Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 49
Filtrar
1.
HIV Med ; 11(9): 545-53, 2010 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-20345884

RESUMO

BACKGROUND: Atazanavir (ATV) boosted with ritonavir (ATV/r) is a potent, well-tolerated, once-daily protease inhibitor (PI). Few data are available on this agent as a treatment simplification option for patients taking other PIs. OBJECTIVE: The aim of the study was to determine the effectiveness and safety of ATV-containing regimens in patients who have simplified their antiretroviral treatment. METHODS: SIMPATAZ was a multicentre, prospective, noninterventional study in patients who had undetectable HIV RNA on their current PI-containing therapy and who were switched to an ATV/r-based regimen. Patients underwent a routine physical examination, and data were collected on HIV RNA levels, CD4 cell counts, liver function, lipid parameters, adverse reactions, adherence to treatment and patient satisfaction. RESULTS: A total of 183 patients were enrolled in the study and included in the analysis (80% were male, 29% had AIDS, and 52% were coinfected with HIV and hepatitis B virus or hepatitis C virus). The median baseline CD4 count was 514 cells/µL. Median exposure to previous HIV therapy was 8 years, and 32% of patients had a history of PI failures. Lopinavir boosted with ritonavir was the most frequent PI replaced (62%) and tenofovir+lamivudine /emtricitabine the backbone most used during the study (29%). The study drug was discontinued early by 25 patients (14%), two of whom discontinued as a result of adverse events (Hodgkin lymphoma and vomiting). Two patients died (lung cancer and myocardial infarction). At month 12, 93% of the study population had an undetectable HIV RNA viral load. Hyperbilirubinaemia >3 mg/dL and increased alanine aminotransferase levels>200 IU/L were observed in 38.5% and 4.4% of patients, respectively. Median changes from baseline to month 12 in total cholesterol, triglycerides and low-density lipoprotein cholesterol were -13 mg/dL (-7%; P<0.0001), -19 mg/dL (-13%; P<0.0001) and -7 mg/dL (-6%; P=0.021), respectively. CONCLUSIONS: In a real-world setting, switching from other PIs to ATV/r is a well-tolerated and safe option for improving the lipid profile and for retaining virological response in controlled pretreated patients.


Assuntos
Terapia Antirretroviral de Alta Atividade/métodos , Infecções por HIV/tratamento farmacológico , Inibidores da Protease de HIV/uso terapêutico , Oligopeptídeos/uso terapêutico , Piridinas/uso terapêutico , Ritonavir/uso terapêutico , Adulto , Sulfato de Atazanavir , Contagem de Linfócito CD4 , HDL-Colesterol/sangue , LDL-Colesterol/sangue , Jejum , Feminino , Infecções por HIV/sangue , Infecções por HIV/imunologia , Inibidores da Protease de HIV/administração & dosagem , Hepatite Viral Humana/complicações , Humanos , Masculino , Adesão à Medicação , Pessoa de Meia-Idade , Oligopeptídeos/administração & dosagem , Satisfação do Paciente , Estudos Prospectivos , Piridinas/administração & dosagem , Ritonavir/administração & dosagem , Transaminases/sangue , Resultado do Tratamento , Triglicerídeos/sangue , Carga Viral
2.
Eur J Clin Nutr ; 44(10): 733-40, 1990 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-2269252

RESUMO

Forty-five patients with alcoholic cirrhosis, 20 chronic alcoholics with normal liver function tests and 36 healthy subjects were investigated. A combined index of nine anthropometric and biochemical parameters (triceps skinfold, arm muscle circumference, mid-arm muscle area, body fat percentage, creatinine-height index, serum albumin, plasma transferrin, prealbumin and retinol-binding protein levels) was used to evaluate nutritional status, allowing a distinction to be made between those patients with adequate nutrition (group I: 40 per cent of cirrhotics and 55 per cent of alcoholics), those with slight malnutrition (group II: 37.7 per cent of cirrhotics and 45 per cent of alcoholics) and those with severe malnutrition (group III: 22.2 per cent of cirrhotics and none alcoholic). Natural Killer (NK) cell activity of peripheral blood lymphocytes was determined using a 51Cr releasing cytotoxicity assay against K562 target cells. This was significantly lower in the cirrhotics than in the controls and chronic alcoholics (P less than 0.001 and P less than 0.01 respectively), but there was no difference between the latter two groups. Natural Killer activity was significantly lower in samples obtained from cirrhotics with severe malnutrition than in those with adequate nutrition, suggesting that malnutrition may play a role in the onset of the immunological disorder. No relationship could be established between nutritional status, NK activity and the clinical activity of the disease using Orrego's index on the liver function tests.


