Orientador: Ricardo Augusto Monteiro de Barros Almeida / Resumo: Introdução: Até há cerca de uma década, a infecção pelo HIV era considerada contraindicação absoluta para transplantes de órgãos. Estudos recentes sugerem que o transplante renal (TxR) é viável para pessoas vivendo com HIV/aids (PVHA) adequadamente selecionadas. Apesar de bastante efetivos, os TxRs em PVHA apresentam dificuldades importantes. A maioria dos estudos relatam incidências mais elevadas de rejeição aguda, chegando a mais de 50%. Fatores imunológicos e farmacológicos teriam grande influência. A literatura atual mostra que o melhor esquema antirretroviral (ARV) para os TxRs em PVHA ainda não foi identificado. Objetivo: Devido à relevância do tema e à ausência de ensaios clínicos randomizados (ECRs), o objetivo do estudo foi identificar, através de metanálise proporcional de série de casos, os esquemas de ARVs mais efetivos e seguros para PVHA submetidas ao TxR. Métodos: Foram incluídos estudos de relato e série de casos que tivessem avaliado qualquer esquema ARV utilizado em PVHA submetidas ao TxR e que fornecessem dados relacionados aos desfechos de interesse, que foram mortalidade, sobrevida do enxerto, episódios de rejeição aguda, função renal e curso clínico e laboratorial da infecção pelo HIV. A pesquisa em bases de dados foi realizada através das fontes: MEDLINE, EMBASE, Scopus e LILACS (até dezembro de 2014). Dois revisores independentemente selecionaram os estudos identificados pelas bases de dados. Foram realizadas metanálises proporcionais de série de casos comparando a ocorrência dos desfechos em diferentes esquemas ARVs por meio do software StatsDirect. A heterogeneidade estatística foi avaliada utilizando o teste estatístico I2 . Resultados e discussão: Dos 2841 estudos inicialmente identificados pela pesquisa bibliográfica, 24 respeitaram os critérios de inclusão e exclusão, totalizando 57 pacientes. Não houve diferença... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Introduction: Until about a decade ago, HIV infection was considered absolute contraindication for organ transplants. Recent studies suggest that kidney transplantation (KTx) is feasible for people living with HIV/AIDS (PLWHA) in select cases. Although highly effective, the KTx in PLWHA presents major difficulties. Most studies report higher incidences of acute rejection, reaching more than 50%. Immunological and pharmacological factors have great influence. Current literature shows that the best antiretroviral (ARV) regimen for KTx in PLWHA has not been identified. Objectives: Due to the relevance of the subject and the absence of randomized controlled trials (RCTs), the objective of the study was to identify, the most effective and safest ARV regimens for PLWHA submitted to KTx. Methods: Case series studies that have evaluated any ARV regimen used in PLWHA submitted to KTx and that provided data related to the outcomes of interest - mortality, graft survival, acute rejection, renal function and clinical and laboratory course of HIV infection - were included. Research in databases was performed using the sources: MEDLINE, EMBASE, Scopus, and LILACS (until December 2014). Two reviewers independently selected studies through the databases. Meta-analyses of case series were conducted comparing the occurrence of different outcomes in ARV schemes through software StatsDirect. Statistical heterogeneity was assessed using the I2 statistic. Results and Discussion: From 2,841 studies initially identified by the literature search, 24 studies complied with the inclusion and exclusion criteria, totaling 57 patients. There was no statistically significant difference between groups of patients who used ARV regimens based on two nucleoside/nucleotide reverse transcriptase inhibitors plus one non-nucleoside/nucleotide reverse transcriptase inhibitors (2NRTI+NNRTI), a combination of abacavir, lamivudine... (Complete abstract click electronic access below) / Mestre

