Suchergebnisse

ObjectivesPrimary ‐ evaluate the improvement in psychiatric symptoms attributable to changing the antiretroviral drug responsible for such symptoms to nevirapine (NVP). The tools used were a sleep test (the Pittsburgh Sleep Quality Index [PSQI]) and the Hospital Anxiety and Depression Scale (HADS). Secondary ‐ determine the neuropsychiatric disorders and evaluate adherence to treatment and quality of life.MethodsProspective, observational post‐authorisation study that included HIV‐1 patients from 36 Spanish hospitals who satisfied the following criteria: age over 18 years; change of antiretroviral treatment to NVP due to CNS side‐effects; a PSQI score >5 (significant sleep disturbance); a HADS score ≥10 on the day of starting NVP treatment; and no psychoactive drug treatment initiated during the 6 weeks prior to starting treatment with NVP. Other data gathered from the patients included clinical and demographic details and administration of the Epworth somnolence scale, the Medical Outcomes Study‐short form 30 items (MOS‐SF‐30) quality of life scale and the Simplified Medication Adherence Questionnaire (SMAQ). Evaluations were performed at baseline, 1 and 3 months after the change.Results129 patients were included (73.6% men; mean age, 43.2 ± 9.8 years; 36.5% homosexual, 30.2% heterosexual; 28.7% drug users; 38% AIDS; 33.3% co‐infection). The drug changed was efavirenz in 89.9% of cases. The reason for the change was sleep disturbances in 75.2%, anxiety in 65.1%, other psychiatric disturbances in 38.7%, attention disturbances in 31%, and other reasons in 31%; a mean of 2.4 neuropsychiatric disturbances were detected in each patient. CD4 rose from 582 ± 261 to 619 ± 299 (non‐significant difference). Only three patients had developed an HIV viral load at the end of the study. The differences produced by the change are shown in Table 1. 29 patients withdrew from the study, for the following reasons: 9 for NVP‐related toxicity (7 cases of rash and 2 of hepatitis); 7 for loss to follow‐up; 4 for voluntary withdrawal; 9 for other reasons.












Baseline (n=129)
1 month (n=100)
3 months (n=100)
p value, baseline‐1 mo
p value, baseline‐3 mo




Percentage of patients with a PSQI score >5, suggestive of a significant alteration of sleep
96.9%
60.7%
44%
<0.001
<0.001


Percentage of patients with clinical problems of anxiety and depression, HADS
86.8%
46.4%
32%
<0.001
<0.001


Mean score and percentage of patients with normal somnolence, Epworth scale
8.3±4.7/(65.9%)
6±4 (89.3%)
5.5±3.6 (91%)
<0.001/0.001
<0.001/0.001


Percentage of compliant patients, SMAQ
65.9%
75.9%
81%
0.036
0.013


Percentage of patients with a good quality of life, MOS‐SF‐30
57.5±18.9%
69.8±19.7%
73.6±16.8%
<0.001
<0.001




DiscussionThe study shows that the change to NVP from a drug that is causing neuropsychiatric disturbances (principally, efavirenz) is effective in resolving those disturbances, with an improvement in all the parameters studied (quality of sleep, anxiety/depression and somnolence). This leads to better adherence and a better quality of life with no detriment to their immunological and virological control.

Purpose of the studySwitching to ritonavir‐boosted darunavir (DRV/r) in patients treated with double ritonavir‐boosted protease inhibitors (PI/r) may result in better tolerability, less pill burden, better lipid profile and a lower cost, while maintaining virologic efficacy.MethodsMulticentre, concurrent cohort observational study. HIV‐infected adults with HIV RNA <50 copies/mL for at least the previous 12 months on a double PI/r‐based therapy were offered to switch to DRV/r (DRV group) or to continue on the same regimen (control group). Visits (including blood tests, adherence and side effects assessment) were performed every 3 months, with a follow‐up of at least one year. Descriptive values are described as n (%) or median (interquartile range). Changes from baseline in quantitative variables have been calculated with the Wilcoxon Signed Ranks Test and comparisons between groups have been performed with the Mann‐Whitney test, using SPSS 20.0 statistical package.Summary of results65 patients were included (35 DRV group and 30 control group); median age was 46 (40–49) years, 76% were male. At baseline, double‐boosted PI regimens were lopinavir‐atazanavir/r 24%, lopinavir‐saquinavir/r 46%, lopinavir‐fosamprenavir/r 8%, atazanavir‐saquinavir/r 18% and others 4%. There were no significant differences between groups in baseline characteristics, except for patients who switched to DRV had a higher number of prior antiretroviral regimens [6 (3–8) vs 2 (1–4), p=.002]. Of the patients who switched to DRV/r, 46% received DRV/r once‐daily and 54% twice‐daily. After 48 weeks, one patient in each arm had virologic failure and one patient in the DRV arm stopped treatment due to side effects (depressive syndrome); there were no episodes of rash or clinical hepatitis. Efficacy (HIV RNA <50 copies/mL) was similar in the DRV and control groups by intention‐to‐treat analysis (94 vs. 97%, p=NS). There were no significant differences in laboratory parameters between treatment groups except for a decrease in total bilirrubin in patients who switched to DRV/r (−0.69 vs +0.28 mg/dL, p=.028). Treatment switch represented a median saving of 157 (32–264) euros per patient per month.ConclusionsSwitching from a double‐boosted PI regimen to DRV maintains virologic efficacy, with good tolerability and a lower cost.

