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1.
HIV Clin Trials ; 16(1): 43-8, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25777189

RESUMO

OBJECTIVES: Our aim is to describe the impact of emtricitabine (FTC)/tenofovir (TDF) versus other nucleoside reverse transcriptase inhibitor (NRTIs)-based regimens on renal function of human immunodeficiency virus (HIV) naïve patients >50 years old who started combination antiretroviral therapy (cART). DESIGN: National, retrospective cohort analysis of patients >50 years old when they started cART (January 1, 2006-December 31, 2009). METHODS: We compared renal safety (changes in estimated glomerular filtration rate [eGFR] during the first year, and time to renal events during 4 years of follow-up) in FTC/TDF versus non-FTC/TDF users. Among FTC/TDF users, we compared protease inhibitors vs non-nucleoside reverse transcriptase inhibitors and Lopinavir/ritonavir vs Efavirenz. RESULTS: We included 103 patients: median age: 54.9 years, 84% males, median CD4 count 247 cells/µl, median viral load 4.7 log; median follow up 18 months (max: 48 months); 73 started with FTC/TDF and 30 with other NRTIs. Change in eGFR was significantly worse for ritonavir-boosted lopinavir (LPV/r) vs efavirenz (EFV) users in the FTC/TDF group (71.2 vs 98.9 ml/min/1.73 m(2) at month 12, P < 0.05). The risk of renal events (progression to an Chronic Kidney Disease Epidemiology Collaboration value < 60 ml/min/1.73 m(2) in subjects with baseline values >60) was comparable for FTC/TDF users and non users, but was higher and almost significant for LPV/r as compared to EFV users in the FTC/TDF group (adjusted hazard ratio 6.1, 95% CI 0.8-45.5). CONCLUSIONS: In our study with a population of HIV infected subjects ≥ 50 years old, renal safety was similar for FTC/TDF and other NRTI-based regimens, but worse for LPV/r as compared to other regimens.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Emtricitabina/uso terapêutico , Infecções por HIV/tratamento farmacológico , Inibidores da Transcriptase Reversa/uso terapêutico , Tenofovir/uso terapêutico , Contagem de Linfócito CD4 , Quimioterapia Combinada , Feminino , Seguimentos , Infecções por HIV/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Espanha/epidemiologia , Resultado do Tratamento , Carga Viral/efeitos dos fármacos
2.
Enferm Infecc Microbiol Clin ; 33(1): 41-7, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25096166

RESUMO

The importance of the metabolic disorders and their impact on patients with HIV infection requires an individualized study and continuous updating. HIV patients have the same cardiovascular risk factors as the general population. The HIV infection per se increases the cardiovascular risk, and metabolic disorders caused by some antiretroviral drugs are added risk factors. For this reason, the choice of drugs with a good metabolic profile is essential. The most common metabolic disorders of HIV infected-patients (insulin resistance, diabetes, hyperlipidemia or osteopenia), as well as other factors of cardiovascular risk, such as hypertension, should also be dealt with according to guidelines similar to the general population, as well as insisting on steps to healthier lifestyles. The aim of this document is to provide a query tool for all professionals who treat HIV-patients and who may present or display any metabolic disorders listed in this document.


Assuntos
Doenças Cardiovasculares/epidemiologia , Infecções por HIV/epidemiologia , Doenças Metabólicas/epidemiologia , Fármacos Anti-HIV/efeitos adversos , Doenças Cardiovasculares/prevenção & controle , Comorbidade , Exercício , Promoção da Saúde , Estilo de Vida Saudável , Humanos , Transtornos do Metabolismo dos Lipídeos/induzido quimicamente , Transtornos do Metabolismo dos Lipídeos/epidemiologia , Doenças Metabólicas/induzido quimicamente , Doenças Metabólicas/terapia , Fatores de Risco , Disfunções Sexuais Fisiológicas/epidemiologia , Disfunções Sexuais Fisiológicas/etiologia , Abandono do Hábito de Fumar
3.
Enferm Infecc Microbiol Clin ; 33(1): 40.e1-40.e16, 2015 Jan.
Artigo em Espanhol | MEDLINE | ID: mdl-25176009

RESUMO

OBJECTIVE: This consensus document is an update of metabolic disorders and cardiovascular risk (CVR) guidelines for HIV-infected patients. METHODS: This document has been approved by an expert panel of GEAM, SPNS and GESIDA after reviewing the results of efficacy and safety of clinical trials, cohort and pharmacokinetic studies published in biomedical journals (PubMed and Embase) or presented in medical scientific meetings. Recommendation strength and the evidence in which they are supported are based on the GRADE system. RESULTS: A healthy lifestyle is recommended, no smoking and at least 30min of aerobic exercise daily. In diabetic patients the same treatment as non-HIV infected patients is recommended. HIV patients with dyslipidemia should be considered as high CVR, thus its therapeutic objective is an LDL less than 100mg/dL. The antihypertensive of ACE inhibitors and ARAII families are better tolerated and have a lower risk of interactions. In HIV-patients with diabetes or metabolic syndrome and elevated transaminases with no defined etiology, the recommended is to rule out a hepatic steatosis Recommendations for action in hormone alterations are also updated. CONCLUSIONS: These new guidelines update previous recommendations regarding all those metabolic disorders involved in CVR. Hormone changes and their management and the impact of metabolic disorders on the liver are also included.


