Recomiendan adelantar el control uterino en las mujeres con VIH

Estimados colegas , este el el artículo que trata sobre HIV y Colposcopia.

Dr. Erazo


Dirección de esta página: http://www.nlm.nih.gov/medlineplus/spanish/news/fullstory_106773.html(*estas noticias no estarán disponibles después del 03/16/2011)

Traducido del inglés: jueves, 16 de diciembre, 2010Temas relacionados en MedlinePlus

• Cáncer de cuello uterino
• Chequeo médico de la mujer
• VIH/SIDA

Por C. Vidya Shankar
NUEVA YORK (Reuters Health) - Las alteraciones premalignas del epitelio del cuello uterino afectan a un tercio de las mujeres VIH positivas, según un estudio realizado en Sudáfrica.
Y una de cada 10 de esas pacientes desarrolla rápidamente lesiones más graves.
"Esto sugiere que el intervalo entre los controles del cuello uterino debería ser inferior a los 10 años, sin importar la edad de las mujeres con conteos de células CD4 por debajo de 500 células/ul", recomienda el equipo de Tanvier Omar, de Johannesburgo, en la edición de enero del 2011 de la revista AIDS.
La prevalencia de VIH y del cáncer de cuello uterino en las mujeres sudafricanas es de las más altas del mundo. El equipo de Omar, de la Universidad de Witwatersrand, evaluó los cambios en la mucosa cervical de 2.325 mujeres VIH positivas tratadas en clínicas de Soweto.
En el estudio, realizado en el período 2003-2009, a todas las mujeres se les ofreció un Papanicolaou.
A las mujeres con lesiones escamosas intraepiteliales normales o de bajo grado (LSIL, por su nombre en inglés) se les ofreció un nuevo test, mientras que a aquellas con las mismas lesiones, pero de alto grado, (HSIL, por sus siglas en inglés) se les indicó una colposcopía.
Al inicio del estudio, 152 participantes utilizaban terapia antirretroviral; 457 comenzaron la terapia más tarde.
Al 38,1 por ciento de las mujeres se les detectaron lesiones precancerosas en el primer test que incluyeron HSIL (el 13,5 por ciento) y LSIL (el 20,4 por ciento). No se detectaron casos con carcinoma de cuello uterino.
El 10,5 por ciento de las 1.074 mujeres con LSIL inicial avanzó a HSIL durante los 2,5 años de seguimiento. En el 44 por ciento de las 225 mujeres con LSIL inicial revaluada se registró una regresión de las lesiones a un estadio normal (21,2 por cada 100 personas por año).
En el análisis multivariante, el riesgo de avance de las lesiones aumentó a medida que disminuía el conteo de CD4 por debajo de 500 células/uL. La terapia antirretroviral retrasó la progresión de las lesiones, mientras que la edad (más de 45 años) estuvo asociada con una regresión de las lesiones.
"El efecto protector de la edad en la persistencia/progresión en esta cohorte con VIH es inexplicable", admiten los autores.
"Las mujeres con sida tienen una incidencia de cáncer invasivo de cuello uterino que es nueve veces mayor que en las mujeres sin sida", dijo el doctor David Adler, profesor asistente de Medicina Comunitaria y Preventiva de la University of Rochester, en Nueva York.
"Las guías de la Sociedad Estadounidense del Cáncer para el screening del cáncer de cuello uterino son distintas para las mujeres con o sin VIH. En las mujeres con el virus, se debe realizar dos veces el primer año a partir de la detección de la infección y anualmente en adelante, sin importar la edad", agregó Adler, que no participó del estudio.


FUENTE: AIDS, enero del 2011

Contexto del Ecuador Situación Epidemiológica (2008) Corporación Kimirina

  Buenas tardes estimados compañeros, se ha dicho que la información sobre la epidemia es escasa o nula en nuestro país por eso estoy tratando de recopilar lo que se encuentra publicado. 

Este artículo pequeño escrito en Kimirina , llama la atención desde el punto de vista histórico.

Saludos

 

Dr. Carlos Erazo

 http://www.kimirina.org/politicascooperacion/articulosypoliticas/contextoecuador#_ftnref1

 

CONTEXTO NACIONAL

Ecuador, situado en el Nor-Occidente de América del Sur, cuenta con una superficie de 256.370 kilómetros cuadrados. Su población es de 12.646.095 habitantes, con una tasa de crecimiento anual del 2,1 %. El país se encuentra en una transición demográfica por cuanto existe una natalidad moderada, urbanización acelerada y fenómenos de migración interna y externa. La población es relativamente joven, el 51% de la misma se ubica en los grupos de edad de 15-49 años. Este grupo engrosa el 78% de la población económicamente activa.

Desde la perspectiva político-administrativa, el Ecuador se encuentra dividido en 24 provincias, 224 cantones, 322 parroquias urbanas y 790 parroquias rurales. Según su Constitución Política (2008), es un país unitario, plurinacional y pluricultural, puesto que varias nacionalidades y etnias coexisten en el territorio nacional; los diferentes colectivos mantienen identidades históricas y culturales particulares que determinan la riqueza y complejidad de la vida del país y la necesidad de abordajes fundamentados en las diversidades en los ámbitos de desarrollo en general y de la salud sexual y reproductiva en particular.

Es un Estado laico, sin embargo su población es mayoritariamente católica y la influencia de esta y otras Iglesias determina un contexto conservador, que en el último tiempo ha tenido embates fuertes de corrientes totalitarias no respetuosas con los derechos sexuales y reproductivos. La Incidencia Política y la presión de los movimientos y organizaciones sociales lograron incorporar en la Constitución del 2008, distintos artículos que promueven en las personas, comunidades, pueblos, nacionalidades y colectivos son titulares y gozarán de los derechos garantizados en la Constitución y en los instrumentos internacionales.

En relación a la situación social, cultural, política y legal de la población GLBT en el Ecuador, podemos decir:

Las relaciones sexuales consentidas entre personas del mismo sexo dejaron de ser tipificadas como delito después de la derogación del articulo 516 del Código Penal; y en la Constituyente del 2008, Ecuador reconoce que todas las personas son iguales y gozaran de los mismos derechos, deberes y oportunidades.

Pese a ello, en términos legales el Ecuador aún no ha armonizado su legislación secundaria para la promoción de los derechos de la comunidades GLBT, el tema no es tratado aún en los servicios de educación, pese a prohibir la discriminación en los centros educativos el tema de la sexualidad no es materia de enseñanza, y los pocos que la incluyen como tal lo hacen desde un punto de vista biologista, quedando al criterio de las autoridades de la institución educativa.

En términos políticos, la protección de los derechos humanos de GLBT, aún no se encuentra explícita en la agenda ni de las instituciones públicas o de otras organizaciones que trabajan en salud o derechos humanos. En el país existen sectores que aún consideran las relaciones sexuales homosexuales como algo no natural y estos mismos sectores fomentan actitudes y comportamientos homofóbicos lo que fomenta que muchas de las personas cuyo comportamiento sexual es diferente al hegemónico, mantengan relaciones clandestinas, lo que hace aún mas difícil ubicar e intervenir con estos grupos.

