RESUMO
BACKGROUND: From October 2020 to October 2022, we conducted an implementation study to offer telemedicine (TM) across four HIV units of general public hospitals in Buenos Aires. The intervention used TM to provide a continuum of care to patients with HIV. METHODS AND SETTING: We used the RE-AIM framework to evaluate the strategy. The study started during a COVID-19 outbreak with strict lockdown policies and continued until return to normal practices. Implementation facilitation served as the core implementation strategy. RESULTS: We reached 4118 patients (58% of eligible individuals), and the main perceived benefits were the ability to avoid exposure to infectious diseases and reduced travel time and cost. After a median of 515 days of follow-up, 95.7% of participants with HIV were receiving antiretroviral therapy, and 87.8% were virally suppressed, with a median CD4+ count of 648 cells/µL. In total, 36.6% reported clinical events, and 20.4% presented with COVID-19 infection. The proportion of physicians adopting TM was 69.37%. After enrolment, 2406 of 5640 (43%) follow-up visits were conducted via TM. By the end of the study, 26.29% of appointments offered in the four centres were through TM, whereas 73.71% were in-person appointments. CONCLUSION: It was feasible to implement TM in the four centres in the public health sector in Buenos Aires, Argentina. It was acceptable for both patients and healthcare workers, and effectively reached a large proportion of the population served in these clinics. Both healthcare workers and patients consider it a model of care that will continue to be offered in the future.
Assuntos
COVID-19 , Infecções por HIV , SARS-CoV-2 , Telemedicina , Humanos , COVID-19/epidemiologia , COVID-19/prevenção & controle , Argentina/epidemiologia , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Pandemias , Continuidade da Assistência ao Paciente/organização & administraçãoRESUMO
Monkeypox is an endemic disease in several African countries. In May 2022, an outbreak was reported in dozens of non-endemic countries. On July 23, 2022, the WHO Director-General declared this multinational outbreak a public health emergency of international concern. We report two cases of patients under follow-up in Buenos Aires, Argentina, between June and July 2022. Both were men who have sex with men, with the appearance of lesions in the genital area without a prodromal period. In both cases, treatment was carried out in the first instance with suspicion of sexually transmitted infections. We highlight the importance of considering this pathology as a differential diagnosis, taking into account the current epidemiological context.
La viruela símica es una enfermedad endémica en varios países de áfrica. En mayo de 2022 varios países donde la viruela símica no es endémica notificaron casos, incluyendo algunos países de las Américas. El 23 de julio de 2022, el Director General de la OMS declaró que este brote multinacional constituye una emergencia de salud pública de importancia internacional. Comunicamos dos casos de pacientes en seguimiento en la Ciudad de Buenos Aires, Argentina, entre junio y julio de 2022. Ambos eran hombres que tienen sexo con hombres, con aparición de lesiones en zona genital sin período prodrómico. En los dos casos se realizó tratamiento en primera instancia con sospecha de infecciones de transmisión sexual. Señalamos la importancia de considerar esta enfermedad como diagnóstico diferencial teniendo en cuenta el contexto epidemiológico actual.
Assuntos
Mpox , Minorias Sexuais e de Gênero , Surtos de Doenças , Feminino , Seguimentos , Homossexualidade Masculina , Humanos , Masculino , Mpox/diagnóstico , Mpox/epidemiologiaRESUMO
Resumen La viruela símica es una enfermedad endémica en varios países de África. En mayo de 2022 varios países donde la viruela símica no es endémica notificaron casos, incluyendo algunos países de las Américas. El 23 de julio de 2022, el Director General de la OMS declaró que este brote multinacional constituye una emergencia de salud pública de importancia internacional. Comunicamos dos casos de pacientes en segui miento en la Ciudad de Buenos Aires, Argentina, entre junio y julio de 2022. Ambos eran hombres que tienen sexo con hombres, con aparición de lesiones en zona genital sin período prodrómico. En los dos casos se realizó tratamiento en primera instancia con sospecha de infecciones de transmisión sexual. Señalamos la importancia de considerar esta enfermedad como diagnóstico diferencial teniendo en cuenta el contexto epidemiológico actual.
Abstract Monkeypox is an endemic disease in several African countries. In May 2022, an outbreak was repor ted in dozens of non-endemic countries. On July 23, 2022, the WHO Director-General declared this multinational outbreak a public health emergency of international concern. We report two cases of patients under follow-up in Buenos Aires, Argentina, between June and July 2022. Both were men who have sex with men, with the appea rance of lesions in the genital area without a prodromal period. In both cases, treatment was carried out in the first instance with suspicion of sexually transmitted infections. We highlight the importance of considering this pathology as a differential diagnosis, taking into account the current epidemiological context.
