“Infeção VIH/SIDA: Diagnóstico Precoce. Sim! E Tratamento Precoce?...”
DOI:
https://doi.org/10.24950/rspmi.1013Palavras-chave:
Diagnóstico Precoce, Tratamento Precoce, VIH/ SIDA, ”test and treat”Resumo
Após uma introdução onde é abordada, de uma forma necessariamente
sintética, a problemática atual da epidemiologia e do tratamento da infeção por VIH/SIDA, com especial enfoque nalguns estudos de natureza fármaco-económica, faz-se seguidamente o desenvolvimento dos dois
principais temas que se pretendem ver abordados neste artigo: O diagnóstico e o tratamento precoces.
Se é verdade que relativamente ao primeiro, não há muitas divergências
a registar, no que concerne ao segundo, não existe tanta unanimidade.
Com efeito, no que toca ao diagnóstico precoce, a grande questão é a
de ter que se proceder à preparação dos profissionais e das instituições
para passarmos a atender um número muito superior de infetados num
espaço de tempo relativamente curto (calcula-se que, para a realidade
portuguesa, possam existir cerca de mais 1/3 de doentes relativamente
ao nº total daqueles que já são conhecidos, ou seja, entre 10 a 15.000
novas pessoas infetadas pelo vírus VIH, perfazendo, no computo geral,
aproximadamente, 40 a 50.000 portadores em todo o país). No que concerne ao tratamento precoce, contudo, as questões que se levantam são bastante mais complexas e polémicas, situando-se essencialmente em
três níveis: As suas implicações na dinâmica epidemiológica no âmbito
comunitário (à escala regional e planetária), e as repercussões a longo
prazo, quer no domínio económico-financeiro, quer no da saúde e, por
fim, no prognóstico funcional e vital de cada um dos portadores da infeção
que inicie precocemente a TARV, eventualmente, logo após a respetiva
confirmação serológica.
Downloads
Referências
Chu C., Selwyn P. An epidemic in evolution: The need for new models of HIV care in the chronic disease era. J of Urban Health. 2011; 88 (3):
-566.
Zuniga J., Young B. Achieving improvements across the HIV treatment cascade: A clinical management algorithm based on IAPAC´s entry into and retention in care and antirretroviral therapy adherence guidelines. JIAPAC. 2013; 12 (1): 15-17.
The Antirretroviral Therapy Cohort Collaboration. Life expetancy of individuals on combination antirretroviral therapy in high-income countries: a collaborative analysis of 14 cohort studies. Lancet. 2008 Jul 26: 372 (9635): 293-299.
Sighem A., Gras L., Reiss P., Brinkman K., Wolf F. on behalf of the ATHENA national observational cohort study. Life expectancy of recently diagnosed asymptomatic HIV-infected patients approaches that of uninfected individuals. AIDS. 2010; 24 (10): 1527-1535.
Nakagawa F., May M., Philips A. Life expectancy living with HIV: recente estimates and future implications. Curr Op Inf Dis. 2013 Feb; 26 (1):
25.
Shrosbree J., Campbell L., Ibrahim F., Hopkins P., Vizca M., Strachan S., et al. Late HIV diagnosis is a major risk factor for intense care unit
admission in HIV-positive patients: a single center observational cohort study. BMC Inf Dis. 2013 Jan 19; 13 (23): 13-23.
The data collection on adverse events of anti-HIV drugs (D:A:D) study group. Factors associated with specific causes of death amongst HIV
-positive individuals in the D:A:D study. AIDS. 2010; 24(10): 1537-1548.
Lucas S. Causes of death in the HAART era. Curr Opin Infect Dis. 2012 Feb; 25 (1): 36-41.
O´Keefe K., Scheer S., Chen M-J., Hughes A., Pipkin S. People fifty years or older now account for the majority of AIDS cases in S. Francisco, California, 2010. AIDS Care. 2013 Jan 15;
Efros R., Fletcher G., Gebo K., Halter J., Hazzard W., Horne F., et al. Workshop on HIV infection and aging: What is known and future research directions. CID. 2008 Aug 15; 47: 542-553.
