Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.467
Filtrar
2.
Int J Mol Sci ; 22(4)2021 Feb 20.
Artículo en Inglés | MEDLINE | ID: mdl-33672735

RESUMEN

Lipodystrophy is a common complication in human immunodeficiency virus (HIV)-infected patients receiving highly active antiretroviral therapy (HAART) or antiretroviral therapy (ART). Previous studies demonstrated that endoplasmic reticulum (ER) stress-mediated unfolded protein response (UPR) is involved in lipodystrophy; however, the detailed mechanism has not been fully described in human adipogenic cell lineage. We utilized adipose tissue-derived stem cells (ADSCs) obtained from human subcutaneous adipose tissue, and atazanavir (ATV), a protease inhibitor (PI), was administered to ADSCs and ADSCs undergoing adipogenic conversion. Marked repression of adipogenic differentiation was observed when ATV was administered during 10 days of ADSC culture in adipogenic differentiation medium. Although ATV had no effect on ADSCs, it significantly induced apoptosis in differentiating adipocytes. ATV treatment also caused the punctate appearance of CCAAT-enhancer-binding (C/EBP) protein homologous protein (CHOP), and altered expression of CHOP and GRP78/Bip, which are the representation of ER stress, only in differentiating adipocytes. Administration of UPR inhibitors restored adipogenic differentiation, indicating that ER stress-mediated UPR was induced in differentiating adipocytes in the presence of ATV. We also observed autophagy, which was potentiated in differentiating adipocytes by ATV treatment. Thus, adipogenic cell atrophy leads to ATV-induced lipodystrophy, which is mediated by ER stress-mediated UPR and accelerated autophagy, both of which would cause adipogenic apoptosis. As our study demonstrated for the first time that ADSCs are unsusceptible to ATV and its deleterious effects are limited to the differentiating adipocytes, responsible target(s) for ATV-induced lipodystrophy may be protease(s) processing adipogenesis-specific protein(s).


Asunto(s)
Adipocitos/patología , Adipogénesis , Antirretrovirales/efectos adversos , Sulfato de Atazanavir/uso terapéutico , Diferenciación Celular , Estrés del Retículo Endoplásmico , Lipodistrofia/inducido químicamente , Células Madre/patología , Adipocitos/efectos de los fármacos , Adipocitos/metabolismo , Adipogénesis/efectos de los fármacos , Tejido Adiposo/patología , Terapia Antirretroviral Altamente Activa , Apoptosis/efectos de los fármacos , Sulfato de Atazanavir/farmacología , Muerte Celular/efectos de los fármacos , Diferenciación Celular/efectos de los fármacos , Células Cultivadas , Daño del ADN , Estrés del Retículo Endoplásmico/efectos de los fármacos , Humanos , Gotas Lipídicas/efectos de los fármacos , Gotas Lipídicas/metabolismo , Estrés Oxidativo/efectos de los fármacos , Inhibidores de Proteasas/farmacología , Inhibidores de Proteasas/uso terapéutico , Especies Reactivas de Oxígeno/metabolismo , Células Madre/efectos de los fármacos , Células Madre/metabolismo , Factor de Transcripción CHOP/metabolismo
3.
Epidemiol Health ; 43: e2021008, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33541012

RESUMEN

OBJECTIVES: This meta-analysis investigated the risk of congenital anomalies among infants of human immunodeficiency virus-infected pregnant women who were exposed to antiretroviral therapy (ART). METHODS: Cohort studies, case-control studies, randomized controlled trials, and controlled clinical trials were reviewed by searching MEDLINE/PubMed, Embase, Web of Science, Scopus, AIDSLINE, CINAHL, Cochrane Library, and Google/Google Scholar. Methodological quality was assessed using the GRADE evaluation. A DerSimonian and Laird random-effects model was used. Subgroup analyses and meta-regression were used to investigate heterogeneity. RESULTS: The electronic searches yielded 765 items. After quality assessment and grading, 30 studies were suitable for metaanalysis. In total, 1,461 congenital anomalies were found among 53,186 births. Children born to women receiving combined antiretroviral therapy (cART) had an approximately 10% higher risk of developing congenital anomalies (relative risk [RR], 1.09; 95% confidence interval [CI], 1.04 to 1.14). A subgroup analysis found no significant difference in the risk of congenital anomalies between cART and efavirenz users. However, zidovudine and protease inhibitor (RR, 1.09; 95% CI, 1.00 to 1.19) users were found to have a 10% increased risk of congenital anomalies, and integrase inhibitor users had a 60% increase in risk (RR, 1.61; 95% CI, 1.60 to 2.43). The subgroup results should be interpreted cautiously because of the moderate heterogeneity (I2 =58%). CONCLUSIONS: The use of protease inhibitors, integrase inhibitors, zidovudine, and newer drugs should be carefully considered in pregnant women. Further studies are needed to address environmental, nutrition, and adherence factors related to ART. Establishing a congenital anomalies surveillance system is recommended.


Asunto(s)
Anomalías Inducidas por Medicamentos/epidemiología , Antirretrovirales/efectos adversos , Efectos Tardíos de la Exposición Prenatal/inducido químicamente , Femenino , Infecciones por VIH/tratamiento farmacológico , Humanos , Lactante , Embarazo , Complicaciones Infecciosas del Embarazo/tratamiento farmacológico , Ensayos Clínicos Controlados Aleatorios como Asunto , Medición de Riesgo
4.
Nursing (Säo Paulo) ; 24(272): 5148-5161, jan.2021.
Artículo en Portugués | LILACS, BDENF - Enfermería | ID: biblio-1148459

