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Background: Patients disengaged from HIV care, e.g., missed medication pick-ups, not attending physician visits, account for ≥70% of new HIV infections. Re-engaging and sustaining engagement is essential to controlling the HIV pandemic. This study tested a physician-delivered evidence-based intervention, Motivational Interviewing (MI), to improve health outcomes, adherence to antiretroviral therapy (ART), HIV virologic suppression, CD4+ count, retention in HIV care, and self-efficacy among patients disengaged from care in Argentina. Methods: Regional clinics (n = 6) were randomised to condition, MI Intervention or Enhanced Standard of Care (ESOC), and recruited N = 360 patients disengaged from HIV care. ART adherence, HIV RNA viral load, CD4+ count retention, and self-efficacy were assessed at baseline, 6, 12, 18, and 24-months. Indirect effects from condition to main outcomes were examined using patient-provider relationship as a mediator. The study was a cluster-randomised clinical trial entitled Conexiones y Opciones Positivas en la Argentina 2 (COPA2) and was registered at clinicaltrials.gov, NCT02846350. Findings: Participants were an average age of 39·15 (SD = 10·96), 51% were women; intervention participants were older (p = ·019), and more ESOC participants were women (60% vs. 42%, p = 0·001). Using mixed models, the intervention had no effect on ART adherence over time by condition on HIV RNA viral load, CD4+ count retention, or self-efficacy. However, analysing mediated paths, there was an indirect effect of condition on ART adherence (B = 0·188, p = 0·009), HIV viral load (B = -0·095, P = 0·027), and self-efficacy (B = 0·063, P = 0·001), suggesting the intervention was associated with improved patient-provider relationships, which was in turn associated with increased ART adherence, lower HIV viral load, and higher self-efficacy. Interpretation: These findings suggest that physician-delivered MI may enhance the patient-provider relationship, self-efficacy, and ART adherence, and reduced HIV viral load in patients disengaged from HIV care. However, these findings are preliminary due to the small number of clusters randomised, and replication is warranted. Funding: National Institutes of Health.
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BACKGROUND: Cumulative burden of multiple mental health conditions may worsen physical health outcomes in vulnerable populations. Accordingly, identifying cumulative burdens of mental health conditions that may affect HIV treatment and care can guide public health strategies to reduce their impact on HIV-related health outcomes. This study examined the relationship between the cumulative burden of mental health conditions and factors associated with engagement in HIV care in Argentina. METHOD: Data for this study was obtained at baseline from Conexiones y Opciones Positivas en la Argentina 2 (COPA2). Participants (N = 360) were cisgender patients living with HIV who were lost to care, recruited from seven clinics serving people living with HIV in four Argentine urban centers. Cumulative burden of mental health conditions (i.e., depressive symptoms, problematic substance use, unhealthy alcohol use, and psychotic symptoms) was assessed. RESULTS: Every one-point increase in the number of mental health conditions present was associated with a decrement in patient-provider communication (b = - 0.22, p < .001), self-efficacy (b = - 0.13, p = .012), and motivation for adherence (b = - 0.11, p = .039). CONCLUSION: This study found cumulative burden of depression, problematic substance use, unhealthy alcohol use, and psychotic symptoms to be negatively associated with factors related to engagement in HIV care. Results highlight the importance of identification and treatment of challenges to mental health, in order to ameliorate their influence on engagement in HIV care.
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Objective The present study compares immune and endocrine parameters between HIV-infected patients who underwent the Immune Reconstitution Inflammatory Syndrome (IRIS-P) during antiretroviral therapy (ART) and HIV-patients who did not undergo the syndrome (non-IRIS-P). Materials and methods Blood samples were obtained from 31 HIV-infected patients (15 IRIS-P and 16 non-IRIS-P) before ART (BT) and 48 ± 2 weeks after treatment initiation (AT). Plasma Interleukin-6 (IL-6) and Interleukin-18 (IL-18) were determined by ELISA. Cortisol, dehydroepiandrosterone sulfate (DHEA-S) and thyroxin concentrations were measured using chemiluminescence immune methods. Results Concentrations of IL-6 (7.9 ± 1.9 pg/mL) and IL-18 (951.5 ± 233.0 pg/mL) were significantly higher (p < 0.05) in IRIS-P than in non-IRIS-P (3.9 ± 1.0 pg/mL and 461.0 ± 84.4 pg/mL, respectively) BT. Mean T4 plasma level significantly decreased in both groups of patients after treatment (p < 0.05). In both groups cortisol levels were similar before and after ART (p > 0.05). Levels of DHEA-S in IRIS-P decreased AT (1080.5 ± 124.2 vs. 782.5 ± 123.8 ng/mL, p < 0.05) and they were significantly lower than in non-IRIS-P (782.5 ± 123.8 vs. 1203.7 ± 144.0 ng/mL, p < 0.05). IRIS-P showed higher values of IL-6 and IL-18 BT and lower levels of DHEA-S AT than in non-IRIS-P. Conclusion These parameters could contribute to differentiate IRIS-P from non-IRIS-P. The significant decrease in DHEA-S levels in IRIS-P after ART might suggest a different adrenal response in these patients, which may reflect the severity of the disease.
