Histoplasmose disseminada em pacientes portadores de HIV/AIDS: tratamento de consolidação em hospital de referência do Ceará

Detalhes bibliográficos
Autor(a) principal: Almeida Júnior, Antônio Mauro Barros
Data de Publicação: 2020
Tipo de documento: Dissertação
Idioma: por
Título da fonte: Repositório Institucional da Universidade Federal do Ceará (UFC)
Texto Completo: http://www.repositorio.ufc.br/handle/riufc/55815
Resumo: Histoplasmosis is a fungal disease caused by Histoplasma capsulatum. The State of Ceará in Northeastern Brazil has one of the highest prevalence, relapse, and death rates in the world due to the disease in Acquired Immunodeficiency Syndrome (AIDS) patients. Currently, the treatment of this mycosis in HIV patients is carried out in three stages: induction, consolidation, and secondary prophylaxis. For consolidation therapy, itraconazole (400mg daily) as the first-choice drug is recommended for a minimum fixed period of 12 months. Recently, a document published by the World Health Organization recommended reducing such period to six months, depending on defined criteria. The one-year consolidation phase has been the target of criticism on account of hindering patient adherence and favoring abandonment, in addition to increasing the risk of drug interactions and adverse effects. The present study aimed to investigated adherence, duration and drug interactions in the consolidation phase of DH treatment in AIDS patients at the Hospital São José of Infectious Diseases (HSJ), a reference in infectious diseases in the State of Ceará. Data collection was conducted by reviewing the medical records of DH/AIDS patients treated at the HSJ, from January 2010 to January 2015. The study included 32 patients who continued consolidation therapy and were followed-up at the HSJ outpatient clinic. The median age was 31.5 years (IQR = 26.5-38.5) and the majority were male (87.5%). Among the antifungal treatment withdrawals for known reasons, 25.9% (7/27) were due to patient abandonment. The median duration of itraconazole use in those who maintained the consolidation dose for up to six months was only 100 days (IQR = 64 - 161) and for those who used itraconazole for more than six months, it did not reach one year (341 days, IQR = 238 - 392; p = 0.09). No deaths were observed in either group. In 59.1% (13/22) of the patients, the nonnucleoside analogue reverse transcriptase inhibitors (NNRTIs) remained a component of highly active antiretroviral therapy (HAART), along with the consolidation phase of DH treatment. In this group, only one relapse was reported, although it occurred in a patient who did not use HAART regularly. The interaction between itraconazole and NNRTI was not significant and the appearance of adverse effects was not a relevant factor for the abandonment of DH consolidation treatment. The risk associated for relapse in DH/AIDS patients in the present study was the lack of immune recovery. The regular use of HAART, combined with immune recovery, showed to be more effective than long periods of consolidation to prevent relapses due to DH in AIDS patients.
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spelling Histoplasmose disseminada em pacientes portadores de HIV/AIDS: tratamento de consolidação em hospital de referência do CearáHistoplasmaHistoplasmoseHIVSíndrome de Imunodeficiência AdquiridaItraconazolHistoplasmosis is a fungal disease caused by Histoplasma capsulatum. The State of Ceará in Northeastern Brazil has one of the highest prevalence, relapse, and death rates in the world due to the disease in Acquired Immunodeficiency Syndrome (AIDS) patients. Currently, the treatment of this mycosis in HIV patients is carried out in three stages: induction, consolidation, and secondary prophylaxis. For consolidation therapy, itraconazole (400mg daily) as the first-choice drug is recommended for a minimum fixed period of 12 months. Recently, a document published by the World Health Organization recommended reducing such period to six months, depending on defined criteria. The one-year consolidation phase has been the target of criticism on account of hindering patient adherence and favoring abandonment, in addition to increasing the risk of drug interactions and adverse effects. The present study aimed to investigated adherence, duration and drug interactions in the consolidation phase of DH treatment in AIDS patients at the Hospital São José of Infectious Diseases (HSJ), a reference in infectious diseases in the State of Ceará. Data collection was conducted by reviewing the medical records of DH/AIDS patients treated at the HSJ, from January 2010 to January 2015. The study included 32 patients who continued consolidation therapy and were followed-up at the HSJ outpatient clinic. The median age was 31.5 years (IQR = 26.5-38.5) and the majority were male (87.5%). Among the antifungal treatment withdrawals for known reasons, 25.9% (7/27) were due to patient abandonment. The median duration of itraconazole use in those who maintained the consolidation dose for up to six months