Assuntos
Doenças Cardiovasculares/epidemiologia , Infecções por HIV/epidemiologia , Doenças Metabólicas/epidemiologia , Fármacos Anti-HIV/efeitos adversos , Doenças Cardiovasculares/prevenção & controle , Comorbidade , Exercício , Promoção da Saúde , Estilo de Vida Saudável , Humanos , Transtornos do Metabolismo dos Lipídeos/induzido quimicamente , Transtornos do Metabolismo dos Lipídeos/epidemiologia , Doenças Metabólicas/induzido quimicamente , Doenças Metabólicas/terapia , Fatores de Risco , Disfunções Sexuais Fisiológicas/epidemiologia , Disfunções Sexuais Fisiológicas/etiologia , Abandono do Hábito de Fumar
4.
Rev Esp Quimioter ; 27(2): 93-7, 2014 Jun.
Artigo em Espanhol | MEDLINE | ID: mdl-24940888

RESUMO

Survey in 349 HIV infected subjects in 19 Spanish Hospitals in 2010-2011, to assess the reasons for antiretroviral treatment change. Simplification was the most frequent reason for change (37%), followed by toxicity (30%) and treatment failure (21%). There were statistically significant differences according to treatment line and transmission category. In conclusion, in many patients treatment is changed in order to obtain the benefits of a regimen easier to follow.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Substituição de Medicamentos , Infecções por HIV/tratamento farmacológico , Adulto , Fármacos Anti-HIV/administração & dosagem , Fármacos Anti-HIV/efeitos adversos , Comorbidade , Estudos Transversais , Feminino , Infecções por HIV/epidemiologia , Humanos , Masculino , Auditoria Médica , Pessoa de Meia-Idade , Motivação , Ambulatório Hospitalar , Aceitação pelo Paciente de Cuidados de Saúde , Fatores Socioeconômicos , Espanha/epidemiologia , Falha de Tratamento
5.
Rev. esp. quimioter ; 27(2): 93-97, jun. 2014. tab
Artigo em Espanhol | IBECS | ID: ibc-123826

RESUMO

Encuesta transversal en 349 pacientes con VIH en 19 hospitales españoles, para caracterizar los motivos de cambio del tratamiento antirretroviral en 2010-2011. La causa más frecuente del cambio fue la simplificación (37%), seguida de la toxicidad (30%) y el fracaso terapéutico (21%). Se encontraron diferencias significativas en los motivos de cambio según la línea de tratamiento y la categoría de transmisión. En conclusión, en muchos pacientes se busca la optimización del tratamiento antirretroviral mediante la simplificación a pautas más fáciles de seguir (AU)


Survey in 349 HIV infected subjects in 19 Spanish Hospitals in 2010-2011, to assess the reasons for antiretroviral treatment change. Simplification was the most frequent reason for change (37%), followed by toxicity (30%) and treatment failure (21%). There were statistically significant differences according to treatment line and transmission category. In conclusion, in many patients treatment is changed in order to obtain the benefits of a regimen easier to follow (AU)


Assuntos
Humanos , Infecções por HIV/tratamento farmacológico , Fármacos Anti-HIV/uso terapêutico , Antirretrovirais/uso terapêutico , Terapia Antirretroviral de Alta Atividade , Conduta do Tratamento Medicamentoso , /epidemiologia
7.
HIV Clin Trials ; 14(5): 204-15, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24144897

RESUMO

OBJECTIVES: Current antiretroviral guidelines state that being older than 50 to 55 years of age is an indication to start antiretroviral therapy (ART), regardless of CD4 status. However, no references to the preferred combination ART (cART) for these patients have been described. Our study compares emtricitabine and tenofovir disoproxil fumarate (FTC/TDF) versus other nucleoside reverse transcriptase inhibitor (NNRTI) regimens in HIV ART-naïve patients who are ≥50 years. DESIGN: National, retrospective cohort analysis of patients who were ≥50 years old when they began the first cART (January 1, 2006 to December 31, 2009). METHODS: We compared safety, effectiveness, and persistence of treatment in FTC/TDF versus non-FTC/TDF users. Among FTC/TDF users, we compared protease inhibitor (PI) versus NNRTI users and lopinavir/r versus efavirenz users. RESULTS: We included 161 patients: median age was 54.6 years, 83% were men, median CD4 count was 191 cells/µL, median viral load was 4.7 log, and median follow-up was 19 months (maximum, 48 months). Of these participants, 112 started with FTC/TDF and 49 with other nucleotide reverse transcriptase inhibitors (NRTIs). During follow-up, 21.9% of subjects developed at least one laboratory event ≥grade 3, 5.6% interrupted cART due to adverse events,19.3% had virologic failure, and 49.1% modified cART. There were no statistically significant differences between FTC/TDF and non-FTC/TDF users for any output except for persistence: The proportion of subjects who changed cART was 71.4% for non-FTC/TDF users and 38.6% for FTC/TDF users (log rank 0.001; adjusted hazard ratio, 2.10; 95% CI, 1.34-3.29). CONCLUSIONS: In a population of HIV-infected subjects who were ≥50 years old, our study suggests that the use of FTC/TDF is generally safe and effective, with a longer persistence as compared to other regimens.


