Factores pronósticos al desarrollo de mutaciones relacionadas con resistencia antiretroviral secundaria en pacientes colombianos viviendo con VIH


Autoria(s): Montes, Jorge
Contribuinte(s)

Sussmann Peña, Otto

Data(s)

28/05/2015

31/12/1969

Resumo

Las mutaciones secundarias de resistencia al manejo antiretroviral es una realidad, y determina el éxito o fracaso del manejo del VIH. En Colombia, los casos de resistencia asociadas a mutaciones han aumentado. Para determinar esta condición en nuestra población, se realiza un estudio de tipo casos y controles, en pacientes VIH manejados en una IPS especializada en manejo y seguimiento de la enfermedad. Toman 71 pacientes con fracaso terapéutico por resistencia antiretroviral, y se documentaron las mutaciones confirmadas con Genotipo, pacientes que han manejado los diferentes esquemas antirretrovirales, y se comparan con pacientes controles que no desarrollaron resistencia a pesar de haber recibido un manejo antiretroviral similar e iniciado al mismo tiempo. Se busca evidenciar factores predictivos para controlar presencia de estas mutaciones a futuro. El estudio encontró que en ambos grupos, no existen diferencias significativas en cuanto a género, preferencia sexual, uso de psicoactivos, nivel social y las etapas de la enfermedad clasificadas según CDC. Observando que los pacientes con resistencia al tratamiento, eran más jóvenes que los controles (OR: 0,891; p> 0,001), y con una menor carga viral al momento del diagnóstico. La adecuada adherencia al tratamiento, se mostró como un factor protector al desarrollo de resistencia (OR: 0,030, p< 0,000). Se evidencia que existe mayor riesgo de generación de mutaciones en pacientes jóvenes. Respecto a los tipos de mutaciones evidenciadas por genotipos, se describen múltiples mutaciones, observando mutaciones para inhibidores de la transcriptasa reversa nucleosidos (33 mutaciones) y no nucleosidos (32 mutaciones), principalmente M184V en INTR (81%) y K103N en INNTR (40%), mutaciones para inhibidores de proteasa (57 mutaciones), principalmente L24I (40%); esta prevalencia de mutaciones son similares a estudios realizados y descritos en la literatura médica (1)

The secondary resistance mutations to antiretroviral management is a reality, and determines the success or failure of management of HIV. In Colombia, cases associated resistance mutations have increased. To determine this condition in our population, a study of case-control is performed in HIV patients managed in a specialized management and disease monitoring IPS. They take 71 patients with antiretroviral treatment failure for resistance, and mutations confirmed by genotype, patients who have handled different antiretroviral schemes were documented and compared with control patients who did not develop resistance despite having received a similar antiretroviral management and initiated the same time. It seeks to demonstrate predictive factors for controlling presence of these mutations in the future. The study found that in both groups, no significant differences in gender, sexual preference, use of psychoactive, social levels and stages of the disease classified according to CDC. Noting that patients with resistance to treatment, were younger than controls (OR: 0.891; p> 0.001) and with a lower viral load at diagnosis. Proper adherence to treatment, showed himself a protector to the development of resistance (OR: 0.030, p <0.000) factor. It is evident that there is a greater risk of generating mutations in young patients. Regarding the types of mutations evidenced by genotypes, multiple mutations are described, having mutations to nucleoside inhibitors of reverse transcriptase (33 mutations) and non-nucleoside (32 mutations) in INTR M184V mainly (81%) and K103N in NNRTIs (40 %), protease inhibitors mutations (57 mutations), L24I mainly (40%); This prevalence of mutations are similar to studies conducted and described in the literature (1)

Formato

application/pdf

Identificador

http://repository.urosario.edu.co/handle/10336/10470

Idioma(s)

spa

Publicador

Facultad de Medicina

Direitos

info:eu-repo/semantics/embargoedAccess

Fonte

instname:Universidad del Rosario

reponame:Repositorio Institucional EdocUR

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TEME

Palavras-Chave #616 #Medicina interna #Síndrome de Inmunodeficiencia Adquirida. SIDA #Genética #HIV, primary resistance to antirretrovirales, virologic faulier, secondary resistance
Tipo

info:eu-repo/semantics/bachelorThesis

info:eu-repo/semantics/acceptedVersion