RESUMEN
Nucleoside/nucleotide analogs such as tenofovir, have been used as long-term therapy for the treatment of hepatitis B and side effects such as the reduction in bone mineral density have been associated with their use. To determine the relationships between bone, hormonal, biochemical, and mineral parameters in patients with hepatitis B treated with nucleoside/nucleotide antiviral. A cross-sectional study was conducted with 81 adult patients with chronic hepatitis B infection. Dual-energy X-ray absorptiometry (DXA) was performed to assess bone mineral density. Biochemical analyses were performed for osteocalcin, deoxypyridinoline, parathyroid hormone, vitamin D, IGF-1, TSH, testosterone, estradiol, FSH, transaminases, urea, creatinine, calcium, serum and urinary phosphorus, magnesium, and FGF-23, body composition was performed by DXA. Participants, both gender, were divided according to the use of antiretrovirals: Group1: 27 inactive virus carriers without medication; Group2: 27 patients using tenofovir; and Group3: 27 patients using lamivudine or entecavir. DXA readings diagnosed osteopenia in the lumbar spine for 7.4% of individuals in Group1, 15% in Group2, and 3.7% in Group3. For all groups, we observed normal values in bone formation markers, osteocalcin levels as well as parathyroid hormone, insulin growth factor 1, and FGF-23. In all groups, we found increased levels of urinary deoxypyridinoline, a bone resorption marker. Increased levels in the bone resorption markers indicated a high resorptive activity of bone tissue. These data suggested high resorption activity of bone tissue in hepatitis B virus-infected patients independent of the use of antiretrovirals.
Asunto(s)
Antirretrovirales/uso terapéutico , Resorción Ósea/complicaciones , Resorción Ósea/metabolismo , Hepatitis B Crónica/complicaciones , Hepatitis B Crónica/tratamiento farmacológico , Osteoclastos/metabolismo , Absorciometría de Fotón , Adulto , Composición Corporal/efectos de los fármacos , Densidad Ósea/efectos de los fármacos , Resorción Ósea/diagnóstico por imagen , Resorción Ósea/virología , Estudios Transversales , Femenino , Cuello Femoral/diagnóstico por imagen , Cuello Femoral/metabolismo , Cuello Femoral/virología , Factor-23 de Crecimiento de Fibroblastos , Guanina/análogos & derivados , Guanina/uso terapéutico , Virus de la Hepatitis B/efectos de los fármacos , Cadera/diagnóstico por imagen , Cadera/virología , Humanos , Lamivudine/uso terapéutico , Vértebras Lumbares/diagnóstico por imagen , Vértebras Lumbares/metabolismo , Vértebras Lumbares/virología , Masculino , Persona de Mediana Edad , Osteoclastos/efectos de los fármacos , Osteoclastos/virología , Tenofovir/uso terapéuticoRESUMEN
The treatment of cryptococcosis is hampered by inefficacy or intolerance to the recommended antifungal agents. A patient diagnosed with AIDS had multiple relapses of cryptococcal infection, which became refractory to antifungal agents during the course of therapy. During the follow-up, the patient developed renal toxicity due to amphotericin B use and non-susceptibility of isolated Cryptococcus neoformans to fluconazole was detected. Thereafter, antifungal treatment was performed exclusively with liposomal amphotericin B, reaching a cumulative dose of 19,180 mg over 46 months. The final relapse of cryptococcosis occurred during the maintenance phase with liposomal formulation in a once-weekly dose. Measurement of the minimum serum concentrations of amphotericin B, determined sequentially before and after this relapse, suggested the importance of monitoring drug levels when the liposomal formulation is used for a long period.