Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 224
Filtrar
Mais filtros










Intervalo de ano de publicação
1.
AIDS ; 2020 Feb 17.
Artigo em Inglês | MEDLINE | ID: mdl-32073449

RESUMO

OBJETIVE: To examine the clinical burden and disease spectrum, as well as time trends for HTLV-1 and HTLV-2 hospital admissions. DESIGN: Retrospective, observational study using the Spanish National Hospital Discharge Database. METHODS: Information for the diagnostic codes HTLV, -1 and -2 using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) was retrieved from the national public registry since 1997 to 2015. RESULTS: From a total of 66,462,136 nationwide hospital admissions recorded during the study period, 135 included HTLV diagnosis, being HTLV-1 in 115 (85.2%) and HTLV-2 in 20 (14.8%). The overall hospital admission rate due to HTLV was 2.03 per million, without significant yearly changes. First admissions represented 104 (77%) whereas 31 (23%) were re-admissions. The median in-hospital stay for HTLV patients was 9 days. In-hospital death occurred in 11 (8.1%). The median age of individuals with HTLV admission was 48 years-old and 60 (44.4%) were female. HTLV was recorded as the main diagnosis in 20%. The most frequent clinical conditions recorded alongside HTLV diagnosis were myelopathy (61; 45.2%), leukemia/lymphoma (30; 22.2%), solid organ transplantation (14; 10.4%) and child delivery (7; 5.2%). CONCLUSION: The rate of HTLV diagnosis in hospitalized patients in Spain is low, roughly of 2 per million admissions. Despite continuous large immigrant flows from HTLV-1 endemic areas, no significant rising in hospitalizations due to HTLV-1 associated illnesses were noticed during the last two decades. Classical clinical complications of HTLV-1 infection, such as myelopathy and lymphoma account for more than two third of cases.

2.
Travel Med Infect Dis ; : 101543, 2019 Dec 02.
Artigo em Inglês | MEDLINE | ID: mdl-31805400

RESUMO

BACKGROUND: From the first Zika virus (ZIKV) description, it has progressively widespread worldwide. We analyzed demographic, clinical, microbiologic and travel-related characteristic from returned patients from a ZIKV endemic country in a referral Tropical Medicine Unit. METHOD: A prospective cohort study performed in a Spanish referral center with the aim of determining the significant factors associated with confirmed Zika virus (ZIKV) infection. RESULTS: 817 patients, (56% women, median age 36 [IQR, Interquartile Range: 32-42]) were enrolled. Most had returned from Latin America (n = 486; 59.4%), travelled for tourism (n = 404; 49.4%) and stayed a median of 18 days (IQR: 10-30). 602 (73.6%) presented symptoms, but only 25 (4%) were finally diagnosed with confirmed ZIKV infection (including two pregnant women, without adverse fetal outcomes), 88% (n:22) presented with fever and 92% (n:23) with rash. 56% (n:14) arthralgia and/or myalgia and 28% (n:7) conjunctivitis. The presence of conjunctivitis, fever and rash were associated with an 8.9 (95% CI: 2.2-34.9), 6.4 (95% CI: 1.2-33.3) and 72.3 (95% CI: 9.2-563.5) times greater probability of confirmed ZIKV infection, respectively. CONCLUSION: Travel characteristics and clinical presentation may help clinicians to optimize requests for microbiological testing. Diagnosis of arboviriasis in travellers arriving form endemic areas remains a challenge for clinicians, but must be detected for the possible transmission outside endemic areas, where the vector is present.

4.
AIDS Rev ; 20(2): 127, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29938707

RESUMO

Well-known AIDS researcher Robert Redfield picked to lead the CDC on March 2018. He is one of the HIV/AIDS pioneers in the United States. During two decades at the Walter Reed Army Institute of Research, in Bethesda, MD, he made pivotal contributions, highlighting the importance of heterosexual HIV transmission, developing the Walter Reed staging system for HIV infection, and demonstrating that active HIV replication takes place during all stages of HIV disease. In 1996, he was one of the cofounders of the Institute of Human Virology in Baltimore, MD. Nowadays, he was running a treatment network for HIV and hepatitis C patients. With this background, he would be well prepared to combat one of the DHHS and CDC's top priorities, the opioid epidemic (Kolodny et al. JAMA 2017;318:1537-8). In an interview, Robert Gallo, director of the Institute of Human Virology, said "Redfield is a dedicated and compassionate physician who truly cares about his patients and is deeply committed to ensuring patients receive the highest quality of care possible. Dr. Redfield has served his country well, and consistently demonstrates strong public health instincts that are grounded in science and clinical medicine. In my view, despite the loss to our institute, I believe this makes him the ideal candidate to direct the CDC".