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Terapia Antirretroviral de Alta Atividade/efeitos adversos , Biomarcadores/sangue , Infecções por HIV/sangue , Síndrome Inflamatória da Reconstituição Imune/sangue , Relação CD4-CD8 , Sulfato de Desidroepiandrosterona/sangue , Ensaio de Imunoadsorção Enzimática , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/imunologia , Infecções por HIV/metabolismo , Humanos , Hidrocortisona/sangue , Síndrome Inflamatória da Reconstituição Imune/imunologia , Síndrome Inflamatória da Reconstituição Imune/metabolismo , Interleucina-18/sangue , Interleucina-6/sangue , Luminescência , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Tiroxina/sangue , Carga ViralRESUMO
Introducción: La infección por VIH puede asociarse a EPOC, sobre todo en estadios avanzados de enfermedad. La inflamación asociada al virus puede facilitar las alteraciones de la función respiratoria. Objetivos: Investigar la presencia de alteraciones de la función respiratoria en pacientes VIH positivos sin inmunocompromisoni hábito tabáquico. Comparar la función respiratoria de pacientes VIH con la población general(grupo control). Establecer la relación entre función pulmonar, sexo, edad del paciente, valor de CD4, uso de TARV,presencia de síntomas, enfermedad respiratoria y antecedentes de las mismas.Material y Métodos: Se realizó un estudio prospectivo, transversal, de tipo observacional y descriptivo. Luego deun análisis de la historia clínica y una entrevista en búsqueda de síntomas respiratorios, se estudiaron 68 pacientes,no fumadores, a los que se les realizó una espirometría. 46 (67%) eran VIH positivos (casos) y 22 (32,4%) VIH negativos (controles)...
Introduction: HIV infection can be associated with COPD, especially in advanced stages. Objectives: To investigate the presence of respiratory function alterations in HIV-positive patients without immunocompromiseor tobacco habit. Compare the respiratory function of HIV patients with the general population (control group).To establish the relationship between lung function and sex, age of the patient, CD4 value, use of ART, presence of symptoms, respiratory disease and history of symptoms. Material and Methods: A prospective, cross-sectional, observational and descriptive study was conducted. After a medical history analysis and an interview in search of respiratory symptoms, 68 patients, non-smokers, were studied and spirometry was performed. 46 (67%) were HIV positive (cases) and 22 (32.4%) were HIV negative (controls)...
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Humanos , Masculino , Feminino , Adulto , Infecções por HIV/complicações , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Doença Pulmonar Obstrutiva Crônica/patologiaRESUMO
ABSTRACT Objective The present study compares immune and endocrine parameters between HIV-infected patients who underwent the Immune Reconstitution Inflammatory Syndrome (IRIS-P) during antiretroviral therapy (ART) and HIV-patients who did not undergo the syndrome (non-IRIS-P). Materials and methods Blood samples were obtained from 31 HIV-infected patients (15 IRIS-P and 16 non-IRIS-P) before ART (BT) and 48 ± 2 weeks after treatment initiation (AT). Plasma Interleukin-6 (IL-6) and Interleukin-18 (IL-18) were determined by ELISA. Cortisol, dehydroepiandrosterone sulfate (DHEA-S) and thyroxin concentrations were measured using chemiluminescence immune methods. Results Concentrations of IL-6 (7.9 ± 1.9 pg/mL) and IL-18 (951.5 ± 233.0 pg/mL) were significantly higher (p < 0.05) in IRIS-P than in non-IRIS-P (3.9 ± 1.0 pg/mL and 461.0 ± 84.4 pg/mL, respectively) BT. Mean T4 plasma level significantly decreased in both groups of patients after treatment (p < 0.05). In both groups cortisol levels were similar before and after ART (p > 0.05). Levels of DHEA-S in IRIS-P decreased AT (1080.5 ± 124.2 vs. 782.5 ± 123.8 ng/mL, p < 0.05) and they were significantly lower than in non-IRIS-P (782.5 ± 123.8 vs. 1203.7 ± 144.0 ng/mL, p < 0.05). IRIS-P showed higher values of IL-6 and IL-18 BT and lower levels of DHEA-S AT than in non-IRIS-P. Conclusion These parameters could contribute to differentiate IRIS-P from non-IRIS-P. The significant decrease in DHEA-S levels in IRIS-P after ART might suggest a different adrenal response in these patients, which may reflect the severity of the disease.