High K., Brennan-Ing M., Clifford D., Cohen M., Currier J., Deeks S., et al. HIV and aging: State of knowledge and areas of critical need for
research. A report to the NIH office of AIDS research by the HIV and aging Working Group. JAIDS. 2012 Jul 1; 60 (sup 1): S1-S18.
Bakanda C., Birungi J., Mwesigwa R., Ford N., Cooper C., Au-Yeung R., et al. Association of aging and survival in a a large HIV-infected
cohort on antiretroviral therapy. AIDS. 2011; 25 (5): 701-705.
Guaraldi G., Orlando G., Zona S., Menozzi M., Carli F., Garlassi E., et al. Premature age-related comorbidities among HIV-infected persons
compared with the general population. CID. 2011 Dec 1; 53 (11): 1120-1126.
Onen N., Overton T. A review of premature frailty in HIV-infected persons; Another manifestation of HIV-related accelarated aging. Curr
Aging Sc. 2011; 4 (1): 33-41.
Capeau J. Premature aging and premature age-related comorbidities in HIV-infected patients: Facts and hypoteses. CID. 2011 Dec 1; 53:
-1129.
Fisher M., Cooper V. HIV and aging: premature aging or premature conclusions? Curr Op Inf Dis. 2012 Feb; 25(1): 1-3.
Rickabaugh T., Kilpatrick R., Hultin L., Hukltin P., Hausner M., Sugar C. et al.The dual impact of HIV-1 infection and aging on naive CD4+ T-cells: Additive and distinct patterns of impairment. PLos one. 2011 Jan; 6 (1): e16459.
Ruiz M., Cefalu C. Frailty syndrome in patients with HIV infection. Clin Ger. 2011; 19 (2): 46-49.
Ianas V., Berg E., Mohler M., Wendel C., Klotz S. Antiretroviral therapy protects against frailty in HIV-1 infection. JIAPAC. 2013 Feb; 12: 62-66.
Mateen F., Mills E., Aging and HIV-Related cognitive loss. JAMA. 2012 Jul 25; 308 (4): 349-350.
Deeks S. HIV infection, inflamation, immunosenescence, and aging. Annu Rev Med. 2011; 62: 141-155.
Ferrando-Martinez S., Ruiz-Mateus E., Romero-Sanchez M., Munoz-Fernandez M., Viciana P., Genebat M., et al. HIV infection-related premature immunosenescence: High Rates of immune exahaustion after short time of infection. Curr HIV Res. 2011; 9 (5): 1-6.
Papagno L., Spina C., Marchant A., Sallo M., Rufer N., Little S., et al. Immune activation and CD8+ T-cell differentiation towards senescence
in HIV-1 infection. PLos Biology. 2004 Feb; 2 (2): e0173.
Stein J., Hsne P. Inflamation, immune activation, and CVD risk in individuals with HIV infection. JAMA. 2012 Jul 25; 308 (4): 405-406.
Bukh A., Melchjorsen J., Offresen R., Jensen J., Toft L., Stovring H., et al. Endotoxemia is associated with altered innate and adaptive immune
responses in untreated HIV-1 infected individuals. PLos one. 2011 Jun; 6 (6): e21275.
Aberg J. Aging, inflammation, and HIV infection. Top in Antiviral Med.2012 Aug/Sep; 20 (3): 101-105.
Dube M., Sattler F. Inflamation and complications of HIV disease. JID. 2010 Jun 15; 201: 1783-1785.
Duprez D., Neuhaus J., Kuller L., Tracy R., Belloso W., Wit S., et al. Inflamation, coagulation and cardiovascular disease in HIV-infected individuals. PLos one. 2012 Sep; 7 (9): e44454.