Assuntos
Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Infecções por HIV/transmissão , Hepatite C/tratamento farmacológico , Hepatite C/epidemiologia , Hepatite C/prevenção & controle , Hepatite C/transmissão , Humanos , Estados Unidos
5.
Viruses ; 10(6)2018 05 30.
Artigo em Inglês | MEDLINE | ID: mdl-29848987

RESUMO

The first cases of AIDS in Spain were reported in 1982. Since then over 85,000 persons with AIDS have been cumulated, with 60,000 deaths. Current estimates for people living with HIV are of 145,000, of whom 20% are unaware of it. This explains the still high rate of late HIV presenters. Although the HIV epidemic in Spain was originally driven mostly by injection drug users, since the year 2000 men having sex with men (MSM) account for most new incident HIV cases. Currently, MSM represent over 80% of new yearly HIV diagnoses. In the 80s, a subset of young doctors and nurses working at Internal Medicine hospital wards became deeply engaged in attending HIV-infected persons. Before the introduction of antiretrovirals in the earlier 1990s, diagnosis and treatment of opportunistic infections was their major task. A new wave of infectious diseases specialists was born. Following the wide introduction of triple combination therapy in the late 1990s, drug side effects and antiretroviral resistance led to built a core of highly devoted HIV specialists across the country. Since then, HIV medicine has improved and currently is largely conducted by multidisciplinary teams of health care providers working at hospital-based outclinics, where HIV-positive persons are generally seen every six months. Antiretroviral therapy is currently prescribed to roughly 75,000 persons, almost all attended at clinics belonging to the government health public system. Overall, the impact of HIV/AIDS publications by Spanish teams is the third most important in Europe. HIV research in Spain has classically been funded mostly by national and European public agencies along with pharma companies. Chronologically, some of the major contributions of Spanish HIV research are being in the field of tuberculosis, toxoplasmosis, leishmaniasis, HIV variants including HIV-2, drug resistance, pharmacology, antiretroviral drug-related toxicities, coinfection with viral hepatitis, design and participation in clinical trials with antiretrovirals, immunopathogenesis, ageing, and vaccine development.


Assuntos
Síndrome de Imunodeficiência Adquirida/epidemiologia , Infecções por HIV/epidemiologia , Pesquisa/estatística & dados numéricos , Síndrome de Imunodeficiência Adquirida/tratamento farmacológico , Síndrome de Imunodeficiência Adquirida/história , Fármacos Anti-HIV/uso terapêutico , Ensaios Clínicos como Assunto , Epidemias/estatística & dados numéricos , Europa (Continente)/epidemiologia , Infecções por HIV/diagnóstico , Infecções por HIV/tratamento farmacológico , História do Século XX , História do Século XXI , Humanos , Médicos , Espanha/epidemiologia
6.
AIDS Rev ; 20(1): 71, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29628512

