Asunto(s)
Antirretrovirales/administración & dosificación , Infecciones por VIH/tratamiento farmacológico , Lipodistrofia/etiología , Adulto , Antirretrovirales/efectos adversos , Brasil , Esquema de Medicación , Femenino , Humanos , Lipodistrofia/prevención & control , Masculino , Persona de Mediana Edad , Proyectos Piloto , Carga ViralRESUMEN
OBJECTIVE: To investigates how the use of HIV-1 resistance tests influences physician decision-making. METHODS: Ten experienced reference physicians from the Brazilian Network for Drug Resistance each received ten patients' case histories. The selected patients had experienced at least two virological failures. First, reference physicians were asked to empirically select a new regimen for each patient. Second, after genotype report (ViroSeq 2.6) was provided, and physicians were again asked to select a new regimen considering this additional information. Finally, they were asked to select a regimen after receiving a virtual phenotype result (vircoTYPE 3.9.00). RESULTS: In 79% of the cases, physicians changed their empirical choice of regimen after receiving the genotype report, resulting in an increase in the mean number of active drugs from 1.8 to 2.2 (p = 0.0003), while the average number of drugs/regimen remained at 4.0. After receipt of the virtual phenotype report, additional changes were made in 75% of the patient cases, resulting in an increase in the number of active drugs to 2.8 (p < 0.0001), while the average number of drugs/regimen remained at 4.0. After receipt of the genotype report, 48% of the changes were in NRTIs, 29% were in NNRTIs and 60% were in PIs; after consideration of the virtual phenotype, 61%, 10% and 49% of the changes, respectively, were in these categories of drugs. Fourteen percent of the physicians rated the genotype report as "extremely useful", whereas 34% rated the subsequent virtual phenotype report as "extremely useful" (p = 0.0003). CONCLUSIONS: Resistance testing has a significant impact on physicians' choices of antiretroviral salvage therapies, and it promotes the selection of more active drugs.
Asunto(s)
Fármacos Anti-VIH/uso terapéutico , Toma de Decisiones , Farmacorresistencia Viral , Infecciones por VIH/tratamiento farmacológico , VIH-1/efectos de los fármacos , Adulto , Brasil , Femenino , Genotipo , Infecciones por VIH/virología , VIH-1/genética , Humanos , Masculino , FenotipoAsunto(s)
Infecciones por VIH/tratamiento farmacológico , VIH-1/efectos de los fármacos , Pirimidinonas/uso terapéutico , Ritonavir/uso terapéutico , Brasil , Recuento de Linfocito CD4 , Combinación de Medicamentos , Resistencia a Múltiples Medicamentos/genética , Farmacorresistencia Viral/genética , Genotipo , Infecciones por VIH/sangre , Infecciones por VIH/virología , Inhibidores de la Proteasa del VIH/uso terapéutico , VIH-1/genética , Humanos , Lopinavir , Mutación , Estudios Prospectivos , ARN Viral/sangre , ARN Viral/genética , Tiempo , Factores de Tiempo , Resultado del TratamientoRESUMEN
Os autores descrevem um caso de fasciite necrotizante em nadegas e coxa esquerda secundaria a neoplasia perfurada de colon descendente. O diagnostico foi confirmado por tomografia abdominal. O tratamento consistiu de ressecçao do colon esquerdo com sepultamento do coto retal e colostomia terminal, multiplas incisoes na coxa e nadega E., antibioticoterapia e oxigenoterapia hiperbarica. Houve melhora progressiva do quadro septico e apos um ano procedeu-se a reconstruçao do transito