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Infecção pelo HIV Aids HIV Aids Manejo Liga de Infectologia 2015

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Infecção pelo HIV Aids HIV Aids Manejo Liga de Infectologia 2015

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Infecção pelo HIV Aids HIV Aids Manejo Liga de Infectologia 2015

  1. 1. Alexandre Naime Barbosa MD, PhD Professor Doutor - Infectologista Liga de Infectologia - Noite de Ingresso Faculdade de Medicina - UNESP Abr/2015 - Botucatu - SP
  2. 2. www.drbarbosa.org
  3. 3. www.drbarbosa.org
  4. 4. Saúde Global www.drbarbosa.org
  5. 5. 6ª 3ª www.drbarbosa.org
  6. 6. Unaids - Aids Epidemic Update, 2014  1981-2013: 78 milhões de casos  1981-2013: 39 milhões de mortes  2013: 35 milhões de PVHA  2013: 2,1 milhões de casos novos  2013: 1,5 milhões de mortes www.drbarbosa.org
  7. 7. MS – Boletim Epidemiológico, 2014 Unaids - Aids Epidemic Update, 201 Prevalência ND Mundo Brasil Prevalência 35 milhões 0,7 - 0,8 milhão (0,5%) Incidência/ano 2,3 milhões 40 mil Mortalidade/ano 1,5 milhão 15 mil www.drbarbosa.org
  8. 8. MS – Boletim Epidemiológico, 2014 www.drbarbosa.org
  9. 9. Grangeiro A - Congresso Brasileiro de Infectologia, 2013 www.drbarbosa.org
  10. 10. MS – Boletim Epidemiológico, 2014 www.drbarbosa.org
  11. 11. www.drbarbosa.org
  12. 12. www.drbarbosa.org
  13. 13. Grangeiro A - Congresso Brasileiro de Infectologia, 2013 www.drbarbosa.org
  14. 14. drbarbosa.org Slide Cedido pela Dra. Maria Clara Gianna
  15. 15. www.drbarbosa.org
  16. 16. drbarbosa.org
  17. 17.  Mucosa ou Epitélio  Vascularização  Rede Linfática  Área de Exposição  DSTs ou Lesões de Órgãos Prepúcio www.drbarbosa.org
  18. 18.  Lesões por Atrito  Lubrificação  Retenção fluídos  Fluídos Sexuais  Muco anal  Sangue www.drbarbosa.org
  19. 19.  Uso de Drogas  Uso de Álcool www.drbarbosa.org
  20. 20.  Festas Barebacking  Saunas e Casas de Banho  Casas de Swing  Gang Bang, Roleta Russa  Transmissão Intencional www.drbarbosa.org
  21. 21. www.drbarbosa.org
  22. 22. www.drbarbosa.org
  23. 23. www.drbarbosa.org
  24. 24. www.drbarbosa.org
  25. 25. www.drbarbosa.org
  26. 26.  RNA: 2 moléculas  Capsídeo Protéico (p17, p24)  Envelope (gp41, gp120)  Enzimas: TR, PT, IT, RNAse  Células Alvo: Receptores CD4 (LT)  Co-receptores: CCR5, CXCR4 RT: transcriptase reversa; PT: protease; IT: integrase www.drbarbosa.org
  27. 27. < 72h, chance de impedir a formação de pró-vírus, ARVs impedem a perpetuação da infecção Infecção crônica pelo HIV, ARVs controlam replicação, mas não esterilizam as células www.drbarbosa.org
  28. 28. www.drbarbosa.org
  29. 29. www.drbarbosa.org
  30. 30. Linfócito T CD4 www.drbarbosa.org
  31. 31. www.drbarbosa.org
  32. 32. www.drbarbosa.org
  33. 33. Sintomas ou não Teste HIV pode ser negativo Elevada Carga Viral www.drbarbosa.org
  34. 34. Oligo ou Assintomático Teste HIV Positivo Carga Viral Alta www.drbarbosa.org
  35. 35. Doenças Oportunistas Teste HIV Positivo Carga Viral Alta www.drbarbosa.org
  36. 36. www.drbarbosa.org
  37. 37. www.drbarbosa.org
  38. 38. www.drbarbosa.org
  39. 39. www.drbarbosa.org
  40. 40. www.drbarbosa.org
  41. 41. www.drbarbosa.org
  42. 42. www.drbarbosa.org
  43. 43. www.drbarbosa.org
  44. 44. www.drbarbosa.org
  45. 45. www.drbarbosa.org
  46. 46. Hutter G, et al N Engl J Med, 2009. www.drbarbosa.org
  47. 47. Serves as proof-of-concept that HIV CURE is possible www.drbarbosa.org