RESUMO

Pre-exposure prophylaxis (PrEP) with oral Truvada (tenofovir plus emtricitabine) is effective at preventing HIV infection in high-risk homosexual men. In the United States, PrEP was approved in 2012 and is reimbursed by Medicaid and the majority of private insurers. The situation is diverse and not uniform in the European Union, being PrEP more widely used in France than in the rest of countries. Concerns have been raised that PrEP use may be accompanied by the phenomena of risk compensation or behavioral disinhibition, whereby PrEP users' perception of decreased risk of HIV acquisition may lead them to engage in overall riskier sexual practices and increase their chances of acquiring sexually transmitted infections (STIs) (Blumenthal, et al. Virtual Mentor. 2014;16:909-15). Modifiable factors that may influence the acquisition of STI include condom use, number of partners, partner characteristics, and healthcare-seeking behaviors. In addition, MSM may alter HIV risk mitigation practices while on PrEP by decreasing seroadaptive practices such as serosorting that is seeking a partner of similar perceived serostatus (Khosopour, et al. AIDS Behav. 2017;21:2935-44). High rates of STI have been reported among PrEP users, as well as high rates of condomless sex, and increasing rates of STI over time (Liu, et al. JAMA Intern Med. 2016;176:75-84; Kojima, et al. AIDS, 2016;30:2251-2). In a new study conducted in Montreal, Canada, increases in the rates of STI in PrEP users were demonstrated measuring incidence rates of STI before and following the initiation of PrEP in the same cohort. The authors measured the incidence of gonorrhea, chlamydia, and/or syphilis in 109 HIV-seronegative homosexual men 12 months before and 12 months after beginning Truvada for HIV prevention (Nguyen, et al. AIDS. 2018;32:523-30). New episodes of gonorrhea, chlamydia, and/or syphilis rose in the cohort after providing Truvada, as shown in Figure 1. Moreover, the incidence of three or more STI increased from 3.7 to 9.2 cases per 100 personyears in this cohort. The Canadian study highlighted that the rate of STI with PrEP was also higher than in a group of 86 homosexual men that had undergone PEP in Montreal during 2010-2015. Other findings of the study we the high rate of STI with anorectal location, symptomless STI (e.g., chlamydia) and the frequency of sex partners contacted by internet. The increased rates of STI in PrEP users suggest a need to reinforce counseling and STI diagnosis and treatment efforts. Although PrEP may provide a public health benefit beyond the immediate prevention of HIV infection as result of bringing into care high-risk homosexual men who might not otherwise be seeking care for STI, doctors in charge must take this opportunity for informing adequately on STI and the risks inherent to multiple and occasional sexual contacts.


Assuntos
Profilaxia Pré-Exposição , Doenças Sexualmente Transmissíveis/epidemiologia , Canadá , Estudos de Coortes , Combinação Emtricitabina e Fumarato de Tenofovir Desoproxila/uso terapêutico , Feminino , Infecções por HIV/tratamento farmacológico , Humanos , Masculino , Doenças Sexualmente Transmissíveis/tratamento farmacológico , Doenças Sexualmente Transmissíveis/etiologia
7.
Expert Rev Clin Pharmacol ; 11(5): 507-517, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29595351

RESUMO

INTRODUCTION: Current antiretroviral therapy allows to achieve and sustain maximal suppression of HIV replication in most treated patients. As result, the life expectancy of HIV-infected persons has improved dramatically and is nowadays similar to that of the HIV-negative population. However, oral antiretrovirals have to be taken daily and indefinitely to avoid resumption of HIV replication and selection of drug resistance. Unfortunately, drug adherence is often suboptimal and tends to decline over time. Areas covered: New drugs, formulations and delivery systems are being developed for extended-release of antiretrovirals. At this time, intramuscular cabotegravir and rilpivirine, dapivirine vaginal rings and tenofovir alafenamide subdermal implants are the products in more advanced stages of clinical development. Their pharmacokinetics/dynamics and safety/efficacy are reviewed. Expert commentary: In the absence of eradicative therapy for individuals with HIV infection and protective vaccines for persons at risk, long-term antiretroviral therapy is the best approach for preventing disease progression in patients and halting transmissions, either as result of 'treatment as prevention' for HIV carriers or 'pre-exposure prophylaxis' for uninfected individuals at risk. In all these scenarios, the advent of long-acting antiretrovirals will expand options for overcoming the challenge of suboptimal drug adherence and reduce the burden of HIV infection.


