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Tāpat kā pirms 10 gadiem pacienti cieš no caurejas
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23.08.2018

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Antiretrovīrusu terapijas (ARVT) 38 klīnisko pētījumu metaanalīzes, kas veiktas pēdējo desmit gadu laikā, rāda, ka aptuveni 17% cilvēku, kas dzīvo ar HIV, cieš no diarejas pat diezgan vēlīnos izmeklējumos.
Diarejai ir vairāki izraisītāji, no kuriem viens ir HIV ārstēšanai paredzēto preparātu blakus iedarbība. Šī problēma turpina iespaidot HIV pozitīvo cilvēku dzīves kvalitāti pat tad, kad tiek lietoti mūsdienīgi preparāti. Pētījumu rezultāti prezentēti XXII Starptautiskajā AIDS konferencē AIDS-2018.
Diareju, kas piemeklē cilvēkus, kuri lieto antiretrovīrusu terapijas preparātus, lai ārstētos no HIV, parasti neizraisa infekcija. Lielākoties tā ir pašu preparātu blakne vai arī HIV infekcijas radītas sekas, kas iespaido kuņģa-zarnu trakta darbību (KZT). Vīruss var inficēt KZT šūnas, bojāt zarnu trakta audus. Šos bojājumus nav iespējams atjaunot ar ARVT preparātu palīdzību. Tāpat ir dati par HIV replicēšanu zarnās pat tad, ja lieto terapiju. Tam par iemeslu var būt arī tas, ka ir bojāti KZT veģetatīvie nervi.
Pētījumā tika analizētas blakusparādības, kādas bijušas pacientiem ASV laika posmā no 2008. gada līdz 2016. gadam. 38 pārbaudījumos piedalījās 21 tūkstotis cilvēku. 21 pētījumā cilvēki pirmoreiz lietoja ARVT terapiju, bet 17 pētījumos – apsekoja cilvēkus, kas bija mainījuši ārstēšanas shēmas. Pacienti lietoja dolutegravīru, raltegravīru, elvitegravīru, efavirenzu, rilpivirīnu, atazanavīru, darunavīru, kobicistātu, emtricitabīnu un tenofovīru.
Abās grupās diarejas līmenis bija aptuveni vienāds: 17,5% un atbilstoši 17,9% . Salīdzinot pētījumus, kas tika veikti pirms 10 gadiem, un tagad, netika atklātas būtiskas pārmaiņas, kaut paši preparāti ir mainījušies.
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Source: NAM Aidsmap | «Diarrhoea continues to affect the quality of life of people with HIV in the modern treatment era» | http://www.aidsmap.com/Diarrhoea-continues-to-affect-the-quality-of-life-of-people-with-HIV-in-the-modern-treatment-era/page/3318310/ |
<... A meta-analysis of 38 clinical trials of antiretroviral therapies (ART) conducted in the past decade found that an average of 17% of study participants suffered from diarrhoea, with no improvement in more recent studies. Diarrhoea has multiple causes and only some of these cases are likely to be due to the drugs used in the studies, but it remains a significant co-morbidity that affects people’s quality of life. The analysis was presented at the 22nd International AIDS Conference (AIDS 2018) in Amsterdam last month.
Diarrhoea in people with well-treated HIV usually has a non-infectious cause, such as ART side-effects or the effects of HIV on the gastrointestinal tract. The virus can infect the cells in the gastrointestinal tract and cause damage, especially to gut-associated immune system tissue. Such damage may not be repaired with ART and there is evidence that HIV continues to replicate in gut tissue despite virologically suppressive ART. Another possible explanation is damage to autonomic nerves in the gastrointestinal tract.
The investigators identified efficacy trials of anti-HIV drugs, conducted in the United States (including multinational trials), between 2008 and 2016, that were listed on www.clinicaltrials.gov. The incidence of diarrhoea reported in each trial was examined for both intervention and control groups.
Over 21,000 people took part in the 38 trials that were identified. In 21 trials, people took ART for the first time, with the rest being studies of people changing treatment. The drugs being taken included dolutegravir, raltegravir, elvitegravir, efavirenz, rilpivirine, atazanavir, darunavir, cobicistat, emtricitabine and tenofovir.
It is important to note that the incidence of diarrhoea reported does not reflect only new cases of diarrhoea or cases that could be attributed to a person’s HIV treatment. A trial participant might simply continue to have the diarrhoea that they already had.
The median incidence of diarrhoea was virtually identical in intervention and control arms of studies, at 17.5% and 17.9% respectively. Comparing trials conducted a decade ago with those conducted more recently, there was no change over time even though the drugs studied had changed. ...>