RESUMO
BACKGROUND: Duration of viral shedding is a determinant of infectivity and transmissibility, but few data exist about oseltamivir's ability to alter viral shedding. METHODS: From January 2012 through October 2017, a randomized, double-blinded multicenter clinical trial was conducted in adults aged 18-64 years at 42 sites in Thailand, the United States, and Argentina. Participants with influenza A or B and without risk factors for complications of influenza were screened for the study. Eligible participants were randomized to receive oseltamivir 75 mg or placebo twice daily for 5 days. The primary endpoint was the percentage of participants with virus detectable by polymerase chain reaction in nasopharyngeal swab at day 3. RESULTS: Of 716 adults screened for the study, 558 were randomized, and 501 were confirmed to have influenza. Forty-six participants in the pilot study were excluded, and 449 of the 455 participants in the population for the primary analysis had day 3 viral shedding results. Ninety-nine (45.0%) of 220 participants in the oseltamivir arm had virus detected at day 3 compared with 131 (57.2%) of 229 participants in the placebo arm (absolute difference of -12.2% [-21.4%, -3.0%], P =; .010). The median time to alleviation of symptoms was 79.0 hours for the oseltamivir arm and 84.0 hours for the placebo arm (P =; .34) in those with confirmed influenza infection. CONCLUSIONS: Oseltamivir decreased viral shedding in this low-risk population. However, in the population enrolled in this study, it did not significantly decrease the time to resolution of clinical symptoms. CLINICAL TRIALS REGISTRATION: NCT01314911.
Assuntos
Antivirais , Influenza Humana , Adolescente , Adulto , Antivirais/uso terapêutico , Argentina/epidemiologia , Método Duplo-Cego , Humanos , Influenza Humana/tratamento farmacológico , Pessoa de Meia-Idade , Oseltamivir/uso terapêutico , Projetos Piloto , Tailândia , Resultado do Tratamento , Adulto JovemRESUMO
INTRODUCCIÓN Los errores de medicación son una amenaza para los pacientes que reciben drogas antirretrovirales (ARV) en el ámbito ambulatorio, exponiéndolos a toxicidad, suspensiones de tratamiento, fallo de tratamiento y resistencia a ARV. La prescripción electrónica es una estrategia utilizada en otros ámbitos para disminuir los errores de medicación y mejorar de esta manera la seguridad de los pacientes. METODOS Se llevo adelante un estudio de implementación de prescripción electrónica de ARV midiendo Alcance, Efectividad, Adopción, Implementación y Mantenimiento en dos hospitales públicos de la República Argentina, en un periodo atravesado por la pandemia COVID cuantitativo prospectivo de diseño hibrido tipo 3 dentro del marco RE-AIM. RESULTADOS La estrategia en su componente primario se comenzó a aplicar el 15/04/20. Los componentes secundarios fueron implementados parcialmente en forma sucesiva. Se logro un alcance del 95.2% de la población objetivo. Con respecto a la efectividad se evaluaron el número y tipo de errores. Previo a la implementación se identificaron 89 errores. Post intervención se identificaron 29. No se identificaron errores tipo E en el periodo post-intervencion. No hubo interrupciones estrictamente relacionadas a dificultad en la prescripción de la medicación, por el contrario, el mecanismo fue percibido favorablemente por todos los usuarios. La adopción de la estrategia fue generalizada por todo el equipo de salud y todos los estamentos. La implementación fue dificultosa por diferentes motivos y se vio atravesada por la pandemia COVID. Se logro la implementación al 100% del componente central de la intervención (dispensa sin receta en papel) pero no se implementaron todos los componentes secundarios. Se objetivo la inclusión sostenida de pacientes, la adherencia a TARV fue aceptable en mas de dos tercios de la población. 78% de los sujetos estaban indetectables previo a la intervención y 83% luego de la misma.DISCUSIÓN La estrategia pudo ser implementada, a pesar de las dificultades que atravesaron este periodo. Se observo un gran alcance y adopción, no se incrementaron los errores y se objetivo una alta adherencia a TARV y alta prevalencia de indetectabilidad en la población alcanzada. Se debe continuar trabajando en la implementación de los componentes secundarios para asegurar el mantenimiento de la estrategia en el largo plazo
Assuntos
Prescrição EletrônicaRESUMO
BACKGROUND: Efavirenz-based antiretroviral therapy (ART) regimens are preferred for treatment of adult HIV-positive patients co-infected with tuberculosis (HIV/TB). Few studies have compared outcomes among HIV/TB patients treated with efavirenz or non-efavirenz containing regimens. METHODS: HIV-positive patients aged ≥16 years with a diagnosis of tuberculosis recruited to the TB:HIV study between Jan 1, 2011, and Dec 31, 2013 in 19 countries in Eastern Europe (EE), Western Europe (WE), and Latin America (LA) who received ART concomitantly with TB treatment were included. Patients either received efavirenz-containing ART starting between 15 days prior to, during, or within 90 days after starting tuberculosis treatment, (efavirenz group), or other ART regimens (non-efavirenz group). Patients who started ART more than 90 days after initiation of TB treatment, or who experienced ART interruption of more than 15 days during TB treatment were excluded. We describe rates and factors associated with death, virological suppression, and loss to follow up at 12 months using univariate, multivariate Cox, and marginal structural models to compare the two groups of patients. RESULTS: Of 965 patients (647 receiving efavirenz-containing ART, and 318 a non-efavirenz regimen) 50% were from EE, 28% from WE, and 22% from LA. Among those not receiving efavirenz-containing ART, regimens mainly contained a ritonavir-boosted protease inhibitor (57%), or raltegravir (22%). At 12 months 1.4% of patients in WE had died, compared to 20% in EE: rates of virological suppression ranged from 21% in EE to 61% in WE. After adjusting for potential confounders, rates of death (adjusted Hazard Ratio; aHR, 95%CI: 1.13, 0.72-1.78), virological suppression (aHR, 95%CI: 0.97, 0.76-1.22), and loss to follow up (aHR, 95%CI: 1.17, 0.81-1.67), were similar in patients treated with efavirenz and non-efavirenz containing ART regimens. CONCLUSION: In this large, prospective cohort, the response to ART varied significantly across geographical regions, whereas the ART regimen (efavirenz or non-efavirenz containing) did not impact on the proportion of patients who were virologically-suppressed, lost to follow up or dead at 12 months.