RESUMEN

OBJETIVO: Conhecer a literatura acerca da prevalência de sobrepeso e obesidade em indivíduos vivendo com HIV/AIDS. MÉTODO: Trata-se de uma revisão integrativa utilizando as bases de dados BVS, SciELO, LILACS, Science Direct, Cochrane Library e MEDLINE/PubMed segundo o instrumento pensado por Pompeo, Rossi e Galvão, com uso dos descritores em DeCS "sobrepeso", "obesidade", "hiv". Foram selecionadas publicações entre 2012 e 2020 em inglês, portugês e espanhol, com indivíduos HIV positivos. Foram excluídos estudos inconclusivos. RESULTADOS: Inicialmente foram encontrados 3029 estudos dos quais 18 atenderam aos critérios de inclusão. Há forte característica de aumento de peso a grande taxa de sedentarismo, grande prevalência de mulheres acima do peso, com baixa escolaridade e idade variando de 38 a 50 anos, raça negra, solteiros, baixa renda e com baixa escolaridade ainda faziam uso de drogas ilícitas. Essas características estão presentes em mais de 60% dos pacientes com o fator clínico estudado. CONCLUSÃO: A introdução de medicamentos antirretrovirais no tratamento do HIV trouxe o aumento da prevalência de sobrepeso e obesidade entre os portadores de HIV/AIDS.(AU)


OBJECTIVE: To know the literature on the prevalence of overweight and obesity in individuals living with HIV/AIDS. METHOD: This is an integrative review using the databases VHL, SciELO, LILACS, Science Direct, Cochrane Library and MEDLINE/PubMed according to the instrument conceived by Pompeo, Rossi and Galvão, using the descriptors in DeCS "overweight", "obesity", "hiv". Publications were selected between 2012 and 2020 in English, Portuguese and Spanish, with HIV positive individuals. Inconclusive studies were excluded. RESULTS: Initially, 3029 studies were found, of which 18 met the inclusion criteria. There is a strong characteristic of weight gain at a high rate of sedentary lifestyle, a high prevalence of overweight women, with low schooling and age ranging from 38 to 50 years, black race, single, low income and with low schooling still used illicit drugs. These characteristics are present in more than 60% of patients with the clinical factor studied. CONCLUSION: The introduction of antiretroviral drugs in hiv treatment has led to an increase in the prevalence of overweight and obesity among HIV/AIDS patients.(AU)


OBJETIVO: Conocer la literatura sobre la prevalencia del sobrepeso y la obesidad en las personas que viven con el VIH/SIDA. METODO: Se trata de una revisión integradora utilizando las bases de datos VHL, SciELO, LILACS, Science Direct, Cochrane Library y MEDLINE/PubMed según el instrumento concebido por Pompeo, Rossi y Galvao, utilizando los descriptores de DeCS "sobrepeso", "obesidad", "hiv". Las publicaciones fueron seleccionadas entre 2012 y 2020 en inglés, portugués y español, con individuos seropositivos. Se excluyeron los estudios no concluyentes. RESULTADOS: Inicialmente, se encontraron 3029 estudios, de los cuales 18 cumplían con los criterios de inclusión. Hay una fuerte característica del aumento de peso a una alta tasa de estilo de vida sedentario, una alta prevalencia de mujeres con sobrepeso, con baja escolaridad y edad que van de 38 a 50 años, raza negra, soltero, de bajos ingresos y con baja escolarización todavía se utilizan drogas ilícitas. Estas características están presentes en más del 60% de los pacientes con el factor clínico estudiado. CONCLUSION: La introducción de medicamentos antirretrovirales en el tratamiento del vih ha dado lugar a un aumento de la prevalencia del sobrepeso y la obesidad entre los pacientes con VIH/SIDA.(AU)


Asunto(s)
Humanos , Prevalencia , Síndrome de Inmunodeficiencia Adquirida , Antirretrovirales/efectos adversos , Sobrepeso , Obesidad , Factores Socioeconómicos , Aumento de Peso , VIH
5.
AIDS ; 35(6): 869-882, 2021 05 01.
Artículo en Inglés | MEDLINE | ID: mdl-33443370

RESUMEN

OBJECTIVE: To compare the incidence of dyslipidemia in people with HIV receiving integrase inhibitors (INSTI) versus boosted protease inhibitors (PI/b) and nonnucleoside reverse transcriptase inhibitors (NNRTI) within RESPOND consortium of prospective cohorts. METHODS: Participants were eligible if they were at least 18 years, without dyslipidemia and initiated or switched to a three-drug antiretroviral therapy (ART)-regimen consisting of either INSTI, NNRTI, or PI/b for the first time, between 1 January 2012 and 31 December 2018. Dyslipidemia was defined as random total cholesterol more than 240 mg/dl, HDL less than 35 mg/dl, triglyceride more than 200 mg/dl, or initiation of lipid-lowering therapy. Poisson regression was used to determine the adjusted incidence rate ratios. Follow-up was censored after 3 years or upon ART-regimen discontinuation or last lipid measurement or 31 December 2019, whichever occurred first. RESULTS: Overall, 4577 people with HIV were eligible (INSTI = 66.9%, PI/b = 12.5%, and NNRTI = 20.6%), 1938 (42.3%) of whom were ART-naive. During 1.7 (interquartile range, 0.6-3.0) median years of follow-up, 1460 participants developed dyslipidemia [incidence rate: 191.6 per 1000 person-years, 95% confidence interval (CI) 182.0-201.7]. Participants taking INSTI had a lower incidence of dyslipidemia compared with those on PI/b (adjusted incidence rate ratio 0.71; CI 0.59-0.85), but higher rate compared with those on NNRTI (1.35; CI 1.15-1.58). Compared with dolutegravir, the incidence of dyslipidemia was higher with elvitegravir/cobicistat (1.20; CI 1.00-1.43) and raltegravir (1.24; CI 1.02-1.51), but lower with rilpivirine (0.77; CI 0.63-0.94). CONCLUSION: In this large consortium of heterogeneous cohorts, dyslipidemia was less common with INSTI than with PI/b. Compared with dolutegravir, dyslipidemia was more common with elvitegravir/cobicistat and raltegravir, but less common with rilpivirine.


