RESUMO
Despite the huge advance that antiretroviral therapy represents for the prognosis of infection by the human immunodeficiency virus (HIV), opportunistic infections (OIs) continue to be a cause of morbidity and mortality in HIV-infected patients. OIs often arise because of severe immunosuppression resulting from poor adherence to antiretroviral therapy, failure of antiretroviral therapy, or unawareness of HIV infection by patients whose first clinical manifestation of AIDS is an OI. The present article updates our previous guidelines on the prevention and treatment of various OIs in HIV-infected patients, namely, infections by parasites, fungi, viruses, mycobacteria, and bacteria, as well as imported infections. The article also addresses immune reconstitution inflammatory syndrome.
Assuntos
Infecções por HIV/complicações , Infecções Oportunistas/tratamento farmacológico , Infecções Oportunistas/prevenção & controle , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/prevenção & controle , Terapia Antirretroviral de Alta Atividade , Infecções Bacterianas/tratamento farmacológico , Coinfecção , Humanos , Síndrome Inflamatória da Reconstituição Imune/tratamento farmacológico , Síndrome Inflamatória da Reconstituição Imune/prevenção & controle , Infecções por Mycobacterium/tratamento farmacológico , Infecções por Mycobacterium/prevenção & controle , Micoses/tratamento farmacológico , Micoses/prevenção & controle , Infecções Oportunistas/etiologia , Doenças Parasitárias/tratamento farmacológico , Doenças Parasitárias/prevenção & controle , Viroses/tratamento farmacológico , Viroses/prevenção & controleRESUMO
Opportunistic infections continue to be a cause of morbidity and mortality in HIV-infected patients. They often arise because of severe immunosuppression resulting from poor adherence to antiretroviral therapy, failure of antiretroviral therapy, or unawareness of HIV infection by patients whose first clinical manifestation of AIDS is an opportunistic infection. The present article is an executive summary of the document that updates the previous recommendations on the prevention and treatment of opportunistic infections in HIV-infected patients, namely, infections by parasites, fungi, viruses, mycobacteria, and bacteria, as well as imported infections. The article also addresses immune reconstitution inflammatory syndrome. This document is intended for all professionals who work in clinical practice in the field of HIV infection.
Assuntos
Infecções por HIV/complicações , Infecções Oportunistas/tratamento farmacológico , Infecções Oportunistas/prevenção & controle , Infecções Oportunistas Relacionadas com a AIDS/prevenção & controle , Infecções Bacterianas/tratamento farmacológico , Infecções Bacterianas/prevenção & controle , Coinfecção/tratamento farmacológico , Coinfecção/prevenção & controle , Humanos , Síndrome Inflamatória da Reconstituição Imune/diagnóstico , Síndrome Inflamatória da Reconstituição Imune/tratamento farmacológico , Síndrome Inflamatória da Reconstituição Imune/prevenção & controle , Micoses/tratamento farmacológico , Micoses/prevenção & controle , Doenças Parasitárias/tratamento farmacológico , Doenças Parasitárias/prevenção & controle , Viroses/tratamento farmacológico , Viroses/prevenção & controleRESUMO
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 Físico , 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 FumarRESUMO
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 Físico , 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 FumarRESUMO
In this update, antiretroviral therapy (ART) is recommended for all patients infected by type 1 human immunodeficiency virus (HIV-1). The strength and grade of the recommendation vary depending on the CD4+ T-lymphocyte count, the presence of opportunistic infections or comorbid conditions, age, and the efforts to prevent the transmission of HIV. The objective of ART is to achieve an undetectable plasma viral load (PVL). Initial ART should comprise three drugs, namely, two nucleoside reverse transcriptase inhibitors (NRTI) and one drug from another family. Three of the recommended regimens, all of which have an integrase strand transfer inhibitor (INSTI) as the third drug, are considered a preferred regimen; a further seven regimens, which are based on an INSTI, an non-nucleoside reverse transcriptase inhibitor (NNRTI), or a protease inhibitor boosted with ritonavir (PI/r), are considered alternatives. The reasons and criteria for switching ART are presented both for patients with an undetectable PVL and for patients who experience virological failure, in which case the rescue regimen should include three (or at least two) drugs that are fully active against HIV. The specific criteria for ART in special situations (acute infection, HIV-2 infection, pregnancy) and comorbid conditions (tuberculosis and other opportunistic infections, kidney disease, liver disease, and cancer) are updated.
