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Texto completo SciELO Chile
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Id: lil-764085
Autor: Mastro-Martínez, Ignacio; Montes-Arjona, Ana María; Escudero-Lirio, Margarita; Hernández-García, Bárbara; Fernández-Cantalejo Padial, José.
Título: Rabdomiólisis grave secundaria a deshidratación hipernatrémica / Severe rhabdomyolysis secondary to severe hypernatraemic dehydration
Fonte: Rev. chil. pediatr;86(4):279-282, ago. 2015. graf.
Idioma: es.
Resumo: Introducción: La rabdomiólisis es una enfermedad poco frecuente en pediatría. El objetivo es presentar un paciente en el que se desarrolló secundario a una deshidratación hipernatrémica grave tras una diarrea aguda. Caso clínico: Lactante de 11 meses que consultó por fiebre, vómitos, diarrea y anuria. Presentó convulsión tónico-clónica autolimitada. Ingresó en mal estado general, severamente deshidratado, con escasa reactividad. En las pruebas complementarias destacó acidosis metabólica grave, hipernatremia e insuficiencia renal prerrenal. Al tercer día apreció leve hipotonía axial y elevación de creatín fosfokinasa 75.076 UI/l, interpretado como rabdomiólisis. Se inició hiperhidratación y alcalinización sistémica, con buena respuesta clínica y bioquímica, siendo dado de alta sin secuelas motoras. Conclusiones: La hipernatremia grave está descrita como causa rara de rabdomiólisis e insuficiencia renal. En pacientes críticos es importante un alto índice de sospecha de rabdomiólisis y determinación seriada de la creatín fosfokinasa para su detección y tratamiento precoz.

Introduction: Rhabdomyolysis is a rare paediatric condition. The case is presented of a patient in whom this developed secondary to severe hypernatraemic dehydration following acute diarrhoea. Case report: Infant 11 months of age who presented with vomiting, fever, diarrhoea and anuria for 15 hours. Parents reported adequate preparation of artificial formula and oral rehydration solution. He was admitted with malaise, severe dehydration signs and symptoms, cyanosis, and low reactivity. The laboratory tests highlighted severe metabolic acidosis, hypernatraemia and pre-renal kidney failure (Sodium [Na] plasma 181 mEq/L, urine density> 1030). He was managed in Intensive Care Unit with gradual clinical and renal function improvement. On the third day, slight axial hypotonia and elevated cell lysis enzymes (creatine phosphokinase 75,076 IU/L) were observed, interpreted as rhabdomyolysis. He was treated with intravenous rehydration up to 1.5 times the basal requirements, and he showed a good clinical and biochemical response, being discharged 12 days after admission without motor sequelae. Conclusions: Severe hypernatraemia is described as a rare cause of rhabdomyolysis and renal failure. In critically ill patients, it is important to have a high index of suspicion for rhabdomyolysis and performing serial determinations of creatine phosphokinase for early detection and treatment.
Descritores: Citosina/análogos & derivados
Preparações de Ação Retardada/administração & dosagem
Preparações de Ação Retardada/química
Organofosfonatos/administração & dosagem
Organofosfonatos/química
Corpo Vítreo/efeitos dos fármacos
-Antivirais/administração & dosagem
Antivirais/química
Química Farmacêutica/métodos
Citosina/administração & dosagem
Citosina/química
Sistemas de Liberação de Medicamentos/métodos
Meia-Vida
Herpes Simples/tratamento farmacológico
Herpesvirus Humano 1/efeitos dos fármacos
Injeções Intravítreas/métodos
Micelas
Pró-Fármacos/administração & dosagem
Pró-Fármacos/química
Retina/efeitos dos fármacos
Retina/virologia
Corpo Vítreo/virologia
Limites: Animais
Cobaias
Coelhos
Tipo de Publ: Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Responsável: CL1.1 - Biblioteca Central


