Características epidemiológicas y clínicas autorreportadas en pacientes con obesidad y COVID-19: un estudio de corte transversal / Epidemiological and clinical characteristics self-reported in patients with obesity and COVID-19 disease: a cross-sectional study

RESUMEN INTRODUCCIÓN En Argentina, la obesidad en adultos es una problemática con una prevalencia media de 25,4%. En la relación entre COVID-19 y obesidad, se observa mayor prevalencia de sobrepeso/obesidad y enfermedad severa entre los pacientes con COVID-19. Por ello, el objetivo del estudio fue conocer las características clínicas y epidemiológicas en pacientes con diagnóstico de obesidad sobrevivientes a la infección por SARS-CoV-2. MÉTODOS Se realizó un estudio observacional descriptivo y analítico de corte transversal. Se aplicó una encuesta autoadministrada. RESULTADOS La mediana de edad fue 41 años, y hubo un 69,9% de mujeres. Los síntomas de presentación más prevalentes fueron astenia (86,7%), anosmia (64,5%) y tos (64%). Con respecto a los síntomas persistentes luego de las 12 semanas del diagnóstico, los más prevalentes fueron astenia (52,9%), trastornos de sueño (32,4%) y falta de concentración/memoria (31,7%). Hubo mayor riesgo en mujeres (OR: 2,86; IC95%: 2,23-3,67) con obesidad (OR: 1,58; IC95%: 1,16-2,16). La enfermedad grave en obesos fue casi el triple comparado con no obesos (15,7% vs. 5,4%; p<0,001). DISCUSIÓN Los pacientes obesos mostraron síntomas de presentación que orientan a un estado inflamatorio sistémico, con disnea y tos más frecuentes, y tienen mayor prevalencia de enfermedad grave y neumonía, así como mayor riesgo de desarrollar síntomas persistentes, sobre todo si las personas son mujeres y sedentarias.

ABSTRACT INTRODUCTION In Argentina, obesity in adults is a problem with an average prevalence of 25.4%. The relationship between COVID-19 and obesity shows a higher prevalence of overweight/obesity and severe disease among patients with COVID-19. Therefore, the objective of the study was to know the clinical and epidemiological characteristics of patients diagnosed with obesity who survived SARSCoV- 2 infection. METHODS A descriptive and analytical cross-sectional observational study was carried out. A self-administered survey was applied. RESULTS The median age was 41 years and 69.9% were women. The most prevalent presenting symptoms were asthenia (86.7%), anosmia (64.5%) and cough (64%). Regarding persistent symptoms 12 weeks after diagnosis, the most prevalent ones were asthenia (52.9%), sleep disorders (32.4%) and lack of concentration/memory (31.7%). The risk was higher for women (OR: 2.865; CI95%: 2.23-3.67) with obesity (OR: 1.58; CI95%: 1.16-2.16). Severe disease in obese was almost threefold that in non-obese patients (15.7% vs. 5.4%; p<0.001). DISCUSSION Obese patients showed presenting symptoms that point to a systemic inflammatory state, with dyspnea and cough being more common, and have a higher prevalence of severe disease and pneumonia, as well as a higher risk of developing persistent symptoms, especially if they are women and sedentary.

Characteristics and outcomes of patients infected with nCoV19 requiring invasive mechanical ventilation in Argentina. / Características y resultados de los pacientes infectados con nCoV19 con requerimiento de ventilación mecánica invasiva en la Argentina.

OBJECTIVE: A novel coronavirus emerged this year as a cause of viral pneumonia. The main characteristics of the virus are rapid transmission, high contagion capacity and potential severity. The objective of this case series study is to describe the clinical characteristics of patients with confirmed coronavirus disease (COVID-19) admitted to different intensive care units in Argentina for mechanical ventilation. METHODS: A descriptive, prospective, multicenter case series study was conducted between April 1 and May 8, 2020. Data from patients older than 18 years who were admitted to the intensive care unit for mechanical ventilation for acute respiratory failure with a positive diagnosis of COVID-19 were included. RESULTS: The variables for 47 patients from 31 intensive care units were recorded: 78.7% were men (median age of 61 years), with a SAPS II score of 43 and a Charlson index score of 3. The initial ventilatory mode was volume control - continuous mandatory ventilation with a tidal volume less than 8mL/kg in 100% of cases, with a median positive end-expiratory pressure of 10.5cmH2O. At the end of the study, 29 patients died, 8 were discharged, and 10 remained hospitalized. The SAPS II score was higher among patients who died (p = 0.046). Charlson comorbidity index was associated with higher mortality (OR = 2.27, 95% CI 1.13 - 4.55, p = 0.02). CONCLUSION: Patients with COVID-19 and on mechanical ventilation in this series presented clinical variables similar to those described to date in other international reports. Our findings provide data that may predict outcomes.