Assuntos
Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/tratamento farmacológico , HIV-1 , Infecções Oportunistas Relacionadas com a AIDS , Adulto , Fármacos Anti-HIV/administração & dosagem , Fármacos Anti-HIV/efeitos adversos , Terapia Antirretroviral de Alta Atividade , Aleitamento Materno , Contagem de Linfócito CD4 , Comorbidade , Contraindicações , Farmacorresistência Viral , Substituição de Medicamentos , Quimioterapia Combinada , Feminino , Infecções por HIV/imunologia , HIV-1/efeitos dos fármacos , HIV-2 , Humanos , Gravidez , Complicações Infecciosas na Gravidez/tratamento farmacológico , Carga Viral , Viremia/tratamento farmacológicoRESUMO
In this update, antiretroviral therapy (ART) is recommended for all patients infected by type 1 human immunodeficiency virus (HIV-1). The strength and grade of the recommendation varies with clinical circumstances, number of CD4 cells, comorbid conditions and prevention of transmission of HIV. The objective of ART is to achieve an undetectable plasma viral load. Initial ART should always comprise a combination of 3 drugs, including 2 nucleoside reverse transcriptase inhibitors and a third drug from a different family (non-nucleoside reverse transcriptase inhibitor, protease inhibitor, or integrase inhibitor). This update presents the causes and criteria for switching ART in patients with undetectable plasma viral load and in cases of virological failure. An update is also provided for the specific criteria for ART in special situations (acute infection, HIV-2 infection, and pregnancy) and with comorbid conditions (tuberculosis or other opportunistic infections, kidney disease, liver disease, and cancer).
Assuntos
Síndrome da Imunodeficiência Adquirida/tratamento farmacológico , Antirretrovirais/uso terapêutico , Adulto , Substituição de Medicamentos , Humanos , EspanhaRESUMO
Spain has some tradition of quality assurance systems, although less than in Anglo-Saxon countries. However, there is scarce implantation of these systems in the field of HIV infection. While this scarcity could be explained by the uncertainty surrounding the disease at the beginning of the epidemic, for several years there has been solid scientific evidence on many features of the approach to this disease, established in the various treatment and clinical practice guidelines. Consequently, the AIDS Study Group [Grupo de Estudio del Sida (GESIDA)] designed the present quality of care indicators for persons with HIV/AIDS. The first draft was developed by a committee of health professionals, with the guidance of the Avedis Donebadian University Institute. This draft was then evaluated by a team of external reviewers and posted on the Web page of the Society's web page. Some of the suggestions were included in the final document, with 66 indicators (structure: 5, process: 45, results: 16) in the following areas: structural conditions, diagnosis and evaluation, follow-up and preventive interventions, follow-up of patients under treatment, specific aspects in women, comorbidities, hospitalization, mortality rates, training and research. In each indicator, the sections guaranteeing the indicators' validity and reliability are specified: justification of the indicator as a measure of quality, the healthcare dimension evaluated, mathematical formula, explanation of terms, population, type of indicator (structure, process result), data source, the standard to be achieved and commentaries on the validity of the indicator. Finally, 22 indicators deemed relevant were chosen. GESIDA believes that these indicators should be constantly monitored in all HIV units to identify their results at all times and thus be able to introduce improvement measures.
