RESUMO
Objective: Data on the frequency of cardiovascular disease in people living with human immunodeficiency virus from low- and middle-income countries is scarce. Methods: We performed an observational study based on data from a historical cohort of people living with human immunodeficiency virus in Colombia during a 10-year follow-up to describe the prevalence of cardiovascular risk factors and their behavior according to CD4 count. Results: One thousand patients were initially included, out of which 390 had a 10-year follow-up. The mean age was 34 (standard deviation 10) years, and 90% were male. We observed an increase in the prevalence of dyslipidemia (29%-52%, p < 0.001) and obesity (1.1%-3.5%, p < 0.001). Major cardiovascular events occurred in less than 1% of patients. Patients with a CD4 count <200 cells/mm3 had a higher frequency of acute myocardial infarction and obesity. Conclusion: Over time, people living with human immunodeficiency virus present with an increasing prevalence of cardiovascular risk factors, particularly those with a lower CD4 count.
RESUMO
Los pacientes con infección por VIH tienen una mayor incidencia de eventos cardiovasculares en comparación con la población general; los factores que contribuyen al incremento del riesgo de eventos cardiovasculares son la prevalencia de factores de riesgo cardiovascular tradicionales (FRCV), la infección por VIH que condiciona tanto un proceso de inflamación crónica como alteración de la función endotelial y la exposición a los antirretrovirales. Los factores que deben ser objeto de intervención son los FRCV tradicionales, en especial la alta tasa de fumadores entre este grupo de pacientes, la tamización y tratamiento de HTA, el síndrome metabólico y el acceso temprano a la terapia antirretroviral con medicamentos con mayor perfil de seguridad . Esta guía pretende proveer información y recomendaciones en el ámbito nacional acerca de la relación entre la infección por VIH/SIDA (Síndrome de Inmunodeficiencia Adquirida), uso de antirretrovirales y riesgo cardiovascular.
Patients with VIH infection have greater risk for cardiovascular diseases compared to general population. Risk factors that increase the frequency of cardiovascular events are: presence of cardiovascular traditional risk factors, chronic inflammation by HIV that impairs endothelial function and the exposure to antiretrovirals. The factors that should be the target for intervention are the traditional know cardiovascular factors such, especially high rate of smokers, screening and treatment for hypertension, metabolic syndrome and early access to HAART. The present guidelines provides information about the use of antiretrovirals in patients with HIV and its relation with cardiovascular risk.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Doenças Cardiovasculares , HIV , Fatores de Risco de Doenças Cardíacas , Associação , Doenças Transmissíveis , Fatores de Risco , Síndrome da Imunodeficiência Adquirida , Colômbia , Terapia Antirretroviral de Alta Atividade , Consenso , Antirretrovirais , InfecçõesRESUMO
El síndrome de dificultad respiratoria aguda del adulto en pacientes con malaria está asociado a infección por Plasmodium falciparum, ocasionalmente manifestado en pacientes infectados por Plasmodium vivax, por lo que han sido pocos los casos reportados en la literatura (1). Reportamos el caso de un paciente de 43 años quien estuvo en área endémica y desarrolló síndrome de dificultad respiratoria aguda del adulto (SDRA) por Plasmodium vivax. El diagnóstico fue realizado por métodos microscópicos. Concluimos que el SDRA asociado a Plasmodium vivax puededesarrollarse antes de iniciar terapia antimalárica, condición con una alta morbimortalidad. (Acta Med Colomb 2014; 39: 211-215).
The adult acute respiratory distress syndrome in patients with malaria is associated with Plasmodium falciparum infection, and only occasionally manifested in patients infected with Plasmodium vivax, so few cases have been reported in the literature. 1 The case of a 43 year old patient who was in an endemic area and developed acute adult respiratory distress syndrome (ARDS) by Plasmodium vivax is reported. The diagnosis was made by microscopic methods. It was concluded that ARDS associated with Plasmodium vivax can develop before starting antimalarial therapy, a condition with high morbidity and mortality. (Acta Med Colomb 2014; 39: 211-215).
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Humanos , Masculino , Adulto , Plasmodium vivax , Síndrome do Desconforto Respiratório do Recém-Nascido , Respiração Artificial , Parasitemia , MaláriaRESUMO
INTRODUCTION: Cefepime efficacy for treatment of febrile neutropenia (FN) in cancer adult patients is a controversial issue. OBJECTIVE: To describe the demographic characteristics and general mortality of patients suffering from febrile neutropenia treated with cefepime in a fourth-level Latin American hospital. PATIENTS AND METHODS: A cross-sectional observational study was performed. Study settled at San Ignacio of Bogotá, Colombia. University Hospital from January 2004 to December 2008. RESULTS: A total of 333 patients were treated with cefepime, of whom 125 had suffered FN and met pre established inclusion and exclusion criteria. The general mortality was 14.4%, which was similar to the overall mortality in FN in other reports. CONCLUSIONS: Although there is still no clarity regarding the efficacy of cefepime in FN, its use has not been restricted. This study did not identify an excess risk of mortality in patients treated with cefepime.
