A carregar...
Publicação
Papel da corticoterapia na terapêutica adjuvante da Síndrome Inflamatória da Reconstituição Imune (IRIS)
| Nome: | Descrição: | Tamanho: | Formato: | |
|---|---|---|---|---|
| 562.28 KB | Adobe PDF |
Autores
Orientador(es)
Resumo(s)
A introdução da terapêutica antirretroviral (TARV) mudou por completo o panorama do tratamento e da evolução da infeção VIH. Com terapêutica eficaz e adequado acompanhamento médico, as pessoas a viver com VIH atingem hoje em dia uma esperança média de vida semelhante à população geral, transformando uma infeção outrora fatal numa doença crónica. No entanto, a TARV não é isenta de efeitos adversos ou complicações: muitos doentes, após início da terapêutica, apresentam agravamento clínico significativo, bem como exacerbações de infeções oportunistas previamente tratadas ou não diagnosticadas. Este fenómeno é designado Síndrome Inflamatória da Reconstituição Imune (IRIS, na sigla em inglês) e, apesar da sua fisiopatologia não se encontrar ainda totalmente compreendida, relaciona-se com uma resposta inflamatória exagerada associada à recuperação das funções imunitárias após início da TARV. A IRIS não tem atualmente critérios de diagnóstico estandardizados e as suas manifestações associam-se às infeções que lhe são subjacentes. Sendo um fator de agravamento clínico e uma complicação associada à TARV, o tratamento da IRIS é fundamental na gestão clínica do doente com infeção VIH. À semelhança de outros processos patológicos caracterizados por respostas imunes exuberantes, os fármacos antinflamatórios, dos quais os corticosteróides são uma das classes mais amplamente utilizadas, podem eventualmente ter interesse terapêutico. No entanto, sabemos também que a corticoterapia em si está associada a um maior risco de imunossupressão iatrogénica. Neste contexto, a IRIS coloca-nos um desafio clínico interessante: é fundamental encontrar equilíbrio entre o potencial benefício da corticoterapia na terapêutica adjuvante da IRIS e o potencial risco de agravar o estado de imunossupressão em que se encontra uma parte significativa dos doentes com VIH/SIDA com infeções oportunistas e/ou que não realizam TARV.
Objetivos: Revisão da literatura científica relativa aos potenciais benefícios e riscos da corticoterapia como terapêutica adjuvante para a IRIS associada a várias infeções oportunistas do doente com VIH/SIDA; Revisão das recomendações para o uso de corticosteróides na IRIS; Revisão da evidência relativa às contraindicações para o uso de corticosteróides na IRIS; Identificar lacunas na literatura científica relativa à corticoterapia na terapêutica adjuvante da IRIS.
The introduction of antiretroviral therapy (ART) has completely changed the landscape of treatment and the natural evolution of HIV infection. With effective therapy and adequate medical follow-up, people living with HIV today might reach a life expectancy similar to the general population, transforming a once fatal infection into a chronic disease. However, ART is not without adverse effects or complications: many patients, after starting therapy, experience significant clinical worsening, as well as exacerbations of previously untreated or undiagnosed opportunistic infections. This phenomenon is called Immune Reconstitution Inflammatory Syndrome (IRIS) and, although its pathophysiology is not yet fully understood, it is related to an exaggerated inflammatory response associated with the recovery of immune functions after initiation of ART. IRIS does not currently have standardized diagnostic criteria and its manifestations are associated with underlying infections. As a clinical worsening factor and a complication associated with ART, the treatment of IRIS is fundamental in the clinical management of the patient with HIV infection. As with other pathological processes characterized by exuberant immune responses, anti-inflammatory drugs, of which corticosteroids are one of the most widely used classes, may eventually be of therapeutic interest. However, we also know that corticosteroid therapy itself is associated with an increased risk of iatrogenic immunosuppression. In this context, IRIS presents us with an interesting clinical challenge: it is essential to find a balance between the potential benefit of corticosteroid therapy in the adjuvant therapy of IRIS and the potential risk of worsening the state of immunosuppression in which a significant part of HIV/AIDS patients find themselves. Objectives: Review of the scientific literature on the potential benefits and risks of corticosteroid therapy as an adjuvant therapy for IRIS associated with various opportunistic infections in patients with HIV/AIDS; Review of recommendations for the use of corticosteroids in IRIS; Review of evidence regarding contraindications for the use of corticosteroids in IRIS; To identify gaps in the scientific literature regarding corticosteroid therapy in the adjuvant therapy of IRIS.
The introduction of antiretroviral therapy (ART) has completely changed the landscape of treatment and the natural evolution of HIV infection. With effective therapy and adequate medical follow-up, people living with HIV today might reach a life expectancy similar to the general population, transforming a once fatal infection into a chronic disease. However, ART is not without adverse effects or complications: many patients, after starting therapy, experience significant clinical worsening, as well as exacerbations of previously untreated or undiagnosed opportunistic infections. This phenomenon is called Immune Reconstitution Inflammatory Syndrome (IRIS) and, although its pathophysiology is not yet fully understood, it is related to an exaggerated inflammatory response associated with the recovery of immune functions after initiation of ART. IRIS does not currently have standardized diagnostic criteria and its manifestations are associated with underlying infections. As a clinical worsening factor and a complication associated with ART, the treatment of IRIS is fundamental in the clinical management of the patient with HIV infection. As with other pathological processes characterized by exuberant immune responses, anti-inflammatory drugs, of which corticosteroids are one of the most widely used classes, may eventually be of therapeutic interest. However, we also know that corticosteroid therapy itself is associated with an increased risk of iatrogenic immunosuppression. In this context, IRIS presents us with an interesting clinical challenge: it is essential to find a balance between the potential benefit of corticosteroid therapy in the adjuvant therapy of IRIS and the potential risk of worsening the state of immunosuppression in which a significant part of HIV/AIDS patients find themselves. Objectives: Review of the scientific literature on the potential benefits and risks of corticosteroid therapy as an adjuvant therapy for IRIS associated with various opportunistic infections in patients with HIV/AIDS; Review of recommendations for the use of corticosteroids in IRIS; Review of evidence regarding contraindications for the use of corticosteroids in IRIS; To identify gaps in the scientific literature regarding corticosteroid therapy in the adjuvant therapy of IRIS.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2022
Palavras-chave
Síndrome inflamatória da reconstituição imune (IRIS) HIV Corticoterapia Infeções oportunistas Terapêutica antirretroviral (TARV) Doenças transmissíveis