La sociedad ecuatoriana tiene una fuerte influencia de la cultura judeo-cristiana, la mayor parte de la población profesa una creencia cristiana, y en relación a la homosexualidad y el uso del condón, discurso oficial de la iglesia es categórico no aceptando su práctica.

Ecuador ha estado inmerso políticamente durante el año 2008 en el proceso de un nuevo Proyecto de Constitución, el mismo que fuera aprobado mayoritariamente en un Referéndum realizado en Septiembre de 2008.

La nueva Constitución evidencia una intención de cambio de modelo económico, inserción de una visión más concreta sobre lo plurinacional, el enfoque humanista y los derechos de la naturaleza.

Ya es historia la movilización de grupos sociales que trabajamos en el marco de los derechos humanos, fue necesario hacer incidencia política y los activistas de las Organizaciones mantuvieron presencia de presión para lograr que los derechos sean progresivos, que no se retroceda frente a lo que ya constaba en la Constitución de 1998. Los grupos ProVida y activistas de esa corriente, mantuvieron una fuerte estrategia.

La constitución, mantiene en el capítulo de Salud, la decisión sobre la vida sexual y reproductiva, en los temas básicos de derechos, la no discriminación por vivir con VIH/SIDA y la libre decisión sobre orientación sexual. La Constitución también reconoce a los diferentes tipos de familias.

PERFIL EPIDEMIOLÓGICO

SITUACIÓN DEL VIH/SIDA EN ECUADOR

En Ecuador la epidemia aún presenta un tendencia al crecimiento, observándose tasas de reporte en el 2007 de 17.3 por cada 100.000 habitantes, con un crecimiento casi tres veces mayor respecto del registro del año 2002 (6.3 por 100.000)[2] 

La epidemia es fundamentalmente de transmisión sexual (99,6%). La información epidemiológica nacional sobre VIH-SIDA recopilada desde su aparición (1984), es fundamentalmente pasiva: proviene de la notificación obligatoria de casos de infecciones de VIH y de SIDA, diagnosticadas en el país. 

Los informes de vigilancia epidemiológica nacional son elaborados por el Programa Nacional del SIDA del Ministerio de Salud Pública y se basan en dos fuentes de información: la vigilancia pasiva de notificación obligatoria semanal de casos y las estadísticas de morbilidad y defunciones de las estadísticas vitales del INEC (Instituto Nacional de Estadísticas y Censos). 

Estudios de sero-prevalencia de VIH, que corresponden al mecanismo activo de la vigilancia, se realizan eventualmente. 

La información y notificación del VIH-SIDA aún sigue siendo deficiente, la sensibilidad del sistema de vigilancia, es decir, la probabilidad de que un caso sea notificado, de acuerdo al proceso establecido se estimó en 75% para el año 2005, lo que reconoció una subnotificación de 35.0%[3].

La epidemia de VIH/SIDA, en Ecuador, está aún concentrada en hombres que tienen sexo con hombres, se presenta sobre todo en las poblaciones en edad productiva y se concentra geográficamente en Guayas, otras provincias de la Costa y con el crecimiento acelerado en Pichincha.

Primera medición de Indicadores Línea de Base de VIH-SIDA (Perú)

 Estimados colegas, hablando de indicadores, encontré unos bién ineteresantes en este estudio de línea de base sobre la epidemia en Perú.

Les dejo abajo el link para que puedan bajarse el pdf de este estudio.

Saludos

Dr. Carlos Erazo

"Aun existen limitaciones para describir a cabalidad la situación de la epidemia debido en parte a que los indicadores de impacto no han sido actualizados sistemáticamente, no son recientes, no se refieren a muestras aleatorias o a poblaciones de referencia claras o ideales. Pero a pesar de esta limitación la información recopilada sugiere que la epidemia del VIH muestra patrones de estabilidad y que la mortalidad en PVVS esta disminuyendo. Reviste especial importancia el análisis demográfico de las
poblaciones afectadas."


http://www.care.org.pe/Websites/FondoMundial/CERRANDOBRECHAS/PDFsEstudios/VIH/5R-Resumen%20Ejecutivo-Linea%20de%20Base%20VIH.pdf

Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents January 10, 2011

Les dejo aquí el link para bajarse la guía completa en pdf, y la Introducción de este documento.

Saludos

Dr. Carlos Erazo

http://www.aidsinfo.nih.gov/contentfiles/AdultandAdolescentGL.pdf

"Introduction (Updated January 10, 2011)
Antiretroviral therapy (ART) for the treatment of human immunodeficiency virus (HIV) infection has improved steadily since the advent of potent combination therapy in 1996. New drugs have been approved that offer new mechanisms of action, improvements in potency and activity even against multidrug-resistant viruses, dosing convenience, and tolerability.
The Department of Health and Human Services (DHHS) Panel on Antiretroviral Guidelines for Adults and Adolescents (the Panel) is a working group of the Office of AIDS Research Advisory Council (OARAC). The primary goal of the Panel is to provide recommendations for HIV care practitioners based on current knowledge of antiretroviral (ARV) drugs used to treat adults and adolescents with HIV infection in the United States. The Panel reviews new evidence and updates recommendations when needed. The primary areas of attention have included baseline assessment, treatment goals, indications for initiation of ART, choice of the initial regimen in ART-naïve patients, drugs or combinations to be avoided, management of adverse effects and drug interactions, management of treatment failure, and special ART-related considerations in specific patient populations.
These guidelines generally represent the state of knowledge regarding the use of ARV agents. However, because the science evolves rapidly, the availability of new agents and new clinical data may change therapeutic options and preferences. Information included in these guidelines may not be consistent with approved labeling for the particular products or indications in question, and the terms “safe” and “effective” may not be synonymous with the Food and Drug Administration (FDA)-defined legal standards for product approval. The guidelines are updated frequently by the Panel (current and archived versions of the guidelines are available on the AIDSinfo Web site at http://www.aidsinfo.nih.gov). However, the guidelines cannot always keep pace with the rapid evolution of new data in this field, and they cannot provide guidance for all patients. Clinicians should exercise clinical judgment in management decisions tailored to unique patient circumstances.
The Panel recognizes the importance of clinical research in generating evidence to address unanswered questions related to the optimal safety and efficacy of ART. The Panel encourages both the development of protocols and patient participation in well-designed, Institutional Review Board (IRB)-approved clinical trials."

Libreria digital sobre el VIH/Sida del Sistema de Vigilancia Epdiemiológica para el VIH/Sida e ITS

 Estimados colegas, dejo aquí el link para entrar en el Mendeley del Sistema de Vigilancia epdiemiológica para el VIH/Sida e ITS.
En este encontrarás documentos , en pdf, word etc, donde podras consultar la situación de la edpiemia en el Ecuador.
Poco a poco iniciaremos con la alimentación de esta biblioteca.

Saludos

http://www.mendeley.com/library/

Dr. Carlos Erazo

Routine Osteoporosis Screening Recommended for All Women over Age 65

Interesante actualización para quienes trabajamos en la atención integral de nuestros pacientes.