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Id: lil-751886
Autor: Hua, Wenhao; Zhang, Guanbin; Guo, Shujun; Weijie, Li; Sun, Lanhua; Xiang, Guangxin.
Título: Microarray-based genotyping and detection of drug-resistant HBV mutations from 620 Chinese patients with chronic HBV infection
Fonte: Braz. j. infect. dis;19(3):291-295, May-Jun/2015. tab, graf.
Idioma: en.
Resumo: Background: Research has shown that hepatitis B virus (HBV) genotypes are closely linked to the clinical manifestations, treatment, and prognosis of the disease. Objective: To study the association between genotype and drug-resistant HBV mutations in 620 Chinese patients with chronic HBV infection. Methods: HBV DNA levels were determined using real-time quantitative PCR in plasma samples. Microarrays were performed for the simultaneous detection of HBV genotypes (HBV/B, C, and D) and drug-resistance-related hotspot mutations. A portion of the samples analyzed using microarrays was selected randomly and the data were confirmed using direct DNA sequencing. Results: Most samples were genotype C (471/620; 76.0%), followed by genotype B (149/620; 24.0%). Among the 620 patient samples, 17 (2.7%) had nucleotide analogs (NA) resistance-related mutations. Of these, nine and eight patients carried lamivudine (LAM)-/telbivudine (LdT)-resistance mutations (rtL180M, rtM204I/V) and adefovir (ADV)-resistance mutations (rtA181T/V, rtN236T), respectively. No patients had both lamivudine (LAM)- and either ade-fovir (ADV) or entecavir (ETV) resistance mutations. Additionally, out of the 620 patient samples, 64.0% (397/620) were also detected with the precore stop-codon mutation (G1896A) by microarray assay. Conclusion: The results of the current study revealed that the prevalence of nucleotide analogs (NA)-resistance in Chinese hospitalized HBV-positive patients was so low that intensive nucleotide analogs (NA)-resistance testing before nucleotide analog (NA) treatment might not be required. In addition, the present study suggests that chronic HBV patients with genotype C were infected with fitter viruses and had an increased prevalence of nucleotide analogs (NA)-resistance mutations compared to genotype B virus. .
Descritores: Antivirais/administração & dosagem
Farmacorresistência Viral/genética
Vírus da Hepatite B/genética
Hepatite B Crônica/virologia
Mutação
-Grupo com Ancestrais do Continente Asiático
Adenina/administração & dosagem
Adenina/análogos & derivados
DNA Viral/genética
Genótipo
Guanina/administração & dosagem
Guanina/análogos & derivados
Vírus da Hepatite B/efeitos dos fármacos
Hepatite B Crônica/tratamento farmacológico
Lamivudina/administração & dosagem
Análise em Microsséries
Organofosfonatos/administração & dosagem
Prognóstico
Análise de Sequência de DNA
Timidina/administração & dosagem
Timidina/análogos & derivados
Limites: Adulto
Feminino
Humanos
Masculino
Responsável: BR1.1 - BIREME