Assuntos
Fármacos Anti-HIV/administração & dosagem , Desenho de Drogas , Infecções por HIV/tratamento farmacológico , Vacinas contra a AIDS/administração & dosagem , Animais , Fármacos Anti-HIV/efeitos adversos , Fármacos Anti-HIV/farmacologia , Progressão da Doença , Sistemas de Liberação de Medicamentos , Infecções por HIV/prevenção & controle , Infecções por HIV/transmissão , Humanos , Adesão à Medicação , Resultado do Tratamento
8.
Antivir Ther ; 23(1): 87-90, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-28353446

RESUMO

BACKGROUND: Roughly 15 million people worldwide have hepatitis delta, the most severe form of chronic viral hepatitis that often leads to cirrhosis and liver cancer. Injection drug users (IDUs) are the largest HDV reservoir. Their resurgence in North America and Europe may represent a new opportunity for HDV to spread more widely. METHODS: We examined all consecutive active IDUs seen for the first time and enrolled in detoxification programmes at two clinics in Spain during two periods (1993-1996 and 2011-2014, respectively). Serum markers of HIV, HBV and HDV infection were tested. RESULTS: A total of 209 IDUs were examined in the first period. Mean age was 27-years-old. All had markers of past or current HBV infection. The rate of HIV-antibody (Ab), hepatitis B surface antigen (HBsAg) and HDV-Ab was as follows: 122 (58.4%), 73 (34.9%) and 62 (29.7%), respectively. Serum HDV-Ab was recognized in 53.4% of HBsAg+ and 16.9% of HBsAg- patients (P<0.001). Positivity for HDV-Ab was associated with HIV regardless HBsAg status. In the second period we tested 47 active IDUs. Anti-HDV was found in only two (4.2%), both immigrants from HDV endemic countries and with HBsAg+. CONCLUSIONS: Acute HBV-HDV coinfections and self-limited HDV infections were frequent in the 1990s among IDUs in Spain, especially in HIV+ individuals. In contrast, circulation of HDV has dramatically declined among active IDUs in Spain and is currently very rare, being concentrated in foreign immigrants. It may reflect the benefit of universal HBV vaccination as well as the success of needle exchange programmes in Spain.


Assuntos
Usuários de Drogas , Hepatite D/epidemiologia , Hepatite D/virologia , Vírus Delta da Hepatite , Adulto , Coinfecção , Feminino , Hepatite D/diagnóstico , Hepatite D/transmissão , Vírus Delta da Hepatite/genética , Vírus Delta da Hepatite/imunologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Vigilância em Saúde Pública , Espanha/epidemiologia , Carga Viral , Adulto Jovem
9.
Ann Agric Environ Med ; 24(4): 712-715, 2017 Dec 23.
Artigo em Inglês | MEDLINE | ID: mdl-29284252

RESUMO

INTRODUCTION: Cutaneous anthrax is a zoonotic disease caused by the spore-forming bacterium Bacillus anthracis, which typically presents with ulcers after contact with animals or animal products, and is rarely seen in high-income countries but is common in those with low- and middle-incomes. Objective. The aim of this study is to show the main clinical characteristics of cutaneous anthrax in endemic areas. MATERIAL AND METHODS: The study describes the main clinical characteristics of cutaneous anthrax in eight patients (six female and two male, age range 1 - 56 years) admitted to the rural General Hospital of Gambo, West Arsi Province of Ethiopia from 2010-2013. RESULTS: In all cases, lesions began as an erythematous papule located on exposed sites (n=7 head; n=1 thigh) and subsequently became a necrotic black eschar surrounded by an edematous halo. Two patients presented with painful ipsilateral adenopathy near the black eschar. Four patients developed a malignant pustule on the suborbital region of the face. Patients responded positively to treatment, and the lesions resolved, leaving eschars. However, one patient suffered the loss of an eyeball, and another died 12 hours after starting treatment. CONCLUSIONS: Physicians working in rural areas of resource-poor settings should be trained in the clinical identification of cutaneous anthrax. Early antibiotic treatment is essential for decreasing morbidity and mortality.


