RESUMEN
Phylogenetic analysis and evaluation of drug-resistance were carried out upon 59 plasma samples from 58 treatment-naïve HIV-1 infected patients from Mozambique, enrolled in a free antiviral-therapy protocol in the frame of Drug-Resource-Enhancement against AIDS and Malnutrition (DREAM) programme. Sequencing of the first 1,300 bases of the pol-gene shows that all virus strains cluster within clade C, with the exception of a single patient carrying a G-subtype virus. Relevant mutations in the reverse transcriptase (RT) are rare: 118A/I/L/G (four patients), 179E/D/I (three patients), 333E/D (two patients), 101R, and 210F (one patient each). In Protease (PR), V82I (10.3%) is the only relevant mutation, while natural polymorphisms/secondary mutations are found, some at very high frequency: 20R (25.9%), 36I (91.4%), 36L (8.6%), 60E (31.0%), 63P (29.3%), and 93L (96.6%). Among them, mutations with a frequency >25% were further investigated to assess their covariation pattern with PI resistance associated mutations. The pattern of covariation observed for K20R and D60E (but not L63P and M36I) was different between C and B subtype isolates from PR-inhibitor-treated patients. The sequences were also analyzed to calculate the ratio of non-synonymous to synonymous substitution. The ratio for PR and RT was 0.116 and 0.093, respectively, suggesting a greater conservation in RT than PR in both subtypes B and C HIV strains. Taken together, the results demonstrate a consistent clade-homogeneity of viral strains circulating in Mozambique, and the very limited presence, in drug-naïve patients, of mutations associated with resistance to RT-inhibitors. The high frequency of secondary mutations/polymorphisms in HIV-PR deserves further studies to evaluate its relevance in clinical settings.
Asunto(s)
Fármacos Anti-VIH/farmacología , Farmacorresistencia Viral/genética , Infecciones por VIH/virología , VIH-1/efectos de los fármacos , VIH-1/genética , Mutación , Sustitución de Aminoácidos/genética , Fármacos Anti-VIH/uso terapéutico , Genes pol , Genotipo , Infecciones por VIH/tratamiento farmacológico , Proteasa del VIH/genética , Transcriptasa Inversa del VIH/genética , VIH-1/clasificación , VIH-1/aislamiento & purificación , Humanos , Mozambique , FilogeniaRESUMEN
Neurosyphilis has been reported in HIV-infected patients previously treated with penicillin G benzathine, which does not achieve treponemicidal levels in cerebrospinal fluid. Therapy combining benzylpenicillin G and its repository form benzylpenicillin G benethamine could be a potentially effective alternative enhanced regimen for treating latent syphilis in HIV-infected patients because peak serum and cerebrospinal fluid concentrations would be achieved early post-administration by the former molecule and sustained for 24 h due to the prolonged half-life of the latter. In this study, 23 asymptomatic HIV and Treponema pallidum co-infected patients received 10 d of combined therapy (2 M IU intramuscular once daily) and were followed up at 3, 6 and 12 months. None experienced side effects or clinical symptoms. Of the 18 patients who were evaluated 1 y later, 8 (44.4%) exhibited serological treatment failure, defined as a positive serum rapid plasma reagin test. In conclusion, a 10-d regimen combining penicillin G and penicillin G benethamine seems to be of no benefit compared to currently recommended treatment.
Asunto(s)
Infecciones por VIH/complicaciones , Penicilina G Benzatina/uso terapéutico , Penicilinas/uso terapéutico , Sífilis Latente/tratamiento farmacológico , Adulto , Quimioterapia Combinada , Femenino , VIH/patogenicidad , Infecciones por VIH/patología , Humanos , Masculino , Persona de Mediana Edad , Mozambique , Penicilina G Benzatina/química , Penicilina G Benzatina/metabolismo , Sífilis Latente/complicaciones , Factores de Tiempo , Resultado del TratamientoRESUMEN
Este estudo apresenta e discute a leitura de duas crianças com dficuldades de leitura e escrita, no contexto clínico fonoaudiológico. Apoia-se em referenciais teóricos da Análise de Discurso de linha francesa (AD), tal como fundada por Pêcheux, na França, e desenvolvida por Eni Orlandi, no Brasil. Tais fundamentos definem o seu sujeito como social e marcado ideologicamente, considerando discurso como efeito de sentidos entre locutores, ressaltando as condições de produção envolvendo, ainda, a noção de leitura como prática social e de leitor como circunscrito a condições sócio-históricas. Com base nestes construtos teóricos, e relacionando aspectos referentes ao objeto leitura vividos no ambiente familiar das crianças, mostramos particularidades e singularidades que permeiam a constituição destas meninas enquanto sujeitos-leitores.