Leishmaniasis is a chronic protozoan disease that is found in diverse geographical areas of the world. Leishmania spp. are endemic in the Mediterranean coasts of southern Europe. Tumour necrosis factor alpha (TNF-α) plays an important role in the defence of the host against infection by Leishmania spp. In this case report we describe Leishmania infection caused by a monoclonal antibody against TNF-α: infliximab. A 51-year-old patient with psoriatic arthritis treated with infliximab, 5 mg/kg every 6 weeks as immunomodulatory treatment and methotrexate 10 mg weekly as a conventional disease-modifying antirheumatic drug, visited his otorhinolaryngologist owing to a lesion in his left nostril. The lesion was diagnosed as cutaneous leishmaniasis so treatment with infliximab was suspended. The patient was then treated with liposomal amphotericin B and showed a total recovery of the lesion; liposomal amphotericin B was maintained at 5 mg/kg monthly.
BackgroundSome of the most common adverse effects of protease inhibitors in treatment of HIV are dislypidaemia, diabetes and other metabolic disorders. These adverse effects should be recognised by health professionals so that they can perform an intervention to minimise the cardiovascular risk of the patient.PurposeTo analyse the impact of the metabolic adverse effects in HIV patients on darunavir/cobicistat monotherapy treatment.Material and methodsThis work is a descriptive observational study which took place in the outpatient consultation of a Hospital Pharmacy in a third-level hospital. We made a search of clinical variables as well as results of analytical tests. The variables included in this study were age, smoking habit, systolic blood pressure, presence of antihypertensive treatment, presence of diabetes mellitus, and HDL and total cholesterol serum concentrations at the beginning of treatment and at 6 and 12 months after. With these data, we calculated the Framingham Risk Score (FRS) at these months and we performed a statistical analysis.ResultsPatients (n=30) had a mean age of 50.2±11.6 years and 66.6% were males. They were all on treatment with a daily tablet of darunavir/cobicistat (800 mg/150 mg) as a single drug for HIV treatment. The median of FRS at the beginning of the treatment was 9.3 (3.9–22.7). At month 6 of treatment the median of FRS was 8.9 (4.2–20.8) and after 12 months was 8.9 (3.4–21.7). None of the patients had an increase of more than 4 points. A small group of patients (n=7) from this sample, who had an initial FRS over 25 were separately studied. Their mean FRS were 38.2 (28.4–39.4) at the beginning, 32.1 (28.9–36.4) at month 6 and 30.5 (25.2–37) at month 12. Five of these seven patients had a decrease in FRS of more than 4 points. Only one of them had an increase (2 points).ConclusionBased on these findings, we can affirm that there was no increase in the cardiovascular risk of the patients on treatment with darunavir/cobicistat, but there was also an improvement. Even patients at greater risk reduced their Framingham Risk Score. We want to show the importance of knowing the drugs deeply to prevent their adverse effects.No conflict of interest
BackgroundHIV therapies are usually based on the action of various antiretroviral drugs coadministered in order to achieve a good virologic (viral loads<50 copies/ml) and immune response (percentage of T CD4 lymphocytes between 32 and 60). In the past few years a single drug therapy based on a protease inhibitor has been used to control HIV infection.PurposeTo analyse the virologic and immune response in patients on darunavir/cobicistat monotherapy.Material and methodsThis work is a descriptive observational study. In it, we have made a search of clinical variables as well as the results of analytical tests. The variables included in this study were sex, age, viral loads at the beginning of the treatment and at months 6 and 12, and percentage of T CD4 lymphocytes in blood samples. After that, we performed a statistical analysis.ResultsPatients (n=30) had a mean age of 50.2±11.6 years and 66.6% were males.They were all on treatment with a daily tablet of darunavir/cobicistat (800 mg/150 mg) as a single drug for HIV treatment. At the beginning of treatment, 76% of patients had undetectable viral load, at month 6.83% and at month 12.73%. Patients with viral load over 50 copies/ml were 20% at the beginning of treatment, 13% at month 6, and 10% at month 12.Only 50% of patients who began the treatment without virological response could achieve it at month 12. Only 6% of patients with virological response failed it at month 12.In terms of immune response, patients without it at the beginning (percentage of T CD4 lymphocytes below 32%) represented 36.7% and they did not achieve it during 12 months. Every patient with immune response at the beginning of the treatment maintained this response. Only one patient had both virologic and immune failures. Thirty-three per cent of patients had no immune response with virologic response.ConclusionBased on these findings we can confirm that monotherapy is a great strategy in patients who already have a good control of the HIV infection. Immune and virologic response is difficult to achieve after 12 months in patients who began the treatment without them.No conflict of interest
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