Neuhaus J., Jacobs D., Baker J., Calmy A., Duprez D., Rosa A., et al. Maekers of inflamation, coagulation, and renal function are elevated in
adults with HIV infection. JID. 2010 Jun 15; 201: 1788-1795.
Kuller L., Tracy R., Belloso W., Wit S., Drumond F., Lane C., et al. Inflamatory and coagulation biomarkers and mortality in patients with HIV infection. PLos Medicine. 2008 Oct; 5 (1): e203.
Subramanian S., Tawakol A., Burdo T., Abbara S., Wei J., Vijayakumar J., et al. Arterial inflamation in patients with HIV. JAMA. 2012 Jul 25; 308
(4): 379-386.
Tien P., Choi A., Zolopa A., Benson C., Tracy R., Schertzer R., et al. Inflamation and mortality in HIV-infected adults: Analysis of the FRAM
study Cohort. JAIDS. 2010; 55 (3): 316-322.
Hsue P., Scherzer R., Hunt P., Schnell A., Bolger A., Kalapus S., et al. Carotid intima-media thickness progression in HIV-infected adults occurs preferentialy at the carotid bifurcation and is predicted by inflammation. J Am Heart Assoc. 2012 Apr 12; 1 (2): e001412.
Helleberg M., Kronborg G., Larsen C., Pedersen G., Pedersen C., Obel N., et al. CD4 decline is associated with increase risk of cardiovascular
disease, cancer and death in viraly suppressed HIV patients. CID. 2013; 57 (2): 314-321.
Keating S., Golu E., Nowicki M., Young M., Anastos K., Crystal H., et al. The effect of HIV infection and HAART on inflamatory biomarkers in a
population based cohort of women. AIDS. 2011; 25 (15): 1823-1832.
Fonkwo P. Pricing infectious diseases> The economic and health implications of infectious diseases. EMBO Reports. 2008; 9: S13-S17.
Catala-Lopez F., Garcia-Altes A., Alvarez-Martin E., Morgant-Ginestar M. Evaluacion económica de intervenciones en enfermidades infecciosas en Espana: revision sistematica y analisis comparativo. Rev Esp de Quimiot. 2011; 24 (3): 143-150.
Pitman R, Melegaro A, Gelb D, Joseph C, Cooper D, Smith G, Gerard E. The burden of infectious diseases. Available in http://www.hpa.org.
uk/webc/HPAwebFile/HPAweb_C/1194947366192
Kretzschmar M, Mangen MJJ, Pinheiro P, Jahn B, Févre EM, Longui S, et al. New methodology for estimating the burden of infectious diseases in Europe. PLos Med. 2012 Apr; 9(4): e1001205.
Kroll M, Carpentes G, Wyman O. The economic and social impact of emerging infectious diseases: Mitigation through detection, research,
and response. Available in http://www.healthcare.philips.com/main/shared/assets/documents/bioshield/ecoandsocialimpactofemerginginfectiousdisease_111208.pdf
Menzies N., Berruti A., Berzon R., Filler S., Ferris R., Ellerbrock T., et al. The cost of providing comprehensive HIV treatment in PEPFAR-supported programs. AIDS. 2011; 25 (14): 1753-1760.
Sloan C., Champenois K., Cholsy P., Losina S., Walensky R., Schackman B. et al. Newer drugs and earlier treatment : Impact on lifetime
cost of care for HIV-infected adults. AIDS. 2012; 26 (1); 45-56.
Walensky P. Cost-effectiveness of HIV interventions: From cohort studies and clinical trials to policy. Top in HIV Med. 2009 Sep/Oct; 17 (4):
-134.
Johnston S., Juday T., Seekine D., Espiridle D., Chu B-C. Association between prescription cost sharing and adherence to initial combination
antirretroviral-nive patients with HIV. J Manag Care Pharm. 2012 Mar; 18 (2): 129-144.
