicity should be carefully monitored. We describe here the case of an HIV-infected patient, without a prior history of renal failure who developed nephrolithiasis and hydronephrosis after starting a tenofovir-containing HAART regimen.
Asunto(s)
Adenina/análogos & derivados , Adenina/efectos adversos , Fármacos Anti-VIH/efectos adversos , Infecciones por VIH/tratamiento farmacológico , Hidronefrosis/inducido químicamente , Cálculos Renales/inducido químicamente , Organofosfonatos/efectos adversos , Adenina/uso terapéutico , Adulto , Fármacos Anti-VIH/uso terapéutico , Terapia Antirretroviral Altamente Activa/efectos adversos , Infecciones por VIH/complicaciones , Humanos , Masculino , Organofosfonatos/uso terapéutico , TenofovirRESUMEN
Presented here are the results of a cohort study conducted on 3,483 consecutive HIV/AIDS patients between January 1993 and December 2000 to determine trends in AIDS incidence and presentation. The incidence of AIDS was calculated in the general population and examined further according to gender, age (< or = or >49 years), and heterosexual behaviour as a risk factor for HIV. Multivariate analysis was used to identify variables associated with AIDS presenters (defined as patients diagnosed with AIDS within 1 month of the first HIV-positive test). The numbers of patients with AIDS classified as (i) AIDS presenters, (ii) known HIV-positive patients on antiretroviral treatment, and (iii) known HIV-positive patients not receiving antiretroviral treatment were calculated. The overall incidence of AIDS decreased over time, mainly due to the lower number of patients on antiretroviral treatment developing AIDS. Factors associated with a higher risk of being an AIDS presenter were male gender and year of HIV diagnosis. Among patients with AIDS, the proportion of AIDS presenters increased from 13.8% prior to 1997 (when protease inhibitors were introduced in Italy) to 32.5% after 1997. Variables predictive of being an AIDS presenter were male gender, age at diagnosis, and AIDS diagnosis in the years 1997-2000. Heterosexuals had a higher risk of being AIDS presenters and a lower risk of being HIV-positive and not receiving antiretroviral treatment than intravenous drug users. In Italy, AIDS occurs mainly in subjects unaware of their HIV status (especially males, the elderly, and those infected heterosexually) or in patients refusing antiretroviral therapy (mainly intravenous drug users who do not refer to specialised centres).