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Texto completo SciELO Saúde Pública
Cherchiglia, Mariângela Leal
Acúrcio, Francisco de Assis
Texto completo
Id: lil-695415
Autor: Oliveira, Gustavo Laine Araujo de; Almeida, Alessandra Maciel; Silva, Anderson Lourenco da; Brandao, Cristina Mariano Ruas; Andrade, Eli Iola Gurgel; Cherchiglia, Mariangela Leal; Acurcio, Francisco de Assis.
Título: Antivirais incorporados no Brasil para hepatite B cronica: analise de custo-efetividade / Antivirales incorporados en Brasil para hepatitis B cronica: analisis de costo-efectividad / Incorporated antivirals for chronic hepatitis B in Brazil: a cost-effectiveness analysis
Fonte: Rev. saúde pública = J. public health;47(4):769-780, ago. 2013. tab, graf.
Idioma: pt.
Projeto: Conselho Nacional de Desenvolvimento Cientifico e Tecnologico.
Resumo: OBJETIVO Avaliar o custo-efetividade de diferentes tratamentos medicamentosos para hepatite B crônica entre pacientes adultos. MÉTODOS Utilizando modelo de Markov, construiu-se coorte hipotética de 40 anos para pacientes HBeAg-positivo ou HBeAg-negativo. Foram comparados os usos de adefovir, entecavir, tenofovir e lamivudina (com terapia de resgate em caso de resistência viral) para tratamento de pacientes adultos com hepatite B crônica, virgens de tratamento, com elevados níveis de alanina aminotransferase, sem evidência de cirrose e sem coinfecção por HIV. Valores para custo e efeito foram obtidos da literatura. A medida do efeito foi expressa em anos de vida ganhos (AVG). Taxa de desconto de 5% foi aplicada. Análise de sensibilidade univariada foi conduzida para avaliar incertezas do modelo. RESULTADOS O tratamento inicial com entecavir ou tenofovir apresentou melhores resultados clínicos. As menores razões custo-efetividade foram de entecavir para pacientes HBeAg-positivo (R$ 4.010,84/AVG) e lamivudina para pacientes HBeAg-negativo (R$ 6.205,08/AVG). Para pacientes HBeAg-negativo, a razão custo-efetividade incremental de entecavir (R$ 14.101,05/AVG) está abaixo do limiar recomendado pela Organização Mundial da Saúde. Análise de sensibilidade mostrou que variação nos custos dos medicamentos pode tornar tenofovir alternativa custo-efetiva tanto para pacientes HBeAg-positivo quanto para HBeAg-negativo. CONCLUSÕES Entecavir é alternativa recomendada para iniciar o tratamento de pacientes com hepatite B crônica no Brasil. Contudo, se houver redução no custo de tenofovir, esta pode se tornar alternativa mais custo-efetiva. .

OBJETIVO Evaluar el costo-efectividad de diferentes tratamientos medicamentosos para hepatitis B crónica entre pacientes adultos. MÉTODOS Utilizando el modelo de Markov, se construyó cohorte hipotética de 40 años para pacientes HBeAg-positivo o HBeAg-negativo. Se compararon los usos de adefovir, entecavir, tenofovir y lamivudina (con terapia de rescate en caso de resistencia viral) para tratamiento de pacientes adultos con hepatitis B crónica, vírgenes de tratamiento, con elevados niveles de alanina aminotransferasa, sin evidencia de cirrosis y sin coinfección por VIH. Valores para costo y efecto fueron obtenidos de la literatura y efecto en años de vida ganados (AVG). Tasa de descuento de 5% fue aplicada. Análisis de sensibilidad univariado fue conducido para evaluar incertidumbres del modelo. RESULTADOS El tratamiento inicial con entecavir o tenofovir presentó mejores resultados clínicos. Los menores cocientes costo-efectividad fueron de entecavir para pacientes HBeAg-positivo (R.010,84/AVG) y lamivudina para pacientes HBeAg-negativo (R.205,08/AVG).Para pacientes HBeAg-negativo, el cociente costo-efectividad incrementado de entecavir (R.101,05/AVG) está por debajo del límite recomendado por la Organización Mundial de la Salud. El análisis de sensibilidad mostró que la variación en los costos de los medicamentos puede tornar tenofovir una alternativa costo-efectiva tanto para pacientes HBeAg-positivo como para los HBeAg-negativo. CONCLUSIONES Entecavir es una alternativa recomendada para iniciar el tratamiento de pacientes con hepatitis B crónica en Brasil. Sin embargo, al haber reducción en el costo de tenofovir, éste puede convertirse en una alternativa más costo-efectiva. .

