Factores associados a falência ao tratamento antiretroviral em adolescentes seguidos no departamento de pediatria do hospital central de Maputo, janeiro de 2010 a janeiro 2020 / Factors associated with antiretroviral treatment failure in adolescents followed at the department of paediatrics, Maputo central hospital, january 2010 to january 2020

A sobrevivência melhorada das crianças vivendo com HIV, resultante de uma excelente cobertura do tratamento antirretroviral pediátrico (TARV) levou a um aumento no número de adolescentes em TARV e por sua vez em falência terapêutica, o que ditou a realização deste estudo com objectivo de conhecer os factores associados á falência ao TARV nos adolescentes em seguimento no Departamento de Pediatria do Hospital Central de Maputo. Foi feito um estudo retrospectivo incluindo adolescentes dos 10 aos 18 anos, com infecção por HIV, em TARV, em seguimento no período compreendido entre 1 de Janeiro de 2010 a 31 de Janeiro de 2020, no HCM. Foi feita uma estatística descritiva e uma análise de regressão multifactorial para se encontrar os factores com significância estatística associados á falência terapêutica ao TARV. Os resultados mostram que, de um total de 206 adolescentes em seguimento nesta consulta, foram excluidos 27, por informação incompleta, e incluidos 179 adolescentes. Dos adolescentes incluidos no estudo, 42 apresentaram critérios de falência terapêutica virológica, correspondendo a 23,5% dos adolescentes estudados. Os factores associados á falência terapêutica foram: o regime TARV anterior com análogos não nucleosídeos com OR 6.16 (IC95% 1.17- 32.4; p - 0.00); índice de massa corporal com OR 6.08 (IC95% 1.23-30.0; p-0,02), e fadiga com OR 5.76 (IC95% 1.01-32.8; p-0,04). De notar que, a boa adesão ao TARV teve uma associação negativa à falência, com OR-0.03 (IC95% 0.00-0.19; p -0.00). Em conclusão, cerca de um quarto dos adolescentes em TARV seguidos no HCM de 2010 ­ 2020, apresentam falência terapêutica e os factores associados são: um regime terapêutico anterior baseado em análogos não nucleosídeos, desnutrição crónica moderada e fadiga .O facto de uma boa adesão mostrar uma associação negativa, sugere que a má adesão possa ser um factor influente no aparecimento da falência terapêutica, aliás demonstrado por diversos autores.

The increased survival of HIV-infected children, associated with excellent antiretroviral treatment (ART) outcomes, resulted in an increase in adolescents living with HIV and a subsequent increase in adolescents. with treatment failure.This increase in the number of adolescents in treatment failure led to the realization of this study with the aim of knowing the factors associated to ART failure in adolescents being followed up at the Pediatrics Department of the Maputo Central Hospital.The study is retrospective- and data extracted from various sources were analyzed as follows: the database of adolescent consultations, clinical records of patients, individual forms of antiretroviral drugs in the pharmacy, and form of the psychological evaluation of adolescents from 10 to 18 years old, on ART, in follow-up in the period between January 1, 2010, and January 31, 2020. The results show a total of 206 adolescents in follow-up, of which 27 were excluded due to incomplete information. In the end, 179 adolescents were included, of which 42 had a virologic failure, corresponding to 23.5% of the adolescents studied. Factors associated with treatment failure were: previous ART regimen with non-nucleoside analogs OR 6.16 (95%CI 1.17-32.4; p -0.00); body mass index between OR 6.08 (IC95% 1.23-30.0; p-0,02) and fatigue OR 5.76 (IC95% 1.01-32.8; p-0,04). Of note, good adherence had a negative association with treatment failure OR-0.03 (95%CI 0.00-0.19; p -0.00). In conclusion, a prior therapeutic regimen based on nucleoside analogs, malnutrition, and fatigue were the factors associated with treatment failure in adolescents followed at HCM from 2010-to 2020. The fact that good adherence showed a negative association suggests that poor adherence may be an influential factor in the upsurge of therapeutic failure, which was demonstrated by several authors.

