RESUMO
INTRODUCTION: Recently, there has been increasing interest in the role of "treatment as prevention" (TasP). Some of the questions regarding TasP strategies arise from the perceived difficulties in achieving and maintaining viral load (VL) suppression over time and the risk of emergence of viral resistance that could compromise future treatment options. This study was conducted to assess these questions in a resource-limited setting. METHODOLOGY: We performed a retrospective observational study of HIV-infected patients diagnosed in the pre-HAART era on follow-up at a private center from Buenos Aires, Argentina. Socio-demographic, clinical, and laboratory data were extracted from clinical charts. Analyses were performed to test for potential associations of selected variables with current virologic failure or use of third-line drugs. RESULTS: Of 619 patients on follow-up, 82 (13.2%) were diagnosed in the pre-HAART era. At the time of our study, 79 (96.3%) patients were on HAART, with a median duration of 14 years (IQR 12-15) of therapy, and exposure to mono or dual nucleoside reverse transcriptase inhibitors regimens in 47.8% of cases. Sixty-nine patients (87.3%) had undetectable VL, 37 (46.8%) never presented virologic failure, and 19 (24.1%) experienced only one failure. Thirteen patients (16.5%) were receiving third-line ART regimens, with an average of 2.7-fold more virologic failures than those on first- or second-line regimens (p = 0.007). CONCLUSIONS: Maintaining viral load suppression over time in resource-limited-settings is feasible.
Assuntos
Fármacos Anti-HIV/administração & dosagem , Quimioprevenção/métodos , Infecções por HIV/tratamento farmacológico , Infecções por HIV/prevenção & controle , HIV/isolamento & purificação , Carga Viral , Adolescente , Adulto , Fármacos Anti-HIV/farmacologia , Argentina , Estudos de Coortes , Países em Desenvolvimento , Farmacorresistência Viral , Feminino , HIV/efeitos dos fármacos , Infecções por HIV/virologia , Humanos , Masculino , Estudos Retrospectivos , Falha de Tratamento , Adulto JovemRESUMO
Post-operative fever incidence varies widely. In clean and clean-contaminated surgery the non-infectious fever is more frequent than the infectious fever. We performed a prospective study including 303 patients who underwent orthopedic and urologic elective surgery. The aims of our study were to investigate the incidence of post-operative fever, its etiology, the relationship between time of onset and the etiology, and the usefulness of extensive fever work-up to determine post-operative infection. The incidence of post-operative fever was 14% (42/303) of which 81% (34/42) was noninfectious and 19% (8/42) was infectious. The etiology of the fever in the first 48 hours after surgery was always non-infectious (p < 0.001). An extensive fever work-up was performed in patients who presented fever only after the initial 48 hours of surgery with normal physical examination (n = 19) consisting of chest x-ray, blood (2) and urine cultures. The chest x-ray was normal in all the patients, the urine cultures were positive in four cases (21%, IC 95%: 6-45) and the blood cultures in only one case (5%, IC 95%: 0.1-26). Seven patients had post-operative infections without fever as a clinical sign. The most frequently observed etiology of post-operative fever was non-infectious, related to the normal inflammatory host response to surgery. Based on the present results, the extensive fever work-up performed to investigate post-operative infection does not seem to be a useful tool. The diagnosis of post-operative infection was based on clinical follow up and the correct interpretation of the patient's symptoms and signs.
Assuntos
Febre de Causa Desconhecida/epidemiologia , Procedimentos Ortopédicos/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Infecção da Ferida Cirúrgica/epidemiologia , Procedimentos Cirúrgicos Urológicos/efeitos adversos , Adolescente , Adulto , Idoso , Argentina/epidemiologia , Feminino , Febre de Causa Desconhecida/etiologia , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Prospectivos , Infecção da Ferida Cirúrgica/complicações , Infecções Urinárias/complicações , Infecções Urinárias/epidemiologia , Adulto JovemRESUMO
La incidencia de fiebre en el postoperatorio varía ampliamente. En la cirugía limpia y la limpia-contaminada, la fiebre no infecciosa es más frecuente que la infecciosa. Fueron estudiados prospectivamente 303 pacientes operados en forma programada de cirugía ortopédica y urológica. Se investigó la incidencia de fiebre postoperatoria, su etiología, la relación entre el momento de su aparición y su origen y la utilidad del pedido empírico de estudios para determinar infección postoperatoria. El 14% (42/303) de los pacientes tuvieron fiebre postoperatoria. En el 81% (34/42) su etiología fue no infecciosa y en el 19% (8/42) infecciosa. Su origen fue siempre no infeccioso dentro de las primeras 48 horas del postoperatorio (p<0.001). A 19 pacientes con fiebre después de las 48 horas y examen clínico normal, se les realizó radiografía de tórax, hemocultivos (2) y cultivo de orina. Las radiografías de tórax fueron normales en todos los casos, fueron positivos 4 urocultivos (21%, IC 95%: 6-45) y un hemocultivo (5%, IC 95%: 0.1-26). Siete pacientes tuvieron infecciones postoperatorias sin fiebre. La causa de fiebre postoperatoria más frecuente fue no infecciosa, causada por respuesta normal inflamatoria al trauma quirúrgico. La realización de estudios de rutina en pacientes con examen clínico normal y fiebre posterior a las 48 horas, de acuerdo a lo observado en este estudio, no permite sacar conclusiones definitivas. El diagnóstico de las infecciones postoperatorias se basó en el seguimiento clínico- quirúrgico y en la interpretación de los síntomas y signos del paciente.