Hirsch J., Gonzales M., Rosenquist A., Miller T, Gilmer T., Best B. Antiretroviral therapy adherence, medication use, and health care costs
during 3 years of a community pharmacy medication therapy management program for medical beneficiaries with HIV/AIDS. J Manag Care
Pharm. 2011 Apr; 17 (3): 213-223.
Gonzalo T., Goni M., Munoz-Fernandez M. Socio-economic impact of antirretroviral treatment in HIV patients. An economic review of cost savings after introduction of HAART. AIDS Rev. 2009; 11: 79-90.
Sacchi P., Patruno S., Bruno R., Cima S., Previtali P., Franchini A., et al. Forecast model for evaluation of economic resourses employed in the health care patients with HIV infection. Clin Econ and Outc Res. 2012; 4: 117-126.
Rizzardini G., Resselli U., Bofariti P., Porazzi E., Ricci E., Foglia E., et al. Cost of human immunodeficiency vírus infection in Italy, 2007-2009:
effective and expensive, are the new drugs worthwhile? Clin Econom and Out Res. 2012; 4: 245-252.
Farnham P., Gopalappa C., Sansom S., Hutchinson A., Brooks, J., Weidle P., et al. Update of lifetime costs of care and quality of life estimates
for HIV-infected persons in the United States: Late versus early diagnosis and entry into care. JAIDS. 2013.
Harris M., Nosyk B., Harrigan R., Lima V., Cohen C., Montaner J. Cost-effectiveness of antirretroviral therapy for multidrug-resistent HIV: Past, present and future. AIDS Res and Treat. 2012: 2012: ID 595762 Available in http://www.hindawi.com/journals/art/2012/595762/
Perelman J., Alves J., Miranda A., Mateus C., Mansinho K., Antunes F., et al., Direct Treatment costs of HIV/AIDS in Portugal. Rev Port Saude
Pub., 2013 (in press)
Vera J., Aragão F., Guimarães M., Vaz J. Benefits of ART simplification on adherence, clinical and economic outcomes. JIAS. 2012; 15 (sup 4):
Colombo G., Colangeli V., Biagio A., Matteo S., Viscoli C., Viale P. Cost effectiveness analysis of initial HIV treatment under Italian guidelines.
Clin Econ and Out Res. 2011; 3: 197-205.
Grupo de trabajo de la Cohorte VACH. Impacto presupestario del tratamento antirretroviral: Reflexion desde las guias de GESIDA. Gac Sanit. 2012; 26 (6): 541-546.
Nosyk B., Montaner J. The evolving landscape of economics of HIV treatment and prevention. PLos Med. 2012 Feb; 9 (2): e1001174.
Barnighausen T., Salomon J., Sangrujee N. HIV treatment as prevention: Issues in economic evaluation. PLos Med. 2012 Jul; 9 (7): e1001263.
Johnston K., Levy A., Lima V., Hogg R., Tyndall M., Gustafson P. et al. Expanding access to HAART: a cost-effective approach for treating and
preventing HIV. AIDS. 2010 Jul 31; 24 (12): 1929-1935.
Connor J., Ralter N., Rodgers A. Do fixed-dose combination pills or unit-of-use packaging improve adherance? A systematic review. Bul WHO 2004 Dec; 82 (12): 935-944.
Marcotullio S., Andreoni M., Antinori A., Monforte A., Ferri G., GalliM., et al. The less drugs regimens therapy approach in HIV-1: an Italian expert panel perspective for the long-term management of HIV-1 infection. New Microb. 2012; 35: 259-277.
Librea J., Arribasb J., Domingoc P., Gatelld J, Lozanoe F., Santosa J., et al. Clinical implications of fixed-dose coformulations of antiretrovirals
on the outcome of HIV-1 therapy. AIDS; 25 (14): 1683-1690.
