RESUMO
BACKGROUND: Switching to the 2-drug regimen dolutegravir/lamivudine demonstrated durable non-inferior efficacy vs continuing 3- or 4-drug tenofovir alafenamide-based regimens for maintaining virologic suppression in people with HIV-1 through Week 144 in TANGO. SETTING: 134 centers, 10 countries. METHODS: Adults with HIV-1 RNA <50 copies/mL for >6 months and no history of virologic failure were randomized to switch from stable tenofovir alafenamide-based regimens to dolutegravir/lamivudine on Day 1 (early-switch group) for 196 weeks. Those randomized to continue tenofovir alafenamide-based regimens on Day 1 who maintained virologic suppression at Week 144 switched to dolutegravir/lamivudine at Week 148 (late-switch group). Efficacy, safety, and tolerability (including weight and biomarker changes) of dolutegravir/lamivudine in early-switch and late-switch groups were assessed through Week 196. RESULTS: Overall, 369 participants switched to dolutegravir/lamivudine on Day 1 (early-switch) and 298 switched at Week 148 (late-switch). In the early-switch group, 83% (306/369) maintained virologic suppression through Year 4, and 3% (11/369) reported new adverse events between Weeks 144 and 196. The late-switch group at Week 196 and early-switch group at Week 48 had comparable proportions with virologic suppression (93% each) and similar safety profiles. No late-switch participants and 1 early-switch participant met confirmed virologic withdrawal criteria through Week 196, with no resistance-associated mutations observed. Treatment continued to be well tolerated long-term. CONCLUSION: Switching from tenofovir alafenamide-based regimens to dolutegravir/lamivudine showed durable efficacy, high barrier to resistance, and good tolerability through 4 years. These results support dolutegravir/lamivudine as a robust treatment for maintaining virologic suppression.
RESUMO
BACKGROUNDPersistent controllers (PCs) maintain antiretroviral-free HIV-1 control indefinitely over time, while transient controllers (TCs) eventually lose virological control. It is essential to characterize the quality of the HIV reservoir in terms of these phenotypes in order to identify the factors that lead to HIV progression and to open new avenues toward an HIV cure.METHODSThe characterization of HIV-1 reservoir from peripheral blood mononuclear cells was performed using next-generation sequencing techniques, such as full-length individual and matched integration site proviral sequencing (FLIP-Seq; MIP-Seq).RESULTSPCs and TCs, before losing virological control, presented significantly lower total, intact, and defective proviruses compared with those of participants on antiretroviral therapy (ART). No differences were found in total and defective proviruses between PCs and TCs. However, intact provirus levels were lower in PCs compared with TCs; indeed the intact/defective HIV-DNA ratio was significantly higher in TCs. Clonally expanded intact proviruses were found only in PCs and located in centromeric satellite DNA or zinc-finger genes, both associated with heterochromatin features. In contrast, sampled intact proviruses were located in permissive genic euchromatic positions in TCs.CONCLUSIONSThese results suggest the need for, and can give guidance to, the design of future research to identify a distinct proviral landscape that may be associated with the persistent control of HIV-1 without ART.FUNDINGInstituto de Salud Carlos III (FI17/00186, FI19/00083, MV20/00057, PI18/01532, PI19/01127 and PI22/01796), Gilead Fellowships (GLD22/00147). NIH grants AI155171, AI116228, AI078799, HL134539, DA047034, MH134823, amfAR ARCHE and the Bill and Melinda Gates Foundation.
