Fırsatçı infeksiyonların geliştiği bir hıv/aıds olgusu

Otuz dokuz yaşında kadın hasta, iştahsızlık, yutma güçlüğü, ishal ve kilo kaybı yakınmalarıyla başvurdu. Hastanın 14 yıl önce HIV infeksiyonu tanısı aldığı,5 yıl öncesine kadar hastaneye başvurmadığı ve daha sonra da ilaçlarını düzenli kullanmadığı öğrenildi. Hastaya kandida özofajiti ve sitomegalovirus(CMV) infeksiyonu tanıları konuldu. Direnç analizinde birçok anti-retrovirale karşı direnç saptandı. Anti-retroviral tedavi değişikliği ve fırsatçı infeksiyonların tedavisi ile olgunun yakınmaları geriledi. İlaçlarını düzenli kullanmayan HIV ile infekte hastalarda ilaç direnci ve fırsatçı infeksiyonlar ortaya çıkabilir. Bu nedenli düzenli tedavinin sağlanması ve bakteriyel/mikotik komplikasyonların önlenmesinde yakın izlem önemlidir.

A hıv/aıds case that has been developed opportunıstıc ınfectıons

A 39 year-old woman was admitted with anorexia, difficulty in swallowing, diarrhea and weight loss. Although the patient was diagnosed with HIV infection 14 years ago,her first admission to hospital was in 2008 and she was not taking her drugs regularly. The patient was diagnosed with CMV infection and candida oesophagitis. Resistance to many of the antiretroviral agents was detected. With the change of anti-retroviral treatment and treating of the opportunistic infections her symptoms were regressed. Drug resistance and opportunistic infections can ocur in HIV-infected patients who do not use their drugs regularly. Therefore, close monitoring is important for maintaining regular therapy and prevention of bacterial and mycotic complications.

Kaynakça

Kaplan JE, Benson C, Holmes KH, et al. Guidelines for preven- tion and treatment of opportunistic infections in HIV-infected adults and adolescents: recommendations from CDC, the Na- tional Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. MMWR Recomm Rep 2009; 58:1.

Whitley RJ, Jacobson MA, Friedberg DN, et al. Guidelines for the treatment of cytomegalovirus diseases in patients with AIDS in the era of potent antiretroviral therapy: recommendations of an international panel. International AIDS Society-USA. Arch Intern Med 1998; 158:957.

Paterson DL, Swindells S, Mohr J, et al. Adherence to protease inhibitor therapy and outcomes in patients with HIV infection. Ann Intern Med 2000; 133:21.

Athe MN Tsibris, Charles Fathing. Surviving antiretroviral re- sistance: Strategies for optimal use of therapeutic agents. The PRN Notebook; 2006:11(3):

Castagna A, Danise A, Menzo S, et al. Lamivudine monother- apy in HIV-1-infected patients harbouring a lamivudine- resistant virus: a randomized pilot study (E-184V study). AIDS. 2006;20:795-803.

Vazquez JA. Therapeutic options for the management of oro- pharyngeal and esophageal candidiasis in HIV/AIDS patients. HIV Clin Trials 2000; 1:47.

McKinsey DS, Wheat LJ, Cloud GA, et al. Itraconazole prophy- laxis for fungal infections in patients with advanced human immunodeficiency virus infection: randomized, placebo- controlled, double-blind study. National Institute of Allergy and Infectious Diseases Mycoses Study Group. Clin Infect Dis 1999; 28:1049.

Cameron ML, Schell WA, Bruch S, et al. Correlation of in vitro fluconazole resistance of Candida isolates in relation to therapy and symptoms of individuals seropositive for human immuno- deficiency virus type 1. Antimicrob Agents Chemother 1993; 37:2449.

Revankar SG, Kirkpatrick WR, McAtee RK, et al. Detection and significance of fluconazole resistance in oropharyngeal candidiasis in human immunodeficiency virus-infected patients. J Infect Dis 1996; 174:821.

Bozzette SA. Fluconazole prophylaxis in HIV disease, revisited. Clin Infect Dis 2005; 41:1481.

Feasey NA, Healey P, Gordon MA.Aliment Pharmacol Ther. 2011 Sep;34(6):587-603.

Moreno S, Baraia-Etxaburu J, Bouza E, et al. Risk for develop- ing tuberculosis among anergic patients infected with HIV. Ann Intern Med 1993; 119:194.

Kaptan F,ve ark. İnsan İmmün Yetmezlik Virüsü ile Enfekte 128 Olgunun Retrospektif Olarak Değerlendirilmesi Türkiye Klinikleri J Med Sci 2011;31(3):525-33

Alp E,ve ark. Kapadokya Bölgesinde Takip Edilen HIV/AIDS Hastalarının Epidemiyolojik ve Klinik Özellikleri: 18 Yıllık Deneyim Mikrobiyol Bul 2011;45(1):125-36

Kaynak Göster