Assuntos
Antraz/diagnóstico , Bacillus anthracis/fisiologia , Dermatopatias Bacterianas/diagnóstico , Adolescente , Adulto , Antraz/tratamento farmacológico , Antraz/epidemiologia , Antraz/microbiologia , Antibacterianos/administração & dosagem , Bacillus anthracis/efeitos dos fármacos , Bacillus anthracis/genética , Bacillus anthracis/isolamento & purificação , Criança , Pré-Escolar , Etiópia/epidemiologia , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , População Rural , Dermatopatias Bacterianas/tratamento farmacológico , Dermatopatias Bacterianas/epidemiologia , Dermatopatias Bacterianas/microbiologia , Adulto Jovem
10.
Gac. sanit. (Barc., Ed. impr.) ; 31(6): 531-534, nov.-dic. 2017. mapas, graf, tab
Artigo em Espanhol | IBECS | ID: ibc-168545

RESUMO

La actual epidemia por virus Zika ha generado gran alarma social, favorecida en parte por la falta de información de la población general. Para proporcionar información veraz y contrastada, la Unidad de Medicina Tropical y del Viajero del Hospital Carlos III-La Paz (Madrid) puso en marcha una línea de atención telefónica sobre la infección por el virus Zika. En este artículo se presentan los datos relativos a los primeros 6 meses de su funcionamiento. El perfil predominante de llamadas corresponde a mujeres solicitando información previa a la realización del viaje. Los destinos sobre los que más información se ha demandado han sido Brasil, Méjico y Colombia. La mayoría de las llamadas se resolvieron ofreciendo información exclusivamente. La implementación de dispositivos de atención telefónica que ofrezcan información contrastada y fiable en el contexto de enfermedades asociadas a gran alarma social es de gran interés sanitario, reduce el número de consultas innecesarias y ahorra costes (AU)


The current outbreak of Zika virus has caused great social alarm, generated in part by the lack of information in the general population. In order to provide accurate and verified information, the Tropical and Travel Medicine Unit of Hospital Carlos III-La Paz (Madrid, Spain) established a hotline for Zika virus infection. We present the data concerning the first 6 months of operation of the telephone hotline. The predominant call profile consisted of women seeking information about the risk of acquiring the disease before travelling. Brazil, Mexico and Colombia were the destinations for which the most information was requested. Most of the consultations were resolved by providing information only. The implementation of call devices that provide confirmed and reliable information on diseases associated with great alarm are of significant public health interest, as they reduce the number of unnecessary medical consultations and save on medical costs (AU)


Assuntos
Humanos , Infecção por Zika virus/epidemiologia , Telefone , Saúde do Viajante , Saúde Global/normas , Epidemias , Medicina Tropical/métodos , Brasil/epidemiologia , México/epidemiologia , Colômbia/epidemiologia , Análise Estatística
11.
Drug Saf ; 40(12): 1163-1165, 2017 12.
Artigo em Inglês | MEDLINE | ID: mdl-28913820
13.
AIDS ; 31(12): 1653-1663, 2017 07 31.
Artigo em Inglês | MEDLINE | ID: mdl-28700391

RESUMO

: Human T-lymphotropic virus type 1 (HTLV-1) infection is a neglected disease despite roughly 15 million people are chronically infected worldwide. Lifelong less than 10% of carriers develop life-threatening diseases, mostly a subacute myelopathy known as tropical spastic paraparesis (TSP) and a lymphoproliferative disorder named adult T-cell leukemia (ATL). HTLV-1 is efficiently transmitted perinatally (breastfeeding), sexually (more from men to women) and parenterally (transfusions, injection drug user (IDU), and transplants). To date there is neither prophylactic vaccine nor effective antiviral therapy. A total of 327 cases of HTLV-1 infection had been reported at the HTLV-1 Spanish registry until December 2016, of whom 34 had been diagnosed with TSP and 25 with ATL. Overall 62% were Latin American immigrants and 13% were persons of African origin. The incidence of HTLV-1 in Spain has remained stable for nearly a decade with 20-25 new cases yearly. Of the 21 newly diagnosed HTLV-1 cases during year 2016, one was a native Spaniard pregnant woman, and four presented with symptomatic disease, including three with ATL and one with TSP. Underdiagnosis of HTLV-1 in Spain must be high (iceberg model), which may account for the disproportionate high rate of symptomatic cases (almost 20%) and the late recognition of preventable HTLV-1 transmissions in special populations, such as newborns and transplant recipients. Our current estimate is of 10 000 persons living with HTLV-1 infection in Spain. Given the large flux of immigrants and visitors from HTLV-1 endemic regions to Spain, the expansion of HTLV-1 screening policies is warranted. At this time, it seems worth recommending HTLV testing to all donor/recipient organ transplants and pregnant women regardless place of birth. Although current leukoreduction procedures largely prevent HTLV-1 transmission by blood transfusions, HTLV testing of all first-time donors should be cost-effective contributing to unveil asymptomatic unaware HTLV-1 carriers.