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Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Biomarcadores/sangue , Infecções por HIV/sangue , Terapia Antirretroviral de Alta Atividade/efeitos adversos , Síndrome Inflamatória da Reconstituição Imune/sangue , Tiroxina/sangue , Ensaio de Imunoadsorção Enzimática , Hidrocortisona/sangue , Infecções por HIV/imunologia , Infecções por HIV/metabolismo , Infecções por HIV/tratamento farmacológico , Estudos Prospectivos , Interleucina-6/sangue , Relação CD4-CD8 , Sulfato de Desidroepiandrosterona/sangue , Carga Viral , Interleucina-18/sangue , Luminescência , Síndrome Inflamatória da Reconstituição Imune/imunologia , Síndrome Inflamatória da Reconstituição Imune/metabolismoRESUMO
INTRODUCTION: Soft-tissue sarcomas account for 0.7% of all malignant tumors, with an incidence rate of 3 per 100,000 persons/year. The undifferentiated pleomorphic sarcoma (UPS) with giant cells, a high grade tumor of soft tissue, is very unusual, especially in young adults before the age of 40. Human T-cell lymphotropic virus type 1 (HTLV-1) is a human retrovirus, classified as group 1 human carcinogens by The International Agency for Research on Cancer, that causes an aggressive malignancy known as adult T-cell lymphoma/leukemia and a progressive chronic inflammatory neurological disease named HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). HTLV-1 causes accumulation of genetic mutations in the host genome that could contribute to cellular transformation, one of the oncogenic features of HTLV-1. CASE REPORT: We describe a case of a young woman with UPS who suffered from HAM/TSP with 3 years of evolution. In 2013, the patient started with neurological symptoms: weakness in the legs and bladder dysfunction. One year later, the patient developed a mild paraparesis in both extremities, anti-HTLV-1 antibodies were detected in plasma and in cerebrospinal fluid, and HAM/TSP was confirmed. In November 2015, a benign ganglion cyst was first suspected without intervention and by March 2016 a sarcoma was diagnosed. Three weeks after surgical resection, the tumor aroused in deep tissue and behaved aggressively, implicating a curative wide resection of the fibula, joint reconstruction, and soft-tissue graft. Histopathological examination confirmed UPS with giant cells. CONCLUDING REMARKS: The unapparent subclinical immunodeficiency state due to HTLV-1 infection deserves to be considered in order to carefully monitor the possibility of developing any type of cancer. Besides, reaching an accurate and timely diagnosis of UPS can be challenging due to the difficulty in diagnosis/classification and delayed consultation. In this particular case, considering the high grade of UPS and the progressive invalidating myelopathy caused by HTLV-1, treatment should be carefully evaluated to positively impact on the patient's life expectancy.