Assuntos
Antirretrovirais/uso terapêutico , Antituberculosos/uso terapêutico , Infecções por HIV/tratamento farmacológico , Tuberculose/tratamento farmacológico , Adulto , Alcinos , Benzoxazinas/uso terapêutico , Ciclopropanos , Europa (Continente) , Europa Oriental , Feminino , Infecções por HIV/complicações , Infecções por HIV/mortalidade , Humanos , América Latina , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Estudos Prospectivos , Fatores de Risco , Taxa de Sobrevida , Resultado do Tratamento , Tuberculose/complicaçõesRESUMO
BACKGROUND: Optimal adherence is critical to achieve the benefits of antiretroviral treatment (ART). The aim of the study is to evaluate the use of mobile devices as a strategy to improve adherence to ART, measured by viral load (VL) in HIV+ patients less than 25 years of age. METHODS: A prospective study was conducted in a cohort of HIV+ patients less than 25 years of age. HIV+ patients, on ART, VL >1000 copies/mL, using mobile devices and suboptimal adherence were included. The intervention was based on a mobile generic contact twice a month using text message and Facebook during 32 weeks. Extended communications were generated by the patient. VL was performed before and after the intervention. RESULTS: Twenty-five patients were included. Three were excluded and 22 patients were enrolled. Mean age was 17.2 ± 6.1 years (range: 6-25); 15 (68%) were female; mean baseline VL was 25,100 copies/mL (range: 1020-500,000 copies/mL), mean log was 4.3 (range: 3-5.7 log). Each participant received a total of 16 contacts; 84% (296) were answered by the patient and 54% (189) of the contacts generated extended communications. After the strategy implementation, 20/22 VL results were available: 13/20 (65%) were undetectable, 14/20 (70%) had VL < 1000 copies/mL and 6/20 (30%) VLs had no changes. CONCLUSIONS: The use of mobile devices and social networks is a valid tool to improve ART adherence in HIV+ pediatric and young adults, evaluated through VL. The strategy is feasible. The reminder messages trigger additional communications between patients and health provider and better engagement with HIV care. Longer follow-up time is needed.
Assuntos
Antirretrovirais/uso terapêutico , Terapia Comportamental/métodos , Infecções por HIV/tratamento farmacológico , Comunicação em Saúde/métodos , Adesão à Medicação , Envio de Mensagens de Texto , Adolescente , Adulto , Argentina , Criança , Feminino , Humanos , Masculino , Estudos Prospectivos , Resultado do Tratamento , Carga Viral , Adulto JovemRESUMO
MARCO REFERENCIAL Múltiples investigaciones demostraron consistentemente, que las mujeres viviendo con VIH experimentan declinación en la adherencia y retención en el sistema de salud luego de un parto, a pesar del éxito de los programas de prevención de la transmisión madre-hijo/a y las bondades de las terapias antirretrovirales. El objetivo de este análisis es determinar si existe asociación entre la retención en cuidados en el sistema de salud y el diagnóstico de VIH durante el embarazo/ puerperio. MÉTODOS Estudio de cohorte retrospectivo en mujeres diagnosticadas con VIH en un hospital público del centro de la CABA durante el periodo ene/2000-jul/2015. Se evaluó la retención en cuidado (REC) de las pacientes al tercer año del seguimiento clínico y la pérdida de seguimiento (PS). Se realizó un análisis descriptivo de las características demográficas y clínicas de las pacientes. Las variables discretas se compararon a través del test X2 o Prueba exacta de Fisher según correspondiese y para variables continuas se utilizó el test de t o Mann-Whitney U-Test. Para investigar el efecto del diagnóstico de VIH en el embarazo/puerperio en la retención a los 3 años seguimiento, realizamos un análisis de corte transversal utilizando una modelo de regresión logística multivariable. Todos los análisis fueron realizados con el programa R versión 3.4.3. RESULTADOS La REC fue del 41.2% en las mujeres diagnosticadas durante el embarazo/puerperio versus 58.8% en aquellas diagnosticadas fuera de un embarazo/puerperio. La pérdida de seguimiento fue mayor en el grupo de las diagnosticadas durante un embarazo/parto comparada con las que no se diagnosticaron en dichas circunstancias; 52,3% vs 47,7% (P= 0,011). DISCUSIÓN Al tercer año del diagnóstico, las mujeres diagnosticadas con VIH durante el embarazo/puerperio, tuvieron una proporción menor de REC, una mayor pérdida de seguimiento, reflejando una deficiente cascada de atención en esta población
Assuntos
Gravidez , HIV , Perda de Seguimento , Retenção nos CuidadosRESUMO
El ergotismo es una complicación bien conocida, aunque poco fre-cuente, asociada a la ingesta de derivados de la ergotamina en dosis habitualmente más altas de las recomendadas. No obstante, también puede presentarse luego del uso de bajas dosis cuando se adminis-tran concomitantemente drogas que inhiben su metabolismo, entre ellas los inhibidores de proteasa (IP), ampliamente utilizados en el tra-tamiento de pacientes con infección por el virus de la inmunodeficien-cia humana (VIH). A pesar de esta interacción predecible se siguen observando en la práctica clínica diaria casos de ergotismo, probable-mente debido a que se trata de una droga de uso frecuente, bajo cos-to y que no requiere prescripción médica, sumado a la falta de conoci-miento del paciente de las potenciales interacciones. Se describen las características, diagnóstico, tratamiento y evolución de cuatro pacien-tes con infección por VIH en tratamiento antirretroviral (TARV), basa-do en IP, que presentaron un cuadro de ergotismo
