RESUMO
INTRODUCTION: Renal disease has emerged as one of the primary comorbid conditions affecting HIV-infected patients, mainly because antiretroviral therapy has improved survival. This study aimed to detect risk factors possibly associated with altered renal function in HIV-infected patients. METHODS: A cross-sectional study was conducted involving 254 HIV-infected patients attending an outpatient clinic at Santa Casa de Vitoria< They were interviewed and blood samples were collected for CD4 cell counts, HIV-1 viral load, glucose, lipids and creatinine measurements. Urine protein was evaluated in the first voiding urine sample. Glomerular filtration was estimated by simplified modified diet in renal disease (MDRD) and Cockcroft-Gault formulas. RESULTS: One hundred and three (40.6%) patients presented some urinary abnormality, and proteinuria was the most common finding (46; 18.1% patients). Twenty-five (9.8%) patients showed estimated glomerular filtration below 60 ml/min/1.73 m² by MDRD. Multivariate logistic regression showed that low glomerular filtration was positively correlated with black race [OR 9.6 (IC95% 1.28-23.80)], arterial hypertension [OR 3.3 (IC95% 1.28-23.81)], age over fifty-one years-old [OR 3.3 (IC95%1.11-9.90)], proteinuria [OR 5.2 {IC95% 1.67-16.25}]; hematuria [OR 3.2 (1.12-9.29)] and negatively correlated with patients using zidovudine [OR 0.2 (0.04-0.78)]. CONCLUSIONS: Traditional risk factors for renal disease, such as black race, arterial hypertension and advancing age were correlated with low estimated glomerular filtration in the present patient sample.
Assuntos
Nefropatia Associada a AIDS/diagnóstico , Fármacos Anti-HIV/efeitos adversos , Nefropatia Associada a AIDS/epidemiologia , Adulto , Fármacos Anti-HIV/uso terapêutico , Contagem de Linfócito CD4 , Estudos Transversais , Feminino , Humanos , Testes de Função Renal , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Carga ViralRESUMO
INTRODUÇÃO: A doença renal é uma das principais comorbidades envolvendo pacientes infectados com o HIV, em razão da melhora da sobrevida proporcionada pela terapêutica antirretroviral. O objetivo deste estudo foi detectar fatores de risco, possivelmente correlacionados com função renal alterada, em pacientes infectados pelo HIV. MÉTODOS: Estudo transversal foi realizado em 254 pacientes infectados pelo HIV, atendidos em ambulatório na Santa Casa de Vitória. Eles foram entrevistados e submetidos a coletas de amostras de sangue para contagem de células CD4, quantificação de carga viral do HIV-1, dosagens de glicose, lipídeos e creatinina. A proteinúria foi avaliada em amostra de primeira urina da manhã. A filtração glomerular foi estimada com as fórmulas de modified diet in renal disease (MDRD) simplificada e Cockcroft-Gault. RESULTADOS: Cento e três (40,6 por cento) pacientes tinham alguma anormalidade no exame de urina, sendo proteinúria o achado mais comum (46; 18,1 por cento pacientes). Vinte e cinco (9,8 por cento) pacientes tinham filtração glomerular estimada inferior a 60ml/min/1.73m² de acordo com MDRD. A análise de regressão logística multivariada mostrou que baixa filtração glomerular foi positivamente correlacionada com raça negra [OR 9,6 (IC95 por cento 1,28-23,80)], hipertensão arterial sistêmica [OR 3,3 (IC95 por cento 1,28-23,81)], idade acima de 51 anos [OR 3,3 (IC95 por cento1,11-9,90)], proteinúria [OR 5,2 {IC95 por cento 1,67-16,25}]; hematúria [OR 3,2 (1,12-9,29)] e negativamente com pacientes em uso de zidovudina [OR 0,2 (0,04-0,78)]. CONCLUSÕES: Os fatores de risco tradicionais para doença renal como raça negra, hipertensão arterial e idade avançada foram correlacionados com menor filtração glomerular estimada em nossos pacientes.