Asunto(s)
Fármacos Anti-VIH , Dislipidemias , Infecciones por VIH , Inhibidores de Integrasa VIH , Fármacos Anti-VIH/uso terapéutico , Antirretrovirales/efectos adversos , Dislipidemias/inducido químicamente , Dislipidemias/tratamiento farmacológico , Dislipidemias/epidemiología , Infecciones por VIH/complicaciones , Infecciones por VIH/tratamiento farmacológico , Inhibidores de Integrasa VIH/efectos adversos , Humanos , Incidencia , Estudios Prospectivos , Inhibidores de la Transcriptasa Inversa/uso terapéutico
6.
AIDS ; 35(1): 81-90, 2021 01 01.
Artículo en Inglés | MEDLINE | ID: mdl-33048874

RESUMEN

OBJECTIVES: To describe the prevalence and incidence of prediabetes and type 2 diabetes mellitus (T2DM) among people living with HIV (PLHIV) and evaluate the association between antiretroviral therapy (ART) initiation with dolutegravir (DTG), elvitegravir/cobicistat (EVG/c), raltegravir (RAL), or boosted darunavir (bDRV) and incident T2DM. DESIGN: Longitudinal study based on electronic health records of 29 674 PLHIV from the Observational Pharmaco-Epidemiology Research and Analysis (OPERA) cohort. METHODS: Calculate prevalence of prediabetes and T2DM at regimen initiation. Among PLHIV without prevalent disease, estimate prediabetes and T2DM incidence (Poisson regression) and association between regimen and incident T2DM (multivariate Cox proportional hazards regression). Analyses stratified by ART experience. RESULTS: Among ART-naive and ART-experienced/suppressed PLHIV, the estimated prevalence of prediabetes was 8 and 11%; that of T2DM was 4 and 10%, respectively. The T2DM incidence rate was 9 per 1000 person-years [95% confidence interval (CI): 8-11] among ART-naive and 13 per 1000 person-years (95% CI: 12-15) among ART-experienced/suppressed PLHIV, with no statistically significant differences between regimens. Compared with DTG, no statistically significant association between T2DM risk and regimen was observed among ART-naive on EVG/c [adjusted hazard ratios: 0.70 (95% CI: 0.47-1.05)] or bDRV [0.53 (0.26-1.04)] and ART-experienced/suppressed on EVG/c [0.96 (0.70-1.33)], RAL [1.17 (0.70-1.96)] or bDRV [0.90 (0.57-1.42)]. CONCLUSION: No increased risk of T2DM was observed with EVG/c, RAL or bDRV compared with DTG in ART-naive and experienced PLHIV. However, despite a large cohort, there was a small number of events and differential risk cannot be excluded.


Asunto(s)
Antirretrovirales/efectos adversos , Diabetes Mellitus Tipo 2 , Infecciones por VIH , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/epidemiología , Infecciones por VIH/complicaciones , Infecciones por VIH/tratamiento farmacológico , Humanos , Estudios Longitudinales
8.
PLoS One ; 15(10): e0239758, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33057367

RESUMEN

OBJECTIVE: People with HIV (PWH) continue to experience sensory neuropathy and neuropathic pain in the combination antiretroviral therapy (cART) era for unclear reasons. This study evaluated the role of iron in a previously reported association of iron-loading hemochromatosis (HFE) gene variants with reduced risk of neuropathy in PWH who received more neurotoxic cART, since an iron-related mechanism also might be relevant to neuropathic symptoms in PWH living in low-resource settings today. DESIGN: This time-to-event analysis addressed the impact of systemic iron levels on the rapidity of neuropathy onset in PWH who initiated cART. METHODS: Soluble transferrin receptor (sTFR), the sTFR-ferritin index of iron stores, and high-sensitivity C-reactive protein (hsCRP) levels were determined in stored baseline sera from participants of known HFE genotype from AIDS Clinical Trials Group (ACTG) Study 384, a multicenter randomized clinical trial that evaluated cART strategies. Associations with incident neuropathy were evaluated in proportional-hazards, time-to-event regression models, adjusting for potential confounders. RESULTS: Of 151 eligible participants with stored serum who were included in the original genetic study, 43 had cART-associated neuropathy; 108 had sufficient serum for analysis, including 30 neuropathy cases. Carriers of HFE variants had higher systemic iron (lower sTFR and sTFR-ferritin index) and lower hsCRP levels than non-carriers (all p<0.05). Higher sTFR or iron stores, the HFE 187C>G variant, and lower baseline hsCRP were associated with significantly delayed neuropathy in self-reported whites (n = 28; all p-values<0.05), independent of age, CD4+ T-cell count, plasma HIV RNA, and cART regimen. CONCLUSIONS: Higher iron stores, the HFE 187C>G variant, and lower hsCRP predicted delayed onset of neuropathy among self-reported white individuals initating cART. These findings require confirmation but may have implications for cART in HIV+ populations in areas with high endemic iron deficiency, especially those PWH in whom older, more neurotoxic antiretroviral drugs are occasionally still used.


Asunto(s)
Antirretrovirales/efectos adversos , Terapia Antirretroviral Altamente Activa/efectos adversos , Variación Genética/genética , Proteína de la Hemocromatosis/genética , Hierro/metabolismo , Enfermedades del Sistema Nervioso Periférico/inducido químicamente , Enfermedades del Sistema Nervioso Periférico/genética , Adulto , Antirretrovirales/uso terapéutico , Femenino , Ferritinas/genética , Genotipo , Infecciones por VIH/tratamiento farmacológico , Hemocromatosis/genética , Heterocigoto , Humanos , Masculino , Neuralgia/inducido químicamente , Neuralgia/genética , Receptores de Transferrina/genética
9.
J Pharmacol Sci ; 144(3): 95-101, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-32921396