Saludos

Dr. Carlos Erazo

Press Release Date: January 17, 2011

"In an update to its 2002 recommendation, the U.S. Preventive Services Task Force (USPSTF) now recommends that all women ages 65 and older be routinely screened for osteoporosis. This is the first final recommendation statement to be published since the USPSTF implemented a new process in July 2010 in which all of its draft recommendation statements are posted for public comment on the USPSTF Web site prior to being issued in final form. The draft recommendation statement on screening for osteoporosis was posted for public comment from July 6 to August 3, 2010.
The USPSTF also recommends that younger women with increased risk factors for osteoporosis be screened if their fracture risk is equal to or greater than that of a 65-year-old white woman who has no additional risk factors. White women are used as the benchmark because they have a markedly higher rate of osteoporosis and fractures than other ethnic groups. Risk factors for osteoporosis include tobacco use, alcohol use, low body mass and parental history of fractures.
The USPSTF did not indicate a specific age limit at which screening should no longer be offered because the risk for fractures continues to increase with age and the evidence indicates that benefits can be realized within 18 to 24 months after starting treatment. The USPSTF also looked at whether to recommend screening men for osteoporosis but found insufficient evidence to make a recommendation at this time. This new final recommendation will become effective when it appears in the January 18 online issue of Annals of Internal Medicine and will also be available on the USPSTF Web site.
"As the number of people over the age of 65 in the United States increases, osteoporosis screening continues to be important in detecting women at risk who will benefit from treatment to prevent fractures," said Task Force Chair Ned Calonge, M.D., who is also the president and CEO of The Colorado Trust. "Clinicians also should talk to their younger patients to learn if they have risk factors that mean they should be screened."
Osteoporosis screening involves a measurement of bone density, which is currently covered by Medicare. The most commonly used bone density measurement tests are dual-energy x-ray absorptiometry (DXA) of the hip and lumbar spine, as well as quantitative ultrasound of the heel, although current diagnostic and treatment criteria are based on DXA tests alone. The USPSTF noted that there is a lack of evidence about how often screening should be repeated in women whose first test is negative.
In postmenopausal women who have no prior fractures caused by osteoporosis, the USPSTF found convincing evidence that drug therapies (including bisphosphonates, parathyroid hormone, raloxifene and estrogen) reduce the risk for osteoporosis-related fractures.
Osteoporosis, a condition that occurs when bone tissue thins or develops small holes, can cause pain, broken bones and loss of body height. Osteoporosis is more common in women than men and is more common in whites than any other racial group. For all demographic groups, the rates of osteoporosis rise with increasing age.
The USPSTF is an independent panel of private-sector experts in prevention and evidence-based medicine that conducts rigorous, impartial assessments of the scientific evidence and makes recommendations on the effectiveness of a broad range of clinical preventive services, including screening, counseling and preventive medications. The USPSTF does not consider costs or cost-effectiveness in creating recommendations. The Agency for Healthcare Research and Quality (AHRQ) is authorized by statute to convene the USPSTF and provide scientific and administrative support.
The USPSTF grades the strength of the evidence for providing clinical preventive services as "A" and "B" (recommends a service), "C" (recommends against routinely providing a service), "D" (recommends against a service) or "I" (insufficient evidence to assess the benefits and harms of a service). The USPSTF recommends screening for osteoporosis in women ages 65 and older and in younger women whose fracture risk is equal to or greater than that of a 65-year-old white woman who has no additional risk factors (B recommendation). Current evidence is insufficient to assess the balance of benefits and harms of screening for osteoporosis in men (I statement).
The USPSTF based its conclusions for this recommendation on a report from a team led by Heidi Nelson, M.D., M.P.H., from AHRQ's Evidence-based Practice Center at the Oregon Health & Science University in Portland. The report is available at http://www.ncbi.nlm.nih.gov/books/NBK45201/. The final recommendation and supporting documents are available on the U.S. Preventive Services Task Force Web site at http://www.uspreventiveservicestaskforce.org/uspstf/uspsoste.htm.


Para más información contactar AHRQ Public Affairs: (301) 427-1244 or (301) 427-1855.

HIV Prevalence Trends in Selected Populations in the United States

Buenas noches
Este articulo es interesante, espero que les guste.

Dr. Carlos Erazo

"Prevalence was 6 times higher among black adolescent medicine clinic patients (0.6%) than
among Hispanic (0.1%) and white patients (0.1%).  The overall prevalence of 0.32% among black
Job Corps entrants was 4 times that for Hispanics (0.08%) and more than 6 times that for whites
(0.05%).  Among military applicants, the overall prevalence among blacks (0.15%) was 5 times
higher than among Hispanics (0.03%) and 15 times higher than among whites (0.01%) "

link:  http://www.cdc.gov/hiv/topics/testing/resources/reports/hiv_prevalence/pdf/HIVPrevalence.pdf

El VIH y los hispanos o latinos

Buenas noches este es un link sobre un articulo que esta publicado en el CDC.

Saludos

Dr. Carlos Erazo

"La epidemia del VIH es una seria amenaza para la comunidad hispana o latina. Aunque los hispanos o 

latinos  representaron aproximadamente el 15% de la población estadounidense en el 2006, el 17% de
las nuevas infecciones por el VIH en los 50 estados y el Distrito de Columbia durante el mismo año
se presentó en este grupo poblacional. La tasa de nuevas infecciones por el VIH en hispanos o latinos
durante el 2006, fue 2.5 veces más alta que la de  los blancos."

Link para acceder al documento:  http://www.cdc.gov/hiv/spanish/hispanics/PDF/hispanos.pdf

American Thoracic Society Issues Guidelines on Treating Pulmonary Fungal Infections

Buenas noches

Este articulo fue publicado en MEDSCAPE, estoy copiandolo integro para que ustedes tengan acceso a esta información sobre como tratar infecciones pulmonares causadas por hongos.

Saludos

Dr. Carlos Erazo

"Laurie Barclay, MD

Authors and Disclosures

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INFORMATION FROM INDUSTRY

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January 12, 2011 — The American Thoracic Society (ATS) has issued updated clinical guidelines on treating pulmonary fungal infections, according to a statement published in the January 1, 2011, issue of the American Journal of Respiratory and Critical Care Medicine. The new recommendations, which replace 1988 ATS guidelines and target pulmonary and critical care practitioners and trainees, describe new medications and treatment approaches to pulmonary fungal infections, as well as provide an overview of emerging fungi.

Increase, Severity in Fungal Infections

"The incidence, diagnosis, and clinical severity of pulmonary fungal infections have dramatically increased in recent years in response to a number of factors," said lead author Andrew Limper, MD, professor and chair of Pulmonary Medicine at Mayo Clinic and chair of the ATS Fungal Infections Working Group, in a news release. "In addition to growing numbers of immune-compromised patients with HIV and other diseases, the number of patients receiving drugs to suppress the immune system following organ transplant or as the result of autoimmune inflammatory conditions has also increased."

The development of newer diagnostic methods and techniques has significantly facilitated a definitive diagnosis of pulmonary fungal infections. These new approaches include antigen detection, polymerase chain reaction, serologies, computed tomography and positron emission tomography scanning, bronchoscopy, mediastinoscopy, and video-assisted thorascopic biopsy.

