Joaquim Oliveira

Miltefosine for visceral leishmaniasis relapse treatment and secondary prophylaxis in HIV-infected patients

Miltefosine is the first effective oral drug against visceral leishmaniasis. However, there are few data about its role against the increasing problem of HIV-associated visceral leishmaniasis. It is necessary to establish a treatment and secondary prophylaxis approach with miltefosine in this population, particularly for those in whom standard treatment was unsuccessful. We report our experience with miltefosine in 5 HIV-infected patients. Miltefosine was used in relapse treatments (50 mg, b.i.d.) in 3 patients and as maintenance therapy (50 mg, 3 times/week) in all of them. Miltefosine was discontinued after full recovery of immune function in 4 patients. The median disease-free period has been 20 months since miltefosine discontinuation. One patient was lost to follow-up. Miltefosine dosage regimens for the treatment of relapses and for maintenance treatment in HIV-infected patients should be established in prospective studies.

Direct treatment costs of HIV/AIDS in Portugal

OBJETIVO Analisar dos custos diretos medicos com VIH/SIDA, de acordo com a perspetiva do Servico Nacional de Saude, em Portugal. METODOS Efetuou-se analise retrospectiva de registros medicos em amostra de 150 pacientes de cinco centros especializados em 2008. Foram obtidos dados de utilizacao de recursos medicos durante 12 meses e das caracteristicas dos pacientes nesse periodo. Aplicou-se o custo unitario a cada componente de custo, usando fontes oficiais e dados contabilisticos dos hospitais. RESULTADOS O custo medio anual de tratamento foi de 14.277 euros por paciente. A parcela de custo mais importante foi o custo com o tratamento antirretroviral (9.598 euros), seguido dos custos de internacao (1.323 euros). Os custos de tratamento com severidade aumentaram de 11.901 euros (> 500 CD4 celulas/µl) para 23.351 euros (CD4 ≤ 50 celulas/µl). A progressao dos custos deve-se principalmente ao aumento dos custos de internacao, dado que os custos com tratamento antirretroviral se mantem constantes ao longo dos estadios. CONCLUSOES O custo elevado do tratamento antirretroviral e compensado com o custo relativamente baixo da internacao, apesar deste aumentar com a severidade. A baixa progressao dos custos totais revela que estrategias de saude publica alternativas que nao alterem a transmissao da doenca terao apenas impacto limitado nas despesas, dado que os custos sao largamente influenciados pelo do tratamento antirretroviral.

Virologic suppression in treatment-experienced patients after virologic rebound or failure of therapy.

PURPOSE OF REVIEW To discuss factors related to virologic failure and review data from recent clinical trials evaluating re-suppression of viremia in extensively-treated HIV-infected patients with resistance. RECENT FINDINGS Factors associated with virologic failure can be related to the virus (e.g. resistance), the patient (e.g. adherence) or HIV therapy (e.g. availability) and must be analyzed to minimize the likelihood of a new failure. Recent clinical trials have shown that it is now possible to achieve virologic suppression in a large proportion of treatment-experienced patients with extensive drug resistance, with several newer agents demonstrating favorable potency, tolerability and long-term efficacy. SUMMARY The benefits of highly active antiretroviral treatment are well recognized, and adding at least two (preferably three) new active drugs to an optimized background regimen can provide effective suppression of viremia even in multidrug-experienced patients. Changing drugs or regimen simplification should be considered when treatment is inadequate, poorly tolerated or associated with poor adherence, and is made easier by the newer agents and formulations now available. Newer antiretrovirals may contribute to a better quality of life and life expectancy in patients with few or no therapy options, although adherence is paramount in ensuring their continued effectiveness.

Treatment of HIV-2 infection: a retrospective study from a Portuguese center

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

Infectious Spondylodiscitis: A Retrospective Study of 140 Patients

BackgroundsSpondylodiscitis (SD), which encompasses vertebral osteomyelitis, spondylitis, and discitis, is a pathology lacking consensus on optimal management. MethodsThis was a retrospective analysis of medical records of all patients with diagnosis of SD admitted in an infectious diseases department, over a 24-year period (1988–2011). Demographic, clinical, etiologic, radiological, and therapeutic data were collected. ResultsOne hundred forty patients were enrolled, mostly male (63%), with mean age 57 years (range, 17–83 years), with average hospital stay of 46 days (range, 1–190 days). Most frequent complaints were pain (96%), fever (46%), and neurological impairment (26%). Average duration of symptoms was 4.5 months (range, 3 days to 48 months). Magnetic resonance imaging was the imaging technique more often performed, showing compatible abnormalities in 115 of 116 patients, with the lumbar vertebrae predominantly involved (55%). In 60% of cases, a definitive diagnosis was achieved (Brucella spp: 47; Staphylococcus aureus: 19; other bacteria: 11; Mycobacterium tuberculosis: 7; Candida albicans: 1). Etiology was presumed in 26% and undetermined in 14% of patients. Overall, the most prevalent was brucellar SD (39%), followed by tuberculous SD (24%) and pyogenic SD (23%). Most patients (96%) were managed medically, with regimens varying according to etiology and treatment response. Outcome was mostly favorable (82%), whereas 5% of patients died, and 10% were lost to follow-up. The remainder exhibited no clinical improvement. ConclusionsResults confirmed that an older population is mainly affected, and nonspecific manifestations lead to significant diagnostic delay. Prolonged antibiotherapy and targeted surgery appear to improve long-term prognosis. In Portugal, like other Mediterranean countries, brucellosis and tuberculosis were frequently implicated.

