Long-Term Outcomes of a National Expanded Access Program to Antiretroviral Therapy: The Chilean AIDS Cohort

Wolff, Marcelo; Cortés, Claudia; Shepherd, Bryan E.; Beltrán, Carlos

doi:10.1097/qai.0b013e3181eb4fb9

Cited by 25 publications

(36 citation statements)

References 36 publications

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“…En Chile, 15,9% de los pacientes requiere cambio de su primer esquema de TARV por toxicidad, siendo además la causa de 47% de las suspensiones de tratamiento ocurrida en los primeros meses de terapia. Las reacciones adversas a medicamentos (RAM) causantes de suspensión más frecuentemente informadas por la cohorte Chilena de SIDA son: toxicidad gastrointestinal, hematológica y dermatológica 1 .…”

Section: Introductionunclassified

Incidencia de reacciones adversas a medicamentos en pacientes que inician o cambian terapia anti-retroviral

Bernal

Vásquez

Giadalah

et al. 2013

Rev. chil. infectol.

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Section: Introductionunclassified

Incidencia de reacciones adversas a medicamentos en pacientes que inician o cambian terapia anti-retroviral

Bernal

Vásquez

Giadalah

et al. 2013

Rev. chil. infectol.

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“…Previo al inicio de la TARV se encontraron co-morbilidades, según registro en ficha clínica, en cerca de 30% de los pacientes, siendo diabetes mellitus o insulino resistencia, hipertensión arterial, hipercolesterolemia y depresión, las patologías más frecuentemente encontradas. La forma de infección de los pacientes fue similar a la reportada por ChiAC 4 , la mayoría fueron debidas a transmisión sexual, con un pequeño número de transmisiones asociadas a drogadicción intravenosa. La gran mayoría de nuestros pacientes tenían el estudio serológico de hepatitis B y C. Sin embargo, muchos no reportaban el estudio de T. cruzi, T. gondii ni de tuberculosis latente con PPD, por lo que podría haber un sub-registro de estas últimas patologías.…”

Section: Discussionunclassified

“…La mayoría de los pacientes que iniciaron TARV en nuestra cohorte se encontraban asintomáticos (categoría A del CDC), con una mediana de LT CD4+ basal mayor a 200 céls/mm 3 . Esta información difiere en forma importante de los datos del sistema público chileno, donde el basal de LT CD4+ es de 102 céls/mm 3 , además de existir una mayor proporción de pacientes con enfermedad avanzada 4 . Estos hallazgos podrían ser explicados por un mayor nivel educacional de nuestra población en control, lo que llevaría a una consulta médica más precoz.…”

Section: Discussionunclassified

“…Los pacientes infectados por VIH que se atienden en el sistema público de salud conforman la cohorte chilena de SIDA (ChiAC). Los resultados del Programa de acceso ampliado a TARV en dicha Cohorte han sido publicados previamente 4 . La Red de Salud de la Universidad Católica de Chile (Red de Salud UC-CHRISTUS) es una red de salud académica privada, que incluye dos hospitales y 11 centros de atención ambulatoria.…”

Section: Introductionunclassified

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Respuesta virológica e inmunológica a la terapia anti-retroviral en pacientes portadores de infección por VIH atendidos en una red de salud académica de Chile

Ceballos

Rojas

Donato

et al. 2016

Rev. chil. infectol.

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“…El programa de acceso expandido a TAR 3 sólo alcanzó cobertura de 100% en quienes la necesitaban, desde el año 2003. La reforma sanitaria de accesos a atenciones de salud legalmente garantizados incluyó a la infección por VIH y desde 2005 la garantía se hizo obligatoria para los prestadores privados de salud [1][2][3] . En 1991 se creó la Fundación Arriarán (FA), organización no gubernamental, dedicada a la atención integral, multiprofesional, de pacientes infectados por VIH, beneficiarios principalmente del Servicio de Salud Metropolitano Central y ubicada al interior del Hospital San Borja Arriarán.…”

Section: Vih/sidaunclassified

Una década de terapia anti-retroviral: Perfil de pacientes con 10 años de triterapia de alta efectividad

Wilson

Wolff

2012

Rev. chil. infectol.

