Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 868
Filtrar
1.
J Acquir Immune Defic Syndr ; 80(2): 224-233, 2019 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-30640204

RESUMO

BACKGROUND: Reducing doses of antiretroviral drugs, including stavudine (d4T), may lower toxicity, while preserving efficacy. There are substantial concerns about renal and bone toxicities of tenofovir disoproxil fumarate (TDF). SETTING: HIV-1-infected treatment-naive adults in India, South Africa, and Uganda. METHODS: A phase-4, 96-week, randomized, double-blind, noninferiority trial compared d4T 20 mg twice daily and TDF, taken in combination with lamivudine (3TC) and efavirenz (EFV). The primary endpoint was the proportion of participants with HIV-1 RNA <50 copies per milliliter at 48 weeks. Adverse events assessments included measures of bone density and body fat. The trial is registered on Clinicaltrials.gov (NCT02670772). RESULTS: Between 2012 and 2014, 536 participants were recruited per arm. At week 96, trial completion rates were 75.7% with d4T/3TC/EFV (n = 406) and 82.1% with TDF/3TC/EFV (n = 440, P = 0.011). Noncompletion was largely due to virological failure [6.2% (33) with d4T/3TC/EFV versus 5.4% (29) with TDF/3TC/EFV; P = 0.60]. For the primary endpoint, d4T/3TC/EFV was noninferior to TDF/3TC/EFV (79.3%, 425/536 versus 80.8% 433/536; difference = -1.49%, 95% CI: -6.3 to 3.3; P < 0.001). Drug-related adverse event discontinuations were higher with d4T (6.7%, 36), than TDF (1.1%, 6; P < 0.001). Lipodystrophy was more common with d4T (5.6%, 30) than TDF (0.2%, 1; P < 0.001). Creatinine clearance increased in both arms, by 18.1 mL/min in the d4T arm and 14.2 mL/min with TDF (P = 0.03). Hip bone density measures, however, showed greater loss with TDF. CONCLUSIONS: Low-dose d4T combined with 3TC/EFV demonstrated noninferior virological efficacy compared with TDF/3TC/EFV, but mitochondrial toxicity remained high. Little renal toxicity occurred in either arm. Implications of bone mineral density changes with TDF warrant investigation.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Osso e Ossos/efeitos dos fármacos , Infecções por HIV/tratamento farmacológico , Rim/efeitos dos fármacos , Estavudina/uso terapêutico , Tenofovir/uso terapêutico , Adulto , Método Duplo-Cego , Estudos de Equivalência como Asunto , Feminino , Infecções por HIV/epidemiologia , Humanos , Masculino , África do Sul/epidemiologia , Uganda/epidemiologia , Adulto Jovem
2.
J Neurol Sci ; 397: 146-149, 2019 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-30634130

RESUMO

Lower limb neuropathic pain in HIV patients is a common manifestation of sensory neuropathy (HIV-SN), but can be seen in patients who do not meet standard definitions of HIV-SN. The drug stavudine is a risk factor for HIV-SN, but some patients treated without stavudine experience HIV-SN, and the prevalence and risk factors influencing neuropathic pain in this setting are unknown. A cross sectional study at Cipto Mangunkusumo Hospital Jakarta tested 197 HIV patients treated for >12 months without stavudine. HIV-SN was defined using the AIDS Clinical Trial Group Brief Peripheral Neuropathy Screening Test (ACTG-BPNST). A validated Indonesia translation of Douleur Neuropathique en 4 (DN4) questionnaire was used to assess lower limb neuropathic pain. Nerve conduction studies assessed large nerve fiber function and Stimulated Skin Wrinkle (SSW) tests were performed to assess small nerve fibers. The prevalence of neuropathic pain was 6.6%. BPNST+HIV-SN was diagnosed in 14.2% of the cohort and 38.5% of patients with pain. Use of protease inhibitors and ART duration <2 years associated with neuropathic pain in univariate (p = .036, p = .002, resp.) and multivariable analyses (model p < .001). SSW tests were abnormal in 53.8% of subjects with neuropathic pain and only 25.5% without pain (p = .05). Patients with pain without BPNST+HIV-SN had begun ART more recently than those with both diagnoses. Overall this preliminary study showed that neuropathic pain associated with protease inhibitors and a shorter duration of ART in Indonesian HIV patients, and may be an early symptom of small fiber neuropathy in this context.


Assuntos
Antirretrovirais/efeitos adversos , Infecções por HIV/tratamento farmacológico , Neuralgia/induzido quimicamente , Estavudina/efeitos adversos , Adulto , Antirretrovirais/uso terapêutico , Estudos Transversais , Feminino , Humanos , Indonésia , Masculino , Neuralgia/epidemiologia , Prevalência , Fatores de Risco , Estavudina/uso terapêutico
3.
Medicine (Baltimore) ; 97(50): e13555, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30558015

RESUMO

Stavudine (D4T), zidovudine (AZT), and tenofovir (TDF) along with lamivudine (3TC) are the most widely used HIV treatment regimens in China. China's National Free Antiretroviral Treatment Programme (NFATP) has replaced D4T with AZT or TDF in the standard first-line regimens since 2010. Few studies have evaluated the adherence, virological outcome, and drug resistance in HIV patients receiving first-line antiretroviral therapy (ART) from 2011 to 2015 due to changes in ART regimen.From 2011 to 2015, 2787 HIV patients were examined, with 364, 1453, and 970 patients having initiated D4T-, AZT-, and TDF-based first-line ART regimens, respectively. The Cochran-Armitage test was used to examine the trends in clinical and virological outcomes during 2011 to 2015. Logistic regression was used to examine the effects of different regimens after 9 to 24 months of ART.From 2011 to 2014-2015, adverse drug reactions decreased from 18.9% to 6.7%, missed doses decreased from 9.9% to 4.6%, virological failure decreased from 16.2% to 6.4%, and drug resistance rates also significantly decreased from 5.4% to 1.1%. These successes were strongly associated with the standardized use of TDF- or AZT-based regimens in place of the D4T-based regimen. Poor adherence decreased from 11.3% in patients who initiated D4T-based regimens to 4.9% in those who initiated TDF-based regimens, adverse drug reactions decreased from 32.4% to 6.7%, virological failure reduced from 18.7% to 8.6%, and drug resistance reduced from 5.8% to 2.9%. Compared with patients who initiated AZT-based regimens, patients who initiated TDF-based regiments showed significant reductions in adherence issues, adverse drug reactions, virological outcomes, and drug resistance. Significant differences were also observed between those who initiated D4T- and AZT-based regimens.The good control of HIV replication and drug resistance was attributed to the success of China's NFATP from 2011 to 2015. This study provided real world evidence for further scaling up ART and minimizing the emergence of drug resistance in the "Three 90" era.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Farmacorresistência Viral/efeitos dos fármacos , Infecções por HIV/tratamento farmacológico , HIV/efeitos dos fármacos , Adesão à Medicação/estatística & dados numéricos , Resposta Viral Sustentada , Adulto , Fármacos Anti-HIV/imunologia , China , Feminino , HIV/imunologia , Infecções por HIV/virologia , Humanos , Lamivudina/imunologia , Lamivudina/uso terapêutico , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Estavudina/imunologia , Estavudina/uso terapêutico , Tenofovir/imunologia , Tenofovir/uso terapêutico , Zidovudina/imunologia , Zidovudina/uso terapêutico
4.
Retrovirology ; 15(1): 77, 2018 12 14.
Artigo em Inglês | MEDLINE | ID: mdl-30547820