INTRODUCTION: Renal disease has emerged as one of the primary comorbid conditions affecting HIV-infected patients, mainly because antiretroviral therapy has improved survival. This study aimed to detect risk factors possibly associated with altered renal function in HIV-infected patients. METHODS: A cross-sectional study was conducted involving 254 HIV-infected patients attending an outpatient clinic at Santa Casa de Vitoria< They were interviewed and blood samples were collected for CD4 cell counts, HIV-1 viral load, glucose, lipids and creatinine measurements. Urine protein was evaluated in the first voiding urine sample. Glomerular filtration was estimated by simplified modified diet in renal disease (MDRD) and Cockcroft-Gault formulas. RESULTS: One hundred and three (40.6 percent) patients presented some urinary abnormality, and proteinuria was the most common finding (46; 18.1 percent patients). Twenty-five (9.8 percent) patients showed estimated glomerular filtration below 60ml/min/1.73m² by MDRD. Multivariate logistic regression showed that low glomerular filtration was positively correlated with black race [OR 9.6 (IC95 percent 1.28-23.80)], arterial hypertension [OR 3.3 (IC95 percent 1.28-23.81)], age over fifty-one years-old [OR 3.3 (IC95 percent1.11-9.90)], proteinuria [OR 5.2 {IC95 percent 1.67-16.25}]; hematuria [OR 3.2 (1.12-9.29)] and negatively correlated with patients using zidovudine [OR 0.2 (0.04-0.78)]. CONCLUSIONS: Traditional risk factors for renal disease, such as black race, arterial hypertension and advancing age were correlated with low estimated glomerular filtration in the present patient sample.
Assuntos
Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nefropatia Associada a AIDS/diagnóstico , Fármacos Anti-HIV/efeitos adversos , Nefropatia Associada a AIDS/epidemiologia , Fármacos Anti-HIV/uso terapêutico , Estudos Transversais , Testes de Função Renal , Fatores de Risco , Carga ViralRESUMO
Chronic inflammatory demyelinating polyneuropathy has a strong association with HIV and HCV infection. A rare association between chronic inflammatory demyelinating polyneuropathy and hepatitis C treatment with pegylated interferon alpha was described recently. We described the first case of chronic inflammatory demyelinating polyneuropathy associated with pegylated interferon alpha 2b in a white man infected with HIV and HCV. The patient recovered completely with the use of intravenous hyperimmune immunoglobulin. Infectologists and hepatologists should be alert regarding this rare and serious association, which requires immediately drug discontinuation and early treatment.
Assuntos
Antivirais/efeitos adversos , Imunoglobulinas Intravenosas/uso terapêutico , Interferon-alfa/efeitos adversos , Polietilenoglicóis/efeitos adversos , Polirradiculoneuropatia Desmielinizante Inflamatória Crônica/induzido quimicamente , Infecções por HIV/complicações , Hepatite C Crônica/complicações , Hepatite C Crônica/tratamento farmacológico , Humanos , Interferon alfa-2 , Masculino , Pessoa de Meia-Idade , Polirradiculoneuropatia Desmielinizante Inflamatória Crônica/tratamento farmacológico , Proteínas RecombinantesRESUMO
A polineuropatia desmielinizante inflamatória cônica possui forte associação com a infecção pelo HIV e HCV. Uma rara associação entre PDIC e o tratamento da hepatite C com interferon peguilado alfa foi descrita recentemente. Nós descrevemos o primeiro caso de polineuropatia desmielinizante inflamatória crônica em um paciente branco, sexo masculino infectado por HIV e HCV associado a interferon peguilado alfa 2b. O paciente recuperou-se completamente após o uso de imunoglobulina hiperimune endovenosa. Infectologistas e hapatologistas devem estar atentos à esta rara e grave associação, que exige imediata descontinuação da droga e tratamento precoce.
Chronic inflammatory demyelinating polyneuropathy has a strong association with HIV and HCV infection. A rare association between chronic inflammatory demyelinating polyneuropathy and hepatitis C treatment with pegylated interferon alpha was described recently. We described the first case of chronic inflammatory demyelinating polyneuropathy associated with pegylated interferon alpha 2b in a white man infected with HIV and HCV. The patient recovered completely with the use of intravenous hyperimmune immunoglobulin. Infectologists and hepatologists should be alert regarding this rare and serious association, which requires immediately drug discontinuation and early treatment.