Episodios oportunistas en pacientes infectados por el virus de la inmunodeficiencia humana durante los primeros 6 meses de la terapia antirretroviral de gran actividad
Opportunistic events shortly after beginning HAART in HIV-infected patients
Juan González-Castillo
, Francisco Blanco, Vicente Soriano, Pablo Barreiro, María Concepción Bravo, Juan González-Lahoz
Autor para correspondencia
jgdelcastillo@terra.es
Correspondencia: Dr. J. González del Castillo. Avda. Juan de Andrés, 45, apto. 501. 28035 Madrid.
Correspondencia: Dr. J. González del Castillo. Avda. Juan de Andrés, 45, apto. 501. 28035 Madrid.
Servicio de Enfermedades Infecciosas.
Inmaculada Jiménez-Nácher*
* Servicio de Farmacia. Hospital Carlos III. Instituto de Salud Carlos III. Madrid.
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"etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "aff005" ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Opportunistic events shortly after beginning HAART in HIV-infected patients" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2000-11-10" "fechaAceptado" => "2001-05-28" "PalabrasClave" => array:2 [ "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec222582" "palabras" => array:3 [ 0 => "Terapia antirretroviral" 1 => "Infecciones oportunistas" 2 => "Reconstitución inmune" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec222581" "palabras" => array:3 [ 0 => "Antiretroviral therapy" 1 => "Opportunistic infections" 2 => "Immune recovery" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Fundamento</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Analizar la incidencia y las características de los episodios oportunistas en los primeros meses tras el inicio de la terapia antirretroviral de gran actividad (TARGA) en pacientes con infección por el virus de la inmunodeficiencia humana (VIH).</p> <span class="elsevierStyleSectionTitle">Pacientes y método</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Análisis retrospectivo de las historias clínicas de todos los pacientes infectados por el VIH atendidos en las consultas externas de un hospital de referencia para VIH/sida de Madrid, que iniciaron TARGA durante el segundo semestre del año 1998, con un recuento de linfocitos CD4 inferior a 250 × 106/l. Se recogieron los episodios oportunistas ocurridos durante los 6 meses tras el inicio de la TARGA, así como los parámetros virológicos e inmunológicos, las variables sociodemográficas y el tipo de tratamiento antirretroviral.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Se incluyó a 269 pacientes y se registraron 21 episodios oportunistas (7,8%). Al inicio de la TARGA la cifra media (desviación estándar [DE]) de linfocitos CD4 de estos 21 enfermos fue de 137 (92) × 10<span class="elsevierStyleSup">6</span>/l, y la mediana de carga viral, de 24.043 copias de VIH-ARN/ml. Una vez realizado al diagnóstico del episodio oportunista estos valores fueron de 218 (114) × 10<span class="elsevierStyleSup">6</span>/l (p = 0,012) y < 500 copias/ml, respectivamente. Los episodios oportunistas se distribuyeron de la siguiente manera: herpes zoster 9 (43%), neumonía por Pneumocystis carinii 5 (24%), sarcoma de Kaposi 3 (14%), tuberculosis 1, toxoplasmosis cerebral uno, retinitis por citomegalovirus uno y linfoma no hodgkiniano 1 (4,7%). Durante los cuatro primeros meses tras el inicio de TARGA ocurrieron el 78% de los episodios. Desarrolló un episodio oportunista el 8% de los pacientes tratados con análogos de nucleósidos e inhibidores de la proteasa, el 2% de los que estaban en tratamiento con nucleósidos y no nucleósidos y el 10% de los que recibían conjuntamente las tres familias de fármacos (p = 0,44).</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Un 7,8% de los pacientes con infección por el VIH con recuentos bajos de linfocitos CD4 desarrollan episodios oportunistas durante los primeros meses después del inicio de TARGA. Una respuesta inflamatoria secundaria al restablecimiento de la inmunidad frente a los agentes patógenos podría explicar esta eventualidad. La retirada de la profilaxis frente a infecciones oportunistas debería demorarse en este grupo de pacientes y la aparición de episodios oportunistas en estos sujetos no puede considerarse un fracaso de la terapia antirretroviral, que debe continuar administrándose.