Homar F., Lozano V., Gomez J., Oyaguez I., Pareja A., Payeras A., et al. Cost analysis of HIV treatment and drug-related events when fixeddose combinations of antiretrovirals (FDCs) are stopped, versus continuation with (FDCs). Health Econ Rev. 2012; 2: 16-27.
Colombo G., Matteo S., Maggiolo F., Antiretroviral therapy in HIV-infected patients: a proposal to assess the economic value of single-tablet regímen. Clin Econ and Out Res. 2013; 5: 59-68.
Perez-Valero I., Martin N., Valente S., Serna J., Mora M., Gaya F., et al. Naive patients receiving TDF/FTC-EFV as 2 pills are more likely to modify regimen components than patients receiving a TDF/FTC/EFV single pill. J Int AIDS Soc. 2010; 13 (Sup 4): P122.
Carr A., Hoy J., Pozniak A. The ethics of switch/simplify in antiretroviral trials: Non-inferior or just inferior? PLos Med. 2012 Jul, 9 (7): e1001240.
Taylor B., Wilkin T., Shalev N., Hammer S., CROI 2013: Advances in antirretroviral therapy. Antivir Ther. 2013 Apr/May; 21 (2): 79-89.
Lafeuillade A. Eliminating the HIV reservoir. Curr HIV AIDS Rep. 2012; 9: 121-131.
Remoli A., Marsili G., Battistini A., Sgarbanti M. The development ofimmune-modulating compounds to disrupt HIV latency. Cytok & Gr
Fact Rev. 2012; 23: 150-172.
Barton K., Burch B., Soriano/Sarabia N., Margolis D. Prospects for treatment of latent HIV. Nature. 2013 Jan; 93 (1): 46-56.
Katlama C., Deeks S., Autran B., Martinez-Picado J., Lundgren L., Rouzioux C., et al. Barriers to cure for HIV: New ways to target and erradicate HIV-1 reservoirs. Lancet. 2013 Mar 29; 381 (9883): 2109-2117.
Johnston R., Barre-Sinoussi F., Controversies in HIV cure research. J Int AIDS Soc, 2012; 15: 16.
Vieira V., Soares M. The role of cytidine deaminases on innate imune responses against human viral infections. Bio Med Res Int. 2013; ID:
Available in http://dx.doi.org/10.1155/2013/683095.
Sabin C., Lundgreen J. The natural history of HIV infection. Curr Opin HIV AIDS. 2013; 8: 311- 317.
Gaarbdo J, Hartling, HJ, Gersloft J., Nielson S., Thirty years with HIV infection: nonprogressors is still puzzeling: Lessons to be learned from
controllers and long term nonprogressors. AIDS Research and Treatment, 2012; 2012: 161564.
Fior J., Is a pacific Coexistence between vírus and host the unexploited path that may lead to an HIV functional cure?, Viruses, 2013; 5: 753-
Ciccarelli N., Fabbiani M., Gianbenederro S., Fanti I., Baldonero E., Bracciale L., et al. Efavirenz associated with cognitive disorders in
otherwise asymptomatic HIV-infected patients. Neurology. 2011 Apr; 76 (19): 1403-1409.
Schouten J., Cinque P., Gisslen M., Reiss P., Portgies P. HIV-1 infection and cognitive impairment in the cART era: a review. AIDS. 2011 Mar 13; 25 (5): 561-575.
Simioni S., Cavassini M., Annoni J-M., Hirschel B., Pasquier R. HIV-associated disorders: A changing pattern. Fut Neurol. 2011 Jan; 6 (1):
-95.
Clifford D. HIV-associated neurocognitive disease continues in the antirretroviral era. Top in HIV Med. 2008 Jun-Jul; 16 (2): 94-98.
Branson B., Handsfield H., Lampe, M., Janssen ot of HIV-1 R., Taylor A., Lyss S. et al. Revised recommendations for HIV testing of adults,
adolescents, and pregnant women in health-care settings. MMWR. 2006 Sep 22; 55 (14): 1-17.