Assuntos
Portador Sadio/epidemiologia , Infecções por HTLV-I/epidemiologia , Infecções por HTLV-I/patologia , Grupos Étnicos , Humanos , Incidência , Espanha/epidemiologia
14.
Expert Opin Drug Metab Toxicol ; 13(9): 1015-1022, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28753040

RESUMO

INTRODUCTION: The fixed-dose combination of three direct-acting antivirals (DAA), namely sofosbuvir, velpatasvir and voxilaprevir is the first pangenotypic, single tablet regimen developed for the treatment of HCV infection. Areas covered: The pharmacokinetics, pharmacodynamics, efficacy and safety of the co-formulation are reviewed. Information on drug absorption, distribution, metabolism and excretion of each of the three antivirals is evaluated. Finally, antiviral activity, safety and potential for drug interactions in phase II/III clinical trials in distinct patient populations are discussed. Expert opinion: The triple co-formulation of sofosbuvir-velpatasvir-voxilaprevir represents a major step towards HCV eradication. It depicts high efficacy even in patients infected with viruses harboring resistance-associated substitutions (RAS), including those selected after DAA failures. Likewise, very high success rates and good tolerance are seen in special patient populations, including decompensated cirrhotics, HIV coinfection, organ transplantation or renal insufficiency. A pill once daily for 8 weeks gives SVR rates above 95%. In prior DAA failures, extending treatment to 12 weeks maximizes SVR rates.


Assuntos
Carbamatos/administração & dosagem , Hepatite C/tratamento farmacológico , Compostos Heterocíclicos de 4 ou mais Anéis/administração & dosagem , Compostos Macrocíclicos/administração & dosagem , Sofosbuvir/administração & dosagem , Sulfonamidas/administração & dosagem , Animais , Antivirais/administração & dosagem , Antivirais/efeitos adversos , Antivirais/farmacocinética , Carbamatos/efeitos adversos , Combinação de Medicamentos , Interações de Medicamentos , Farmacorresistência Viral , Hepatite C/virologia , Compostos Heterocíclicos de 4 ou mais Anéis/efeitos adversos , Humanos , Compostos Macrocíclicos/efeitos adversos , Compostos Macrocíclicos/farmacocinética , Sofosbuvir/efeitos adversos , Sofosbuvir/farmacocinética , Sulfonamidas/efeitos adversos , Sulfonamidas/farmacocinética , Comprimidos , Resultado do Tratamento
15.
Expert Opin Drug Metab Toxicol ; 13(8): 807-816, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28689442

RESUMO

INTRODUCTION: The introduction of direct-acting antivirals (DAA) has revolutionized the hepatitis C field. Most hepatitis C patients can now be cured, including those coinfected with HIV. However, drug-drug interactions (DDI) between DAA and antiretrovirals (ARV) should be known to prevent either toxicity due to drug overexposure or treatment failures due to low drug concentrations. Areas covered: Clinically significant DDI may be classified as major (when co-administration should be contraindicated) or minor (when they require close monitoring, changes in drug dosage or in timing). Strategies for preventing and managing DDI influence response rates in HIV/HCV-coinfected patients. Pharmacokinetic evidence of interactions from clinical trials and reports from real-world experience are discussed. Expert opinion: The most frequent DDI between DAA and ARV affect drug metabolism by CYP450 induction/inhibition, leading to abnormal drug exposures. Throughout this mechanism interact HCV and HIV boosted protease inhibitors, and most non-nucleoside HCV and HIV polymerase inhibitors. In contrast, HIV and HCV nucleos(t)ide analogue polymerase inhibitors, most HCV NS5A inhibitors and HIV integrase inhibitors (e.g., dolutegravir), do not or only marginally affect CYP450, and therefore are relatively free of DDI. Exposure to some HIV and HCV nucleos(t)ide analogues (e.g., tenofovir and sofosbuvir, respectively) is subject to induction/inhibition of drug transporters (e.g., P-glycoprotein) and requires special attention in patients with renal insufficiency.