Assuntos
Infecções por HIV , HIV-1 , Humanos , HIV-1/genética , Leucócitos Mononucleares , Provírus/genética , Infecções por HIV/tratamento farmacológico , Antirretrovirais/uso terapêuticoRESUMO
Administration of antiretroviral drugs to individuals exposed to, but not infected by, HIV has been shown to reduce the risk of transmission. The efficacy of pre-exposure prophylaxis (PrEP) makes it obligatory to include it in an integral program of prevention of HIV transmission, together with other measures, such as use of the condom, training, counseling, and appropriate treatment of infected individuals. In this document, the AIDS Study Group (GeSIDA) of the Spanish Society of Infectious Diseases and Clinical Microbiology (Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica [SEIMC]) provides its views on this important subject. The available evidence on the usefulness of PrEP in the prevention of transmission of HIV is presented, and the components that should make up a PrEP program and whose development and implementation are feasible in Spain are set out (AU)
Se ha demostrado que la administración de fármacos antirretrovirales a personas expuestas y no infectadas por el VIH puede reducir el riesgo de transmisión. La eficacia de la profilaxis pre-exposición obliga a considerar su inclusión en un programa integral de prevención de la transmisión del VIH, junto con otras medidas como el uso del preservativo, la formación y el consejo asistido y el tratamiento adecuado de las personas infectadas. En este documento, el Grupo de Estudio de SIDA (GeSIDA) de la SEIMC aporta su visión sobre este importante tema. Se presenta la evidencia disponible acerca de la utilidad de la PrEP en la prevención de la transmisión del VIH y se enumeran los elementos que deberían integrar un programa de PrEP, cuyo desarrollo y puesta en marcha sea factible y viable en nuestro medio (AU)
Assuntos
Humanos , Infecções por HIV/prevenção & controle , Antirretrovirais/administração & dosagem , Tenofovir/administração & dosagem , Profilaxia Pré-Exposição/métodos , Comportamento Sexual , Sexo sem Proteção/prevenção & controle , Sexo Seguro , Avaliação de Resultado de Ações PreventivasRESUMO
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
Objetivos: Describir la prevalencia de síndrome gripal en el invierno de 2009 y los factores asociados a su ocurrencia. Método: Estudio transversal en 18 hospitales españoles. Los voluntarios respondieron un cuestionario de salud, informando sobre si habían sufrido síndrome gripal y su estado vacunal. Resultados: Participaron 1289 trabajadores sanitarios, y de ellos, 72 (5,6%) refirieron gripe en su familia, 195 (15,1%) se vacunaron frente al virus A/California/7/2009/H1N1 y 75 (5,8%, intervalo de confianza del 95% [IC95%]: 4,5-7,1) sufrieron síndrome gripal. Hubo diferencias entre comunidades autónomas. En el análisis de regresión logística, se asoció a síndrome gripal trabajar en la Comunidad de Madrid (odds ratio [OR]=8,31, IC95%: 1.05-65.39), tener casos de gripe en la familia (OR=2,84, IC95%: 1,41-5,73) y no estar vacunado frente a la gripe A (OR=2,68, IC95%: 1,05-6,82). Conclusiones: La presencia de casos en la familia y la comunidad donde se trabaja determinaron una diferente prevalencia de síndrome gripal. La vacuna se asoció a una menor prevalencia de la enfermedad (AU)
Objectives: To describe the prevalence of influenza-like syndrome in winter 2009 and the factors associated with its occurrence. Methods: A cross-sectional study was carried out in 18 hospitals in Spain. Volunteers completed a health questionnaire in which they reported the occurrence of influenza-like syndrome and vaccination and demographic status. Results: A total of 1,289 healthcare workers participated. Of these, 72 (5.6%) reported influenza in their family, 195 (15.1%) had been vaccinated against the A/California/7/2009/H1N1 virus and 75 (5.8%, 95%CI: 4.5-7.1%) had been diagnosed with influenza like-syndrome. There were differences among regions. In logistic regression analysis, the following factors were associated with a higher prevalence of influenza-like syndrome: working in Madrid (OR=8.31, 95%CI: 1.05-65.39), the occurrence of cases of influenza in the family (OR=2.84, 95%CI: 1.41-5.73) and not having been vaccinated against influenza A (H1N1) (OR=2.68, 95% CI: 1.05-6.82). Conclusions: Differences in the prevalence of influenza-like syndrome were due to the occurrence of familiar cases and region. Vaccination against influenza A (H1N1) was associated with a lower prevalence of the disease (AU)
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoal de Saúde , Vírus da Influenza A Subtipo H1N1 , Influenza Humana/diagnóstico , Influenza Humana/epidemiologia , Pandemias , Autorrelato , Estudos Transversais , Vacinação , Espanha/epidemiologiaRESUMO
Background: Vascular risk is an important cause of morbidity and mortality in HIV infected patients. Aim: To study the value of the ankle-brachial index (ABI) in vascular risk stratification in a cohort of people with HIV infection. Patients and Methods: Vascular risk was calculated in all the patients that agreed to participate in the study and clinical reports were reviewed retrospectively. Ten year risk of fatal myocardial infarction was calculated according to Framingham equation, National Cholesterol Education Program (NCEP) III and Systematic Coronary Risk Evaluation (SCORE) project score. ABI was calculated measuring resting systolic blood pressure at the ankle, that was compared with the systolic brachial pressure. The ratio of the two pressures defined ABI, that was considered abnormal if it was d" 0.9 or e" 1.3. Results: A total of 231 HIV infected patients aged 23 to 82 years (80 percent males) were enrolled. Ten years risk according to Framingham equation was 8.4 percent, 95 percent confidence intervals (CI): 7.54-9.15 and according to SCORE scale was 0.8 percent, 95 percent CI: 0.62-1.01. According to NCEP III 9 percent of patients had a high or very high cardiovascular risk. Median ABI was 1.17 (95 percent CI intervals: 1.16-1.19) and 58 patients (25 percent) had an abnormal value. Using ABI results, approximately 20 percent of patients were re-classified as having a high vascular risk. Conclusions: ABI identified approximately 20 percent of this cohort of HIV infected subjects as having high vascular risk.