Assuntos
Adenina/análogos & derivados , Fármacos Anti-HIV/uso terapêutico , Desoxicitidina/análogos & derivados , Infecções por HIV/tratamento farmacológico , Organofosfonatos/uso terapêutico , Adenina/administração & dosagem , Adenina/efeitos adversos , Adenina/uso terapêutico , Envelhecimento , Fármacos Anti-HIV/administração & dosagem , Fármacos Anti-HIV/efeitos adversos , Desoxicitidina/administração & dosagem , Desoxicitidina/efeitos adversos , Desoxicitidina/uso terapêutico , Quimioterapia Combinada , Emtricitabina , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Organofosfonatos/administração & dosagem , Organofosfonatos/efeitos adversos , Tenofovir
8.
Rev Esp Quimioter ; 26(2): 103-7, 2013 Jun.
Artigo em Espanhol | MEDLINE | ID: mdl-23817646

RESUMO

INTRODUCTION: In 2009 a deep change in ARV treatment took place in Spain with the introduction of new ARV drugs. The principal objective of the study was to determine the clinical situation of the patients in which DRV/r was introduced in the ARV therapy. METHODS: Observational, cross sectional and multicentre study in which 91 reference hospitals participated. Patient's enrollment was carried out between 2008 and 2009. Data were collected retrospectively considering standard clinical practice. RESULTS: 719 medical records were reviewed. Patients had a different clinical situation compared to nowadays with predominance of multiresistant virus which leaded to virologic failure. The principal reason for introducing DRV/r in the ARV regimen was the virologic failure (54.2%). CONCLUSIONS: Considering this situation, DRV/r became a therapeutic option which represented a change in the ARV paradigm in that period.


Assuntos
Terapia Antirretroviral de Alta Atividade/métodos , Infecções por HIV/tratamento farmacológico , Inibidores da Protease de HIV/uso terapêutico , Sulfonamidas/uso terapêutico , Adolescente , Adulto , Fatores Etários , Terapia Antirretroviral de Alta Atividade/estatística & dados numéricos , Terapia Antirretroviral de Alta Atividade/tendências , Estudos Transversais , Darunavir , Farmacorresistência Viral , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores Sexuais , Fatores Socioeconômicos , Espanha , Resultado do Tratamento , Carga Viral , Adulto Jovem
9.
Rev. esp. quimioter ; 26(2): 103-107, jun. 2013. ilus
Artigo em Espanhol | IBECS | ID: ibc-113461

RESUMO

Introducción. En el año 2009 se produjo un cambio muy sustancial en el tratamiento antirretroviral (ARV) de nuestro país con la introducción de nuevos fármacos antiretrovirales. El objetivo fue conocer la situación clínica de los pacientes en los que se introducía darunavir (DRV/r) en el tratamiento antirretroviral. Métodos. Estudio observacional, transversal y retrospectivo, en el que participaron 91 centros españoles de referencia. El periodo de reclutamiento del estudio se llevó a cabo entre 2008 y 2009. Se recogieron datos relacionados con la práctica clínica habitual. Resultados. Se revisaron 719 historias clínicas. La situación clínica prevalente entre los pacientes que necesitaban un ajuste al tratamiento antirretroviral era diferente a la actual con predominio de multirresistencias que llevaban a fracaso. El motivo principal por el que se había incluido DRV/r en la pauta fue el fracaso virológico (54,2%). Conclusiones. En esa situación, DRV/r constituyó una opción terapéutica que supuso un cambio en el paradigma del tratamiento antirretroviral de la época(AU)


Introduction. In 2009 a deep change in ARV treatment took place in Spain with the introduction of new ARV drugs. The principal objective of the study was to determine the clinical situation of the patients in which DRV/r was introduced in the ARV therapy. Methods. Observational, cross sectional and multicentre study in which 91 reference hospitals participated. Patient’s enrolment was carried out between 2008 and 2009. Data were collected retrospectively considering standard clinical practice. Results. 719 medical records were reviewed. Patients had a different clinical situation compared to nowadays with predominance of multiresistant virus which leaded to virologic failure. The principal reason for introducing DRV/r in the ARV regimen was the virologic failure (54.2%). Conclusions. Considering this situation, DRV/r became a therapeutic option which represented a change in the ARV paradigm in that period(AU)