was only 100 days (IQR = 64 - 161) and for those who used itraconazole for more than six months, it did not reach one year (341 days, IQR = 238 - 392; p = 0.09). No deaths were observed in either group. In 59.1% (13/22) of the patients, the nonnucleoside analogue reverse transcriptase inhibitors (NNRTIs) remained a component of highly active antiretroviral therapy (HAART), along with the consolidation phase of DH treatment. In this group, only one relapse was reported, although it occurred in a patient who did not use HAART regularly. The interaction between itraconazole and NNRTI was not significant and the appearance of adverse effects was not a relevant factor for the abandonment of DH consolidation treatment. The risk associated for relapse in DH/AIDS patients in the present study was the lack of immune recovery. The regular use of HAART, combined with immune recovery, showed to be more effective than long periods of consolidation to prevent relapses due to DH in AIDS patients.Histoplasmose é uma doença fúngica causada por Histoplasma capsulatum e o Estado do Ceará no Nordeste do Brasil tem uma das maiores taxas do mundo de prevalência, recaída e morte de histoplasmose disseminada (HD) em pacientes com aids. Atualmente, o tratamento dessa micose em pacientes com HIV é realizado em três etapas: indução, consolidação e profilaxia secundária. A fase de consolidação caracteriza-se pelo uso do itraconazol como primeira escolha por um período fixo mínimo de 12 meses, na dose de 400mg por dia. Recentemente, um documento publicado pela Organização Mundial da Saúde recomendou a redução desse período para seis meses a depender de critérios definidos. O período de um ano é alvo de críticas, por dificultar a adesão dos pacientes e favorecer o abandono, além de aumentar o risco de interações medicamentosas e efeitos colaterais. O presente estudo visa investigar a adesão, a duração e as interações medicamentosas da fase de consolidação do tratamento da HD em pacientes com aids no Hospital São José (HSJ), referência em doenças infecciosas no estado do Ceará. A coleta de dados foi realizada por revisão de prontuários de pacientes coinfectados com HD/Aids no HSJ, de janeiro de 2010 a janeiro 2015. Foram incluídos no estudo 32 pacientes que continuaram o tratamento de consolidação e foram acompanhados no ambulatório do HSJ. A mediana de idade foi de 31,5 anos (IIQ= 26,5-38,5) e a maioria era do sexo masculino (87,5%); 25,9% das suspensões de antifúngicos por motivo conhecido (7/27) foram por abandono do próprio paciente. A mediana de tempo de uso de itraconazol naqueles que mantiveram dose de consolidação por até seis meses foi de apenas 100 dias (IIQ= 64 – 161) e para aqueles que usaram itraconazol por mais de 6 meses não alcançou um ano (341 dias, IIQ= 238 - 392; p= 0,09). Em nenhum dos grupos houve óbito. Em 59,1% (13/22) o ITRNN permaneceu como componente da TARV em conjunto com a fase de consolidação do tratamento da HD. Neste grupo, foi relatada apenas uma recidiva, porém esta aconteceu em um paciente que não fazia uso regular de TARV. A interação entre itraconazol e ITRNN não se mostrou importante, e o surgimento de efeitos colaterais não foi um fator relevante para o abandono do tratamento de consolidação da HD. O fator relacionado à recidiva da HD no nosso trabalho foi a ausência de recuperação imunológica. O uso regular de TARV com recuperação imune revelou-se mais importante que longos períodos de consolidação para evitar recidivas de HD em pacientes com aids.Leitão, Terezinha do Menino Jesus SilvaDamasceno, Lisandra SerraAlmeida Júnior, Antônio Mauro Barros2020-12-24T11:22:53Z2020-12-24T11:22:53Z2020-10-02info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/masterThesisapplication/pdfALMEIDA JÚNIOR, A. M. B. Histoplasmose disseminada em pacientes portadores de HIV/AIDS: tratamento de consolidação em hospital de referência do Ceará. 2020. 73 f. Dissertação (Mestrado em Saúde Pública) - Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, 2020.http://www.repositorio.ufc.br/handle/riufc/55815porreponame:Repositório Institucional da Universidade Federal do Ceará (UFC)instname:Universidade Federal do Ceará (UFC)instacron:UFCinfo:eu-repo/semantics/openAccess2021-03-18T13:13:41Zoai:repositorio.ufc.br:riufc/55815Repositório InstitucionalPUBhttp://www.repositorio.ufc.br/ri-oai/requestbu@ufc.br || repositorio@ufc.bropendoar:2024-09-11T19:03:54.377104Repositório Institucional da Universidade Federal do Ceará (UFC) - Universidade Federal do Ceará (UFC)false
dc.title.none.fl_str_mv Histoplasmose disseminada em pacientes portadores de HIV/AIDS: tratamento de consolidação em hospital de referência do Ceará
title Histoplasmose disseminada em pacientes portadores de HIV/AIDS: tratamento de consolidação em hospital de referência do Ceará
spellingShingle Histoplasmose disseminada em pacientes portadores de HIV/AIDS: tratamento de consolidação em hospital de referência do Ceará
Almeida Júnior, Antônio Mauro Barros
Histoplasma
Histoplasmose
HIV
Síndrome de Imunodeficiência Adquirida
Itraconazol
