Browsing by Author "Lampreia, F"
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- Efavirenz Concentrations in HIV-Infected Patients With and Without Viral HepatitisPublication . Pereira, SA; Caixas, U; Branco, T; Germano, I; Lampreia, F; Papoila, AL; Monteiro, EAIMS: Data on efavirenz in HIV/viral hepatitis co-infected patients is non-consensual, probably due to liver function heterogeneity in the patients included. METHODS: A case control study was performed on 27 HIV-infected patients, with controlled and homogenous markers of hepatic function, either mono-infected or co-infected with HBV/HCV, to ascertain the influence of viral hepatitis on efavirenz concentrations over a 2-year follow-up period. RESULTS: No differences were found in efavirenz concentrations between groups both during and at the end of the follow-up period: control (2.43 +/- 1.91 mg l(-1)) vs. co-infected individuals (2.37 +/- 0.37 mg l(-1)). CONCLUSION: It was concluded that HBV/HCV infections in themselves do not predispose to an overexposure to efavirenz.
- Effect of Efavirenz on High-Density Lipoprotein Antioxidant Properties in HIV-Infected PatientsPublication . Pereira, SA; Batuca, JR; Caixas, U; Branco, T; Delgado-Alves, J; Germano, I; Lampreia, F; Monteiro, ECWHAT IS ALREADY KNOWN ABOUT THIS SUBJECT: * In previous work, we showed a long-term and concentration-dependent beneficial effect of the non-nucleoside reverse transcriptase inhibitor efavirenz (EFV) on high-density lipoproteins (HDL) in human immunodeficiency virus (HIV)-infected patients. * Furthermore, it has been suggested that instead of the current practice of only measuring HDL-chelesterol values, the evaluation of HDL function, namely its antioxidant properties, might be an improved tool for identifying subjects at increased risk for cardiovascular events. * Paraoxonase-1 (PON-1) is an enzyme associated with HDL that is responsible for HDL antioxidant function. WHAT THIS STUDY ADDS: * In the present work, we studied the effect of EFV on the activity of PON-1 and showed, for the first time, that EFV-based antiretroviral therapy is associated with a better antioxidant function, i.e. with a higher PON-1 activity. AIMS: A long-term and concentration-dependent beneficial effect of efavirenz (EFV) on cholesterol associated with high-density lipoprotein (HDL-c) in human immunodeficiency virus (HIV)-infected patients has been documented. Furthermore, it has been suggested that, instead of the current practice of only measuring HDL-c values, the evaluation of HDL quality might be an improved tool for identifying subjects at increased risk of cardiovascular events. Paraoxonase-1 (PON-1) is an enzyme associated with HDL that is involved in the onset of cardiovascular disease and responsible for HDL antioxidant function. The aim of the present study was to investigate the effect of EFV on the circulating activity of PON-1 in HIV-infected patients. METHODS: The patients included were adults with a documented HIV-1 infection, nontreated or treated with antiretroviral regimens including EFV 600 mg once daily as first therapeutic regimen for at least 3 months. The influence of treatment with EFV, HDL-c and CD4 cell count on PON-1 activity was analysed. RESULTS: HIV-infected White patients treated with EFV had higher PON-1 activity [77.35 U l(-1) (65.66, 89.04)] (P < 0.05) and higher PON-1 activity : HDL-c ratio [1.88 (1.49, 2.28)] (P < 0.01) than untreated patients. PON-1 activity was higher in Black patients (P < 0.001) and in patients with a CD4 cell count >500 cells ml(-1) (P= 0.0120). CONCLUSIONS: EFV-based antiretroviral regimens are associated with HDL particles with a better antioxidant function, i.e. with a higher PON-1 activity. The PON-1 activity of Black patients is higher than that found in Whites regardless of treatment. Ethnicity should be taken into consideration when studying drug effects on PON-1 activity.
