RESUMEN
Malaria is a major public health concern in the countries affected by the Ebola virus disease epidemic in West Africa. We determined the feasibility of using molecular malaria diagnostics during an Ebola virus disease outbreak and report the incidence of Plasmodium spp. parasitemia in persons with suspected Ebola virus infection.
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Coinfección , Brotes de Enfermedades , Ebolavirus , Fiebre Hemorrágica Ebola/epidemiología , Malaria/diagnóstico , Malaria/parasitología , Humanos , Malaria Falciparum/diagnóstico , Malaria Falciparum/parasitología , Carga de Parásitos , Plasmodium falciparum/clasificación , Plasmodium falciparum/genética , PrevalenciaAsunto(s)
Diagnóstico Tardío , Ebolavirus/aislamiento & purificación , Fiebre Hemorrágica Ebola/diagnóstico , Complicaciones Infecciosas del Embarazo/diagnóstico , Adulto , Ebolavirus/genética , Resultado Fatal , Femenino , Fiebre Hemorrágica Ebola/inmunología , Humanos , Embarazo/inmunología , Complicaciones Infecciosas del Embarazo/inmunología , Complicaciones Infecciosas del Embarazo/virología , ARN Viral/sangre , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Carga ViralRESUMEN
Immune reconstitution inflammatory syndrome (IRIS) in HIV-1-infected patients is associated with an exaggerated inflammatory response against an opportunistic infection during highly active antiretroviral therapy. The only review on IRIS associated with Criptococcus neoformans reported 21 episodes including lymphadenitis, necrotizing pneumonitis, breast and cutaneous abscess, and cryptococcomas. To our knowledge this is the first report of IRIS associated with previous meningeal criptococcal infection which required neurosurgical intervention with placement of a ventriculo-peritoneal shunt to drain a CSF cyst formed by exclusion of the temporal horn of the right lateral ventricle. We demonstrate that this procedure is possible without complications such as cryptococcal dissemination into the peritoneum.
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Infecciones Oportunistas Relacionadas con el SIDA/microbiología , Terapia Antirretroviral Altamente Activa/efectos adversos , Criptococosis/líquido cefalorraquídeo , Síndrome Inflamatorio de Reconstitución Inmune/inducido químicamente , Síndrome Inflamatorio de Reconstitución Inmune/cirugía , Infecciones Oportunistas Relacionadas con el SIDA/líquido cefalorraquídeo , Infecciones Oportunistas Relacionadas con el SIDA/tratamiento farmacológico , Antifúngicos/uso terapéutico , Encéfalo/patología , Criptococosis/tratamiento farmacológico , Criptococosis/microbiología , Cryptococcus neoformans/efectos de los fármacos , Cryptococcus neoformans/metabolismo , Femenino , Fluconazol/uso terapéutico , VIH-1/efectos de los fármacos , Humanos , Síndrome Inflamatorio de Reconstitución Inmune/patología , Persona de Mediana Edad , Derivación VentriculoperitonealRESUMEN
OBJECTIVES: To evaluate simplified protease inhibitor (PI)-sparing antiretroviral treatment versus lipid-lowering therapy for the management of highly active antiretroviral therapy (HAART)-induced hyperlipidaemia. DESIGN: Randomized, open-label clinical trial assessing the efficacy on hyperlipidaemia of a switching therapy from PI to non-nucleoside reverse transcriptase inhibitor (NNRTI) nevirapine or efavirenz versus a hypolipidaemic treatment (with pravastatin or bezafibrate) added to current, unchanged antiretroviral combination. METHODS: All HIV-infected patients on their first HAART regimen, with stable immuno-virological features, naive to all NNRTIs, and with mixed hyperlipidaemia, were randomized to replace PI with nevirapine (arm A) or efavirenz (arm B), or to receive pravastatin (arm C) or bezafibrate (arm D) with unchanged HAART regimen, and were followed-up for 12 months. RESULTS: One hundred and thirty patients were evaluated: 29 patients were randomized to arm A, 34 to arm B, 36 to arm C, and 31 to arm D. At the end of the 12-month follow-up, a reduction of 25.2, 9.4, 41.2 and 46.6% in mean triglyceridaemia versus respective baseline values was reported in groups A, B, C and D, respectively, with statistically significant difference between arms A-B and C-D (P < 0.01). Similar results were reported for total and low-density lipoprotein cholesterol levels. Viro-immunological efficacy and tolerability profile were comparable in all considered arms. CONCLUSION: Pravastatin and bezafibrate proved significantly more effective in the management of HAART-related hyperlipidaemia than the switching therapy from PI to nevirapine or efavirenz.
Asunto(s)
Fármacos Anti-VIH/uso terapéutico , Terapia Antirretroviral Altamente Activa/efectos adversos , Infecciones por VIH/tratamiento farmacológico , Hiperlipidemias/tratamiento farmacológico , Hipolipemiantes/uso terapéutico , Inhibidores de Proteasas/uso terapéutico , Adulto , Alquinos , Benzoxazinas , Bezafibrato/uso terapéutico , Ciclopropanos , Femenino , Humanos , Hiperlipidemias/inducido químicamente , Masculino , Nevirapina/uso terapéutico , Oxazinas/uso terapéutico , Pravastatina/uso terapéutico , Inhibidores de la Transcriptasa Inversa/uso terapéutico , Resultado del TratamientoRESUMEN
Sixteen HIV-infected patients with protease inhibitor (PI)-related, persisting hypercholesterolaemia were treated with 10 mg a day rosuvastatin for 24 weeks. At the end of the observation period, the median reductions in total cholesterol and triglyceride levels versus median baseline values were 21.7 and 30.1%, respectively (P < 0.01). In our small pilot study, rosuvastatin was found to be effective for the treatment of PI-associated hyperlipidaemia, in association with a favourable tolerability profile, without significant clinical or laboratory adverse events.