RESUMO

BACKGROUND: HIV infection and antiretroviral treatment are associated with changes in lipid levels, insulin resistance and risk of cardiovascular disease (CVD). We investigated these changes in the first 96 weeks of treatment with low-dose stavudine or tenofovir regimens. METHODS: This is a secondary analysis of a double blind, randomised controlled trial performed in South-Africa, Uganda and India comparing low-dose stavudine (20 mg twice daily) with tenofovir in combination with efavirenz and lamivudine in antiretroviral-naïve adults (n = 1067) (Clinicaltrials.gov, NCT02670772). Over 96 weeks, data were collected on fasting lipids, glucose and insulin. Insulin resistance was assessed with the HOMA-IR index and 10-year CVD risk with the Framingham risk score (FRS). A generalized linear mixed model was used to estimate trends over time. RESULTS: Participants were on average 35.3 years old, 57.6% female and 91.8% Black African. All lipid levels increased following treatment initiation, with the sharpest increase in the first 24 weeks of treatment. The increase in all lipid subcomponents over 96 weeks was higher among those in the stavudine than the tenofovir group. Insulin resistance increased steadily with no difference detected between study groups. FRS rose from 1.90% (1.84-1.98%) at baseline to 2.06 (1.98-2.15%) at week 96 for the total group, with no difference between treatment arms (p = 0.144). Lipid changes were more marked in Indian than African participants. CONCLUSION: Lipid levels increased in both groups, with low-dose stavudine resulting in a worse lipid profile compared to tenofovir. Insulin resistance increased, with no difference between regimens. CVD risk increased over time and tended to increase more in the group on stavudine. The low CVD risk across both arms argues against routine lipid and glucose monitoring in the absence of other CVD risk factors. In high risk patients, monitoring may only be appropriate at least a year after treatment initiation.


Assuntos
Terapia Antirretroviral de Alta Atividade/efeitos adversos , Doenças Cardiovasculares/diagnóstico , Infecções por HIV/tratamento farmacológico , Resistência à Insulina , Lipídeos/sangue , Estavudina/uso terapêutico , Tenofovir/uso terapêutico , Adulto , Fármacos Anti-HIV/administração & dosagem , Fármacos Anti-HIV/uso terapêutico , Glicemia , Doenças Cardiovasculares/etiologia , Método Duplo-Cego , Feminino , Infecções por HIV/complicações , HIV-1/efeitos dos fármacos , Humanos , Índia , Masculino , Fatores de Risco , África do Sul , Estavudina/administração & dosagem , Tenofovir/administração & dosagem , Uganda
5.
PLoS One ; 13(10): e0204111, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30273369

RESUMO

BACKGROUND: The use of the HIV antiretroviral drug stavudine (d4T), a thymidine analogue, is associated with the development of mitochondrial toxicities such as sensory neuropathy (SN). Genetic variation in genes relating to d4T transport and metabolism, as well as genetic variation in the thymidine synthesis pathway, could influence occurrence of d4T-related toxicity. METHODS: We examined this hypothesis in a cohort of HIV-positive South African adults exposed to d4T, including 143 cases with SN and 120 controls without SN. Ten SNPs in four genes associated with stavudine transport, and 16 SNPs in seven genes of the thymidine synthesis / phosphorylation pathway were genotyped using Agena mass spectrometry methods. Associations between sensory neuropathy and genetic variants were evaluated using PLINK by univariate and multivariable analyses. RESULTS: Age and height were significantly associated with SN occurrence. Using logistic regression with age and height as covariates, and uncorrected empirical p-values, genetic variation in SLC28A1, SAMHD1, MTHFR and RRM2B was associated with SN in South Africans using d4T. CONCLUSION: Variation in genes relating to d4T transport and metabolism, as well as genetic variation in the thymidine synthesis pathway may influence occurrence of d4T-related SN. These data contribute to the characterisation of African pharmacogenetic variation and its role in adverse response to antiretroviral therapy.


Assuntos
Fármacos Anti-HIV/efeitos adversos , Infecções por HIV/tratamento farmacológico , Doenças do Sistema Nervoso Periférico/induzido quimicamente , Variantes Farmacogenômicos , Polimorfismo de Nucleotídeo Único , Estavudina/efeitos adversos , Adulto , Grupo com Ancestrais do Continente Africano , Fármacos Anti-HIV/uso terapêutico , Estudos de Casos e Controles , Proteínas de Ciclo Celular/genética , Feminino , Infecções por HIV/genética , Humanos , Masculino , Proteínas de Membrana Transportadoras/genética , Metilenotetra-Hidrofolato Redutase (NADPH2)/genética , Pessoa de Meia-Idade , Doenças do Sistema Nervoso Periférico/genética , Ribonucleotídeo Redutases/genética , Proteína 1 com Domínio SAM e Domínio HD/genética , África do Sul , Estavudina/uso terapêutico
6.
AIDS Res Ther ; 15(1): 11, 2018 04 16.
Artigo em Inglês | MEDLINE | ID: mdl-29661246