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Objetivo. Describir la función sexual de un grupo de mujeres con VIH bajo tratamiento antirretroviral. Evaluar si existe diferencia entre las tratadas con un esquema que contiene Inhibidores No Nucleósidos de la Transcriptasa Inversa (INNTI) y aquéllas que reciben Inhibidores de la Proteasa (IP). Material y métodos. Estudio descriptivo, transversal. Muestra: 92 pacientes mujeres con VIH bajo tratamiento antirretroviral, que son asistidas en el Instituto Centralizado de Asistencia e Investigación Clínica Integral (CAICI). Instrumento: Se les realizó una encuesta que consta de características demográficas, preguntas referidas al VIH y al The Female Sexual Function Index (FSFI). Análisis estadístico: se utilizó ANOVA, Kruskall-Wallis, Chi cuadrado, regresión logística y alpha de Cronbach. Resultados. Edad media: 42±10 años; 65% tenían pareja estable, siendo el 73% de estas sero-discordantes. La mayoría (45,7%) estaban en tratamiento antirretroviral por más de dos años, con una media de CD4 mayor a 500 cél/ml y el 90% con carga viral plasmática indetectable. El 64,1% presentaba otra enfermedad asociada, por lo que el 55,4% tomaba medicación concomitante. El 27,2% continuó con su actividad sexual luego del diagnóstico de VIH, pero el 26,1% nunca la retomó. La puntuación total alcanzada por medio del FSFI fue de 20,4±10,1 para las tratadas con IP y 20±10,6 para las tratadas con INNTI (p <0,005). Conclusiones. La muestra analizada presentó un puntaje compatible con disfunción sexual. No hubo diferencia estadísticamente significativa en la función sexual de las mujeres tratadas con IP y las tratadas con INNTI(AU)
Summary Objective: To describe the sexual function in a group of women with HIV on antiretroviral treatment. To assess whether there is a difference between those treated with Non-nucleoside Inhibitors of he Reverse Transcriptase (NNRTI) and those receiving protease inhibitors (PIs). Material and methods: Descriptive, transversal study. Study sample: 92 women with HIV on antiretroviral therapy who are assisted in the Central Institute of Integral Assistance and Clinical Research (CAICI). Instrument: They completed a survey consisting of questions about demographic characteristics, HIV, and The Female Sexual Function Index (FSFI). Statistical analysis: ANOVA, Kruskal-Wallis, Chi-square, logistic regression and CronbachÆs alpha. Results: Average age was 42±10 years; 65% had a steady partner, of which 73% were sero-discordant. Most patients (45.7%) had been on antiretroviral treatment for more than two years, with a mean CD4 greater than 500 cells/ml and 90% with undetectable plasma viral load. Other illnesses were present in 64.1%, and 55.4% were taking concomitant medication. Sexual activity after HIV diagnosis was continued by 27.2%, while 26.1% never resumed it. The total score achieved by the FSFI was 20.4±10.1 among those treated with IP and 20.0±10.6 among those treated with NNRTI(p<0.005). Conclusions: The score in the present sample supports the existence of sexual dysfunction. There was no statistically significant difference in the sexual function of women treated with either PI or NNRTI(AU)
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Humanos , Feminino , Sexualidade/efeitos dos fármacos , HIV/efeitos dos fármacos , Resultado do Tratamento , Doenças Autoimunes/prevenção & controle , Inibidores da Protease de HIV/uso terapêutico , Inibidores da Transcriptase Reversa/uso terapêutico , Transcriptase Reversa do HIV/uso terapêuticoRESUMO
Objetivo. Describir la función sexual de un grupo de mujeres con VIH bajo tratamiento antirretroviral. Evaluar si existe diferencia entre las tratadas con un esquema que contiene Inhibidores No Nucleósidos de la Transcriptasa Inversa (INNTI) y aquéllas que reciben Inhibidores de la Proteasa (IP). Material y métodos. Estudio descriptivo, transversal. Muestra: 92 pacientes mujeres con VIH bajo tratamiento antirretroviral, que son asistidas en el Instituto Centralizado de Asistencia e Investigación Clínica Integral (CAICI). Instrumento: Se les realizó una encuesta que consta de características demográficas, preguntas referidas al VIH y al The Female Sexual Function Index (FSFI). Análisis estadístico: se utilizó ANOVA, Kruskall-Wallis, Chi cuadrado, regresión logística y alpha de Cronbach. Resultados. Edad media: 42±10 años; 65% tenían pareja estable, siendo