OBJETIVO: El coronavirus ha emergido este año como causa de neumonía viral. Una de las principales características es su rápida transmisión y su potencial severidad. El objetivo de este estudio de serie de casos es describir las características clínicas de los pacientes con confirmación de enfermedad por coronavirus (COVID-19) admitidos en diferentes unidades de cuidados intensivos de la Argentina con requerimiento de ventilación mecánica. MÉTODOS: Estudio de serie de casos, descriptivo-prospectivo, multicéntrico realizado entre el 01 de abril y el 08 de mayo de 2020. Se incluyeron los datos de los pacientes mayores a 18 años, que ingresaron a la unidad de cuidados intensivos con requerimiento de ventilación mecánica por falla respiratoria aguda con diagnóstico positivo de COVID-19. RESULTADOS: Se registraron las variables de 47 pacientes de 31 unidades cuidados intensivos, 78.7% hombres de una mediana de edad de 61 años, con un SAPS II de 43, un índice de Charlson de 3. El modo ventilatorio inicial fue volume control - continuous mandatory ventilation con volumen corriente menor a 8mL/kg en el 100% de los casos, con una mediana de presión positiva al final de la espiración de 10,5cmH2O. A la fecha de cierre del estudio, 29 pacientes fallecieron, 8 alcanzaron el alta, y 10 pacientes continúan internados al cierre del estudio. El SAPS II fue mayor entre los fallecidos (p = 0.046). El índice de Charlson se asoció con mayor mortalidad (OR = 2,27 IC95% 1,13 - 4,55; p = 0,02). CONCLUSIÓN: Los pacientes con COVID-19 y ventilación mecánica de esta serie presentan variables clínicas similares a las descriptas a la fecha en otros reportes internacionales. Nuestros hallazgos proporcionan datos que permitirían de alguna manera predecir los resultados.

Características y resultados de los pacientes infectados con nCoV19 con requerimiento de ventilación mecánica invasiva en la Argentina / Characteristics and outcomes of patients infected with nCoV19 requiring invasive mechanical ventilation in Argentina

RESUMEN Objetivo: El coronavirus ha emergido este año como causa de neumonía viral. Una de las principales características es su rápida transmisión y su potencial severidad. El objetivo de este estudio de serie de casos es describir las características clínicas de los pacientes con confirmación de enfermedad por coronavirus (COVID-19) admitidos en diferentes unidades de cuidados intensivos de la Argentina con requerimiento de ventilación mecánica. Métodos: Estudio de serie de casos, descriptivo-prospectivo, multicéntrico realizado entre el 01 de abril y el 08 de mayo de 2020. Se incluyeron los datos de los pacientes mayores a 18 años, que ingresaron a la unidad de cuidados intensivos con requerimiento de ventilación mecánica por falla respiratoria aguda con diagnóstico positivo de COVID-19 Resultados: Se registraron las variables de 47 pacientes de 31 unidades cuidados intensivos, 78.7% hombres de una mediana de edad de 61 años, con un SAPS II de 43, un índice de Charlson de 3. El modo ventilatorio inicial fue volume control - continuous mandatory ventilation con volumen corriente menor a 8mL/kg en el 100% de los casos, con una mediana de presión positiva al final de la espiración de 10,5cmH2O. A la fecha de cierre del estudio, 29 pacientes fallecieron, 8 alcanzaron el alta, y 10 pacientes continúan internados al cierre del estudio. El SAPS II fue mayor entre los fallecidos (p = 0.046). El índice de Charlson se asoció con mayor mortalidad (OR = 2,27 IC95% 1,13 - 4,55; p = 0,02). Conclusión: Los pacientes con COVID-19 y ventilación mecánica de esta serie presentan variables clínicas similares a las descriptas a la fecha en otros reportes internacionales. Nuestros hallazgos proporcionan datos que permitirían de alguna manera predecir los resultados.