OBJECTIVE To evaluate the cost-effectiveness of different drug therapies for chronic hepatitis B in adult patients. METHODS Using a Markov model, a hypothetical cohort of 40 years for HBeAg-positive or HBeAg-negative patients was constructed. Adefovir, entecavir, tenofovir and lamivudine (with rescue therapy in cases of viral resistance) were compared for treating adult patients with chronic hepatitis B undergoing treatment for the first time, with high levels of alanine aminotransferase, no evidence of cirrhosis and without HIV co-infection. Values for cost and effect were obtained from the literature, and expressed in effect on life years (LY). A discount rate of 5% was applied. Univariate sensitivity analysis was conducted to assess model uncertainties. RESULTS Initial treatment with entecavir or tenofovir showed better clinical outcomes. The lowest cost-effectiveness ratio was for entecavir in HBeAg-positive patients (R$ 4,010.84/LY) and lamivudine for HBeAg-negative patients (R$ 6,205.08/LY). For HBeAg-negative patients, the incremental cost-effectiveness ratio of entecavir (R$ 14,101.05/LY) is below the threshold recommended by the World Health Organization. Sensitivity analysis showed that variation in the cost of drugs may make tenofovir a cost-effective alternative for both HBeAg-positive and HBeAg-negative patients. CONCLUSIONS Entecavir is the recommended alternative to start treating patients with chronic hepatitis B in Brazil. However, if there is a reduction in the cost of tenofovir, it can become a cost-effective alternative. .
Descritores: Antivirais/economia
Hepatite B Crônica/tratamento farmacológico
-Análise de Variância
Adenina/análogos & derivados
Adenina/economia
Adenina/uso terapêutico
Antivirais/classificação
Antivirais/uso terapêutico
Brasil
Análise Custo-Benefício
Progressão da Doença
Guanina/análogos & derivados
Guanina/economia
Guanina/uso terapêutico
Vírus da Hepatite B
Lamivudina/economia
Lamivudina/uso terapêutico
Cadeias de Markov
Organofosfonatos/economia
Organofosfonatos/uso terapêutico
Resultado do Tratamento
Limites: Adulto
Humanos
Tipo de Publ: Research Support, Non-U.S. Gov't
Responsável: BR1.1 - BIREME


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Id: lil-683128
Autor: Wiens, Astrid; Lenzi, Luana; Venson, Rafael; Pedroso, Maria Lúcia Alves; Correr, Cassyano Januário; Pontarolo, Roberto.
Título: Economic evaluation of treatments for chronic hepatitis B
Fonte: Braz. j. infect. dis;17(4):418-426, July-Aug. 2013. ilus, tab.
Idioma: en.
Resumo: The aim of this study was to conduct a cost-utility study of adefovir, entecavir, interferon alpha, pegylated interferon alpha, lamivudine and tenofovir for chronic hepatitis B in the context of Brazilian Public Health Care System. A systematic review was carried out for efficacy and safety. Another review was performed to collect utility data and transition probabilities between health states. A Markov model was developed in a time horizon of 40 years with annual cycles for three groups of: HBeAg positive, HBeAg negative, and all patients. These strategies were compared to a fourth group that received no treatment. Discount rates of 5% were applied and sensitivity analyses were performed. Tenofovir offered the best cost-utility ratio for the three evaluated models: U$397, U$385 and U$384 (per QALY, respectively, for HBeAg positive, negative, and all patients). All other strategies were completely dominated because they showed higher costs and lower effectiveness than tenofovir. The sequence of cost-utility in the three models was: tenofovir, entecavir, lamivudine, adefovir, telbivudine, pegylated interferon alpha, and interferon alpha. In the sensitivity analysis, adefovir showed lower cost-utility than telbivudine in some situations. The study has some limitations, primarily related to the creation of scenarios and modeling. In this study, tenofovir presented the best cost-utility ratio. The results obtained in this study will be valuable in decision-making and in the review of the clinical protocol, mainly involving the allocation of available resources for health care.
Descritores: Antivirais/economia
Antígenos E da Hepatite B/sangue
Hepatite B Crônica/tratamento farmacológico
-Adenina/análogos & derivados
Adenina/economia
Adenina/uso terapêutico
Antivirais/uso terapêutico
Brasil
Análise Custo-Benefício
Quimioterapia Combinada/economia
Guanina/análogos & derivados
Guanina/economia
Guanina/uso terapêutico
Interferon-alfa/economia
Interferon-alfa/uso terapêutico
Lamivudina/economia
Lamivudina/uso terapêutico
Cadeias de Markov
Organofosfonatos/economia
Organofosfonatos/uso terapêutico
Polietilenoglicóis/economia
Polietilenoglicóis/uso terapêutico
Proteínas Recombinantes/economia
Proteínas Recombinantes/uso terapêutico
Limites: Feminino
Humanos
Masculino
Tipo de Publ: Revisão
Responsável: BR1.1 - BIREME