el 73% de estas sero-discordantes. La mayoría (45,7%) estaban en tratamiento antirretroviral por más de dos años, con una media de CD4 mayor a 500 cél/ml y el 90% con carga viral plasmática indetectable. El 64,1% presentaba otra enfermedad asociada, por lo que el 55,4% tomaba medicación concomitante. El 27,2% continuó con su actividad sexual luego del diagnóstico de VIH, pero el 26,1% nunca la retomó. La puntuación total alcanzada por medio del FSFI fue de 20,4±10,1 para las tratadas con IP y 20±10,6 para las tratadas con INNTI (p <0,005). Conclusiones. La muestra analizada presentó un puntaje compatible con disfunción sexual. No hubo diferencia estadísticamente significativa en la función sexual de las mujeres tratadas con IP y las tratadas con INNTI
Summary Objective: To describe the sexual function in a group of women with HIV on antiretroviral treatment. To assess whether there is a difference between those treated with Non-nucleoside Inhibitors of he Reverse Transcriptase (NNRTI) and those receiving protease inhibitors (PIs). Material and methods: Descriptive, transversal study. Study sample: 92 women with HIV on antiretroviral therapy who are assisted in the Central Institute of Integral Assistance and Clinical Research (CAICI). Instrument: They completed a survey consisting of questions about demographic characteristics, HIV, and The Female Sexual Function Index (FSFI). Statistical analysis: ANOVA, Kruskal-Wallis, Chi-square, logistic regression and Cronbachs alpha. Results: Average age was 42±10 years; 65% had a steady partner, of which 73% were sero-discordant. Most patients (45.7%) had been on antiretroviral treatment for more than two years, with a mean CD4 greater than 500 cells/ml and 90% with undetectable plasma viral load. Other illnesses were present in 64.1%, and 55.4% were taking concomitant medication. Sexual activity after HIV diagnosis was continued by 27.2%, while 26.1% never resumed it. The total score achieved by the FSFI was 20.4±10.1 among those treated with IP and 20.0±10.6 among those treated with NNRTI(p<0.005). Conclusions: The score in the present sample supports the existence of sexual dysfunction. There was no statistically significant difference in the sexual function of women treated with either PI or NNRTI
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Humanos , Feminino , HIV , Resultado do Tratamento , Sexualidade , Inibidores da Protease de HIV , Doenças Autoimunes/prevenção & controle , Inibidores da Transcriptase Reversa/uso terapêutico , Transcriptase Reversa do HIV/uso terapêuticoRESUMO
Las onicomicosis son un grupo de afecciones ungueales causadas por dermatofitos, levaduras y hongos no dermatofitos, que pueden confundirse con otras onicopatías. Objetivos. 1. Aislar e identificar los hongos presentes en uñas de manos y pies en un grupo depacientes con infección por VIH que presenten lesiones compatibles con onicomicosis. 2. Comparar estos hallazgos con la microbiota presente en pacientes también VIH positivos pero que noevidencien clínica de onicomicosis. 3. Evaluar la asociación entre la afectación ungueal y diversas variables propias de la patología de base, como la cantidad de células CD4, carga viral, terapiaantirretroviral y otras comorbilidades.Materiales y métodos. En este estudio descriptivo, prospectivo, observacional, se evaluaron pacientes con y sin lesiones ungueales. Se observó el grado de afectación y se tomaron muestras deescamas de uñas, sometiéndolas a análisis micológico de rutina. Resultados. Se observó mayor frecuencia de onicomicosis en pacientes con carga viral mayor a 50copias/ml; así se obtuvo una asociación estadísticamente significativa entre estas variables (p <0,05), no observándose asociación entre la presencia de onicomicosis y el nivel de CD4 en sangre.Conclusiones. Destacamos la importancia de realizar el estudio micológico en pacientes VIH con onicopatías, debido a que hay diversas causas de afectación del lecho ungueal, más aún teniendoen cuenta los fracasos terapéuticos, las recidivas y las interacciones medicamentosas entre agentesantimicóticos y antirretrovirales. Dado que en este estudio preliminar encontramos asociaciones estadísticamente significativas entre algunas de las variables estudiadas, continuaremos con este trabajo con el fin de poder ampliar la información disponible sobre la etiopatogenia de las lesiones ungueales en pacientes VIH positivos...
