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Auxílio Didático 6º Ano 2011
 

Auxílio Didático 6º Ano 2011

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Auxílio Didático 6º Ano 2011

Auxílio Didático 6º Ano 2011

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    Auxílio Didático 6º Ano 2011 Auxílio Didático 6º Ano 2011 Presentation Transcript

    • Dr. Alexandre Naime Barbosa MD, PhD Infectologista Assistente  barbosa.an@ymail.com SAE/Hospital Dia "Domingos Alves Meira" Medicina Unesp - Botucatu
    • Eventos Científicos: Abbott, Bristol-Myers Squibb, Boehringer Ingelheim , Glaxo Smith Kline, Merck Sharp Dome, Pfizer, Roche, Schering Plough, United MedicalPatrocínio de Eventos Boehringer Ingelheim, Jansen e MerckApoio à Pesquisa: Abbott, CNPq, Fapesp, RochePalestrante: Abbott, Boehringer Ingelheim , Bristol-Myers- Squibb, Glaxo Smith KlineTextos: Bristol-Myers-Squibb, RocheVínculos: HC Unesp, Roche Pharma - Virologia, SAE/HD DAM - FMB UnespBolsa Pesquisa: CNPq - DTI - Upeclin - FMB Unesp, Fundep DN DST/Aids e Hepatites Virais Barbosa AN, 2011
    • Aids Hepatite B Hepatite C Pbmicose Tuberculose Influenza OfidismoFebres Hemorrágicas Meningites http://br.groups.yahoo.com/group/infecto_unesp Barbosa AN, 2011
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    •  Prevalência: 33,3 milhões (2009) Incidência: 2,6 milhões (2009) Taxas estáveis na atual década Mortalidade: 1,8 milhões (2009) Feminização dos casos novos Situação sem controle na África  Estabilização da epidemia, com exceção em países pobres http://br.groups.yahoo.com/group/infecto_unesp Barbosa AN, 2011
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    •  Prevalência: 630 mil Incidência: 0,61% (1,2 milhão) Estabilização nos últimos anos Feminização em mais novas (1,5:1,0) Vulnerabilidade  Estabilização da epidemia, exceto em populações vulneráveis http://br.groups.yahoo.com/group/infecto_unesp Barbosa AN, 2011
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    •  ↓ Entrada (CCR5): maraviroque ↓ Fusão: enfuvertida ITRN: AZT, 3TC, ddI, TDF ITRNN: EFZ, NVP, ETV IP: LOP/r, ATV, FOS, SQV ↓ Integrase: raltegravirITRN: ↓ transcriptase reversa análogo à nucleos(t)ídeo;ITRNN:↓ transcriptase reversa não análogo à nucleos(t)ídeo;IP: ↓ protease; AZT: zidovudina; 3TC: lamivudina; ddI: didanosina;TDF: tenofovir; EFZ: efavirenz; NVP: nevirapina; LOP/r: lopinavir/ritonavir;ATV: atazanavir; FOS: fosamprenavir; SQV: saquinavir http://br.groups.yahoo.com/group/infecto_unesp Barbosa AN, 2011
    •  RNA: 2 moléculas Capsídeo Protéico (p17, p24) Envelope (gp41, gp120) Enzimas: TR, PT, IT, RNAse Receptores: CD4 Co-receptores: CCR5, CXCR4  O conhecimento virológico propiciou um grande número de drogas http://br.groups.yahoo.com/group/infecto_unesp Barbosa AN, 2011
    •  HAART: CV indetectável Supressão em virgens ou não Grande redução da mortalidade Taxas próximas do normal ↑ comorbidades (coração, fígado) ↑ toxicidade medicamentosa Envelhecimento PrecoceHAART: terapia antirretroviral de alta potênciaCV: carga viral  Objetivo: supressão virológica sustentada http://br.groups.yahoo.com/group/infecto_unesp Barbosa AN, 2011
    • Sintomas ou nãoTeste HIV pode ser negativo Elevada Carga Viralhttp://br.groups.yahoo.com/group/infecto_unesp Barbosa AN, 2011
    • Oligo ou Assintomático Teste HIV Positivo Carga Viral Altahttp://br.groups.yahoo.com/group/infecto_unesp Barbosa AN, 2011
    • Doenças Oportunistas Teste HIV Positivo Carga Viral Alta http://br.groups.yahoo.com/group/infecto_unesp Barbosa AN, 2011
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    • Sintomáticos AssintomáticosIndependente CD4 CD4 < 350 CD4: 350 - 500 CD4 > 500 Hepatite B Sorodiscordantes Iniciar sempre Iniciar sempre Iniciar em subgrupos: Iniciar em exceções: Hepatite C Gestantes Idade > 55 anos Cardiopatia/Risco Cardíaco Nefropatia do HIV Neoplasias Carga Viral > 100.000 http://br.groups.yahoo.com/group/infecto_unesp Barbosa AN, 2011
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    •  Objetivo: supressão virológica sustentada, carga viral indetectável em no máximo seis meses http://br.groups.yahoo.com/group/infecto_unesp Barbosa AN, 2011
    •  FT Virológica: CV detectável, CD4 estável FT Imunológica: CV detectável, CD4 em queda, assintomático FT Clínica: CV detectável, CD4 em queda, IOs  Objetivo: supressão virológica sustentada http://br.groups.yahoo.com/group/infecto_unesp Barbosa AN, 2011
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    • 100%90%80%70% Doenças Cardíacas60% Acidentes50% Infecções bacterianas40% Neoplasias Doenças Hepáticas30% Doenças por aids20%10% 0% 1997 1998 1999 2000 2001 http://br.groups.yahoo.com/group/infecto_unesp Barbosa AN, 2011
    •  Co-Infecção HVB e/ou HVC Toxicidade dos antirretrovirais IOs Álcool Doenças Metabólicas Outras  Objetivo: tratar as causas possíveis e modificar hábitos de risco http://br.groups.yahoo.com/group/infecto_unesp Barbosa AN, 2011
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    • SAE/Hospital Dia "Domingos Alves Meira" Medicina Unesp - Botucatu