Seguimiento prospectivo de una población infectada por VIH con y sin posibilidades de terapia anti-retroviral: impacto en sobrevida y complicaciones

Background: Three-drug antiretroviral therapy (ART-3) has reduced complications and improved survival in HIV+ patients. The Chilean Public Health System began dual therapy (ART-2) in 1997, covering approximately 40% of patients in need. Aim: To report the results of a follow-up of patients with and...

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Autores principales:	Wolff R,Marcelo, Diomedi A,Alexis, Morales B,Omar, Bidart H,Teresa, Dabanch P,Jeannette, Bustamante M,Claudia, Northland A,Rebeca
Lenguaje:	Spanish / Castilian
Publicado:	Sociedad Médica de Santiago 2001
Materias:	Antiviral agents HIV infections Retroviridae
Acceso en línea:	http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872001000800007
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spelling	oai:scielo:S0034-988720010008000072001-10-29Seguimiento prospectivo de una población infectada por VIH con y sin posibilidades de terapia anti-retroviral: impacto en sobrevida y complicacionesWolff R,MarceloDiomedi A,AlexisMorales B,OmarBidart H,TeresaDabanch P,JeannetteBustamante M,ClaudiaNorthland A,Rebeca Antiviral agents HIV infections Retroviridae Background: Three-drug antiretroviral therapy (ART-3) has reduced complications and improved survival in HIV+ patients. The Chilean Public Health System began dual therapy (ART-2) in 1997, covering approximately 40% of patients in need. Aim: To report the results of a follow-up of patients with and without access to ART in a Chilean public hospital. Patient and Methods: Prospective follow-up of patients with ART-2 and 3 (cases) and patients with no access to ART (controls). All patients needed ART but it was available to a minority of them. Selection for ART was at random. Follow-up was between 6-24 months (11/96 to 3/99). Basal and periodic clinical and laboratory parameters were determined. Mortality and occurrence of new AIDS-defining events (ADE) were compared statistically using chi square. Results: One hundred and fifty cases (106 ART2, 28 ART3 and 16 ART2 expanded to ART3) and 166 controls were studied. Basal parameters were similar except prior ART (32.7 and 18.7% in cases and controls respectively). Close to 1/3 patients had AIDS. Cases had a mean follow up of 527 days; controls, 478. Six cases (4%) (5 in ART-2) and 17 controls (10%) died. Mortality x 100/pts/yr was 2.7 in cases and 7.7 in controls, p <0.05. ADE per 100/pts/yr was 21 in cases (24.4 in ART2, 15.1 in TAR3) and 54.5 in controls, p <0.05. Cases had a reduction of: esophageal candidiasis (84%), tuberculosis (75%), cryptococcosis and toxoplasmosis (66%), P carinii pneumonia (55%) and bacterial pneumonia (46%) and they had fewer hospitalizations (73%). Late assessment: 70 of 101 ART-2 patients had changed to ART-3 (1 death); 22 of 101 kept original ART-2 (12 dead, 10 alive), 39 of 43 ART-3 patients were alive and 1 died. Conclusions: Short-term ART-2 and 3 significantly reduced mortality (60% and 73%) ADE (65% and 76% respectively) and hospitalizations. Benefits of ART-2 were short lived. Resource-constrained countries cannot depend on weaker than standard ART for proper care of people with HIV disease. (Rev Méd Chile 2001; 129: 886-94)info:eu-repo/semantics/openAccessSociedad Médica de SantiagoRevista médica de Chile v.129 n.8 20012001-08-01text/htmlhttp://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872001000800007es10.4067/S0034-98872001000800007
institution	Scielo Chile
collection	Scielo Chile
language	Spanish / Castilian
topic	Antiviral agents HIV infections Retroviridae
spellingShingle	Antiviral agents HIV infections Retroviridae Wolff R,Marcelo Diomedi A,Alexis Morales B,Omar Bidart H,Teresa Dabanch P,Jeannette Bustamante M,Claudia Northland A,Rebeca Seguimiento prospectivo de una población infectada por VIH con y sin posibilidades de terapia anti-retroviral: impacto en sobrevida y complicaciones