Assuntos
Células Matadoras Naturais/imunologia , Cirrose Hepática Alcoólica/imunologia , Adulto , Idoso , Antropometria , Testes Imunológicos de Citotoxicidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estado Nutricional , Pré-Albumina/análise , Proteínas de Ligação ao Retinol/análise , Proteínas Plasmáticas de Ligação ao Retinol , Albumina Sérica/análise , Transferrina/análise
3.
Hepatogastroenterology ; 38(4): 307-10, 1991 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-1937376

RESUMO

Natural killer (NK) cell activity against K562 cell line, and interleukin-2 (IL-2) activity in supernatants from lectin-activated PBMC cultures from 17 patients with acute hepatitis B in the early phase of illness were studied. These patients showed enhanced NK cytotoxicity and higher levels of IL2 activity as compared with control subjects. There was a positive correlation between cytotoxicity values and levels of IL2 activity. Furthermore, in the recovery phase of illness there was a tendency towards normalization in both parameters. When patients were divided in accordance with markers of HBV replication, HBV-DNA positive patients showed increased NK cell activity and IL2 levels as compared with the control group, whereas in HBV-DNA-negative patients no differences were found. However, no differences were found between patients with HBeAg and patients with anti-HBe. These results suggest that natural cytotoxicity is increased early in the course of acute hepatitis B, while NK cell activity returns to normal later, during convalescence. Enhanced NK cell activity appears to be secondary, at least in part, to increased production of IL2. Natural cytotoxicity may be one mechanism that controls the HBV infection before other cytotoxic mechanisms become fully operative.


Assuntos
Citotoxicidade Imunológica/imunologia , Hepatite B/imunologia , Interleucina-2/imunologia , Células Matadoras Naturais/imunologia , Doença Aguda , Adulto , DNA Viral/análise , Feminino , Vírus da Hepatite B/isolamento & purificação , Humanos , Leucócitos Mononucleares/imunologia , Masculino , Fatores de Tempo
4.
Hepatogastroenterology ; 45(23): 1695-701, 1998.
Artigo em Inglês | MEDLINE | ID: mdl-9840131

RESUMO

BACKGROUND/AIMS: In our area most of the human immunodeficiency virus (HIV) infected patients are intravenous drug users; HIV and hepatitis C virus infections often coexist in these patients. Due to the repercussions of both infections, we designed a trial to evaluate the efficacy, response-related factors and tolerance during an eight-month regime of recombinant interferon alpha-2b on hepatitis C virus infection. METHODOLOGY: We included 79 patients in an open, prospective and multicentric trial with zidovudine and interferon alpha-2b. Response to interferon treatment was evaluated by biochemical and histopathological criteria. RESULTS: A complete response (alanine aminotransferase normalization) was obtained in 57.4% of patients. The significant response-related factors were: degree of histopathological activity, CD4+ cell number and initial leukocyte number. CONCLUSIONS: Recombinant interferon therapy seems to be effective for chronic hepatitis C in HIV infected patients; the best response was in those with active chronic hepatitis and CD4+ cell counts > or = 200/mm3. General tolerance was variable, although side effects were not different from those seen in non-HIV patients. The most common side effect was flu-like syndrome (constitutional manifestations), with no interference on treatment continuity; however, hematological toxicity prevents the indiscriminate use of interferon.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Antivirais/uso terapêutico , Infecções por HIV/complicações , Hepatite C Crônica/tratamento farmacológico , Interferon-alfa/uso terapêutico , Zidovudina/uso terapêutico , Adolescente , Adulto , Antivirais/efeitos adversos , Contagem de Linfócito CD4 , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/imunologia , Hepatite C Crônica/complicações , Hepatite C Crônica/diagnóstico , Humanos , Interferon alfa-2 , Interferon-alfa/efeitos adversos , Fígado/enzimologia , Masculino , Estudos Prospectivos , Proteínas Recombinantes
5.
Rev Esp Enferm Dig ; 85(3): 185-91, 1994 Mar.
Artigo em Espanhol | MEDLINE | ID: mdl-8204383

RESUMO

OBJECTIVES: To analyze the prevalence and clinical significance of HCV an HIV infections among a group of patients with chronic delta hepatitis. METHODS: We have studied the clinical and the histological activity and the serological profile the HBV DNA was analyzed by dot blot and PCR and the HDV RNA by dot blot) in 46 patients with chronic delta hepatitis. These results were correlated with HCV infection (assessed by ELISA-2, RIBA-2 and RT-PCR) and HIV infection (ELISA and immunoblot). RESULTS: HBV DNA and HDV RNA was detected by dot in 28.2% and 71.4% of patients respectively, and by PCR, 89.1% of patients had HBV DNA in their serum. Twenty two of 46 patients with chronic delta hepatitis were anti-HCV positives (with HCV RNA detectable in sera by RT-PCR in 19 cases). Anti-HIV positivity was detected in 19 of 46 patients. The mean aminotransferase level, histological activity and serological profile was similar in the anti-HCV positive and negative patients. Likewise, clinical and histological activity and serological profile was similar in the anti-HIV positive and negative patients. CONCLUSIONS: Concomitant infection with HCV or HIV does not seem to significantly modify the clinical course of chronic delta hepatitis. In addition, no significant serological difference has been noted in patients with chronic delta hepatitis with anti-HIV or anti-HCV antibodies.


Assuntos
Infecções por HIV , Hepatite C , Hepatite D , Adulto , Sequência de Bases , Doença Crônica , Comorbidade , Feminino , Anticorpos Anti-HIV/sangue , Infecções por HIV/sangue , Infecções por HIV/epidemiologia , Anticorpos Anti-Hepatite/sangue , Hepatite C/sangue , Hepatite C/epidemiologia , Hepatite D/sangue , Hepatite D/epidemiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Dados de Sequência Molecular , Estudos Soroepidemiológicos
6.
Acta Otorrinolaringol Esp ; 46(4): 305-9, 1995.
Artigo em Espanhol | MEDLINE | ID: mdl-7546857

RESUMO

Simultaneous bilateral facial paralysis (SBFP) is very rare, but it can present itself as the first complaint in a wide spectrum of diseases and a comprehensive evaluation must be completed. Bilateral Bell's Palsy can be diagnosed only when all other possible causes have been excluded. The prognosis and treatment for SBFP is dependent upon the underlying etiology. We present four cases of SBFP seen in our department which were finally diagnosed as leukemic infiltration, sarcoidosis, Bell's Palsy and demyelinating polyneuropathy (probably Guillain-Barré syndrome). The most important etiologies of the SBFP and the management of this entity are discussed.


Assuntos
Paralisia Facial/fisiopatologia , Lateralidade Funcional , Adulto , Idoso , Eletromiografia , Paralisia Facial/tratamento farmacológico , Paralisia Facial/etiologia , Feminino , Humanos , Leucemia/complicações , Polirradiculoneuropatia/complicações , Sarcoidose/complicações , Esteroides/uso terapêutico
7.
Int J STD AIDS ; 24(1): 39-41, 2013 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-23467294

RESUMO

Although peripheral facial palsy is the most common cranial neuropathy in HIV-infected patients, no series have been reported recently in the literature. In this study we reviewed the clinical records of HIV-infected patients with a diagnosis of peripheral facial palsy between 2000 and 2011 attending the Hospital Marqués de Valdecilla (Infectious Diseases Unit), a 900-bed university hospital in northern Spain. We identified eight patients (4 men, 4 women): median CD4 count and viral load were 232 cells per µL and 130,000 RNA copies per mL, respectively. Most of them presented co-morbidities, including hepatitis C virus in 75%, hepatitis B virus in 15% and tuberculosis in 15%. Aetiologies of palsy were varied: idiopathic Bell's palsy predominated at early stages of the disease, whereas secondary causes, such as lymphoma and infections were frequently the cause of paralysis in advanced HIV/AIDS. At early stages of HIV infection, facial palsy is similar, both in aetiology and prognosis, to cases in the general population. However, in advanced stages the palsy is frequently secondary to underlying complications. Clinicians should be aware of these differences to tailor the diagnostic work-up.


Assuntos
Paralisia Facial/complicações , Infecções por HIV/complicações , Corticosteroides/uso terapêutico , Adulto , Antivirais/uso terapêutico , Contagem de Linfócito CD4 , Comorbidade , Paralisia Facial/epidemiologia , Paralisia Facial/etiologia , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Infecções por HIV/virologia , Hepatite B/tratamento farmacológico , Hepatite B/epidemiologia , Hepatite C/tratamento farmacológico , Hepatite C/epidemiologia , Hospitais Universitários , Humanos , Masculino , Índice de Gravidade de Doença , Espanha/epidemiologia , Resultado do Tratamento , Tuberculose/epidemiologia , Carga Viral
8.
Curr HIV Res ; 10(6): 513-20, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-22716109

RESUMO

OBJECTIVE: To evaluate long-term outcomes in patients maintaining a nevirapine (NVP)-based regimen. METHODS: Retrospective, multicenter, cohort study including patients currently receiving an NVP regimen that had been started at least 5 years previously. Demographic, clinical, and analytical variables were recorded. RESULTS: Median follow-up was 8.9 (5.7-11.3) years. Baseline characteristics: 74% men, 47 years old, 36% drug users, 40% AIDS, 40% HCV+, 51.4% detectable HIV-1 viral load, CD4 count 395 (4-1,421)/µL, 19% CD4 < 200/µL, 27% ALT grade 1-2, 36% AST grade 1-2. Thirty percent ART-naive, 83%received NVP associated with 2 nucleoside analogues during the study period, and 17% a protease inhibitor. A significant improvement was observed in general health status markers, including hemoglobin, platelets, and albumin, regardless of HCV coinfection. CD4 cell gain was +218 and +322/µL after 6 and 9 years, respectively (+321 and +391 in naive patients). Triglycerides significantly decreased in pretreated patients, whereas the percentage of patients with HDLc < 1.03 mmol/L and LDL-c > 3.37 mmol/L significantly decreased in a subsample with available values. A significant decrease in transaminases, alkaline phosphatase, and Fib4 score was observed, mainly in HCV+ and ARV-naive patients. CONCLUSIONS: In patients who tolerate NVP therapy, (even those with HCV coinfection), long term benefits may be significant in terms of a progressive improvement in general health status markers and CD4 response, a favorable lipid profile, and good liver tolerability.


Assuntos
Síndrome da Imunodeficiência Adquirida/tratamento farmacológico , Fármacos Anti-HIV/administração & dosagem , Hepatite C/tratamento farmacológico , Fígado/efeitos dos fármacos , Nevirapina/administração & dosagem , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Síndrome da Imunodeficiência Adquirida/sangue , Síndrome da Imunodeficiência Adquirida/epidemiologia , Contagem de Linfócito CD4 , Colesterol/sangue , Estudos de Coortes , Coinfecção , Quimioterapia Combinada , Feminino , Seguimentos , Hepatite C/sangue , Hepatite C/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Espanha/epidemiologia , Fatores de Tempo , Resultado do Tratamento , Triglicerídeos/sangue , Carga Viral
9.
Transplant Proc ; 42(5): 1569-75, 2010 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-20620476

