Posts filed under ‘HIV/SIDA Trastornos Oculares’

CONSENSO GeSIDA TARV en adultos

2015-01 CONSENSO GeSIDA TARV en adultos EIMC 101 págs.

PDF

http://www.seimc.org/contenidos/gruposdeestudio/gesida/dcientificos/documentos/2015/gesida-guiasclinicas-2015-tar.pdf

 

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March 6, 2015 at 8:56 am

Documento de consenso de GeSIDA/Plan Nacional sobre el Sida respecto al tratamiento antirretroviral en adultos infectados por el virus de la inmunodeficiencia humana (Actualización enero 2014)

Enfermedades Infecciosas y Microbiología Clínica Agosto-Septiembre 2014 V.32 N.7

2014 – CONSENSO GeSIDA – TARV en adultos -Update

Documento de consenso de GeSIDA/Plan Nacional sobre el Sida respecto al tratamiento antirretroviral en adultos infectados por el virus de la inmunodeficiencia humana (Actualización enero 2014)

Panel de expertos de GeSIDA y Plan Nacional sobre el Sida

Objetivo

Actualizar las recomendaciones sobre el tratamiento antirretroviral (TAR) para adultos infectados por el VIH-1.

Métodos

Este documento ha sido consensuado por un panel de expertos de GESIDA y de la Secretaría del Plan Nacional sobre el Sida tras revisar los resultados de eficacia y seguridad de ensayos clínicos, estudios de cohortes y de farmacocinética publicados en revistas biomédicas (PubMed y Embase) o presentados en congresos. La fuerza de cada recomendación y la gradación de su evidencia se basan en una modificación de los criterios de la Infectious Diseases Society of America.

Resultados

Se recomienda el TAR en todos los pacientes infectados por el VIH-1. La fuerza y la gradación de la recomendación varían según la circunstancia clínica: enfermedades B o C de los CDC (A-I), pacientes asintomáticos según número de CD4+ (< 350, A-I; 350-500, A-II; > 500, B-III), comorbilidades (nefropatía por VIH, hepatitis crónica por VHB o VHC, edad superior a 55 años, riesgo cardiovascular elevado, trastornos neurocognitivos o neoplasias, A-II) y prevención de la transmisión del VIH (materno-fetal o heterosexual, A-I; homosexual entre hombres, A-III). El objetivo del TAR es lograr una carga viral plasmática (CVP) indetectable. El TAR de inicio debe ser siempre una combinación de 3 fármacos que incluya una asociación de 2 ITIAN y otro fármaco de distinta familia (ITINN, IP/r o InInt). De las posibles pautas de inicio se han considerado algunas como alternativa. Se exponen las causas y los criterios para cambiar un TAR estando con CVP indetectable, así como en el fracaso virológico en el que en el TAR de rescate se deben usar 3 o 2 fármacos plenamente activos frente al virus. Se actualizan igualmente los criterios específicos del TAR en situaciones especiales (infección aguda, infección por VIH-2, embarazo) o comorbilidades (tuberculosis u otra enfermedad oportunista, afectación renal, hepatopatías y neoplasias).

Conclusiones

Este nuevo documento actualiza las recomendaciones previas respecto a cuándo y con qué regímenes iniciar el TAR, cómo monitorizarlo y qué hacer cuando fracasa o desarrolla toxicidad. Se actualizan los criterios específicos del TAR en pacientes con comorbilidades y en situaciones especiales.