</p>" ] "en" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Background</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">We aimed at analysing the incidence and characteristics of opportunistic events (OE) within a few months after starting highly active antiretroviral therapy (HAART) in HIV infected patients.</p> <span class="elsevierStyleSectionTitle">Patients and methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Retrospective study of HIV infected outclinic patients attended in a HIV/AIDS reference hospital in Madrid, who initiated HAART during the second semester of 1998, with a baseline CD4 cell count < 250 × 10<span class="elsevierStyleSup">6</span> cells/l. We recorded the incidence of OE within 6 months after begining HAART and analysed virological and immunological parameters, sociodemographic variables and types of antiretroviral treatment.</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">The study included 269 patients. Twenty-one (7.8%) OE were recorded. At the onset of HAART, the mean CD4 cell count in these 21 patients was 137 (92) × 10<span class="elsevierStyleSup">6</span>/l and the median viral load was 24,043 cop/ml. At the time of OE diagnosis, these parameters were 218 (114) × 10 (6)/l (p = 0.012) and < 500 cop/ml, respectively. OE were distributed as follows: herpes zoster, 9 cases (43%), Pneumocystis carinii pneumonia, 5 cases (24%), Kaposi sarcoma, 3 cases (14%) and tuberculosis, cerebral toxoplasmosis, cytomegalovirus retinitis, and non-Hodgkin lymphoma, 1 case each. Overall, 78% of OE occurred within first 4 months after begining HAART. In addition, an OE was developed by 8% patients treated with NRTI and PI, 2% treated with NRTI and NNRTI, and 10% treated with NRTI, NNRTI and PI (p = 0.44).</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">HIV-infected subjects with low CD4 counts are prone to develop OE within the first few moths after begining HAART. An inflammatory response to latent antigens due to the immune recovery might explain this fact.</p><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Therefore, prophylaxis against opportunistic pathogens should not be discontinued soon after begining HAART. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2023 Marzo | 0 | 1 | 1 |
| 2017 Octubre | 1 | 0 | 1 |
| 2017 Septiembre | 2 | 2 | 4 |
| 2017 Agosto | 4 | 1 | 5 |
| 2017 Julio | 5 | 2 | 7 |
| 2017 Junio | 8 | 2 | 10 |
| 2017 Mayo | 4 | 3 | 7 |
| 2017 Abril | 7 | 10 | 17 |
| 2017 Marzo | 11 | 31 | 42 |
| 2017 Febrero | 11 | 1 | 12 |
| 2017 Enero | 8 | 1 | 9 |
| 2016 Diciembre | 20 | 2 | 22 |
| 2016 Noviembre | 28 | 6 | 34 |
| 2016 Octubre | 30 | 10 | 40 |
| 2016 Septiembre | 23 | 3 | 26 |
| 2016 Agosto | 17 | 1 | 18 |
| 2016 Julio | 12 | 2 | 14 |
| 2016 Junio | 21 | 15 | 36 |
| 2016 Mayo | 21 | 2 | 23 |
| 2016 Abril | 9 | 3 | 12 |
| 2016 Marzo | 12 | 4 | 16 |
| 2016 Febrero | 8 | 9 | 17 |
| 2016 Enero | 18 | 5 | 23 |
| 2015 Diciembre | 11 | 5 | 16 |
| 2015 Noviembre | 22 | 3 | 25 |
| 2015 Octubre | 15 | 2 | 17 |
| 2015 Septiembre | 18 | 5 | 23 |
| 2015 Agosto | 5 | 2 | 7 |
| 2015 Julio | 6 | 7 | 13 |
| 2015 Junio | 7 | 4 | 11 |
| 2015 Mayo | 18 | 6 | 24 |
| 2015 Abril | 9 | 12 | 21 |
| 2015 Marzo | 24 | 5 | 29 |
| 2015 Febrero | 14 | 3 | 17 |
| 2015 Enero | 14 | 2 | 16 |
| 2014 Diciembre | 27 | 1 | 28 |
| 2014 Noviembre | 22 | 0 | 22 |
| 2014 Octubre | 18 | 0 | 18 |
| 2014 Septiembre | 28 | 1 | 29 |
| 2014 Agosto | 30 | 1 | 31 |
| 2014 Julio | 34 | 0 | 34 |
| 2014 Junio | 51 | 1 | 52 |
| 2014 Mayo | 23 | 0 | 23 |
| 2014 Abril | 16 | 1 | 17 |
| 2014 Marzo | 25 | 0 | 25 |
| 2014 Febrero | 17 | 2 | 19 |
| 2014 Enero | 22 | 1 | 23 |
| 2013 Diciembre | 24 | 3 | 27 |
| 2013 Noviembre | 18 | 1 | 19 |
| 2013 Octubre | 42 | 3 | 45 |
| 2013 Septiembre | 32 | 5 | 37 |
| 2013 Agosto | 44 | 2 | 46 |
| 2013 Julio | 34 | 2 | 36 |
| 2013 Mayo | 1 | 0 | 1 |
| 2001 Junio | 1115 | 0 | 1115 |
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