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Id: lil-672646
Autor: Duke, N; Aboh, S; Bosivert, N.
Título: Analysis of resistance testing in South Trinidad / Análisis de prueba de resistencia en Trinidad Sur
Fonte: West Indian med. j;59(4):400-402, July 2010. graf.
Idioma: en.
Resumo: The introduction of antiretroviral therapy in Trinidad and Tobago in the 1980s has resulted in a decrease in mortality of HIV-infected persons. Poor adherence to antiretroviral therapy (ART) has resulted in the development of multidrug resistant HIV. Resistance testing done on 40 samples showed that 64.8% of patients had K103 mutation, 75.6% of patients had M184 mutations and 62% of patients showed resistance to tenofovir suggesting that the K65R mutation was highly likely to be present. There was reduced activity to the protease inhibitors; no resistance was found to the protease inhibitor, darunavir. Thus, there is a need for salvage therapy to be introduced which will result in virologic suppression and potentially stop the spread of multidrug resistant HIV. Darunavir, a new generation protease inhibitor, is an essential part of salvage therapy and needs to be introduced into the national formulary.

La introducción de la terapia antiretroviral en Trinidad y Tobago en la década de 1980, ha producido una disminución en la mortalidad de personas infectadas por el VIH. La adhesión pobre a la terapia antiretroviral (TAR) ha conducido al desarrollo de una variedad de VIH resistente a las multidrogas. Las pruebas de resistencia realizadas a 40 muestras mostró que el 64.8% de los pacientes tenían mutación K103, 75.6% de los pacientes tenían mutaciones M184, y 62% de pacientes mostraron resistencia al tenofovir, lo que indica una alta probabilidad de mutación K65R. Había actividad reducida respecto a los inhibidores de la proteasa; mientras que no se halló ninguna resistencia en el inhibidor de la protease, darunavir. Así, hay necesidad de introducir una terapia de salvamento qué produzca una supresión virológica y potencialmente detenga la diseminación del VIH resistente a las multidrogas. El darunavir - inhibidor de nueva generación frente a la proteasa -es una parte fundamental de la terapia de salvamento y necesita ser introducido en el formulario nacional.
Descritores: Fármacos Anti-HIV/farmacologia
Farmacorresistência Viral
Infecções por HIV/tratamento farmacológico
Inibidores da Protease de HIV/farmacologia
-Adenina/análogos & derivados
Adenina/farmacologia
Resistência a Múltiplos Medicamentos
Infecções por HIV/epidemiologia
Infecções por HIV/virologia
Mutação/efeitos dos fármacos
Organofosfonatos/farmacologia
Cooperação do Paciente
Sulfonamidas/farmacologia
Trinidad e Tobago/epidemiologia
Limites: Humanos
Responsável: BR1.1 - BIREME


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Texto completo SciELO Brasil
Cherchiglia, Mariângela Leal
Acúrcio, Francisco de Assis
Texto completo
Id: lil-667604
Autor: Almeida, Alessandra Maciel; Silva, Anderson Lourenço da; Brandão, Cristina Mariano Ruas; Cherchiglia, Mariângela Leal; Andrade, Eli Iola Gurgel; Oliveira, Gustavo Laine Araújo de; Carmo, Ricardo Andrade; Acurcio, Francisco de Assis.
Título: Custo-efetividade dos análogos de nucleosídeos/nucleotídeos para hepatite crônica B / Cost-effectiveness of nucleoside/nucleotide analogues in chronic hepatitis B / Costo-efectividad de los análogos de nucleósidos/nucleótidos para hepatitis crónica B
Fonte: Rev. saúde pública = J. public health;46(6):942-949, Dez. 2012. ilus, graf, tab.
Idioma: pt.
Projeto: Conselho Nacional de Desenvolvimento Científico e Tecnológico; . Fundação de Amparo à Pesquisa do Estado de Minas Gerais.
Resumo: .