Assuntos
Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Índice Tornozelo-Braço/métodos , Doenças Cardiovasculares/diagnóstico , Infecções por HIV/complicações , Doenças Cardiovasculares/complicações , Valores de Referência , Estudos Retrospectivos , Medição de Risco/métodos , Fatores de RiscoRESUMO
Fundamento y objetivo: La hipertensión arterial pulmonar (HAP) es una enfermedad grave más prevalente en la población con infección por el virus de la inmunodeficiencia humana (VIH). No está claramente establecido el papel que el tratamiento antiretroviral de gran actividad (TARGA) desempeña en su desarrollo. Nuestro objetivo fue describir la prevalencia de HAP en una serie de pacientes con infección por VIH e identificar la relación que pudiera existir con el uso actual y acumulado de antirretrovirales. Pacientes y método: Estudio transversal de una cohorte de pacientes con infección por el VIH de un hospital del sur de España. Se recogieron datos demográficos, sobre el estado de la infección VIH y sobre el TARGA actual y acumulado. Se realizó ecocardiografía transtorácica a todos los participantes, definiéndose la HAP como la presencia de una presión sistólica de arteria pulmonar de 36 mmHg o más. Resultados: Participaron 400 pacientes; 178 presentaban insuficiencia tricuspídea y, de estos, 22 tenían HAP (5,5%). No se observaron diferencias en la edad, el sexo, los linfocitos CD4, la proporción de pacientes naive o con sida, ni en el uso acumulado de antirretrovirales. Sin embargo, el uso reciente de lamivudina se asoció a mayor prevalencia de HAP, y el de emtricitabina y tenofovir a una menor. El análisis de regresión logística se realizó incluyendo el uso actual de estos 3 fármacos. Solo el uso actual de tenofovir se asoció a menor presencia de HAP (odds ratio 0,31; intervalo de confianza del 95% 0,17-0,84). Conclusiones: La prevalencia de HAP en nuestro estudio es similar a la publicada en el resto de series en pacientes con infección por VIH. El uso actual de tenofovir podría estar asociado con una menor prevalencia de HAP (AU)
Background and objective: Pulmonary arterial hypertension (PAH) is a serious disorder, more prevalent in patients infected with human immunodeficiency virus (HIV). It is not entirely clear what role is played by highly active antiretroviral therapy (HAART) in PAH development or course. Our aim was to describe PAH prevalence in a series of HIV-infected patients and identify possible links with cumulative and current use of different antiretrovirals. Patients and method: Cross-sectional study of a cohort of HIV-infected patients attending a hospital in southern Spain. Demographic data, data on HIV infection status and on cumulative and recent antiretroviral treatment were recorded. Transthoracic echocardiography was performed in all study participants. PAH was defined as pulmonary artery systolic pressure of 36 mmHg or more. Results: A total of 400 patients participated in the study; 178 presented with tricuspid regurgitation and 22 of these presented with PAH (5.5%). No differences were encountered in age, sex, CD4 lymphocytes, proportion of naive patients or patients with AIDS. No differences were encountered in cumulative use of antiretrovirals. However, recent use of lamivudine was associated with a greater presence of PAH, whereas recent use of tenofovir and emtricitabine was associated with a lower presence of PAH. Logistic regression analysis was performed including the use of lamivudine, emtricitabine and tenofovir. Only recent use of tenofovir was associated with a lower presence of PAH (odds ratio 0.31; 95% confidence interval: 0.17-0.84). Conclusions: PAH prevalence in our study was similar to others series. Current use of tenofovir may be associated with lower PAH prevalence (AU)
Assuntos
Humanos , Antirretrovirais/efeitos adversos , Infecções por HIV/tratamento farmacológico , Hipertensão Pulmonar/induzido quimicamente , Terapia Antirretroviral de Alta Atividade/efeitos adversos , Fármacos Anti-HIV/efeitos adversos , Fatores de RiscoRESUMO