PDF

http://apps.elsevier.es/watermark/ctl_servlet?_f=10&pident_articulo=90340091&pident_usuario=0&pcontactid=&pident_revista=28&ty=107&accion=L&origen=zonadelectura&web=zl.elsevier.es&lan=es&fichero=28v32n07a90340091pdf001.pdf

 

August 30, 2014 at 8:35 pm

Guidelines for the Use of ARV Agents in HIV-1-Infected Adults and Adolescents DHHS MAY, 2014

Developed by the HHS Panel on Antiretroviral Guidelines for Adults and Adolescents – A Working Group of the Office of AIDS Research Advisory Council (OARAC)

PDF

http://www.aidsinfo.nih.gov/contentfiles/lvguidelines/adultandadolescentgl.pdf

August 30, 2014 at 8:32 pm

Syphilis Predicts HIV Incidence Among Men and Transgender Women Who Have Sex With Men in a Preexposure Prophylaxis Trial

Clin Infect Dis 2014 June 16 

Marc M. Solomon1,2, Kenneth H. Mayer4,5, David V. Glidden2, Albert Y. Liu3, Vanessa M. McMahan1, Juan V. Guanira6, Suwat Chariyalertsak7, Telmo Fernandez8, and Robert M. Grant1,2 for the iPrEx Study Teama

+ Author Affiliations

1The Gladstone Institutes

2University of California

3Bridge HIV, San Francisco Department of Public Health, California

4Fenway Health, Beth Israel Deaconess Medical Center, Fenway Institute

5Harvard Medical School, Boston, Massachusetts

6Investigaciones Medicas en Salud, Lima, Peru

7Research Institute for Health Sciences and Department of Community Medicine, Faculty of Medicine, Chiang Mai University, Thailand

8Fundacion Ecuatoriana Equidad, Guayaquil, Ecuador

Correspondence: Marc M. Solomon, MD, MPH, 1650 Owens St, 5th Floor, San Francisco, CA 94158 (marc.solomon@ucsf.edu).

Syphilis infection may potentiate transmission of human immunodeficiency virus (HIV). We sought to determine the extent to which HIV acquisition was associated with syphilis infection within an HIV preexposure prophylaxis (PrEP) trial and whether emtricitabine/tenofovir (FTC/TDF) modified that association.

Methods

The Preexposure Prophylaxis Initiative (iPrEx) study randomly assigned 2499 HIV-seronegative men and transgender women who have sex with men (MSM) to receive oral daily FTC/TDF or placebo. Syphilis prevalence at screening and incidence during follow-up were measured. Hazard ratios for the effect of incident syphilis on HIV acquisition were calculated. The effect of FTC/TDF on incident syphilis and HIV acquisition was assessed.

Results

Of 2499 individuals, 360 (14.4%) had a positive rapid plasma reagin test at screening; 333 (92.5%) had a positive confirmatory test, which did not differ between the arms (FTC/TDF vs placebo, P = .81). The overall syphilis incidence during the trial was 7.3 cases per 100 person-years. There was no difference in syphilis incidence between the study arms (7.8 cases per 100 person-years for FTC/TDF vs 6.8 cases per 100 person-years for placebo, P = .304). HIV incidence varied by incident syphilis (2.8 cases per 100 person-years for no syphilis vs 8.0 cases per 100 person-years for incident syphilis), reflecting a hazard ratio of 2.6 (95% confidence interval, 1.6–4.4; P < .001). There was no evidence for interaction between randomization to the FTC/TDF arm and incident syphilis on HIV incidence.

Conclusions

In HIV-seronegative MSM, syphilis infection was associated with HIV acquisition in this PrEP trial; a syphilis diagnosis should prompt providers to offer PrEP unless otherwise contraindicated.

PDF

http://cid.oxfordjournals.org/content/early/2014/07/16/cid.ciu450.full.pdf+html

July 19, 2014 at 10:26 am

Timing of initiation of antiretroviral drugs during tuberculosis therapy.

N Engl J Med 2010 Feb 25; 362(8) :697-706.

Abdool Karim SS, Naidoo K, Grobler A, et al.

Centre for the AIDS Programme of Research in South Africa, University of KwaZulu-Natal, Durban, South Africa. caprisa@ukzn.ac.za

BACKGROUND

The rates of death are high among patients with coinfection with tuberculosis and the human immunodeficiency virus (HIV). The optimal timing for the initiation of antiretroviral therapy in relation to tuberculosis therapy remains controversial.