OBJECTIVE: To conduct a cost-effectiveness analysis of drug alternatives with rescue therapy in case of relapse due to viral resistance for the treatment of patients with chronic hepatitis B (CHB). METHODS: Hypothetical cohort of patients with CHB, HBeAg-negative, without clinical or histological evidence of cirrhosis, detectable HBV DNA, histological diagnosis of the disease, positive serum HBsAg for longer than six months, high levels of alanine aminotransferase (ALT) (twice as high as the upper limit of normality) and mean age of 40 years. A Markov model was developed for chronic hepatitis B (HBeAg- negative) with a 40-year time horizon. Costs and benefits were discounted at 5%. Annual rates of disease progression, costs due to complications and the efficacy of medicines were obtained from the literature. One-way and probabilistic sensitivity analysis evaluated uncertainties. RESULTS: Initiation of treatments with entecavir resulted in an increase of 0.35 discounted life-years gained compared to lamivudine. The incremental cost-effectiveness ratio was R$16,416.08 per life-years gained. In the sensitivity analysis, the incremental cost-effectiveness ratio was more sensitive to variation in the probability of transition from chronic hepatitis B to compensated cirrhosis, discount rate and medicine prices (± 10%). In the probabilistic sensitivity analysis, the acceptability curve showed that beginning treatment with entecavir was the most cost-effective alternative in comparison with the use of lamivudine. CONCLUSIONS: The availability of entecavir is economically attractive as part of early treatment for patients with chronic hepatitis B without HIV co-infection.

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Descritores: Antivirais/economia
Farmacorresistência Viral
Hepatite B Crônica/tratamento farmacológico
-Adenina/análogos & derivados
Adenina/economia
Adenina/uso terapêutico
Antivirais/uso terapêutico
Análise Custo-Benefício
Quimioterapia Combinada
Guanina/análogos & derivados
Guanina/economia
Guanina/uso terapêutico
Hepatite B Crônica/economia
Cadeias de Markov
Modelos Teóricos
Organofosfonatos/economia
Organofosfonatos/uso terapêutico
Anos de Vida Ajustados por Qualidade de Vida
Limites: Humanos
Tipo de Publ: Research Support, Non-U.S. Gov't
Responsável: BR1.1 - BIREME


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Texto completo SciELO Brasil
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Id: lil-645427
Autor: Zhao, Si-Hai; Liu, En-Qi; Cheng, Da-Xin; Li, Ya-Feng; Wang, Yan-Li; Chen, Yu-Long; Sun, Wen-Tao; Yan, Xi-Cai; Dang, Shuang-Suo.
Título: Comparison of entecavir and adefovir for the treatment of chronic hepatitis B
Fonte: Braz. j. infect. dis;16(4):366-372, July-Aug. 2012. ilus, tab.
Idioma: en.
Resumo: The results of several new clinical trials that compared the effectiveness of entecavir (ETV) treatment with that of adefovir (ADV) treatment in patients with chronic hepatitis B (CHB) were published in recent years. However, the numbers of patients included in these clinical trials were too small to draw a clear conclusion as to whether ETV is more effective than ADV. Therefore, a new meta-analysis was needed to compare ETV with ADV for the treatment of CHB. A search of the Cochrane Central Register of Controlled Trials (CCTR), MEDLINE, the Science Citation Index, Embase, the China National Knowledge Infrastructure (CNKI), and the Wanfang Database for relevant studies published between 1966 and 2010 was performed. Trials comparing the use of ETV and ADV for the treatment of CHB were assessed. Of the 2,358 studies screened, 13 randomized controlled clinical trials comprising 1,230 patients (ETV therapy, 621; ADV therapy, 609) were analyzed. The serum hepatitis B virus (HBV) DNA clearance rate obtained in patients treated with ETV was significantly higher than that in patients treated with ADV at the 24th and 48th weeks of treatment (24 weeks: 59.6% vs. 31.8%, relative risk [RR], 1.82, 95% CI: 1.49-2.23; 48 weeks: 78.3% vs. 50.4%, RR, 1.61, 95% CI: 1.32-1.96). The serum HBeAg clearance rate, the HBeAg seroconversion rate, and the ALT normalization rate obtained for patients treated with ETV were also higher than the corresponding values for patients treated with ADV at the 48th week of treatment. The safety profiles were similar between patients treated with ETV and those treated with ADV. The evidence reviewed in this meta-analysis suggests that patients with hepatitis B have a greater likelihood of achieving a viral response and a biomedical response when treated with ETV than when treated with ADV.
Descritores: Adenina/análogos & derivados
Antivirais/uso terapêutico
Guanina/análogos & derivados
Hepatite B Crônica/tratamento farmacológico
Organofosfonatos/uso terapêutico
-Adenina/uso terapêutico
Guanina/uso terapêutico
Ensaios Clínicos Controlados Aleatórios como Assunto
Limites: Humanos
Tipo de Publ: Estudo Comparativo
Metanálise
Research Support, Non-U.S. Gov't
Responsável: BR1.1 - BIREME