No disponible
Assuntos
Humanos , Síndrome Antifosfolipídica/epidemiologia , Anticorpos Antifosfolipídeos/análise , Fatores de RiscoAssuntos
Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , /tratamento farmacológico , Peptídeo 1 Semelhante ao Glucagon/análogos & derivados , Hipoglicemiantes/uso terapêutico , Biomarcadores/metabolismo , /metabolismo , Peptídeo 1 Semelhante ao Glucagon/uso terapêutico , Medição de RiscoRESUMO
Introducción: Nos proponemos recoger la experiencia de uso de raltegravir en el contexto del tratamiento antirretroviral de gran actividad (TARGA) en pacientes de alto riesgo vascular. Método: Estudio retrospectivo de casos y controles. Los casos fueron aquellos pacientes que al comenzar con raltegravir presentaban un riesgo de enfermedad cardiovascular ≥ 20% según el algoritmo de la Sociedad Europea de Sida. Debían haber permanecido con dicho tratamiento durante al menos seis meses. Se parearon controles 1:1 con riesgo vascular también ≥ 20%.Resultados: Se seleccionaron diez casos y diez controles. Tras seis meses de uso de raltegravir, se observó un descenso de los valores de colesterol unido a lipoproteínas de alta densidad (colesterol HDL) (-2,5mg/dL en los controles frente a 2,5mg/dL en los casos, p=0,015), triglicéridos (10mg/dL frente a -101mg/dL, p=0,009), y en la ratio colesterol total/colesterol HDL (0,17 frente a -0,73, p=0,002). El riesgo de enfermedad cardiovascular a diez años disminuyó un 4,85% en los casos frente a un 0,05% en los controles (p=0,07). Conclusiones: Raltegravir muestra un buen perfil para ser usado en pacientes de alto riesgo vascular, con descenso de la ratio colesterol total/colesterol HDL y del riesgo vascular (AU)
Objectives: To record the experience with use of raltegravir (RTG) for devising highly active antiretroviral therapy (HAART) regimens based on RTG in high vascular risk patients. Methods:A retrospective study was conducted on high vascular risk patients taking RTG. Case was a patient who, at the time raltegravir was started, had ≥ 20% 10-year risk of cardiovascular disease, estimated by the algorithm of the European AIDS Clinical Society. Patients should have been on stable HAART including RTG for at least six months. A matched control with ≥ 20% risk of cardiovascular disease, was selected for each case. Results:Ten controls and ten cases were selected. After six months using RTG, a significant decreased was seen in levels of HDL cholesterol (median -2,5mg/dL in controls versus 2,5mg/dL in cases, p=0.015), triglycerides (10mg/dL versus -101mg/dL, p=0.009), and TC/HDL-C ratio (0.17 versus -0.73, p=0.002). Ten-year risk of cardiovascular disease was -4.85% in cases versus -0.05% in controls (p=0.07). Conclusions: RTG shows a good profile to be used in people with high vascular risk, with a decrease in TC/HDL-C ratio and vascular risk (AU)
Assuntos
Humanos , Infecções por HIV/tratamento farmacológico , Doenças Cardiovasculares/prevenção & controle , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Fatores de Risco , Estudos Retrospectivos , Fármacos Anti-HIV/uso terapêutico , Hipercolesterolemia/tratamento farmacológicoRESUMO
Objetivo: El uso inadecuado de antibióticos puede originar un incremento en la resistencia bacteriana a los principales antimicrobianos. No existe una previsión en el futuro inmediato de comercialización de nuevos antibióticos de amplio espectro, en especial con actividad frente a enterobacterias. Por este motivo deben implantarse programas para la optimización del tratamiento antimicrobiano. Describimos los resultados de un año de un programa de asesoramiento en tratamiento antibiótico en un hospital de segundo nivel andaluz. Métodos: Se describen 276 intervenciones de un programa multidisciplinar de consejo terapéutico no impositivo en el Hospital Costa del Sol de Marbella. Se valoró la adecuación del tratamiento empírico, posibilidades de desescalado antibiótico, la duración y dosis empleada. Se analizó la evolución del perfil de