Assuntos
Fármacos Anti-HIV/administração & dosagem , Antivirais/administração & dosagem , Interações de Medicamentos , Fármacos Anti-HIV/efeitos adversos , Fármacos Anti-HIV/farmacocinética , Antivirais/efeitos adversos , Antivirais/farmacocinética , Coinfecção , Relação Dose-Resposta a Droga , Esquema de Medicação , Monitoramento de Medicamentos/métodos , Infecções por HIV/tratamento farmacológico , Hepatite C/tratamento farmacológico , Humanos
16.
Expert Opin Drug Saf ; 16(8): 923-932, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28621159

RESUMO

INTRODUCTION: For two decades, triple combinations of antiretrovirals have been the standard treatment for HIV infection. The challenges of such lifelong therapy include long-term side effects, high costs and reduced drug adherence. The recent advent of more potent and safer antiretrovirals has renewed the interest for simpler HIV regimens. Areas covered: We discuss the pros and cons of dual antiretroviral therapies in both drug-naïve and in treatment-experienced patients with viral suppression (switch strategy). Expert opinion: Some dual antiretroviral regimens are safe and efficacious, particularly as maintenance therapy. At this time, combinations of dolutegravir plus rilpivirine represent the best dual regimen. Longer follow-up and larger study populations are needed before supporting dolutegravir plus lamivudine. In contrast, dual therapy based on maraviroc is less effective. Although dual regimens with boosted protease inhibitors plus either lamivudine or raltegravir may be effective, they are penalized by metabolic side effects and risk for drug interactions. The newest dual regimens could save money, reduce toxicity and spare drug options for the future. For the first time in HIV therapeutics, less can be more. Dual therapy switching has set up a new paradigm in HIV treatment that uses induction-maintenance.


Assuntos
Fármacos Anti-HIV/administração & dosagem , Infecções por HIV/tratamento farmacológico , Adesão à Medicação , Fármacos Anti-HIV/efeitos adversos , Fármacos Anti-HIV/economia , Custos de Medicamentos , Interações de Medicamentos , Quimioterapia Combinada , Infecções por HIV/economia , Humanos
17.
Expert Opin Pharmacother ; 18(12): 1235-1242, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28644739

RESUMO

INTRODUCTION: The advent of oral direct-acting antivirals (DAA) has revolutionized the hepatitis C virus (HCV) therapeutic landscape providing cure rates over 90%. However, a subset of patients remains at higher risk for treatment failure, including those infected with: i) genotype 3 and cirrhosis; ii) resistance-associated substitutions (RAS) occurring either as natural polymorphisms or selected after prior DAA failure; and iii) poor drug adherence associated with social disabilities (homeless, psychiatric illnesses, injection drug use, alcoholism, etc.). Whereas discovery of new DAA with increased antiviral activity across all genotypes and over RAS may enhance efficacy, development of fixed dose combinations (FDC) may be the best way to improve drug adherence in difficult-to-treat HCV populations. Areas covered: Three FDC regimens are in the last steps of clinical development for treating hepatitis C. Two distinct nucleotide analogues that inhibit the HCV polymerase, sofosbuvir and uprifosbuvir, are part of the FDC from Gilead and Merck, respectively. The AbbVie dual FDC does not include a polymerase inhibitor. All three new FDC include second-generation NS3 protease inhibitors and NS5A inhibitors active across all HCV genotypes and over common RAS. Expert opinion: Hepatitis C cure rates over 95% are expected with all three next-coming DAA, even in the most difficult-to-treat and/or cure patient populations. These regimens would be particularly needed for the growing number of prior DAA failures. Co-formulations and 8-week shorter treatment lengths will help to overcome drug adherence challenges in certain populations.


