RESUMO
Antiretroviral medications for the treatment of HIV are common drugs with diverse and frequent skin manifestations. Multiple new cutaneous effects have been recognized in the past decade. Dermatologists play an important role in accurately diagnosing and managing the cutaneous toxicities of these medications, thereby ensuring that a patient has as many therapeutic options as possible for life-long viral suppression. Part I of this two-part series on the cutaneous adverse effects of antiretroviral medications will discuss HIV-associated lipodystrophy syndrome, which can be seen as a result of many antiretroviral medications for HIV, and the specific cutaneous effects of the nucleoside reverse transcriptase inhibitors and protease inhibitors.
Assuntos
Toxidermias/etiologia , Infecções por HIV/tratamento farmacológico , Inibidores da Protease de HIV/efeitos adversos , Síndrome de Lipodistrofia Associada ao HIV/induzido quimicamente , Síndrome de Lipodistrofia Associada ao HIV/epidemiologia , Inibidores da Transcriptase Reversa/efeitos adversos , Fármacos Anti-HIV/efeitos adversos , Fármacos Anti-HIV/uso terapêutico , Terapia Antirretroviral de Alta Atividade/efeitos adversos , Terapia Antirretroviral de Alta Atividade/métodos , Relação Dose-Resposta a Droga , Esquema de Medicação , Toxidermias/epidemiologia , Toxidermias/fisiopatologia , Educação Médica Continuada , Feminino , Seguimentos , Infecções por HIV/diagnóstico , Inibidores da Protease de HIV/uso terapêutico , Síndrome de Lipodistrofia Associada ao HIV/fisiopatologia , Humanos , Incidência , Masculino , Inibidores da Transcriptase Reversa/uso terapêutico , Medição de RiscoRESUMO
Cutaneous manifestations of antiretroviral medications for HIV are common and potentially dangerous conditions encountered by dermatologists. Part II of this two-part series on the cutaneous effects of antiretroviral medications for HIV will discuss the four most recent classes of medications that have been developed and immune reconstitution syndrome--an important diagnostic consideration when evaluating a dermatologic patient who is taking antiretroviral medications.
Assuntos
Toxidermias/etiologia , Inibidores da Fusão de HIV/efeitos adversos , Infecções por HIV/tratamento farmacológico , Inibidores de Integrase de HIV/efeitos adversos , Síndrome Inflamatória da Reconstituição Imune/induzido quimicamente , Terapia Antirretroviral de Alta Atividade/efeitos adversos , Terapia Antirretroviral de Alta Atividade/métodos , Relação Dose-Resposta a Droga , Esquema de Medicação , Toxidermias/epidemiologia , Toxidermias/fisiopatologia , Educação Médica Continuada , Feminino , Seguimentos , Inibidores da Fusão de HIV/uso terapêutico , Infecções por HIV/diagnóstico , Inibidores de Integrase de HIV/uso terapêutico , Humanos , Síndrome Inflamatória da Reconstituição Imune/epidemiologia , Síndrome Inflamatória da Reconstituição Imune/fisiopatologia , Incidência , Masculino , Medição de RiscoRESUMO
OBJECTIVE: The heightened risk of persons with serious mental illness to contract and transmit HIV is recognized as a public health problem. Persons with HIV and mental illness may be at risk for poor treatment adherence, development of treatment-resistant virus, and worse outcomes. The objective of this study was to test the effectiveness of a community-based advanced practice nurse (APN) intervention (PATH, Preventing AIDS Through Health) to promote adherence to HIV and psychiatric treatment regimens. METHODS: Community-dwelling HIV-positive participants with co-occurring serious mental illnesses (N=238) were recruited from community HIV provider agencies from 2004 to 2008 to participate in the randomized controlled trial. Participants in the intervention group (N=128) were assigned an APN who provided community-based care management at a minimum of one visit per week and coordinated clients' medical and mental health care for one year. Viral load and CD4 cell count were evaluated at baseline and 12 months. RESULTS: Longitudinal models for continuous log viral load showed that compared with the control group, the intervention group exhibited a significantly greater reduction in log viral load at 12 months (d=-.361 log 10 copies per milliliter, p<.001). Differences in CD4 counts from baseline to 12 months were not statistically significant. CONCLUSIONS: This project demonstrated the effectiveness of community-based APNs in delivering a tailored intervention to improve outcomes of individuals with HIV and co-occurring serious mental illnesses. Persons with these co-occurring conditions can be successfully treated; with appropriate supportive services, their viral loads can be reduced.