sensibilidad de los principales microorganismos así como un análisis de coste-eficacia. Resultados: El 90% de los consejos emitidos fueron aceptados. Las principales actuaciones fueron para valoración de tratamiento empírico y desescalado en función de cultivos. Los principales fármacos evaluados fueron imipenem, ertapenem, cefepima y linezolid. El perfil de sensibilidad de imipenem y meropenem mejoró discretamente respecto a años previos. Se constató un considerable ahorro en el gasto farmacéutico anual. Conclusiones: Los programas de asesoramiento no impositivos son herramientas útiles para la optimización del tratamiento antimicrobiano, pueden evitar el incremento de resistencias bacterianas y disminuir el coste del tratamiento antibiótico(AU)
Background: The inappropriate use of antimicrobial agents may contribute to the development of bacterial resistance to the principal antimicrobial drugs. There is no provision in the immediate future of marketing of new broad-spectrum antibiotics, especially with activity against Enterobacteriaceae, so programs should be implemented to optimize antimicrobial therapy. We describe the results of a year of a counselling program in antibiotic treatment in a secondary Andalusian hospital. Methods: We describe 276 interventions of a multidisciplinary non-compulsory counselling program of antimicrobial management on the Costa del Sol Hospital in Marbella. We evaluated the adequacy of empirical treatment, possibility of antibiotic de-escalation, duration and dose used. We analyzed the evolution of the sensitivity profile of the main microorganisms as well as a cost-effective analysis. Results: 90% of the recommendations were accepted. The main actions were assessment of empirical therapy and deescalation in relation with the result of cultures. The main drugs tested were imipenem, meropenem, cefepime, and linezolid. The sensitivity profile of imipenem and meropenem improved slightly over previous years. It was found a considerable savings in annual drug spending. Conclusions: The non-compulsory counselling programs are useful tools for optimization of antimicrobial therapy, can prevent an increase of antimicrobial resistance and reduce the cost of antibiotic treatment(AU)
Assuntos
Humanos , Masculino , Feminino , Antibacterianos/administração & dosagem , Custos e Análise de Custo/métodos , Custos e Análise de Custo/estatística & dados numéricos , Análise Custo-Eficiência , Sensibilidade e Especificidade , Resistência Microbiana a Medicamentos , 51426 , Investimentos em Saúde/economiaRESUMO
Fundamento y objetivos: Evaluar los cambios en la función renal en una cohorte de pacientes con infección por el virus de la inmunodeficiencia humana (VIH) y describir cuáles son los factores asociados a su deterioro.Pacientes y método: Estudio transversal prospectivo. El período de seguimiento ha sido de 12 meses. Al inicio del estudio y al cabo de un año se obtuvo el filtrado glomerular (FG). Además, se analizaron datos epidemiológicos, comorbilidades, valores de linfocitos CD4, carga viral (CV) y estadio de sida. Resultados: Se incluyeron un total de 365 pacientes. Estaban con tratamiento antirretroviral de gran actividad (TARGA) 313 pacientes (85%), la media (DE) de linfocitos CD4 era 606 (314) células/mm3 y la CV era indetectable en el 85% de los casos. Al año, se apreció un deterioro medio del FG de 9,7ml/h. Presentaron un descenso del FG > 10ml/h 80 pacientes (21,8%) y mayor de 30ml/h 20 pacientes (5,8%). Se encontró asociación con la edad, tratamiento con didanosina (DDI) y con el sexo masculino (odds ratio [OR] 1,89 e intervalo de confianza del 95% [IC 95%] 0,3-4,08, OR 2,3 e IC 95% 1,9-23, y OR 3,47 e IC 95% 1,6-14,20, respectivamente). Sí hubo asociación entre el hecho de recibir TARGA y presentar un menor deterioro del FG (OR 0,54, IC 95% 0,25-0,8). Conclusiones: Se aprecia un papel protector del tratamiento con TARGA en el deterioro del FG de los pacientes con infección por el VIH. El sexo masculino, la edad y el uso de DDI estuvieron asociados con un mayor deterioro de la función renal. El tenofovir (TDF) y los inhibidores de la proteasa (IP) no se asociaron a un mayor deterioro de la función renal (AU)