Assuntos
Antibacterianos/uso terapêutico , Cefalosporinas/uso terapêutico , Demografia , Neutropenia Febril/tratamento farmacológico , Adulto , Cefepima , Colômbia/epidemiologia , Comorbidade , Estudos Transversais , Neutropenia Febril/mortalidade , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Introduction: Cefepime efficacy for treatment of febrile neutropenia (FN) in cancer adult patients is a controversial issue. Objective: To describe the demographic characteristics and general mortality of patients suffering from febrile neutropenia treated with cefepime in a fourth-level Latin American hospital. Patients and Methods: A cross-sectional observational study was performed. Study settled at San Ignacio of Bogotá, Colombia. University Hospital from January 2004 to December 2008. Results: A total of 333 patients were treated with cefepime, of whom 125 had suffered FN and met pre established inclusion and exclusion criteria. The general mortality was 14.4%, which was similar to the overall mortality in FN in other reports. Conclusions: Although there is still no clarity regarding the efficacy of cefepime in FN, its use has not been restricted. This study did not identify an excess risk of mortality in patients treated with cefepime.
Introducción: La eficacia de cefepima en pacientes adultos con cáncer y neutropenia febril (NF) es objeto de controversia en las publicaciones científicas. Objetivo: Describir las características demográficas y la mortalidad general de los pacientes adultos con NF tratados con cefepima en un hospital latinoamericano de cuarto nivel. Pacientes y Métodos. Estudio observacional descriptivo, de corte transversal en el que se incluyeron todos los pacientes tratados con cefepima en el Hospital Universitario San Ignacio de Bogotá, Colombia entre enero de 2004 y diciembre de 2008. Resultados: Recibieron cefepime un total 333 pacientes, de los cuales 125 tenían diagnóstico de NF y cumplían criterios pre-establecidos de inclusión y exclusión. Como desenlace final se encontró una mortalidad de 14,4%, un porcentaje similar a la mortalidad general en NF reportada en la literatura médica. Conclusiones: Aún no hay claridad sobre la eficacia del uso de cefepima en NF; sin embargo, tampoco se ha proscrito su uso y los datos del presente estudio no encontraron un riesgo adicional de mortalidad.
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Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Antibacterianos/uso terapêutico , Cefalosporinas/uso terapêutico , Demografia , Neutropenia Febril/tratamento farmacológico , Comorbidade , Estudos Transversais , Colômbia/epidemiologia , Neutropenia Febril/mortalidadeRESUMO
INTRODUCTION: The objective of this study was to evaluate the frequency of thyroid function alterations and its associated factors in a group of patients from a university hospital in Colombia. METHODS: From June 2007 through June 2008, 636 HIV patients were followed in order to assess the relation of thyroid function with the use of HAART. RESULTS: The overall prevalence of hypothyroidism (TSH > 4.6 µUI/mL) was 15.5% (100/636). The association of hypothyroidism in the independent analysis showed significant relation only for the use of nevirapine (RR 1.6; CI 95% 1.1- 2.34) and stavudine (RR 1.5; CI 95%, 1 - 2.3). CONCLUSIONS: The prevalence of hypothyroidism was surprisingly high among the studied population.
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Fármacos Anti-HIV/efeitos adversos , Infecções por HIV/tratamento farmacológico , Hipotireoidismo/induzido quimicamente , Nevirapina/efeitos adversos , Estavudina/efeitos adversos , Adolescente , Adulto , Idoso , Terapia Antirretroviral de Alta Atividade , Estudos de Coortes , Colômbia , Estudos Transversais , Feminino , Hospitais Universitários , Humanos , Hipotireoidismo/diagnóstico , Masculino , Pessoa de Meia-Idade , Tireotropina/sangue , Carga Viral , Adulto JovemRESUMO
El síndrome de reconstitución inmunológica inflamatorio (SRII) en pacientes con infección por el virus de inmunodeficiencia humana (VIH), es una entidad clínica rara caracterizada por un aumento de linfocitos T CD4+(CLTCD4+) y disminución de la carga viral servirá del VIH, que aparece corto tiempo después de iniciar terapia antirretroviral de gran actividad (TARGA). Usualmente se manifiesta con un deterioro paradójico del estado del paciente secundario a una reactivación de procesos infecciosos oportunistas.Caso clínico: hombre con diagnóstico de toxoplasmosis cerebral en el curso de infección por VIH, quien posterioral inicio de la TARGA desarrollo coriorretinitis. El paciente experimento mejoría poco tiempo después de haber suspendido la TARGA y de administrar esteroides.Conclusión: La incidencia del SRII ha aumentado en los pacientes VIH que cursan con alta carga antigénica yCLTCD4+ bajo. Su patofisiología genera incertidumbre debido a que los biomarcadores diagnósticos y pronósticos no se conocen del todo. El tratamiento propuesto lo constituye en algunos casos la suspensión temporal de la TARGA con administración de esteroides, no obstante es necesaria la realización de más estudios.