Ergotism is a well-known but rare complication associated with the intake of ergotamine derivatives at doses usually higher than recommended. However, it may also occur after low doses of ergotamine when it is co-administered with drugs that inhibit its metabolism, such as protease inhibitors (PIs), widely used in the treatment of patients with human immunodeficiency virus. Despite this predictable interaction, cases of ergotism are still being observed in daily clinical practice, probably because it is a frequently used, low cost drug that does not require medical prescription, in addition to the patient's lack of knowledge of the potential interactions. We describe here the characteristics, diagnosis, treatment and evolution of four HIV-infected patients on PI-based antiretroviral treatment who presented a clinical picture of ergotism
Assuntos
Humanos , Masculino , Feminino , Inibidores de Proteases/uso terapêutico , Automedicação , Infecções por HIV/imunologia , Ergotismo , Terapia Antirretroviral de Alta Atividade , Ergotamina/administração & dosagem , Uso Indevido de Medicamentos sob PrescriçãoRESUMO
Cardiovascular risk is increased in HIV-infected patients and has become a leading cause of morbi-mortality in this population. The purpose of this study is to compare HIV-infected patients on antiretroviral therapy (ART) and ART-naïve HIV-infected patients regarding arterial elasticity. From September 2010 to September 2015, 105 HIV-infected subjects were enrolled, 41 ART-naïve and 64 on ART with stable viral suppression. Elasticity of large and small arteries (LAE and SAE) was assessed by analysis of radial pulse waveforms using a calibrated device. A single set of measurements was performed. Multivariate linear regression models were constructed to estimate independent correlates of arterial elasticity. On-ART and ART-naïve patients were similar with respect to gender, age, body mass index, Framingham cardiovascular risk score, smoking habits, and CD4+ counts. Median time on treatment was 60 months and 79% of patients were on regimens based on non-nucleoside reverse-transcriptase inhibitors. No significant differences in LAE and SAE assessments were found between groups. However, time on ART and cholesterol levels were independently associated with LAE impairment. No association between arterial elasticity and CD4+ counts was found. We conclude that cumulative exposure to ART may play a role on LAE impairment and deserves further investigation.
Assuntos
Fármacos Anti-HIV/uso terapêutico , Artérias/fisiopatologia , Elasticidade/fisiologia , Infecções por HIV/fisiopatologia , Resistência Vascular/fisiologia , Adulto , Terapia Antirretroviral de Alta Atividade , Estudos Transversais , Feminino , Infecções por HIV/tratamento farmacológico , Humanos , MasculinoRESUMO
Cardiovascular risk is increased in HIV-infected patients and has become a leading cause of morbimortality in this population. The purpose of this study is to compare HIV-infected patients on antiretroviral therapy (ART) and ART-naïve HIV-infected patients regarding arterial elasticity. From September 2010 to September 2015, 105 HIV-infected subjects were enrolled, 41 ART-naïve and 64 on ART with stable viral suppression. Elasticity of large and small arteries (LAE and SAE) was assessed by analysis of radial pulse waveforms using a calibrated device. A single set of measurements was performed. Multivariate linear regression models were constructed to estimate independent correlates of arterial elasticity. On-ART and ART-naïve patients were similar with respect to gender, age, body mass index, Framingham cardiovascular risk score, smoking habits, and CD4+ counts. Median time on treatment was 60 months and 79% of patients were on regimens based on non-nucleoside reverse-transcriptase inhibitors. No significant differences in LAE and SAE assessments were found between groups. However, time on ART and cholesterol levels were independently associated with LAE impairment. No association between arterial elasticity and CD4+ counts was found. We conclude that cumulative exposure to ART may play a role on LAE impairment and deserves further investigation.
El riesgo cardiovascular está incrementado en los pacientes HIV seropositivos y se ha convertido en una de las principales causas de morbimortalidad en esta población. El objetivo de este estudio fue comparar la elasticidad de grandes y pequeñas arterias (LAE y SAE) en pacientes infectados por HIV con y sin terapia antirretroviral. De septiembre de 2010 a septiembre de 2015 se enrolaron 105 pacientes con infección por HIV, 41 vírgenes de antirretrovirales y 64 con tratamiento estable en supresión viral. LAE y SAE fueron evaluados mediante análisis de la onda de pulso radial. Se construyeron modelos de regresión lineal múltiple para evaluar los predictores independientes de la elasticidad arterial. Los grupos en tratamiento y naïve fueron similares con respecto al sexo, edad, índice de masa corporal, índice de Framingham, tabaquismo y recuento de CD4+. La mediana de tiempo en tratamiento antirretroviral fue 60 meses y el 79% de los pacientes recibieron inhibidores no nucleosídicos. No hubo diferencias significativas entre los grupos en los valores de LAE y SAE. Sin embargo, el tiempo en tratamiento y el nivel de colesterol plasmático se asociaron independientemente con deterioro de LAE. No observamos asociaciones entre la elasticidad arterial y los recuentos de CD4+. Concluimos que la exposición acumulada al tratamiento antirretroviral podría contribuir al deterioro de la LAE. Este hallazgo merece ulterior investigación.