  48. 48. www.drbarbosa.org
  49. 49. A JH K I G F E D C B www.drbarbosa.org
  50. 50. www.drbarbosa.org
  51. 51. POPULAÇÃO SEXUALMENTE ATIVA EM RISCO INFECTADAS PERCEBEM SINTOMAS PROCURAM ATENDIMENTO ATENDIDAS DIAGNÓSTICO CORRETO TRATAMENTO ADEQUADO PARCEIROS TRATADOS www.drbarbosa.org
  52. 52. www.drbarbosa.org
  53. 53. www.drbarbosa.org
  54. 54. www.drbarbosa.org
  55. 55. Grangeiro A - Congresso Brasileiro de Infectologia, 2013 www.drbarbosa.org
  56. 56. www.drbarbosa.org
  57. 57. 2015: 28 drogas , DTV www.drbarbosa.org
  58. 58. www.drbarbosa.org
  59. 59. Consenso Vigente em 2013: Esquemas para Início de TARV Esquemas Preferenciais - 2 ITRN + ITRNN - ITRN: TDF ou AZT + 3TC - ITRNN: EFZ (NVP como alternativa) Esquemas Alternativos - 2 ITRN + IP/r - 2 ITRN + IP* - ITRN: ddI ou ABC - IP: LOP/r (ATV/r ou FPV/r como alternativa) - IP: ATV Objetivo da TARV Tempo Carga Viral 4 - 6 semanas ↓ 1 log 4 meses ↓ 2 log 6 meses Indetectável À longo prazo Indetectável www.drbarbosa.org
  60. 60.  HAART: CV indetectável  Supressão em virgens ou não  Grande redução da mortalidade  Taxas próximas do normal  Objetivo: supressão virológica sustentada Bhaskaran K, Hamouda O, Sannes M, et al. Changes in the risk of death after hiv seroconversion compared with mortality in the general population. JAMA. 2008;300(1):51-59. www.drbarbosa.org
  61. 61. Grangeiro A - Congresso Brasileiro de Infectologia, 2013 www.drbarbosa.org
  62. 62. Grangeiro A - Congresso Brasileiro de Infectologia, 2013 www.drbarbosa.org
  63. 63. www.drbarbosa.org
  64. 64. Revista Unesp Ciência - Out/2011 www2.unesp.br/revista/?p=4095 www.unesp.br/revista/24 www.drbarbosa.org
  65. 65. Guaraldi G et al. CID 2011; 53:1120 www.drbarbosa.org
  66. 66.  Doença Cardiovascular (IAM, AVE)  Câncer (Não-Aids)  Osteopenias e Fraturas  Disfunção Ventricular Esquerda  Insuficiência Hepática  Insuficiência Renal  Distúrbios Neuro-Cognitivos  “Síndrome da Fragilidade”  Imunossenescência Weber et al. HIV Med 2013; 14:195 HIV+ HIV+ HIV+ HIV - www.drbarbosa.org
  67. 67. HAART PÓS PRÉ www.drbarbosa.org
  68. 68. ↑ Comorbidades Contágio na 3ª Idade Aumento da Sobrevida Inflamação Crônica Hábitos de Vida Toxicidade dos ARVs www.drbarbosa.org
  69. 69. Deeks, 2011 www.drbarbosa.org
  70. 70. Maus Hábitos de Vida Inflamação, ARVs www.drbarbosa.org
  71. 71. www.drbarbosa.org
  72. 72. www.drbarbosa.org
  73. 73. www.drbarbosa.org
  74. 74. www.drbarbosa.org
  75. 75. < 72h, chance de impedir a formação de pró-vírus, ARVs impedem a perpetuação da infecção Infecção crônica pelo HIV, ARVs controlam replicação, mas não esterilizam as células www.drbarbosa.org
  76. 76. www.drbarbosa.org
  77. 77. www.drbarbosa.org
  78. 78. www.drbarbosa.org
  79. 79. www.drbarbosa.org
  80. 80. www.drbarbosa.org
  81. 81. www.drbarbosa.org
  82. 82. Comparação de Eficácia entre as Estratégias de Prevenção Abdool Karim S, Abdool Karim Q, et al. Lancet. 2011;378:e23-e25. www.drbarbosa.org
  83. 83. www.drbarbosa.org
  84. 84.  HIV/Aids: um dos mais graves problemas de saúde global  Brasil: desperdício oportunidades, mais infecções e mortes  Importante otimizar ferramentas disponíveis, sem banalizar  Referenciar sempre que tiver dúvidas  Oferecer sempre a possibilidade  Divulgar em grupos mais vulneráveis  Promover sempre o uso do preservativo www.drbarbosa.org
  85. 85. Obrigado pela Atenção!

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