title_short Histoplasmose disseminada em pacientes portadores de HIV/AIDS: tratamento de consolidação em hospital de referência do Ceará
title_full Histoplasmose disseminada em pacientes portadores de HIV/AIDS: tratamento de consolidação em hospital de referência do Ceará
title_fullStr Histoplasmose disseminada em pacientes portadores de HIV/AIDS: tratamento de consolidação em hospital de referência do Ceará
title_full_unstemmed Histoplasmose disseminada em pacientes portadores de HIV/AIDS: tratamento de consolidação em hospital de referência do Ceará
title_sort Histoplasmose disseminada em pacientes portadores de HIV/AIDS: tratamento de consolidação em hospital de referência do Ceará
author Almeida Júnior, Antônio Mauro Barros
author_facet Almeida Júnior, Antônio Mauro Barros
author_role author
dc.contributor.none.fl_str_mv Leitão, Terezinha do Menino Jesus Silva
Damasceno, Lisandra Serra
dc.contributor.author.fl_str_mv Almeida Júnior, Antônio Mauro Barros
dc.subject.por.fl_str_mv Histoplasma
Histoplasmose
HIV
Síndrome de Imunodeficiência Adquirida
Itraconazol
topic Histoplasma
Histoplasmose
HIV
Síndrome de Imunodeficiência Adquirida
Itraconazol
description Histoplasmosis is a fungal disease caused by Histoplasma capsulatum. The State of Ceará in Northeastern Brazil has one of the highest prevalence, relapse, and death rates in the world due to the disease in Acquired Immunodeficiency Syndrome (AIDS) patients. Currently, the treatment of this mycosis in HIV patients is carried out in three stages: induction, consolidation, and secondary prophylaxis. For consolidation therapy, itraconazole (400mg daily) as the first-choice drug is recommended for a minimum fixed period of 12 months. Recently, a document published by the World Health Organization recommended reducing such period to six months, depending on defined criteria. The one-year consolidation phase has been the target of criticism on account of hindering patient adherence and favoring abandonment, in addition to increasing the risk of drug interactions and adverse effects. The present study aimed to investigated adherence, duration and drug interactions in the consolidation phase of DH treatment in AIDS patients at the Hospital São José of Infectious Diseases (HSJ), a reference in infectious diseases in the State of Ceará. Data collection was conducted by reviewing the medical records of DH/AIDS patients treated at the HSJ, from January 2010 to January 2015. The study included 32 patients who continued consolidation therapy and were followed-up at the HSJ outpatient clinic. The median age was 31.5 years (IQR = 26.5-38.5) and the majority were male (87.5%). Among the antifungal treatment withdrawals for known reasons, 25.9% (7/27) were due to patient abandonment. The median duration of itraconazole use in those who maintained the consolidation dose for up to six months was only 100 days (IQR = 64 - 161) and for those who used itraconazole for more than six months, it did not reach one year (341 days, IQR = 238 - 392; p = 0.09). No deaths were observed in either group. In 59.1% (13/22) of the patients, the nonnucleoside analogue reverse transcriptase inhibitors (NNRTIs) remained a component of highly active antiretroviral therapy (HAART), along with the consolidation phase of DH treatment. In this group, only one relapse was reported, although it occurred in a patient who did not use HAART regularly. The interaction between itraconazole and NNRTI was not significant and the appearance of adverse effects was not a relevant factor for the abandonment of DH consolidation treatment. The risk associated for relapse in DH/AIDS patients in the present study was the lack of immune recovery. The regular use of HAART, combined with immune recovery, showed to be more effective than long periods of consolidation to prevent relapses due to DH in AIDS patients.
publishDate 2020
dc.date.none.fl_str_mv 2020-12-24T11:22:53Z
2020-12-24T11:22:53Z
2020-10-02
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
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dc.identifier.uri.fl_str_mv ALMEIDA JÚNIOR, A. M. B. Histoplasmose disseminada em pacientes portadores de HIV/AIDS: tratamento de consolidação em hospital de referência do Ceará. 2020. 73 f. Dissertação (Mestrado em Saúde Pública) - Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, 2020.
http://www.repositorio.ufc.br/handle/riufc/55815
identifier_str_mv ALMEIDA JÚNIOR, A. M. B. Histoplasmose disseminada em pacientes portadores de HIV/AIDS: tratamento de consolidação em hospital de referência do Ceará. 2020. 73 f. Dissertação (Mestrado em Saúde Pública) - Faculdade de Medicina, Universidade Federal do Ceará, Fortaleza, 2020.
url http://www.repositorio.ufc.br/handle/riufc/55815
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instname:Universidade Federal do Ceará (UFC)
instacron:UFC
instname_str Universidade Federal do Ceará (UFC)
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reponame_str Repositório Institucional da Universidade Federal do Ceará (UFC)
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