Introduction: The outbreak of the new coronavirus (COVID-19) was declaredas a pandemic by the World Health Organization in March 2020. TheArgentinian government adopted a preventive social isolation and lockdownstrategy as an exceptional measure in this critical world context. This lockdownstrategy has kept a large number of people in isolation and affectedmany aspects of people?s lives. Objective: To describe the physical and mentalhealth status and possible changes in hygienic, nutritional and, daily habitsduring quarantine in the COVID-19 pandemic. Materials and Method: Anonline anonymous survey was sent to the general population of Buenos Airescity, 434 people answered the questionnaire. Results: Fifty-one percent ofrespondents were between 40 and 70 years old. Most respondents were female(75.8%) and had higher education (62.2%). Thirty point eight percent had apre-existing disease and in 50.7% of these cases, the usual symptoms experiencedby respondents remained unchanged. The onsets of anxiety (38.2%),depression symptoms (27.9%), sleep disorders (20.5%), and irritability(27.2%) were reported during the isolation period. Also, changes in eatinghabits (55.5%) were reported. Significant improvement was reported in personalhygiene (80.2%) and home cleaning (81.3%) habits. It was also observedthat despite the isolation some people continued doing physical activity.Conclusions: Respondents did not report significant changes in the symptomsof their preexisting diseases and had a positive mindset towards personalhygiene and home cleaning. Also, reported continuity in physical activity during isolation. However, the onset of psychiatric symptoms such as anxiety, depression, irritability and sleep problems, and, changes in eating habits were observed during the quarantine. ; Fil: Dillon, Carol. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. CEMIC-CONICET. Centro de Educaciones Médicas e Investigaciones Clínicas "Norberto Quirno". CEMIC-CONICET; Argentina. Universidad de Palermo; Argentina ; Fil: Pérez Leguizamón, Patricio Rosendo. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. CEMIC-CONICET. Centro de Educaciones Médicas e Investigaciones Clínicas "Norberto Quirno". CEMIC-CONICET; Argentina ; Fil: Castro, Diego. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. CEMIC-CONICET. Centro de Educaciones Médicas e Investigaciones Clínicas "Norberto Quirno". CEMIC-CONICET; Argentina ; Fil: Guelar, Veronica. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. CEMIC-CONICET. Centro de Educaciones Médicas e Investigaciones Clínicas "Norberto Quirno". CEMIC-CONICET; Argentina ; Fil: Garcia, Virginia. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. CEMIC-CONICET. Centro de Educaciones Médicas e Investigaciones Clínicas "Norberto Quirno". CEMIC-CONICET; Argentina ; Fil: Feldman, Monica. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. CEMIC-CONICET. Centro de Educaciones Médicas e Investigaciones Clínicas "Norberto Quirno". CEMIC-CONICET; Argentina ; Fil: Leis, Adriana. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. CEMIC-CONICET. Centro de Educaciones Médicas e Investigaciones Clínicas "Norberto Quirno". CEMIC-CONICET; Argentina ; Fil: Romano, Marina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. CEMIC-CONICET. Centro de Educaciones Médicas e Investigaciones Clínicas "Norberto Quirno". CEMIC-CONICET; Argentina ; Fil: Peralta, Cecilia. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. CEMIC-CONICET. Centro de Educaciones Médicas e Investigaciones Clínicas "Norberto Quirno". CEMIC-CONICET; Argentina ; Fil: Rojas, Juan Ignacio. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. CEMIC-CONICET. Centro de Educaciones Médicas e Investigaciones Clínicas "Norberto Quirno". CEMIC-CONICET; Argentina ; Fil: Maggi, Silvana. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. CEMIC-CONICET. Centro de Educaciones Médicas e Investigaciones Clínicas "Norberto Quirno". CEMIC-CONICET; Argentina ; Fil: Viaggio, María Belen. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Parque Centenario. CEMIC-CONICET. Centro de Educaciones Médicas e Investigaciones Clínicas "Norberto Quirno". CEMIC-CONICET; Argentina