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Wânia da Silva Carvalhohttp://lattes.cnpq.br/3569654279768803Silvana Spíndola de MirandaAdriano Max Moreira ReisTatiana Chama Borges LuzEliane Viana MancuzoYone de Almeida NascimentoJuliana Alvares Teodorohttp://lattes.cnpq.br/3454080611072557Natália Helena de Resende2023-01-13T10:58:17Z2023-01-13T10:58:17Z2022-12-07http://hdl.handle.net/1843/48901https://orcid.org/0000-0002-8553-1083A infecção pelo vírus da imunodeficiência humana (HIV) representa um grande desafio para o controle da tuberculose (TB) e a farmacoterapia de ambas as doenças é complexa. Este estudo teve como objetivo avaliar os aspectos relacionados ao tratamento da TB e do HIV/aids no acompanhamento dos pacientes coinfectados. Para atingir esse fim, ele foi organizado metodologicamente em quatro artigos: I- Análise de sobrevivência e dos fatores associados à efetividade do tratamento da TB em pacientes coinfectados com HIV/aids em uma coorte. II- Revisão sistemática da literatura com meta-análise sobre os inibidores da integrase (INI). III- Revisão integrativa dos problemas relacionados ao uso de medicamentos (PRM) no acompanhamento farmacoterapêutico de pacientes com TB, HIV/AIDS e na coinfecção. IV- Avaliação qualitativa da experiência subjetiva com uso de medicamentos e do abandono. No estudo de coorte realizado entre janeiro de 2015 e dezembro de 2019 foram acompanhados 244 pacientes, dos quais 58,2% não apresentaram efetividade do tratamento da TB, 12,3% foram a óbito e 11,1% abandonaram o tratamento. A supressão virológica no início do tratamento da TB (HR=1.961, IC=1.123- 3.422), a utilização prévia da terapia antirretroviral (HR= 1,68, IC =1,06-2,65), não ter tratado previamente a TB (HR=2.407, CI=1.197-3.501), não utilizar drogas ilícitas (HR= 1,77, IC =1,14-2,72) e utilizar o esquema básico da tuberculose (HR= 1,86, IC =1,08-3,21) foram variáveis significativas e associadas à cura segundo a análise de regressão de Cox. Não foram identificadas diferenças estatísticas entre os pacientes que utilizaram INI e outros esquemas antirretrovirais. Na revisão sistemática com metanálise não houve diferença significativa nos desfechos de eficácia, efetividade e segurança nos estudos que avaliaram efavirenz versus INI. Além disso, a utilização dos INI duas vezes ao dia compromete a adesão ao tratamento. O papel desses medicamentos deve ser melhor determinado por mais estudos de boa qualidade metodológica para avaliar sua eficácia, efetividade e segurança a longo prazo. Os PRM mais frequentes identificados por meio da revisão integrativa foram relacionados à segurança do medicamento e à indicação. Os estudos reforçaram que a intervenção farmacêutica pode reduzir o número de PRM e aumentar a qualidade do cuidado aos pacientes. Para o estudo qualitativo foram realizadas entrevistas de 81 pacientes. Na análise temática sobre a experiência com o uso de medicamentos se destacaram as experiências de adversidade e aspectos construídos socialmente. A resolutividade está associada ao entendimento de alívio dos sinais e sintomas e recuperação da saúde, entretanto os sentimentos de ambivalência permeiam os demais, podendo levar ao abandono do tratamento. Uma vez diagnosticado com TB, o tratamento oportuno e sem interrupções, independentemente da terapia antirretroviral utilizada proporciona o desfecho favorável, além da influência em fatores comportamentais, como o não uso de drogas ilícitas. Por serem pacientes com especificidades relacionadas ao tratamento medicamentoso, os profissionais de saúde devem ter atenção especial no processo de acompanhamento.Human immunodeficiency virus (HIV) infection represents a major challenge for tuberculosis (TB) control and the pharmacotherapy of both diseases is complex. This study aimed to evaluate the aspects related to TB and HIV/aids in the follow-up of coinfected patients. To achieve this end, it was methodologically organized in four articles: I- Analysis of survival and factors associated with the effectiveness of TB treatment in patients co-infected with HIV/AIDS in a cohort. II- Systematic review of the literature with meta-analysis on integrase inhibitors (INI). III- Integrative review of drug-related problems (DRP) in the pharmacotherapeutic follow-up of patients with TB, HIV/AIDS and co-infection. IV- Qualitative evaluation of the subjective experience with medication use and of the abandonment. In the cohort study carried out between January 2015 and December 2019 a total of 244 patients were followed up, of which 58.2% did not show effectiveness of the treatment, 12.3% died and 11.1% abandoned the treatment. Virological suppression at the beginning of TB treatment (HR=1,961, CI=1.123-3.422), previous use of antiretroviral therapy (HR=1.676, CI=1.060-2.651), not having previously treated tuberculosis (HR= 2.407, CI =1.197-3.501), not using illicit drugs (HR= 1.77, CI =1.14-2.72) and using the tuberculosis (HR=1.864, CI=1.084-3.205) were significant variables associated with cure according to Cox regression analysis. No statistical differences were identified between patients who used INI or others antiretrovirals regimens. In the systematic review with meta-analysis, there was no significant difference in efficacy, effectiveness and safety outcomes in the studies that evaluated efavirenz versus INI. In addition, the use of INI twice a day compromises adherence to treatment. The role of these drugs should be better determined by further studies of good methodological quality to assess their long-term efficacy, effectiveness and safety. The most frequent DRP identified through the integrative review were related to drug safety and indication. The studies reinforced that pharmaceutical intervention can reduce the number of DRP and increase the quality of patient care. For the qualitative study, interviews were carried out with 81 patients. In the thematic analysis of the medication experience, the experiences of adversity and socially constructed aspects were highlighted. Resolution is associated with the understanding of relief from signs and symptoms and health recovery, however, feelings of ambivalence permeate the others, which can lead to treatment abandonment. Once diagnosed with TB, timely and uninterrupted treatment, regardless of the antirretroviral therapy used, favors a favorable outcome, in addition to influencing behavioral factors, such as not using illicit drugs. As they are patients with specificities related to drug treatment, health professionals should pay special attention to the follow-up process.CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível SuperiorporUniversidade Federal de Minas GeraisPrograma de Pós-Graduação em Medicamentos e Assistencia FarmaceuticaUFMGBrasilFARMACIA - FACULDADE DE FARMACIAhttp://creativecommons.org/licenses/by-nc-nd/3.0/pt/info:eu-repo/semantics/openAccessTuberculoseHIVAidsCoinfecçãoEfetividadeFarmacoterapiaAspectos relacionados ao tratamento da tuberculose e HIV/aids: abordagens qualitativa e quantitativa.Aspects related to the treatment of tuberculosis and HIV/aids: qualitative and quantitative approachesinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/doctoralThesisreponame:Repositório Institucional da UFMGinstname:Universidade Federal de Minas Gerais (UFMG)instacron:UFMGORIGINALTese_Natalia Helena de Resende - Final.pdfTese_Natalia Helena de Resende - Final.pdfASPECTOS RELACIONADOS AO TRATAMENTO DA TUBERCULOSE E HIV/AIDS:ABORDAGENS QUALITATIVA E QUANTITATIVAapplication/pdf5537290https://repositorio.ufmg.br/bitstream/1843/48901/1/Tese_Natalia%20Helena%20de%20Resende%20-%20Final.pdfc3ae15fbd377f000686a5f23d12f1282MD51CC-LICENSElicense_rdflicense_rdfapplication/rdf+xml; charset=utf-8811https://repositorio.ufmg.br/bitstream/1843/48901/2/license_rdfcfd6801dba008cb6adbd9838b81582abMD52LICENSElicense.txtlicense.txttext/plain; charset=utf-82118https://repositorio.ufmg.br/bitstream/1843/48901/3/license.txtcda590c95a0b51b4d15f60c9642ca272MD531843/489012023-01-13 07:58:17.947oai:repositorio.ufmg.br:1843/48901TElDRU7Dh0EgREUgRElTVFJJQlVJw4fDg08gTsODTy1FWENMVVNJVkEgRE8gUkVQT1NJVMOTUklPIElOU1RJVFVDSU9OQUwgREEgVUZNRwoKQ29tIGEgYXByZXNlbnRhw6fDo28gZGVzdGEgbGljZW7Dp2EsIHZvY8OqIChvIGF1dG9yIChlcykgb3UgbyB0aXR1bGFyIGRvcyBkaXJlaXRvcyBkZSBhdXRvcikgY29uY2VkZSBhbyBSZXBvc2l0w7NyaW8gSW5zdGl0dWNpb25hbCBkYSBVRk1HIChSSS1VRk1HKSBvIGRpcmVpdG8gbsOjbyBleGNsdXNpdm8gZSBpcnJldm9nw6F2ZWwgZGUgcmVwcm9kdXppciBlL291IGRpc3RyaWJ1aXIgYSBzdWEgcHVibGljYcOnw6NvIChpbmNsdWluZG8gbyByZXN1bW8pIHBvciB0b2RvIG8gbXVuZG8gbm8gZm9ybWF0byBpbXByZXNzbyBlIGVsZXRyw7RuaWNvIGUgZW0gcXVhbHF1ZXIgbWVpbywgaW5jbHVpbmRvIG9zIGZvcm1hdG9zIMOhdWRpbyBvdSB2w61kZW8uCgpWb2PDqiBkZWNsYXJhIHF1ZSBjb25oZWNlIGEgcG9sw610aWNhIGRlIGNvcHlyaWdodCBkYSBlZGl0b3JhIGRvIHNldSBkb2N1bWVudG8gZSBxdWUgY29uaGVjZSBlIGFjZWl0YSBhcyBEaXJldHJpemVzIGRvIFJJLVVGTUcuCgpWb2PDqiBjb25jb3JkYSBxdWUgbyBSZXBvc2l0w7NyaW8gSW5zdGl0dWNpb25hbCBkYSBVRk1HIHBvZGUsIHNlbSBhbHRlcmFyIG8gY29udGXDumRvLCB0cmFuc3BvciBhIHN1YSBwdWJsaWNhw6fDo28gcGFyYSBxdWFscXVlciBtZWlvIG91IGZvcm1hdG8gcGFyYSBmaW5zIGRlIHByZXNlcnZhw6fDo28uCgpWb2PDqiB0YW1iw6ltIGNvbmNvcmRhIHF1ZSBvIFJlcG9zaXTDs3JpbyBJbnN0aXR1Y2lvbmFsIGRhIFVGTUcgcG9kZSBtYW50ZXIgbWFpcyBkZSB1bWEgY8OzcGlhIGRlIHN1YSBwdWJsaWNhw6fDo28gcGFyYSBmaW5zIGRlIHNlZ3VyYW7Dp2EsIGJhY2stdXAgZSBwcmVzZXJ2YcOnw6NvLgoKVm9jw6ogZGVjbGFyYSBxdWUgYSBzdWEgcHVibGljYcOnw6NvIMOpIG9yaWdpbmFsIGUgcXVlIHZvY8OqIHRlbSBvIHBvZGVyIGRlIGNvbmNlZGVyIG9zIGRpcmVpdG9zIGNvbnRpZG9zIG5lc3RhIGxpY2Vuw6dhLiBWb2PDqiB0YW1iw6ltIGRlY2xhcmEgcXVlIG8gZGVww7NzaXRvIGRlIHN1YSBwdWJsaWNhw6fDo28gbsOjbywgcXVlIHNlamEgZGUgc2V1IGNvbmhlY2ltZW50bywgaW5mcmluZ2UgZGlyZWl0b3MgYXV0b3JhaXMgZGUgbmluZ3XDqW0uCgpDYXNvIGEgc3VhIHB1YmxpY2HDp8OjbyBjb250ZW5oYSBtYXRlcmlhbCBxdWUgdm9jw6ogbsOjbyBwb3NzdWkgYSB0aXR1bGFyaWRhZGUgZG9zIGRpcmVpdG9zIGF1dG9yYWlzLCB2b2PDqiBkZWNsYXJhIHF1ZSBvYnRldmUgYSBwZXJtaXNzw6NvIGlycmVzdHJpdGEgZG8gZGV0ZW50b3IgZG9zIGRpcmVpdG9zIGF1dG9yYWlzIHBhcmEgY29uY2VkZXIgYW8gUmVwb3NpdMOzcmlvIEluc3RpdHVjaW9uYWwgZGEgVUZNRyBvcyBkaXJlaXRvcyBhcHJlc2VudGFkb3MgbmVzdGEgbGljZW7Dp2EsIGUgcXVlIGVzc2UgbWF0ZXJpYWwgZGUgcHJvcHJpZWRhZGUgZGUgdGVyY2Vpcm9zIGVzdMOhIGNsYXJhbWVudGUgaWRlbnRpZmljYWRvIGUgcmVjb25oZWNpZG8gbm8gdGV4dG8gb3Ugbm8gY29udGXDumRvIGRhIHB1YmxpY2HDp8OjbyBvcmEgZGVwb3NpdGFkYS4KCkNBU08gQSBQVUJMSUNBw4fDg08gT1JBIERFUE9TSVRBREEgVEVOSEEgU0lETyBSRVNVTFRBRE8gREUgVU0gUEFUUk9Dw41OSU8gT1UgQVBPSU8gREUgVU1BIEFHw4pOQ0lBIERFIEZPTUVOVE8gT1UgT1VUUk8gT1JHQU5JU01PLCBWT0PDiiBERUNMQVJBIFFVRSBSRVNQRUlUT1UgVE9ET1MgRSBRVUFJU1FVRVIgRElSRUlUT1MgREUgUkVWSVPDg08gQ09NTyBUQU1Cw4lNIEFTIERFTUFJUyBPQlJJR0HDh8OVRVMgRVhJR0lEQVMgUE9SIENPTlRSQVRPIE9VIEFDT1JETy4KCk8gUmVwb3NpdMOzcmlvIEluc3RpdHVjaW9uYWwgZGEgVUZNRyBzZSBjb21wcm9tZXRlIGEgaWRlbnRpZmljYXIgY2xhcmFtZW50ZSBvIHNldSBub21lKHMpIG91IG8ocykgbm9tZXMocykgZG8ocykgZGV0ZW50b3IoZXMpIGRvcyBkaXJlaXRvcyBhdXRvcmFpcyBkYSBwdWJsaWNhw6fDo28sIGUgbsOjbyBmYXLDoSBxdWFscXVlciBhbHRlcmHDp8OjbywgYWzDqW0gZGFxdWVsYXMgY29uY2VkaWRhcyBwb3IgZXN0YSBsaWNlbsOnYS4KRepositório InstitucionalPUBhttps://repositorio.ufmg.br/oaiopendoar:2023-01-13T10:58:17Repositório Institucional da UFMG - Universidade Federal de Minas Gerais (UFMG)false
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