Assuntos
Antivirais/uso terapêutico , Hepacivirus/efeitos dos fármacos , Hepatite C/tratamento farmacológico , Antivirais/administração & dosagem , Combinação de Medicamentos , Genótipo , Hepacivirus/genética , Humanos , Adesão à Medicação
18.
Gac Sanit ; 31(6): 531-534, 2017.
Artigo em Espanhol | MEDLINE | ID: mdl-28645459

RESUMO

The current outbreak of Zika virus has caused great social alarm, generated in part by the lack of information in the general population. In order to provide accurate and verified information, the Tropical and Travel Medicine Unit of Hospital Carlos III-La Paz (Madrid, Spain) established a hotline for Zika virus infection. We present the data concerning the first 6 months of operation of the telephone hotline. The predominant call profile consisted of women seeking information about the risk of acquiring the disease before travelling. Brazil, Mexico and Colombia were the destinations for which the most information was requested. Most of the consultations were resolved by providing information only. The implementation of call devices that provide confirmed and reliable information on diseases associated with great alarm are of significant public health interest, as they reduce the number of unnecessary medical consultations and save on medical costs.


Assuntos
Linhas Diretas , Medicina de Viagem/organização & administração , Medicina Tropical/organização & administração , Infecção por Zika virus , Surtos de Doenças , Feminino , Humanos , América Latina , Masculino , Espanha , Fatores de Tempo , Doença Relacionada a Viagens , Infecção por Zika virus/prevenção & controle
19.
AIDS Rev ; 19(2): 113-114, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28534888

RESUMO

Hepatitis A virus (HAV) is a small RNA, non-enveloped agent predominantly transmitted via the fecal/oral route through person-to-person contact or contaminated food and water. The mean incubation period is 28 days (range: 15-50). Acute hepatitis A is always self-limited and very rarely fatal. Moreover, it never progresses to chronicity. Acutely infected persons are most likely to transmit HAV before the onset of jaundice, when viral particle concentration in stool is highest.


Assuntos
Surtos de Doenças , Europa (Continente)/epidemiologia , Hepatite A/epidemiologia , Homossexualidade Masculina , Humanos , Masculino
20.
Expert Opin Investig Drugs ; 26(7): 843-851, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28521532

RESUMO

INTRODUCTION: Current treatment with oral nucleos(t)ides entecavir or tenofovir provide sustained suppression of HBV replication and clinical benefit in most chronic hepatitis B virus (HBV) infected persons. However, HBV rebound generally occurs upon drug discontinuation due to persistence of genomic HBV reservoirs as episomic cccDNA and chromosomic integrated HBV-DNA. There is renewed enthusiasm on HBV drug discovery following recent successes with antivirals for hepatitis C and immunotherapies for some cancers. Areas covered: New drugs that target distinct steps of the HBV life cycle are been developed, including inhibitors of viral entry, new polymerase inhibitors, capsid and assembly inhibitors, virus release blockers, and disruptors of cccDNA formation and transcription. Alongside these antivirals, agents that enhance anti-HBV specific immune responses are being tested, including TLR agonists, checkpoint inhibitors and therapeutic vaccines. Expert opinion: The achievement of a 'functional cure' for chronic HBV infection, with sustained HBsAg clearance and undetectable viremia once medications are stopped, represents the next step in the pace towards HBV elimination. Hopefully, the combination of new drugs that eliminate or functionally inactivate the genomic HBV reservoirs (cccDNA and integrated HBV-DNA) along with agents that enhance or activate immune responses against HBV will lead to a 'definitive cure' for chronic HBV infection.


Assuntos
Antivirais/uso terapêutico , Desenho de Drogas , Hepatite B Crônica/tratamento farmacológico , Animais , Antivirais/farmacologia , Descoberta de Drogas/métodos , Drogas em Investigação/farmacologia , Drogas em Investigação/uso terapêutico , Antígenos de Superfície da Hepatite B/sangue , Vírus da Hepatite B/efeitos dos fármacos , Vírus da Hepatite B/isolamento & purificação , Hepatite B Crônica/virologia , Humanos , Terapia de Alvo Molecular , Viremia/tratamento farmacológico , Viremia/virologia , Replicação Viral/efeitos dos fármacos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA