RESUMO
BACKGROUND: Increasing incidence of hepatitis C virus (HCV) infection in human immunodeficiency virus (HIV)-positive men having sex with men (MSM) has been described in recent years. Phylogenetic analyses of acute HCV infections were undertaken to characterize the dynamics during the epidemic in Paris, and associated sexually transmitted infections (STIs) were evaluated. METHODS: Sanger sequencing of polymerase gene was performed. Maximum likelihood phylogenies were reconstructed using FastTree 2.1 under a GTR+CAT model. Transmission chains were defined as clades with a branch probability ≥0.80 and intraclade genetic distances <0.02 nucleotide substitutions per sites. STIs detected ≤1 month before HCV diagnosis were considered. RESULTS: Among the 85 studied patients, at least 81.2% were MSM. Respectively, 47.6%, 39.0%, 11.0% and 2.4% were infected with genotypes 1a, 4d, 3a and 2k. At least 91.8% were co-infected with HIV. HCV re-infection was evidenced for 24.7% of patients and STIs for 20.0% of patients. Twenty-two transmission chains were identified, including 52 acute hepatitis C (11 pairs and 11 clusters from three to seven patients). CONCLUSIONS: These results revealed strong clustering of acute HCV infections. Thus, rapid treatment of both chronic and acute infections is needed among this population to decrease the prevalence of HCV, in combination with preventive behavioural interventions.
Assuntos
Análise por Conglomerados , Transmissão de Doença Infecciosa , Infecções por HIV/complicações , Hepacivirus/isolamento & purificação , Hepatite C/epidemiologia , Infecções Sexualmente Transmissíveis/epidemiologia , Adulto , Genótipo , Hepacivirus/classificação , Hepacivirus/genética , Hepatite C/transmissão , Homossexualidade Masculina , Humanos , Masculino , Pessoa de Meia-Idade , Epidemiologia Molecular , Paris/epidemiologia , Filogenia , Prevalência , Estudos Retrospectivos , Análise de Sequência de DNA , Infecções Sexualmente Transmissíveis/transmissãoRESUMO
Among protease inhibitors, atazanavir has not been associated with urolithiasis in clinical studies. We describe 11 cases of atazanavir-associated urolithiasis in patients with human immunodeficiency virus (HIV) infection. Patients with low water intake, high urinary pH, and a prior history of urinary stones may have a higher risk of atazanavir-associated urine crystallization.
Assuntos
Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Inibidores da Protease de HIV/efeitos adversos , Oligopeptídeos/efeitos adversos , Piridinas/efeitos adversos , Urolitíase/induzido quimicamente , Adulto , Sulfato de Atazanavir , Feminino , Inibidores da Protease de HIV/uso terapêutico , Humanos , Concentração de Íons de Hidrogênio , Masculino , Pessoa de Meia-Idade , Oligopeptídeos/uso terapêutico , Piridinas/uso terapêutico , Fatores de Risco , Urina/química , Água/metabolismoRESUMO
The emergence of HIV strains that are resistant to antiretroviral drugs is a major cause of treatment failure. Two sets of mutations: the Q151 M complex and the 69 insert, cause resistance to multiple nucleoside analogues. We report the response to treatment in 12 patients with multiple NRTI-resistant HIV-1 strains. Seven of 12 patients (58%) were able to maintain a viral load below 200 copies/ml at week 48. The patients most likely to obtain therapeutic success were those having no or low-level resistance to non-nucleoside reverse transcriptase inhibitors and/or protease inhibitors. New and more effective drugs are needed for patients with HIV-1 that is resistant to more than one of the current three classes of HIV drugs.