"At the same time, the introduction of new medications has significantly broadened the options that are available to the physicians who treat these patients," Dr. Limper said. "In view of all of these developments, the ATS convened a working group of experts in fungal infections to develop an expert yet concise guide to currently available therapeutic options for the treatment of the myriad fungal infections that are of particular relevance to pulmonary and critical care practice."

During the past several years, the ATS Fungal Working Group met on multiple occasions at ATS meetings, reviewed journal articles and previously published guidelines, and performed a comprehensive search of online databases to gather all relevant diagnostic and treatment data. The resulting recommendations are a complete revision and expansion of the 1988 ATS fungal treatment guidelines.

"The treatment of fungal infections has undergone tremendous change since the earlier ATS treatment guidelines were published in 1988," Dr. Limper said. "These new guidelines offer physicians a source of updated treatment recommendations backed by relevant clinical data, including the use of novel drugs and the treatment of emerging fungi."

New Arsenal of Drugs

Amphotericin B, flucytosine, and a few clinically available azole agents (eg, itraconazole and fluconazole) were the mainstay of traditional antifungal therapy. Now, however, the pharmacotherapeutic arsenal includes potent new triazoles (ketoconazole, itraconazole, fluconazole, voriconazole, and posaconazole), polyenes, and newer antifungal drugs including the echinocandins (caspofungin, micafungin, and anidulafungin), which act by inhibiting the formation of the cell walls of fungi. Newer representatives of the polyene class include amphotericin B deoxycholate; lipid-associated liposomal amphotericin B, which is less toxic to the kidneys; and amphotericin B lipid complex.

"The expanded availability of agents offer[s] clinicians a broader range of treatment options, which is especially critical in treating some of the more recalcitrant infections," Dr. Limper said. "This statement offers recommended guidelines for the optimal use of these new and promising drugs."

The statement highlights 3 main areas of treatment recommendations: the endemic mycoses (eg, histoplasmosis, sporotrichosis, blastomycosis, and coccidioidomycosis); fungal infections with increased prevalence in immunocompromised and critically ill patients (eg, cryptococcosis, aspergillosis, candidiasis, andPneumocystis pneumonia); and rare and emerging fungal infections.

Endemic Mycoses

Mild to moderate histoplasmosis, sporotrichosis, and blastomycosis can be treated with itraconazole. However, antifungal agents are not needed for most immunocompetent patients with primary pulmonary coccidioidomycosis and no risk factors for dissemination, although triazoles are recommended for all patients with disseminated infection. Severe histoplasmosis, sporotrichosis, and blastomycosis should be treated initially with amphotericin B, followed, if needed, by systemic glucocorticosteroids for histoplasmosis or blastomycosis or itraconazole for sporotrichosis.

Immunocompetent patients with pulmonary cryptococcosis should receive fluconazole, whereas those with disseminated or central nervous system disease should receive amphotericin B plus flucytosine, followed by azole drugs. Depending on the severity of aspergillosis, treatment options may include prednisone, intravenous voriconazole, liposomal amphotericin B, or itraconazole.

Central venous catheters should be removed, and ophthalmology examination should be performed in patients with candidiasis. Indicated antifungal drugs may include fluconazole, amphotericin B, echinocandin, voriconazole, or combined fluconazole and amphotericin B.

"We also cover infections with Candida and Aspergillus species, which are increasingly common in the environment of the intensive care unit," Dr. Limper said. "The specific recommendations are concisely organized and should be readily applicable to practice."

Fungal Infections in Immunocompromised Patients

Immunosuppressed patients and those with HIV infection should receive prophylaxis for Pneumocystispneumonia. Oral trimethoprim and sulfamethoxazole, oral primaquine plus clindamycin, or oral atovaquone are recommended for mild to moderate Pneumocystis pneumonia, whereas immunocompromised patients with moderate to severe pneumonia should be treated with trimethoprim and sulfamethoxazole, and possibly prednisone.

Emerging, Rare Fungal Infections

For treatment of emerging or rare fungal infections, such as the zygomycoses, hyalohyphomycoses, phaeohyphomycoses, and Trichosporon-related infections, the statement recommends reducing use of immunosuppressive agents, treating with immunostimulant drugs, and controlling underlying conditions. Necrotic tissues, cysts, or abscesses should be debulked or debrided; and specific antifungal agents can be administered locally, systemically, or for wound irrigation.

For zygomycosis, recommended treatment is amphotericin B; for fusariosis, lipid-associated amphotericin B, voriconazole, or posaconazole; for scedosporiosis, voriconazole; and for phaeohyphomycoses, itraconazole, voriconazole, or posaconazole. For trichosporonosis and Paecilomyces infections, extended-spectrum triazoles may possibly be effective.

The ATS Fungal Working Group is considering developing a future statement detailing only diagnosis of fungal infections using newer techniques such as serologies, antigen testing, nucleic acid amplification methodologies, and immune-detection strategies.

Some of the statement authors have disclosed various financial relationships with AlphaMed Pharmaceuticals, Pfizer, Ortho-McNeil, MiraBella Technologies, AstraZeneca, GlaxoSmithKline, Bayer, Novartis, Aradigm, Astellas, Enzon, Merck, and/or Schering-Plough.

Am J Respir Crit Care Med. 2011;183:96-128. Abstract

 LINK:  http://www.medscape.com/viewarticle/735650?src=mpnews&spon=34

Otitis Media Is Better Treated with Antibiotics Than Observation

Este es un tema que es controversial en los servicios de atención primaria , aqui les dejo algunos artículos y sus links sobre el manejo de la Otitis Media en niños.

Saludos 

Dr. Carlos Erazo 

"In children with acute otitis media, two placebo-controlled trials establish that antibiotic treatment with amoxicillin-clavulanate is superior to watchful waiting. The trials appear in the New England Journal of Medicine.
Researchers in Finland and the U.S. separately randomized a total of some 600 children under age 3 years to roughly 10 days of double-blind treatment with either amoxicillin-clavulanate or placebo. All children had been diagnosed with acute otitis media according to strict standards.
In both trials, treatment failure was at least twice as frequent among placebo recipients. Rash and diarrhea were more common among those receiving antibiotics.
An editorialist writes that the trials provide "the best data yet" to answer the question: Is acute otitis media treatable? "The answer is yes," he writes."

Podemos revisar los siguientes artículos del NEJM  gratuitos en pdf estos son los links :

Treatment of Acute Otitis Media in Children under 2 Years of Age : http://www.nejm.org/doi/pdf/10.1056/NEJMoa0912254

A Placebo-Controlled Trial of Antimicrobial Treatment for Acute Otitis Media :http://www.nejm.org/doi/pdf/10.1056/NEJMoa1007174

Is Acute Otitis Media a Treatable Disease? : http://www.nejm.org/doi/full/10.1056/NEJMe1009121

El H1N1 puede contener la clave para una vacuna universal contra la gripe

Artículo de interés y de actualidad.