RESUMO

BACKGROUND: The prevalence of HIV-1 resistance to antiretroviral therapies (ART) has declined in high-income countries over recent years, but drug resistance remains a substantial concern in many low and middle-income countries. The Q151M and T69 insertion (T69i) resistance mutations in the viral reverse transcriptase gene can reduce susceptibility to all nucleoside/tide analogue reverse transcriptase inhibitors, motivating the present study to investigate the risk factors and outcomes associated with these mutations. METHODS: We considered all data in the UK HIV Drug Resistance Database for blood samples obtained in the period 1997-2014. Where available, treatment history and patient outcomes were obtained through linkage to the UK Collaborative HIV Cohort study. A matched case-control approach was used to assess risk factors associated with the appearance of each of the mutations in ART-experienced patients, and survival analysis was used to investigate factors associated with viral suppression. A further analysis using matched controls was performed to investigate the impact of each mutation on survival. RESULTS: A total of 180 patients with Q151M mutation and 85 with T69i mutation were identified, almost entirely from before 2006. Occurrence of both the Q151M and T69i mutations was strongly associated with cumulative period of virological failure while on ART, and for Q151M there was a particular positive association with use of stavudine and negative association with use of boosted-protease inhibitors. Subsequent viral suppression was negatively associated with viral load at sequencing for both mutations, and for Q151M we found a negative association with didanosine use but a positive association with boosted-protease inhibitor use. The results obtained in these analyses were also consistent with potentially large associations with other drugs. Analyses were inconclusive regarding associations between the mutations and mortality, but mortality was high for patients with low CD4 at detection. CONCLUSIONS: The Q151M and T69i resistance mutations are now very rare in the UK. Our results suggest that good outcomes are possible for people with these mutations. However, in this historic sample, viral load and CD4 at detection were important factors in determining prognosis.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Farmacorresistência Viral Múltipla/genética , HIV-1/genética , Mutação , Teorema de Bayes , Estudos de Casos e Controles , Estudos de Coortes , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Infecções por HIV/mortalidade , Transcriptase Reversa do HIV/efeitos dos fármacos , Transcriptase Reversa do HIV/genética , Humanos , Epidemiologia Molecular , Inibidores da Transcriptase Reversa/uso terapêutico , Fatores de Risco , Estavudina/uso terapêutico , Análise de Sobrevida , Resultado do Tratamento , Reino Unido/epidemiologia , Carga Viral/efeitos dos fármacos
7.
PLoS One ; 13(4): e0194132, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29617438

RESUMO

BACKGROUND: Following widespread use of stavudine, a thymidine analogue, in antiretroviral therapy (ART) over the past three decades, up to a third of children developed lipoatrophy (LA) and/or lipohypertrophy (LH). Following phasing-out of stavudine, incidence of newly-diagnosed LA and LH declined dramatically. However, the natural history of existing cases should be explored, particularly with prolonged protease inhibitor exposure. METHODS: The Collaborative HIV Paediatric Study (CHIPS) is a multicentre cohort study of most HIV-infected children in the United Kingdom and Ireland. Those on ART with a LA/LH assessment recorded in 2003-2011 were included. Assessments were completed annually by consultant physicians. Using the 0-3 grading system, LA or LH was defined as grade 2 or 3. Resolution was defined as return to grade 1 or 0 in all body regions. RESULTS: Of 1345 children followed for median (IQR) 5.5 (2.9, 8.2) years after ART initiation, 30 developed LA and 27 developed LH, all at least 2 years after ART initiation. Median age at LA diagnosis was 11 (10, 13) years and at LH diagnosis was 13 (11, 15) years. Children with LA were more likely white (p<0.0001); lower height-for-age z-score at ART initiation (p = 0.02); initiated ART earlier (p = 0.04), with longer ART exposure (p = 0.04). Children with LH were similar to those without. Analysis of individual drugs revealed that LA was associated with greater duration of exposure to stavudine and didanosine; while LH was associated with greater duration of exposure to stavudine and ritonavir (given alone or in combination with another protease inhibitor). Median time in follow-up following ART switch was 2.8 (1.9, 4.9) and 2.5 (1.6, 4.7) years respectively. Resolution occurred in 10 (30%) of LA cases (median time to resolution 2.3 [1.8, 3.6] years) and 3 (11%) of LH cases (median time to resolution 2.0 [1.7, 2.1] years). CONCLUSIONS: Prevalence of LA and LH were low, with some resolution noted, especially for LA. More long-term data are needed.


Assuntos
Lipodistrofia/epidemiologia , Inibidores da Transcriptase Reversa/efeitos adversos , Estavudina/efeitos adversos , Adolescente , Criança , Feminino , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Humanos , Incidência , Irlanda/epidemiologia , Lipodistrofia/complicações , Estudos Longitudinais , Masculino , Inibidores da Transcriptase Reversa/uso terapêutico , Estavudina/uso terapêutico , Resultado do Tratamento , Reino Unido/epidemiologia
8.
J Pediatric Infect Dis Soc ; 7(3): e70-e77, 2018 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-29373687