Assuntos
Humanos , Masculino , Feminino , Adulto , Artérias/fisiopatologia , Resistência Vascular/fisiologia , Infecções por HIV/fisiopatologia , Fármacos Anti-HIV/uso terapêutico , Elasticidade/fisiologia , Infecções por HIV/tratamento farmacológico , Estudos Transversais , Terapia Antirretroviral de Alta AtividadeRESUMO
BACKGROUND: Influenza continues to have a substantial socioeconomic and health impact despite a long established vaccination programme and approved antivirals. Preclinical data suggest that combining antivirals might be more effective than administering oseltamivir alone in the treatment of influenza. METHODS: We did a randomised, double-blind, multicentre phase 2 trial of a combination of oseltamivir, amantadine, and ribavirin versus oseltamivir monotherapy with matching placebo for the treatment of influenza in 50 sites, consisting of academic medical centre clinics, emergency rooms, and private physician offices in the USA, Thailand, Mexico, Argentina, and Australia. Participants who were aged at least 18 years with influenza and were at increased risk of complications were randomly assigned (1:1) by an online computer-generated randomisation system to receive either oseltamivir (75 mg), amantadine (100 mg), and ribavirin (600 mg) combination therapy or oseltamivir monotherapy twice daily for 5 days, given orally, and participants were followed up for 28 days. Blinded treatment kits were used to achieve masking of patients and staff. The primary endpoint was the percentage of participants with virus detectable by PCR in nasopharyngeal swab at day 3, and was assessed in participants who were randomised, had influenza infection confirmed by the central laboratory on a baseline nasopharyngeal sample, and had received at least one dose of study drug. Safety assessment was done in all patients in the intention-to-treat population. This trial is registered with ClinicalTrials.gov, number NCT01227967. FINDINGS: Between March 1, 2011, and April 29, 2016, 633 participants were randomly assigned to receive combination antiviral therapy (n=316) or monotherapy (n=317). Seven participants were excluded from analysis: three were not properly randomised, three withdrew from the study, and one was lost to follow-up. The primary analysis included 394 participants, excluding 47 in the pilot phase, 172 without confirmed influenza, and 13 without an endpoint sample. 80 (40·0%) of 200 participants in the combination group had detectable virus at day 3 compared with 97 (50·0%) of 194 (mean difference 10·0, 95% CI 0·2-19·8, p=0·046) in the monotherapy group. The most common adverse events were gastrointestinal-related disorders, primarily nausea (65 [12%] of 556 reported adverse events in the combination group vs 63 [11%] of 585 reported adverse events in the monotherapy group), diarrhoea (56 [10%] of 556 vs 64 [11%] of 585), and vomiting (39 [7%] of 556 vs 23 [4%] of 585). There was no benefit in multiple clinical secondary endpoints, such as median duration of symptoms (4·5 days in the combination group vs 4·0 days in the monotherapy group; p=0·21). One death occurred in the study in an elderly participant in the monotherapy group who died of cardiovascular failure 13 days after randomisation, judged by the site investigator as not related to study intervention. INTERPRETATION: Although combination treatment showed a significant decrease in viral shedding at day 3 relative to monotherapy, this difference was not associated with improved clinical benefit. More work is needed to understand why there was no clinical benefit when a difference in virological outcome was identified. FUNDING: National Institute of Allergy and Infectious Diseases, National Institutes of Health, USA.
Assuntos
Amantadina/uso terapêutico , Influenza Humana/tratamento farmacológico , Oseltamivir/administração & dosagem , Oseltamivir/uso terapêutico , Ribavirina/uso terapêutico , Amantadina/administração & dosagem , Antivirais/administração & dosagem , Antivirais/uso terapêutico , Argentina/epidemiologia , Austrália/epidemiologia , Método Duplo-Cego , Quimioterapia Combinada , Feminino , Humanos , Influenza Humana/epidemiologia , Masculino , México/epidemiologia , Ribavirina/administração & dosagem , Tailândia/epidemiologia , Estados Unidos/epidemiologiaRESUMO
En la actualidad, sabemos que los niños y púberes necesitan conocer sobre su salud o la de sus padres. No obstante, las familias afectadas por el virus de la inmunodeficiencia humana suelen demorar la revelación del diagnóstico por miedo al estigma y la discriminación o simplemente porque se preguntan cuándo y cómo comunicarlo. Presentamos la experiencia de aplicar un programa destinado a "revelar" el diagnóstico de virus de la inmunodeficiencia humana a niños, adolescentes y sus cuidadores. El objetivo fue describir y comprender el impacto del anuncio para colaborar en acciones que mejoraran la atención integral de las familias que vivían con el virus de la inmunodeficiencia humana.
