RESUMO
This study compared the efficacies of clarithromycin-ethambutol and clarithromycin-ethambutol-clofazimine for the treatment of Mycobacterium avium complex (MAC) in AIDS patients. Thirty-four patients were randomized into two groups to receive clarithromycin 2 g/day and ethambutol 20 mg/kg/day, with or without clofazimine 200 mg/day. The evaluation was based primarily on blood cultures becoming negative after 2 months of therapy, but survival at 12 months and clinical evolution were also assessed. Inclusions were prematurely stopped because of a communication reporting increased mortality associated with clofazimine. At 2 months, the blood cultures of 55% of the clarithromycin-ethambutol group patients versus 81% of the clarithromycin-ethambutol-clofazimine group were negative; this difference is not significant (P=0.42). Only one relapse was observed during the study. No clarithromycin-resistant strain was isolated. No apparent difference in either survival or clinical evolution was observed in this small number of patients (median survival, 144 days in the clarithromycin-ethambutol group and 236 days in the clarithromycin-ethambutol-clofazimine group, P=0.44). The clarithromycin-ethambutol combination appears to be an effective and well-tolerated first-line therapy against MAC infections in AIDS patients.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Anti-Inflamatórios não Esteroides/uso terapêutico , Bacteriemia/tratamento farmacológico , Claritromicina/uso terapêutico , Clofazimina/uso terapêutico , Etambutol/uso terapêutico , Infecção por Mycobacterium avium-intracellulare/tratamento farmacológico , Idoso , Quimioterapia Combinada/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complexo Mycobacterium avium , Análise de SobrevidaAssuntos
Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/tratamento farmacológico , Infecções por HIV/imunologia , Cadeias Pesadas de Imunoglobulinas/fisiologia , Região Variável de Imunoglobulina/fisiologia , Adulto , Idoso , Criança , Pré-Escolar , Regulação para Baixo , Quimioterapia Combinada , Feminino , Inibidores da Protease de HIV/uso terapêutico , Humanos , Fragmentos de Imunoglobulinas , Imunoglobulina G/sangue , Imunoglobulina G/metabolismo , Cadeias Pesadas de Imunoglobulinas/sangue , Região Variável de Imunoglobulina/sangue , Linfocinas/metabolismo , Masculino , Pessoa de Meia-Idade , Inibidores da Transcriptase Reversa/uso terapêutico , Sialoglicoproteínas/metabolismo , Superantígenos/imunologiaRESUMO
The interleukin-2 (IL-2)/IL-2 receptor (IL-2R) system is the main regulatory determinant of T cell reactivity. Although it is well known that IL-2 secretion is impaired during HIV infection, up to now IL-2R expression has not been extensively studied in HIV-infected patients despite the use of IL-2 in clinical therapy trials. We show here that IL-2R expression in HIV patients with high viral load (group 1 in the study) is greatly enhanced on B lymphocytes, CD8 T lymphocytes, and monocytes, but not on CD4 T lymphocytes, compared with noninfected individuals. Paradoxically, this modified IL-2R expression does not lead to increased IL-2 responsiveness, except for B lymphocytes. In patients receiving triple combination therapy (TCT, two reverse transcriptase inhibitors and one protease inhibitor) that has triggered a drastic reduction in plasma viral load and an increase in CD4 counts (group 2 patients), IL-2R expression is significantly lower than in group 1 patients. Moreover, cells involved in cellular immunity and CD4 T lymphocytes have the capacity to respond to IL-2 after TCT. These results allow us to anticipate a beneficial role of IL-2 immunotherapy in combination with TCT.