RESUMO
The availability of highly active antiretroviral therapy has markedly improved the survival rate and quality of life in patients infected with HIV. At present, however, there is still no cure for HIV and those undergoing treatment have to do so for life. The use of antiretroviral drugs has been associated with several toxicities that limit their success. Some acute and chronic toxicities associated with these drugs include hypersensitivity reactions, neurotoxicity, nephropathy, liver damage, the appearance of body fat redistribution syndrome and the different metabolic alterations that accompany it. Some of these toxicities are family- or even drug-specific. Since not all patients that take a particular antiretroviral medication develop the adverse effect that has been attributed to that drug, it has therefore been postulated that there must be a genetically-conditioned individual predisposition to developing the adverse effect. Pharmacogenetics is the science that studies interindividual variations in the response to and toxicity of drugs due to variations in the genetic composition of individuals. Sufficient advances have been made in this discipline to allow this fertile field of research to move out of the basic science laboratory and into clinical applications. The present article reviews the investigations that have been published regarding the association between the genetic determinants of persons infected with HIV and the metabolic toxicity and chronic vascular consequences resulting from antiretroviral drugs. The influence of host genetic variants on dyslipidemia, hyperglycemia and insulin resistance, lipodystrophy and atherosclerosis are presented and discussed.
Assuntos
Fármacos Anti-HIV/efeitos adversos , Aterosclerose/induzido quimicamente , Doenças Metabólicas/induzido quimicamente , Animais , Fármacos Anti-HIV/farmacologia , Fármacos Anti-HIV/uso terapêutico , Terapia Antirretroviral de Alta Atividade/efeitos adversos , Terapia Antirretroviral de Alta Atividade/métodos , Aterosclerose/genética , Aterosclerose/patologia , Predisposição Genética para Doença , Variação Genética , Infecções por HIV/tratamento farmacológico , Síndrome de Lipodistrofia Associada ao HIV/induzido quimicamente , Síndrome de Lipodistrofia Associada ao HIV/genética , Síndrome de Lipodistrofia Associada ao HIV/patologia , Humanos , Resistência à Insulina , Doenças Metabólicas/genética , Doenças Metabólicas/patologia , FarmacogenéticaAssuntos
Trombose do Corpo Cavernoso/etiologia , Infecções Comunitárias Adquiridas/complicações , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Infecções Estafilocócicas/complicações , Doenças do Nervo Abducente/etiologia , Falso Aneurisma/etiologia , Bacteriemia/complicações , Toxinas Bacterianas/genética , Blefaroptose/etiologia , Artéria Carótida Interna , Portador Sadio , Criança , Colômbia/etnologia , Coagulação Intravascular Disseminada/etiologia , Exotoxinas/genética , Saúde da Família , Feminino , Arterite de Células Gigantes/etiologia , Humanos , Leucocidinas/genética , Staphylococcus aureus Resistente à Meticilina/genética , EspanhaRESUMO
El número de inmigrantes procedentes de áreas endémicas para la enfermedad de Chagas ha experimentado un gran aumento en los últimos años. Hasta el momento, no se ha realizado ningún estudio de prevalencia de infección chagásica en los niños procedentes de esas áreas ni en mujeres en edad fértil antes de hallarse en período de gestación. El objetivo general del estudio es conocer la prevalencia de la enfermedad de Chagas en esos dos grupos poblacionales. Se analizan muestras de sangre de estos dos grupos de personas que son atendidas en el Consorci dAtenció Primària de Salut de l´Eixample (CAPse).La duración del estudio es de un año (marzo del 2006 hasta febrero del 2007).Se realiza un cribado serológico mediante inmunocromatografía (IC) (Stat-Pak®Chagas de Chembio®) y confirmación de los casos positivos mediante un ELISAcon antígeno total de T. cruzi y un ELISA con antígeno recombinante (Biokit®ELISA) para Chagas. Se analizaron, hasta septiembre del 2006, 70 muestras de niños de 0 a 14 años y 98 de mujeres en edad fértil. Según la inmunocromatografía hallamos 17/168 (10,11%) resultados positivos, de los cuales 9 (5 niños y 4 mujeres) fueron falsos positivos. En el grupo de mujeres en edad fértil hallamos una prevalencia del 4,25%.Esteestudio aporta resultados que pueden aumentar la sensibilización del pediatrao médico de familia hacia esta enfermedad (AU)
Recently, there has been a large increase in immigration from areas with endemic Chagas disease. Until now, there has been no study of the prevalence of Chagas infection in children and non-pregnant women of childbearing age immigrating from South and Central America. This study aimed to measure the prevalence of Chagas disease in these two populations. The study began in March 2006 and is expected to conclude in Februaryof 2007. Blood samples from children and women attending the Consorcid´Atenció Primària de Salut of l´Eixample (CAPse) were analyzed. An analysis of immunocromatography (IC) (Stat-Pak® Chagas de Chembio®) for the detection of the IgG antibodies was used. Confirmation of positive cases was made using conventional ELISA and recombinant ELISA (Biokit® ELISA)for Chagas. As of September 2006, 70 samples of children aged 0 to 14years and 98 samples of women of reproductive age were analyzed. The ICindicated 18/168 (10.65%) positive results, of which 9 (5 children and 4women) were false positives. In women of childbearing age the prevalence was 4,25%. These results suggest that pediatricians and family medicine doctors should increase awareness and attention to Chagas disease in the seat-risk populations (AU)