Costos originados por tratamiento del VIH/SIDA en Portugal

OBJETIVO Analisar dos custos diretos medicos com VIH/SIDA, de acordo com a perspetiva do Servico Nacional de Saude, em Portugal. METODOS Efetuou-se analise retrospectiva de registros medicos em amostra de 150 pacientes de cinco centros especializados em 2008. Foram obtidos dados de utilizacao de recursos medicos durante 12 meses e das caracteristicas dos pacientes nesse periodo. Aplicou-se o custo unitario a cada componente de custo, usando fontes oficiais e dados contabilisticos dos hospitais. RESULTADOS O custo medio anual de tratamento foi de 14.277 euros por paciente. A parcela de custo mais importante foi o custo com o tratamento antirretroviral (9.598 euros), seguido dos custos de internacao (1.323 euros). Os custos de tratamento com severidade aumentaram de 11.901 euros (> 500 CD4 celulas/µl) para 23.351 euros (CD4 ≤ 50 celulas/µl). A progressao dos custos deve-se principalmente ao aumento dos custos de internacao, dado que os custos com tratamento antirretroviral se mantem constantes ao longo dos estadios. CONCLUSOES O custo elevado do tratamento antirretroviral e compensado com o custo relativamente baixo da internacao, apesar deste aumentar com a severidade. A baixa progressao dos custos totais revela que estrategias de saude publica alternativas que nao alterem a transmissao da doenca terao apenas impacto limitado nas despesas, dado que os custos sao largamente influenciados pelo do tratamento antirretroviral.

Custos diretos com tratamento do VIH/SIDA em Portugal

OBJETIVO Analisar dos custos diretos medicos com VIH/SIDA, de acordo com a perspetiva do Servico Nacional de Saude, em Portugal. METODOS Efetuou-se analise retrospectiva de registros medicos em amostra de 150 pacientes de cinco centros especializados em 2008. Foram obtidos dados de utilizacao de recursos medicos durante 12 meses e das caracteristicas dos pacientes nesse periodo. Aplicou-se o custo unitario a cada componente de custo, usando fontes oficiais e dados contabilisticos dos hospitais. RESULTADOS O custo medio anual de tratamento foi de 14.277 euros por paciente. A parcela de custo mais importante foi o custo com o tratamento antirretroviral (9.598 euros), seguido dos custos de internacao (1.323 euros). Os custos de tratamento com severidade aumentaram de 11.901 euros (> 500 CD4 celulas/µl) para 23.351 euros (CD4 ≤ 50 celulas/µl). A progressao dos custos deve-se principalmente ao aumento dos custos de internacao, dado que os custos com tratamento antirretroviral se mantem constantes ao longo dos estadios. CONCLUSOES O custo elevado do tratamento antirretroviral e compensado com o custo relativamente baixo da internacao, apesar deste aumentar com a severidade. A baixa progressao dos custos totais revela que estrategias de saude publica alternativas que nao alterem a transmissao da doenca terao apenas impacto limitado nas despesas, dado que os custos sao largamente influenciados pelo do tratamento antirretroviral.

Tuberculosis with pulmonary involvement in HIV patients

Background Tuberculosis (TB) is a leading cause of death worldwide and is closely associated with HIV-infection. The higher probability of spreading TB in patients with pulmonary involvement is always a great concern and demands immediate action. The aim of this study is to analyze, retrospectively, cases of TB with confirmed pulmonary involvement in the HIV infected population observed in an Infectious Diseases Unit and diagnosed from January 2000 to December 2008.

Péricardite au cours de l'infection méningococcique

Summary A 20 years old male has been admitted to our Hospital for a serogroup B Neisseria meningitidis meningitis. During the recovery the patient developped a pericarditis, probably of immunologic ethiology. The outcome was uneventful only with symptomatic therapy. Finally, the authors discuss the pericardium damage ocurring with meningococcal infection.