Abstract Objective: A novel coronavirus emerged this year as a cause of viral pneumonia. The main characteristics of the virus are rapid transmission, high contagion capacity and potential severity. The objective of this case series study is to describe the clinical characteristics of patients with confirmed coronavirus disease (COVID-19) admitted to different intensive care units in Argentina for mechanical ventilation. Methods: A descriptive, prospective, multicenter case series study was conducted between April 1 and May 8, 2020. Data from patients older than 18 years who were admitted to the intensive care unit for mechanical ventilation for acute respiratory failure with a positive diagnosis of COVID-19 were included. Results: The variables for 47 patients from 31 intensive care units were recorded: 78.7% were men (median age of 61 years), with a SAPS II score of 43 and a Charlson index score of 3. The initial ventilatory mode was volume control - continuous mandatory ventilation with a tidal volume less than 8mL/kg in 100% of cases, with a median positive end-expiratory pressure of 10.5cmH2O. At the end of the study, 29 patients died, 8 were discharged, and 10 remained hospitalized. The SAPS II score was higher among patients who died (p = 0.046). Charlson comorbidity index was associated with higher mortality (OR = 2.27, 95% CI 1.13 - 4.55, p = 0.02). Conclusion: Patients with COVID-19 and on mechanical ventilation in this series presented clinical variables similar to those described to date in other international reports. Our findings provide data that may predict outcomes.

Performance of Different Active Humidification Systems in High-Flow Oxygen Therapy.

BACKGROUND: We sought to evaluate the performance in terms of absolute humidity (AH), relative humidity (RH), and temperature of different heated humidifiers (HH) and circuits that are commonly used to deliver high-flow oxygen therapy in conventional ranges (30-60 L/min) and unconventional ranges (70-100 L/min). METHODS: In this prospective, observational study, an electronic thermohygrometer was used to obtain the required measurements. A mechanical ventilator was used as a source for high-flow nasal cannula oxygen therapy. For active humidification, the following equipment was used: a HH with standard disposable water trap circuit, 3 servo-controlled HH, and 7 circuits with a heated wire. Data on environmental conditions (ie, temperature, RH, AH) were collected from the laboratory during each measurement; the temperature, RH, and AH resulting from the application of 8 flows (30-100 L/min) were also recorded. Variables were compared with analysis of variance for repeated measurements with Tukey post hoc tests. A value of P < .05 was assumed to be significant. RESULTS: During the study, a statistically significant difference was found in the average AH for each flow for the different devices (P < .005). The highest AH values were recorded with the Fisher & Paykel MR850 and the Medtronic-DAR circuit (AH = 40.8 mg/L with flow of 50 L/min, P < .005), and the lowest AH values were recorded with the Flexicare FL9000 HH and the Flexicare circuit (AH = 11.4 mg/L with 100 L/min flow, P < .005). For flows > 50 L/min, the best performance for all flows in terms of AH was found with the Fisher & Paykel MR850 HH, regardless of the circuit used. CONCLUSIONS: During oxygen therapy with very high gas flows, HH devices behave differently and in many cases are inefficient in delivering adequate humidification, even at conventional flows. Caution is therefore recommended when selecting the device and flow settings for the implementation of high-flow nasal cannula oxygen therapy.