Post-operative fever incidence varies widely. In clean and clean-contaminated surgery the non-infectious fever is more frequent than the infectious fever. We performed a prospective study including 303 patients who underwent orthopedic and urologic elective surgery. The aims of our study were to investigate the incidence of post-operative fever, its etiology, the relationship between time of onset and the etiology, and the usefulness of extensive fever work-up to determine post-operative infection. The incidence of post-operative fever was 14% (42/303) of which 81% (34/42) was noninfectious and 19% (8/42) was infectious. The etiology of the fever in the first 48 hours after surgery was always non-infectious (p<0.001). An extensive fever work-up was performed in patients who presented fever only after the initial 48 hours of surgery with normal physical examination (n=19) consisting of chest x-ray, blood (2) and urine cultures. The chest x-ray was normal in all the patients, the urine cultures were positive in four cases (21%, IC 95%: 6-45) and the blood cultures in only one case (5%, IC 95%: 0.1-26). Seven patients had post-operative infections without fever as a clinical sign. The most frequently observed etiology of post-operative fever was non-infectious, related to the normal inflammatory host response to surgery. Based on the present results, the extensive fever work-up performed to investigate post-operative infection does not seem to be a useful tool. The diagnosis of post-operative infection was based on clinical follow up and the correct interpretation of the patient's symptoms and signs.
Assuntos
Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Febre de Causa Desconhecida/epidemiologia , Procedimentos Ortopédicos/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Infecção da Ferida Cirúrgica/epidemiologia , Procedimentos Cirúrgicos Urológicos/efeitos adversos , Argentina/epidemiologia , Seguimentos , Febre de Causa Desconhecida/etiologia , Incidência , Período Pós-Operatório , Estudos Prospectivos , Infecção da Ferida Cirúrgica/complicações , Infecções Urinárias/complicações , Infecções Urinárias/epidemiologiaRESUMO
Estudio sobre la incidencia de nuevas enfermedades de trasmisión sexual posteriores al diagnóstico de VIH, cuyo objetivo es evidenciar la frecuencia de conductas sexuales de riesgo en personas que viven con SIDA; y para el que se tomaron datos de las historias clínicas de pacientes con seguimiento regular entre Diciembre de 1998 y Diciembre de 2003, evaluados como adherentes al tratamiento
Assuntos
Síndrome da Imunodeficiência Adquirida , Infecções Sexualmente Transmissíveis/epidemiologiaRESUMO
Estudio sobre la incidencia de nuevas enfermedades de trasmisión sexual posteriores al diagnóstico de VIH, cuyo objetivo es evidenciar la frecuencia de conductas sexuales de riesgo en personas que viven con SIDA; y para el que se tomaron datos de las historias clínicas de pacientes con seguimiento regular entre Diciembre de 1998 y Diciembre de 2003, evaluados como adherentes al tratamiento
Assuntos
Síndrome da Imunodeficiência Adquirida , Infecções Sexualmente TransmissíveisAssuntos
Humanos , Emergências , Unidades de Terapia Intensiva/normas , Infecções Bacterianas/tratamento farmacológico , Meningites Bacterianas/tratamento farmacológico , Meningites Bacterianas/microbiologia , Endocardite Bacteriana/tratamento farmacológico , Endoftalmite/tratamento farmacológico , Celulite/tratamento farmacológico , Antibacterianos/uso terapêuticoAssuntos
Humanos , Infecções Bacterianas/tratamento farmacológico , Emergências , Unidades de Terapia Intensiva/normas , Antibacterianos/uso terapêutico , Celulite (Flegmão)/tratamento farmacológico , Endocardite Bacteriana/tratamento farmacológico , Endoftalmite/tratamento farmacológico , Meningites Bacterianas/tratamento farmacológico , Meningites Bacterianas/microbiologiaRESUMO
El 18 de junio de 1986 se efectuó en el Hospital de Clínicas José de San Martín un estudio para evaluar el uso de los antibióticos en pacientes internados y los gastos que surgen de su empleo inadecuado. El 28% de los internados recibían antibióticos, el 69% de las indicaciones con finalidad terapéutica y el 35% de las profilaxisis fueron correctas. El error más frecuente en el tratamiento fue el uso del antibiótico no electivo y en la profilaxis, la utilización innecesaria. El gasto por uso inadecuado fue de u$s 494.17 en un día, u$s 14.825 en un mes y u$s 180.372 por año
Assuntos
Humanos , Masculino , Feminino , Antibacterianos/uso terapêutico , Custos de Medicamentos , Uso de Medicamentos/economia , ArgentinaRESUMO
El 18 de junio de 1986 se efectuó en el Hospital de Clínicas José de San Martín un estudio para evaluar el uso de los antibióticos en pacientes internados y los gastos que surgen de su empleo inadecuado. El 28% de los internados recibían antibióticos, el 69% de las indicaciones con finalidad terapéutica y el 35% de las profilaxisis fueron correctas. El error más frecuente en el tratamiento fue el uso del antibiótico no electivo y en la profilaxis, la utilización innecesaria. El gasto por uso inadecuado fue de u$s 494.17 en un día, u$s 14.825 en un mes y u$s 180.372 por año (AU)