Submitted by Suzana Dias (suzana.dias@famerp.br) on 2018-11-09T18:53:26Z No. of bitstreams: 1 RenatoFerneda_dissert.pdf: 585980 bytes, checksum: 7c6b97dc0f3805fe789d0fdbee741928 (MD5) / Made available in DSpace on 2018-11-09T18:53:26Z (GMT). No. of bitstreams: 1 RenatoFerneda_dissert.pdf: 585980 bytes, checksum: 7c6b97dc0f3805fe789d0fdbee741928 (MD5) Previous issue date: 2018-04-27 / Although the antirretroviral therapy, in spite of having reduced the mortality for AIDS and increased the lifespan of the HIV bearers, it can contribute to the arrise of adverse long time effects, besides renal ones. The tenofovir (TDF), a first line antirretroviral (ARV) for treatment, has low general toxicity. TDF can take to moderate reduction in glomerular filtration rate (GFR) and a larger prevalence of renal tubular dysfunction (RTD) when compared to those patients who are not on therapy of this medication. The decline of the renal function found in the patients can vary from mild to chronic injuries or a simple reduction in GFR. The mechanism of RTD is not completely understood, and it has been attributed to the mitocondrial lesion in the proximal tubule cells caused by the increasing of the intracelular TDF concentration. Aditionaly, host´s genetic polymorphisms have been considered one of the TDF concentration increasing causes. RTD can be characterized concisely by the deficiency in the solutes reabsorption as bicarbonate, uric acid, phosphate, glucose and low weight molecular proteins. Objectives: verify the prevalence of RTD in the HIV bearers on TDF treatment, identify the risk factors associated and compare the 24-hours urine methods with the serum creatinine and its clearance for the RTD identification. Methods: longitudinal prospective study, performed in the Complexo de Doenças Transmissíveis em São José do Rio Preto/SP, between january 2011 to december 2015. Results: 163 patients were included in the study, in which 106 (68,4%) didn't use TDF and 57 (31,6%) used TDF. RTD occured in 8 patients that used TDF, a prevalence of 14%. The patients age was identified as significant risk factor for the development of RTD. The proteinuria (average 109,2mg/24h) and the phosphaturia (average 791,9mg/24h) were significant for the diagnosis of RTD. Conclusions: the prevalence of RTD was 14%. The age was determined as risk factor for RTD, mainly in patients over 60 years-old. Phosphaturia and the proteinuria showed the greatest diagnosis sensibility for RTD, respectively. The serum creatinine and phosphorus concentration, the creatinine clearance and the stand alone hyperproteinuria should not be used as diagnosis predictors for RTD. / A TARV, apesar de ter reduzido a mortalidade por AIDS e aumentado a expectativa de vida dos portadores de HIV, pode contribuir para o aparecimento de efeitos adversos de longo prazo, inclusive renal. O tenofovir (TDF), antirretroviral (ARV) de primeira linha para o tratamento, tem baixo perfil geral de toxicidade. No entanto, pode levar a uma moderada redução na taxa de filtração glomerular (TFG) e uma maior prevalência de disfunção tubular renal (DTR) quando comparado àqueles pacientes que não o utilizam. O declínio da função renal encontrado nos pacientes podem ser injúrias agudas, crônicas ou uma simples redução na TFG. O mecanismo da DTR não é totalmente conhecido; atribui-se à lesão mitocondrial nas células dos túbulos proximais pelo aumento da concentração do TDF intracelular, além da suspeita da influência de polimorfismos genéticos dos hospedeiros. Pode ser resumidamente caracterizada pela deficiência na reabsorção de solutos como bicarbonato, ácido úrico, fosfato, glicose e proteínas de baixo peso molecular. Objetivos: Verificar a prevalência da DTR nos portadores de HIV em uso de TDF; identificar os fatores de risco associados e comparar os métodos de Urina de 24 horas com a creatinina sérica e o clearance para a sua identificação. Casuística e método: estudo longitudinal prospectivo, com 163 pacientes, realizado no Complexo de Doenças Transmissíveis em São José do Rio Preto/SP, no período de janeiro de 2011 a dezembro de 2015. Resultados: Foram incluídos 163 pacientes no estudo, dos quais 106 (68,4%) não utilizaram TDF e 57 (31,6%) utilizaram TDF. A DTR ocorreu em 8 pacientes que utilizaram TDF; uma prevalência de 14%. A idade dos pacientes (média de 43,9 anos) foi identificada como fator de risco significante para o desenvolvimento da DTR. A proteinúria (média 109,2mg/24h) e a fosfatúria (média 791,9mg/24h) foram significantes para o diagnóstico da DTR. Conclusões: A prevalência da DTR foi de 14%. A idade foi determinada como fator de risco para a DTR, principalmente, na faixa acima dos 60 anos. Os exames laboratoriais que mostraram a maior sensibilidade diagnóstica para a DTR foram a fosfatúria e a proteinúria, respectivamente. A creatinina sérica, o fósforo sérico, o clearance de creatinina e a hiperproteinúria isolada não mostraram sensibilidade como preditores diagnósticos para a DTR.

