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Reacciones de hipersensibilidad cutánea debidas a tiacetazona en pacientes VIH-1 seropositivos tratados por

P Nunn¹, D Kibuga, S Gathua

¹Kenya Medical Research Institute, Nairobi.

Lancet (London, England)

|March 16, 1991

Resumen

El virus de la inmunodeficiencia humana (VIH) aumenta significativamente el riesgo de reacciones cutáneas graves durante el tratamiento de la tuberculosis con estreptomicina, isoniazida y tiacetazona (STH). Los regímenes alternativos como SHRZ / TH pueden reducir estos eventos adversos en individuos VIH positivos.

Área de la Ciencia:

Enfermedades infecciosas Enfermedades infecciosas.
Farmacología clínica Farmacología clínica.
Salud Pública La salud pública.

Sus antecedentes:

El manejo de la tuberculosis (TB) se complica por la coinfección con el virus de la inmunodeficiencia humana (VIH).
La seguridad y eficacia de los medicamentos contra la tuberculosis en individuos seropositivos para el VIH requieren una evaluación cuidadosa.
Las reacciones de hipersensibilidad cutánea son una preocupación significativa en el tratamiento de la TB.

Objetivo del estudio:

Investigar el impacto del estado de VIH en la incidencia y gravedad de las reacciones adversas durante el tratamiento de la tuberculosis.
Para comparar los perfiles de seguridad de diferentes regímenes de medicamentos antituberculosos en pacientes VIH-seropositivos y VIH-seronegativos.
Para identificar componentes específicos del fármaco responsables de las reacciones de hipersensibilidad.

Principales métodos:

Análisis retrospectivo de 227 pacientes con tuberculosis, comparando los resultados basados en el estado de VIH y el régimen de tratamiento (STH vs. SHRZ / TH).
Registro detallado y análisis de las reacciones de hipersensibilidad cutánea y otros eventos adversos.
Pruebas de desafío específicas de medicamentos en pacientes que experimentaron reacciones adversas.

Principales resultados:

Los pacientes seropositivos al VIH tuvieron una incidencia significativamente mayor de reacciones de hipersensibilidad cutánea (20%) en comparación con los pacientes seronegativos al VIH (1%) cuando fueron tratados con STH (RR = 18).
El régimen de STH se asoció con una mayor tasa de reacciones tempranas en pacientes VIH positivos en comparación con el régimen SHRZ / TH (p = 0,04).
La tiacetazona fue identificada como la droga probable culpable en la mayoría de las reacciones de hipersensibilidad, con 6 de 7 pacientes desafiados reaccionando.

Conclusiones:

El estado seropositivo al VIH es un factor de riesgo importante para las reacciones adversas cutáneas graves durante el tratamiento de la TB con STH.
El régimen SHRZ / TH parece más seguro con respecto a las reacciones de hipersensibilidad en pacientes con TB VIH-positivos.
Estos hallazgos tienen implicaciones críticas para los programas de control de la TB en entornos de alta prevalencia del VIH, lo que requiere una reevaluación de las pautas de tratamiento estándar.

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