Terapia antirretroviral directamente observada en mujeres privadas de libertad Directly observed anti-retroviral therapy amongst female inmates

• Main Authors: L. De Carolis (Author), C. Wainstein (Author)
• Format: Book
• Published: Sociedad Española de Sanidad Penitenciaria, 2009-02-01T00:00:00Z.
• Subjects: article
• Online Access: Connect to this object online.

Summary

Objetivos: La adherencia al tratamiento antirretroviral de alta eficacia (TARV) se considera el gold standard para el éxito del mismo. Para mejorar la adherencia en persona privadas de libertad viviendo con VIH-Sida, se propuso la utilización del tratamiento directamente observado tomando el modelo para el tratamiento de la tuberculosis. Material y métodos: se incluyeron las mujeres VIH positivas con criterios de TARV que voluntariamente decidieron participar. Los datos principales a evaluar fueron control inicial y final de CD4 y carga viral para VIH. Resultados: estudiamos 52 mujeres, edad promedio 34 años, entre 1 y 20 años de infección VIH. CD4 menor a 100 cél/ml inicial en 16 pacientes (30.7%) y final en 4 pacientes (7.6%). Carga viral indetectable inicial en ninguna paciente y final en 33 pacientes (63.4%) 21 % con infecciones oportunistas, principal tuberculosis. 17% coinfectadas con HCV. El esquema de TARV más utilizado fue 2 INTR más 1 INNTR. Conclusiones: La estrategia DOT aplicada al TARV fue efectiva en nuestras pacientes, evidenciado por el aumento de los CD4 y el mayor número de pacientes con disminución de la carga viral hasta permanecer indetectables. Si bien es difícil de implementar en tratamientos crónicos consideramos que es una herramienta útil para personas privadas de libertad.<br>Objectives: It is considered that the gold standard for success in HAART is adherence. To improve adherence amongst inmates with HIV-AIDS, the use of directly observed treatment (DOT) is proposed using the tuberculosis treatment model. Material and methods: HIV positive female patients with ARVT criteria who voluntarily participated were used for the study. The initial and final CD4 cell count and HIV viral load were the principal data used for assessment purposes. Results: 52 women with an average age of 34 years were studied, with an average HIV infection time span of between 1 and 20 years. Initial CD4 cell count of <100 copies/mL in 16 patients (30.7%) and an equivalent final count in 4 patients (7.6%) were found. Initial undetectable viral loads were not found in any patient, while final undetectable viral loads were found in 33 (63.4%). 21% of patients had opportunistic infections. The most important of these was tuberculosis, followed by HCV co-infection. The most frequently used ARVT schedule was two NRTI with one NNTRI. Conclusions: The application of DOT strategy to ARVT was effective amongst our patients, as shown by the increase in CD4 counts and the increased number of patients with reductions in viral loads to undetectable levels. While it is a tool that is not easy to use for cases of chronic treatment, we do consider it to be useful for prison inmates.

Item Description

1575-0620