Background and objective: To assess changes in renal function in a cohort of patients infected with the human immunodeficiency virus (HIV) and describe which factors are associated with deterioration.Patients and methods: This was a prospective transversal study. The follow-up period was 12 months. Data were collected at baseline and one year including the glomerular filtration rate (GFR). We analyzed epidemiological data, comorbidities, CD4 lymphocytes, viral load, and AIDS status. Results: A total of 365 patients. Three hundred and thirteen (85%) were under highly active antiretroviral therapy (HAART); the median CD4 was 606±314 and the CV was undetectable in 85%. At 1-year, we found a mean deterioration in the GFR of 9.7ml/h. Eighty patients (21.8%) had a fall in GFR > 10ml/h, while in 20 patients (5.8%) it was > 30ml/h. An association was found regarding age, treatment with didanosine (DDI) and males (OR 1.89 95% CI 1.3 to 4.08, OR 2.3 95% CI 1.9 to 23 and OR 3.47 95% CI 1.6 to 14.20 respectively). We found a protective role of being under HAART (OR 0.54, 95% CI, 0.25 to 0.8). Conclusions: There was a protective role of HAART in the deterioration of GFR of patients with HIV infection. Male gender, age and use of DDI were associated with worsening renal function. Tenofovir and protease inhibitors were not associated with further deterioration of renal function (AU)
Assuntos
Humanos , Infecções por HIV/tratamento farmacológico , Antirretrovirais/farmacocinética , Insuficiência Renal/prevenção & controle , Infecções por HIV/complicações , Taxa de Filtração Glomerular , Didanosina/farmacocinética , Inibidores de Proteases/farmacocinéticaRESUMO
Fundamento y objetivos:Conocer la prevalencia de pacientes con infección por el virus de la inmunodeficiencia humana que no cumplen los objetivos de colesterol ligado a lipoproteínas de baja densidad (cLDL).Pacientes y método: Estudio multicéntrico transversal de todos los pacientes con virus de la inmunodeficiencia humana que acudieron a revisión en 5 hospitales de la provincia de Málaga entre marzo y agosto de 2007. Se clasificaron en función de su cLDL deseable National Cholesterol Education Program (NCEP): grupo A inferior a 160mg/dl (pacientes sin factor de riesgo cardiovascular [FRCV] o solo un FRCV); grupo B inferior a 130mg/dl (pacientes con 2 o más FRCV), y grupo C inferior a 100mg/dl (pacientes con enfermedad cardiovascular o equivalentes o con un riesgo cardiovascular [RCV] a 10 años superior al 20%). Se contrastaron los pacientes con cLDL deseable con los que no lo alcanzaban. Programa estadístico: SPSS.Resultados: Se analizó a 1.019 pacientes, de los que 232 (22,8%) tenían un nivel de cLDL no deseable. En el grupo A había 693 pacientes, en el grupo B 163 pacientes y en el grupo C 153 pacientes; no alcanzaban el cLDL deseable el 6,6, el 53,3 y el 65,0%, respectivamente (p<0,05). Los únicos factores asociados a un cLDL no deseable fueron la obesidad (OR=1,98; IC 95%: 1,143,46; p=0,01), el tiempo de tratamiento antirretroviral (por cada 2 años, OR=1,92; IC 95%: 1,851,99; p=0,02) y estar incluido en los grupos B y C (OR=16,9; IC 95%: 10,826,6; p=0,00001) (AU)
Background and objective: To analyse the prevalence of HIV-infected patients who do not reach their target LDL-cholesterol (LDL-C) levels. Patients and methods:Multicenter, cross-sectional study of all HIV-infected patients on regular follow-up in 5 hospitals in the province of Malaga (March-August/07). They were classified depending on their target LDL-C levels (NCEP): group A:<160mg/dl, if ≤1 cardiovascular risk factor (CVRF); group B: <130mg/dl, if ≥2 CVRF; group C: <100mg/dl, if cardiovascular disease or equivalents or CVR at 10 years >20%). A comparison between patients reaching their target LDL-C levels and those not reaching them was done. Statistic program: SPSS.Results: Of 1019 included patients, 232 (22.8%) did not reach their target LDL-C levels. There were 693 patients in Group A, 163 in Group B, and 153 in Group C (6.6%, 53.3 % and 65.0% respectively (p<0.05)) who did not reach their target LDL-C. Factors associated with LDL-C levels higher than target were: obesity (OR=1.98; 95%CI: 1.143.46; p=0.01), time on antiretroviral therapy (for each 2 years OR=1.92; 95%CI: 1.851.99; p=0.02), and being included in Groups B and C (OR=16.9; 95%CI: 10.826.6; p=0.00001). Conclusions: More than 20% of the patients in this cohort did not reach their target LDL-C levels. Factors associated with high LDL-C levels were central obesity, time on antiretroviral therapy and being included in Groups B and C (AU)
Assuntos
Humanos , Infecções por HIV/complicações , Dislipidemias/epidemiologia , Doenças Cardiovasculares/epidemiologia , LDL-Colesterol/sangue , Fatores de Risco , /uso terapêutico , Antirretrovirais/uso terapêutico , Carga ViralRESUMO
Objetivo. Conocer la prevalencia de factores de riesgo cardiovascular (FRCV) y síndrome metabólico (SM) en pacientes con infección por el virus de la inmunodeficiencia humana (VIH). Métodos. Estudio observacional, multicéntrico y transversal de todos los pacientes con infección por el VIH atendidos de forma ambulatoria en 5 hospitales de la provincia de Málaga entre marzo y agosto de 2007. A todos los pacientes se realizó un cuestionario sobre FRCV, examen físico y analítica en ayunas. El riesgo cardiovascular (RCV) a 10 años se realizó mediante la ecuación de Framingham y el diagnóstico de SM se hizo en función de los criterios del National Cholesterol Education Program. Resultados. Se incluyó a 1.155 pacientes. El 76,9% eran varones y la edad media fue de 44,3 años. El 86,1% de los pacientes estaba en tratamiento antirretroviral. La prevalencia de FRCV fue la siguiente: tabaco 59%, hipertrigliceridemia 38,2%, cHDL bajo 40,6%, hipertensión arterial 10,6% y diabetes mellitus 9,4%. El 14,3% de los pacientes cumplía criterios de SM y los componentes más frecuentes fueron hipertrigliceridemia (88,3%) y colesterol unido a lipoproteínas de alta densidad bajo (78,7%). Los pacientes con SM tenían mayor RCV a 10 años (el 10,9 frente al 5,6%; p < 0,0001). El único factor asociado al SM fue la edad (odds ratio = 4,7; intervalo de confianza del 95%, 4,6-4,8). Conclusiones. Los FRCV en pacientes con infección por el VIH de nuestro medio son muy frecuentes, entre los cuales destaca el consumo de tabaco. La prevalencia de SM es similar a la de la población general española y se asocia a un mayor RCV. El único factor asociado al desarrollo de SM fue la edad (AU)
Objective. To analyse the prevalence of cardiovascular risk factors (CVRF) and metabolic syndrome (MS) in a cohort of HIV-infected patients. Methods. Observational, multicenter, and cross-sectional study of all HIV-infected outpatients from five hospitals in Málaga (Southern Spain). A questionnaire about CVRF, a physical exploration, and 12 hours fasting blood tests were performed in all cases. Cardiovascular risk at 10 years was assessed by Framingham equation, and MS diagnosis was based on the NCEP criteria. Results. 1155 patients were included. 76.9% were men, and the mean age was 44.3 years. 86.1% of the patients were on antiretroviral therapy. The prevalence of CVRF was the following: tobacco 59%, hypertriglicerydemia 38.2%, low cHDL 40.6%, hypertension 10.6%, diabetes 9.4%. 14.3% patients had MS, being hypertriglycerydemia (88.3%) and low cHDL (78.7%) the most frequent criteria. Patients with MS had a higher CVR at 10 years (10.9 vs 5.6%, p < 0.0001). Age was the only factor associated with MS (odds ratio = 4.7; 95% confidence interval 4.6-4.8). Conclusions. CVRF, mainly tobacco use, are very frequent among HIV-patients in our area. The prevalence of MS is similar as that of the Spanish general population and it is associated with a higher CVR. Age was the only factor associated with the development of MS (AU)
Assuntos
