Adverse drug reaction in HIV-infected people treated with HAART in Maringá, Southern Brazil

Purpose: To assess the knowledge of adverse drug reactions (ADRs) among HIV-infected patients on prolonged treatment with highly active antiretroviral therapy (HAART) at a public health facility in Maringá, Southern Brazil.Methods: A retrospective and prospective analysis of laboratory results and clinical epidemiological characteristics was conducted among 220 HIV-infected patients treated with HAART between January 2010 and December 2013, at a public health care and treatment center in Maringá, Southern Brazil. The immunological and virological profiles of participants were evaluated.Results: The mean age of antiretroviral therapy (ART) participants was 44.3 ± 10.8 years and there was no substantial age difference between males and females. The mean of the first and last CD4+ T count were 550 ± 309 cells/μL and 642 ± 372 cells/μL, respectively. Similarly, the first and last mean viral load were 14,476 ± 58,067 copies/mL and 20,828 ± 106,028 copies/mL, respectively. The therapeutic regimen was either two nucleoside reverse transcriptase inhibitors (NRTIs) and one protease inhibitor (PI) in 102 (46.4 %) patients, or two NRTIs and one non-nucleoside reverse inhibitor (NNRTI) in 79 (35.9 %). Gastrointestinal disorders (25.9 %), hypertension (25.4 %), and neuropsychiatric symptoms (18.2 %) were the most common clinical ADRs. The most common laboratory-based ADRs were anemia (48.8 %), hypertriglyceridemia (47.3 %), hypercholesterolemia (36.1 %) and hyperglycemia (22.6 %).Conclusion: The results demonstrate a high incidence of ADRs in HIV-patients treated with HAART, which should be monitored closely during follow-up therapy.Keywords: HIV, AIDS, Highly active antiretroviral therapy (HAART), Adverse drug reactio

Suppression of HIV-1 viral load after multiple changes in high active antiretroviral therapy: A case report

High active antiretroviral therapy (HAART) can reduce plasma viremia to levels below the limit of detection, leading to adequate immune recovery and clinical stability in most HIV-1-infected patients. However, the virus persists in reservoirs, and free virions can be found in the plasma. We report here the case of an HIV-infected patient diagnosed in 1999, who exhibited good adherence to medication and HAART efficacy after multiple protocol changes. In this study, we describe the clinical features, chronological changes in HIV viral load and CD4+ T-cell count, and treatment outcomes of multiple combinations of antiretrovirals (ARV).The patient presented cycles of viral load during treatment ranging from undetectable, low, and intermediate HIV-1 RNA levels, to levels above the limits of quantification. A therapeutic regimen intensified with raltegravir (RAL) promoted constant depletion of HIV viral load and an increase in CD4+ T-cells. The report shows that enhanced HAART efficacy using RAL can reduce HIV viral load.Keywords: HAART, HIV, Viral load, Antiretroviral therapy, Raltegravi

Identificação microbiológica e sensibilidade in vitro de Candida isoladas da cavidade oral de indivíduos HIV positivos

A candidíase orofaríngea é a infecção fúngica mais comum entre os pacientes infectados pelo vírus da imunodeficiência humana e seu tratamento é realizado com antifúngicos tópicos ou sistêmicos, que são indicados empiricamente com base em dados clínicos. O objetivo deste estudo foi determinar a freqüência de leveduras em lavados bucais de indivíduos HIV positivos, comparando os resultados entre pacientes com diferentes condições de imunodeficiência e verificar o perfil de susceptibilidade das espécies isoladas frente aos antifúngicos visando avaliar se as opções de tratamento utilizadas na prática clínica atingem a maioria das espécies identificadas. Leveduras foram isoladas em 58% das amostras de lavado bucal coletadas e Candida albicans foi a espécie mais (93%) freqüente. Resistência ou susceptibilidade dose dependente, frente aos antifúngicos testados foi registrada em aproximadamente 17% das amostras. A importante variabilidade de resposta sugere limitações quanto à eficácia das terapias instituídas empiricamente