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Antirretrovirais/uso terapêutico , Síndromes de Imunodeficiência/tratamento farmacológico , Síndrome de Imunodeficiência Adquirida/tratamento farmacológico , Estudos Transversais/métodos , Estudos Transversais , Estudos Retrospectivos , Ensaio de Imunoadsorção Enzimática/métodos , Ensaio de Imunoadsorção Enzimática , Western Blotting
10.
AIDS Res Hum Retroviruses ; 28(2): 165-70, 2012 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-21790273

RESUMO

Despite having demonstrated noninferior efficacy against atazanavir/ritonavir plus coformulated tenofovir/emtricitabine (cTDF/FTC), the combination of nevirapine plus cTDF/FTC is not included among preferred regimens in some international guidelines. This combination is frequently used in Spain. We analyzed its effectiveness and safety as first-line therapy in a routine clinical practice. A retrospective, multicenter study was performed in treatment-naive HIV-1-infected subjects who started nevirapine plus cTDF/FTC as first-line therapy according to the nevirapine CD4(+) cell count threshold. The primary endpoint was the proportion of subjects with plasma HIV-1 RNA <50 copies/ml at week 48. We included 123 subjects starting the regimen from 2005 to 2008. The median age was 41.0 years, the median baseline CD4(+) cell count was 215 cells/µl, the median plasma viral load (VL) was 4.83 log(10) copies/ml, and 22% had hepatitis C coinfection. At week 48, 96 subjects (78%; 95% CI: 69.9-84.4) had a VL <50 copies/ml in an ITT analysis, and the median rise in the CD4(+) cell count was 118 cells/µl. Virological failure was observed in 6.5% (8/123) of subjects, all them before week 24 and related to poor adherence. There was no relationship between virological failure and baseline CD4(+) cell count or VL. Ten percent (13/123) of the subjects discontinued the treatment due to adverse events. There was a significant decrease in total/HDL-cholesterol ratio (p=0.03) with an increase in HDL-cholesterol (p=0.01) over 48 weeks. The combination of nevirapine plus cTDF/FTC showed a high virological efficacy without unexpected toxicities as a first-line treatment in a routine clinical practice.


Assuntos
Síndrome de Imunodeficiência Adquirida/tratamento farmacológico , Adenina/análogos & derivados , Fármacos Anti-HIV/farmacologia , Desoxicitidina/análogos & derivados , Nevirapina/farmacologia , Organofosfonatos/farmacologia , Síndrome de Imunodeficiência Adquirida/epidemiologia , Adenina/efeitos adversos , Adenina/farmacologia , Adulto , Fármacos Anti-HIV/efeitos adversos , Contagem de Linfócito CD4 , Desoxicitidina/efeitos adversos , Desoxicitidina/farmacologia , Combinação de Medicamentos , Quimioterapia Combinada , Emtricitabina , Feminino , Inibidores da Protease de HIV/farmacologia , Humanos , Masculino , Pessoa de Meia-Idade , Nevirapina/efeitos adversos , Organofosfonatos/efeitos adversos , RNA Viral/efeitos dos fármacos , Espanha/epidemiologia , Tenofovir , Carga Viral/efeitos dos fármacos
11.
BMC Womens Health ; 11: 36, 2011 Aug 04.
Artigo em Inglês | MEDLINE | ID: mdl-21816091

RESUMO

BACKGROUND: Information concerning lipid disturbances in HIV-infected women on antiretroviral therapy (ART) is scarce. The objective of the study is to describe the lipid profile in a large cohort of HIV-infected women on contemporary ART and analyse differences between regimes and patient's characteristics. METHODS: Observational, multicentre, cross-sectional study from the Spanish VACH Cohort. 922 women on stable ART without lipid-lowering treatment were included. RESULTS: Median age was 42 years, median CD4 lymphocyte count was 544 cells/mm3, and 85.6% presented undetectable HIV-1 viral load. Median total cholesterol (TC) was 189 mg/dL (interquartile range, IQR, 165-221), HDL cholesterol 53 mg/dL (IQR, 44-64), LDL cholesterol 108 mg/dL (IQR, 86-134), and triglycerides 116 mg/dL (IQR, 85-163). Mean accumulated time on ART was 116 months; 47.4% were on NNRTI-based regimes, 44.7% on PI, and 6.7% on only-NRTI therapy. 43.8% were also hepatitis C (HCV) coinfected. Patients on PI treatment presented higher TC/HDL ratio than those on NNRTI (p < 0.001). Significantly higher HDL values were observed in NNRTI-treated patients. HCV-coinfected patients presented lower TC/HDL ratio than the non HCV-coinfected. In multivariate analysis, factors independently associated with TC/HDL ratio were age, triglyceride levels and HCV co-infection. PI treatment presented a non-significant association with higher TC/HDL ratio. CONCLUSIONS: In HIV-infected women, the NNRTI-based ART is associated with a better lipid profile than the PI-based. Factors unrelated to ART selection may also exert an independent, significant influence on lipids; in particular, age, and triglyceride levels are associated with an increased TC/HDL ratio while HCV co-infection is associated with a reduced TC/HDL ratio.