Saludos

Dr. Carlos Erazo

JANO.es y agencias · 10 Enero 2011 15:16

"Investigadores de Estados Unidos descubren que algunos afectados por esta cepa han desarrollado anticuerpos que les protegen del resto de virus de la gripe.

Investigadores de la Facultad de Medicina y el Centro de Vacunas de la Universidad de Emory, en Estados Unidos, aseguran que el virus A/H1N1 -que se expandió por todo el mundo en 2009- puede ser el punto de partida para desarrollar una vacuna universal contra la gripe, ya que algunos afectados por esta cepa han sido capaces de desarrollar anticuerpos que les protegen del resto.

Según explica en el último número del Journal of Experimental Medicine el autor de esta investigación, el profesor Jens Wrammert, "la protección que han demostrado estos anticuerpos rara vez se había visto en quienes pasaban la gripe estacional".

Para identificarlos, se seleccionaron nueve pacientes que habían tenido la gripe A el año de su aparición con diferentes grados de intensidad, que iban desde casos más leves en que los síntomas desaparecieron a los pocos días, a otros más graves que requirieron hospitalización, incluso de dos meses. La mayoría de los participantes tenía entre 20 y 30 años, y a todos ellos se les tomó sangre unos 10 días después de la aparición de los primeros síntomas.

Gracias a estos análisis, los investigadores identificaron los glóbulos blancos de la sangre de los pacientes que desarrollaron protección contra el virus y, a continuación, aislaron los genes de estos anticuerpos para analizarlos individualmente. Tras esto, utilizaron los genes para producir nuevos anticuerpos mediante cultivo celular -hasta un total de 86 variedades- y, luego, trataron de comprobar si las cepas de gripe reaccionaban en contra.

Así, identificaron cinco anticuerpos aislados capaces de doblegar a todas las cepas de la gripe estacional de la última década, la cepa de la conocida como 'gripe española' de 1918 y también a un patógeno de la cepa H5N1 de la gripe aviar.

Hemaglutinina, base de una futura vacuna

Uno de los problemas de las vacunas contra la gripe es que la aparición de nuevas cepas impide una protección universal contra nuevas variantes que puedan surgir, como sucedió en 2009. Sin embargo, en esta ocasión algunos anticuerpos identificados han demostrado su capacidad para adherirse a una parte del virus inactivo que incluye la vacuna, gracias a una proteína llamada hemaglutinina, que según estos expertos puede ser la base de una futura vacuna con una protección más amplia.

Tras este trabajo de microscopio, los investigadores probaron si tres de los anticuerpos aislados podían proteger a los ratones contra la cepa A/H1N1 de 2009 y otras dos cepas de laboratorio. Dos de estos anticuerpos demostraron su capacidad inmunitaria, incluso cuando el anticuerpo se aplicó 60 h después de la infección, aunque sólo uno ofreció protección contra la cepa pandémica.

Además, los investigadores comprobaron que dicho anticuerpo procedía del paciente con la enfermedad más grave. "El resultado es algo así como el Santo Grial de la investigación en vacunas de la gripe", explica Patrick Wilson, coautor del estudio. A su juicio, pese a haber tanta diversidad en las cepas de la gripe, este hallazgo demuestra que "hacer una sola vacuna con inmunidad permanente para todas las gripes es algo cada vez más factible".

 LINK:

http://www.jano.es/jano/actualidad/ultimas/noticias/janoes/agencias/h1n1/puede/contener/clave/vacuna/universal/contra/gripe/_f-11+iditem-12520+idtabla-1?utm_source=MailingList&utm_medium=email&utm_campaign=Jano+Diario+%2811%2F01%2F2011%29

No Concurrence in Identifying Cutaneous Abscesses

Este artículo es muy interesante sobre la diferencia entre absceso y celulitis y como tratarlo.

Saludos 

Dr. Carlos Erazo

"Physician agreement on the presence of abscess and the need for drainage was only fair to moderate.

Most cutaneous abscesses require incision and drainage but not systemic antibiotics. By contrast, patients with cellulitis need systemic antibiotics, but incision and drainage are unnecessary and sometimes harmful. Distinguishing between these two disorders, therefore, is important, but how often do clinicians agree in their diagnoses of these conditions?

In this study from an emergency department in an urban, tertiary-care, pediatric hospital, 349 immunocompetent children with 394 lesions affecting the abdomen, legs, buttocks, or arms were evaluated for presence of an abscess and for the necessity for drainage. Each patient was independently examined by two physicians from a pool of 62 clinicians. The amount of agreement among the physicians was assessed by kappa statistic (poor, <0.0; slight, 0.0–0.20; fair, 0.21–0.40; moderate, 0.41–0.60; substantial, 0.61–0.8; nearly perfect, 0.81–1.00). The kappa value for agreement was 0.39 on the presence of an abscess (fair) and 0.43 on the necessity for drainage (moderate). More-experienced examiner pairs did not have better agreement than less seasoned physicians.

Comment: This study demonstrates a substantial and disturbing lack of agreement among clinicians about fundamental issues in children with apparent skin infections — namely, whether a cutaneous abscess was present and whether drainage was required. The relevance of this study to adult patients is uncertain but deserves investigation. My own experience in adults suggests that results might be similar, for I have seen many cutaneous abscesses misdiagnosed as cellulitis by emergency department physicians, internists, and even surgeons, who prescribed antibiotics without benefit. Better training in distinguishing between these entities may improve both the accuracy of diagnosis and the appropriate management of these common skin infections."

— Jan V. Hirschmann, MD

Published in Journal Watch Dermatology January 7, 2011

Inhaled Corticosteroids Might Provoke Diabetes

"Randomized trials have not shown a connection between use of inhaled corticosteroids (ICS) and risk for diabetes; however, these studies might have been underpowered to detect this association. In a new study, researchers evaluated risk for developing diabetes among nearly 400,000 residents of Quebec, Canada, who did not have diabetes when they began ICS treatment between 1990 and 2005.
During a mean follow-up of 5.5 years, 30,000 people initiated treatment for diabetes. After adjustment for multiple factors, including respiratory disease severity and comorbid conditions, incidence of diabetes was 34% higher among people who were currently receiving ICS than among those who were not. A dose–response association also was detected (rate ratios, 1.18 for low-dose ICS; 1.64 for high-dose ICS). Use of ICS also was associated with 34% higher risk for insulin therapy.
Comment: This population-based observational study showed a significantly higher incidence of diabetes and more-rapid diabetes progression (defined as initiating insulin therapy) among individuals who received ICS. Current guidelines recommend close monitoring of patients who receive high-dose ICS for development of osteoporosis or cataracts; this study suggests that diabetes could be added to this list. The findings also remind us to follow asthma and chronic obstructive pulmonary disease guidelines on when to initiate inhaled corticosteroid therapy and on using the lowest effective dose."
— Jamaluddin Moloo, MD, MPH

Artículo interesante encontrado sobre el uso de corticoides inhalados y diabetes.

Saludos


Dr. Carlos Erazo

Herpes Zoster Vaccine Found Effective in Community Setting

Buenos días con todos, aquí algo interersante sobre el Herpes Zoster....la vacuna.