Factores de riesgo para el fracaso de destete en una población de pacientes con EPOC en ventilación mecánica prolongada / Risk Factors for Weaning Failure in Patients with Chronic Obstructive Pulmonary Disease in Prolonged Mechanical Ventilation

Introducción: Los pacientes con EPOC experimentan episodios de falla respiratoria que requieren de asistencia ventilatoria mecánica (AVM). Debido al compromiso pulmonar, muscular y nutricional, experimentan dificultad en el destete. Hay escasa información de los factores que puedan predecir el fracaso del destete en pacientes con EPOC en VM prolongada (VMP). El objetivo de este trabajo es encontrar factores de riesgo para el fracaso del destete en pacientes con EPOC y evaluar mortalidad según éxito o fracaso en el destete. Materiales y Métodos: El estudio se realizó en un centro de weaning (CW) y se incluyeron pacientes internados en una unidad de terapia intensiva (UTI) por reagudización de su EPOC derivados a nuestro CW traqueostomizados con requerimiento de AVM. Resultados: Se recolectaron los datos de 40 pacientes, de los cuales 21 finalizaron AVM de manera exitosa y 19 fracasaron. El análisis univariado arrojó 4 variables asociadas al fracaso del destete: Pimax (p = 0.035), días de AVM en el CW (p = 0.005), pH (p = 0.039) y la PaCO2 (p = 0.002). Sin embargo, solo la PaCO2 a las 12hs de la prueba de respiración espontánea (PRE) fue predictor de fracaso de destete (p = 0.007). No se encontraron predictores de mortalidad. Conclusión: Encontrar factores de riesgo que permitan identificar el fracaso en la desvinculación de la VM puede contribuir en la decisión de insistir con el destete, o bien, plantear un programa de internación domiciliaria con la finalidad de mejorar la calidad de vida. La única variable asociada al fracaso de destete fue la PaCO2 a las 12hs de comenzada la PRE.

Introduction: Patients suffering from chronic obstructive pulmonary disease (COPD) have an airflow limitation and require mechanical ventilation (MV). Because of deteriorated lung function, respiratory muscles weakness and malnutrition, patients also present difficulties in the weaning process. Information on the factors that can predict weaning failure in patients with COPD after prolonged MV is scarce. To identify risk factors for weaning failure in patients with COPD and evaluate the mortality depending on weaning success or failure. Materials and Methods: This study was carried out at a weaning center in Buenos Aires, Argentina. We evaluated patients admitted to an intensive care unit (ICU) and referred to the weaning center as a result of COPD exacerbation, after tracheostomy and in need of mechanical ventilation. Results: Data from 40 patients were collected; 21 were successfully weaned from MV and 19 failed the weaning process. Univariate analysis showed 4 variables associated with weaning failure: maximum inspiratory pressure (MIP) (p = 0.035), length of MV at weaning center (p = 0.005), pH (p = 0.039) and PaCO2 (p = 0.002). However, only PaCO2 twelve hours after the spontaneous breathing trial (SBT) was a predictor of weaning failure (p=0.007). Mortality predictors were not found. Conclusion: The only predictive variable associated with weaning failure was PaCO2 twelve hours after SBT. Finding risk factors for failure in discontinuing MV may provide information to decide whether to insist in the weaning process or choose home MV to improve life quality.

Decanulación después de la estadía en UCI: Análisis de 181 pacientes traqueotomizados / Decannulation after the ICU Stay. Analysis of 181 Tracheostomized Patients

Objetivo: Encontrar predictores de decanulación en pacientes traqueostomizados y desvinculados de la asistencia ventilatoria mecánica. Analizar la mortalidad en el centro de weaning y supervivencia al alta. Materiales y métodos: Estudio retrospectivo. Se revisaron historias clínicas de pacientes que ingresaron al centro de weaning entre enero de 2004 y junio de 2011. Se estudiaron diferentes variables como posibles predictores de decanulación. Se analizó la mortalidad y se realizó seguimiento al alta. Resultados: Se incluyeron 181 pacientes con una media de 62 años. Se logró decanular al 44.2% de los pacientes (mediana 20 días). El análisis univariado encontró 6 variables asociadas al fracaso de decanulación: sexo masculino, antecedentes respiratorios, antecedentes cardiovasculares, albúmina al ingreso al centro de weaning, días de internación en centro de weaning y días de internación en Unidad de Cuidados Intensivos + centro de weaning. La regresión logística encontró como predictores independientes: sexo masculino y antecedentes respiratorios. En el análisis de regresión logística la decanulación fue un factor protectivo con respecto a la mortalidad. El 80% de los pacientes decanulados y el 15,8% de los no decanulados obtuvieron alta médica. La mediana de supervivencia de los decanulados fue de 45.47 meses y los no decanulados de 10.87. Conclusiones: Los pacientes de sexo masculino y aquellos con antecedentes respiratorios se asocian con fracaso de decanulación. Los pacientes decanulados tienen menor riesgo de muerte durante la internación.

