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Wânia da Silva Carvalhohttp://lattes.cnpq.br/3569654279768803Silvana Spindola MirandaMaria das Graças CeccatoWânia da Silva CarvalhoSilvana Spindola MirandaMaria das Graças Braga CeccatoCristiane Aparecida Menezes de PáduaEliane Viana Mancuzohttp://lattes.cnpq.br/6858770923141197Sarah Beatriz Silva2020-07-14T02:19:21Z2020-07-14T02:19:21Z2019-06-24http://hdl.handle.net/1843/33777A tuberculose continua sendo a doença infecciosa que mais mata no mundo. Em Pessoas que Vivem com HIV é a doença oportunista mais comum, sendo a principal causa de hospitalização e morte. A Lesão Hepática Induzida por Medicamentos é uma doença comum do fígado que vem manifestar-se, geralmente, entre um e 90 dias após a administração do medicamento em doses usuais. Os fármacos de primeira linha para o tratamento da tuberculose são conhecidos por serem potenciais causadores de Lesão Hepática Induzida por Medicamentos. A aplicação de instrumentos validados à pacientes coinfectados, com o objetivo de identificar lesão hepática, pode ser uma forma de potencializar o manejo terapêutico desses pacientes. O objetivo do estudo foi avaliar a causalidade de LHIM no tratamento da tuberculose em Lesão Hepática Induzida por Medicamentos por meio dos instrumentos de Naranjo e RUCAM, em um centro de referência no Sudeste do Brasil para doenças infectocontagiosas. Foi realizado um estudo de coorte retrospectiva. Os dados foram coletados em prontuários e laudos laboratoriais de pacientes notificados no Sistema de Informação de Agravos de Notificação, para TB e com o Vírus da Imunodeficiência Humana no período de abril de 2015 a dezembro de 2018. Foram considerados prontuários e laudos laboratoriais com potencial de avaliação de Lesão Hepática Induzida por Medicamentos, aqueles que apresentaram dosagens de Alanina Aminotransferase e Fosfatase Alcalina acima do limite normal superior após a introdução do tratamento para tuberculose, sendo aplicados os algoritmos de Naranjo e RUCAM para determinação de causalidade. Foram incluídos 160 pacientes entre os quais 76% (121/160) eram do sexo masculino. A idade variou entre 19 a 69 anos, com mediana igual a 41 anos. Foram observados 28 eventos de Lesão Hepática Induzida por Medicamentos durante o tratamento da tuberculose, sendo que 92,9% (26/28) aconteceram nas três primeiras semanas do início da terapia antituberculose. A classificação de lesão hepática colestática foi a mais observada na população estudada (57,1%). A determinação causal provável foi a mais observada pelos algoritmos de Naranjo (39,3%) e RUCAM (42,9%). Das LHIM 39,3% foram associadas ao uso do esquema básico de tratamento para tuberculose (Rifampicina, Isoniazida, Pirazinamida e Etambutol) seguido do fluconazol (14,3%) e a dose fixa combinada de tenofovir, lamivudina e efavirenz (10,7%). O uso dos algoritmos de Naranjo e RUCAM demonstrou a causalidade as Lesões Hepáticas Induzidas por Medicamentos, o que pode vir a ser um grande auxiliar na definição de medicamentos associados as lesões, contribuindo assim no processo de manejo das mesmas e colaborando no processo de notificação sanitária.Tuberculosis remains the most deadly infectious disease in the world. In People Living with HIV is the most common opportunistic disease, being the leading cause of hospitalization and death. Drug-Induced Liver Injury is a common liver disease that usually develops between one and 90 days after administration of the drug at usual doses. First-line drugs for the treatment of tuberculosis are known to be potential causes of drug-induced liver injury. The application of validated instruments to co-infected patients, aiming to identify liver injury, may be a way to enhance the therapeutic management of these patients. The aim of the study was to evaluate the causality of LHIM in the treatment of tuberculosis in drug-induced liver injury by the Naranjo and RUCAM instruments at a reference center in southeastern Brazil for infectious diseases. A retrospective cohort study was performed. Data were collected from medical records and laboratory reports of patients notified in the Notification Disease Information System for TB and the Human Immunodeficiency Virus from April 2015 to December 2018. Medical records and laboratory reports with potential for Evaluation of Drug-Induced Liver Injury, those with Alanine Aminotransferase and Alkaline Phosphatase levels above the upper normal limit after the introduction of tuberculosis treatment, using the Naranjo and RUCAM algorithms to determine causality. We included 160 patients, of which 76% (121/160) were male. Age ranged from 19 to 69 years, with a median of 41 years. Twenty-eight drug-induced liver injury events were observed during tuberculosis treatment, 92.9% (26/28) of which occurred within the first three weeks of initiation of anti-tuberculosis therapy. The classification of cholestatic liver injury was the most observed in the studied population (57.1%). Probable causal determination was the most observed by the Naranjo (39.3%) and RUCAM (42.9%) algorithms. Of the LHIM 39.3% were associated with the use of the basic treatment regimen for tuberculosis (rifampicin, isoniazid, pyrazinamide and ethambutol) followed by fluconazole (14.3%) and the combined fixed dose of tenofovir, lamivudine and efavirenz (10.7 %). The use of Naranjo and RUCAM algorithms has demonstrated the causality of Drug-Induced Liver Injuries, which can be a great aid in defining drug-associated injuries, thus contributing to their management process and collaborating in the health notification process.porUniversidade Federal de Minas GeraisPrograma de Pós-Graduação em Medicamentos e Assistencia FarmaceuticaUFMGBrasilFARMACIA - FACULDADE DE FARMACIAMedicamentosAssistência FarmacêuticaHIV(Vírus)TuberculoseCasualidade de lesão hepática induzida por medicamentos na coinfecção tuberculose/HIVinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/masterThesisinfo:eu-repo/semantics/openAccessreponame:Repositório Institucional da UFMGinstname:Universidade Federal de Minas Gerais (UFMG)instacron:UFMGORIGINALDissertação_Mestrado_SARAH__2017716094.pdfDissertação_Mestrado_SARAH__2017716094.pdfapplication/pdf2016244https://repositorio.ufmg.br/bitstream/1843/33777/1/Disserta%c3%a7%c3%a3o_Mestrado_SARAH__2017716094.pdf9e38b35159260411e54aa9f175155dddMD51LICENSElicense.txtlicense.txttext/plain; charset=utf-82119https://repositorio.ufmg.br/bitstream/1843/33777/2/license.txt34badce4be7e31e3adb4575ae96af679MD521843/337772020-07-13 23:19:21.038oai:repositorio.ufmg.br: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Repositório InstitucionalPUBhttps://repositorio.ufmg.br/oaiopendoar:2020-07-14T02:19:21Repositório Institucional da UFMG - Universidade Federal de Minas Gerais (UFMG)false
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