Background
Integrase strand transfer inhibitor (INSTI)-based regimens are recommended for first-line therapy in HIV-2. Nonetheless, dolutegravir (DTG) clinical trial data is lacking.
Methods
We conducted a phase II, single arm, open-label trial to evaluate the safety and efficacy of a triple therapy regimen including DTG, in persons with HIV-2 (PWHIV-2) in Portugal. Treatment-naïve adults were recruited to receive DTG in combination with two nucleoside reverse transcriptase inhibitors (NRTIs). Treatment efficacy was evaluated by the proportion of subjects achieving a plasma viral load (pVL) <40 copies/mL and/or by the change from baseline in CD4+T cell count and in CD4/CD8 ratio at week 48.
Results
A total of 30 subjects were enrolled [22 women, median age 55 years-old]. At baseline, 17 (56.7%) individuals were viremic [median pVL 190 copies/mL; interquartile range (IQR): 99-445 copies/mL]. The median CD4 count was 438 cells/μL (IQR: 335-605) and CD4/CD8 ratio was 0.8. During follow-up, 3 subjects discontinued the study. At week 48, all participants (27) had pVL<40 copies/mL. No virological failures were observed. Mean changes of CD4 count and CD4/CD8 ratio at week 48 were of + 95.59 (95%CI: 28.05-163.14) cells/µL and +0.32 (95%CI: 0.19-0.46). The most common drug-related adverse events were headache and nausea. One participant discontinued due to central nervous system symptoms. No serious adverse events were reported.
Conclusions
DTG plus two NRTIs is safe and effective as first-line treatment for PWHIV-2 with a tolerability profile previously known. No virological failures were observed which suggest a high potency of DTG in HIV-2 as occurs in HIV-1.
Objectives
We aimed to characterize neurocognitive impairment (NI) in an HIV‐2 population using an observational cross‐sectional study in four Portuguese hospitals.
Methods
Adult HIV‐2‐infected patients were included. Montreal Cognitive Assessment Test (MoCA) and International HIV Dementia Scale (IHDS) scales were applied for screening of NI. Patient Health Questionnaire‐9 (PHQ‐9) and Instrumental Activities of Daily Living (IADL) scales were used for assessment of depression and functionality. A multivariate analysis was performed to assess for risk factors for NI.
Results
Eighty‐one patients were included, 50.6% of African origin (n = 41) and 49.4% of Portuguese origin (n = 40). The MoCA scale showed alterations in 81.5% of patients (100% of migrants vs. 62.5% of non‐migrants, P < 0.001) and the IHDS scale showed alterations in 42%. Both scales were altered simultaneously in 35.8%. Variables independently associated with NI were age [odds ratio (OR) = 0.885] and migrant status (OR = 9.150).
Conclusions
Neurocognitive impairment (both scales altered) was present in 35.8%, which is comparable to what is described for HIV‐1. The MoCA performed worse in the migrant population and might not be applicable in this setting.
The combination of artemether/lumefantrine is indicated for the treatment of acute uncomplicated Plasmodium falciparum malaria. There have been no clinical trials to assess the efficacy of this medication in patients with renal impairment. While it is unlikely that artemether/lumefantrine would be removed during dialysis, clinical experience regarding drug use in this setting is limited. In this article, the authors report successful treatment of Plasmodium malariae malaria on a patient with end-stage kidney disease undergoing hemodialysis.
Ao longo dos últimos 35 anos, grandes progressos foram alcançados em termos de prevenção, diagnóstico e tratamento de infeção VIH, com redução da incidência de infeção em Portugal, na última década. Ainda assim, continua a existir uma taxa elevada de doentes com diagnóstico tardio, com consequências individuais e populacionais. Este artigo tem como objectivos: apresentar um ponto de situação da infeção VIH em Portugal, rever brevemente a evolução natural da infeção e explicitar o mais recente algoritmo de diagnóstico de infeção VIH, revisto em 2014, reforçando a necessidade de manter um elevado nível de suspeição clínica para o diagnóstico precoce de infeção.
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