RESUMEN
OBJECTIVE: To assess responses to indinavir (IDV)-ritonavir (RTV)-based regimens among HIV-1 infected patients with prior failure of protease inhibitors, and to assess the effects of adherence to therapy and pre-existing genotypic and phenotypic resistance on this response. METHODS: Twenty-eight patients initiating salvage regimens with IDV-RTV (800 mg and 200 mg twice daily, respectively) plus one or more reverse transcriptase inhibitor (RTI) were identified retrospectively. Genotypic and phenotypic susceptibilities to multiple antiretroviral agents were determined on viral samples collected at initiation of the salvage regimens, and adherence to therapy was determined through patient self-reporting. Response to therapy (viral RNA = 400 copies/ml) was assessed at the end of and beyond 6 months of follow-up. RESULTS: Based on responses measured in the first 6 months of follow-up, 16 responders and 12 non-responders were identified without differences in baseline demographic factors, laboratory parameters, extent of prior antiretroviral therapy, or characteristics of the RTI components of the new IDV-RTV-based regimens. Adequate adherence was associated with virologic responses (P = 0.005). There were trends for genotypic and phenotypic resistance to be associated with adequate adherence, and, surprisingly, phenotypic resistance to IDV was associated with virologic response rather than with therapeutic failure (P = 0.02). Beyond 6 months of follow-up (mean follow-up 69 weeks), adequate adherence was still associated with virologic response (P = 0.001), but genotypic or phenotypic resistance to IDV were not associated with therapeutic failure. CONCLUSIONS: These results suggest that IDV-RTV-based regimens may be able to overcome IDV resistance. This underscores the importance of drug adherence, potency, and exposure in determining virologic responses to antiretroviral therapy.
Asunto(s)
Infecciones por VIH/tratamiento farmacológico , Inhibidores de la Proteasa del VIH/uso terapéutico , VIH-1 , Indinavir/uso terapéutico , Ritonavir/uso terapéutico , Farmacorresistencia Viral , Quimioterapia Combinada , Femenino , Estudios de Seguimiento , Genotipo , Infecciones por VIH/virología , Proteasa del VIH/genética , VIH-1/efectos de los fármacos , VIH-1/genética , Humanos , Masculino , Cooperación del Paciente , Fenotipo , Estudios Retrospectivos , Terapia Recuperativa/métodos , Insuficiencia del Tratamiento , Carga ViralRESUMEN
Large, ulcerative lesions over the skin, scalp, and oral mucosa were observed in a patient with acquired inmunodeficiency syndrome (AIDS) receiving chronic suppressive therapy with fluconazole. Candida glabrata was recovered in culture from biopsy material, and was found to be resistant to fluconazole and itraconazole. Treatment with amphotericin B resulted in marked improvement. The reported frequency of infections with Candida spp. resistant to fluconazole has increased in recent years. We review the literature regarding fluconazole resistant infections in patients with AIDS, discuss the possible mechanisms of resistance, and management options
Asunto(s)
Humanos , Masculino , Candidiasis/etiología , Fluconazol/uso terapéutico , Síndrome de Inmunodeficiencia Adquirida/complicaciones , Candida/efectos de los fármacos , Candida albicans/efectos de los fármacos , Fluconazol/administración & dosificación , Fluconazol/efectos adversos , Infecciones por VIH , Control de InfeccionesRESUMEN
Ocho pacientes con SIDA fueron sometidos a biopsia de hígado para determinar el espectro de enfermedad de hígado en esta condición. Las indicaciones para biopsua fueron fiebre, hepatomegalia o alteración en las enzimas hepáticas. En siete pacientes se realizó prueba de perfil de hepatitis. Las biopsias se tiñeron con H & E, reticulina, PAS, tinte FITE pra bacilos ácidos-resistentes y plata, se examinaron por microscopía electrónica y todas se cultivaron para bacilos ácido-resistentes y hongos. Cinco de 8 pacientes (62.5%) tenían historial de abuso de drogas intravenosas, 3(37.5%) eran homosexuales. La edad media era de 37 años (30-43), y la duración de enfermedad era de 8 meses (2-15). Siete (100%) tenían algún marcador de hepatitis B, 6 de 7 (85.7%) tenían anticuerpos de hepatitis A. Todos los pacientes estaban recibiendo por lo menos un agente hepatotóxico. Los hallazgos histológicos incluyeron hígado graso (2/8), granulomas de schistosomiasis (1/8), hepatitis crónica activa (3/8). Los estudios de bacteriológia fueron negativos en todos. Concluimos que los pacientes con SIDA tenían una incidencia alta de anormalidades hepáticas, pero no se identificaron cambios hepáticos específicos o patognomónicos