RESUMO
OBJECTIVES: to determine the incidence and risk factors for nevirapine (NVP)-associated toxicity in a cohort of HIV-infected people in Buenos Aires, Argentina. DESIGN: retrospective study. METHODS: HIV-infected adults who received NVP-based highly active antiretroviral therapy (HAART) at least for 2 weeks between May 1997 and March 2008 were included in this study. We analyzed patients' age, gender, HIV transmission route, HIV disease stage, pregnancy, alcohol intake, adverse events, coinfection with hepatitis B or C virus, time until toxicity, and withdrawal rates. RESULTS: a total of 1110 patients (631 men) were included. Rash was the most frequently observed adverse event; it was more frequent in women. The incidence of severe rash and hepatotoxicity was similar in women and men. Female sex was the only variable significantly associated with mild-to-moderate rash. High CD4 count, pregnancy, and chronic hepatitis were not associated with NVP-related toxicity. An undetectable viral load at the time of starting NVP treatment resulted in a lower risk of NVP-related rash.
Assuntos
Fármacos Anti-HIV/efeitos adversos , Infecções por HIV/tratamento farmacológico , Nevirapina/efeitos adversos , Adulto , Argentina/epidemiologia , Contagem de Linfócito CD4 , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Análise Multivariada , Gravidez , Complicações Infecciosas na Gravidez/tratamento farmacológico , Complicações Infecciosas na Gravidez/virologia , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco , Distribuição por SexoRESUMO
A study was conducted on all newborns from mothers with Chagas disease who were attended at Hospital Donación F. Santojanni between January 1, 2001, and August 31, 2007. Each child was investigated for the presence of Trypanosoma cruzi parasitemia through direct examination of blood under the microscope using the buffy coat method on three occasions during the first six months of life. Serological tests were then performed. Ninety-four children born to mothers infected with Trypanosoma cruzi were attended over the study period. Three of these children were born to mothers coinfected with the human immunodeficiency virus. Vertical transmission of Chagas disease was diagnosed in 13 children, in all cases by identifying parasitemia. The overall Chagas disease transmission rate was 13.8% (13/94). It was 100% (3/3) among the children born to mothers with HIV infection and 10.9% (10/91) among children born to mothers without HIV [Difference = 0.89; CI95 = 0.82-0.95; p = 0.0021]. We concluded that coinfection with HIV could increase the risk of vertical transmission of Chagas disease.
Assuntos
Doença de Chagas/transmissão , Infecções por HIV/complicações , Transmissão Vertical de Doenças Infecciosas , Complicações Parasitárias na Gravidez , Trypanosoma cruzi , Animais , Doença de Chagas/complicações , Doença de Chagas/diagnóstico , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Recém-Nascido , Testes de Fixação do Látex , GravidezRESUMO
A study was conducted on all newborns from mothers with Chagas disease who were attended at Hospital Donación F. Santojanni between January 1, 2001, and August 31, 2007. Each child was investigated for the presence of Trypanosoma cruzi parasitemia through direct examination of blood under the microscope using the buffy coat method on three occasions during the first six months of life. Serological tests were then performed. Ninety-four children born to mothers infected with Trypanosoma cruzi were attended over the study period. Three of these children were born to mothers coinfected with the human immunodeficiency virus. Vertical transmission of Chagas disease was diagnosed in 13 children, in all cases by identifying parasitemia. The overall Chagas disease transmission rate was 13.8 percent (13/94). It was 100 percent (3/3) among the children born to mothers with HIV infection and 10.9 percent (10/91) among children born to mothers without HIV [Difference = 0.89; CI95 = 0.82-0.95; p = 0.0021]. We concluded that coinfection with HIV could increase the risk of vertical transmission of Chagas disease.
Foi realizado um estudo com todos os recém nascidos de mães chagásicas atendidas no Hospital Donación F. Santojanni, no período de1 de janeiro de 2001 a 31 de agosto de 2007. Cada criança foi submetida a pesquisa de parasitemia por Trypanosoma cruzi através do exame microscópico direto do sangue pelo método buffy coat, em três oportunidades, nos primeiros seis meses de vida. Após, foram realizados exames sorológicos. Foram avaliadas 94 crianças nascidas de mães infectadas com Trypanosoma cruzi durante o período do estudo. Três destas crianças eram filhas de mães co-infectadas pelo vírus da imunodeficiência humana. A transmissão vertical de doença de Chagas foi diagnosticada em 13 crianças, todos os casos por identificação de parasitemia. A taxa de transmissão global de doença de Chagas foi de 13,8 por cento (13/94); 100 por cento (3/3) entre os recém nascidos de mães infectadas com HIV e de 10,9 por cento (10/91) entre as crianças nascidas de mães sem HIV [Diferenta=0,89; IC95=0,82-0,95; p=0,0021]. Concluímos que a co-infecção com HIV pode aumentar o risco de transmissão vertical de doença de Chagas.