RESUMO

Objectives: Abacavir has replaced stavudine in antiretroviral therapy (ART) regimens because it has largely been phased out as a result of toxicity concerns; this loss has reduced further the already-limited drug options for children. Few data regarding virologic and metabolic outcomes among children who undergo substitution of stavudine exist. We evaluated the effects of preemptive substitution of abacavir for stavudine in children initially without lipodystrophy and virally suppressed on a stavudine-containing regimen. Methods: At Rahima Moosa Mother and Child Hospital in Johannesburg, South Africa, virally suppressed human immunodeficiency virus (HIV)-infected children ≥36 months of age without lipodystrophy were randomly assigned to continue taking stavudine as part of their ART regimen (n = 106) or to have abacavir substituted for stavudine (n = 107). The children were followed for 56 weeks after randomization in the context of a larger trial of treatment options for ART-experienced children. Results: The mean age of the children was 4.3 years, and the mean duration of ART before random assignment was 3.5 years. No differences in virological outcomes, CD4 response, growth, or dyslipidemia were noted between the stavudine and abacavir groups. By 56 weeks, children in the abacavir group had less clinically detected lipodystrophy (4.7% vs 16%, respectively), a higher proportion of leg fat relative to total fat (0.243 vs 0.230, respectively; P = .006), and a lower trunk/leg-skinfold ratio (0.547 vs 0.569, respectively; P = .003) than the children in the stavudine group. Conclusion: Substituting abacavir for stavudine did not compromise virological response to treatment and was associated with significantly less lipodystrophy. These results support recommendations that favor abacavir in this population.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Didesoxinucleosídeos/uso terapêutico , Substituição de Medicamentos , Infecções por HIV/tratamento farmacológico , Infecções por HIV/virologia , Estavudina/uso terapêutico , Carga Viral , Antropometria , Fármacos Anti-HIV/efeitos adversos , Composição Corporal , Contagem de Linfócito CD4 , Pré-Escolar , Didesoxinucleosídeos/efeitos adversos , Quimioterapia Combinada , Feminino , Seguimentos , Infecções por HIV/imunologia , Humanos , Lactente , Lipodistrofia/induzido quimicamente , Masculino , África do Sul , Estavudina/efeitos adversos
9.
AIDS Care ; 30(6): 696-700, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29058457

RESUMO

We investigated features of major adherence lapses in antiretroviral therapy (ART) at public Emusanda Health Centre in rural Kakamega County, Kenya using medical records from 2008 to 2015 for all 306 eligible patients receiving ART. Data were modelled using survival analysis. Patients were more likely to lapse if they received stavudine (hazard ratio (HR) 2.54, 95% confidence interval (95%CI):1.44-4.47) or zidovudine (HR 1.64, 95%CI:1.02-2.63) relative to tenofovir. Each day a patient slept hungry per month increased risk of major adherence lapse by 3% (95%CI:0-7%). Isolated home visits by community health workers (CHWs) were more effective to assist patients to return to the health centre than isolated phone calls (HR 2.52, 95%CI:1.02-6.20).


Assuntos
Fármacos Anti-HIV/uso terapêutico , Agentes Comunitários de Saúde , Relações Comunidade-Instituição , Infecções por HIV/tratamento farmacológico , Adesão à Medicação , População Rural , Estavudina/uso terapêutico , Tenofovir/uso terapêutico , Zidovudina/uso terapêutico , Adolescente , Adulto , Feminino , Visita Domiciliar , Humanos , Quênia , Masculino , Pessoa de Meia-Idade , Análise de Sobrevida , Adulto Jovem
10.
J Infect ; 76(2): 168-176, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29197600

RESUMO

OBJECTIVE: We explored if HIV infection is associated with impaired T-Helper 17 responses against Streptococcus pneumoniae in the lung. METHODS: We recruited 30 HIV-uninfected healthy controls, 23 asymptomatic HIV-infected adults not on ART, and 40 asymptomatic HIV-infected adults on ART (Median time 3.5yrs), in whom we collected bronchoalveolar lavage fluid. We measured alveolar CD4+ T cell immune responses following stimulation with pneumococcal cell culture supernatant using flow cytometry-based intracellular cytokine staining. RESULTS: We found that the proportion of alveolar CD4+ T cells producing IL-17A following stimulation with pneumococcal cell culture supernatant (CCS) was similar between HIV-uninfected controls and ART-naïve HIV-infected adults (0.10% vs. 0.14%; p = 0.9273). In contrast, the proportion and relative absolute counts of CD4+ T cells producing IL-17A in response to pneumococcal CCS were higher in ART-treated HIV-infected adults compared HIV-uninfected controls (0.22% vs. 0.10%, p = 0.0166; 5420 vs. 1902 cells/100 ml BAL fluid; p = 0.0519). The increase in relative absolute numbers of IL-17A-producing alveolar CD4+ T cells in ART-treated individuals was not correlated with the peripheral blood CD4+ T cell count (r=-0.1876, p = 0.1785). CONCLUSION: Alveolar Th17 responses against S. pneumoniae are preserved in HIV-infected adults. This suggests that there are other alternative mechanisms that are altered in HIV-infected individuals that render them more susceptible to pneumococcal pneumonia.


Assuntos
Infecções por HIV/tratamento farmacológico , Interleucina-17/imunologia , Pulmão/imunologia , Pneumonia Pneumocócica/imunologia , Células Th17/imunologia , Adulto , Líquido da Lavagem Broncoalveolar/imunologia , Líquido da Lavagem Broncoalveolar/virologia , Meios de Cultura/farmacologia , Feminino , Infecções por HIV/microbiologia , HIV-1/efeitos dos fármacos , Humanos , Interferon gama/imunologia , Lamivudina/uso terapêutico , Pulmão/citologia , Pulmão/microbiologia , Malaui/epidemiologia , Masculino , Pessoa de Meia-Idade , Nevirapina/uso terapêutico , Estavudina/uso terapêutico , Streptococcus pneumoniae , Células Th17/efeitos dos fármacos , Carga Viral/efeitos dos fármacos , Carga Viral/imunologia , Adulto Jovem
11.
J Int AIDS Soc ; 20(4)2017 12.
Artigo em Inglês | MEDLINE | ID: mdl-29211347