Assuntos
Antirretrovirais/uso terapêutico , Dislipidemias/etiologia , Infecções por HIV/complicações , Adulto , Fatores Etários , Antirretrovirais/efeitos adversos , Índice de Massa Corporal , Contagem de Linfócito CD4 , Linfócitos T CD4-Positivos , Colesterol/sangue , HDL-Colesterol/sangue , Estudos de Coortes , Estudos Transversais , Dislipidemias/sangue , Feminino , Infecções por HIV/sangue , Infecções por HIV/tratamento farmacológico , Hepatite C/complicações , Humanos , Observação , Estudos Prospectivos , Espanha , Triglicerídeos/sangue , Carga Viral
13.
Enferm Infecc Microbiol Clin ; 29(7): 556-7, 2011.
Artigo em Espanhol | MEDLINE | ID: mdl-21565428
15.
Enferm. infecc. microbiol. clín. (Ed. impr.) ; 28(5): 266-272, mayo 2010. ilus, tab
Artigo em Inglês | IBECS | ID: ibc-84098

RESUMO

Objective To study the characteristics of HIV infection in the gypsy (Roma) population in Spain, as compared with those of the Caucasian, non-gypsy majority. Design Cross-sectional, historical cohort study from the Spanish VACH Cohort. Methods Patients attending VACH clinics between 1 June 2004 and 30 November 2004 were classified according to their racial and ethnic origin as “gypsies”, Caucasian non-gypsy Spanish natives (CNGN), and “other” (the last being excluded from this study). Their sociodemographic and clinico-epidemiological characteristics were compared, as well as the Kaplan–Meier curves of time to AIDS, or death, or disease progression (either of the 2 outcomes).Results4819 (48%) of 10,032 cases included in the VACH database were eligible: 210 (4.2%) were gypsies and 4252 (84.8%) were CNGN. Differences were observed in age, household, academic, inmate, marital, and employment history. Injecting drug use had been the most frequent mechanism of transmission in both groups, but to a greater extent among gypsies (72% versus 50%; P<0.000). Sex distribution, CD4 cell counts, and viral loads at the first visit were similar in the 2 groups, as was the percentage of patients with previous AIDS, percentage receiving antiretrovirals, and percentage subsequently starting antiretroviral therapy. Up to 1 April 2005, 416 new AIDS cases and 85 deaths were recorded. The percentage of these outcomes did not differ between groups, but log-rank test showed a shorter time to AIDS and disease progression among gypsies. Conclusions The sociodemographic characteristics of gypsies, the largest minority in the VACH Cohort, show differences relative to those of CNGN. HIV-related outcomes suggest that gypsies have a poorer prognosis (AU)


Objetivo estudiar las características de la infección por el VIH en gitanos en España, en comparación con las de la mayoría caucásica no gitana (CNG).Métodos estudio transversal y de cohortes históricas en la Cohorte VACH. Clasificamos a los pacientes que acudieron a las clínicas participantes en VACH entre el 1 de junio de 2004 y el 30 de noviembre de 2004 de acuerdo a su raza y etnia, como «gitanos», «nativos españoles CNG» u «otros» (estos, excluidos de este estudio). Comparamos sus características sociodemográficas y clinicoepidemiológicas, así como sus curvas de Kaplan–Meier del tiempo hasta sida, muerte o progresión de la enfermedad (cualquiera de ambos).Resultados4819 (48%) de 10.032 casos recogidos en la base de datos de VACH fueron incluidos en el estudio: 210 (4,2%) eran gitanos y 4.252 (84,8%) eran nativos CNG. Observamos diferencias en sus distribuciones por edad, domicilio, estudios, antecedentes penales, situación laboral y marital. La inyección de drogas había sido el mecanismo de transmisión del VIH más frecuente en los dos grupos, pero más marcadamente en los gitanos (72% frente a 50%; p<0,000). La distribución por sexos, los recuentos de linfocitos CD4 y las cargas virales en la primera visita fueron similares en ambos grupos, así como las proporciones de pacientes con sida previo y las de quienes estaban ya en, o iniciaron entonces, tratamiento antirretroviral. Hasta el 1 de abril de 2005 se registraron 416 nuevos casos de sida y 85 muertes. La proporción de ambos resultados fue similar en ambos grupos, pero la prueba del rango logarítmico demostró una evolución más rápida a sida y a progresión de la (..) (AU)


Assuntos
Humanos , Masculino , Feminino , Adulto , Roma (Grupo Étnico) , Infecções por HIV/epidemiologia , Estudos Transversais , Espanha
16.
BMC Med Genet ; 11: 63, 2010 Apr 26.
Artigo em Inglês | MEDLINE | ID: mdl-20420684