RESUMEN

Patients living with HIV in malarial endemic regions may experience clinically significant drug interaction between antiretroviral and antimalarial drugs. Effects of nevirapine (NVP), efavirenz (EFV) and lopinavir/ritonavir (LPVr) on lumefantrine (LM) therapeutic concentrations and toxicity were evaluated. In a four-arm parallel study design, the blood samples of 40 participants, treated with artemether/lumefantrine (AL), were analysed. Lumefantrine Cmax was increased by 32% (p = 0.012) and 325% (p < 0.0001) in the NVP and LPVr arms respectively but decreased by 62% (p < 0.0001) in the EFV-arm. AUC of LM was, respectively, increased by 50% (p = 0.27) and 328% (p < 0.0001) in the NVP and LPVr arms but decreased in the EFV-arm by 30% (p = 0.019). Median day 7 LM concentration was less than 280 ng/mL in EFV-arm (239 ng/mL) but higher in control (290 ng/mL), NVP (369 ng/mL, p = 0.004) and LPVr (1331 ng/mL, p < 0.0001) arms. There were no clinically relevant toxicities nor adverse events in both control and test arms. Artemether/lumefantrine is safe and effective for treatment of malaria in PLWHA taking NVP and LPVr based ART regimen but not EFV-based regimen.


Asunto(s)
Antirretrovirales/efectos adversos , Antimaláricos/efectos adversos , Combinación Arteméter y Lumefantrina/efectos adversos , Benzoxazinas/efectos adversos , Interacciones Farmacológicas , Infecciones por VIH/tratamiento farmacológico , Malaria/tratamiento farmacológico , Nevirapina/efectos adversos , Adulto , Alquinos , Antirretrovirales/administración & dosificación , Antirretrovirales/sangre , Antimaláricos/administración & dosificación , Antimaláricos/sangre , Combinación Arteméter y Lumefantrina/administración & dosificación , Combinación Arteméter y Lumefantrina/sangre , Benzoxazinas/administración & dosificación , Benzoxazinas/sangre , Ciclopropanos , Combinación de Medicamentos , Quimioterapia Combinada , Femenino , Infecciones por VIH/complicaciones , Humanos , Lopinavir , Malaria/complicaciones , Masculino , Persona de Mediana Edad , Nevirapina/administración & dosificación , Nevirapina/sangre , Nigeria , Ritonavir , Resultado del Tratamiento , Adulto Joven
10.
PLoS One ; 15(8): e0236642, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32756581

RESUMEN

INTRODUCTION: The long-term prognosis of HIV-2-infected patients receiving antiretroviral therapy (ART) is still challenging, due to the intrinsic resistance to non-nucleoside reverse transcriptase inhibitors (NNRTI) and the suboptimal response to some protease inhibitors (PI). The objective was to describe the 5-years outcomes among HIV-2 patients harboring drug-resistant viruses. METHODS: A clinic-based cohort of HIV-2-patients experiencing virologic failure, with at least one drug resistance mutation was followed from January 2012 to August 2017 in Côte d'Ivoire. Follow-up data included death, lost to follow-up (LTFU), immuno-virological responses. The Kaplan-Meier curve was used to estimate survival rates. RESULTS: A total of 31 HIV-2 patients with virologic failure and with at least one drug resistance mutation were included. Two-third of them were men, 28(90.3%) were on PI-based ART-regimen at enrolment and the median age was 50 years (IQR = 46-54). The median baseline CD4 count and viral load were 456 cells/mm3 and 3.7 log10 c/mL respectively, and the participants have been followed-up in median 57 months (IQR = 24-60). During this period, 21 (67.7%) patients switched at least one antiretroviral drug, including two (6.5%) and three (9.7%) who switched to a PI-based and an integrase inhibitor-based regimen respectively. A total of 10(32.3%) patients died and 4(12.9%) were LTFU. The 36 and 60-months survival rates were 68.5% and 64.9%, respectively. Among the 17 patients remaining in care, six(35.3%) had an undetectable viral load (<50 c/mL) and for the 11 others, the viral load ranged from 2.8 to 5.6 log10 c/mL. Twelve patients were receiving lopinavir at the time of first genotype, five(42%) had a genotypic susceptibility score (GSS) ≤1 and 4(33%) a GSS >2. CONCLUSIONS: The 36-months survival rate among ART-experienced HIV-2 patients with drug-resistant viruses is below 70%,lower than in HIV-1. There is urgent need to improve access to second-line ART for patients living with HIV-2 in West Africa.


Asunto(s)
Terapia Antirretroviral Altamente Activa/efectos adversos , Farmacorresistencia Viral/efectos de los fármacos , Infecciones por VIH/tratamiento farmacológico , VIH-2/genética , Adulto , Fármacos Anti-VIH/administración & dosificación , Fármacos Anti-VIH/efectos adversos , Antirretrovirales/administración & dosificación , Antirretrovirales/efectos adversos , Costa de Marfil/epidemiología , Farmacorresistencia Viral/genética , Femenino , Genotipo , Infecciones por VIH/epidemiología , Infecciones por VIH/genética , Infecciones por VIH/virología , Inhibidores de Integrasa VIH/administración & dosificación , Inhibidores de Integrasa VIH/efectos adversos , VIH-2/efectos de los fármacos , VIH-2/patogenicidad , Humanos , Lopinavir/administración & dosificación , Persona de Mediana Edad , Mutación , Ritonavir/administración & dosificación , Ritonavir/efectos adversos , Carga Viral/efectos de los fármacos , Carga Viral/genética
11.
Oral Dis ; 26 Suppl 1: 80-90, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-32862541

RESUMEN

As a result of the extension of life span produced by increasing access to combined antiretroviral therapy, people living with HIV/AIDS (PLWH) face new challenges from comorbidities. Although advances in medical care for HIV infection have dramatically reduced opportunistic infections and AIDS-defining cancers, some non-AIDS-defining cancers (NADC) and specific oral diseases such as periodontitis and salivary gland disease are now more prevalent. Cancer prevention is, therefore, a priority issue in care of PLWH, stressing both restoration of immune function and reduction of non-HIV cancer risk factors (tobacco in all its forms; areca nut; heavy alcohol consumption; diets lacking antioxidant vitamins and minerals; and oncogenic virus infections) through specific interventions, especially tobacco and areca nut cessation and alcohol moderation. Detection of oral high-risk human papillomaviruses (HR-HPV) and the universal preventive HPV vaccination among PLWH should be promoted to reduce the malignancy burden, along with routine oral examinations which remain the cheapest, most reliable, most reproducible, and non-invasive tool to identify suspicious lesions. Also, considerations of oral inflammation and periodontal health are important to replication and gene expression of viruses in the mouth. Considering that a key risk factor for this scenario is the presence of oncogenic virus infection such as several members of the human herpesvirus and human papillomavirus families, here we analyze the variables involved in the seeming increase in comorbidities in PLWH.


