RESUMEN
OBJECTIVES: Analyze the decision to enact or to refrain from chemoprophylaxis (CP) with isoniazide (INH) in patients who are intravenous drug users (IVDU) in Spain infected by the human immunodeficiency virus (HIV), either classified or not with hypersensitive skin tests. METHODS: With the bibliographic information available and the help of decision tree, an analysis of the effectiveness and of the consequences of drug costs of CP with INH in those patients is performed. RESULTS: Overall, the HIV+ IVDU benefit from CP is an increase in survival of 80 days, with a savings of 7,252 pesetas per patient. The intradermal reaction with PPD and the retarded hypersensitivity tests (HCR) allow us to classify them in three subgroups: a) PPD+ where CP is universally admitted and thus corroborates our study; b) PPD-/HCR- where CP increases survival 201 days and saves 20,616 pesetas per patient; and c) PPD-/HCR+ where survival is increased 33 days and the pharmacological costs increase 1,536 pesetas per patient under CP. CONCLUSIONS: For the present situation in Spain, CP with INH is effective in HIV+ IVDU patients, independent of the results of the intradermal reaction skin tests.
Asunto(s)
Árboles de Decisión , Infecciones por VIH/complicaciones , Isoniazida/uso terapéutico , Abuso de Sustancias por Vía Intravenosa/complicaciones , Tuberculosis/prevención & control , Técnicas de Apoyo para la Decisión , Humanos , Tasa de Supervivencia , Prueba de Tuberculina , Tuberculosis/complicaciones , Tuberculosis/economía , Tuberculosis/mortalidadRESUMEN
An epidemic of a new illness involving multiple organ systems began in Spain in May 1981, with 19,828 cases and 315 deaths reported by June 1, 1982. An epidemiologic investigation has linked the occurrence of illness with ingestion of an unlabeled, illegally marketed cooking oil. To elucidate the natural history of this illness, we reviewed the medical records of 121 patients in one severely affected town 100 km northwest of Madrid. The findings during the first week after onset were those of a febrile, pneumonia-like illness. Gastrointestinal findings and striking eosinophilia became prominent later in the first month. Although the disease followed a self-limited course in many patients, severe neuromuscular manifestations (myalgia severe enough to restrict movement, motor deficits, atrophy of major muscle groups, and contractures of the jaw and extremities) occurred late in the course of the illness (an average of 96 days after onset) in 23 per cent of the patients. The onset of disease early in the epidemic and particularly severe initial systemic findings were associated with progression to neuromuscular illness.