Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 6 de 6
Filtrar
1.
Intern Med J ; 48(12): 1514-1520, 2018 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-30517986

RESUMEN

There is a global outbreak of infections due to Mycobacterium chimaera associated with cardiac surgery. The most serious infections involve prosthetic material implantation, and all have followed surgical procedures involving cardiopulmonary bypass. We describe a cluster of four cases following cardiac surgery at a tertiary referral centre in Sydney, Australia. We report novel clinical findings, including haemolysis and kidney rupture possibly related to immune reconstitution inflammatory syndrome. The positive effect of corticosteroids on haemodynamic function in two cases and the failure of currently recommended antimicrobial therapy to sterilise prosthetic valve material in the absence of surgery despite months of treatment are also critically examined. Positron emission tomography was positive in two cases despite normal transoesophageal echocardiograms. The proportion of cases with M. chimaera infection after aortic valve replacement (4/890, 0.45%; 95% confidence interval 0.18-1.15%) was significantly higher than after all other cardiothoracic surgical procedures (0/2433, 0%; 95% confidence interval 0-0.16%).


Asunto(s)
Antibacterianos , Válvula Aórtica , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Prótesis Valvulares Cardíacas/microbiología , Infecciones por Mycobacterium no Tuberculosas , Mycobacterium , Complicaciones Posoperatorias , Adulto , Anciano , Anciano de 80 o más Años , Antibacterianos/administración & dosificación , Antibacterianos/clasificación , Válvula Aórtica/microbiología , Válvula Aórtica/cirugía , Australia/epidemiología , Femenino , Enfermedades de las Válvulas Cardíacas/cirugía , Implantación de Prótesis de Válvulas Cardíacas/métodos , Humanos , Masculino , Persona de Mediana Edad , Mycobacterium/efectos de los fármacos , Mycobacterium/aislamiento & purificación , Infecciones por Mycobacterium no Tuberculosas/diagnóstico , Infecciones por Mycobacterium no Tuberculosas/etiología , Tomografía de Emisión de Positrones/métodos , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/microbiología , Medición de Riesgo , Factores de Riesgo , Resultado del Tratamiento
2.
Ther Adv Infect Dis ; 5(5): 91-95, 2018 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-30224952

RESUMEN

A case of tenofovir-induced Fanconi syndrome in a patient receiving antiretroviral therapy for HIV infection, with resolution of the related electrolyte abnormalities upon switch from tenofovir disoproxil fumarate to tenofovir alafenamide fumarate, is reported. Tenofovir alafenamide fumarate, a novel prodrug of tenofovir containing significantly lower doses of tenofovir than tenofovir disoproxil fumarate, has been associated with a favourable renal profile compared to tenofovir disoproxil fumarate. Generally, the rare complication of tenofovir disoproxil fumarate-induced Fanconi syndrome is managed by cessation of tenofovir. There are limited reports of the impact of a switch strategy from tenofovir disoproxil fumarate to tenofovir alafenamide fumarate, which may be necessary in patients unable to discontinue tenofovir.

3.
Pediatr Infect Dis J ; 37(8): 794-800, 2018 08.
Artículo en Inglés | MEDLINE | ID: mdl-29356763

RESUMEN

BACKGROUND: Increasing numbers of children are requiring long-term HIV care and antiretroviral treatment (ART) in public ART programs in Africa, but temporal trends and long-term outcomes in care remain poorly understood. METHODS: We analyzed outcomes in a longitudinal cohort of infants (<2 years of age) and children (2-10 years of age) enrolling in a public tertiary ART center in Zimbabwe over an 8-year period (2004-2012). RESULTS: The clinic enrolled 1644 infants and children; the median age at enrollment was 39 months (interquartile range: 14-79), with a median CD4% of 17.0 (interquartile range: 11-24) in infants and 15.0 (9%-23%) in children (P = 0.0007). Among those linked to care, 33.5% dropped out of care within the first 3 months of enrollment. After implementation of revised guidelines in 2009, decentralization of care and increased access to prevention of mother to child transmission services, we observed an increase in infants (48.9%-68.3%; P < 0.0001) and children (48.9%-68.3%; P < 0.0001) remaining in care for more than 3 months. Children enrolled from 2009 were younger, had lower World Health Organization clinical stage, improved baseline CD4 counts than those who enrolled in 2004-2008. Long-term retention in care also improved with decreasing risk of loss from care at 36 months for infants enrolled from 2009 (aHR: 0.57; 95% confidence interval: 0.34-0.95; P = 0.031). ART eligibility at enrollment was a significant predictor of long-term retention in care, while delayed ART initiation after 5 years of age resulted in failure to fully reconstitute CD4 counts to age-appropriate levels despite prolonged ART. CONCLUSIONS: Significant improvements have been made in engaging and retaining children in care in public ART programs in Zimbabwe. Guideline and policy changes that increase access and eligibility will likely to continue to support improvement in pediatric HIV outcomes.