Assuntos
Infecções por HIV/terapia , Indicadores de Qualidade em Assistência à Saúde , Sociedades Médicas/normas , Comorbidade , Continuidade da Assistência ao Paciente , Gerenciamento Clínico , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/mortalidade , Infecções por HIV/prevenção & controle , Recursos em Saúde , Hospitalização , Humanos , Masculino , Gravidez , Complicações Infecciosas na Gravidez/terapia , Garantia da Qualidade dos Cuidados de Saúde , Melhoria de Qualidade , Espanha , Padrão de Cuidado/normasRESUMO
Despite the huge advance that antiretroviral therapy represents for the prognosis of infection by the human immunodeficiency virus (HIV), opportunistic infections (OIs) continue to be a cause of morbidity and mortality in HIV-infected patients. OIs often arise because of severe immunosuppression resulting from poor adherence to antiretroviral therapy, failure of antiretroviral therapy, or unawareness of HIV infection by patients whose first clinical manifestation of AIDS is an OI. The present article updates our previous guidelines on the prevention and treatment of various OIs in HIV-infected patients, namely, infections by parasites, fungi, viruses, mycobacteria, and bacteria, as well as imported infections. The article also addresses immune reconstitution inflammatory syndrome
A pesar del gran avance que ha supuesto el tratamiento antirretroviral (TAR) para el pronóstico de la infección por el VIH, las infecciones oportunistas (IO) continúan siendo causa de morbilidad y mortalidad en estos pacientes. Ello ocurre en muchos casos debido a la inmunodepresión grave, bien ante la falta de adherencia al TAR, el fracaso del mismo o el desconocimiento de la existencia de la infección por el VIH en pacientes que comienzan con una IO. El presente artículo actualiza las recomendaciones de prevención y tratamiento de diferentes infecciones en pacientes con infección por VIH: parasitarias, fúngicas, víricas, micobacterianas, bacterianas e importadas, además del síndrome de reconstitución inmune
Assuntos
Humanos , Infecções por HIV/complicações , Infecções Oportunistas Relacionadas com a AIDS/prevenção & controle , Antirretrovirais/uso terapêutico , Avaliação de Resultado de Ações Preventivas , Coinfecção/epidemiologia , Síndrome da Imunodeficiência Adquirida/complicações , Síndrome da Imunodeficiência Adquirida/tratamento farmacológico , Padrões de Prática MédicaRESUMO
Opportunistic infections continue to be a cause of morbidity and mortality in HIV-infected patients. They often arise because of severe immunosuppression resulting from poor adherence to antiretroviral therapy, failure of antiretroviral therapy, or unawareness of HIV infection by patients whose first clinical manifestation of AIDS is an opportunistic infection. The present article is an executive summary of the document that updates the previous recommendations on the prevention and treatment of opportunistic infections in HIV-infected patients, namely, infections by parasites, fungi, viruses, mycobacteria, and bacteria, as well as imported infections. The article also addresses immune reconstitution inflammatory syndrome. This document is intended for all professionals who work in clinical practice in the field of HIV infection
Las infecciones oportunistas siguen siendo una causa importante de morbi mortalidad en pacientes con infección por VIH. Ello ocurre en muchos casos debido a la inmunodepresión grave, bien ante la falta de adherencia al tratamiento antirretroviral, el fracaso del mismo o el desconocimiento de la existencia de la infección por el VIH en pacientes que comienzan con una infección oportunista. Este artículo es un resumen del documento de consenso que actualiza las recomendaciones previas de GESIDA respecto a la prevención y el tratamiento de las diferentes infecciones oportunistas en pacientes infectados por VIH: parasitarias, fúngicas, víricas, micobacterianas, bacterianas e importadas, además del síndrome de reconstitución inmune. Está dirigido a los profesionales que trabajan en la práctica clínica en el campo del VIH, con el objetivo de facilitarles una atención de calidad en la prevención y tratamiento de estas infecciones
Assuntos
Humanos , Infecções por HIV/complicações , Infecções Oportunistas Relacionadas com a AIDS/prevenção & controle , Antirretrovirais/uso terapêutico , Coinfecção/epidemiologia , Síndrome da Imunodeficiência Adquirida/complicações , Síndrome da Imunodeficiência Adquirida/tratamento farmacológico , Padrões de Prática MédicaRESUMO
OBJECTIVE: To provide an update of the metabolic and morphologic alterations in patients infected with HIV with an in-depth analysis of their clinical management and treatment. METHODS: These recommendations were agreed by consensus by a committee of experts in metabolic alterations and HIV patient care, under the auspices of the Secretariat for the National AIDS Plan. To do this, the latest clinical, epidemiological and physiopathological advances described in studies published in the scientific literature and/or presented in congresses were reviewed. RESULTS: The most frequent metabolic alterations in HIV patients and in antiretroviral treatment (ART) are dyslipidemia with an atherogenic profile and alterations in carbohydrate metabolism/insulin resistance. A high prevalence of cardiovascular risk factors, especially smoking, has been described. The same criteria for their management as those used in the general population have been employed, with specific nuances. Diet and exercise should be the first therapeutic recommendation. In patients with dyslipidemia who require drug treatment, statins and/or fibrates are indicated. Glitazones have demonstrated efficacy in the treatment of insulin resistance. The approach to anomalous fat distribution continues to be controversial. The main approaches at present are a switch of ART, reparative surgery, psychological support and lifestyle changes. Lactic acidosis is an infrequent but highly serious complication, and the first step is withdrawal of ART. In bone metabolism alterations, prevention and early detection are essential, especially in children and perimenopausal women. Sexual dysfunction is a frequent problem in both men and women; because the causes are highly varied, treatment should be individualized. CONCLUSIONS: The prevalence of metabolic and morphologic alterations has increased since the introduction of highly active antiretroviral treatment (HAART). Knowledge of the various aspects involved in their diagnosis and treatment is essential for the appropriate care of patients with HIV infection.
