Resposta ao tratamento para leishmaniose visceral em pacientes coinfectados por Leishmania/HIV
DOI:
https://doi.org/10.18378/rebes.v13i3.9827Resumo
A Leishmaniose Visceral (LV) em pacientes imunossuprimidos pelo vírus da imunodeficiência humana (HIV) costuma ser uma doença oportunista grave. O manejo da LV em pessoas vivendo com HIV (PVHIV) é desafiador, uma vez que esses pacientes apresentam uma má resposta ao tratamento antileishmania, com risco de evolução crônica e alta taxa de recidiva da LV. Este estudo tem como objetivo descrever a resposta ao tratamento antileishmania nos pacientes coinfectados por Leishmania/HIV, destacando os fatores que dificultam o manejo adequado da LV e as alternativas de tratamento capazes de melhorar a resposta desses pacientes à terapia antileishmania. Trata-se de uma pesquisa bibliográfica conduzida nas bases de dados MEDLINE, LILACS, EMBASE, SCOPUS e SCIENCE DIRECT, tendo sido incluídos artigos publicados entre 2017 e 2023, com temática pertinente ao objeto de estudo, sendo selecionados 16 estudos para serem discutidos. Os estudos apontam que os principais fatores associados à má resposta ao tratamento da LV em PVHIV são a dificuldade de se atingir a concentração adequada dos fármacos antileishmania no organismo desses pacientes, falta de profilaxia secundária, ausência de terapia antirretrovial (TARV) efetiva, recidiva prévia da LV, baixa imunidade, coinfecção com tuberculose e mau estado nutricional. A administração de fármacos antileishmania em regime combinado ao invés de monoterapia, juntamente com o início precoce da TARV e a instituição de uma profilaxia secundária podem melhorar o desfecho da LV nos pacientes coinfectados por Leishmania/HIV. No entanto, o tratamento efetivo para a LV nesses pacientes ainda é um desafio, sendo necessário encontrar formas mais eficazes de melhorar a resposta terapêutica.
Palavras-chave: Leishmaniose visceral. Infecção por HIV. Tratamento antileishmania. Terapia combinada.
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Copyright (c) 2023 Marianny da Silva Barreto, Ana Leticia Lira Paulino, Maria Clara Sousa Evangelista Vieira, TATIANA PASCHOALETTE RODRIGUES BACHUR
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