RESUMO
We describe a case of an HIV-infected man on effective combined antiretroviral therapy, presenting with bilateral gynaecomastia revealing breast carcinoma. Gynaecomastia was first considered to be related to efavirenz and/or didanosine. Although breast carcinoma is rare among HIV-infected men, it should be considered as a potential cause of breast enlargement.
Assuntos
Neoplasias da Mama Masculina/diagnóstico , Carcinoma Intraductal não Infiltrante/diagnóstico , Ginecomastia/etiologia , Infecções por HIV/tratamento farmacológico , Inibidores da Transcriptase Reversa/efeitos adversos , Alcinos , Benzoxazinas/administração & dosagem , Benzoxazinas/efeitos adversos , Neoplasias da Mama Masculina/cirurgia , Carcinoma Intraductal não Infiltrante/cirurgia , Ciclopropanos , Didanosina/administração & dosagem , Didanosina/efeitos adversos , Quimioterapia Combinada , Humanos , Lamivudina/administração & dosagem , Lamivudina/efeitos adversos , Masculino , Pessoa de Meia-Idade , Inibidores da Transcriptase Reversa/administração & dosagemRESUMO
We report a second observation of autoimmune myelofibrosis associated with an inflammatory myositis in a 30-year-old female. The links between myelofibrosis and autoimmunity are discussed.
Assuntos
Doenças Autoimunes , Dermatomiosite/complicações , Mielofibrose Primária/complicações , Transtornos Puerperais , Adulto , Anti-Inflamatórios/administração & dosagem , Anti-Inflamatórios/uso terapêutico , Biópsia , Fármacos Dermatológicos/administração & dosagem , Fármacos Dermatológicos/uso terapêutico , Dermatomiosite/diagnóstico , Dermatomiosite/tratamento farmacológico , Dermatomiosite/patologia , Quimioterapia Combinada , Feminino , Seguimentos , Glucocorticoides/administração & dosagem , Glucocorticoides/uso terapêutico , Humanos , Ácido Micofenólico/administração & dosagem , Ácido Micofenólico/análogos & derivados , Ácido Micofenólico/uso terapêutico , Prednisona/administração & dosagem , Prednisona/uso terapêutico , Mielofibrose Primária/imunologia , Fatores de TempoRESUMO
The primary objective of antiretroviral therapy has recently evolved from a virologic endpoint towards the achievement of normal CD4T cell count (greater than 500/mm(3)) to avoid progression to AIDS. This shift in the primary objective is supported by many clinical and epidemiological studies. Recent data have shown that HIV-infected adults with a CD4T cell count greater than 500cells/mm(3) on long-term combination antiretroviral therapy reach same mortality rates as the general population. However, less than 50% of patients receiving long-term suppressive antiretroviral combination reach such a CD4T cell level. New antiretroviral strategies to improve immune reconstitution, such as specific or non-specific immune-based therapy on one hand and the use of novel antiretroviral drugs from new classes on the other hand are currently under investigation. Here we review several current strategies that may improve immune reconstitution, keeping in mind that the best way to reach normal CD4T cell count is an early treatment initiation.