RESUMO

BACKGROUND: Tumor necrosis factor alpha (TNF-alpha) is thought to be involved in the various immunogenetic events that influence HIV-1 infection. METHODS: We aimed to determine whether carriage of the TNF-alpha-238G>A, -308G>A and -863 C>A gene promoter single nucleotide polymorphisms (SNP) and the CCR5 Delta 32 variant allele influence the risk of HIV-1 infection and disease progression in Caucasian Spaniards. The study group consisted of 423 individuals. Of these, 239 were uninfected (36 heavily exposed but uninfected [EU] and 203 healthy controls [HC]) and 184 were HIV-1-infected (109 typical progressors [TP] and 75 long-term nonprogressors [LTNP] of over 16 years' duration). TNF-alpha SNP and the CCR5 Delta 32 allele were assessed using PCR-RFLP and automatic sequencing analysis methods on white blood cell DNA. Genotype and allele frequencies were compared using the chi 2 test and the Fisher exact test. Haplotypes were compared by logistic regression analysis. RESULTS: The distribution of TNF-alpha-238G>A, -308G>A and -863 C>A genetic variants was non-significantly different in HIV-1-infected patients compared with uninfected individuals: -238G>A, p = 0.7 and p = 0.3; -308G>A, p = 0.05 and p = 0.07; -863 C>A, p = 0.7 and p = 0.4, for genotype and allele comparisons, respectively. Haplotype analyses, however, indicated that carriers of the haplotype H3 were significantly more common among uninfected subjects (p = 0.04). Among the infected patients, the distribution of the three TNF-alpha genetic variants assessed was non-significantly different between TP and LTNP: -238G>A, p = 0.35 and p = 0.7; -308G>A, p = 0.7 and p = 0.6: -863 C>A, p = 0.2 and p = 0.2, for genotype and allele comparisons, respectively. Haplotype analyses also indicated non-significant associations. Subanalyses in the LTNP subset indicated that the TNF-alpha-238A variant allele was significantly overrepresented in patients who spontaneously controlled plasma viremia compared with those who had a detectable plasma viral load (genotype comparisons, p = 0.02; allele comparisons, p = 0.03). The CCR5 Delta 32 distribution was non-significantly different in HIV-1-infected patients with respect to the uninfected population (p = 0.15 and p = 0.2 for genotype and allele comparisons, respectively) and in LTNP vs TP (p = 0.4 and p = 0.5 for genotype and allele comparisons, respectively). CONCLUSIONS: In our cohort of Caucasian Spaniards, TNF-alpha genetic variants could be involved in the vulnerability to HIV-1 infection. TNF-alpha genetic variants were unrelated to disease progression in infected subjects. The -238G>A SNP may modulate the control of viremia in LTNP. Carriage of the CCR5 Delta 32 variant allele had no effect on the risk of infection and disease progression.


Assuntos
Infecções por HIV/genética , HIV-1 , Receptores CCR5/genética , Fator de Necrose Tumoral alfa/genética , Adulto , Progressão da Doença , Grupo com Ancestrais do Continente Europeu , Feminino , Predisposição Genética para Doença , Humanos , Masculino , Pessoa de Meia-Idade , Polimorfismo de Nucleotídeo Único , Populações Vulneráveis
17.
Enferm Infecc Microbiol Clin ; 28(5): 266-72, 2010 May.
Artigo em Inglês | MEDLINE | ID: mdl-20129716

RESUMO

OBJECTIVE: To study the characteristics of HIV infection in the gypsy (Roma) population in Spain, as compared with those of the Caucasian, non-gypsy majority. DESIGN: Cross-sectional, historical cohort study from the Spanish VACH Cohort. METHODS: Patients attending VACH clinics between 1 June 2004 and 30 November 2004 were classified according to their racial and ethnic origin as "gypsies", Caucasian non-gypsy Spanish natives (CNGN), and "other" (the last being excluded from this study). Their sociodemographic and clinico-epidemiological characteristics were compared, as well as the Kaplan-Meier curves of time to AIDS, or death, or disease progression (either of the 2 outcomes). RESULTS: 4819 (48%) of 10,032 cases included in the VACH database were eligible: 210 (4.2%) were gypsies and 4252 (84.8%) were CNGN. Differences were observed in age, household, academic, inmate, marital, and employment history. Injecting drug use had been the most frequent mechanism of transmission in both groups, but to a greater extent among gypsies (72% versus 50%; P<0.000). Sex distribution, CD4 cell counts, and viral loads at the first visit were similar in the 2 groups, as was the percentage of patients with previous AIDS, percentage receiving antiretrovirals, and percentage subsequently starting antiretroviral therapy. Up to 1 April 2005, 416 new AIDS cases and 85 deaths were recorded. The percentage of these outcomes did not differ between groups, but log-rank test showed a shorter time to AIDS and disease progression among gypsies. CONCLUSIONS: The sociodemographic characteristics of gypsies, the largest minority in the VACH Cohort, show differences relative to those of CNGN. HIV-related outcomes suggest that gypsies have a poorer prognosis.