Asunto(s)
Antirretrovirales , Infecciones por VIH , Enfermedades de la Boca , Neoplasias , Antirretrovirales/efectos adversos , Antirretrovirales/uso terapéutico , Comorbilidad , Infecciones por VIH/complicaciones , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/epidemiología , Humanos , Enfermedades de la Boca/epidemiología , Enfermedades de la Boca/virología , Neoplasias/epidemiología , Papillomaviridae
12.
Oral Dis ; 26 Suppl 1: 149-152, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-32862548

RESUMEN

OBJECTIVES: Significant pain from HIV-associated sensory neuropathy (HIV-SN) affects 40% of HIV-infected individuals treated with antiretroviral therapy (ART). The most salient symptom of the neuropathy is pain, which frequently is moderate-to-severe intensity, associated with reduced activities and physical function, sleep disruption, increased severity of depression, and anxiety. Yet, evidence for managing painful HIV-SN is poor. The purpose of this study was to verify by scientific evidence the neuropathy complication in HIV/AIDS patients to develop effective pain management strategies. METHODS: Design: Systematic review. DATA SOURCES: PubMed (MEDLINE), Cochrane, www.controlled-trials.com. SELECTION CRITERIA: the filter "English" was used, timeframed searched was 2009-2019, randomized controlled trials (RCT). Keywords were verified in MeSH "Peripheral Nervous System Disease" and "Antiretroviral Agents" or "Antiretroviral therapy." REVIEW METHOD: the PRISMA flowchart was used. RESULT: A systematic search following PRISMA guidelines was carried out, and 12 specific articles/studies on the subject were selected. The results revealed that HIV therapy, aging, body mass index, height, and systemic conditions influence neuropathy conditions in HIV/AIDS patients. The multistudies focused on pain management approaches such as administration of pain medication, drug combination to prevent side effects, or ART with minimal side effects. CONCLUSION: Sensory neuropathy is a frequent complication of HIV infection and ART. An understanding of the mechanism and pathophysiology of neuropathy in HIV is urgently required to develop alternative treatment modalities and to evaluate preventive strategies.


Asunto(s)
Síndrome de Inmunodeficiencia Adquirida , Antirretrovirales , Infecciones por VIH , Enfermedades del Sistema Nervioso Periférico , Antirretrovirales/efectos adversos , VIH , Infecciones por VIH/complicaciones , Infecciones por VIH/tratamiento farmacológico , Humanos , Enfermedades del Sistema Nervioso Periférico/inducido químicamente , Enfermedades del Sistema Nervioso Periférico/tratamiento farmacológico , Ensayos Clínicos Controlados Aleatorios como Asunto
13.
BMC Infect Dis ; 20(1): 460, 2020 Jul 01.
Artículo en Inglés | MEDLINE | ID: mdl-32611405

RESUMEN

BACKGROUND: Although the United Nations program on HIV/AIDS 90-90-90-targets recommends achieving 90% of viral suppression for patients on first-line antiretroviral therapy by 2020, virological failure is still high and it remains a global public health problem. Therefore, assessing the incidence and predictors of virological failure among adult HIV patients on first-line ART in Amhara regional referral hospitals, Ethiopia is vital to design appropriate prevention strategies for treatment failure and preventing the unnecessary switching to second-line regimens. METHOD: An institution-based retrospective follow-up study was conducted on 490 adult HIV patients. The simple random sampling technique was used, and data were entered into Epi data Version 4.2.0.0 and was exported to Stata version 14 for analysis. The proportional hazard assumption was checked, and the Weibull regression was fitted. Cox-Snell residual was used to test the goodness of fit, and the appropriate model was selected by AIC/BIC. Finally, an adjusted hazard ratio with a 95% CI was computed, and variables with P-value < 0.05 in the multivariable analysis were taken as significant predictors of virological failure. RESULTS: The overall incidence rate of virological failure was 4.9 events per 1000 person-month observations (95%CI: 3.86-6.38). Users of CPT (AHR = 0.55, 95%CI: 0.31-0.97), poor adherence (AHR = 5.46, 95%CI: 3.07-9.74), CD4 Count <=200 cells/mm3 (AHR = 3.9, 95%CI: 1.07-13.9) and 201-350 cells/mm3 (AHR 4.1, 95%CI: 1.12-15) respectively, and NVP based first line drug regimen (AHR = 3.53, 95%CI: 1.73-7.21) were significantly associated with virological failure. CONCLUSION: The incidence rate of virological failure was high. CPT, poor adherence, low baseline CD4 count and NVP based first-line drug regimen were independent risk factors associated with virological failure. Therefore, strengthening HIV care intervention and addressing these significant predictors is highly recommended in the study setting.


Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/tratamiento farmacológico , Síndrome de Inmunodeficiencia Adquirida/epidemiología , Antirretrovirales/efectos adversos , Antirretrovirales/uso terapéutico , VIH/efectos de los fármacos , Adolescente , Adulto , Recuento de Linfocito CD4 , Etiopía/epidemiología , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Masculino , Cumplimiento de la Medicación , Persona de Mediana Edad , Modelos de Riesgos Proporcionales , Derivación y Consulta , Estudios Retrospectivos , Factores de Riesgo , Insuficiencia del Tratamiento , Adulto Joven
14.
Cardiovasc J Afr ; 31(4): 190-195, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32634198

RESUMEN

INTRODUCTION: With improved access to anti-retroviral therapy (ART) the focus of HIV treatment is changing to reducing chronic co-morbidities and their effects, but guidelines for HIV care in many African countries do not include screening for cardiac disease. Our study aimed to determine the pattern of cardiac abnormalities in HIV-positive patients on ART. METHODS: We implemented a prospective, observational study for 24 months on a random sample of adult patients seen at a dedicated HIV clinic in Mozambique. Demographic, clinical and full cardiovascular evaluations were performed on all participants. RESULTS: We enrolled 264 HIVvpositive patients (mean age 39.3 years; 186 female, 70.5%). The mean time on ART was 46 (SD 36) months and most had low viral load (174, 65%). Obesity (45, 17%), overweight (65, 24.6%), hypertension (54, 20.5%) and severe anaemia (21, 8.3%) were frequent. Diabetes was present in four patients (1.5%). The most important conditions in 252 patients submitted to echocardiography (88, 34.9% had cardiac abnormalities) were: severe rheumatic heart valve disease (six), severe dilated cardiomyopathy (five), aortic degenerative disease and congenital heart disease (in three patients each). At 24-month follow up, six of the 252 patients had died; of the 196 reviewed on echocardiography 29 had progressed and two had improved ventricular systolic function. CONCLUSION: This young cohort of HIV-positive patients on ART showed lower occurrence of tuberculous pericarditis and dilated cardiomyopathy but high cardiovascular risk, as assessed by the presence of obesity, hypertension and anaemia. Cardiac abnormalities needing multidisciplinary care were also found. There is a need for tailored cardiovascular risk stratification and screening for cardiovascular disease in HIV-positive patients on ART in Africa.


Asunto(s)
Antirretrovirales/uso terapéutico , Enfermedades Cardiovasculares/epidemiología , Infecciones por VIH/tratamiento farmacológico , Adolescente , Adulto , Anciano , Antirretrovirales/efectos adversos , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/mortalidad , Enfermedades Cardiovasculares/terapia , Comorbilidad , Estudios Transversales , Duración de la Terapia , Femenino , Infecciones por VIH/diagnóstico , Infecciones por VIH/epidemiología , Infecciones por VIH/mortalidad , Humanos , Masculino , Persona de Mediana Edad , Mozambique/epidemiología , Estudios Prospectivos , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento , Adulto Joven
15.
PLoS One ; 15(6): e0233849, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32497153

RESUMEN

BACKGROUND: Sleep is a natural, restorative, physiological process that is characterized by perceptual disengagement from and unresponsiveness to whatever going around, which is reversible. Sleep quality refers to a sense of being rested and refreshed after waking up from sleep. People living with HIV/AIDS (PLWHA) are vulnerable to poor sleep quality as they suffer from social stigma and Anti-Retroviral drug side effects. The study aimed to examine the quality of sleep and its associated factors among people living with HIV/AIDS attending Anti-Retroviral Therapy (ART) clinic at Hawassa University comprehensive specialized hospital. METHOD: Institutional based cross-sectional study was conducted among PLWHA attending ART clinic at Hawassa University comprehensive specialized hospital from May 1-30, 2019. A systematic random sampling technique was used to select an estimated 422 study participants and data was collected using interviewer-administered technique. Sleep Quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). Data were entered and analyzed using SPSS 22 software. Bivariable and multivariable logistic regression model was fitted to identify factors associated with quality of sleep. An adjusted odds ratio with a 95% confidence interval was computed to determine the level of significance with P-value less than 0.05. RESULT: Out of 422 respondents, 389 participated in the study giving a response rate of 92.1%. The prevalence of poor quality of sleep among study participants was found to be 57.6% (95% CI: 54.72, 60.48). 31.9% (124) and 30.6% (119) of study participants had anxiety and depression respectively. Being between the age of 55-64 years (AOR = 5.7, 95% CI (1.9, 17.8), Age ≥ 65 (AOR:6.6, 95% CI (1.2, 36.9), Monthly income <1656 Ethiopian Birr (ETB) (AOR = 2.17, 95% CI (1.06, 4.4), having anxiety (AOR = 4.4, 95% CI (2.12, 9.2), having depression (AOR = 4.97, 95% CI (2.28, 10) and poor social support (AOR = 2.9, 95% CI (1.16, 7.3) were factors associated with poor quality of sleep. CONCLUSION: The prevalence of poor quality of sleep among PLWHA was significantly high. Average monthly income, age, anxiety, depression, and social support were found to be significantly associated with poor sleep quality. Health care professionals working at the ART clinic need to assess the sleep pattern of ART clients, give psychoeducation on the prevention and management of sleep pattern problems.


Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/tratamiento farmacológico , Síndrome de Inmunodeficiencia Adquirida/psicología , Antirretrovirales/uso terapéutico , VIH , Síndromes de la Apnea del Sueño/epidemiología , Trastornos del Inicio y del Mantenimiento del Sueño/epidemiología , Síndrome de Inmunodeficiencia Adquirida/virología , Adolescente , Adulto , Anciano , Antirretrovirales/efectos adversos , Ansiedad/complicaciones , Estudios Transversales , Depresión/complicaciones , Etiopía/epidemiología , Femenino , Hospitales Universitarios , Humanos , Masculino , Persona de Mediana Edad , Pobreza , Prevalencia , Síndromes de la Apnea del Sueño/etiología , Trastornos del Inicio y del Mantenimiento del Sueño/etiología , Estigma Social , Adulto Joven
16.
BMC Infect Dis ; 20(1): 383, 2020 May 29.
Artículo en Inglés | MEDLINE | ID: mdl-32471350