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Humanos , Síndrome da Imunodeficiência Adquirida , Onicomicose/diagnóstico , Onicomicose/patologia , Antirretrovirais , AntifúngicosRESUMO
OBJECTIVES: To compare the efficacy and safety of an individualized treatment-simplification strategy consisting of switching from a highly-active anti-retroviral treatment (HAART) with a ritonavir-boosted protease inhibitor (PI/r) and 2 nucleoside reverse-transcriptase inhibitors (NRTIs) to lopinavir/ritonavir (LPV/r) monotherapy, with intensification by 2 NRTIs if necessary, to that of continuing their HAART. METHODS: This is a one-year, randomized, open-label, multi-center study in virologically-suppressed HIV-1-infected adults on their first PI/r-containing treatment, randomized to either LPV/r-monotherapy or continue their current treatment. Treatment efficacy was determined by plasma HIV-1 RNA viral load (VL), time-to-virologic rebound, patient-reported outcomes (PROs) and CD4+T-cell-count changes. Safety was assessed with the incidence of treatment-emergent adverse events (AE). RESULTS: Forty-one patients were randomized to LPV/r and 39 to continue their HAART. No statistically-significant differences between the two study groups in demographics and baseline characteristics were observed. At day-360, 71(39:LPV/r;32:HAART) patients completed treatment, while 9(2:LPV/r;7:HAART) discontinued. In a Last Observation Carried Forward Intent-to-Treat analysis, 40(98%) patients on LPV/r and 37(95%) on HAART had VL<200 copies/mL (Pâ=â0.61). Time-to-virologic rebound, changes in PROs, CD4+ T-cell-count and VL from baseline, also exhibited no statistically-significant between-group differences. Most frequent AEs were diarrhea (19%), headache (18%) and influenza (16%). Four (10%) patients on LPV/r were intensified with 2 NRTIs, all regaining virologic control. Eight serious AEs were reported by 5(2:LPV/r;3:HAART) patients. CONCLUSION: At day-360, virologic efficacy and safety of LPV/r appears comparable to that of a PI+2NRTIs HAART. These results suggest that our individualized, simplified maintenance strategy with LPV/r-monotherapy and protocol-mandated NRTI re-introduction upon viral rebound, in virologically-suppressed patients merits further prospective long-term evaluation. TRIAL REGISTRATION: ClinicalTrials.gov NCT00159224.
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Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/tratamento farmacológico , Lopinavir/uso terapêutico , Medicina de Precisão/métodos , Adulto , Idoso , Fármacos Anti-HIV/efeitos adversos , Terapia Antirretroviral de Alta Atividade/métodos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Feminino , Inibidores da Protease de HIV , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Inibidores da Transcriptase Reversa , Ritonavir/uso terapêutico , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: Non-nucleoside reverse transcriptase inhibitor-containing regimens may be a valid alternative to protease inhibitor-containing regimens for initial antiretroviral therapy, but to date few studies comparing these two strategies have been performed. OBJECTIVE: To evaluate the efficacy and safety of nelfinavir or nevirapine associated to zidovudine/lamivudine in HIV-infected naive patients. DESIGN: Randomized, open-label, multicentre trial. SETTING: Twelve centres in Spain (9) and Argentina (3). PATIENTS: One hundred and forty-two HIV-infected naive patients without AIDS. INTERVENTIONS: Patients received combivir (zidovudine 300 mg/lamivudine 150 mg, twice-daily) plus either nelfinavir (1250 mg) twice-daily (zidovudine/lamivudine/nelfinavir, n=70) or nevirapine (200 mg) twice-daily (zidovudine/lamivudine/nevirapine, n=72), and were followed for 12 months. The primary endpoint was the proportion of patients with a plasma HIV-1 RNA (pVL) of less than 200 copies/ml by PCR at 12 months. pVL of less than 20 copies/ml (PCR), changes in CD4 counts, clinical progression and adverse events were also evaluated. Efficacy was assessed using intent-to-treat (ITT) (missing=failure) and on-treatment analysis. RESULTS: At 12 months in the ITT analysis the proportion of patients with pVL below 200 copies/ml was 60% (95% CI 48.5-71.5) in the zidovudine/lamivudine/nelfinavir arm and 75% (95% CI 65-85) in the zidovudine/lamivudine/nevirapine arm (P=0.06), and the proportion below 20 copies/ml was 50% (95% CI 38.3-61.7) and 65% (95% CI 54.2-76.2), respectively (P=0.06). No differences were found when comparing the subgroup of patients with baseline pVL of more than 100,000 copies/ml. A gain of +173 and +162 CD4 cells/mm3, respectively, was observed. Zidovudine/lamivudine/nelfinavir was discontinued in 21% of patients, and zidovudine/lamivudine/nevirapine in 25%, due to toxicity (P>0.2). CONCLUSIONS: Our results suggest that zidovudine/lamivudine/nevirapine is at least as effective as zidovudine/lamivudine/nelfinavir as first-line therapy for HIV disease.
