Adverse effects of chronic treatment with the Main subclasses of highly active antiretroviral therapy: a systematic review

OBJECTIVES

The aim of the review was to elucidate the adverse effects of chronic treatment with the main subclasses of highly active antiretroviral therapy (HAART).

METHODS

A systematic review was carried out using the methods recommended in the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA-P). Searches of articles in MEDLINE, SCIELO, Web of Science and LILACS were conducted from January to October 2018 based on the following descriptors and keywords: 'HIV' [AND]; 'AIDS' [OR]; 'HAART' [AND]; 'Highly Active Antiretroviral Therapy' [OR]; 'Adverse Effects' [AND]. All articles selected described the biochemical changes produced by, and the main adverse effects of, using one or more of the following HAART subclasses: nucleoside reverse transcriptase inhibitors (NRTIs), nonnucleoside reverse transcriptase inhibitors (NNRTIs), protease inhibitors (PIs) and other new drugs. The selected articles included patients living with HIV (PLWH) initiating or continuing any type of HAART. The results are presented qualitatively and discussed.

RESULTS

Twenty-one articles found in the searches were selected for the review, and they included a total of 5626 participants. Seven of the studies investigated mainly NRTIs, three studies mainly NNRTIs, eight studies predominantly PIs, and three studies other antiretroviral drugs as the main treatment. The most common adverse effects on biochemical parameters were the emergence of anaemia for NRTIs as well as NNRTIs and PIs, and plasma lipid alterations caused by their prolonged use. In general, it was found that biological differences among individuals can cause differences in adverse effects, such as virological and treatment failure.

CONCLUSIONS

One or more occurrences of adverse effects of the chronic utilization of drugs were found for all subclasses of HAART, and certain combinations of drugs from different subclasses were also found to be associated with adverse events.

The Impact of Sublethal Concentrations of Treated Leachate on Nile tilápia (Oreochromis niloticus)

The objective of this study was to evaluate the impact of sublethal concentrations of treated landfill leachate on Oreochromis niloticus individuals after exposure for 96 h, by assessing biochemical, genotoxic and immunologic biomarkers. Among biochemical biomarkers (activities of ALT, AST and GST enzymes), the treated landfill leachate did not cause significant alterations on O. niloticus and did not significantly affect leukocytes used as an immunologic biomarker. On the other hand, treated leachate induced genotoxic damages, since an increase in erythrocytic micronuclei and in DNA damage (comet assay) were observed in fish exposed to all treatment (2, 4 and 6 mL L^-1). Acute toxicity of treated leachate in O. niloticus caused only genotoxic changes in blood cells, showing that micronuclei and comet assay, together, are effective biomarkers in determining the acute toxicity of treated leachate in aquatic environments. This work also shows that leachate, although treated, caused some damages to O. niloticus, which indicates the employed treatment was not efficient in eliminating all genotoxic substances from the leachate.

Toxicological impact of cadmium-based quantum dots towards aquatic biota: Effect of natural sunlight exposure

Cadmium-based quantum dots (QDs) are increasingly applied in existent and emerging technologies, especially in biological applications due to their exceptional photophysical and functionalization properties. However, they are very toxic compounds due to the high reactive and toxic cadmium core. The present study aimed to determine the toxicity of three different QDs (CdS 380, CdS 480 and CdSeS/ZnS) before and after the exposure of suspensions to sunlight, in order to assess the effect of environmentally relevant irradiation levels in their toxicity, which will act after their release to the environment. Therefore, a battery of ecotoxicological tests was performed with organisms that cover different functional and trophic levels, such as Vibrio fischeri, Raphidocelis subcapitata, Chlorella vulgaris and Daphnia magna. The results showed that core-shell type QDs showed lower toxic effects to V. fischeri in comparison to core type QDs before sunlight exposure. However, after sunlight exposure, there was a decrease of CdS 380 and CdS 480 QD toxicity to bacterium. Also, after sunlight exposure, an effective decrease of CdSeS/ZnS and CdS 480 toxicity for D. magna and R. subcapitata, and an evident increase in CdS 380 QD toxicity, at least for D. magna, were observed. The results of this study suggest that sunlight exposure has an effect in the aggregation and precipitation reactions of larger QDs, causing the degradation of functional groups and formation of larger bulks which may be less prone to photo-oxidation due to their diminished surface area. The same aggregation behaviour after sunlight exposure was observed for bare QDs. These results further emphasize that the shell of QDs seems to make them less harmful to aquatic biota, both under standard environmental conditions and after the exposure to a relevant abiotic factor like sunlight.

Acute copper toxicity in juvenile fat snook Centropomus parallelus (Teleostei: Centropomidae) in sea water

Three experiments were designed to assess the accumulation and acute toxicity of copper (Cu) in juvenile fat snook Centropomusparallelus. The first experiment was performed to determine the 96-h lethal concentration (LC50) of Cu. The second experiment was designed to assess the effects of sublethal concentrations of Cu (0.47 and 0.94 mg/L), while the third one allowed us to test the recovery capacity of fish exposed to the sublethal concentrations Cu and kept in sea water without Cu addition. The LC50value for Cu was found to be 1.88 mg/L Cu. Fish exposed to the sublethal concentrations of Cu showed a significant accumulation of Cu in gills at 96 h respect to the control ones (0.43 µg/g Cu). No significant difference was observed in the accumulation of Cu in gills between fish exposed to 0.47 mg/L (1.09 µg/g Cu) and 0.94 mg/L (1.26 µg/g Cu). Exposure (24 and 96 h) to the sublethal concentrations of Cu tested induced DNA damage in the erythrocytes. The results show that acute exposure to sublethal concentrations induces Cu accumulation and DNA damage in fish, these effects being recovered after 240 h in sea water without Cu addition.

