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1.
J Clin Lab Anal ; 30(5): 628-32, 2016 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-26892231

RESUMEN

BACKGROUND: Laboratory diagnosis of neurosyphilis is complicated especially when it is asymptomatic, no single laboratory test result being appropriate to diagnose central nervous system infectivity caused by Treponema pallidum. Our objective was to evaluate two polymerase chain reaction (PCR) techniques for the detection of T. pallidum DNA in the cerebrospinal fluid (CSF) of patients with syphilis. METHODS: One hundred twenty-four CSF samples from patients with reactive blood tests for syphilis were obtained. Two PCR techniques (47-PCR, polA-PCR) were used to detect T. pallidum DNA. The laboratory criteria used for the diagnosis of neurosyphilis to which the PCR techniques were compared were those recommended by the IUSTI: 2008 European guidelines on the management of syphilis. RESULTS: Treponema pallidum DNA was detected amplified in 37 of 124 (29.8%) and 30 of 124 (24.2%) samples with the 47-PCR and polA-PCR, respectively. Sensitivities were 75.8% and 69.7% and specificities 86.8% and 92.3%, respectively, for 47-PCR and polA-PCR techniques, respectively. The three CSF samples of patients with primary syphilis did not fulfill the criteria of neurosyphilis and DNA was only detected in one by the 47-PCR. In samples from secondary syphilis and neurosyphilis, three of nine and nine of nine respectively, results were coincident for the two PCR techniques and neurosyphilis criteria. Major discrepancies between the two PCR techniques and neurosyphilis diagnostic criteria were observed in latent syphilis. CONCLUSION: Beyond some limitations of the study, which are discussed here, both PCR techniques seem to be useful for the diagnosis of neurosyphilis, although 47-PCR presents a higher sensitivity and polA-PCR a higher specificity.


Asunto(s)
ADN Protozoario/líquido cefalorraquídeo , Reacción en Cadena de la Polimerasa/métodos , Treponema pallidum/aislamiento & purificación , Adulto , Humanos , Sensibilidad y Especificidad , Sífilis/líquido cefalorraquídeo , Sífilis/parasitología , Treponema pallidum/genética
2.
J Antimicrob Chemother ; 68(4): 911-4, 2013 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-23228933

RESUMEN

OBJECTIVES: Despite a decreasing mortality and morbidity in treated HIV-1 patients, highly active antiretroviral treatment (HAART) can still fail due to the development of drug resistance. Especially, multidrug-resistant viruses pose a threat to efficient therapy. We studied the changing prevalence of multidrug resistance (MDR) over time in a cohort of HIV-1-infected patients in Portugal. PATIENTS AND METHODS: We used data of 8065 HIV-1-infected patients followed from July 2001 up to April 2012 in 22 hospitals located in Portugal. MDR at a specific date of sampling was defined as no more than one fully active drug (excluding integrase and entry inhibitors) at that time authorized by the Portuguese National Authority of Medicines and Health Products (INFARMED), as interpreted with the Rega algorithm version 8.0.2. A generalized linear mixed model was used to study the time trend of the prevalence of MDR. RESULTS: We observed a statistically significant decrease in the prevalence of MDR over the last decade, from 6.9% (95% CI: 5.7-8.4) in 2001-03, 6.0% (95% CI: 4.9-7.2) in 2003-05, 3.7% (95% CI: 2.8-4.8) in 2005-07 and 1.6% (95% CI: 1.1-2.2) in 2007-09 down to 0.6% (95% CI: 0.3-0.9) in 2009-12 [OR=0.80 (95% CI: 0.75-0.86); P<0.001]. In July 2011 the last new case of MDR was seen. CONCLUSIONS: The prevalence of multidrug-resistant HIV-1 is decreasing over time in Portugal, reflecting the increasing efficiency of HAART and the availability of new drugs. Therefore, in designing a new drug, safety and practical aspects, e.g. less toxicity and ease of use, may need more attention than focusing mainly on efficacy against resistant strains.


Asunto(s)
Fármacos Anti-VIH/farmacología , Farmacorresistencia Viral , Infecciones por VIH/epidemiología , Infecciones por VIH/virología , VIH-1/efectos de los fármacos , VIH-1/genética , VIH-1/aislamiento & purificación , Humanos , Mutación Missense , Portugal/epidemiología , Prevalencia , Proteínas Virales/genética
3.
PLoS One ; 9(3): e92747, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-24681625

RESUMEN

To characterize the HIV-2 integrase gene polymorphisms and the pathways to resistance of HIV-2 patients failing a raltegravir-containing regimen, we studied 63 integrase strand transfer inhibitors (INSTI)-naïve patients, and 10 heavily pretreated patients exhibiting virological failure while receiving a salvage raltegravir-containing regimen. All patients were infected by HIV-2 group A. 61.4% of the integrase residues were conserved, including the catalytic motif residues. No INSTI-major resistance mutations were detected in the virus population from naïve patients, but two amino acids that are secondary resistance mutations to INSTIs in HIV-1 were observed. The 10 raltegravir-experienced patients exhibited resistance mutations via three main genetic pathways: N155H, Q148R, and eventually E92Q - T97A. The 155 pathway was preferentially used (7/10 patients). Other mutations associated to raltegravir resistance in HIV-1 were also observed in our HIV-2 population (V151I and D232N), along with several novel mutations previously unreported. Data retrieved from this study should help build a more robust HIV-2-specific algorithm for the genotypic interpretation of raltegravir resistance, and contribute to improve the clinical monitoring of HIV-2-infected patients.