RESUMEN

BACKGROUND: HIV affects the central nervous system resulting in HIV associated neurocognitive impairment (NCI) in approximately 50% of people living with HIV. It typically affects memory, learning, working memory, fine motor skills, speed of information processing, verbal fluency and executive functioning cognitive domains. NCI can affect adherence to antiretroviral therapy (ART), employability, driving ability and activities of daily living. NCI is not routinely screened for in Zimbabwe, and the burden is not known in this setting. The objectives of this study were: 1) To determine NCI prevalence using a comprehensive neuropsychological battery at two primary health care clinics in Harare; 2) To assess the pattern of cognitive impairment across cognitive domains using a gold standard neuropsychological (NP) battery in HIV-positive patients compared to HIV-negative controls. METHODS: Inclusion criteria: 18 years or older; minimum 7 years education; no neurological or psychiatric disorders. HIV-positive participants were on ART for ≥3 months; HIV-negative participants had a confirmed HIV negative status in the past month. A comprehensive NP battery, functional assessments, demographic and medical history questionnaires were administered. The NP battery consisted of tests assessing memory, learning, working memory, fine motor skills, speed of information processing, verbal fluency and executive functioning. RESULTS: Two-hundred-and-thirty-one participants were recruited. Of those, 155 were HIV-positive (Female = 70%, Age M = 37.8; SD 11.2) and 76 HIV-negative (Female = 63%, Age M = 31.2; SD 9.9). HIV-positive participants were on ART for an average of 6 years. NCI was present in 49.7% HIV positive participants. Compared to HIV-negative participants, the HIV-positive group had significantly poorer scores in 5 out of 7 cognitive domains. A good level of education is negatively correlated with NCI. CONCLUSIONS: NCI prevalence in HIV-positive population Zimbabwe is consistent with global estimates. NCI persists in adults who are on ART. Routine assessment of NCI in adults attending primary care clinics using this adapted battery is therefore important so that they are identified early and are provided the necessary interventions.


Asunto(s)
Antirretrovirales/uso terapéutico , Disfunción Cognitiva/epidemiología , Disfunción Cognitiva/etiología , Infecciones por VIH/complicaciones , Infecciones por VIH/tratamiento farmacológico , VIH , Atención Primaria de Salud , Actividades Cotidianas , Adolescente , Adulto , Antirretrovirales/efectos adversos , Función Ejecutiva , Femenino , Infecciones por VIH/virología , Humanos , Aprendizaje , Masculino , Persona de Mediana Edad , Pruebas Neuropsicológicas , Prevalencia , Encuestas y Cuestionarios , Adulto Joven , Zimbabwe/epidemiología
17.
Artículo en Inglés | MEDLINE | ID: mdl-32312690

RESUMEN

Drug intake in pregnant women is common, including prescribed and over-the-counter medications, and herbal medicine and supplements. Drug-induced liver injury (DILI) has become the leading cause of acute liver failure in Western countries, and pregnancy is thought to be a risk factor, but only few anecdotal reports concerning pregnant women are found. These involved antihypertensive, antithyroid, antiretroviral, and antituberculosis medications, and antibiotics. Presentation was usually in the first 20 weeks of gestation following a latency of several weeks, because these drugs were usually prescribed before or in early pregnancy due to their fetal safety. The hepatotoxicity is usually of the idiosyncratic form, and most would resolve spontaneously although occasional liver transplantation and maternal death were reported. The scanty reports could have been related to under-reporting and missed diagnosis due to spontaneous resolution in most cases. DILI should remain one of the differential diagnoses in pregnant women with hepatitis.


Asunto(s)
Enfermedad Hepática Inducida por Sustancias y Drogas/epidemiología , Enfermedad Hepática Inducida por Sustancias y Drogas/etiología , Complicaciones del Embarazo/inducido químicamente , Antibacterianos/efectos adversos , Antirretrovirales/efectos adversos , Antihipertensivos/efectos adversos , Antitiroideos/efectos adversos , Antituberculosos/efectos adversos , Enfermedad Hepática Inducida por Sustancias y Drogas/diagnóstico , Suplementos Dietéticos/efectos adversos , Femenino , Humanos , Trasplante de Hígado , Extractos Vegetales/efectos adversos , Embarazo , Factores de Riesgo , Índice de Severidad de la Enfermedad
18.
PLoS One ; 15(4): e0231952, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32343742

RESUMEN

BACKGROUND: Despite access to free antiretroviral therapy (ART) for all people living with human immunodeficiency virus (HIV), noncompliance to treatment continues to be a significant challenge in Eswatini. Yet studies investigating barriers to ART adherence in Eswatini are scarce. Most notably, there is a lack of research regarding rural women in Eswatini, who are currently the country's most vulnerable to HIV infection. Therefore, the objective of the study is to investigate individual, household, and community level barriers to ART adherence among rural women living with HIV. METHODS: We conducted a qualitative study to investigate individual, household, and community level barriers to ART adherence. We conducted focus group discussions with HIV-infected women (n = 4) from rural villages in Eswatini, and in-depth interviews with healthcare workers (n = 8) serving the area clinics. Open and axial coding techniques were used for data analysis and interpreted within a social ecological framework. RESULTS: Our findings revealed several individual level barriers including hunger, side effects of ART, personal stress, lack of disclosure of HIV status, alcohol use, and forgetting to take ART. Lack of food, unemployment and scarcity of financial resources were identified as critical barriers at the household level. Community and institutional barriers encompassed factors related to health delivery such as lack of privacy, travel time, transportation costs, excessive alcohol use by healthcare workers, maltreatment, public and self-stigma, gossip, and long waits at clinics. CONCLUSIONS: Rural women living with HIV face multilevel barriers to ART adherence. Support programs aimed at increasing ART adherence among this vulnerable population need to develop targeted polices to alleviate challenges rural women face, beginning with expanding qualifications for food assistance programs.