Assuntos
Terapia Antirretroviral de Alta Atividade , Infecções por HIV/tratamento farmacológico , Infecções por HIV/fisiopatologia , Síndrome de Lipodistrofia Associada ao HIV/prevenção & controle , Acidose Láctica/etiologia , Acidose Láctica/prevenção & controle , Algoritmos , Terapia Antirretroviral de Alta Atividade/efeitos adversos , Doenças Ósseas Metabólicas/etiologia , Doenças Ósseas Metabólicas/prevenção & controle , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/prevenção & controle , Diabetes Mellitus/etiologia , Diabetes Mellitus/prevenção & controle , Dislipidemias/etiologia , Dislipidemias/prevenção & controle , Síndrome de Lipodistrofia Associada ao HIV/cirurgia , Humanos , Resistência à Insulina , Metabolismo dos Lipídeos , Fatores de Risco , Disfunções Sexuais Fisiológicas/etiologia , Disfunções Sexuais Fisiológicas/prevenção & controle , Estresse Psicológico/etiologia , Estresse Psicológico/prevenção & controleRESUMO
Since the appearance of AIDS, the study of this disease has generated a large amount of information and an extensive related vocabulary comprised of new terms or terms borrowed from other scientific fields. The urgent need to provide names for newly described phenomena and concepts in this field has resulted in the application of terms that are not always appropriate from the linguistic and scientific points of view. We discuss the difficulties in attempting to create adequate AIDS terminology in the Spanish language, considering both the general problems involved in building any scientific vocabulary and the specific problems inherent to this activity in a field whose defining illness has important social connotations. The pressure exerted by the predominance of the English language in reporting scientific knowledge is considered, and the inappropriate words most often found in a review of current literature are examined. Finally, attending to the two most important criteria for the creation of new scientific terms, accuracy and linguistic correction, we propose some well thought-out alternatives that conform to the essence of the Spanish language.