Asunto(s)
Farmacorresistencia Viral/genética , Infecciones por VIH/tratamiento farmacológico , Integrasa de VIH/genética , VIH-2/efectos de los fármacos , VIH-2/genética , Polimorfismo Genético/genética , Pirrolidinonas/uso terapéutico , Genotipo , Inhibidores de Integrasa VIH/uso terapéutico , VIH-1/efectos de los fármacos , Humanos , Raltegravir Potásico
4.
BMJ Case Rep ; 20122012 Jul 03.
Artículo en Inglés | MEDLINE | ID: mdl-22761210

RESUMEN

Acute encephalitis is a life-threatening condition. A wide variety of infectious agents are implicated and in many patients no cause is found. HIV acute seroconversion illness can rarely present as acute encephalitis. Although most experts agree in starting antiretroviral treatment in severe acute HIV infection, the evidence of the benefits are still lacking. The authors report a case of severe acute encephalitis as a primary presentation of HIV infection in which introduction of highly active antiretroviral treatment resulted in clinical recovery. This case highlights the need to consider HIV infection in the differential diagnosis of treatable viral encephalitis.


Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/tratamiento farmacológico , Fármacos Anti-VIH/uso terapéutico , Candidiasis Bucal/etiología , Encefalitis/tratamiento farmacológico , Seropositividad para VIH/tratamiento farmacológico , Infecciones Oportunistas Relacionadas con el SIDA/etiología , Infecciones Oportunistas Relacionadas con el SIDA/virología , Enfermedad Aguda , Terapia Antirretroviral Altamente Activa , Encefalitis/virología , Femenino , Seropositividad para VIH/complicaciones , Seropositividad para VIH/diagnóstico , Humanos , Persona de Mediana Edad
5.
Curr Opin HIV AIDS ; 6 Suppl 1: S12-20, 2011 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-22156775

RESUMEN

PURPOSE OF REVIEW: To discuss factors related to virologic failure and review data from recent clinical trials evaluating re-suppression of viremia in extensively-treated HIV-infected patients with resistance. RECENT FINDINGS: Factors associated with virologic failure can be related to the virus (e.g. resistance), the patient (e.g. adherence) or HIV therapy (e.g. availability) and must be analyzed to minimize the likelihood of a new failure. Recent clinical trials have shown that it is now possible to achieve virologic suppression in a large proportion of treatment-experienced patients with extensive drug resistance, with several newer agents demonstrating favorable potency, tolerability and long-term efficacy. SUMMARY: The benefits of highly active antiretroviral treatment are well recognized, and adding at least two (preferably three) new active drugs to an optimized background regimen can provide effective suppression of viremia even in multidrug-experienced patients. Changing drugs or regimen simplification should be considered when treatment is inadequate, poorly tolerated or associated with poor adherence, and is made easier by the newer agents and formulations now available. Newer antiretrovirals may contribute to a better quality of life and life expectancy in patients with few or no therapy options, although adherence is paramount in ensuring their continued effectiveness.


Asunto(s)
Fármacos Anti-VIH/administración & dosificación , Terapia Antirretroviral Altamente Activa/métodos , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/virología , Terapia Recuperativa/métodos , Ensayos Clínicos como Asunto , Farmacorresistencia Viral , Humanos , Cumplimiento de la Medicación , Resultado del Tratamiento , Carga Viral
6.
J Clin Lab Anal ; 20(6): 233-8, 2006.
Artículo en Inglés | MEDLINE | ID: mdl-17115423

RESUMEN

The Treponema pallidum particle agglutination technique (TP.PA) was evaluated, in comparison with the Venereal Disease Research Laboratory (VDRL) test, microhemagglutination assay for Treponema pallidum antibodies (MHA-TP), and fluorescent treponemal antibody-ABS (FTA-Abs) test for the diagnosis of neurosyphilis. We have studied 198 cerebrospinal fluid (CSF) samples from patients with syphilis, including neurosyphilis, treated syphilis, and with other neurological manifestations than neurosyphilis. All tests were nonreactive in these last group of patients. In the neurosyphilis patients, sensitivity of the TP.PA was 100%. The performance of this test in CSF from patients with primary syphilis was as good as that of the other tests. In secondary and latent syphilis, the TP.PA results (27 reactive samples/73) were similar to those of the MHA-TP (25 reactive samples/73). In the individuals treated for syphilis, the TP.PA, FTA-Abs, and MHA-TP tests were found to be reactive in eight, six, and eight samples, respectively. In conclusion, it seems that the TP.PA can be used in CSF to diagnose neurosyphilis, although as for other serological tests, interpretation of results should be done in conjunction with other neurosyphilis parameters.


Asunto(s)
Pruebas de Aglutinación/métodos , Neurosífilis/diagnóstico , Serodiagnóstico de la Sífilis/métodos , Treponema pallidum , Técnicas Bacteriológicas , Estudios de Casos y Controles , Pruebas de Hemaglutinación/métodos , Humanos , Neurosífilis/líquido cefalorraquídeo , Neurosífilis/microbiología , Treponema pallidum/inmunología
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