description	Background: Three-drug antiretroviral therapy (ART-3) has reduced complications and improved survival in HIV+ patients. The Chilean Public Health System began dual therapy (ART-2) in 1997, covering approximately 40% of patients in need. Aim: To report the results of a follow-up of patients with and without access to ART in a Chilean public hospital. Patient and Methods: Prospective follow-up of patients with ART-2 and 3 (cases) and patients with no access to ART (controls). All patients needed ART but it was available to a minority of them. Selection for ART was at random. Follow-up was between 6-24 months (11/96 to 3/99). Basal and periodic clinical and laboratory parameters were determined. Mortality and occurrence of new AIDS-defining events (ADE) were compared statistically using chi square. Results: One hundred and fifty cases (106 ART2, 28 ART3 and 16 ART2 expanded to ART3) and 166 controls were studied. Basal parameters were similar except prior ART (32.7 and 18.7% in cases and controls respectively). Close to 1/3 patients had AIDS. Cases had a mean follow up of 527 days; controls, 478. Six cases (4%) (5 in ART-2) and 17 controls (10%) died. Mortality x 100/pts/yr was 2.7 in cases and 7.7 in controls, p <0.05. ADE per 100/pts/yr was 21 in cases (24.4 in ART2, 15.1 in TAR3) and 54.5 in controls, p <0.05. Cases had a reduction of: esophageal candidiasis (84%), tuberculosis (75%), cryptococcosis and toxoplasmosis (66%), P carinii pneumonia (55%) and bacterial pneumonia (46%) and they had fewer hospitalizations (73%). Late assessment: 70 of 101 ART-2 patients had changed to ART-3 (1 death); 22 of 101 kept original ART-2 (12 dead, 10 alive), 39 of 43 ART-3 patients were alive and 1 died. Conclusions: Short-term ART-2 and 3 significantly reduced mortality (60% and 73%) ADE (65% and 76% respectively) and hospitalizations. Benefits of ART-2 were short lived. Resource-constrained countries cannot depend on weaker than standard ART for proper care of people with HIV disease. (Rev Méd Chile 2001; 129: 886-94)
author	Wolff R,Marcelo Diomedi A,Alexis Morales B,Omar Bidart H,Teresa Dabanch P,Jeannette Bustamante M,Claudia Northland A,Rebeca
author_facet	Wolff R,Marcelo Diomedi A,Alexis Morales B,Omar Bidart H,Teresa Dabanch P,Jeannette Bustamante M,Claudia Northland A,Rebeca
author_sort	Wolff R,Marcelo
title	Seguimiento prospectivo de una población infectada por VIH con y sin posibilidades de terapia anti-retroviral: impacto en sobrevida y complicaciones
title_short	Seguimiento prospectivo de una población infectada por VIH con y sin posibilidades de terapia anti-retroviral: impacto en sobrevida y complicaciones
title_full	Seguimiento prospectivo de una población infectada por VIH con y sin posibilidades de terapia anti-retroviral: impacto en sobrevida y complicaciones
title_fullStr	Seguimiento prospectivo de una población infectada por VIH con y sin posibilidades de terapia anti-retroviral: impacto en sobrevida y complicaciones
title_full_unstemmed	Seguimiento prospectivo de una población infectada por VIH con y sin posibilidades de terapia anti-retroviral: impacto en sobrevida y complicaciones
title_sort	seguimiento prospectivo de una población infectada por vih con y sin posibilidades de terapia anti-retroviral: impacto en sobrevida y complicaciones
publisher	Sociedad Médica de Santiago
publishDate	2001
url	http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872001000800007
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Seguimiento prospectivo de una población infectada por VIH con y sin posibilidades de terapia anti-retroviral: impacto en sobrevida y complicaciones

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