Navegando por Palavras-chave "Antiretroviral"

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    Baixa prevalência de não resposta virológica no resgate antirretroviral e fatores associados em uma coorte de pacientes vivendo com HIV-1 com falha virológica e resistência a múltiplos antirretrovirais
    (Universidade Federal de São Paulo (UNIFESP), 2019-12-18) Sachetti, Rachel Juliana [UNIFESP]; Ferreira, Paulo Roberto Abrão [UNIFESP]; Tenore, Simone de Barros [UNIFESP]; Tenore, Simone de Barros [UNIFESP]; http://lattes.cnpq.br/2681150056322250; http://lattes.cnpq.br/2681150056322250; http://lattes.cnpq.br/4420057010932690; Universidade Federal de São Paulo (UNIFESP)
    Introduction: The treatment of patients with antiretroviral resistance, involving the association of potent drugs with high genetic barrier is very effective. However, rescue therapies have been poorly studied in routine clinical care, outside the conditions of a randomized trial, especially in low- and middleincome countries. In this study, we evaluated factors associated with virological non-response in patients with antiretroviral resistance following rescue therapy. Objective: The primary objective was to analyze the rate of nonresponse to antiretroviral treatment in multi-experienced antiretroviral patients receiving rescue regimen. Factors associated with virological nonresponse were evaluated, comparing those with responders to the rescue scheme with nonresponding patients. Methodology: Retrospective cross-sectional analysis of medical records of multi-experienced patients undergoing antiretroviral rescue treatment at an Infectious Disease Day Clínic in the city of São Paulo, Brazil. Rescue treatment responders were those patients who had an undetectable viral load within 24 weeks of introduction of the antiretroviral rescue regimen. Resistance analysis was based on genotyping test. Those who, after 24 weeks of adherence, did not and who never presented undetectable viral load were considered nonresponders. Factors analyzed for non-response were: sex, age, viral load and LTCD4+ at the beginning of the treatment, time of viral load negativity among responders, associated comorbidities, previous opportunistic infections, antiretroviral history, number of active drugs in the regimen and use of new classes. Statistical analysis: Data were entered into Excel and analyzed using STATA statistical software version 13.0 (StataCorp LP, CollegeStation, Texas, USA). Results: In this study, 140 multi-experimented patients were analyzed from July 2008 to March 2016. At baseline, LTCD4+ greater than 200 cells / mm3 was observed in 52.1% of patients and viral load below 100,000 copies / mL (50.7%). The mean number of previous failures was 5 (1-12 failures), with an average of 159 months from diagnosis of HIV infection. Upon rescue, approximately half of the patients received 3 or 4 active medications. One hundred and twelve patients (80.0%) used new classes. One hundred and thirty one (93.5%) were considered responders to rescue treatment. The average response time was 6.7 months.xviii Nine patients continued with detectable viral load after salvage treatment (Prevalence: 6.4%; [95% CI 3.0 - 11.9]). In the bivariate analysis, the factors significantly associated with non-response, were: alcoholism (p = 0.048), less than two rescue active drugs (p = 0.007) and LT CD4 + less than 200 prior to rescue (p = 0.017). In the multiple logistic regression analysis, it was observed that LTCD4 + less than 200 cells / mm3 prior to the rescue treatment, and the use of less than two active drugs in ARV rescue was independently associated with virologic non-response. Conclusion: Multidrug-resistant patients with antiretroviral resistance who underwent rescue therapy had a high virologic response rate, with CD4 + LT less than 200 cells / mm3 prior to rescue and use of less than two active drugs were independently associated with treatment failure.
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    Bone mineral density and vitamin D concentration: the challenges in taking care of children and adolescents infected with HIV
    (Elsevier Brazil, 2017) Carmo, Fabiana Bononi [UNIFESP]; Terreri, Maria Teresa [UNIFESP]; de Menezes Succi, Regina Celia [UNIFESP]; Beltrao, Suenia Vasconcelos [UNIFESP]; Tome Barbosa Gouvea, Aida de Fatima [UNIFESP]; Cruz Paulino, Erica Regina [UNIFESP]; Machado, Daisy Maria [UNIFESP]
    Background: The increase in life expectancy for patients living with human immunodeficiency virus (HIV) infection has resulted in health complications related to a chronic disease. Objectives: To evaluate the prevalence of bone mineral density (BMD) alterations and vitamin D concentrations in HIV-infected children and adolescents and to verify the variations in those parameters during a 12-month interval. Methods: A prospective cohort study with a dual period of evaluation was conducted in 57 patients perinatally HIV-infected and one patient with sexual abuse in early infancy. Demographic, anthropometric, pubertal stage, viral load, T CD4+ cell count and antiretroviral therapy were evaluated. Biochemical tests and total body (TB) and lumbar spine (L1-L4) bone density evaluations by dual X-ray absorptiometry (DXA) were performed. Calcium or vitamin D supplements were prescribed if reduction in BMD or deficiency for vitamin D was detected. Results: 58 patients (ages 5.4-18.3 years
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    Trends in the management and outcome of HIV-1-infected women and their infants in the NISDI Perinatal and LILAC cohorts, 2002-2009
    (Elsevier B.V., 2013-07-01) Stoszek, Sonia K.; Duarte, Geraldo; Hance, Laura Freimanis; Pinto, Jorge; Gouvea, Maria I.; Cohen, Rachel A.; Santos, Breno; Teles, Elizabete; Succi, Regina [UNIFESP]; Alarcon, Jorge O.; Read, Jennifer S.; NISDI Perinatal LILAC Study Grp; WESTAT Corp; Universidade de São Paulo (USP); Universidade Federal de Minas Gerais (UFMG); Hosp Servidores Estado Saude; Hosp Nossa Senhora da Conceicao; Hosp Femina; Universidade Federal de São Paulo (UNIFESP); Univ Nacl Mayor San Marcos; Eunice Kennedy Shriver Natl Inst Child Hlth & Hum; US Dept HHS
    Objective: To describe temporal management and outcome trends among HIV-1-infected pregnant women and their infants enrolled in the NISDI Perinatal and LILAC cohorts. Methods: A prospective cohort of 1548 HIV-1-infected pregnant women and their 1481 singleton live-born infants was analyzed. Participants were enrolled at 24 Latin American and Caribbean sites and followed-up for at least 6 months postpartum. Variables were compared by 2-year enrollment periods from September 27, 2002, to June 30, 2009, using logistic and linear regression modeling. Results: Antiretroviral (ARV) use during pregnancy remained high (99.0%). ARVs became increasingly used for treatment (P < 0.001). Regimens containing 2 nucleoside reverse transcriptase inhibitors plus a protease inhibitor became more common in later years (P < 0.001). the proportion of women with viral loads below 1000 copies/mL at hospital discharge after delivery (HD) increased over time (P = 0.0031). Median CD4 lymphocyte counts also rose at HD, from 441 cell/mm(3) to 515 cells/mm(3) (P < 0.05). Elective cesarean deliveries increased from 30.5% to 42.0% (P = 0.018). Most infants received ARV prophylaxis (99.7%). Few infants were breastfed (0.5%) or became infected with HIV-1 (1.2%). Conclusion: the results indicate that national HIV-1 treatment and transmission prevention policies are effective among patients with healthcare access in the region. (c) 2013 Published by Elsevier Ireland Ltd. on behalf of International Federation of Gynecology and Obstetrics.