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1.
Curr HIV Res ; 10(6): 513-20, 2012 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-22716109

RESUMEN

OBJECTIVE: To evaluate long-term outcomes in patients maintaining a nevirapine (NVP)-based regimen. METHODS: Retrospective, multicenter, cohort study including patients currently receiving an NVP regimen that had been started at least 5 years previously. Demographic, clinical, and analytical variables were recorded. RESULTS: Median follow-up was 8.9 (5.7-11.3) years. Baseline characteristics: 74% men, 47 years old, 36% drug users, 40% AIDS, 40% HCV+, 51.4% detectable HIV-1 viral load, CD4 count 395 (4-1,421)/µL, 19% CD4 < 200/µL, 27% ALT grade 1-2, 36% AST grade 1-2. Thirty percent ART-naive, 83%received NVP associated with 2 nucleoside analogues during the study period, and 17% a protease inhibitor. A significant improvement was observed in general health status markers, including hemoglobin, platelets, and albumin, regardless of HCV coinfection. CD4 cell gain was +218 and +322/µL after 6 and 9 years, respectively (+321 and +391 in naive patients). Triglycerides significantly decreased in pretreated patients, whereas the percentage of patients with HDLc < 1.03 mmol/L and LDL-c > 3.37 mmol/L significantly decreased in a subsample with available values. A significant decrease in transaminases, alkaline phosphatase, and Fib4 score was observed, mainly in HCV+ and ARV-naive patients. CONCLUSIONS: In patients who tolerate NVP therapy, (even those with HCV coinfection), long term benefits may be significant in terms of a progressive improvement in general health status markers and CD4 response, a favorable lipid profile, and good liver tolerability.


Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/tratamiento farmacológico , Fármacos Anti-VIH/administración & dosificación , Hepatitis C/tratamiento farmacológico , Hígado/efectos de los fármacos , Nevirapina/administración & dosificación , Trastornos Relacionados con Sustancias/epidemiología , Síndrome de Inmunodeficiencia Adquirida/sangre , Síndrome de Inmunodeficiencia Adquirida/epidemiología , Recuento de Linfocito CD4 , Colesterol/sangre , Estudios de Cohortes , Coinfección , Quimioterapia Combinada , Femenino , Estudios de Seguimiento , Hepatitis C/sangre , Hepatitis C/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , España/epidemiología , Factores de Tiempo , Resultado del Tratamiento , Triglicéridos/sangre , Carga Viral
2.
Enferm Infecc Microbiol Clin ; 22(3): 142-9, 2004 Mar.
Artículo en Español | MEDLINE | ID: mdl-14987534

RESUMEN

INTRODUCTION: To assess the factors associated with progression of infection and death in HIV-positive patients with severe immunodepression in the era of highly active antiretroviral therapy (HAART). METHODS: We studied 146 HIV-infected patients with < 100 x 10(6)/L CD4+ lymphocytes and positive cytomegalovirus (CMV) serology enrolled between December 1997 and October 1998 and prospectively followed a median of 12.1 months. The main outcome measures were progression of HIV infection, defined as the appearance of a new AIDS-defining disease (CDC category C) or death. HIV viral load, lymphocyte count (CD4+ and CD8+), HAART administration and other clinical variables were evaluated at baseline. CMV viremia (determined by PCR) and HAART efficacy were recorded during follow-up. RESULTS: Progression was observed in 40% of patients and 17% died. Factors associated with progression or death were CD4+ lymphocyte count less than 50 x 10(6)/L, CD8+ lymphocyte count less than 500 x 10(6)/L, HIV viral load more than 300,000 copies RNA/mL, CMV viremia, and absence or inefficacy of HAART. In the multivariate model, absence of HAART and low CD4+ and CD8+ counts remained statistically associated with progression, but the only variable associated with death was CMV viremia. CONCLUSIONS: In patients with advanced HIV infection, CD4+ and CD8+ cell count and HAART were the most important factors related to progression, and CMV viremia was the strongest predictor of death.


Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/mortalidad , Terapia Antirretroviral Altamente Activa , Infecciones por Citomegalovirus/epidemiología , Viremia/mortalidad , Infecciones Oportunistas Relacionadas con el SIDA/epidemiología , Síndrome de Inmunodeficiencia Adquirida/tratamiento farmacológico , Adulto , Recuento de Linfocito CD4 , Relación CD4-CD8 , Comorbilidad , Progresión de la Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Masculino , Factores de Riesgo , España/epidemiología , Insuficiencia del Tratamiento , Carga Viral , Viremia/tratamiento farmacológico
3.
Gastroenterol Hepatol ; 26(3): 152-5, 2003 Mar.
Artículo en Español | MEDLINE | ID: mdl-12586008

RESUMEN

We describe the case of a 64-year-old woman with a previous diagnosis of celiac sprue and no clinical or histological response to gluten withdrawal. The patient presented a history of longstanding recurrent watery diarrhea and was found to have collagenous colitis after further investigation of her diarrhea. Immunological study was incompatible with celiac disease and no other cause of villous atrophy was found. We suggest that this patient may have a separate disease entity unrelated to celiac sprue and consisting of a pan-intestinal inflammatory disorder characterized by the combination of a chronic inflammatory infiltrate in the small and lower bowel together with a subepithelial collagenous band in the colon.