RESUMO

INTRODUCTION: Achieving viral suppression is key in the global strategy to end the HIV epidemic. However, the levels of viral suppression have yet to be described in many resource-limited settings. METHODS: We investigated the time to virologic failure (VF; defined as a viral load of ≥1000 copies/ml) and changes in CD4 counts since starting antiretroviral therapy (ART) in a cohort of HIV-infected adults in Hanoi, Vietnam. Factors related to the time to VF and impaired early immune recovery (defined as not attaining an increase in 100 cells/mm3 in CD4 counts at 24 months) were further analysed. RESULTS: From 1806 participants, 225 were identified as having VF at a median of 50 months of first-line ART. The viral suppression rate at 12 months was 95.5% and survival without VF was maintained above 90% until 42 months. An increase in CD4 counts from the baseline was greater in groups with lower baseline CD4 counts. A younger age (multivariate hazard ratio (HR) 0.75, vs. <30), hepatitis C (HCV)-antibody positivity (HR 1.43), and stavudine (d4T)-containing regimens (HR 1.4, vs. zidovudine (AZT)) were associated with earlier VF. Factors associated with impaired early immune recovery included the male sex (odds ratio (OR) 1.78), HCV-antibody positivity (OR 1.72), d4T-based regimens (OR 0.51, vs. AZT), and nevirapine-based regimens (OR 0.53, vs. efavirenz) after controlling for baseline CD4 counts. CONCLUSION: Durable high-rate viral suppression was observed in the cohort of patients on first-line ART in Vietnam. Our results highlight the need to increase adherence support among injection drug users and HCV co-infected patients.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/tratamento farmacológico , Carga Viral , Adolescente , Adulto , Idoso , Benzoxazinas/uso terapêutico , Contagem de Linfócito CD4 , Estudos de Coortes , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Nevirapina/uso terapêutico , Estavudina/uso terapêutico , Fatores de Tempo , Vietnã , Adulto Jovem , Zidovudina/uso terapêutico
12.
BMC Res Notes ; 10(1): 623, 2017 Nov 28.
Artigo em Inglês | MEDLINE | ID: mdl-29183354

RESUMO

OBJECTIVE: The rapid scale-up of antiretroviral therapy (ART) coverage in sub-Saharan Africa has encountered the challenge of maintaining international clinical standards of ART utilization and change of ART regimens. In Cameroon, scarce reports have documented the motives for change of ART. This study had as objective to investigate the reasons for switch in ART through a secondary analysis and descriptive synthesis of data from a cross-sectional study at the Limbe Regional Hospital. RESULTS: One hundred participants were included. Their mean age was 40.2 ± 8.0 years and 70% of them were females. The median duration of ART use was 60 months. Zidovudine-Lamivudine-Nevirapine regimen was received by 83% of patients while the Stavudine-Lamivudine-Nevirapine regimen had the highest median duration of use (58 months). Most patients had experienced changes in ART (especially from Stavudine-Lamivudine-Nevirapine regimen) with the chief reason being unavailability of their previous regimens. Four patients had their ART changed due to active tuberculosis, 4 due to pregnancy and 7 due to ART toxicity (4 and 3 for peripheral neuropathy and lipodystrophy respectively). In conclusion, shortages in ART hugely influenced switch in regimens. In such a context, modifications in ART possibly deviate from guidelines with resultant sub-optimal therapy and enhanced drug resistance.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Substituição de Medicamentos , Infecções por HIV/tratamento farmacológico , Lamivudina/uso terapêutico , Nevirapina/uso terapêutico , Estavudina/uso terapêutico , Zidovudina/uso terapêutico , Adulto , Fármacos Anti-HIV/administração & dosagem , Camarões , Estudos de Coortes , Estudos Transversais , Combinação de Medicamentos , Feminino , Humanos , Lamivudina/administração & dosagem , Masculino , Pessoa de Meia-Idade , Nevirapina/administração & dosagem , Encaminhamento e Consulta , Estavudina/administração & dosagem , Zidovudina/administração & dosagem
13.
BMC Infect Dis ; 17(1): 664, 2017 10 02.
Artigo em Inglês | MEDLINE | ID: mdl-28969591

RESUMO

BACKGROUND: There is limited information on patterns of treatment change among new initiators of highly active antiretroviral therapy (HAART) in the regions most affected by HIV/AIDS. This makes it difficult to identify the determinants of treatment change. In this retrospective cohort study, we examined treatment change patterns over a five-year period among initiators of HAART. METHODS: De-identified data were obtained from the Fevers' Unit Database at the Korle-Bu Teaching Hospital. All adult treatment-naive patients who started treatment with first line HAART between 1st January, 2008 and 31st December, 2012 were followed over a minimum period of three months. The main outcome was the first treatment change, defined as the first substitution/switch in accordance with the standard treatment guidelines. Data were analyzed stratified by year of treatment initiation. Crude and adjusted hazard ratios were calculated. RESULTS: A total of 3933 patients were followed with almost equal numbers of initiators per year. The mean age (standard deviation) at treatment initiation was 39 (10.3) years. The most prescribed HAART combination was AZT/3TC/EFV and overall for initiators zidovudine combination therapy was about 60%. Utilization of stavudine containing HAART increased gradually until 2010 and then dropped to zero. Over the study period, 44.9% of recorded deaths were from those initiated with a stavudine backbone, 41.1% from a zidovudine backbone, and 11.5% from a tenofovir backbone. Females had a significantly higher rate of treatment change compared to males (p-value = 0.0002), and d4T/3TC/EFV and d4T/3TC/NVP recorded independent treatment change hazard ratios of 12.05 (CI 9.58 to 15.16) and 12.03 (CI 9.27 to 15.61) respectively.. Kaplan-Meier curves showed that treatment change was higher among those who started treatment later in the study period compared with those who started earlier. CONCLUSION: A major treatment change in the utilization of antiretroviral medicines in Ghana occurred during the study period which was associated with type of treatment, year of treatment, gender and disease stage. The influence of a policy change during the period may have made a significant impact.. For diseases involving life-long treatment in particular, it is important to monitor and periodically evaluation treatment utilization patterns.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Terapia Antirretroviral de Alta Atividade/estatística & dados numéricos , Infecções por HIV/tratamento farmacológico , Síndrome de Imunodeficiência Adquirida/tratamento farmacológico , Adulto , Idoso , Estudos de Coortes , Feminino , Gana , Infecções por HIV/mortalidade , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Estavudina/uso terapêutico , Tenofovir/uso terapêutico , Adulto Jovem , Zidovudina/uso terapêutico
14.
BMJ Open ; 7(9): e016012, 2017 Sep 07.
Artigo em Inglês | MEDLINE | ID: mdl-28882911