Terapia antirretroviral para HIV/AIDS: o estado da arte / Antiretroviral therapy for HIV/AIDS: state of the art

Objetivo: descrever a evolução histórica da terapêutica para o HIV/AIDS, as mudanças ocorridas e protocolos atuais. Método: estudo descritivo, informativo, com análise dos protocolos clínicos de diretrizes terapêuticas e busca nas bases LILACS e MEDLINE, abrangendo artigos na integra, publicados de 1996 a 2017. Resultados: O acesso ao tratamento em alguns países permitiu o aumento e melhoria da sobrevida. A estratégia de unir três drogas em apenas um comprimido, uma das mais recentes, dentre outros benefícios, busca fortalecer a adesão à terapia antirretroviral. Conclusão: a história da adesão à terapia antirretroviral e seu impacto na prevenção do HIV/AIDS continua sendo um grande desafio, cuja meta é o controle e erradicação da epidemia. Nesse sentido, faz-se necessário uma maior conscientização dos profissionais de saúde para fazer parte desta luta, na qual a enfermagem tem importante participação.(AU)

The AIDS pandemic in historic perspective.

Potent antiretroviral drugs (ART) have changed the nature of AIDS, a once deadly disease, into a manageable illness and offer the promise of reducing the spread of HIV. But the pandemic continues to expand and cause significant morbidity and devastation to families and nations as ART cannot be distributed worldwide to all who need the drugs to treat their infections, prevent HIV transmission, or serve as prophylaxis. Furthermore, conventional behavioral prevention efforts based on theories that individuals can be taught to modify risky behaviors if they have the knowledge to do so have been ineffective. Noting behavioral strategies targeting individuals fail to address broader social and political structures that create environments vulnerable to HIV spread, social scientists and public health officials insist that HIV policies must be comprehensive and also target a variety of structures at the population and environmental level. Nineteenth-century public health programs that targeted environmental susceptibility are the historical analogues to today's comprehensive biomedical and structural strategies to handle AIDS. Current AIDS policies underscore that those fighting HIV using scientific advances in virology and molecular biology cannot isolate HIV from its broader environment and social context any more than their nineteenth-century predecessors who were driven by the filth theory of disease.

The history of antiretroviral therapy and of its implementation in resource-limited areas of the world.

HIV/AIDS not only represents the most severe epidemic in modern times, but also the greatest public health challenge in history. The response of the scientific community has been impressive and in just a few years, turned an inevitably fatal disease into a chronic manageable although not yet curable condition. The development of antiretroviral therapy is not only the history of scientific advancements: it is the result of the passionate 'alliance' towards a common goal between researchers, doctors and nurses, pharmaceutical industries, regulators, public health officials and the community of HIV-infected patients, which is rather unique in the history of medicine. In addition, the rapid and progressive development of antiretroviral therapy has not only proven to be life-saving for many millions but has been instrumental in unveiling the inequities in access to health between rich and poor countries of the world. Optimal benefits indeed, are not accessible to all people living with HIV, with challenges to coverage and sustainability in low and middle income countries. This paper will review the progress made, starting from the initial despairing times, till the current battle towards universal access to treatment and care for all people living with HIV.

HIV-associated neurocognitive disorders: a historical review.

BACKGROUND: The central nervous system represents a major target of the human immunodeficiency virus (HIV), and the neurocognitive impairments associated with the disease represent a major cause of disability. REVIEW SUMMARY: The HIV-associated neurocognitive disorders are presented from a historical point of view. The evolution of our knowledge and understanding of these primary complications of HIV infection is reviewed, starting with nomenclature and clinical staging and continuing with therapeutic options. CONCLUSIONS: Although considerable progress has been made in the research of HIV-associated neurocognitive disorders, they continue to represent a clinical challenge for neurologists. Because the evolution and the clinical manifestations of HIV infection have changed with the introduction of antiretroviral therapy and the life expectancy has increased, the problems in these patients are complex and need neurologists with a thorough knowledge in HIV infection.