Children and adolescents need to know about their health or that of their parents. However, families affected by human immunodeficiency virus often delay disclosure of diagnosis for fear of stigma or discrimination or simply because they wonder when and how to communicate it. We present the experience of implementing a program to "reveal" the human immunodeficiency virus diagnosis to children, adolescents and caregivers. The aim was to describe and understand the impact of disclosure and to collaborate on actions to improve comprehensive care for families living with human immunodeficiency virus.
Assuntos
Humanos , Criança , Adolescente , Revelação da Verdade , Infecções por HIV/diagnóstico , Cuidadores , Pesquisa QualitativaRESUMO
Children and adolescents need to know about their health or that of their parents. However, families affected by human immunodeficiency virus often delay disclosure of diagnosis for fear of stigma or discrimination or simply because they wonder when and how to communicate it. We present the experience of implementing a program to "reveal" the human immunodeficiency virus diagnosis to children, adolescents and caregivers. The aim was to describe and understand the impact of disclosure and to collaborate on actions to improve comprehensive care for families living with human immunodeficiency virus.
En la actualidad, sabemos que los niños y púberes necesitan conocer sobre su salud o la de sus padres. No obstante, las familias afectadas por el virus de la inmunodeficiencia humana suelen demorar la revelación del diagnóstico por miedo al estigma y la discriminación o simplemente porque se preguntan cuándo y cómo comunicarlo. Presentamos la experiencia de aplicar un programa destinado a "revelar" el diagnóstico de virus de la inmunodeficiencia humana a niños, adolescentes y sus cuidadores. El objetivo fue describir y comprender el impacto del anuncio para colaborar en acciones que mejoraran la atención integral de las familias que vivían con el virus de la inmunodeficiencia humana.
Assuntos
Cuidadores , Infecções por HIV , Revelação da Verdade , Adolescente , Criança , Infecções por HIV/diagnóstico , HumanosRESUMO
La infección por el virus de inmunodeficiencia humana produce una enfermedad sistémica crónica. El tratamiento con fármacos antirretrovirales altamente activos ha modificado la evolución de estos pacientes incrementando la sobrevida. En contraposición, asociadas a su enfermedad y/o a la medicación antirretroviral, se describen múltiples enfermedades crónicas que comprometen aún más la calidad de vida de estos pacientes. Nuestro objetivo es describir las alteraciones endocrinometabólicas en nuestros pacientes ambulatorios con infección por el virus de inmunodeficiencia humana y realizar una actualización del tema.
The human immunodeficiency virus causes a chronic systemic disease. Treatment with highly active antiretroviral drugs has changed the evolution of the disease, and increasing the rate of survival. However, due to the disease and/or the antiretroviral drugs, there are other multiple chronic diseases that compromise the quality of life of the patients even more. The aim of this study is to present endocrine and metabolic changes in outpatients with human immunodeficiency virus, and present an update of the related literature.
RESUMO
Recent findings from the START Trial provided evidence that early initiation of antiretroviral treatment should be implemented as the global standard of care. However, a large proportion of patients are still being diagnosed in late stages. Our objective was to evaluate the temporal trend in the CD4+ cell count at diagnosis during a 13 year period and the factors associated with late HIV diagnosis in asymptomatic individuals tested in the Centre for Prevention, Counselling and Diagnosis of our hospital. It was a retrospective study including all asymptomatic patients with new diagnosis of HIV infection. Very late presenters (VLP) were defined as those with CD4+ counts < 200 and late presenters (LP) with CD4+ < 350 cell/mm3. We also evaluated the proportion of patients diagnosed with CD4+ cell counts below 500 cell/mm3. Between January 2002 and December 2014, 20 263 patients were tested for HIV, 1104 with a positive result of whom 995 asymptomatic individuals were included. Overall, median CD4+ count was 372 cells/mm3 and HIV-RNA 31 145 copies/ml. There was no evidence that the CD4+ count at diagnosis progressively increased over time, nor that the proportion of VLP and LP decreased. In a multivariate model older age, heterosexual transmission and intravenous drug use remained as independent factors associated with LP. In conclusion, late diagnosis of HIV infection remains prevalent among asymptomatic patients, highlighting the need to continue implementing strategies towards early diagnosis.
Assuntos
Infecções Assintomáticas , Contagem de Linfócito CD4 , Diagnóstico Tardio/tendências , Infecções por HIV/diagnóstico , Adulto , Fatores Etários , Escolaridade , Feminino , Humanos , Modelos Logísticos , Masculino , Estudos Retrospectivos , Fatores de Risco , Comportamento Sexual , Fatores de Tempo , Carga ViralRESUMO
Recent findings from the START Trial provided evidence that early initiation of antiretroviral treatment should be implemented as the global standard of care. However, a large proportion of patients are still being diagnosed in late stages. Our objective was to evaluate the temporal trend in the CD4+ cell count at diagnosis during a 13 year period and the factors associated with late HIV diagnosis in asymptomatic individuals tested in the Centre for Prevention, Counselling and Diagnosis of our hospital. It was a retrospective study including all asymptomatic patients with new diagnosis of HIV infection. Very late presenters (VLP) were defined as those with CD4+ counts < 200 and late presenters (LP) with CD4+ < 350 cell/mm³. We also evaluated the proportion of patients diagnosed with CD4+ cell counts below 500 cell/mm3. Between January 2002 and December 2014, 20 263 patients were tested for HIV, 1104 with a positive result of whom 995 asymptomatic individuals were included. Overall, median CD4+ count was 372 cells/mm3 and HIV-RNA 31 145 copies/ml. There was no evidence that the CD4+ count at diagnosis progressively increased over time, nor that the proportion of VLP and LP decreased. In a multivariate model older age, heterosexual transmission and intravenous drug use remained as independent factors associated with LP. In conclusion, late diagnosis of HIV infection remains prevalent among asymptomatic patients, highlighting the need to continue implementing strategies towards early diagnosis.