Assuntos
Infecções por HIV/epidemiologia , Roma , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Espanha
18.
Emergencias (St. Vicenç dels Horts) ; 21(5): 325-332, oct. 2009.
Artigo em Espanhol | IBECS | ID: ibc-84434

RESUMO

Objetivos: Investigar la evolución clínica de los síntomas y comprobar la seguridad del alta directa desde el servicio de urgencias hospitalario (SUH) en mujeres afectadas depielonefritis aguda (PNA) no complicada. Método: Estudio prospectivo, longitudinal, no intervencionista y multicéntrico de pacientes procedentes de 2 SUH diferentes con PNA no complicada cuya permanencia en el SUH fuese inferior o igual a 24 horas. Se recogieron antecedentes, datos de la enfermedad actual, exploraciones complementarias y tratamiento prescrito. A los 3-5días del alta se contactó telefónicamente para valorar su curación clínica (resoluciónde la fiebre, el dolor lumbar y el síndrome miccional) y, en caso de persistir algún síntoma, se contactó de nuevo a los 7-10 días. Se registraron las reconsultas y si ellohabía comportado cambios en el tratamiento y/o había requerido hospitalización. Resultados: Se incluyeron 71 mujeres, el 83% presentaba curación completa a los 10días del alta del SUH. Las curvas de curación resultaron casi superponibles en ambos SUH (p = NS). El dolor lumbar fue el síntoma que más tardó en desaparecer (p < 0,01respecto a la fiebre y el síndrome miccional). Reconsultaron 12 pacientes (16,9%) y sólo2 de ellas (2,8%) tuvieron que ser hospitalizadas. Algún factor se relacionó con la mayor persistencia de algún síntoma en concreto, pero ninguno con una curación más precoz. Conclusiones: La mayoría de las pacientes diagnosticadas de PNA no complicada alcanzan la curación clínica sin necesidad de hospitalización, por lo que es seguro proceder al alta directa desde el SUH tras un periodo de observación que permita administrarla primera dosis de antibiótico parenteral, elegir un antibiótico oral adecuado, advertir a la paciente de la posible duración prolongada de algunos síntomas y remitirla a un control ambulatorio adecuado (AU)


Objective: To determine the clinical course and safety of patients discharged home after hospital emergency department treatment of acute uncomplicated pyelonephritis. Methods: This prospective, longitudinal, nonintervention, multicenter study enrolled women diagnosed with acute uncomplicated pyelonephritis at 2 hospital emergency services. No patient stayed in the emergency room longer than24 hours. Medical history, current complaints, test results, and prescribed treatment were recorded for all patients. Between 3 to 5 days after discharge the patient was telephoned to assess clinical course (resolution of fever, lower backpain, and urinary tract symptoms). If symptoms persisted, the patient was called again between 7 and 10 days after discharge. The caller asked if the patient had consulted another doctor and if that consultation led to changes in treatment and/or hospitalization was required. Results: Seventy-one patients were enrolled; 83% experienced complete resolution within 10 days of discharge. The survival curves of cures were practically identical for the 2 emergency services (no significant difference). Lower back pain was the symptom that took the longest to resolve (P<.01, with respect to both fever and urinary tract symptoms).Twelve patients (16.9%) consulted a doctor again and only 2 (2.8% of the entire cohort) had to be hospitalized. Although certain factors were associated with longer duration of certain symptoms, no particular factor was found to correlate with early resolution. Conclusions: Most patients diagnosed with acute pyelonephritis are cured without requiring hospitalization. Discharge home from the emergency department is therefore justified after an observation period in which a first parenteral antibiotic dose is administered and an appropriate oral antibiotic is chosen. The patient should be warned of the possibility of the persistence of some symptoms and referred for appropriate outpatient follow-up (AU)


Assuntos
Humanos , Feminino , Pielonefrite/epidemiologia , Infecções Urinárias/epidemiologia , Estudos Prospectivos , Assistência Ambulatorial/métodos , Recidiva , Pielonefrite/diagnóstico , Pielonefrite/tratamento farmacológico
19.
J Acquir Immune Defic Syndr ; 52(4): 443-51, 2009 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-19779356

RESUMO

BACKGROUND: Mitochondrial damage of HIV and antiretrovirals, especially nucleoside-analogue interference on mitochondrial DNA (mtDNA) replication, is reported to underlay highly active antiretroviral therapy (HAART)-related hyperlactatemia, but scarce approaches have been performed to correlate clinical manifestations and mitochondrial abnormalities. METHODS: We obtained lymphocytes and monocytes of 26 HIV-infected and treated patients who developed hyperlactatemia and after recovery, 28 nonhyperlactatemic HIV subjects on HAART, 31 naive individuals, and 20 uninfected controls. Mitochondrial replication and transcription analysis were performed by quantitative real-time PCR, mitochondrial translation quantification by western blot and mitochondrial enzymatic activities by spectrophotometry. RESULTS: Mitochondrial parameters decreased during hyperlactatemia and improved at recovery. Mitochondrial replication and transcription species were reduced (P = 0.16 and P = 0.71), but the most significant decay was observed on mitochondrial protein content (P < 0.05) and mitochondrial complexes III and IV activities (P < 0.01 and P < 0.001). During hyperlactatemia lactate level correlated complexes III and IV function (P < 0.05). After recovery mitochondrial parameters achieved values of nonhyperlactatemic HIV individuals, which were lower than ranges of naive subjects and uninfected controls. CONCLUSIONS: HIV and HAART-related hyperlactatemia is associated with a general mitochondrial impairment which reverts after recovery. Mitochondrial biochemistry show a better correlation with lactate levels than mitochondrial genetics suggesting that mitochondrial function could be a better marker of hyperlactatemia development than mtDNA content.