Immune responses in sheep naturally infected with Oestrus ovis (Diptera: Oestridae) and gastrointestinal nematodes

This study was carried out to evaluate the immune response in young Ile de France (IF) and Santa Ines (SI) sheep naturally infected by Oestrus ovis and gastrointestinal nematodes (GIN). Mast cells, eosinophils and globule leucocytes were enumerated in the upper respiratory tract (septum, middle meatus and ventral nasal conchae) and in the mucosa of abomasum and small intestine. Immunoglobulin G (IgG) levels in serum samples and immunoglobulin A (IgA) levels in mucus from the nasal, abomasum and small intestinal mucosae were determined against O. ovis, Haemonchus contortus and Trichostrongylus colubriformis antigens. Significant positive correlation coefficients were observed in both breeds between the number of O. ovis larvae×IgG against Oestrus crude extract (IF: r=0.58; SI: r=0.66; P<0.05), and between O. ovis larvae x IgG against Oestrus excretory and secretory products (IF: r=0.59; SI: r=0.63; P<0.05). Apparently, the presence of antibodies in the serum or nasal mucus, as well as inflammatory cells, was not able to efficiently protect against O. ovis infestation. With regard to GIN, the levels of immunoglobulins and the inflammatory cell numbers in the gastrointestinal mucosa presented a significant inverse relationship with H. contortus worm burden in SI animals and this may have contributed to the fact that these animals presented the lowest FEC and worm burden compared to IF. In conclusion, the immune responses against O. ovis and GIN are very similar and involve the recruitment of inflammatory cells and production of immunoglobulins against the parasites.

Effects of hypoxia and petroleum on the genotoxic and morphological parameters of Hippocampus reidi

Hypoxia events are common in many aquatic systems, which may be a natural event or provoked by anthropogenic actions, as well as accidents involving oil occurring throughout the world are frequent. Thus, through the possibility of occurrence of these two situations in same place the purpose of this study was to evaluate if damage caused by crude oil on genotoxic and morphological parameters in the marine fish species Hippocampus reidi will be aggravated by events of severe hypoxia. Sea horses were exposed during 8h to the following conditions: crude oil (OIL), severe hypoxia (HYP), association of severe hypoxia and crude oil (HYP+OIL) and normoxia without contaminant (CONT). An increase in micronuclei observed in OIL and HYP+OIL groups indicates that the crude oil exposure was a determining factor in the micronuclei induction and hypoxia did not intensify this result. In comet assays, both petroleum and hypoxia provoke DNA damage. The most frequent histopathology in the control groups and in those exposed to OIL and HYP+OIL groups were: hypertrophy and capillary dilation; hypertrophy and hyperplasia; hypertrophy, epithelial "lifting" and epithelial hyperplasia. An elongation of the lamellae was observed in fish from the two groups exposed to hypoxia, probably due to the fact that these groups required a greater flow of blood in the gills to increase the efficiency of gas exchange, since they were in a hypoxic environment. In summary, the micronuclei test and comet assay can be used as a good biomarker of contamination by petroleum. The association of hypoxia with crude oil in some aspects may exacerbate the responses of fish, in the light of the increase in DNA damage and the alterations in thickness of the gill epithelium.

Vertical migration of Haemonchus contortus third stage larvae on Brachiaria decumbens grass

The present study aimed at evaluating the vertical migration of Haemonchus contortus third stage larvae (L3) on Brachiaria decumbens grass, as well as at verifying whether larval numbers on pasture varies over the day due to climatic conditions. Feces containing H. contortus L3 were deposited on the soil in the middle of herbage which was initially 30 cm high. Seven days later, samples of different herbage strata (0-10, 10-20 and >20 cm), remaining feces and a layer of approximately 1cm soil were collected. Tests were carried out in four periods: September 2006, December 2006, March 2007, and June 2007. Samples were collected at sunrise, mid-day, sunset, and mid-night. The humidity and temperature conditions observed in different months influenced larval migration from the feces to the grass. In September, December and March, it rained after fecal deposition on pasture, which favored migration of larvae from the feces to the herbage. Conversely, in June 2007, when there was no rainfall after fecal deposition and temperatures were lower, L3 were mainly recovered from feces. As regards the vertical migration of larvae, the numbers of H. contortus L3 in the forage strata remained relatively constant over the day. This indicates there is not a determined period in which sheep on pasture are at higher risk of infection. Finally, in all collection periods a considerable amount of third stage larvae was observed on the herbage top, which is the first plant part consumed by sheep.

[Homicide clusters and drug traffic in Belo Horizonte, Minas Gerais State, Brazil from 1995 to 1999]

The article presents a spatial analysis of homicides in Belo Horizonte according to the Minas Gerais Military Police records from 1995 to 1999. The authors identify clusters of high mortality risk and relate them to areas with drug traffic and associated violence. SaTScan software is used to locate the clusters.

[Intracranial arachnoid cyst associated with subdural hygroma: report of a case]

A case of a 10-year-old boy with a congenital arachnoid cyst in the right middle cranial fossa is reported. The symptoms were precipitated by head injury of moderate intensity, occurred some days before the beginning of the clinical picture. The computerized tomography has demonstrated the existence of a simultaneous right fronto-parietal subdural hygroma that was responsible for the intracranial hypertension syndrome. The influence of the cyst in the hygroma formation has been suggested. The mechanisms of growth, the etiology, clinical aspects, the diagnostics and the surgical treatment of the arachnoid cysts are discussed.