Los resultados del estudio START han evidenciado que la iniciación temprana del tratamiento antirretroviral debe ser un estándar global. No obstante, una gran proporción de pacientes aún se diagnostican en etapas tardías. Nuestro objetivo fue evaluar la tendencia en el recuento de CD4+ al diagnóstico de infección por HIV, la proporción de presentadores tardíos entre 2002 y 2014, y los factores asociados con el diagnóstico tardío en pacientes asintomáticos en el Centro de Prevención, Asesoramiento y Diagnóstico de nuestro hospital. Se incluyeron en un estudio retrospectivo todos los sujetos asintomáticos con un diagnóstico de HIV. Se consideraron presentadores muy tardíos (PMT) a aquellos pacientes con CD4+ < 200 y presentadores tardíos (PT) con cifras de CD4+ < 350 células/mm³. Adicionalmente evaluamos la proporción de pacientes diagnosticados con recuentos de CD4+ inferiores a 500 células/mm³. Desde enero 2002 a diciembre de 2014 se testearon para HIV 20 263 pacientes, 1104 con resultado positivo, de los cuales 995 eran asintomáticos. Globalmente, la mediana de CD4+ fue 372 células/mm3 y la de HIV-ARN de 31 145 copias/ml. No hubo evidencia de que el recuento de CD4+ al diagnóstico haya aumentado en el tiempo, ni de disminución de la proporción de PT o PMT. En un modelo multivariado, la mayor edad, la transmisión heterosexual y el uso de drogas intravenosas se asociaron independientemente con PT. En conclusión, el diagnóstico tardío de infección por HIV se mantiene prevalente en pacientes asintomáticos, resaltando la necesidad de continuar implementando estrategias orientadas a favorecer el diagnóstico temprano.
Assuntos
Humanos , Masculino , Feminino , Adulto , Infecções por HIV/diagnóstico , Contagem de Linfócito CD4 , Diagnóstico Tardio/tendências , Infecções Assintomáticas , Comportamento Sexual , Fatores de Tempo , Modelos Logísticos , Estudos Retrospectivos , Fatores de Risco , Fatores Etários , Carga Viral , EscolaridadeRESUMO
INTRODUCCIÓN Se estima que cerca del 30% de los individuos infectados en la Argentina con el VIH desconocen su diagnóstico. En este escenario, se estima un incremento significativo de la población que recibe tratamiento antirretroviral (TARV) por el resto de su vida, por lo cual es esencial conocer la prevalencia de efectos adversos, así como su manejo adecuado. El Tenofovir, componente del TARV inicial en más del 90% de los casos, puede generar nefrotoxicidad. La enfermedad renal crónica (ERC) se presenta en un 17% aproximadamente de los pacientes VIH positivos. En el marco de la ausencia de datos locales de prevalencia de albuminuria como predictor de daño renal subclínico, se plantea este proyecto de investigación, para describir la prevalencia de albuminuria en una cohorte bien establecida de pacientes que inician tratamiento antirretroviral. OBJETIVOS 1. Describir la prevalencia de albuminuria en pacientes con diagnóstico de VIH que reciben TARV. 2. Analizar los factores asociados a enfermedad renal en pacientes con infección por VIH. MÉTODOS Estudio de corte transversal, se enrolaron en forma consecutiva pacientes mayores de 18 años, con diagnóstico de VIH, que aceptaran participar del estudio. Se les solicitó muestra única de orina (20 ml) y la albuminuria fue medida por un método cuantitativo, luego se diseñó un instrumento de captura, y se volcaron los datos. Los datos se analizaron utilizando el programa estadístico SPSS 20.0. RESULTADOS Participaron del estudio 285 pacientes. La mediana de edad fue de 43 años, con un 62% de hombres. La principal vía de transmisión de la infección por HIV, fue a través de relaciones sexuales, sin diferencias significativas entre heterosexuales y hombres que tienen sexo con hombres (51% vs 46% respectivamente). Un 24.3% de la población, presentó carga viral plasmática basal mayor a 100.000 copias/mm, la mediana de recuento de CD4 fue de 392 células/mm3. La totalidad de pacientes estaban en terapia antiretroviral al ingreso en el estudio, con una mediana de tiempo de tratamiento de 38 meses, de los cuales un 87% recibía Tenofovir como parte del esquema antiviral, y un 4.9% recibían otros tratamientos potencialmente nefrotóxicos, incluidas las sulfas. Solo un 5% de la población presento HTA. La mediana de RAC fue de 12 pero con una prevalencia de RAC fuera del rango normal de 44.1%. Se encontró una asociación estadísticamente significativa entre la exposición a drogas ARV (mediana de tiempo de tratamiento) y la presencia de hipertensión arterial con un resultado de la razón albuminuria/creatinuria en rango patológico (ambos con una p 0.003). DISCUSIÓN Los resultados hallados en el presente estudio permiten confirmar la hipótesis de que el tratamiento antirretroviral se asocia al desarrollo de albuminuria como marcador de daño renal subclínico, con un 40.1% de alteración de la función renal subclínica en pacientes en terapia antiviral. Sin embargo el número de pacientes enrolados fue significativamente menor al estimado según el cálculo de tamaño muestral, lo cual limita la interpretación de los