[Diagnosis and treatment of mycobacterial infections in patients with HIV/AIDS].
Mycobacterial infection remains as a frequent complication associated to HIV infection. Although the widespread use of HAART has intensely decreased incidence of disseminated Mycobacterium avium (MAC) infection, it does not seem that it has affected tuberculosis occurrence so intensely. In spite of the intense search of new methods of rapid diagnosis, in the clinical practice the diagnosis of the mycobacterial illnesses continues based on culture, although the appearance of new media has allowed to shorten the time of growth. The combination of isoniazid (INH), rifampin (RIF) and pirazinamide (PZ) (with ethambutol [ETB] when primary resistance to INH is higher than 4%), remains as the elective treatment for tuberculosis in HIV infected patients. Due to the interaction between RIF and some antiretovirals drugs, such as proteasa inhibitors, a change in the usual regimens could be necessary. Combinations without RIF or antiretroviral therapy with drugs not interacting with RIF (nucleosides, ritonavir or nevirapin) have been suggested. The emergence of strains of Mycobacterium tuberculosis resistant to the antituberculosis drugs, the lack of adherence to treatment, and the frequency of adverse events hinders even more the control of the tuberculosis and they demand a narrow follow up of these patients. The treatment of the disseminated infection by MAC has improved in the last years with the generalization of the combinations including macrolides as claritromicin or azitromicin with ETB. The doubt persists about what combination is more effective, although like in other opportunists infections associated with a severe immunodeficiency, using antiretrovirals combinations that enhance the immune system could be a fundamental therapeutic approach.
Pulido
F
F
Hospital 12 de Octubre, Madrid. fpulido@correo.interlink.es
Iribarren
J A
JA
Kindelan
J M
JM
Moreno
S
S
D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis* / Q000188:drug therapy*; D000900:Anti-Bacterial Agents; D019380:Anti-HIV Agents / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D000995:Antitubercular Agents / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D004347:Drug Interactions; D004352:Drug Resistance, Microbial; D018432:Drug Resistance, Multiple; D004359:Drug Therapy, Combination / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D017320:HIV Protease Inhibitors / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D006801:Humans; D015994:Incidence; D009161:Mycobacterium / Q000187:drug effects / Q000254:growth & development / Q000302:isolation & purification; D009164:Mycobacterium Infections / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D009165:Mycobacterium Infections, Nontuberculous / Q000175:diagnosis / Q000188:drug therapy; D015270:Mycobacterium avium-intracellulare Infection / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D017211:Treatment Failure; D014376:Tuberculosis / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology
D000900:Anti-Bacterial Agents; D019380:Anti-HIV Agents; D000995:Antitubercular Agents; D017320:HIV Protease Inhibitors
Diagnóstico y tratamiento de las infecciones por microbacterias en pacientes con VIH/SIDA.