Assuntos
Fármacos Anti-HIV/efeitos adversos , Terapia Antirretroviral de Alta Atividade/efeitos adversos , Infecções por HIV/tratamento farmacológico , Lactatos/sangue , Mitocôndrias/efeitos dos fármacos , Fármacos Anti-HIV/administração & dosagem , DNA Mitocondrial/genética , DNA Mitocondrial/metabolismo , Feminino , Regulação Enzimológica da Expressão Gênica , Regulação Viral da Expressão Gênica , Infecções por HIV/genética , Humanos , Masculino , Pessoa de Meia-Idade , Mitocôndrias/enzimologia , Mitocôndrias/genética , Mitocôndrias/metabolismo , Proteínas Mitocondriais/biossíntese , Proteínas Mitocondriais/genética , RNA/genética , RNA/metabolismo , RNA Mitocondrial
20.
Enferm. infecc. microbiol. clín. (Ed. impr.) ; 27(supl.1): 40-47, sept. 2009. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-177848

RESUMO

El aumento del riesgo cardiovascular (RCV) entre los pacientes postivos al virus de la inmunodeficiencia humana (VIH) hace indispensable adoptar medidas de prevención de la morbimortalidad cardiovascular y, para ello, se necesitan escalas de estimación de éste, entre ellas: Framingham, PROCAM y Score. Los factores de RCV (FRCV) clásicos guardan una estrecha relación con el RCV en los pacientes con VIH, pero no se conoce sí es equiparable al de la población general. Es por ello que estas escalas probablemente infravaloren el riesgo en estos pacientes. Actualmente, se recomienda aplicar las mismas estrategias que en población general, sin olvidar las singularidades de los pacientes VIH-positivos y la importancia del estado inflamatorio persistente que presentan, que podría acelerar el desarrollo de arteriosclerosis y traducirse en un aumento en la morbimortalidad cardiovascular. Es por esto que, además de los FRCV tradicionales, los marcadores biológicos de inflamación podrían contribuir a identificar a los pacientes más susceptibles de presentar un episodio cardiovascular, por lo que son revisados. También se revisan diversas técnicas para la valoración de aterosclerosis subclínica que podrían ayudar a identificar pacientes de riesgo de forma precoz. Los cambios en el estilo de vida (dieta saludable, dejar de fumar, mantener un peso adecuado y ejercicio físico diario) consiguen, en la población general, un descenso en la probabilidad de presentar un episodio coronario de hasta el 80%. Se revisan las medidas terapéuticas tradicionales (dislipemia, hipertensión arterial, diabetes mellitus) y las particulares de la condición VIH (supresión viral, tratamientos discontinuos, etc.)


Because of the increased cardiovascular risk (CVR) in HIV-positive patients, preventive measures are essential, requiring algorithms for risk estimation, such as the Framingham risk equation, the Prospective Cardiovascular Munster Study (PROCAM) algorithm and the Systematic Coronary Risk Evaluation (SCORE) chart. Classical cardiovascular risk factors (CVRF) are closely related to CVR in HIV-infected patients but whether this risk is comparable to that in the general population is unknown. Therefore, these algorithms probably underestimate the risk in these patients. Currently, application of the same strategies as those used in the general population is recommended, without forgetting the specific characteristics of HIV positive patients or the importance of their inflammatory status, which can accelerate the development of arteriosclerosis and lead to an increase in cardiovascular morbidity and mortality. Therefore, in addition to traditional CVRF, biological markers of inflammation could help to identify the patients most at risk of a cardiovascular event. These markers, as well as the diverse techniques for assessment of subclinical atherosclerosis that could help in the early identification of at-risk patients, are reviewed in the present study. Lifestyle changes (healthy diet, smoking cessation, maintaining a healthy weight and daily physical exercise) reduce the probability of a coronary event by up to 80% in the general population. Traditional therapeutic measures (dyslipidemia, hypertension, diabetes mellitus) and those specific to HIV infection (viral suppression, discontinuous treatment, etc.) are reviewed


Assuntos
Humanos , Síndrome de Imunodeficiência Adquirida/tratamento farmacológico , Doenças Cardiovasculares/diagnóstico , Terapia Antirretroviral de Alta Atividade/efeitos adversos , Síndrome de Imunodeficiência Adquirida/complicações , Doenças Cardiovasculares/induzido quimicamente , Doenças Cardiovasculares/epidemiologia , Fármacos Anti-HIV/efeitos adversos , Fatores de Risco , Biomarcadores , Indicadores de Morbimortalidade
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