Introducción. Una breve historia del sida / Introduction. A brief history of AIDS

La infección por el virus de la inmunodeficiencia humana(VIH) ilustra cómo el conocimiento de los mecanismosmoleculares implicados en la patogenia de unmicroorganismo puede generar rápidamente nuevosfármacos para el tratamiento de los pacientesinfectados. Desde la descripción en 1981 del síndromede inmunodeficiencia adquirida (sida) y la identificaciónde su agente causal en 1983, se han comercializado 23antirretrovirales pertenecientes a 5 familias. La entradaviral representa una diana preferente de intervenciónterapéutica pero la obtención de antagonistas frente alos distintos receptores del VIH ha sido un proceso largoy plagado de dificultades. Maraviroc es el primerfármaco antagonista de CCR5 aprobado para uso clínicoy representa un hito de gran importancia en eldesarrollo de nuevos tratamientos contra la infecciónpor el VIH. Maraviroc es un fármaco novedoso ydiferente del resto de antirretrovirales debido a lapeculiaridad de su mecanismo de acción y a que es elprimer antirretroviral dirigido a una diana celular. Enesta monografía se analizan distintos aspectos deltratamiento con maraviroc: mecanismo de acción,toxicidad, eficacia, mecanismos de resistencia y su papelen el contexto del tratamiento antirretroviral delpaciente infectado por el VIH(AU)

Human immunodeficiency virus (HIV) infection showsthat knowledge of the molecular mechanisms involved inthe pathogenesis can lead to the rapid development ofnew drugs to treat infected patients. Since thedescription of acquired immunodeficiency syndrome(AIDS) in 1981 and the identification of its causal agent in1983, twenty-three antiretrovirals, belonging to 5families, have been marketed. The viral entry point is oneof the preferred therapeutic treatment targets, but thedevelopment of antagonists against the different HIVreceptors has been a long process and fraught with difficulties. Maraviroc is the first CCR5 antagonist drugapproved for clinical use and represents a milestone inthe development of new treatments against HIVinfection. Maraviroc is a novel drug and different from therest of the antiretrovirals due to the specialcharacteristics of its mechanism of action and is also thefirst antiretroviral directed towards a cell target. Thedifferent aspects of treatment with Maraviroc areanalysed in this article; mechanism of action, toxicity,efficacy, resistance mechanisms, and its role in thecontext of antiretroviral treatment of the HIV infectedpatient(AU)

The antiretrovirals in pregnancy registry: a fifteenth anniversary celebration.

UNLABELLED: The year 2007 marks the fifteenth anniversary year of the founding of a landmark effort in drug safety risk management, the formation of the first monitoring effort of an antiretroviral (ARV) drug in pregnancy which has become the Antiretrovirals in Pregnancy Registry, the APR. This multicompany, multi-national voluntary collaborative registry monitors pregnancy exposure to a class of highly important drugs for any indication of an increase in the postexposure incidence of birth defects in the offspring of these pregnancies. To recognize the anniversary, the Steering Committee of the APR has commissioned this review of the contributions and lessons learned over the past decade and a half and, in the spirit of continuous process improvement, has committed to apply these lessons for the next fifteen years. This retrospective examines the antecedents to this registry and the context in which the APR was formed; the early efforts to establish technical and organizational procedures and policies; the evolving experiences with enrollment and follow-up, patient and participant protections, information management and oversight; public and regulatory dissemination; and of course, the accomplishments and lessons learned. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES: After completion of this article, the reader should be able to explain the value of a drug registry in determining safety risk management; summarize that the Antiretroviral (ARV) drugs in Pregnancy Registry (APR) is a very successful multinational, multicompany collaborative effort that has been in place for 15 years; and state that it has been an ideal public interest effort dealing with the devastating pandemic of human immunodeficiency viral disease.