Carmela Piñeiro

Reasons for treatment discontinuation in the first year after beginning antiretroviral therapy in a cohort of Portuguese HIV-infected patients

7‐11 November 2010, Tenth International Congress on Drug Therapy in HIV Infection, Glasgow, UK

Prevalence of abacavir-associated hypersensitivity syndrome and HLA-B*5701 allele in a Portuguese HIV-positive population

Background: Human Immunodeficiency Virus (HIV)‐positive patients treated with the antiretroviral drug abacavir (ABC) may develop a potentially fatal ABC‐associated hypersensitivity syndrome (ABC‐HS), typically characterized by fever, malaise, rash, vomiting/diarrhoea and/or dyspnoea/cough. ABC‐HS has been strongly associated with HLA‐B*57:01 carriage and screening for this allele is recommended. Objective: To determine the prevalence of HLA‐B*57:01 and to characterize suspected ABC‐HS in the adult HIV population from our hospital during a 7‐year period. Methods: Clinical data on patients under ABC treatment from January 2006 to December 2012 were analyzed to search for symptoms of ABC‐HS. Reactions of suspected ABC‐HS were characterized. HLA‐B*57:01 and patch tests (1% and 10% ABC in petrolatum) with readings at 48 h were performed in those without previous testing. From January 2008 routine HLA‐B*57:01 screening was implemented. Results: From January 2006 to December 2007, 186 patients began treatment with ABC (data from 163 were available): 7 (4%) patients stopped ABC for suspected ABC‐HS (71% males, median age 45 years) and the median time for onset of the reaction after starting ABC was 7 days. Four of the 7 patients had the HLA‐B*57:01 allele and 2 of these 4 had positive patch tests. After HLA‐B*57:01 screening implementation (January 2008), 573 patients were evaluated and 35 (6.1%) were HLA‐B*57:01 positive; no suspected ABC‐HS were observed since then. Conclusion: Four patients with suspected ABC‐HS (of 6 screened) were HLA‐B*57:01 positive. No ABC‐HS occurred since January 2008, after HLA‐B*57:01 screening was implemented.

Prevention of mother-to-child transmission: experience of a Portuguese centre.

HIV infection during pregnancy still raises controversial issues. Combined antiretroviral therapy (cART) has been successful in reducing mother‐to‐child transmission (MTCT). Routine screening in pregnancy and in pre‐conception consultation proved to be one of the best methods able to get this treatment on time. We review our experience with pregnant patients with HIV infection.

Factors associated with immune status in the diagnosis of HIV infection

Current guidelines recommend the start of antiretroviral therapy before advanced immunosuppression, which is not always possible. The purpose of this study is to evaluate factors associated with the degree of immunosuppression at the diagnosis of HIV infection.

Artritis tuberculosa - Auto inoculación en profesional sanitario por accidente laboral

Mycobacterium tuberculosis infection may occur after inoculation with infected biological material into the skin or mucous membranes. The authors describe a case of tuberculous monoarthritis in a previously healthy orthopedic surgeon, due to an accidental inoculation during the surgical drainage of a septic arthritis. Treatment with oral antituberculous drugs and surgical drainage was sufficient, without resorting to synovectomy.

Clinical and immunological presentation of new HIV-infected patients in an outpatient clinic

Results 311 new patients were observed (305 HIV-1 infected and 6 HIV-2 infected), with a mean age of 42 ± 13,7 years. 218 (70%) patients were men. Risk factor for HIV-infection was sexual in 271 (87%) patients (18% were homo-bisexual). At the time of diagnosis the mean CD4+ cell count was 333 ± 305 cells/mm3; 132 (42,4%) patients had CD4 cell count <200/mm. In 89 (28,6%) patients an AIDS-defining illness was diagnosed simultaneously with HIV-infection diagnosis; 43% of these were tuberculosis. After a mean follow-up of 15 ± 9,7 months 27 (8,6%) patients died, 24/27 (88,8%) with AIDS and the other 3 patients one each with eosophageal cancer, hepatic failure and MSSA sepsis,. In 22/27 (81,4%) of the deceased patients the CD4 cell count was <200 cells/mm at the time of the HIV diagnosis. Discussion In the last 3 years, 42% of the new diagnosed patients had a serious immunological deficit. In 28% of them HIV-infection was diagnosed simultaneously with a defining AIDS opportunistic infection. The fact that 81,4% of the deceased patients had a CD4 cell count <200/mm at diagnosis shows that HIV-infection diagnosis was done too late for ART to be of benefit.