Saludos 

Dr. Carlos Erazo

A study conducted in a clinical practice setting confirms the effectiveness of herpes zoster vaccine, according to a report in JAMA.
In a retrospective cohort study of health plan members, researchers examined the incidence of herpes zoster among some 75,000 vaccinees aged 60 and older and 225,000 age-matched controls who did not receive the vaccine. After a follow-up averaging about 2 years, the incidence of herpes zoster was twice as high among controls as among vaccinees (13.0 vs. 6.4 per 1000 person-years). The difference remained after adjustment for sex, race, presence of chronic disease, and health care utilization. There was also a significant reduction in risk for ophthalmic herpes zoster.
The authors estimate that one episode of herpes zoster would be prevented for every 71 patients vaccinated. They write that their results "support recommendations to offer herpes zoster vaccine to eligible patients of all ages, including the oldest population."

JAMA article (Free abstract)

HIV/AIDS Clinical Care for January 10, 2011

Buenos días este es una copia de los temarios recibidos sobre VIH/SIDA, publicados en Journal Watch, que quiero compartir con ustedes.

Cada uno de los artículos tienen sus referencias para que puedan buscarlos y leerlos. 

Saludos 

Dr. Carlos Erazo

 

"SUMMARY AND COMMENT

Curing HIV? Free!

January 10, 2011 | Rajesh T. Gandhi, MD

An HIV-infected man who underwent stem-cell transplantation for leukemia continues to be free of the virus more than 3.5 years later, without any antiretroviral therapy.

Reviewing: Allers K et al. Blood 2010 Dec 8;

DRUG WATCH

New Formulation of Etravirine; Label Changes for Darunavir and d4T

January 10, 2011 | Paul E. Sax, MD

Etravirine is now available in a 200-mg tablet, darunavir is approved for once-daily dosing in some treatment-experienced patients, and the d4T label no longer calls for dose reduction to prevent toxicity.

SUMMARY AND COMMENT

Structural Cardiac Abnormalities Appear to Persist Despite ART

January 10, 2011 | Abigail Zuger, MD

Echocardiographic abnormalities were prevalent but mostly mild in a cohort of HIV-infected patients, the majority of whom were receiving ART.

Reviewing: Mondy K et al. Clin Infect Dis 2011 Feb 1; 52:378

SUMMARY AND COMMENT

Antiretrovirals and Cognitive Function

January 10, 2011 | Rajesh T. Gandhi, MD

The extent to which individual antiretrovirals penetrate the central nervous system may influence whether those drugs improve cognitive function, but the jury's still out.

Reviewing: Smurzynski M et al. AIDS 2010 Nov 30;""

Pandemic Flu Offers Clue to Better Vaccines

Buenos días 

Este es un artículo sobre la gripe pandémica publicado en http://www.medpagetoday.com, interesante en cuanto a la vacuna.

 Al final tenemos el link donde fué publicado originalmente y pueden ver un video sobre el tema.

Saludos 

Dr. Carlos Erazo

By Michael Smith, North American Correspondent, MedPage Today Published: January 10, 2011 Reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of Medicine, Harvard Medical School, Boston and Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner

The pandemic H1N1 influenza may have helped researchers solve a long-standing problem: how to make a flu vaccine that protects against multiple strains. Such a vaccine is "the holy grail of influenza vaccinology," according to Patrick Wilson, PhD, of the University of Chicago, and colleagues. But researchers have been frustrated because each influenza strain is just different enough from previous strains that a new vaccine has been needed every year, he told MedPage Today. On the face of it, the 2009 pandemic strain was no improvement -- it was markedly different from all earlier H1N1 strains, and vaccines had to be painstakingly developed in the same way the seasonal flu vaccines are made. Action Points   Explain that researchers found broadly cross-reactive antibodies to more than the rapidly changing hemagglutinin protein when analyzing blood from patients who had H1N1 pandemic influenza infection. Note that the investigators suggested that these antibodies arose from memory B cells and could provide an avenue for development of a cross-protective influenza vaccine that might not have to be administered yearly. But, Wilson and colleagues reported in the Jan. 10 issue of the Journal of Experimental Medicine, the very novelty of the virus may have opened the door to better vaccines. An analysis of immune responses of a handful of patients infected with the pandemic strain, Wilson and colleagues reported, allowed the researchers to isolate and clone antibodies that not only neutralized the 2009 virus, but also a range of other H1N1 strains, including the highly pathogenic 1918 strain. "The surprise was, when we made these antibodies, that they were unusually broadly reactive," Wilson said. Current vaccines target a section of the viral hemagglutinin protein, the so-called globular head, which is highly variable. But more than half of the antibodies found by the researchers bound to regions in the stalk of the protein, which is thought to be more highly conserved, Wilson said. Interestingly, however, some antibodies found in the study did bind to the head of the protein and even they were broadly neutralizing, suggesting that their binding regions are also highly conserved over time, Wilson said. Using those highly conserved regions, it might be possible to create a flu vaccine that would protect year after year, he said. "With the proper immunogen," the researchers argued, "the long-sought development of a pan-influenza vaccine might be possible." Wilson and colleagues are currently analyzing immune responses to the monovalent H1N1 vaccine to see if the vaccinated people have similar antibodies to those who actually had the infection, he said. The origin of the antibodies, the researchers think, may be memory B cells in the patients that were created during previous exposures to different flu strains -- a small part of a host of responses to various antigens, including the usual suspects on the globular head. Evidence for that, they said, may be the fact that the cells have highly mutated immunoglobulin genes, indicating extensive affinity maturation, the process that over time improves how well antibodies match an antigen. The novel pandemic strain, however, was sufficiently different that only the rare antibodies to the conserved regions had targets, so they were preferentially amplified. Interestingly, Wilson and colleagues said, the one antibody they found that is highly specific for the pandemic strain was derived from the patient with the most severe illness. The specificity combined with the severity of the illness suggests, they said, that he had no preexisting immunity to previous strains. As a sidelight on the discovery, the monoclonal antibodies created by the researchers appear to have both preventive and therapeutic possibilities in mice. Given before infection, the researchers found, they were highly effective at preventing death in animals from a lethal dose of a mouse-adapted version of the H1N1 pandemic strain. On the other hand, mice injected with a lethal dose of the pandemic strain could be rescued by a bolus of antibodies, even as much as 60 hours after infection, and well after they had developed symptoms, the researchers reported. In one experiment, mice were given the antibodies 48 hours after infection. But six days after infection, the virus was either undetectable or barely detectable. Meanwhile, control animals had all died by day seven or eight, they reported. The study was supported by the National Institutes of Health, the Northeast Biodefense Center, and the National Foundation for Cancer Research. The authors said they had no financial or commercial conflicts of interest.

http://www.medpagetoday.com/InfectiousDisease/SwineFlu/24253?utm_content=GroupCL&utm_medium=email&impressionId=1294731282824&utm_campaign=DailyHeadlines&utm_source=mSpoke&userid=188864

Human Immunodeficiency Virus (HIV) types Western blot (WB) band profiles as potential surrogate markers of HIV disease progression and predictors of vertical transmission in a cohort of infected but antiretroviral therapy naive pregnant women in Harare, Zimbabwe

