Conteo CD4+ y carga viral en la evolución clínica de pacientes con vih-sida en Las Tunas

La comprensión de la inmunopatogénesis de la infección por vih-sida es un requisito para mejorar racionalmente los tratamientos disponibles y desarrollar inmunoterapias y vacunas. Se estudiaron 314 sujetos con diagnóstico confirmado de esta infección en la provincia de Las Tunas, en el periodo comprendido entre enero de 1986 hasta diciembre de 2011, según los criterios establecidos en el programa cubano para el control de la enfermedad. Se calcularon las frecuencias para las variables: sexo, municipio de residencia, estadio de la enfermedad, progresión clínica, enfermedades coexistentes, conteo de CD4, carga viral y protocolo de tratamiento. El sexo masculino predominó en la muestra de estudio (79,4%) y en los progresores rápidos (77,3%). El tiempo medio estimado de progresión a sida fue de 3,6 años. Los pacientes con más de diez años de infectados tuvieron niveles sanguíneos por encima de 500 células CD4+/µL. Los dos esquemas de tratamiento antirretroviral más empleados fueron Zidovudina – Lamivudina – Nevirapina y Estavudina - Lamivudina – Nevirapina, con cifras aceptables para las cifras de linfocitos T CD4+ y la viremia. Más de la cuarta parte de los portadores asintomáticos mantuvieron niveles de células T CD4+ en valores normales, proporción que se reduce a una quinta parte en los enfermos de sida. La muestra estudiada de sujetos infectados por el vih-sida de la provincia de Las Tunas tiene características similares a lo reportado para la epidemia en Cuba.</strong

Outcomes of patients with drug-resistant-tuberculosis treated with bedaquiline-containing regimens and undergoing adjunctive surgery

Objectives: No study evaluated the contribution of adjunctive surgery in bedaquiline-treated patients. This study describes treatment outcomes and complications in a cohort of drug-resistant pulmonary tuberculosis (TB) cases treated with bedaquiline-containing regimens undergoing surgery.Methods: This retrospective observational study recruited patients treated for TB in 12 centres in 9 countries between January 2007 and March 2015.Patients who had surgical indications in a bedaquiline-treated programme-based cohort were selected and surgery-related information was collected. Patient characteristics and surgical indications were described together with type of operation, surgical complications, bacteriological conversion rates, and treatment outcomes. Treatment outcomes were evaluated according to the time of surgery.Results: 57 bedaquiline-exposed cases resistant to a median of 7 drugs had indication for surgery (52 retreatments; 50 extensively drug-resistant (XDR) or pre XDR-TB). Sixty percent of cases initiated bedaquiline treatment following surgery, while 36.4% underwent the bedaquiline regimen before surgery and completed it after the operation. At treatment completion 90% culture-converted with 69.1% achieving treatment success; 21.8% had unfavourable outcomes (20.0% treatment failure, 1.8% lost to follow-up), and 9.1% were still undergoing treatment.Conclusions: The study results suggest that bedaquiline and surgery can be safely and effectively combined in selected cases with a specific indication. (C) 2018 The British Infection Association. Published by Elsevier Ltd. All rights reserved

Effectiveness and safety of bedaquiline-containing regimens in the treatment of MDR- and XDR-TB: a multicentre study

Large studies on bedaquiline used to treat multidrug-resistant (MDR-) and extensively drug-resistant tuberculosis (XDR-TB) are lacking. This study aimed to evaluate the safety and effectiveness of bedaquiline-containing regimens in a large, retrospective, observational study conducted in 25 centres and 15 countries in five continents. 428 culture-confirmed MDR-TB cases were analysed (61.5% male; 22.1% HIV-positive, 45.6% XDR-TB). MDR-TB cases were admitted to hospital for a median (interquartile range (IQR)) 179 (92-280) days and exposed to bedaquiline for 168 (86-180) days. Treatment regimens included, among others, linezolid, moxifloxacin, clofazimine and carbapenems (82.0%, 58.4%, 52.6% and 15.3% of cases, respectively). Sputum smear and culture conversion rates in MDR-TB cases were 63.6% and 30.1%, respectively at 30 days, 81.1% and 56.7%, respectively at 60 days; 85.5% and 80.5%, respectively at 90 days and 88.7% and 91.2%, respectively at the end of treatment. The median (IQR) time to smear and culture conversion was 34 (30-60) days and 60 (33-90) days. Out of 247 culture-confirmed MDR-TB cases completing treatment, 71.3% achieved success (62.4% cured; 8.9% completed treatment), 13.4% died, 7.3% defaulted and 7.7% failed. Bedaquiline was interrupted due to adverse events in 5.8% of cases. A single case died, having electrocardiographic abnormalities that were probably non-bedaquiline related. Bedaquiline-containing regimens achieved high conversion and success rates under different nonexperimental conditions