Humanos , Síndrome Metabólica/epidemiologia , Infecções por HIV/complicações , Fatores de Risco , Fatores Etários , Terapia Antirretroviral de Alta Atividade , Antirretrovirais/farmacocinética , Estudos TransversaisRESUMO
OBJETIVOS. Se evaluó la durabilidad de la primera pauta de tratamiento antirretroviral de gran actividad (TARGA) en pacientes sin tratamiento antirretroviral previo infectados por el virus de la inmunodeficiencia humana (VIH) y los factores asociados a su modificación. MÉTODOS. Estudio multicéntrico, retrospectivo, de pacientes con infección por el VIH que iniciaron su primer TARGA entre 1997 y 2003. La variable principal medida fue la durabilidad de la primera pauta de TARGA hasta su cambio. Se realizó estadística descriptiva, curvas de Kaplan-Meier para evaluar la durabilidad y se construyó un modelo de regresión múltiple de Cox para valorar los factores asociados a la durabilidad. RESULTADOS. Iniciaron su primer TARGA 603 pacientes y 130 (21,6%) lo mantuvieron hasta la visita final, con una mediana de duración de 17,5 meses. Un 36% de los pacientes interrumpió el tratamiento antes del año. Cuando se excluyeron las causas no desfavorables(simplificación/interrupción estructurada), la mediana de duración aumentó hasta los 2 años. La causa principal del cambio fue la toxicidad (25%), seguida de la simplificación(19%) y el fracaso virológico (15%). Se encontró una mayor durabilidad de las pautas con un inhibidor de la transcriptasa inversa no análogo de nucleósidos (ITINAN)(p < 0,046; hazard ratio [HR], 1,58) y de aquellas con menos de cinco comprimidos (p < 0,001; HR, 2,05).CONCLUSIÓN. La mediana de duración del primer TARGA fue algo menor de 1,5 años y la causa principal del cambio fue la toxicidad. Se constata una mayor durabilidad de las pautas con ITINAN que, al menos en parte, podría explicarse por su menor número de comprimidos (AU)
AIM. To analyze the durability of the first highly active antiretroviral therapy (HAART) regimen used in naïve HIV-infected patients and the factors leading to therapy changes. METHODS. Multicenter, retrospective study of naïve HIV-infected patients from 5 hospitals in Málaga(southeast Spain), who started HAART between January 1997 and December 2003. The main outcome measure was median time to the first change in the antiretroviral regimen. A descriptive analysis was performed and Kaplan-Meier curves were used to assess durability of the first HAART used. Independent factors associated with durability were evaluated with a Cox multiple regression model. RESULTS. A total of 603 patients started HAART, and130 (21.6%) remained under the same treatment at the latest evaluation point. Median time on the same HAART was 17.5 months, and reached 24 months when cases of simplification or structured intermittent treatment interruption were excluded from the analysis. HAART had been interrupted in 36% by one-year of follow-up. Toxicity was the main cause of switching therapy (25%), followed by simplification (19%), and virologic failure (15%). Longer durability of HAART was observed in non-nucleoside reverse transcriptase inhibitor (NNRTI) regimens, (P < 0.046; HR, 1.58) and in those with less than 5 pills (P < 0.001; HR, 2.05).CONCLUSION. Median durability of the first HAART was almost one year and a half, and discontinuation was mainly due to toxicity. NNRTI regimens showed longer durability, which could be attributable to a lower pill burden, at least in part (AU)
Assuntos
Humanos , Infecções por HIV/tratamento farmacológico , Antirretrovirais/administração & dosagem , Estudos Retrospectivos , Terapia Antirretroviral de Alta Atividade , /epidemiologia , Terapia Antirretroviral de Alta Atividade/efeitos adversosRESUMO
No disponible
Assuntos
Humanos , Tuberculose , Infecções por HIV , Hospedeiro Imunocomprometido , Progressão da Doença , Fármacos Anti-HIV , Tuberculose Resistente a Múltiplos Medicamentos , Contagem de Linfócito CD4 , Antituberculosos , Diagnóstico Diferencial , Hipersensibilidade TardiaRESUMO
No disponible