RESUMO

OBJECTIVE: To explore factors associated with HIV virological failure (VF) and HIV drug resistance (HIVDR) among HIV-positive Chinese individuals 4 years after initiating first-line lamivudine-based antiretroviral treatment (ART) in 2008 at five sentinel sites. DESIGN: First-line ART initiators who were previously treatment naïve were selected using consecutive ID numbers from the 2008 National Surveillance Database into a prospective cohort study. Questionnaires and blood samples were collected in 2011 and 2012 to assess the outcomes of interest: VF (defined as viral load ≥1000 copies/mL) and HIVDR (defined as VF with genetic drug-resistant mutations). Questionnaires and data from National Surveillance Database assessed demographics and drug adherence data. RESULTS: 536 individuals with HIV were analysed; the 4-year risk of VF was 63 (11.8%) and HIVDR was 27 (5.0%). Female participants initiating stavudine (D4T)-based regimens were more susceptible to both VF (adjusted OR (aOR)=2.5, 95% CI 1 to 6.1, p=0.04) and HIVDR (aOR=3.6, 95% CI 1 to 12.6, p=0.05) versus zidovudine-based regimens. Male participants missing doses in past month were more susceptible to both VF (aOR=2.8, 95% CI 1.1 to 7, p=0.03) and HIVDR (aOR=9.7, 95% CI 2.1 to 44.1, p<0.01). Participants of non-Han nationality were of increased risk for HIVDR (aOR from 4.8 to 12.2, p<0.05) and non-Han men were at increased risk for VF (aOR=2.9, 95% CI 1.1 to 7.3, p=0.02). All 27 participants detected with HIVDR had non-nucleoside reverse-transcriptase inhibitor mutations, 21 (77.8%) also had nucleoside reverse-transcriptase inhibitor mutations, and no protease inhibitor mutations were detected. CONCLUSIONS: Our findings suggest successful treatment outcomes at 4 years for roughly 90% of patients. We suggest conducting further study on whether and when to change ART regimen for women initiated with D4T-based regimen, and reinforcing adherence counselling for men. Increased VF and HIVDR risk among non-Han minorities warrants further exploration, and ethnic minorities may be an important group to tailor adherence-focused interventions.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Farmacorresistência Viral/genética , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Adulto , Idoso , Contagem de Linfócito CD4 , China/epidemiologia , Feminino , Humanos , Modelos Logísticos , Masculino , Adesão à Medicação , Pessoa de Meia-Idade , Análise Multivariada , Mutação , Estudos Prospectivos , Fatores de Risco , Vigilância de Evento Sentinela , Estavudina/uso terapêutico , Resposta Viral Sustentada , Falha de Tratamento , Carga Viral , Zidovudina/uso terapêutico
15.
BMC Infect Dis ; 17(1): 453, 2017 06 27.
Artigo em Inglês | MEDLINE | ID: mdl-28655306

RESUMO

BACKGROUND: Highly active antiretroviral therapy (HAART) has shown a dramatic change in controlling the burden of HIV/AIDS. However, the new challenge of HAART is to allow long-term sustainability. Toxicities, comorbidity, pregnancy, and treatment failure, among others, would result in frequent initial HAART regimen change. The aim of this study was to evaluate the durability of first line antiretroviral therapy and to assess the causes of initial highly active antiretroviral therapeutic regimen changes among patients on HAART. METHODS: A Hospital based retrospective study was conducted from January 2007 to August 2013 at Jimma University Hospital, Southwest Ethiopia. Data on the prescribed ARV along with start date, switching date, and reason for change was collected. The primary outcome was defined as the time-to-treatment change. We adopted a multi-state survival modeling approach assuming each treatment regimen as state. We estimate the transition probability of patients to move from one regimen to another. RESULT: A total of 1284 ART naive patients were included in the study. Almost half of the patients (41.2%) changed their treatment during follow up for various reasons; 442 (34.4%) changed once and 86 (6.69%) changed more than once. Toxicity was the most common reason for treatment changes accounting for 48.94% of the changes, followed by comorbidity (New TB) 14.31%. The HAART combinations that were robust to treatment changes were tenofovir (TDF) + lamivudine (3TC)+ efavirenz (EFV), tenofovir + lamivudine (3TC) + nevirapine (NVP) and zidovudine (AZT) + lamivudine (3TC) + nevirapine (NVP) with 3.6%, 4.5% and 11% treatment changes, respectively. CONCLUSION: Moving away from drugs with poor safety profiles, such as stavudine(d4T), could reduce modification rates and this would improve regimen tolerability, while preserving future treatment options.


Assuntos
Terapia Antirretroviral de Alta Atividade/métodos , Infecções por HIV/tratamento farmacológico , Modelos Teóricos , Tempo para o Tratamento/estatística & dados numéricos , Adulto , Benzoxazinas/uso terapêutico , Quimioterapia Combinada , Etiópia , Feminino , Humanos , Lamivudina/uso terapêutico , Masculino , Nevirapina/uso terapêutico , Gravidez , Estudos Retrospectivos , Estavudina/uso terapêutico , Tenofovir/uso terapêutico , Falha de Tratamento , Zidovudina/uso terapêutico
16.
Artigo em Inglês | MEDLINE | ID: mdl-28559274

RESUMO

We explored if baseline CD4/CD8 T-cell ratio is associated with immunodiscordant response to antiretroviral therapy in HIV-infected subjects. Comparing immunodiscordant and immunoconcordant subjects matched by pretreatment CD4 counts, we observed a lower pretreatment CD4/CD8 T-cell ratio in immunodiscordant subjects. Furthermore, pretreatment CD4/CD8 T-cell ratio, but not CD4 counts, correlated with the main immunological alterations observed in immunodiscordants, including increased regulatory T-cell (Treg) frequency and T-cell turnover-related markers. Then, in a larger cohort, only baseline CD4/CD8 T-cell ratio was independently associated with immunodiscordance, after adjusting by the viral CXCR4-tropic HIV variants. Our results suggest that the CD4/CD8 T-cell ratio could be an accurate biomarker of the subjacent immunological damage triggering immunodiscordance.