Assuntos
Síndrome da Imunodeficiência Adquirida , Terminologia como Assunto , Humanos , IdiomaRESUMO
Los sistemas de garantía de calidad asistencial tienen una cierta tradición en España y mucho mayor en los países anglosajones, pero en el campo de la infección VIH es escasa su implantación. Aunque ello podía ser comprensible al inicio de la epidemia por la incertidumbre que rodeaba a la enfermedad, desde hace varios años existe suficiente solidez científica en muchos aspectos de su abordaje, concretada en numerosas guías de tratamiento y práctica clínica. Esto ha inducido a GESIDA a realizar los presentes indicadores de calidad asistencial para la atención de personas infectadas por el VIH/sida. Un comité de profesionales, con la asesoría del Instituto Universitario Avedis Donabedian, redactó un primer borrador, posteriormente evaluado por un equipo de asesores externos y expuesto en la página web de la Sociedad. Las sugerencias fueron en parte incorporadas al texto final, resultando un total de 66 indicadores (estructura: 5; proceso: 45; resultados: 16) en las siguientes áreas: Condiciones estructurales, Diagnóstico y evaluación, Seguimiento e intervenciones de prevención, Seguimiento de pacientes en tratamiento, Aspectos específicos en la mujer, Comorbilidades, Hospitalización, Índices de mortalidad, Formación e investigación. En cada indicador se especifican los apartados que garantizan su validez y fiabilidad: justificación, dimensión, fórmula, explicación de términos, población, tipo, fuente de datos, estándar y comentarios. Finalmente, se seleccionaron 22 indicadores considerados como relevantes y que GESIDA entiende que todas las unidades VIH deberían monitorizar para conocer en todo momento sus resultados en esos aspectos de la práctica asistencial y así poder introducir medidas de mejora
Spain has some tradition of quality assurance systems, although less than in Anglo-Saxon countries. However, there is scarce implantation of these systems in the field of HIV infection. While this scarcity could be explained by the uncertainty surrounding the disease at the beginning of the epidemic, for several years there has been solid scientific evidence on many features of the approach to this disease, established in the various treatment and clinical practice guidelines. Consequently, the AIDS Study Group [Grupo de Estudio del Sida (GESIDA)] designed the present quality of care indicators for persons with HIV/AIDS. The first draft was developed by a committee of health professionals, with the guidance of the Avedis Donebadian University Institute. This draft was then evaluated by a team of external reviewers and posted on the Web page of the Society's web page. Some of the suggestions were included in the final document, with 66 indicators (structure: 5, process: 45, results: 16) in the following areas: structural conditions, diagnosis and evaluation, follow-up and preventive interventions, follow-up of patients under treatment, specific aspects in women, comorbidities, hospitalization, mortality rates, training and research. In each indicator, the sections guaranteeing the indicators' validity and reliability are specified: justification of the indicator as a measure of quality, the healthcare dimension evaluated, mathematical formula, explanation of terms, population, type of indicator (structure, process result), data source, the standard to be achieved and commentaries on the validity of the indicator. Finally, 22 indicators deemed relevant were chosen. GESIDA believes that these indicators should be constantly monitored in all HIV units to identify their results at all times and thus be able to introduce improvement measures
Assuntos
Humanos , Masculino , Feminino , Gravidez , Infecções por HIV/terapia , Indicadores de Qualidade em Assistência à Saúde , Sociedades Médicas/normas , Comorbidade , Continuidade da Assistência ao Paciente , Gerenciamento Clínico , Infecções por HIV/diagnóstico , Infecções por HIV/mortalidade , Infecções por HIV/prevenção & controle , Recursos em Saúde , Hospitalização , Complicações Infecciosas na Gravidez/terapia , Garantia da Qualidade dos Cuidados de Saúde , Melhoria de Qualidade , Padrão de Cuidado/normasRESUMO
Objetivo. Efectuar una puesta al día de las alteraciones metabólicas y morfológicas presentes en los pacientes con infección por virus de la inmunodeficiencia humana (VIH), ahondando en su manejo clínico y tratamiento. Métodos. Estas recomendaciones han sido consensuadas por un comité de expertos en alteraciones metabólicas y en la atención al paciente con VIH, bajo los auspicios de la Secretaría del Plan Nacional sobre el Sida (PNS). Para ello se han revisado los últimos avances clínicos, epidemiológicos y fisiopatológicos reseñados en estudios publicados en las revistas médicas y/o presentados en los congresos. Resultados. Las alteraciones metabólicas que con mayor frecuencia aparecen en los pacientes con infección por VIH y en tratamiento antirretroviral (TAR) son la