Este artículo es muy interesante, espero que lo disfruten.
Saludos

Dr. Carlos Erazo


"Abstract
Background: Expensive CD4 count and viral load tests have failed the intended objective of
enabling access to HIV therapy in poor resource settings. It is imperative to develop simple,
affordable and non-subjective disease monitoring tools to complement clinical staging efforts
of inexperienced health personnel currently manning most healthcare centres because of brain
drain. Besides accurately predicting HIV infection, sequential appearance of specific bands of
WB test offers a window of opportunity to develop a less subjective tool for monitoring
disease progression.
Methods: HIV type characterization was done in a cohort of infected pregnant women at 36
gestational weeks using WB test. Student-t test was used to determine maternal differences in
mean full blood counts and viral load of mothers with and those without HIV gag antigen
bands. Pearson Chi-square test was used to assess differences in lack of bands appearance
with vertical transmission and lymphadenopathy.
Results: Among the 64 HIV infected pregnant women, 98.4 % had pure HIV-1 infection and
one woman (1.7%) had dual HIV-1/HIV-2 infections. Absence of HIV pol antigen bands was
associated with acute infection, p=0.002. All women with chronic HIV-1 infection had
antibody reactivity to both the HIV-1 envelope and polymerase antigens. However, antibody
reactivity to gag antigens varied among the women, being 100%, 90%, 70% and 63% for p24,
p17, p39 and p55, respectively. Lack of antibody reactivity to gag p39 antigen was associated
with disease progression as confirmed by the presence of lymphadenopathy, anemia, higher
viral load, p=0.010, 0.025 and 0.016, respectively. Although not statistically significant,
women with p39 band missing were 1.4 times more likely to transmit HIV-1 to their infants.Conclusion: Absence of antibody reactivity to pol and gag p39 antigens was associated with
acute infection and disease progression, respectively. Apart from its use in HIV disease
diagnosis, WB test could also be used in conjunction with simpler tests like full blood counts
and patient clinical assessment as a relatively cheaper disease monitoring tool required prior
to accessing antiretroviral therapy for poor resource settings. However, there is also need to
factor in the role of host-parasite genetics and interactions in disease progression."
 Este es el link para acceder el pdf completo y gratuito.

http://www.biomedcentral.com/content/pdf/1471-2334-11-7.pdf

Dynamics and Constraints of Early Infant Diagnosis of HIV Infection in Rural Kenya.

Buenos días con todos, aqui un  nuevo artículo realcionado con VIH/SIDA.

Saludos 

Dr. Carlos Erazo

AIDS Behav. 2011 Jan 7. [Epub ahead of print]

Hassan AS, Sakwa EM, Nabwera HM, Taegtmeyer MM, Kimutai RM, Sanders EJ, Awuondo KK, Mutinda MN, Molyneux CS, Berkley JA.

Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute, PO Box 230, Kilifi, 80108, Kenya.

Abstract

A cohort design was used to determine uptake and drop out of 213 HIV-exposed infants eligible for Early Infant Diagnosis (EID) of HIV. To explore service providers and care givers knowledge, attitudes and perceptions of the EID process, observations and in-depth interviews were conducted. 145 (68%) infants enrolled after 2 months of age. 139 (65%) dropped out before follow up to 18 months old. 60 (43%) drop outs occurred within 2 months of enrolment. Maternal factors associated with infant drop out were maternal loss to follow up (48 [68%] vs. 8 [20%], P < 0.001) and younger maternal age (27.2 vs. 30.1 years, P = 0.033). Service providers and caregivers had inadequate training, knowledge and understanding of EID. Poverty and lack of social support were challenges in accessing EID services. EID should be more closely aligned within PMTCT services, integrated with routine mother and child health (MCH) activities and its implementation more closely monitored.

Link:    http://www.ncbi.nlm.nih.gov/pubmed/21213034

Novel HIV Drug a 'Trade-Off'

Este artículo, salió publicado en http://www.medpagetoday.com/MeetingCoverage/ICAAC/22219?shield=0;  y habla de una nueva droga , pero también nos menciona que debemos ser cautos en su lectura e intrerpretación, hasta que sea publicado el artículo.  Espero que les sea útil. Dr. Carlos Erazo Action Points   Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal. Clinicians should note that when TMC278 was compared with efavirenz in naive patients, both taken with two nucleoside reverse transciptase agents, overall results were similar but adherence was especially critical to TMC278's efficacy in those with baseline HIV RNA over 100,000. Clinicians should note that TMC278 appeared to be better tolerated than efavirenz in these head-to-head studies. Note that mutational patterns developing on treatment were different in the two study groups. BOSTON -- In HIV patients starting therapy, an investigational non-nucleoside reverse transcriptase inhibitor had a higher rate of virologic failure than a standard medication, researchers said here. But treatment with TMC278 (rilpivirine) also caused fewer adverse events and led to fewer dropouts for such events than efavirenz (Sustiva), according to Joseph Eron, MD, of the University of North Carolina Chapel Hill. In both arms of two nearly identical phase III trials, virologic failure was more common in those with a higher baseline viral load and suboptimal adherence, Eron said during an oral presentation here at the Interscience Conference on Antimicrobial Agents and Chemotherapy. But the effect was more apparent among those taking the novel drug, he said. In the two trials -- dubbed THRIVE and ECHO -- a total of 1,368 treatment-naive patients were randomly assigned to get either TMC278 or efavirenz, combined with two other anti-HIV medications. In the ECHO trial, all patients also got the combination of tenofovir and emtricitabine (Truvada), but in THRIVE, physicians could choose any two nucleoside reverse transcriptase inhibitors. The main goal of the study was to see if the TMC278 regimens were noninferior to the efavirenz regimens, and researchers reported at the International AIDS Conference in Vienna that that was the case. (See IAC: New HIV Drug Matches Old Standard) At the AIDS meeting, Tibotec -- the developer of the drug and the sponsor of the two trials -- announced it was filing for approval of the drug. Here, Eron was filling in some of the gaps, including how and why some patients failed to respond to the drugs. In a pooled analysis of data from the two trials, the researchers found that 84.3% of TMC278 patients had a viral load of fewer than 50 copies of HIV RNA per milliliter of serum after 48 weeks of therapy, compared with 82.3% of efavirenz patients. The result met criteria for noninferiority, he said. When the patients were analyzed on the basis of baseline viral load, the two drugs were also noninferior among those starting with more than 100,000 copies, but TMC278 was actually better among those with a viral load below that cutoff with 90% responding, compared with 84%. The proportion of patients who suffered a grade 2,3, or 4 adverse event regarded as possibly related to treatment was 16% among TMC278 patients and 31% among efavirenz patients (P<0.0001), Eron said. Moreover, only 3% of TMC278 patients dropped out because of adverse events, compared with 8% of those taking efavirenz (P=0.0005). Neurological adverse events were also significantly more common (P<0.0001) among those taking efavirenz. The incidence of virologic failure -- defined as never having suppressed HIV or having rebounded after initial success -- was 10% among TMC278 patients and 6% among those taking efavirenz. Much of the difference was driven by patients with initial viral loads greater than 100,000 copies whose adherence to therapy was poor, Eron said. Among TMC278 patients, he said, there were 42 who met both criteria and 26 of them failed therapy. Among efavirenz patients, 38 met the criteria, but only 12 failed. Among those who failed therapy, Eron reported, 63% of TMC278 patients had developed at least one mutation that was associated with resistance to non-nucleoside reverse transcriptase inhibitors, compared with 54% of efavirenz patients. Each drug had a distinct pattern of resistance-associated mutations, he said, with only one seen in both groups. "The most important new information was that patients with both a high viral load at baseline and suboptimal adherence had a higher risk of failure on TMC278 than on efavirenz," said Paul Sax, MD, of Brigham and Women's Hospital in Boston, who co-moderated the session but was not involved in the research. On the other hand, he told MedPage Today, for patients who are easier to treat -- those with a low viral load when they start therapy -- "it did better." From the clinical point of view, he said, "it's a trade-off." His co-moderator, Jens Lundgren, MD, of the University of Copenhagen, commented that it's not surprising to see fewer TMC278 patients dropping out because of adverse effects, since efavirenz is known to have central nervous system impacts that many patients find difficult to tolerate "and TMC278 doesn't have that." But the bottom line, he said, may be that TMC278 is slightly less potent, but easier to take. The study was supported by Tibotec, which is developing the drug. Eron has disclosed financial relationships with GlaxoSmithKline, Bristol-Myers Squibb, Virologic, Boehringer Ingelheim, Virco, Abbott, and Merck. Some authors were employees of Tibotec. Sax reported financial links with a range of pharmaceutical companies. Lundgren said he had no disclosures.