Assuntos
Terapia Antirretroviral de Alta Atividade/métodos , Relação CD4-CD8 , Linfócitos T CD8-Positivos/imunologia , Infecções por HIV/tratamento farmacológico , Infecções por HIV/imunologia , Linfócitos T Reguladores/imunologia , Adulto , Fármacos Anti-HIV/uso terapêutico , Biomarcadores/metabolismo , Sobrevivência Celular/efeitos dos fármacos , Didanosina/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Receptores CXCR4/imunologia , Estavudina/uso terapêutico , Carga Viral , Zalcitabina/uso terapêutico , Zidovudina/uso terapêutico
17.
PLoS One ; 12(6): e0178942, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28582463

RESUMO

INTRODUCTION: Antiretroviral therapy (ART) has been successfully introduced in low-middle income countries. However an increasing rate of ART failure with resistant virus is reported. We therefore described the pattern of drug resistance mutations at antiretroviral treatment (ART) failure in a real-life Tanzanian setting using the remote genotyping procedure and thereafter predicted future treatment options using rule-based algorithm and the EuResist bioinformatics predictive engine. According to national guidelines, the default first-line regimen is tenofovir + lamivudine + efavirenz, but variations including nevirapine, stavudine or emtricitabine can be considered. If failure on first-line ART occurs, a combination of two nucleoside reverse transcriptase inhibitors (NRTIs) and boosted lopinavir or atazanavir is recommended. MATERIALS AND METHODS: Plasma was obtained from subjects with first (n = 174) or second-line (n = 99) treatment failure, as defined by clinical or immunological criteria, as well as from a control group of ART naïve subjects (n = 17) in Dar es Salaam, Tanzania. Amplification of the pol region was performed locally and the amplified DNA fragment was sent to Sweden for sequencing (split genotyping procedure). The therapeutic options after failure were assessed by the genotypic sensitivity score and the EuResist predictive engine. Viral load was quantified in a subset of subjects with second-line failure (n = 52). RESULTS: The HIV-1 pol region was successfully amplified from 55/174 (32%) and 28/99 (28%) subjects with first- or second-line failure, respectively, and 14/17 (82%) ART-naïve individuals. HIV-1 pol sequence was obtained in 82 of these 97 cases (84.5%). Undetectable or very low (<2.6 log10 copies/10-3 L) viral load explained 19 out of 25 (76%) amplification failures in subjects at second-line ART failure. At first and second line failure, extensive accumulation of NRTI (88% and 73%, respectively) and NNRTI (93% and 73%, respectively) DRMs but a limited number of PI DRMs (11% at second line failure) was observed. First line failure subjects displayed a high degree of cross-resistance to second-generation NNRTIs etravirine (ETR; 51% intermediate and 9% resistant) and rilpivirine (RPV; 12% intermediate and 58% resistant), and to abacavir (ABC; 49% resistant) which is reserved for second line therapy in Tanzania. The predicted probability of success with the best salvage regimen at second-line failure decreased from 93.9% to 78.7% when restricting access to the NRTIs, NNRTIs and PIs currently available in Tanzania compared to when including all approved drugs. DISCUSSION: The split genotyping procedure is potential tool to analyse drug resistance in Tanzania but the sensitivity should be evaluated further. The lack of viral load monitoring likely results in a high false positive rate of treatment failures, unnecessary therapy switches and massive accumulation of NRTI and NNRTI mutations. The introduction of regular virological monitoring should be prioritized and integrated with drug resistance studies in resource limited settings.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Farmacorresistência Viral/genética , Genótipo , Infecções por HIV/tratamento farmacológico , HIV-1/genética , Adulto , Terapia Antirretroviral de Alta Atividade , Sulfato de Atazanavir/uso terapêutico , Benzoxazinas/uso terapêutico , Tomada de Decisão Clínica , Biologia Computacional , Estudos Transversais , Emtricitabina/uso terapêutico , Feminino , Infecções por HIV/virologia , HIV-1/classificação , HIV-1/efeitos dos fármacos , HIV-1/crescimento & desenvolvimento , Humanos , Lamivudina/uso terapêutico , Lopinavir/uso terapêutico , Masculino , Monitorização Fisiológica , Nevirapina/uso terapêutico , Estavudina/uso terapêutico , Tanzânia , Tenofovir/uso terapêutico , Falha de Tratamento , Carga Viral/efeitos dos fármacos , Produtos do Gene pol do Vírus da Imunodeficiência Humana/genética
18.
Bull Soc Pathol Exot ; 110(5): 301-309, 2017 Dec.
Artigo em Francês | MEDLINE | ID: mdl-28623554

RESUMO

Little is known about the major cardiovascular risk factors in HIV-infected as compared to the HIV-uninfected patients in the Democratic Republic of Congo (DR Congo). We determined the prevalence of hypertension, obesity (BMI ≥ 30 kg/m2), total cholesterol > 200 mg/dl, HDLcholesterol &≤ 40 mg/dl, and glycemia > 126 mg/dl. We also calculated the average and/or median of total cholesterol, HDL-cholesterol, and glycemia among HIV-infected and HIV-uninfected patients.We conducted a cross-sectional study that enrolled 592 HIV-uninfected and 445 HIV-infected patients of whom 425 (95.5%) were on first-line antiretroviral therapy based on stavudine-lamivudine-nevirapine. Clinical and laboratory data of the patients were collected. The results were analyzed by chi-square, t-student, and Wilcoxon rank sum tests. 11.5% of HIV-infected patients had an average blood pressure suggesting hypertension versus 10.6% of HIV-uninfected (P = 0.751). But in absolute value, HIVinfected patients had a median of diastolic blood pressure of 90 mmHg versus 85 mmHg of HIV-uninfected (P < 0.001). 4.04% of HIV-infected patients had a BMI suggesting obesity versus 6.08% of HIV-uninfected patients (P = 0.187). For fasting glucose: 2.50% of HIV-infected patients versus 4.20% of HIV-uninfected patients had a serum fasting glucose suggesting diabetes (P<0.176). 11.9% of HIV-infected patients had a total cholesterol greater than 200 mg/dl versus 7.4% of HIVuninfected patients (P=0.019). For HDL-cholesterol: 36.40% of HIV-infected patients had a serum fasting ≤ 40 mg/dl versus 15.70% of HIV-uninfected patients (P < 0.001). HIV-infected patients had a median fasting total cholesterol higher (140 mg/ dl) thanHIV-uninfected patients (133mg/dl) [P=0.015].HIVuninfected patients had a median fasting HDL-cholesterol higher (58.5 mg/dl) than HIV-infected patients (49 mg/dl) [P < 0.001]. HIV-infected women were more likely to have a higher mean of total cholesterol: 147.70 #x00B1; 52.09 mg/dl versus 135.72 ± 48.23 mg/dl for the HIV-infected men (P = 0.014) and of HDL-cholesterol: 55.80 ± 30.77 mg/dl versus 48.24 ± 28.57mg/dl for the HIV-infected men (P = 0.008). In this study population, prevalence of hypertension was elevated in HIVinfected versus HIV-uninfected patients. Being HIV positive on first-line antiretroviral therapy based on stavudine-lamivudine-nevirapine was associated with high prevalence of total cholesterol > 200 mg/dl and HDL-cholesterol ≤ 40 mg/dl. Proactive screening and prompt management of dyslipidemia and hypertension in this population should be a priority.


