Anna Soler

Mitochondrial involvement in antiretroviral therapy-related lipodystrophy

ObjectivesThe management of HIV infection has greatly improved during recent years essentially because of the appearance of new antiretroviral drugs. Highly active antiretroviral therapy (HAART) has achieved important reductions of viraemia and significant recoveries of CD4+ cell counts in HIV-infected patients. Nonetheless, cases of HIV-infected individuals experiencing lipodystrophy (LD) are being increasingly reported. The purpose of this work was to analyse whether the presence of mitochondrial abnormalities is a frequent feature in LD, since we previously detected mitochondrial abnormalities in an HIV-patient. The second main objective was to study whether LD could be associated with a specific drug. DesignSeven HIV patients presenting LD and five HIV non-LD controls participated in the study. LD patients met the following criteria: (1) LD was their only clinical abnormality, (2) LD was clinically relevant, (3) compliance with antiretroviral treatment was higher than 90% and (4) patients did not have personal or familial history suggestive of mitochondrial disease or neuromuscular disorder. MethodsHistological stainings, histo-enzymatic reactions, enzymatic and respiratory activities of mitochondrial respiratory chain complexes, and mitochondrial DNA (mtDNA) depletion and rearrangements were examined on muscle mitochondria. ResultsStructural muscle abnormalities, mitochondrial respiratory chain dysfunction or mtDNA deletions were detected in all HIV lipodystrophic patients. ConclusionsThe mitochondrial abnormalities found suggest that mitochondrial dysfunction could play a role in the development of antiretroviral therapy-related lipodystrophy.

Uso de bupropión en la deshabituación tabáquica en pacientes infectados por el VIH en tratamiento antirretroviral

El tabaquismo es el factor de riesgo cardiovascular modificable mas importante. El bupropion es el metodo de deshabituacion tabaquica (DT) mas eficaz, pero se metaboliza por el citocromo P-450 y podria provocar interacciones con los antirretrovirales. Presentamos un estudio prospectivo de DT con bupropion en pacientes VIH+ en tratamiento antirretroviral. Se incluyeron 21 pacientes. El 38% seguian sin fumar al ano. No se encontraron interacciones clinicamente significativas. La DT con bupropion es efectiva y no ha provocado interacciones clinicamente significativas con los antirretrovirales.Smoking is the most important modifiable cardiovascular risk factor. Bupropion administration is an effective method to achieve smoking cessation (SC), but the drug is metabolized by the cytochrome P450 enzyme system and this might cause interactions with antiretroviral drugs. We present a prospective study of bupropion SC therapy in HIV-positive patients under antiretroviral treatment. A total of 21 patients were studied; 38% of them stopped smoking for more than one year. No clinically significant drug interactions were found. Bupropion SC therapy was effective in HIV-positive patients and did not cause significant clinical interactions with antiretroviral drugs.

Tratamiento de la hiperlactatemia sintomática y de la acidosis láctica en pacientes con infección por el virus de la inmunodeficiencia humana en tratamiento con inhibidores de la transcriptasa inversa análogos de los nucleósidos