Primary source: Interscience Conference on Antimicrobial Agents and Chemotherapy Source reference: Rimsky L, et al "Characterization of the resistance profile of TMC278: 48-week analysis of the phase III studies ECHO and THRIVE" ICAAC 2010.

LINK:  http://www.medpagetoday.com/MeetingCoverage/ICAAC/22219?shield=0

The Pattern of Indeterminate Human Immunodeficiency Virus Test and Follow-Up Evaluation in Pregnant Women.

Este arículo es interesante, el link esta al final de esta entrada para que ustedes puedan obtener más información. 

Dr. Carlos Erazo

Am J Perinatol. 2010 Dec 6. [Epub ahead of print]

Jain S, Basraon S, Loeffelholz MJ, Patel JA.

Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas.

Abstract

We studied the pattern of indeterminate HIV serological tests among pregnant women with follow-up testing in the postpartum period. Medical records of pregnant women were reviewed over a 2-year period. Of 16,596 pregnant women, 127 (0.8%) had positive HIV enzyme-linked immunoassay (ELISA) result. With Western blot (WB) test, 54 (0.33%) were positive, 43 (0.26%) were negative, and 30 (0.18%) were indeterminate. One of the 30 women (3.3%) with indeterminate WB converted to positive WB during pregnancy. White and black women were more likely to have an unconfirmed positive ELISA (indeterminate or negative WB) than Hispanics ( P = 0.021). The positive WB rate for black women was significantly higher ( P < 0.001) than other racial/ethnic groups. The postpartum follow-up testing of 14 women with indeterminate WB varied between 4 to 20 weeks; 16 did not have any postpartum follow-up test. The common bands in indeterminate WB were P24, P18, and nonviral proteins. The pattern of indeterminate WB result and its follow-up was variable during pregnancy and postpartum period. There is a need for development of national standards of care for indeterminate WB mothers and their infants in the postpartum period. Additional studies are needed to determine the cause of indeterminate tests, reducing their occurrence in the testing process, and the optimum time for testing in the postpartum period.

LINK :  http://www.ncbi.nlm.nih.gov/pubmed/21136348

Approach to Dyslipidemia, Lipodystrophy, and Cardiovascular Risk in Patients with HIV Infection.

Pensando en la Atención Integral de los pacientes con VIH /SIDA , me parece interesante este tipo de artículos.

Les dejo aqui el abstract y el link en la parte inferior para que puedan acceder a más información.

Saludos

Dr. Carlos Erazo

Curr Atheroscler Rep. 2010 Dec 23. [Epub ahead of print]

Troll JG.

Touro University College of Osteopathic Medicine, 1310 Club Drive, Vallejo, CA, 94592, USA, greg.troll@tu.edu.

Abstract

There is a significant prevalence (20%-80% depending on the population and the study) of lipid disorders and other cardiovascular risk factors in people living with HIV infection. This review focuses on HIV and HIV treatment-associated metabolic and cardiovascular concerns, including dyslipidemias, lipodystrophy syndromes, endothelial dysfunctions, and associated metabolic events such as insulin resistance. Emerging hypotheses of the underlying pathophysiology of these issues, with impact on selection of specific antiretroviral treatment (ART) strategies, therapy, and preventive approaches to decreasing cardiovascular risk and other problems associated with these syndromes are discussed. Screening for cardiovascular risk as part of the decision of starting antiretroviral therapy, and during care of patients with HIV regardless of ART therapy status, is suggested with particular areas of focus. Statins, other hyperlipidemic therapies, treatment for specific problems arising due to lipodystrophy, and implications on ART selection to avoid drug interactions and adverse effects are also discussed.

LINK:     http://www.ncbi.nlm.nih.gov/pubmed/21181310

TB and HIV in children - advances in prevention and management.

Interesante artículo, debemos pensar un poco más en la Co- infección. Aqui les mando el abstract y el link, este no esta disponible sin subscripción. Pero pueden pedirlo y comprarlo a quien esté interesado.

Paediatr Respir Rev. 2011 Mar;12(1):39-45. Epub 2010 Oct 18.

Marais BJ, Rabie H, Cotton MF.

Department of Paediatrics and Child Health, Faculty of Health Sciences, Stellenbosch University, South Africa. bjmarais@sun.ac.za

Abstract

The human immunodeficiency virus (HIV) epidemic has had a major impact on the age and gender profile of adult tuberculosis (TB) patients, resulting in increased exposure of HIV-infected and uninfected children at a very young age. Young and/or HIV-infected children are extremely vulnerable to develop severe forms of TB following recent exposure and infection. There is an urgent need to implement safe and pragmatic strategies to prevent TB in children, especially in TB endemic areas where they suffer the greatest burden of disease. The management of TB in HIV-infected children poses multiple challenges, but recent advances in the implementation of prevention of mother to child transmission (PMTCT) strategies and HIV care of infants offer hope. These include HIV testing and access to PMTCT for all pregnant women, routine testing of all HIV exposed infants and rapid initiation of antiretroviral treatment irrespective of clinical or immunological disease staging. In addition, careful scrutiny for TB exposure should occur at every health care visit, with provision of isoniazid preventive therapy (IPT) following each documented exposure event. Knowing the HIV infection status of child TB suspects is essential to optimize case management. Although multiple difficulties remain, recent advances demonstrate that the management of children with TB and/or HIV can be vastly improved by well focused interventions using readily available resources.
2010 Elsevier Ltd. All rights reserved.

 

Link: http://www.ncbi.nlm.nih.gov/pubmed/21172674