METHODS

In an open-label, randomized, controlled trial in Durban, South Africa, we assigned 642 patients with both tuberculosis and HIV infection to start antiretroviral therapy either during tuberculosis therapy (in two integrated-therapy groups) or after the completion of such treatment (in one sequential-therapy group). The diagnosis of tuberculosis was based on a positive sputum smear for acid-fast bacilli. Only patients with HIV infection and a CD4+ cell count of less than 500 per cubic millimeter were included. All patients received standard tuberculosis therapy, prophylaxis with trimethoprim-sulfamethoxazole, and a once-daily antiretroviral regimen of didanosine, lamivudine, and efavirenz. The primary end point was death from any cause.

RESULTS

This analysis compares data from the sequential-therapy group and the combined integrated-therapy groups up to September 1, 2008, when the data and safety monitoring committee recommended that all patients receive integrated antiretroviral therapy. There was a reduction in the rate of death among the 429 patients in the combined integrated-therapy groups (5.4 deaths per 100 person-years, or 25 deaths), as compared with the 213 patients in the sequential-therapy group (12.1 per 100 person-years, or 27 deaths); a relative reduction of 56% (hazard ratio in the combined integrated-therapy groups, 0.44; 95% confidence interval, 0.25 to 0.79; P=0.003). Mortality was lower in the combined integrated-therapy groups in all CD4+ count strata. Rates of adverse events during follow-up were similar in the two study groups.

CONCLUSIONS

The initiation of antiretroviral therapy during tuberculosis therapy significantly improved survival and provides further impetus for the integration of tuberculosis and HIV services. (ClinicalTrials.gov number, NCT00398996.)

PDF

http://www.nejm.org/doi/pdf/10.1056/NEJMoa0905848

October 27, 2013 at 11:49 am

Successful treatment of syphilitic uveitis in HIV-positive patients.

Clin Ophthalmol. 2013;7:1651-4.

Nurfahzura MJ, Hanizasurana H, Zunaina E, Adil H.

Source

Department of Ophthalmology, Hospital Selayang, Lebuhraya Selayang-Kepong, Selangor, Malaysia ; Department of Ophthalmology, School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia ; Hospital Universiti Sains Malaysia, Jalan Raja Perempuan Zainab II, Kelantan, Malaysia.

Abstract

We report successful treatment of syphilitic uveitis in a case series of three Human immunodeficiency virus (HIV)-positive patients at Malaysia’s Selayang Hospital eye clinic. All three patients with syphilitic uveitis were male, aged from 23 to 35 years old, with a history of high-risk behaviors. Of the patients, two presented with blurring of vision and only one patient presented with floaters in the affected eye. Ocular examination revealed intermediate uveitis (case 1 and case 3) and panuveitis (case 2). Each patient showed a high Venereal Disease Research Laboratory (VDRL) titer at presentation and they were also newly diagnosed as HIV positive with variable CD4 counts. All three patients responded well to a neurosyphilis regimen of intravenous penicillin G. At 3 months posttreatment, there was reduction in VDRL titer with improvement of vision in the affected eye. Diagnosis of syphilis needs to be ruled out in all cases of uveitis. All syphilitic uveitis cases should have HIV screening and vice versa, as syphilis is one of the most common infectious diseases associated with HIV-positive patients. Early detection and treatment are important for a good visual outcome.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3754817/pdf/opth-7-1651.pdf

September 29, 2013 at 1:46 pm

2012-NOV IV CONSENSO TERAPIA ANTIRRETROVIRAL SADI

Sociedad Argentina de Infectología (SADI)

 

Para su consulta, la bibliografía de cada capítulo, así como las versiones

completas, están disponibles en www.sadi.org.ar al igual que el glosario

de abreviaturas más comunes aquí utilizadas

 

https://dl.dropboxusercontent.com/u/42385022/SADIconsenso%202012.pdf

May 25, 2013 at 5:38 pm

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