RESUMO
INTRODUCTION AND OBJECTIVES: Implementation of a one-step strategy for diagnosis of active Hepatitis C virus (HCV) infection would encourage the early diagnosis and reduce the time to access antiviral treatments. The aim of this study was to evaluate the impact of a HCV one-step diagnosis compared to the traditional two-step protocol in terms of the time required for patients to be seen by specialists and the time taken to start antiviral treatment. MATERIAL AND METHODS: A comparative study was carried out to assess two diagnostic algorithms (one-step and two-step) for active HCV infection. Serological markers were quantified using the same serum sample to determine both anti-HCV antibodies (HCV-Ab) and HCV core antigen (HCV-cAg) by Architect i2000 SR kit. In this period, a multidisciplinary procedure was started for telematics referral of viremic patients. RESULTS: One-step approach reduced the time required for patient HCV diagnosis, referral to a specialist, access to treatment, and eliminated the loss of patients to follow-up. Significant differences were observed between one-step and two-step diagnosis methods in the time required for patients to be seen by a specialist (18 days [Interquartile range (IQR) = 14-42] versus 107 days [IQR = 62-148]) and for the initiation of treatment (54 days [IQR = 43-75] versus 200 days [IQR = 116-388]), mainly for patients with advanced fibrosis (35 days [IQR = 116-388] versus 126 days [IQR = 152-366]). CONCLUSIONS: Use of HCV-cAg has proven to be a useful tool for screening patients with active hepatitis C. The development of a multidisciplinary protocol for the communication of results improved the efficiency of the care process.
Assuntos
Antivirais/uso terapêutico , Hepacivirus/imunologia , Anticorpos Anti-Hepatite C/análise , Antígenos da Hepatite C/análise , Hepatite C/diagnóstico , Telemedicina/métodos , Feminino , Hepatite C/tratamento farmacológico , Hepatite C/virologia , Humanos , MasculinoRESUMO
Notificamos un caso de microangiopatía trombótica, caracterizado por un proceso de agregación plaquetaria amenazante para la vida, que presentó afectación multisistémica y rápida evolución en una paciente con infección por el VIH. En este caso exponemos ampliamente los síntomas, la evolución y, finalmente, la necropsia clínica. Esta enfermedad es ahora infrecuente tras la llegada de los antirretrovirales de gran actividad, no obstante, se presenta con síntomas inespecíficos y evoluciona rápidamente a la afectación multisistémica y muerte. En consecuencia, un diagnóstico precoz con base en criterios clínicos y analíticos es fundamental para instaurar el tratamiento adecuado y mejorar la supervivencia.
We report on a case of thrombotic microangiopathy, defined as an extensive and dangerous intravascular platelet aggregation disorder, which progressed to multisystem involvement in a patient with HIV infection. For this clinical case, we detail the symptoms, evolution and, ultimately, the clinical autopsy. This disease is now uncommon due to the arrival of highactivity antiretroviral drugs; however, it can appear with nonspecific symptoms and rapidly progress to multisystem involvement and death. An accurate diagnosis on the basis of clinical and analytical criteria is essential to starting treatment and improving survival.