Asunto(s)
Fármacos Anti-VIH/uso terapéutico , Infecciones por VIH/tratamiento farmacológico , Salud Pública/estadística & datos numéricos , Resultado del Tratamiento , Recuento de Linfocito CD4 , Niño , Preescolar , Estudios de Cohortes , Femenino , VIH/efectos de los fármacos , Infecciones por VIH/epidemiología , Humanos , Transmisión Vertical de Enfermedad Infecciosa , Estudios Longitudinales , Masculino , Salud Pública/legislación & jurisprudencia , Estudios Retrospectivos , Carga Viral , Zimbabwe/epidemiología
4.
AIDS Behav ; 22(1): 86-101, 2018 01.
Artículo en Inglés | MEDLINE | ID: mdl-28063075

RESUMEN

Using a pilot trial design in an HIV care clinic in Zimbabwe, we randomised 32 adults with poor adherence to antiretroviral therapy and at least mild depression to either six sessions of Problem-Solving Therapy for adherence and depression (PST-AD) delivered by an adherence counsellor, or to Enhanced Usual Care (Control). Acceptability of PST-AD was high, as indicated by frequency of session attendance and through qualitative analyses of exit interviews. Fidelity was >80% for the first two sessions of PST-AD but fidelity to the adherence component of PST-AD dropped by session 4. Contamination occurred, in that seven patients in the control arm received one or two PST-AD sessions before follow-up assessment. Routine health records proved unreliable for measuring HIV viral load at follow-up. Barriers to measuring adherence electronically included device failure and participant perception of being helped by the research device. The study was not powered to detect clinical differences, however, promising change at 6-months follow-up was seen in electronic adherence, viral load suppression (PST-AD arm 9/12 suppressed; control arm 4/8 suppressed) and depression (Patient Health Questionnaire-4.7 points in PST-AD arm vs. control, adjusted p value = 0.01). Results inform and justify a future randomised controlled trial of task-shifted PST-AD.


Asunto(s)
Depresión/etiología , Depresión/terapia , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/psicología , Cumplimiento de la Medicación/psicología , Aceptación de la Atención de Salud/psicología , Solución de Problemas , Adulto , Terapia Cognitivo-Conductual , Estudios de Factibilidad , Femenino , Infecciones por VIH/complicaciones , Infecciones por VIH/virología , Humanos , Masculino , Persona de Mediana Edad , Admisión y Programación de Personal , Evaluación de Programas y Proyectos de Salud , Zimbabwe/epidemiología
6.
Curr Opin Infect Dis ; 25(1): 4-9, 2012 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-22156897

RESUMEN

PURPOSE OF REVIEW: The aim is to review the recent confirmation of the continued high prevalence of HIV-associated neurocognitive disorders (HAND) despite highly active antiretroviral therapy (HAART) in a large cohort study and to review the recent studies that have begun to address the potential reasons for such persistence. RECENT FINDINGS: HAND remains prevalent, despite effective viral suppression in cerebrospinal fluid and plasma. Several studies have shown the benefit of a central nervous system (CNS) penetrating HAART regimen (neuro-HAART) in improving neurocognitive outcomes. New evidence supports the early initiation of HAART. There are recent data to suggest that HAART may be CNS toxic, but evidence is still limited. Ageing does not currently explain the persistence of HAND. A recent study has also shown a correlation between cardiovascular risk factors and HAND. SUMMARY: The prevalence of HAND remains high in the HAART era. Most studies point towards the benefit of neuro-HAART in the prevention and treatment of HAND. The possible neurotoxicity of HAART needs to be further evaluated. It may be too early to detect a combined ageing and HIV effect and long-term studies are required. The link between cardiovascular disease and neurocognitive decline in HIV needs further exploration. Effective screening in clinical practice is paramount in prevention of the morbidity and mortality associated with HAND.


Asunto(s)
Complejo SIDA Demencia/epidemiología , Complejo SIDA Demencia/prevención & control , Terapia Antirretroviral Altamente Activa , Infecciones por VIH/complicaciones , Infecciones por VIH/tratamiento farmacológico , Envejecimiento/efectos de los fármacos , Terapia Antirretroviral Altamente Activa/efectos adversos , Estudios de Cohortes , Humanos , Prevalencia , Factores de Riesgo
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA
...