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A decade of antiretroviral therapy: a profile of patients with 10 years of highly effective triple therapyIntroduction: Highly effective antiretroviral triple therapy (TAR 3 ) has led to a significant increase in survival of patients (pts) infected with human immunodeficiency virus. In 1999 it was started in the Chilean public health system, including Arriarán Foundation (FA) access to TAR 3 , reaching full coverage since 2003. By October 31, 2009 124 pts had reached 10 years of uninterrupted TAR 3 in FA.Objective: To describe and analyze the profile of pts, their therapeutic regimen (s) and clinical outcomes during 10 years of TAR 3 . Methods: Retrospective descriptive study. We reviewed the records of pts who had reached 10 years of uninterrupted TAR 3 in FA. Demographic data, baseline and virological staging at start of TAR 3 , comorbidities and complications were recorded. Drug regimens used were analyzed, as well as toxicity, virological and immunological outcomes, frequency and reasons for change in therapy. Complications were classified as opportunistic and not opportunistic during this evolution and the latest known clinical and laboratory data were registered. A database program based on Excel was used. Results: 121/124 pts were available for analysis, 76.8% male, male-female ratio was 3.3:1. Baseline median age: 36 years (20-69); CD4 cells 176/ mm 3 (8-1,224) with 65.3% < 200; median viral load (VL): 60,078 copies/ml (1,100-7,900,000); 36.3% were in clinical AIDS stage. Patients received an average of 3.5 therapies regimens during the decade (range, 1 [14 pts, 11.5%] to 7 [3 pts, 2.4%]), with average duration of 42 months each and a median of 36 months. As initial TAR 3 regimen 2 backbone nucleoside analogues (ITRN) was the most frequent, with a protease inhibitor (PI) in 51.2% and non-nucleoside RTIs (NNRTIs) in 38.8%. Adverse reactions were the main reason for change of therapy (24.7%), followed by virological failure (24.2%) and treatment simplification (16.6%). At the latest assessment, all with ≥ 10 years of TAR 3 median CD4 was 602 cells/mm 3 , 11 pts (9%) had CD4 < 200/mm 3 ; 85.2% had undetectable VL (< 80 copies/mL); the remaining 14.8% had a median of 1,800 copies/mL. Only 2 pts (1.7%) were in AIDS clinical stage. Current regimens were 2 NRTI plus 1 NNRTI in 61 pts (50.4%), 2 or more NRTI plus 1 PI in 46 (38%). Seventy two pts (60.3%) had chronic comorbidities at latest follow up. Dyslipidemia, hypertension, diabetes mellitus and renal failure were the most frequent conditions; 17 pts (14%) had clinical lipodystrophy secondary to TAR 3 . Conclusion: Achieving a decade of TAR 3 is already a reality and in the short term will be routine. This is rarely achieved with the initial therapeutic regimen. The major obstacles to prolonged maintenance of a single therapeutic regimen have been adverse effects and virological failure, although current drugs with better efficacy and safety profile may allow longer use for each regimen. Despite the difficulty of treating these pts, they can achieve long-ter...

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Long-Term Outcomes of a National Expanded Access Program to Antiretroviral Therapy: The Chilean AIDS Cohort

Abstract: In this middle-income country, wide access highly active antiretroviral therapy has been successfully implemented and evaluated. Despite advanced disease at initiation, survival, clinical, virologic, and immunologic outcomes have been comparable with that of industrialized countries.

Cited by 25 publications

References 36 publications

Incidencia de reacciones adversas a medicamentos en pacientes que inician o cambian terapia anti-retroviral

Incidencia de reacciones adversas a medicamentos en pacientes que inician o cambian terapia anti-retroviral

Respuesta virológica e inmunológica a la terapia anti-retroviral en pacientes portadores de infección por VIH atendidos en una red de salud académica de Chile

Una década de terapia anti-retroviral: Perfil de pacientes con 10 años de triterapia de alta efectividad

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