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Infecções por HIV/tratamento farmacológico , Inibidores da Protease de HIV/uso terapêutico , HIV-1 , Lamivudina/uso terapêutico , Nelfinavir/uso terapêutico , Nevirapina/uso terapêutico , Inibidores da Transcriptase Reversa/uso terapêutico , Zidovudina/uso terapêutico , Adulto , Idoso , Terapia Antirretroviral de Alta Atividade , Argentina , Estudos de Coortes , Quimioterapia Combinada , Feminino , Infecções por HIV/sangue , Humanos , Lamivudina/efeitos adversos , Masculino , Pessoa de Meia-Idade , Nelfinavir/efeitos adversos , Nevirapina/efeitos adversos , RNA Viral/análise , RNA Viral/sangue , RNA Viral/líquido cefalorraquidiano , Espanha , Resultado do Tratamento , Zidovudina/efeitos adversosRESUMO
Se realizó un estudio en base al seguimiento de 134 pacientes hospitalizados (105 de sexo masculino y 29 de sexo femenino) con infección por HIV/SIDA. Los pacientes se evaluaron teniendo en cuenta parámetros dermatológicos. El objetivo del trabajo es conocer las manifestaciones dermatológicas más frecuentes e intentar delucidar su relación con el recuento de los CD4 en nuestra población HIV/SIDA. Las manifestaciones cutáneas fueron clasificadas en dermatosis infecciosas y no infecciosas, dividiéndose estas últimas en tumorales y no tumorales (pigmentación, alergias, etc). Las dermatosis más frecuentemente halladas en casi todos los enfermos fueron las infecciosas. Las no infecciosas se presentaron en un 53 por ciento de los casos y los tumores en el 12 por ciento, siendo el más frecuente de ellos el sarcoma de Kaposi
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Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Síndrome da Imunodeficiência Adquirida/complicações , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Fármacos Anti-HIV/efeitos adversos , Candidíase/complicações , Herpes Zoster/complicações , Histoplasmose/complicações , Leucoplasia Pilosa/complicações , Linfoma/complicações , Molusco Contagioso/complicações , Sarcoma de Kaposi/complicações , Síndrome da Imunodeficiência Adquirida/diagnóstico , Dermatopatias/complicaçõesRESUMO
Se realizó un estudio en base al seguimiento de 134 pacientes hospitalizados (105 de sexo masculino y 29 de sexo femenino) con infección por HIV/SIDA. Los pacientes se evaluaron teniendo en cuenta parámetros dermatológicos. El objetivo del trabajo es conocer las manifestaciones dermatológicas más frecuentes e intentar delucidar su relación con el recuento de los CD4 en nuestra población HIV/SIDA. Las manifestaciones cutáneas fueron clasificadas en dermatosis infecciosas y no infecciosas, dividiéndose estas últimas en tumorales y no tumorales (pigmentación, alergias, etc). Las dermatosis más frecuentemente halladas en casi todos los enfermos fueron las infecciosas. Las no infecciosas se presentaron en un 53 por ciento de los casos y los tumores en el 12 por ciento, siendo el más frecuente de ellos el sarcoma de Kaposi (AU)
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Síndrome da Imunodeficiência Adquirida/complicações , Síndrome da Imunodeficiência Adquirida/diagnóstico , Fármacos Anti-HIV/efeitos adversos , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Histoplasmose/complicações , Candidíase/complicações , Herpes Zoster/complicações , Molusco Contagioso/complicações , Leucoplasia Pilosa/complicações , Sarcoma de Kaposi/complicações , Linfoma/complicações , Dermatopatias/complicaçõesRESUMO
La fiebre de origen desconocido (FOD) es frecuente en pacientes infectados por el HIV. Existen numerosas causas que pueden originar FOD y su frecuencia relativa depende de múltiples factores. Usualmente se debe de una infección oportunista agregada. La evaluación diagnóstica depende de la presentación clínica y del estadio de la infección por HIV. Existe una asociación entre el recuerdo de linfocitos CD4 y ciertas enfermedades oportunistas que pueden originar FOD. El área geográfica y la prevalencia local de infecciones endémicas es un factor importante. Las infecciones de distribución mundial como la tuberculosis siempre deben ser consideradas y otras como la histoplasmosis diseminada son causa frecuente de FOD en áreas endémicas como la Argentina. La mayor utilidad diagnóstica se obtiene con los cultivos de esputo y hemocultivos para microbacterias, y entre los métodos invasivos con cultivos a partir de la aspiración/biopsia de ganglio linfático, la biopsia de médula ósea y la biopsia hepática. La eficacia del tratamiento empírico ha sido documentada en ciertas infecciones.