Fundamento y objetivo: Conocer la efectividad de un tratamiento para la hiperlactatemia sintomatica y la acidosis lactica secundarias al tratamiento con antirretrovirales dirigido a corregir la toxicidad mitocondrial. Pacientes y metodo: Se recluto de forma consecutiva a pacientes infectados por el virus de la inmunodeficiencia humana (VIH) a los que se les diagnostico hiperlactatemia secundaria o acidosis lactica. Se considero hiperlactatemia con concentraciones por encima de 2,2 mmol/l. El tratamiento consistia en la administracion diaria de L-carnitina, tiamina, vitamina B6, hidroxicobalamina y vitamina C, ademas de interrumpir la administracion de glucosa intravenosa y el tratamiento antirretroviral de forma inmediata. Resultados: Se incluyo a 9 pacientes, a los que se les diagnostico de hiperlactatemia sintomatica (n = 4) o acidosis lactica (n = 5) entre enero de 2001 y septiembre de 2002. Todos eran pacientes con sida y habian recibido inhibidores de la transcriptasa inversa analogos de los nucleosidos (ITIAN) durante una media de 5 anos: 7 habian recibido didanosina, 5 estavudina, 3 zidovudina, 2 lamivudina y 1 abacavir. Los sintomas que mas frecuentemente se presentaron fueron taquipnea, febricula, dolor abdominal, nauseas, vomitos y diarreas. Todos los pacientes tuvieron un buen pronostico tras administrar L-carnitina y el complejo vitaminico descrito, asi como tras la interrupcion del tratamiento antirretroviral y de la perfusion de glucosa. Los sintomas desaparecieron a los 7 dias. Despues de una media (desviacion estandar) de 15 (5) meses de seguimiento, no se ha observado recurrencia de esta complicacion. Conclusion: La administracion de L-carnitina, tiamina, vitamina B6, hidroxicobalamina y vitamina C junto a la suspension del tratamiento antirretroviral podria desempenar un papel en el tratamiento de la acidosis lactica por ITIAN en pacientes infectados por VIH.

Eficacia y tolerancia de la atorvastatina en el tratamiento de la dislipemia secundaria a tratamiento antirretroviral

BACKGROUND AND OBJECTIVE: We investigated atorvastatin effectiveness and tolerance in HIV patients with hypercholesterolemia related to antiretroviral treatment. PATIENTS AND METHOD: Prospective study that included HIV+ patients under antiretroviral treatment who displayed secondary dyslipemia and medical treatment criteria (according to NCEP-III). These patients were given 10 mg/day atorvastatin and hygienic-dietetic measures. If the therapeutic objectives were not achieved, the dose of atorvastatin was increased to 20 mg/day. Patients were followed up for 6 months. RESULTS: 32 patients were included. In 5 cases it was necessary to increase the dose from 10 mg atorvastatin to 20 mg. The therapeutic objective was obtained in 62% cases, with a good clinical tolerance. Only one adverse effect was noticed, which forced the removal of the drug. CONCLUSION: In our study atorvastatin was effective for the treatment of dyslipemia in HIV patients, and it was safe and well tolerated.

Cambios asistenciales en las consultas urgentes de los pacientes infectados por el virus de la inmunodeficiencia humana desde la generalización de los inhibidores de las proteasas

Objetivo Valorar los cambios en las consultas urgentes de los pacientes VIH+ desde la generalizacion de los inhibidores de las proteasas. Pacientes y metodos Comparacion de las consultas realizadas durante un periodo anterior y otro posterior al uso de los inhibidores de las proteasas. Resultados Tras la generalizacion de los inhibidores de las proteasas, disminuyo el porcentaje de consultas, variaron los motivos de estas y las exploraciones complementarias realizadas, se redujeron porcentualmente las medidas terapeuticas invasivas, los ingresos y los fallecimientos. Conclusiones Los inhibidores de las protea-sas han cambiado el perfil de las consultas urgentes de los pacientes VIH+.

Urgencias motivadas por pacientes controlados en un centro de atención y seguimiento de drogodependencias

BACKGROUND AND OBJECTIVE: To find out the type of emergency consultations made by users at a substance abuse treatment center (SATC). PATIENTS AND METHOD: Prospective study of emergency consultations made during six months by patients controlled at a SATC. RESULTS: 333 patients were followed up; 27 (8%) of them consulted and 9 (33%) were found to have an HIV infection. Heroin addicts consulted more times and repeated visits more commonly than cocaine addicts (p < 0.04 and 0.03). Patients enrolled in the methadone maintenance programme consulted less commonly than patients included in other programmes (p < 0.01). 35% of visited patients did not need treatment and 75% were discharged. CONCLUSIONS: We have detected two different types of consultations: those owing to a psychiatric/drug disorder in patients followed-up for less than 1 year, which are resolved after just one visit, without need of hospitalization; and those consultations caused by medical disorders, frequently related to HIV, which are generated by patients submitted to longer follow-up periods; these patients use to repeat the consultations and are commonly admitted.