Asunto(s)
Infecciones por VIH/psicología , Cumplimiento de la Medicación , Adulto , Consumo de Bebidas Alcohólicas , Antirretrovirales/efectos adversos , Antirretrovirales/uso terapéutico , Esuatini , Femenino , Infecciones por VIH/tratamiento farmacológico , Personal de Salud/psicología , Humanos , Entrevistas como Asunto , Pobreza , Privacidad , Población Rural , Clase Social , Apoyo Social , Estrés Psicológico
19.
Top Antivir Med ; 27(4): 106-111, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32224502

RESUMEN

A high proportion of individuals with HIV infection currently are diagnosed at an advanced stage of disease (late presenters), increasing their risk for immune reconstitution inflammatory syndrome (IRIS). IRIS typically occurs within 6 months of initiation of antiretroviral therapy (ART) in patients with low CD4+ cell counts and can occur before any marked elevation in CD4+ count is achieved on ART. In addition to low CD4+ count at ART initiation, 2 other major clinical predictors of IRIS are preexisting opportunistic infection (including subclinical infection) and shorter treatment period for opportunistic infection prior to starting ART. Mycobacterial infection-associated IRIS, including tuberculosis (TB)-associated IRIS, and cryptococcal infection-associated IRIS are the most common forms of the syndrome. Corticosteroid prophylaxis and early treatment can be effective in reducing incidence of TB-IRIS and severity of symptoms in select patients. Sterilization of the cerebrospinal fluid should be achieved prior to starting ART in patients with TB meningitis and cryptococcal meningitis. This article summarizes a presentation by Irini Sereti, MD, MHS, at the International Antiviral Society-USA (IAS-USA) continuing education program held in Washington, DC, in April 2019.


Asunto(s)
Antirretrovirales/efectos adversos , Antirretrovirales/uso terapéutico , Infecciones por VIH , Síndrome Inflamatorio de Reconstitución Inmune/diagnóstico por imagen , Síndrome Inflamatorio de Reconstitución Inmune/epidemiología , Infecciones Oportunistas Relacionadas con el SIDA/tratamiento farmacológico , Antirretrovirales/agonistas , Antirretrovirales/inmunología , Recuento de Linfocito CD4 , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/inmunología , Humanos , Síndrome Inflamatorio de Reconstitución Inmune/inducido químicamente , Incidencia , Meningitis Criptocócica/tratamiento farmacológico , Tuberculosis/tratamiento farmacológico , Carga Viral
20.
Rev. clín. esp. (Ed. impr.) ; 220(3): 149-154, abr. 2020. tab, graf
Artículo en Español | IBECS | ID: ibc-198986

RESUMEN

ANTECEDENTES: La mayor supervivencia de los pacientes con infección por VIH gracias al tratamiento antirretroviral (TAR) se acompaña de una mayor frecuencia de enfermedad cardiovascular (ECV). Analizamos la prevalencia de los factores de riesgo cardiovascular (FRCV) y la estimación del riesgo de ECV en una cohorte de personas con infección por VIH en España. MÉTODOS: Estudio transversal, observacional de los FRCV en la cohorte española VACH de pacientes con infección por VIH que recibían TAR. RESULTADOS: Se evaluaron 15.559 pacientes con infección por VIH (76% varones; edad media: 46 años). Un 3,7% había experimentado al menos un evento de ECV. La prevalencia de FRCV era elevada: hiperlipidemia, 64%; tabaquismo, 47%; HTA, 22%; y diabetes, 16%. Según la escala Framingham, un 10,9% presentaba alto riesgo de ECV y un 28,8% riesgo moderado. De los pacientes con elevado riesgo de ECV, el 49% recibía inhibidores de proteasa y el 43% abacavir. Se usaron fármacos hipotensores en el 53% de los pacientes con diagnóstico de HTA, y fármacos antidiabéticos en el 2,6% de los pacientes con diabetes. CONCLUSIONES: Los FRCV tradicionales son frecuentes en los pacientes con infección por VIH con TAR en España, y una elevada proporción de ellos tiene riesgo moderado-alto de ECV. Por tanto, el control de los FRCV modificables en los pacientes con infección por VIH debería mejorarse y valorar el uso de fármacos con mejor perfil de riesgo cardiovascular


BACKGROUND: The increased survival of patients with HIV infection thanks to antiretroviral therapy (ART) is accompanied by a higher rate of cardiovascular disease (CVD). We analysed the prevalence of the cardiovascular risk factors (CRFs) and estimated the risk of CVD in a cohort of patients with HIV in Spain. METHODS: We conducted a cross-sectional, observational study of CRFs in the Spanish VACH cohort of patients with HIV who undergo ART. RESULTS: The study assessed 15,559 patients with HIV (76% men; mean age, 46 years). Some 3.7% had experienced at least 1 CVD event. The prevalence of CRFs was high (hyperlipidaemia, 64%; tobacco use, 47%; arterial hypertension, 22%; and diabetes, 16%). According to the Framingham scale, 10.9% of the patients presented a high CVD risk, and 28.8% presented a moderate risk. Of the patients with a high CVD risk, 49% took protease inhibitors and 43% took abacavir. Fifty-three percent of the patients diagnosed with arterial hypertension took antihypertensive drugs, and 2.6% of the patients with diabetes took antidiabetic agents. CONCLUSIONS: Classical CRFs are common in patients with HIV undergoing ART in Spain, and a large proportion of them have a moderate-high risk of CVD. Therefore, controlling the modifiable CRFs in patients with HIV should be improved, and the use of drugs with a better cardiovascular risk profile should be assessed


Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Enfermedades Cardiovasculares/inducido químicamente , Infecciones por VIH/complicaciones , Infecciones por VIH/tratamiento farmacológico , Antirretrovirales/efectos adversos , Estudios Transversales , Antirretrovirales/clasificación , Enfermedades Cardiovasculares/sangre , Factores Sexuales
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA
...