resultados obtenidos. Dicho inconveniente no estuvo relacionado con el número de pacientes que cumplían con los criterios de inclusión, sino que estuvo asociado a diversos inconvenientes con la alternancia en la disponibilidad de reactivos para las determinaciones de RAC. Aun así, al día de la fecha continuamos con el enrolamiento consecutivo de pacientes, y el procesamiento de las muestras de orina para mejorar la precisión en nuestra valoración de la prevalencia del evento en estudio. Un posible confusor podría ser hipertensión arterial como factor independiente de desarrollo de insuficiencia renal, sin embargo la prevalencia de presión arterial elevada fue de 5.8% de la población. El tiempo de exposición al TARV tuvo una asociación significativa con el desarrollo de alteración de la función renal subclínica, sin embargo al tratarse de un estudio de prevalencia, no podemos afirmar que dicho evento se sostenga en el tiempo, por lo que creemos que se necesitarán de estudios de seguimiento (cohorte prospectiva) para confirmar la hipótesis
Assuntos
Proteinúria , Infecções por HIV , HIV-1 , Terapia Antirretroviral de Alta Atividade , AlbuminúriaRESUMO
Nearly 2 million people are infected with human immunodeficiency virus (HIV) in Latin America. However, information regarding population-scale outcomes from a regional perspective is scarce. We aimed to describe the baseline characteristics and therapeutic outcomes of newly-treated individuals with HIV infection in Latin America. A Retrospective cohort study was undertaken. The primary explanatory variable was combination antiretroviral therapy based on either a protease inhibitor (PI) or a non-nucleoside reverse transcriptase inhibitor (NNRTI). The main outcome was defined as the composite of all-cause mortality and the occurrence of an AIDS-defining clinical event or a serious non-AIDS-defining event during the first year of therapy. The secondary outcomes included the time to a change in treatment strategy. All analyses were performed according to the intention to treat principle. A total of 937 treatment-naive patients from four participating countries were included (228 patients with PI therapy and 709 with NNRTI-based treatment). At the time of treatment initiation, the patients had a mean age of 37 (SD: 10) years and a median CD4 + T-cell count of 133 cells/mm(3) (interquartile range: 47.5-216.0). Patients receiving PI-based regimens had a significantly lower CD4 + count, a higher AIDS prevalence at baseline and a shorter time from HIV diagnosis until the initiation of treatment. There was no difference in the hazard ratio for the primary outcome between groups. The only covariates associated with the latter were CD4 + cell count at baseline, study site and age. The estimated hazard ratio for the time to a change in treatment (NNRTI vs PI) was 0.61 (95% CI 0.47-0.80, p < 0.01). This study concluded that patients living with HIV in Latin America present with similar clinical outcomes regardless of the choice of initial therapy. Patients treated with PIs are more likely to require a treatment change during the first year of follow up.
Assuntos
Fármacos Anti-HIV/uso terapêutico , Contagem de Linfócito CD4 , Infecções por HIV/tratamento farmacológico , Inibidores da Transcriptase Reversa/uso terapêutico , Carga Viral/efeitos dos fármacos , Adolescente , Adulto , Terapia Antirretroviral de Alta Atividade , Estudos de Coortes , Feminino , Infecções por HIV/etnologia , Infecções por HIV/mortalidade , Humanos , Estimativa de Kaplan-Meier , América Latina/epidemiologia , América Latina/etnologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Taxa de Sobrevida , Adulto JovemRESUMO
Antiretroviral adherence in the postpartum period is crucial for maternal health and decreasing the risk of mother-to-child HIV transmission and transmission to sexual partners. Self-reported antiretroviral adherence was examined between 6- to 12-weeks and 30 months postpartum among 270 HIV-infected women enrolled in a prospective cohort study from 2008 to 2010 at multiple sites in Latin America. Adherence data were collected at each study visit to quantify the proportion of prescribed antiretrovirals taken during the previous three days, assess the timing of the last missed dose, and identify predictors of adherence. Mean adherence rates were 89.5% at 6-12 weeks and 92.4% at 30 months; the proportions with perfect adherence were 80.3% and 83.6%, respectively. The overall trend for perfect adherence was not significant (p = 0.71). In adjusted regression modelling, younger age was associated with an increased probability of non-perfect adherence at 18 and 24 months postpartum. Other factors associated with increased probability of non-perfect adherence were higher parity, current use of alcohol and tobacco, and more advanced HIV disease. Women with perfect adherence had lower viral loads. Interventions for alcohol and tobacco use cessation, and support for young women and those with advanced HIV disease should be considered to improve postpartum adherence.