Immune reconstitution inflammatory syndrome (IRIS) in context of severe immunosupression secondary to humanimmunodeficiency virus (HIV), is characterized by a dramatic rise of T lymphocyte CD4+ count in addition to aHIV viral load drop in, typically it is manifested by a paradoxical clinical impairment due to reactivation opportunistic of infectious processes previously under immune surveillance. A 36 years old male with cerebral toxoplasmosis in context of HIV infection developed chorioretinitis 8 weeks after commencing HAART. Workup laboratories only showed a marked T Lymphocyte CD4+ count increase with a HIV viral load lower than 40 copies/ml and other possible causes of chorioretinitis were excluded. After cessation of HAART and establishing corticosteroid therapy clinical improvement of this condition was documented. IRIS incidence has increased among AIDS patients especially with high antigenic burden and very low CD4 + T lymphocytecount. However its mechanism is still unclear due to biomarkers for diagnosis and prognosis are not completely known at all. In order to validate and refine diagnostic criteria and therapeutic approaches of IRIS more studies are needed.
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Humanos , HIV , Coriorretinite , ToxoplasmoseRESUMO
El síndrome inflamatorio de reconstitución inmunológica en caso de infección por el virus de inmunodeficiencia humana (VIH) es una entidad clínica rara, que se manifiesta con la activación de procesos infecciosos oportunistas que se encontraban estables. Presentamos dos casos de este síndrome con compromiso del sistema nervioso central: síndrome de movimientos anormales y periférico, y síndrome de Guillain Barré...
Immune reconstitution inflammatory syndrome in the context of severe immunosupression secondary to human immunodeficiency virus (HIV) is a clinical entity manifested by a paradoxical clinical impairment due to an activation of infectious opportunistic processes previously under immune surveillance. We illustrate two case reports of immune reconstitution inflammatory syndrome with atypical central nervous system involvement (choreoathetosis) and acute inflammatory demyelinating polineuropathy (Guillain-Barré syndrome)...
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Humanos , HIV , Infecções por HIV/terapia , Polineuropatias , Síndrome da Imunodeficiência Adquirida , Síndrome de Lesch-NyhanRESUMO
Objetivos: Evaluar la frecuencia de alteración tiroidea y los factores asociados en los pacientes con VIH/SIDA de un hospital universitario en Colombia. Pacientes y Métodos: Estudio tipo corte transversal de pacientes con VIH/SIDA durante el periodo de 2007 a 2008. Se registró niveles hormonales, inmunológicos, carga viral y tratamiento anti-retroviral. Resultados: En 636 pacientes la prevalencia de hipotiroidismo (TSH > 4,6 μUI/mL) fue de 15,5 por ciento (100/636). El análisis independiente demostró relación significativa para el uso de nevirapina (RR 1,6; IC 95 por ciento 1,1 - 2,3) y estavudina (RR 1,5; IC 95 por cientoo 1 - 2,3). Conclusiones: La prevalencia de hipotiroidismo fue alta y se relacionó con el uso de nevirapina.
Introduction: The objective of this study was to evaluate the frequency of thyroid function alterations and its associated factors in a group of patients from a university hospital in Colombia. Methods: From June 2007 through June 2008, 636 HIV patients were followed in order to assess the relation of thyroid function with the use of HAART. Results: The overall prevalence of hypothyroidism (TSH > 4.6 μUI/mL) was 15.5 percent (100/636). The association of hypothyroidism in the independent analysis showed significant relation only for the use of nevirapine (RR 1.6; CI 95 percent 1.1- 2.34) and stavudine (RR 1.5; CI 95 percent, 1 - 2.3). Conclusions: The prevalence of hypothyroidism was surprisingly high among the studied population.
Assuntos
Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Fármacos Anti-HIV/efeitos adversos , Infecções por HIV/tratamento farmacológico , Hipotireoidismo/induzido quimicamente , Nevirapina/efeitos adversos , Estavudina/efeitos adversos , Terapia Antirretroviral de Alta Atividade , Estudos de Coortes , Colômbia , Estudos Transversais , Hospitais Universitários , Hipotireoidismo/diagnóstico , Tireotropina/sangue , Carga ViralRESUMO
La polineuropatia desmielinizante aguda (AIDP) es un desorden inmune que afecta el nervio periférico produciendolesión axonal o mielínica. las infecciones respiratorias altas, gastrointestinales o los cuadros febriles inespecíficosusualmente preceden este caudro clínico caracterizado por debilidad progresiva y disminución de reflejos miotendinosos.En el paciente con infección VIH la AIDP usulamnete aparece en el periodo de seroconversión cuandoel conteo de CD4 es mayor a 500 células/uL. Se presume origen infecciosos a pesar de no existir un anticuerpoespecífico. reportamos dos casos de paciente con VIH y ADPI con presentación atípica. El primero con un conteode CD4 menos a 100 células/uL, el segundo en el contexto de síndrome de reconstitución inmunológica (IRIS).Ambos pacientes tuvieron recuperación satisfactoria luego de tratamiento con inmunoglobulina intravenosa ysuspensión temporal del tratamiento antiretroviral respectivamente.