Lucas A., Armbruster B. The cost-effectiveness of expanded HIV screening in the United States, AIDS. 2013; 27 (5): 795-801.
Mavedzenge S., Baggaley R., Corbett E. A review of self testing for HIV: Research and policy priorities in a new era of HIV prevention. CID. 2013 July 1; 57: 126-138.
Wilson D., Hoare A., Regan D., Law M. Importance of promoting HIV testing for preventing secondary transmissions: Modelling the Australian HIV epidemic among men who have sex with men. Sexual Health. 2009; 6: 19-33.
Girardi E., Sabin C., Monforte A. Late diagnosis of HIV infection: Epidemiological features, consequences and strategies to encourage earlier diagnosis. J Acquir Immune Defic Syndr. 2007 Sept; 46 (Suppl 1): S3-S8.
Smith M., Rutstein S., Powers K., Fidler S., Miller W., Eron J. et al. The detection and management of early HIV infection: A clinical and public
health emergency. J Acquir Immune Deffic Syndr. 2013 July 1; 63 (Suppl 2): S187-S199.
Cohen M., Gay C., Busch M., Hecht F. The detection of acute HIV infection. JID. 2010; 202 (Suppl 2): S270-S277.
Sugarman J., Meyerhoff H. Implications of universal screenhing for HIV infection. BMJ. 2013; 346: 2957-2958.
Castel A., Befus M., Willis S., Griffin A., West T., Hader S., et al. Use of the community viral load as a population-based biomarker of HIV
burden. AIDS. 2012; 26 (3): 345-353.
Miller W., Powers K., Smith M., Cohen M. Community viral load as a measure for assessment of HIV treatment as prevention. Lancet Inf Dis.
May; 13: 459-464.
Das M., Chu P., Santos G-M., Scheer S., Vittinghoff E., McFarland W., Colfax G. Decreases in community viral load are accompanied by reductions in new HIV infections on S. Francisco. PLos one. 2010 Jun; 5 (6): e11068.
Delva W., Eaton J., Meng F., Fraser C., White R., Vickerman P., et al. HIV treatment as prevention: Optimising the impact of expanded HIV
treatment programs. PLos Med. 2012 Jul; 9 (2): e1001258.
Cohen M., Dye C., Fraser C., Miller W., Powers K., Williams B. HIV treatment as prevention: Debate and commentary. Will early infection
compromise treatment-as-prevention strategies? Plos Med. 2012 Jul; 9 (7): e1001232.
The HIV Modelling Consortium Treatment as Prevention Editorial Writing Group. PLos Med. 2012 Jul; 9 (2): e1001259.
Smith M., Powers K., Muessig K., Miller W., Cohen M. HIV treatment as prevention: The utility and limitations of ecological observation. Plos
Med. 2012 Jul; 9 (2): e1001260.
Wilson D. HIV treatment as prevention: Natural experiments highlight limits of antirretroviral treatment as HIV prevention. PLos Med. 2012 Jul; 9 (2): e1001231.
Bolly M-C. Masse B., Alsallaq R., Padian N., Eaton J., Vesga J., et al. HIV treatment as prevention: Considerations in the design, conduct, and analysis of cluster randomized controlled trials of combination HIV prevention. PLos Med. 2012 Jul; 9 (2): e1001250.
Granich R., Gilks, C., Dye C., Cock K., Williams B. Universal voluntary HIV testing with immediate antirretroviral therapy as a strategy for elimination of HIV transmission: a mathematical model. Lancet. 2009 Jan 3; 373 (9657): 48-57
Cohen M., Chen Y., McCauley M., Gamble T., Hosseinipour M., Kumarasamy N. et al. Prevention of HIV-1 infection with early antiretroviral
therapy. NEJM. 2011 Aug 11; 365 (6): 493-505.