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Id: lil-624012
Autor: Mello, Francisco Campello do Amaral; Fernandes, Carlos Augusto; Gomes, Selma de Andrade.
Título: Antiviral therapy against chronic hepatitis B in Brazil: high rates of lamivudine resistance mutations and correlation with HBV genotypes
Fonte: Mem. Inst. Oswaldo Cruz;107(3):317-325, May 2012. graf, tab.
Idioma: en.
Resumo: The effectiveness of antiviral treatments of chronic hepatitis B has been poorly studied in Brazil. Here, hepatitis B virus (HBV) DNA positivity, drug resistance mutations and their association with HBV genotypes were evaluated in chronically HBV-infected patients under different drug regimens in Brazil. The study involved 129 patients under interferon or nucleos(t)ide analogue therapy for a median treatment time of 12 months. One hundred and five (81%) of these patients were treated with lamivudine (LAM), either in monotherapy or in combination with newer drugs, such as entecavir (ETV) or tenofovir (TDF). High (37.5-100%) rates of HBV DNA positivity were observed with all but one drug regimen (LAM + ETV). However, patients that were treated with ETV alone, TDF alone or with LAM combination therapies had a mean viral load that was 3-4 log lower than patients treated with LAM monotherapy. Of the patients treated with LAM, 47% developed resistance mutations. HBV genotypes A (59.1%), D (30.3%) and F (9.1%) were found. There was no association between the presence of LAM resistance mutations and genotypes, HBeAg status or treatment duration. Nevertheless, the rtM204V mutation was observed more frequently (12/13, 92%) in genotype A than in the others (p = 0.023). Six out of nine isolates that contained the rtM204I mutation belonged to genotype D and half of them displayed a single mutation. Genotype D isolates with the rtM204V variant preferentially displayed a triple mutation, while genotype A preferentially displayed a double mutation (p = 0.04).
Descritores: Antivirais/administração & dosagem
Farmacorresistência Viral/genética
Vírus da Hepatite B/efeitos dos fármacos
Hepatite B Crônica/tratamento farmacológico
Lamivudina/administração & dosagem
Mutação/efeitos dos fármacos
-Adenina/administração & dosagem
Adenina/análogos & derivados
Estudos Transversais
DNA Viral/análise
Quimioterapia Combinada/métodos
Genótipo
Guanina/administração & dosagem
Guanina/análogos & derivados
Vírus da Hepatite B/genética
Hepatite B Crônica/virologia
Mutação/genética
Organofosfonatos/administração & dosagem
Carga Viral
Limites: Adolescente
Adulto
Idoso
Feminino
Humanos
Masculino
Pessoa de Meia-Idade
Adulto Jovem
Responsável: BR1.1 - BIREME



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BIREME/OPAS/OMS - Centro Latino-Americano e do Caribe de Informação em Ciências da Saúde