Asunto(s)
Colágeno/metabolismo , Colon/patología , Duodeno/patología , Enterocolitis/patología , Atrofia , Colon/metabolismo , Colonoscopía , Diarrea/etiología , Diarrea/terapia , Duodenoscopía , Duodeno/metabolismo , Enterocolitis/metabolismo , Enterocolitis/terapia , Femenino , Humanos , Mucosa Intestinal/metabolismo , Mucosa Intestinal/patología , Persona de Mediana Edad , Resultado del Tratamiento
5.
Rev Clin Esp ; 199(9): 569-72, 1999 Sep.
Artículo en Español | MEDLINE | ID: mdl-10568147

RESUMEN

OBJECTIVES: To determine the frequency of pregnancies among HIV-infected women in a sanitary area. To evaluate the proportion of women not receiving anti-retroviral treatment to decrease vertical transmission and the reasons why this treatment was not administered. PATIENTS AND METHODS: Point prevalence study performed on all women followed for 1997 at the HIV Infection Unit in a 360-bed hospital. The following variables were obtained: social class, civil status and place of residence, risk factors for HIV infection, obstetric antecedents (pregnancies, number of term pregnancies, living newborns) as well as prescription or not of anti-retroviral therapy during pregnancy. RESULTS: Out of 85 women included in the study, 51 (60%) reported to have had a pregnancy and 17 of these (33%) had interrupted the pregnancy at some time. No significant differences were found between pregnancy or abortion and the analyzed socio-demographic variables or risk factors for HIV infection. Only 12% of women with a full length pregnancy received anti-retroviral therapy. Of women with term pregnancy who were not treated, most (63%) did not know they were infected before delivery and an additional 10% refused therapy. Forty-four percent of women with children continued with pregnancy despite knowing they were infected. Vertical transmission occurred in a 13% of cases in which no therapy was instituted and in no case in which zidovudine was administered during pregnancy. CONCLUSIONS: The frequency of pregnancies among HIV-infected women is high in our area and a substantial number of women do not know they are infected. These data support the serological study to HIV in all pregnant women and the necessity of a higher level of information in order that the seropositive women be aware of the responsibility she takes when she decides to go on with her pregnancy.


Asunto(s)
Serodiagnóstico del SIDA , Pruebas Diagnósticas de Rutina , Infecciones por VIH/diagnóstico , VIH-1 , Complicaciones Infecciosas del Embarazo/diagnóstico , Aborto Inducido/estadística & datos numéricos , Distribución de Chi-Cuadrado , Femenino , Infecciones por VIH/epidemiología , Humanos , Incidencia , Embarazo , Complicaciones Infecciosas del Embarazo/epidemiología , Prevalencia , Factores de Riesgo , Factores Socioeconómicos , España/epidemiología
7.
Enferm Infecc Microbiol Clin ; 11(5): 235-40, 1993 May.
Artículo en Español | MEDLINE | ID: mdl-8324018

RESUMEN

BACKGROUND: Intravenous drug addicts (IVDA) are a group of patients in whom it is difficult to complete standard treatment of infectious endocarditis due to frequent antisocial behavior and in whom, once clinical improvement is achieved, voluntary discharge is frequently requested. This is why the evaluation of new treatment schedules tending to decrease the length of the same is of great interest. This non randomized study has the aim of knowing the efficacy of a short treatment with cloxacillin or vancomycin associated to gentamicin in right-sided endocarditis by methicillin-sensitive Staphylococcus aureus, comparing this with the standard schedule of 28 days. METHODS: This series was made up of IVDA patients diagnosed of right endocarditis by S. aureus. Inclusion criteria were the presence of intravenous drug addiction, isolation of methicillin-sensitive S. aureus in 2 or more blood cultures and achievement of the diagnostic criteria of right-sided endocarditis. Two schedules were used: a) standard: cloxacillin or vancomycin for 4 weeks, associating aminoglucoside in the first 3-5 days; b) short; cloxacillin or vancomycin associated to gentamicin for 2 weeks with no ulterior treatment. The study was not randomized and the treatment of 2 weeks was compared with historic controls treated for 4 weeks. The criteria evaluated were those of clinical cure, relapse, appearance of complications during treatment and mortality. RESULTS: Both the standard treatment and the combination of cloxacillin or vancomycin with gentamicin for 2 weeks cured 100% of the episodes of right endocarditis by S. aureus. There were no relapses and mortality was nul. Neither were there any differences between the two groups with regard to appearance of complications. CONCLUSIONS: In intravenous drug addict patients with right-sided endocarditis by methicillin S. aureus, the association of cloxacillin and gentamicin for 2 weeks is an effective alternative to long (4 week) treatments with only one antibiotic. The low number of cases treated with vancomycin does not allow conclusions to be drawn on its efficacy.


Asunto(s)
Cloxacilina/administración & dosificación , Endocarditis Bacteriana/tratamiento farmacológico , Gentamicinas/administración & dosificación , Infecciones Estafilocócicas/tratamiento farmacológico , Abuso de Sustancias por Vía Intravenosa/complicaciones , Vancomicina/administración & dosificación , Adulto , Cloxacilina/uso terapéutico , Esquema de Medicación , Endocarditis Bacteriana/etiología , Femenino , Estudios de Seguimiento , Gentamicinas/uso terapéutico , Humanos , Masculino , Infecciones Estafilocócicas/etiología , Factores de Tiempo , Vancomicina/uso terapéutico
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