Cremin I., Alsallaq. R., Dybul M., Piot P., Garnett G., Hallett T. Thw new role of antiretrovirals in combination HIV prevention: a mathematical modeling analysis. AIDS. 2013; 27 (3): 447-458.
Sood N., Wagner Z., Jaycocks A., Drabo E., Vardavas R. Teste and treat in Los Angeles: A mathematical model of the effects of test-andtreat for the population of men who have sex with men in Los Angeles county. CID. 2013 Jun 15; 56: 1789-1796.
Wagner B., Blower S. Universal access to HIV treatment versus universal test and treat: Transmission, drug resistance & treatment costs.
PLos Med., 2012 Jul; 7 (9): e41212.
Jena A. Balancing disease erradication with emergence of multidrug-resistant HIV in test-and-treat policies. CID. 2013 Jun 15; 56: 1797-1799.
Gallant J., Mehta S., Sugarman J. Universal antiretroviral therapy for HIV infection: Should US treatment guidelines be applied to resource-limited setting? CID. 2013 Sep; 57 (6): 884-887.
Meyer-Rath G., Over M. HIV treatment as prevention: Modelling the cost of antirretroviral treatment. State of the art and future directions. PLos Med. 2012 Jul; 9 (2): e1001247.
Geng E., Hare B, Kahn J., Jain V., Nunnery T., Christopoulus K., ert al. The effect of a universal antiretroviral therapy recommendation on HIV RNA levels among HIV-infected entering care with a CD4 count greater than 500/micL in a public heath setting. CID. 2012 Dec 15; 55: 1690-
Supervie V. Les moyens de prevention a VIH a base d´antiretroviraux: Quel impact sur l´épidemie du VIH? Med Sci. 2013 Avr; 4 (29): 373-382.
Cohen M., Muessing K., Smith M., Powers K., Kashuba A. Antiviral agents and HIV prevention: Controversies, confflits and consensus.
AIDS. 2012 Aug 24; 26 (13): 1585-1598.
Babiker A., Emery S., Fatkenhsuer G., Gordin F., Grund B., Lundgren J., et al. Considerations in the rationale, design and methods of the strategic timing of antiretroviral treatment (START) study. Clin Trials. 2013; 10 (10): S5-S36.
Kitahata M., Gange S., Abraham A., Merriman B., Saag M., JusticeA.,et al. Effect of early versus deferred antirretroviral therapy for HIV on
survival. NEJM. 2009 Apr 30; 360 (18): 1815-1826.
Study Group on Death Rates at High CD4 count in Antiretroviral Naive Patients. Death rates in HIV-positive antirretroviral-naive patients with CD4 count greater than 350 cells per micL in Europe and North America: a pooled cohort observational study. Lancet. 2010 July 31; 376
(9738): 340-345.
The HIV-Causal Collaboration. The effect of combined antirretroviral therapy on the overall mortality of HIV-infected individuals. AIDS. 2010; 24 (1): 123-137.
Yiannoutsos C., Johnson L., Boulle A., Musick B., Gsponer T., Balestre E., et a for the International epidemiologic databasees to evaluate AIDS (IeDEA) Collaboration. Estimated mortality of adult HIV-infected patients starting treatment with antirretroviral therapy. Sex Transm Infect. 2012; 88: 33-43.
When to Start Consortium. Timing of initiation of antiretroviral therapy in AIDS-free HIV-1-infected patients: a collaborative analysis of 18 HIV cohort studies. Lancet. 2009 Apr 18; 373: 1352-1363.
The HIV-CAUSAL Collaboration. When to initiate combined antiretroviral therapy to reduce mortality and AIDS-defining illness in HIV-infected persons in developed countries: An observational study. AIM. 2011 Apr 19; 154 (8): 509-515.
Lundgren J. Wood R. Universal antirretroviral therapy for HIV infection? CID. 2013 Sep; 57 (6): 888-890.
Lundgren J., Babiker A., Gordin F., Borges A., Neaton J. When to start antirretroviral therapy: the need for an evidence base during early HIV infection. BMC Medicine. 2013; 11: 148-158.
Chao C., Leyden A., Xu L., Horberg A., Klein D., Towner J., et al. Exposure to antiretroviral therapy and risk of cancer in HIV-infected persons. AIDS. 2012 Nov 13; 26 (17): 2223-2231.
Shama G. Kaur G. Mehra N. Genetic correlates influencing immunopathogenesis of HIV infection. IJMR. 2011 Dec; 134 (6): 749-768
Michaud V. Bar-Magen T. Turgeon J. Flockhart D. Desta Z. Wainberg M. The dual role of pharmacogenetics in HIV treatment: Mutations and polymorphisms regulating antiretroviral drug resistance and disposition. Pharmacol Rev. 2012; 64: 803-833
Coffin J. Ewanstrom R. HIV pathogenesis: Dynamics and genetics of viral populations and infected cells. Cold Spring Harb Perspect Med
; 3: a012526
Aouizerat B. Pearce C. Miaskowski C. The search for host genetic factors if HIV/AIDS pathogenesis in the post-genome era: Progress to date and new avenues for discovery. Curr HIV/AIDS Rep. 2011; 8: 38-44
Schwarze-Zander C. Blackard J. Rockstroch J. Role of GB virusC in modulating HIV disease. Expert Rev Anti Infect Ther. 2012 May; 10 (5):
-572122. Writing Committee for the CASCADE Collaboration. Timing of HAART initiantion and Clinical Outcomes in human immunedeficiency vírus. Arch Int Med. 2011 Sep 26; 171 (17): 1560-1569
Kuritzkes D. HAART for HIV-1 infection: Zeroing in on when to start, Arch Int Med. 2011 Sep 26; 171 (17); 1569-1570.
Hogan C., DeGruttola V., Sun X., Fiscus S., Del Rio C., Hare B., et al. The set point study (ACTG A5217): Effect of immediate versus deferred
antirretroviral therapy on virologic set point in recently HIV-1-infected individuals. JID Jan 1; 2012; 205: 87-96.
O´Brien M., Markowitz M., Should we treat acute HIV infection? Curr HIV/AIDS Rep., 2012 Jun; 9 (2): 101-110.
Stekler J., Wellman R., Holte S., Maenza J., Stevens C., Corey L.et al, Are there benefits to starting HAART during primary HIV infection? Conclusions from the Seattle primary infection Cohort vary by control group. Int J STD AIDS, 2012 Mar; 23 (3): 201-206.
Saez-Cirion A., Bacchus C., Hocqueloux L., Avettand-Fenoel V., Girault I., Lecuroux C., et al. Post-treatment HIV-1 controllers with a long-term virological remission after the interruption of early initiated antiretroviral therapy ANRS VISCONTI study. PLOS Pathogens 2013 Mar; 9 (3), e1003211.
Paci P., Martini F., Berraschi M., D´Offizi G., Castiglione F. Timely HAART initiation may pave the way for a better viral control. BMC Inf Dis. 2011; 11:56.
Archin N., Vaidya N. Kuruc J., Liberty A., Wiegand A., Keraney M., et al, Immediate antiviral therapy appears to restrict resting CD4 cell HIV-1 infection without accelerating the decay in latent infection. PNAS, 2012 Jun 12; 109 (24), 9523-9528.
Vinikoor M., Cope A., Gay C., Ferrari G., McGee K., Kuruk J., et al. Antiretroviral therapy initiated during acute HIV infection fails to prevent
T-cell activation. JAIDS Apr 15; 62 (5): 505-508
Ficheiros Adicionais
Publicado
Como Citar
Edição
Secção
Licença
Este trabalho encontra-se publicado com a Licença Internacional Creative Commons Atribuição 4.0.
Direitos de Autor (c) 2023 Medicina Interna
Acesso livre