Diss. (sammanfattning) Stockholm : Karol. inst., 2002. / Härtill 6 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst., 2004. / Härtill 5 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst., 2006. / Härtill 4 uppsatser.

Diss. (sammanfattning) Göteborg : Göteborgs universitet, 2007. / Härtill 4 uppsatser.

Thematic Paper (M.C.T.M. (Clinical Tropical Medicine))--Mahidol University, 2006. / LICL has E-Thesis 0011 ; please contact computer services. LIRV has E-Thesis 0011 ; please contact circulation services.

Thematic Paper (M.C.T.M. (Clinical Tropical Medicine))--Mahidol University, 2007. / LICL has E-Thesis 0024 ; please contact computer services. LIRV has E-Thesis 0024 ; please contact circulation services.

Thesis (D.P.H.)--University of Alabama at Birmingham, 2008. / Title from first page of PDF file (viewed on June 25, 2009). Includes bibliographical references.

>Magister Scientiae - MSc / Adverse effects are a significant factor that determine how long patients will tolerate a given antiretroviral drug regimen. They also influence treatment options, and play an important role in the much needed adherence to treatment by patients on Highly Active Antiretroviral Therapy (HAART). This study is aimed at understanding adverse effects experienced by patients on the first line antiretroviral therapy at Keetmanshoop Hospital in Namibia. Methods : A retrospective quantitative method was used to review records of patients on first line antiretroviral treatment who started treatment between November 1st 2007 and December 1st, 2008 and followed up until they reached 36 – 48 months on treatment. Records of 94 patients were found eligible to be included in the study. Data was analysed using Stata 12 data analysis software. Results : The most reported adverse effect was musculoskeletal disorders (25%) whereas headache (16%) was the least reported. Low haemoglobin (78%) was the most common recorded hematologic adverse effect whereas low red cell distribution width and low mean platelet volume were the least recorded adverse effects (0%). A Male patient was more likely to experience a low haemoglobin levels compared to a female patient (adjusted OR: 3.29, 95% CI: 1.3 – 8.3). A male patient was found to be 64% times less likely to experience a higher mean cell haemoglobin compared to a female patient (adjusted OR. 0.31, 95% CI: 0.11 – 0.87). A patient on nevirapine was more likely to experience an elevated creatinine level compared to a patient on efavirenz (adjusted OR; 36.0, 95%CI: 2.02 – 62.5). At baseline, a patient who had prior exposure to ART had an 81 times (adjusted OR: 81.4, 95%CI: 5.3 – 119, p-value=0.00) increased odds of experiencing a high mean cell volume (MCV) compared to a patient with no ART exposure. A patient with a higher CD4 count was also less likely to experience a low hemoglobin compared to a patient with low CD4 count (adjusted OR; 0.31, 95% CI: 0.12 – 0.77). The author recommends further studies with higher sample size to confirm whether higher creatinine levels are more prevalent in patients on nevirapine compared to patients on efavirenz; this will have clinical implications especially in patients with impaired renal system. Antiretroviral treatment increases chances of developing macrocytosis anaemia; clinical implication of this condition may need to be investigated.