Assuntos
Diabetes Mellitus/epidemiologia , Infecções por HIV/epidemiologia , Hipercolesterolemia/epidemiologia , Hipertensão/epidemiologia , Obesidade/epidemiologia , Adulto , Terapia Antirretroviral de Alta Atividade/estatística & dados numéricos , Estudos de Casos e Controles , Estudos Transversais , Diagnóstico Tardio/estatística & dados numéricos , República Democrática do Congo/epidemiologia , Diabetes Mellitus/diagnóstico , Feminino , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , HIV-1 , Humanos , Hipercolesterolemia/complicações , Hipertensão/complicações , Lamivudina/uso terapêutico , Masculino , Pessoa de Meia-Idade , Nevirapina/uso terapêutico , Obesidade/complicações , Prevalência , Estavudina/uso terapêutico
19.
J Clin Endocrinol Metab ; 102(8): 2896-2904, 2017 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-28531309

RESUMO

Context: HIV antiretroviral (ARV) therapy is associated with renal and bone toxicity, but little is known about the potential cumulative effects in adults exposed to ARVs from birth. Objective: To prospectively evaluate renal and bone health in young adults with lifelong HIV and extensive ARV exposure. Design: Cross-sectional comparison of bone mineral density (BMD) by dual-energy X-ray absorptiometry, bone turnover, and renal function in young adults infected with HIV in early life (n = 65) to matched healthy controls (n = 23) and longitudinal evaluation (mean follow-up = 4.4 years) within a subset of the HIV cohort (n = 33). Setting: Government outpatient research clinic. Results: Albumin/creatinine ratio, protein/creatinine ratio, anion gap, N-terminal telopeptides, and osteocalcin were significantly increased in persons with HIV compared with controls, whereas whole-body BMD and BMD z scores were lower. Within the HIV group, duration of tenofovir disoproxil fumarate (TDF) correlated with higher anion gap but did not correlate with bone parameters. Longer duration of didanosine and stavudine use correlated with lower BMD and BMD z scores. Longitudinal analyses revealed that BMD and bone metabolism significantly improved over time. No subject had an estimated glomerular filtration rate (eGFR) <60, but decline in eGFR correlated with increasing years of TDF exposure. Conclusions: Subclinical markers of renal dysfunction were increased in HIV-infected young adults and associated with TDF exposure, whereas lower bone density was associated with didanosine and stavudine exposure. The tendency for improvement in markers of bone health over time and the availability of less toxic ARV alternatives may herald improvements in renal and bone health for perinatally infected patients in adulthood.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Densidade Óssea , Doenças Ósseas Metabólicas/diagnóstico por imagem , Remodelação Óssea , Infecções por HIV/tratamento farmacológico , Insuficiência Renal/urina , Absorciometria de Fóton , Equilíbrio Ácido-Base , Adulto , Idade de Início , Albuminúria , Terapia Antirretroviral de Alta Atividade , Doenças Ósseas Metabólicas/complicações , Doenças Ósseas Metabólicas/metabolismo , Estudos de Casos e Controles , Creatinina/urina , Estudos Transversais , Didanosina/uso terapêutico , Feminino , Taxa de Filtração Glomerular , Infecções por HIV/complicações , Infecções por HIV/metabolismo , Humanos , Testes de Função Renal , Estudos Longitudinais , Masculino , Osteocalcina/metabolismo , Estudos Prospectivos , Proteinúria , Insuficiência Renal/complicações , Fatores de Risco , Estavudina/uso terapêutico , Tenofovir/uso terapêutico , Fatores de Tempo , Adulto Jovem
20.
AIDS Res Ther ; 14(1): 23, 2017 Apr 21.
Artigo em Inglês | MEDLINE | ID: mdl-28431556

RESUMO

BACKGROUND: There is limited data on factors associated with loss to follow-up (LTFU) of health care workers (HCWs) following occupational exposure to HIV, and most studies were conducted in an era when poorly tolerated antiretrovirals like zidovudine were used. METHODS: A retrospective cohort study was conducted of HCWs attending a referral hospital's Occupational Health Clinic in Cape Town, South Africa for post-exposure prophylaxis (PEP) during a period when tenofovir was available. Our primary outcome was LTFU at the 3-month visit. We selected seven variables a priori for our logistic regression model and ensured there were at least 10 outcome events per variable to minimize bias. RESULTS: Two hundred and ninety-three folders were evaluated for descriptive analysis. LTFU worsened with successive visits: 36% at 6 weeks, 60% at 3 months, and 72% at 6 months. In multivariate analysis at the 3-month visit LTFU was associated with age (adjusted odds ratio (aOR), 0.6 per 10-year increase [95% CI, 0.5-0.9]), HCW category of doctor (aOR 2.7 [95% CI, 1.3-5.5]), and time from exposure to receiving PEP of more than 24 h (aOR 5.9 [95% CI, 1.3-26.9]). CONCLUSION: We identified factors associated with LTFU of HCWs after occupational HIV exposure, which could be used to target interventions to improve follow-up.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/transmissão , Pessoal de Saúde , Transmissão de Doença Infecciosa do Paciente para o Profissional , Perda de Seguimento , Exposição Ocupacional , Profilaxia Pós-Exposição/métodos , Adulto , Emtricitabina/uso terapêutico , Feminino , Infecções por HIV/tratamento farmacológico , Humanos , Lamivudina/uso terapêutico , Masculino , Estudos Retrospectivos , África do Sul , Estavudina/uso terapêutico , Tenofovir/uso terapêutico , Adulto Jovem , Zidovudina/uso terapêutico
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA