Neste episódio, o Infectologista Dr. Estevão Portela comenta os principais estudos presentes no material que embasam o cuidado necessário para realizar um switch de classes terapêuticas e, assim, evitar falha e resistência. Acesse o artigo pela biblioteca de materiais do Janssen Pro.

Referências:

Refs: 

• Mayer KH, Drechsler H, Powderly WG. Switching effective antiretroviral therapy: a review. Clinical Infectious Diseases. 2002;35(10):1219-1230.
• Carr A, Hoy J, Pozniack A. The ethics of switch/simplify in antiretroviral trials: non-Inferior or Just Inferior? PLoS Med. 2012;9(7):e1001240.
• Clutter DS, Jordan MR, Bertagnolio S, Shafer RW. HIV-1 drug resistance and resistance testing. Infect Genet Evol. 2016 Dec;46:292-307.
• Boyd MA, Kumarasamy N, Moore CL, Nwizu C, Losso MH, Mohapi L et al. Ritonavir-boosted lopinavir plus nucleoside or nucleotide reverse transcriptase inhibitors versus ritonavir-boosted lopinavir plus raltegravir for treatment of HIV-1 infection in adults with virological failure of a standard first-line ART regimen (SECOND-LINE): a randomised, open-label, non-inferiority study. Lancet. 2013;381(9883):2091-209.
• Paton NI, Kityo C, Hoppe A, Reid A, Kambugu A, Lugemwa A et al. Assessment of second-line antiretroviral regimens for HIV therapy in Africa. N Engl J Med. 2014;371(3):234-47.
• La Rosa AM, Harrison LJ, Taiwo B et al. Raltegravir in second-line antiretroviral therapy in resource-limited settings (SELECT): a randomised, phase 3, non-inferiority study. Lancet HIV. 2016;6(3):e247-58.
• Boyd MA, Moore CL, Molina JM, Wood R, Madero JS, Wolff M et al. Baseline HIV-1 resistance, virological outcomes, and emergent resistance in the SECOND-LINE trial: an exploratory analysis. Lancet HIV. 2015;2(2):e42-51.
• Braithwaite RS, Shechter S, Roberts MS, Schaefer A, Bangsberg DR, Harrigan PR, Justice AC. Explaining variability in the relationship between antiretroviral adherence and HIV mutation accumulation. J Antimicrob Chemother. 2006;58:1036-1043.
• Eron JJ, Young B, Cooper DA, Youle M, DeJesus E et al. Switch to a raltegravir-based regimen versus continuation of a lopinavir-ritonavir-based regimen in stable HIV-infected patients with suppressed viraemia (SWITCHMRK 1 and 2): two multicentre, double-blind, randomised controlled trials. Lancet. 2010;375:396-407.
• Trottier B, Lake J, Logue K et al. Dolutegravir/abacavir/lamivudine versus current ART in virally suppressed patients (STRIIVING): a 48-week, randomized, non-inferiority, open-label, Phase IIIb study. Antiviral Therapy 2017;22:295-305.
• Gatell JM, Assoumou L, Moyle G et al. Switching from a ritonavir-boosted protease inhibitor to a dolutegravir-based regimen for maintenance of HIV viral suppression in patients with high cardiovascular risk. AIDS. 2017;31(18):2503-2514.
• Llibre JM, Pulido F, Garcia F, Garcia Deltoro M, Blanco JL, Delgado R. Genetic barrier to resistance for dolutegravir. AIDS. 2015;17(1):56-64.
• Wijting I, Rokx C, Boucher C et al. Dolutegravir as maintenance monotherapy for HIV (DOMONO): a phase 2, randomised non-inferiority trial. Lancet HIV. 2017;4(12):e547-e554.
• Blanco JL, Rojas J, Paredes R, Negredo E, Mallolas J, Casadella M, Clotet B, Gatell JM, Lazzari E, Martinez E et al. Dolutegravir-based maintenance monotherapy versus dual therapy with lamivudine: a planned 24 week analysis of the DOLAM randomized clinical trial. Journal of Antim Chemo. 2018;73(7):1965-1971.
• Walmsley SL, Antela A, Clumeck N, Duiculescu D, Eberhard A, Gutierrez F et al. Dolutegravir plus abacavir-lamivudine for the treatment of HIV-1 infection. N Engl J Med. 2013;369(19):1807-1818.
• Raffi F, Jaeger H, Quiros-Roldan E, Albrecht H, Belonosova E, Gatell JM et al. Once-daily dolutegravir versus twice-daily raltegravir in antiretroviral-naive adults with HIV-1 infection (SPRING-2 study): 96 week results from a randomised, double-blind, non-inferiority trial. Lancet Infect Dis. 2013;13(11):927-935.
• Arribas JR, Girard PM, Paton N et al. Efficacy of protease inhibitor monotherapy vs. triple therapy: meta-analysis of data from 2303 patients in 13 randomized trials. HIV Med. 2016;17:358-367.
• Aboud M, Kaplam M, Lombaard J et al. Superior effi cacy of dolutegravir (DTG) plus 2 nucleoside reverse transcriptase inhibitors (NRTIs) compared with lopinavir/ritonavir (LPV/RTV) plus 2NRTIs in second-line treatment: 48-week data from the DAWNING Study. In: 22nd International AIDS Conference. Amsterdã: 2018.
• Banhegyi D, Katlama C, da Cunha CA et al. Week 96 efficacy, virology and safety of darunavir/r versus lopinavir/r in treatment-experienced patients in TITAN. Curr HIV Res. 2012;10(2):171-81.
• Molina JM1, Andrade-Villanueva J, Echevarria J et al. Once-daily atazanavir/ritonavir compared with twice-daily lopinavir/ritonavir, each in combination with tenofovir and emtricitabine, for management of antiretroviral-naive HIV-1-infected patients: 96-week efficacy and safety results of the CASTLE study. J Acquir Immune Defic Syndr. 2010;53(3):323-32.
• Madruga JV1, Berger D, McMurchie M, Suter F, Banhegyi D, Ruxrungtham K et al. Efficacy and safety of darunavir-ritonavir compared with that of lopinavir-ritonavir at 48 weeks in treatment-experienced, HIV-infected patients in TITAN: a randomised controlled phase III trial. Lancet. 2007;370(9581):49-58.
• Aboud M, Brites C, Lu H et al. DTG versus lpv/r in second line (dawning): outcomes by who-recommended nrti backbone. Boston: CROI; 2018.
• Protocolo Clínico e Diretrizes Terapêuticas para Manejo da Infecção pelo HIV em Adultos. Departamento de Vigilância, Prevenção e Controle das IST, do HIV/Aids e das Hepatites Virais [Internet]. 2013. Disponível em: http://www.aids.gov.br/pt-br/pub/2013/protocolo-clinico-e-diretrizes-terapeuticas-paramanejo-da-infeccao-pelo-hiv-em-adultos
• Fatores determinantes para modificações da terapia antirretroviral inicial. [Internet]. 2012. Disponível em: https://www.sciencedirect.com/science/article/pii/S0104423012704980
• Wang R, Horton J, Hopking Jet al. Resistance through week 48 in the DAWNING Study Comparing Dolutegravir (DTG) Plus 2 nucleoside reverse transcriptase Inhibitors (NRTIs) Compared With Lopinavir/Ritonavir (LPV/r) plus 2 NRTIs in second-line treatment. In: 22nd International AIDS Conference. Amsterda: 2018.
• Meireles M, Pascom AR, Perini F et al. Comparative eff ectiveness of fi rst-line antirretroviral therapy regimens: results from a large realworld cohort in Brazil aft er the implementation of Dolutegravir. 22nd International AIDS Conference. Amsterda: 2018.
• Ministerio da Saude. Nota informativa no 03/2018 - COVIG/CGVP/DIAHV/SVS/MS. Apresenta as recomendacoes de substituicao (switch) de esquemas de terapia antirretroviral contendo ITRNN ou IP/r por dolutegravir, para pessoas vivendo com HIV com supressao viral maiores de 12 anos de idade Departamento de Vigilancia, Prevencao e Controle das IST, do HIV/Aids e das Hepatites Virais [Internet]. 2018. Disponível em:

Neste episódio, o Infectologista Dr. Estevão Portela e o Gerente de Assuntos Médicos Vinicius Zillmer respondem as principais perguntas que surgiram durante o Webinar HIV e COVID-19, que ocorreu dia 09 de abril.

Referências:

Refs:

• Qun Li et al., 2020; Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus–Infected Pneumonia
• The New York Times, How Bad Will the Coronavirus Outbreak Get? Here Are 6 Key Factors, by Knvul Sheikh, Derek Watkins, Jin Wu and Mika Gröndahl (Updated Feb. 28, 2020). Disponível em: <https://www.nytimes.com/interactive/2020/world/asia/china-coronavirus-contain.html?searchResultPosition=3>
• CDC 2007. Disponível em: <https://www.cdc.gov/flu/pandemic-resources/pdf/community_mitigation-sm.pdf>
• Ferguson N et al., 2020. Disponível em: <https://www.imperial.ac.uk/media/imperial-college/medicine/sph/ide/gida-fellowships/Imperial-College-COVID19-NPI-modelling-16-03-2020.pdf>
• COVID-19 dashboard by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University. Disponível em: <https://www.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6>
• Public Health Agency of Sweden. Disponível em: <https://www.folkhalsomyndigheten.se/the-public-health-agency-of-sweden/communicable-disease-control/protect-yourself-and-others-from-spread-of-infection/>
• Siddiqi e Mehra et al., 2020 
• Cao et al. NEJM 2020 - A Trial of Lopinavir-Ritonavir in Adults Hospitalized with Severe Covid-19. 
• Shen et. Al JAMA 2020 - JAMA Preliminary Communication March 27, 2020 - Treatment of 5 Critically Ill Patients With COVID-19 With Convalescent Plasma 
• Wu et al. JAMA 2020 - April 10, 2020 - Association of Public Health Interventions With the Epidemiology of the COVID-19 Outbreak in Wuhan, China 
• Wang M et al. Cell Res. 2020 - Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro.
• Xu X chinaXiv:202003.00026v1 2020 - Why tocilizumab could be an effective treatment for severe COVID-19?
• Gautret P Int J Antimicrob Agents. 2020 - Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial.
• Molina JM, Médecine et Mal Infectieuses 2020 - Knowledge and practices of Parisian family physicians for the management of men who have sex with men in the era of HIV pre-exposure prophylaxis.
• Cai Q , Engineering 2020 - TEMPORARY REMOVAL: Experimental Treatment with Favipiravir for COVID-19: An Open-Label Control Study
• Dong L, Drug Discov Ther. 2020 - Discovering drugs to treat coronavirus disease 2019 (COVID-19).
• Baron SA. et al. Int J Antimicrob Agents. 2020 - Teicoplanin: an alternative drug for the treatment of COVID-19?
• Elfiky A Life Sci. 2020 - Ribavirin, Remdesivir, Sofosbuvir, Galidesivir, and Tenofovir against SARS-CoV-2 RNA dependent RNA polymerase (RdRp): A molecular docking study.
• Protocolo de Manejo de la Infección por SARS-CoV2 (COVID-19), versión 11. Disponível em: <https://portalarquivos.saude.gov.br/images/pdf/2020/April/14/Protocolo-de-Manejo-Cl--nico-para-o-Covid-19.pdf>
• Zhu F, Cao Y, Xu S, Zhou M. J Med Virol. 2020 Mar 11 - Co-infection of SARS-CoV-2 and HIV in a patient in Wuhan city, China.
• Guo W, Ming F, Dong Y, et al The Lancet - A Survey for COVID-19 Among HIV/AIDS Patients in Two Districts of Wuhan, China
• COVID-19 in patients with HIV: clinical case series 
• Chloroquine/ Hydroxychloroquine Prevention of Coronavirus Disease (COVID-19) in the Healthcare Setting (COPCOV). Disponível em: <https://clinicaltrials.gov/ct2/show/NCT04303507>
• Hydroxychloroquine Post Exposure Prophylaxis for Coronavirus Disease (COVID-19). Disponível em: <https://clinicaltrials.gov/ct2/show/NCT04318444>
• Post-exposure Prophylaxis or Preemptive Therapy for SARS-Coronavirus-2: A Pragmatic Randomized Clinical Trial. Disponível em: <https://clinicaltrials.gov/ct2/show/NCT04308668>
• Treatment of Non-severe Confirmed Cases of COVID-19 and Chemoprophylaxis of Their Contacts as Prevention Strategy: a Cluster Randomized Clinical Trial (PEP CoV-2 Study). Disponível em:<https://clinicaltrials.gov/ct2/show/NCT04304053>

O Dr. José Del Porto apresentou os conceitos entre transtorno bipolar, depressão unipolar, transtorno borderline de personalidade e apresentou as características que diferenciam essas doenças, além de comentar a publicação em português da Hypomania Checklist (Dr. Jules Angst) que auxilia no screening da bipolaridade.

Referências:

- Ghaemi SN, Dalley S, Catania C, Barroilhet S. Bipolar or borderline: a clinical overview. Acta Psychiatr Scand. 2014 Aug;130(2):99-108

- Goodwin F. e Jamison KR “Doença Maníaco-Depressiva: transtrono bipolar e depeessoes recorrentes”Segunda Edição, Porto Alegre, ARTMED, 2010

- McIntyre RS1,2, Zimmerman M3, Goldberg JF4, First MB5. Differential Diagnosis of Major Depressive Disorder Versus Bipolar Disorder: Current Status and Best Clinical Practices. J Clin Psychiatry. 2019 May 14;80(3). pii: ot18043ah2. doi: 10.4088/JCP.ot18043ah2.

- McIntyre RS, Calabrese JR. Bipolar depression: the clinical characteristics and unmet needs of a complex disorder. Curr Med Res Opin. 2019 Nov;35(11):1993-2005.