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Infectio ; 23(supl.1): 61-72, dic. 2019. tab, graf
Artigo em Espanhol | LILACS-Express | ID: biblio-984510


Resumen: La Guía Colombiana de práctica clínica para la atención de la infección por VIH / Sida en adolescentes y adultos incluye como primera línea de tratamiento el uso de Inhibidores de integrasa; sin embargo, no incluye recomendaciones que soporten la decisión de tratar a los pacientes controladores elite (CE). La definición de controladores elite es confusa pues varía de un estudio a otro y se desconoce si las recomendaciones de tratamiento, se pueden aplicar a los controladores de forma similar; tampoco existen mecanismos apropiados para el seguimiento sistemático de los controladores elite cuando se inicia en ellos una terapia antirretroviral. Este artículo es una revisión bibliográfica de la información disponible sobre la definición de los pacientes controladores, y los controladores elite, su evolución clinica e inmunológica, el tratamiento y las terapias disponibles en Colombia.

Abstract: The Colombian Guide to Clinical Practice for HIV / AIDS Care in Adolescents and Adults, includes as first line of treatment the use of integrase inhibitors; however, there is no information to support the decision to treat elite control patients (EC). The definition of elite controller is confusing, because of the changes in definitions between studies, and it is unknown whether these recommendations apply to these patients in a similar way; and how should be systematic follow-up of elite controllers when antiretroviral therapy is initiated. Present paper is a bibliographic review of the available information on the definition of the controllers, and elite controllers its clinical and immunological evolution, the treatment and therapies available in Colombia.

BMC Infect Dis ; 19(1): 793, 2019 Sep 09.
Artigo em Inglês | MEDLINE | ID: mdl-31500584


BACKGROUND: The HLA-B*57:01 allele is associated with a hypersensitivity reaction to abacavir. Due to the lack of knowledge of HLA-B*57:01 prevalence in Colombia, routine screening is not performed and is not recommended by the national guidelines. We aimed to determine the prevalence of HLA-B*57:01 in HIV population from Colombia. METHODS: This cross-sectional study included naïve HIV-infected adults from 13 cities of the country. The presence of HLA-B*57:01 was determined by using SSP-PCR in blood samples. Prevalence rates were stratified by sex, race, and region of origin. RESULTS: HLA-B*57:01 allele prevalence in Colombian HIV-infected individuals was 2.7%. When stratifying for the race, the prevalence was 4% for whites, 2.6% for other race (mainly mestizo), and 1.9% for Afro-Colombians. The prevalence varied from 0% up to 11.4% depending on the department of origin. The highest prevalence rates were found in Caldas (11.4%), Antioquia (5%), Risaralda (4.8%), and Valle del Cauca (4.3%). When distributed by country zones, the central, with a racial predominance of Caucasians and mestizos, was the highest (6.0%, 0R = 4.1, CI 1.2-12.8, p = 0,016). CONCLUSIONS: The overall prevalence of HLA-B*57:01 in Colombia was lower than the reported rates for other Latin American countries such as Brazil, Costa Rica, and Argentina, but similar in comparison to Chile and Mexico. The diversity in the racial and ethnic heritage shown in our data supports the recommendation to implement routine screening for the HLA-B*57:01 allele before initiation of abacavir-containing antiretroviral therapy in the Colombian HIV management guidelines.

Hipersensibilidade a Drogas/genética , Infecções por HIV/epidemiologia , Antígenos HLA-B/genética , Adulto , Alelos , Antirretrovirais/uso terapêutico , Colômbia/epidemiologia , Estudos Transversais , Feminino , Infecções por HIV/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Adulto Jovem
Int J Infect Dis ; 14(4): e298-303, 2010 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-19665910


BACKGROUND: Systematically obtained data on antiretroviral (ARV) resistance in Colombia are lacking. Local estimates of resistance are needed to guide testing, therapy, and policy. METHODS: A cross-sectional study was performed in ARV-naïve individuals and in patients with first ARV failure. Genotypic resistance testing was performed using Viro-seq. Predicted success to first- and second-line regimens recommended by the Colombian HIV treatment guidelines was estimated. RESULTS: One hundred and three naïve and 77 experienced patients were included. For naïve patients, resistance mutations were detected in 5.8%, with the most common mutations being 103N (n=5; 4.9%) and 184V (n=3; 2.9%). CD4 count <200cells/mm(3) (p=0.04) and Centers for Disease Control and Prevention (CDC) category C (p=0.004) were associated with primary resistance. For experienced individuals, regimens were non-nucleoside reverse transcriptase inhibitor (NNRTI)-based in 57.1%, protease inhibitor (PI)-based in 14.3%, boosted PI-based in 26.0%, and nucleoside reverse transcriptase inhibitor (NRTI)-based in 2.6% of the cases. Resistance mutations were found in 66 patients (85.7%) with failure. The most common mutations were 184V (n=48; 62.3%), 103N (n=37; 48.1%), G190A/S (n=9; 11.7%), and L90M (n=9; 11.7%). Twelve percent had thymidine analogue mutations (TAMs) but only 1% had more than 1 TAM. The predicted success of regimens recommended by the Colombian guidelines was 95% for naïve patients and 84% for experienced patients. Genotyping could increase the success rates to 100% and 94%, respectively. CONCLUSIONS: The frequency of primary HIV resistance in Colombia is similar to estimates from other countries in Latin America. CD4 count and CDC category C may allow identification of most of the naïve patients who would benefit from resistance testing. Resistance testing could favorably impact therapy modification in about 5% and 10% of naïve and experienced patients, respectively.

Fármacos Anti-HIV/uso terapêutico , Farmacorresistência Viral Múltipla , Infecções por HIV/tratamento farmacológico , HIV/crescimento & desenvolvimento , Adulto , Contagem de Linfócito CD4 , Colômbia , Estudos Transversais , Feminino , Infecções por HIV/virologia , Humanos , Masculino , Estudos Prospectivos , Análise de Regressão , Carga Viral