Objective: Find predictors of decannulation in tracheostomized patients and without mechanical ventilation. A secondary objective was the analysis of mortality in the weaning center and survival at discharge. Material and methods: We reviewed, retrospectively, the medical records of patients admitted to the weaning center with tracheostomy and without mechanical ventilation between January 2004 and June 2011. Different variables as possible predictors of decannulation were studied. Mortality at weaning center and outcomes during follow up after discharge were analyzed. Results: We included 181 patients with an average age of 62 years old. Decannulation was carried out in 44.2% of the patients. The decannulation process took 20 days. The univariate analysis found six variables associated with decannulation failure: male gender, respiratory or cardiovascular history, albumin at admission to the weaning center, days of hospitalization in the weaning center and admission to intensive care units plus the weaning center. Logistic regression analysis found that male sex and respiratory history were independent predictors. Regarding mortality during hospitalization, logistic regression analysis found that decannulation was a protective factor. Another finding was that 80% of patients decannulated were discharged; only 15.8% of the group was not decannulated. The average survival was 45.47 months among the decannulated patients and 10.87 months for the non decannulated patients. Conclusions: We found that male sex and a history of respiratory failure were factors associated with unsuccessful decannulation. Decannulated patients had lower risk of death during hospitalization.

Decanulación después de la estadía en UCI: Análisis de 181 pacientes traqueotomizados

Objetivo: Encontrar predictores de decanulación en pacientes traqueostomizados y desvinculados de la asistencia ventilatoria mecánica. Analizar la mortalidad en el centro de weaning y supervivencia al alta. Materiales y métodos: Estudio retrospectivo. Se revisaron historias clínicas de pacientes que ingresaron al centro de weaning entre enero de 2004 y junio de 2011. Se estudiaron diferentes variables como posibles predictores de decanulación. Se analizó la mortalidad y se realizó seguimiento al alta. Resultados: Se incluyeron 181 pacientes con una media de 62 años. Se logró decanular al 44.2% de los pacientes (mediana 20 días). El análisis univariado encontró 6 variables asociadas al fracaso de decanulación: sexo masculino, antecedentes respiratorios, antecedentes cardiovasculares, albúmina al ingreso al centro de weaning, días de internación en centro de weaning y días de internación en Unidad de Cuidados Intensivos + centro de weaning. La regresión logística encontró como predictores independientes: sexo masculino y antecedentes respiratorios. En el análisis de regresión logística la decanulación fue un factor protectivo con respecto a la mortalidad. El 80% de los pacientes decanulados y el 15,8% de los no decanulados obtuvieron alta médica. La mediana de supervivencia de los decanulados fue de 45.47 meses y los no decanulados de 10.87. Conclusiones: Los pacientes de sexo masculino y aquellos con antecedentes respiratorios se asocian con fracaso de decanulación. Los pacientes decanulados tienen menor riesgo de muerte durante la internación.(AU)

Objective: Find predictors of decannulation in tracheostomized patients and without mechanical ventilation. A secondary objective was the analysis of mortality in the weaning center and survival at discharge. Material and methods: We reviewed, retrospectively, the medical records of patients admitted to the weaning center with tracheostomy and without mechanical ventilation between January 2004 and June 2011. Different variables as possible predictors of decannulation were studied. Mortality at weaning center and outcomes during follow up after discharge were analyzed. Results: We included 181 patients with an average age of 62 years old. Decannulation was carried out in 44.2% of the patients. The decannulation process took 20 days. The univariate analysis found six variables associated with decannulation failure: male gender, respiratory or cardiovascular history, albumin at admission to the weaning center, days of hospitalization in the weaning center and admission to intensive care units plus the weaning center. Logistic regression analysis found that male sex and respiratory history were independent predictors. Regarding mortality during hospitalization, logistic regression analysis found that decannulation was a protective factor. Another finding was that 80% of patients decannulated were discharged; only 15.8% of the group was not decannulated. The average survival was 45.47 months among the decannulated patients and 10.87 months for the non decannulated patients. Conclusions: We found that male sex and a history of respiratory failure were factors associated with unsuccessful decannulation. Decannulated patients had lower risk of death during hospitalization.(AU)

Evaluation of tracheal cuff pressure variation in spontaneously breathing patients.

BACKGROUND: Most of the studies referring cuff tubes' issues were conducted on intubated patients. Not much is known about the cuff pressure performance in chronically tracheostomized patients disconnected from mechanical ventilation. OBJECTIVE: To evaluate cuff pressure (CP) variation in tracheostomized, spontaneously breathing patients in a weaning rehabilitation center. MATERIALS AND METHODS: Experimental setup to test instruments in vitro, in which the gauge (TRACOE) performance at different pressure levels was evaluated in six tracheostomy tubes, and a clinical setupin which CP variation over 24 h, every 4 h, and for 6 days was measured in 35 chronically tracheostomized clinically stable, patients who had been disconnected from mechanical ventilation for at least 72 h. The following data were recorded: Tube brand, type, and size; date of the tube placed; the patient's body position; the position of the head; axillary temperature; pulse and respiration rates; blood pressure; and pulse oximetry. RESULTS: In vitro difference between the initial pressure (IP) and measured pressure (MP) was statistically significant (P < 0.05). The difference between the IP and MP was significant when selecting for various tube brands (P < 0.05). In the clinical set-up, 207 measurements were performed and the CP was >30 cm H2O in 6.28% of the recordings, 20-30 cm H2O in 42.0% of the recordings, and <20 cm H2O in 51.69% of the recordings. CONCLUSION: The systematic CP measurement in chronically tracheostomized, spontaneously breathing patients showed high variability, which was independent of tube brand, size, type, or time of placement. Consequently, measurements should be made more frequently.

[Rosuvastatin for the treatment of dyslipidemia in HIV-infected patients receiving highly active antiretroviral therapy. Preliminary experience]. / Rosuvastatina para tratamiento de la dislipidemia en pacientes infectados con VIH en tratamiento antirretroviral de gran actividad. Experiencia preliminar.

INTRODUCTION: Highly active antiviral therapy (HAART) results in a sharp decrease in HIV-related morbidity and mortality, but also induces adverse effects such as dyslipidemia, which is difficult treat because of drug interactions. Guidelines recommend lipid-lowering therapy with pravastatin or atorvastatin to reduce LDL cholesterol in these patients, and gemfibrozil or fenofibrate for treating hypertriglyceridemia. The use of statins in the management of dyslipidemia is complicated by drug interactions with some of the components of HAART. Rosuvastatin, a statin with minimal cytochrome P-450-mediated metabolism, could be an alternative option for this population. METHODS: Retrospective study to evaluate the efficacy and safety of rosuvastatin (10 mg/day) for 16 weeks in HAART-treated HIV-infected patients with dyslipidemia, and moderate to high cardiovascular risk. Results were analyzed with the Shapiro-Wilks, K-S Lilliefors, and sign tests. Percentages were analyzed with the chi-square test. RESULTS: Seventy-eight patients were started on rosuvastatin for dyslipidemia, 60 as single therapy. After 16 weeks of treatment, a significant median decrease was seen in both LDL-cholesterol and non-HDL cholesterol (31.3% reduction in LDL and 29.9% in non-HDL). The therapeutic goal for non-HDL was achieved in 65.8% of patients. The decrease in triglyceride levels was also significant (34.1%); 35% of subjects achieved the therapeutic goal. The drug was withdrawn in 2 patients because of myositis, and in 1 because of gastrointestinal intolerance. There were no differences in efficacy or toxicity between patients receiving protease inhibitors, non-nucleoside reverse transcriptase inhibitors, or fibrates. CONCLUSION: Rosuvastatin was safe and effective for treating dyslipidemia in HAART-treated HIV-infected patients. Results were similar to those observed in the HIV-uninfected population.

Rosuvastatina para tratamiento de la dislipidemia en pacientes infectados con VIH en tratamiento antirretroviral de gran actividad. Experiencia preliminar / Rosuvastatin for the treatment of dyslipidemia in HIV-infected patients receiving highly active antiretroviral therapy. Preliminary experience

INTRODUCCIÓN. El tratamiento antirretroviral combinado de gran actividad (TARGA) redujo la morbimortalidad por la infección por el virus de la inmunodeficiencia humana(VIH), pero indujo efectos adversos como la dislipidemia, cuyo tratamiento se dificulta por interacciones farmacológicas. En las guías para su tratamiento sepropuso usar pravastatina o atorvastatina para reducir el colesterol de las lipoproteínas de baja densidad (c-LDL), y gemfibrozil o fenofibrato para tratar la hipertrigliceridemia. Rosuvastatina, una estatina con escaso metabolismo hepático, podría ser una nueva alternativa. MÉTODOS. Estudio retrospectivo para evaluar la efectividad y la toxicidad del uso de rosuvastatina (10 mg/día) por 16 semanas en pacientes con dislipidemia, portadores del VIH con TARGA y riesgo cardiovascular de moderado a muy elevado. Los resultados se analizaron mediante las pruebas de Shapiro-Wilks, K-S Lilliefors y el test del signo; los porcentajes se compararon mediante la prueba de chi al cuadrado. RESULTADOS. Setenta y ocho pacientes recibieron rosuvastatina, 60 como único hipolipemiante. Tras16 semanas, el descenso mediano del c-LDL y del colesterol no ligado a las lipoproteínas de alta densidad(c-no-HDL) fue significativo (–31,3 y –29,9%,respectivamente); el 65,8% de los pacientes lograron la meta para c-no-HDL. La reducción de la trigliceridemia también fue significativa (–34,1%); el 35% de los pacientes alcanzaron la meta terapéutica para trigliceridemia. Dos individuos suspendieron la droga por toxicidad muscular y uno por intolerancia digestiva. No hubo diferencia en la toxicidad y la eficacia de acuerdo a si los pacientes recibían concomitantemente inhibidores de proteasa, inhibidores de transcriptasa inversa no nucleosídicos o fibratos. CONCLUSIÓN. Rosuvastatina fue efectiva y segura para tratar la dislipidemia de pacientes VIH con TARGA, logrando resultados similares a los descritos en población no infectada por VIH (AU)

INTRODUCTION. Highly active antiviral therapy (HAART)results in a sharp decrease in HIV-related morbidity and mortality, but also induces adverse effects such as dyslipidemia, which is difficult treat because of drug interactions. Guidelines recommend lipid-lowering therapy with pravastatin or atorvastatin to reduce LDL cholesterol in these patients, and gemfibrozil or fenofibrate for treating hypertriglyceridemia. The use of statins in the management of dyslipidemia is complicated by drug interactions with some of the components of HAART. Rosuvastatin, a statin with minimal cytochrome P-450-mediated metabolism, could be an alternative option for this population. METHODS. Retrospective study to evaluate the efficacy and safety of rosuvastatin (10 mg/day) for 16 weeks in HAART-treated HIV-infected patients with dyslipidemia, and moderate to high cardiovascular risk. Results were analyzed with the Shapiro-Wilks, K-S Lilliefors, and sign tests. Percentages were analyzed with the chi-square test. RESULTS. Seventy-eight patients were started on rosuvastatin for dyslipidemia, 60 as single therapy. After 16 weeks of treatment, a significant median decrease was seen in both LDL-cholesterol and non-HDL cholesterol (31.3% reduction in LDL and 29.9% in non-HDL). The therapeutic goal for non-HDL was achieved in 65.8% of patients. The decrease in triglyceride levels was also significant (34.1%); 35% of subjects achieved the therapeutic goal. The drug was withdrawn in 2 patients because of myositis, and in 1 because of gastrointestinal intolerance. There were no differences in efficacy or toxicity between patients receiving protease inhibitors, non-nucleoside reverse transcriptase inhibitors, or fibrates. CONCLUSION. Rosuvastatin was safe and effective for treating dyslipidemia in HAART-treated HIV-infected patients. Results were similar to those observed in the HIV-uninfected population (AU)