dislipidemia con perfil aterogénico y las alteraciones del metabolismo hidrocarbonado/resistencia a la insulina. Se ha descrito una elevada prevalencia de factores de riesgo cardiovascular, especialmente el tabaquismo. Para su manejo se han utilizado los mismos criterios que para la población general, con matices específicos. La dieta y el ejercicio deben ser la primera recomendación terapéutica. En los pacientes con dislipidemia y necesidad de tratamiento farmacológico, estarían indicadas las estatinas y/o los fibratos. En el tratamiento de la resistencia a la insulina las glitazonas han demostrado su eficacia. El abordaje del reparto anómalo de la grasa sigue siendo controvertido. El cambio de TAR, la cirugía reparadora, el soporte psicológico y los cambios de estilo de vida son las bases para abordar este problema en el momento actual. La acidosis láctica es una complicación infrecuente pero muy grave, siendo la primera actitud terapéutica la retirada del TAR. En cuanto a las alteraciones del metabolismo óseo son fundamentales la prevención y la detección precoz, especialmente en mujeres perimenopáusicas y niños. La disfunción sexual es un problema frecuente tanto en varones como en mujeres; la diversidad de causas obliga a un tratamiento individualizado. Conclusiones. La prevalencia de alteraciones metabólicas y morfológicas ha aumentado desde la introducción del tratamiento antirretroviral de gran actividad (TARGA). Es fundamental el conocimiento de los diversos aspectos relacionados con su diagnóstico y tratamiento para una correcta atención de los pacientes con infección por VIH (AU)
Objective. To provide an update of the metabolic and morphologic alterations in patients infected with HIV with an in-depth analysis of their clinical management and treatment. Methods. These recommendations were agreed by consensus by a committee of experts in metabolic alterations and HIV patient care, under the auspices of the Secretariat for the National AIDS Plan. To do this, the latest clinical, epidemiological and physiopathological advances described in studies published in the scientific literature and/or presented in congresses were reviewed. Results. The most frequent metabolic alterations in HIV patients and in antiretroviral treatment (ART) are dyslipidemia with an atherogenic profile and alterations in carbohydrate metabolism/insulin resistance. A high prevalence of cardiovascular risk factors, especially smoking, has been described. The same criteria for their management as those used in the general population have been employed, with specific nuances. Diet and exercise should be the first therapeutic recommendation. In patients with dyslipidemia who require drug treatment, statins and /or fibrates are indicated. Glitazones have demonstrated efficacy in the treatment of insulin resistance. The approach to anomalous fat distribution continues to be controversial. The main approaches at present are a switch of ART, reparative surgery, psychological support and lifestyle changes. Lactic acidosis is an infrequent but highly serious complication, and the first step is withdrawal of ART. In bone metabolism alterations, prevention and early detection are essential, especially in children and perimenopausal women. Sexual dysfunction is a frequent problem in both men and women; because the causes are highly varied, treatment should be individualized. Conclusions. The prevalence of metabolic and morphologic alterations has increased since the introduction of highly active antiretroviral treatment (HAART). Knowledge of the various aspects involved in their diagnosis and treatment is essential for the appropriate care of patients with HIV infection (AU)
Assuntos
Humanos , Terapia Antirretroviral de Alta Atividade/efeitos adversos , Infecções por HIV/tratamento farmacológico , Infecções por HIV/fisiopatologia , Síndrome de Lipodistrofia Associada ao HIV , Acidose Láctica/etiologia , Acidose Láctica/prevenção & controle , Algoritmos , Doenças Ósseas Metabólicas/etiologia , Doenças Ósseas Metabólicas/prevenção & controle , Doenças Cardiovasculares/etiologia , Diabetes Mellitus/etiologia , Resistência à Insulina , Disfunções Sexuais Psicogênicas/prevenção & controle , Estresse Psicológico/etiologia , Hiperlipidemias/prevenção & controleRESUMO
No disponible
Assuntos
Humanos , Chlamydia trachomatis , Idioma , Editoração , Fatores de Risco , Espanha , Infecções por ChlamydiaRESUMO
No disponible
Assuntos
Adulto , Humanos , Espanha , Sociedades Médicas , Redação , Publicações Periódicas como Assunto , Inquéritos e Questionários , IdiomaRESUMO
No disponible
Assuntos
Adulto , Feminino , Humanos , Comitê de Profissionais , Redação , Publicações Periódicas como Assunto , Aspirina , Carcinoma , Uso de Medicamentos , Diagnóstico Diferencial , Doença das Coronárias , Doença Aguda , Fibrinolíticos , Doença da Mama Fibrocística , Doença da Mama Fibrocística , Editoração , Neoplasias Encefálicas , Diabetes Mellitus Tipo 1RESUMO
No disponible