- Long-Term and Concentration-Dependent Beneficial Effect of Efavirenz on HDL-Cholesterol in HIV-Infected PatientsPublication . Pereira, SA; Branco, T; Côrte-Real, R; Germano, I; Lampreia, F; Caixas, U; Monteiro, EAIMS: To investigate the long-term effects of efavirenz on cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein (LDL-C) and triglycerides (TG). METHODS: Thirty-four HIV-infected patients who commenced efavirenz therapy were monitored for 36 months. RESULTS: In patients with baseline HDL-C<40 mg.dL-1 an increase in HDL-C from 31+/-1 mg.dL-1 to 44+/-2 mg.dL-1 (95% confidence interval 5.9, 21.9, P<0.01) was observed and remained throughout the follow-up period. Median efavirenz plasma concentration was 1.98 mg.L-1 and a direct correlation between percentage of HDL-C variation or TC/HDL-C ratio and efavirenz plasma concentrations was found. CONCLUSIONS: There is evidence of a long-term and concentration-dependent beneficial effect of efavirenz on HDL-C in HIV-infected patients.
- Long-Term Maraviroc Use As Salvage Therapy in HIV-2 InfectionPublication . Caixas, U; Ferreira, J; Marinho, A; Faustino, I; Grilo, N; Lampreia, F; Germano, I; Monteiro, E; Pereira, S
- Miocardiopatia de Takotsubo: na Origem do Choque CardiogénicoPublication . Fevereiro, MC; Simões, I; Lampreia, F; Marcão, I; Godinho, A; Lopes, VA miocardiopatia de Takotsubo, de etiologia desconhecida, caracteriza-se pela disfunção sistólica súbita e transitória dos segmentos médio-apicais do ventrículo esquerdo, sem doença coronária significativa, com total normalização das alterações segmentares. É mais frequente em mulheres de meia-idade, implicando diagnóstico diferencial com a sindrome coronária aguda. Apresentamos o caso de uma mulher de 59 anos que recorreu ao Serviço de Urgência por dispneia súbita e dor torácica. À admissão apresentava-se em edema pulmonar agudo hipotensivo com necessidade de suporte aminérgico e ventilação invasiva. A avaliação analítica demonstrava elevação dos marcadores cardíacos. Electrocardiogramas seriados em ritmo sinusal com inversão progressiva da onda T nas derivações precordiais (v2 - v6). Ecocardiogramas de controlo revelando acinésia apical com diminuição da função sistólica global, e reversão total das alterações em duas semanas. Admitido choque cardiogénico de etiologia não esclarecida foi excluída doença coronária, sustentando o diagnóstico de miocardiopatia de Takotsubo.
- Pneumatocele Gigante: Um Achado InesperadoPublication . Fevereiro, MC; Cardoso, S; Lampreia, F; Godinho, A
- Síndrome Retrovírica AgudaPublication . Serrão, V; Caldas Lopes, L; Lampreia, F; Germano, I; Paiva Lopes, MJA síndrome retrovírica aguda ou infecção primária pelo Vírus da Imunodeficiência Humana (VIH), tem manifestações clínicas inespecíficas, sendo raramente diagnosticada. Como a sintomatologia pode ocorrer antes da formação de anticorpos detectáveis pelos testes classicamente utilizados, o diagnóstico deverá basear-se num elevado índice de suspeição clínica associado a um correcto pedido e interpretação dos testes laboratoriais. Apresenta-se doente de sexo feminino, 64 anos, internada por quadro com 3 dias de evolução de exantema maculopapular do tronco e da face, ulcerações aftosas orais, febre, mialgias e quebra do estado geral. Negava consumo de qualquer fármaco ou drogas recreativas, comportamento sexual de risco ou patologia dermatológica prévia. Foi efectuado estudo analítico, de cujos resultados se salientam: VIH por teste ELISA de 4ª Geração fracamente positivo; Antigénio p24 positivo; Western-Blot negativo; Carga Viral elevada para VIH1. O exame histológico das lesões cutâneas foi compatível com exantema viral. Após avaliação em Consulta de Imunodeficiência, iniciou terapêutica anti-retrovírica tripla. Teve alta ao 7º dia de internamento, com melhoria franca das lesões cutâneas e da restante sintomatologia. A valorização dos testes analíticos para a infecção VIH deverá ser baseada no conhecimento da evolução clínica e analítica da mesma. Dado o “período de janela” da infecção, é importante salientar que perante a suspeita de síndrome retrovírica aguda é essencial a pesquisa de partículas virais (Antigénio p24 ou carga Viral). Discute-se a controvérsia associada à introdução de terapêutica anti-retrovírica nesta fase precoce da infecção.