RESUMO

OBJECTIVES: Ischemic preconditioning (IP) affords resistance to liver ischemia-reperfusion (IR) injury, providing an early phase of protection. Development of delayed IP against IR injury was assessed using partial IR in rat liver. METHODS: The IP manuver (10 minutes of ischemia and up to 72 hours of reperfusion) was induced before 1 hour of ischemia and 20 hours of reperfusion. At the end of the reperfusion period, blood and liver samples were analyzed for serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), lactate dehydrogenase (LDH), haptoglobin and tumor necrosis factor-alpha (TNF-alpha) levels, hepatic histology, protein carbonyl and glutathione (GSH) contents as well as nuclear factor-kappaB (NF-kappaB), and activating protein-1 (AP-1) DNA binding. RESULTS: The IP manuver significantly increased protein carbonyl/GSH ratios (275%), serum ALT (42%), and AST (58%); these changes normalized after 12 hours. Serum AST, ALT, and LDH levels were significantly increased by IR (4-, 5.6-, and 7.0-fold, respectively), with significant changes in liver histology, protein carbonyl/GSH ratio (481% enhancement), and serum TNF-alpha (6.1-fold increase). Delayed IP in IR animals reduced serum AST (66%), ALT (57%), and LDH (90%) and liver GSH depletion (89%), with normalization of protein carbonyl content, serum TNF-alpha levels, and liver histology. Enhanced AP-1/NF-kappaB DNA binding ratios and diminished haptoglobin expression induced by IR were normalized by IP. CONCLUSION: These data support that delayed IP suppresses IR-induced liver injury, oxidative stress, and TNF-alpha response, which coincide with recovery of IR-altered signaling functions represented by normal AP-1/NF-kappaB DNA binding ratios and acute phase responses.


Assuntos
Precondicionamento Isquêmico/métodos , Fígado/patologia , Traumatismo por Reperfusão/prevenção & controle , Alanina Transaminase/sangue , Alanina Transaminase/metabolismo , Animais , Aspartato Aminotransferases/sangue , Aspartato Aminotransferases/metabolismo , Glutationa/metabolismo , Haptoglobinas/metabolismo , Inflamação/prevenção & controle , L-Lactato Desidrogenase/sangue , L-Lactato Desidrogenase/metabolismo , Fígado/metabolismo , Fígado/fisiopatologia , Masculino , NF-kappa B/genética , NF-kappa B/metabolismo , Estresse Oxidativo/fisiologia , Ratos , Ratos Sprague-Dawley , Fator de Transcrição AP-1/metabolismo
20.
J Viral Hepat ; 14(6): 387-91, 2007 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-17501758

RESUMO

The response to hepatitis C virus (HCV) therapy seems to be lower in HCV/HIV-coinfected patients than in HCV-monoinfected individuals. Given that most pivotal trials conducted in coinfected patients have used the combination of pegylated interferon (pegIFN) along with fixed low doses (800 mg/day) of ribavirin (RBV), it is unclear whether HIV itself and/or suboptimal RBV exposure could explain this poorer outcome. Two well-defined end points of early virological response were evaluated in Peginterferon Ribavirina España Coinfección (PRESCO), a multicentre trial in which the combination of pegIFN plus RBV (1000 mg if body weight <75 kg and 1200 mg if >75 kg) was prescribed to coinfected patients. For comparisons, we used unpublished data from early kinetics in two other large trials, one performed in HIV-negative patients [Pegasys International Study Group (PISG)] in which RBV 1000-1200 mg/day was used and another [AIDS Pegasys Ribavirin Coinfection Trial (APRICOT)] in which HIV-positive patients received fixed low RBV doses (800 mg/day). A total of 348 HCV/HIV-coinfected patients from the PRESCO trial were analysed as well as all patients treated with pegIFN plus RBV, who completed 12 weeks of therapy in the comparative studies (435 in PISG and 268 in APRICOT). Negative serum HCV-RNA at week 4 (which has the highest positive predictive value of sustained virological response, SVR) was attained in 33.3%, 31.2% and 13% of treated patients with HCV genotype 1, respectively, in PRESCO, PISG and APRICOT. For HCV genotypes 2/3, responses were 83.7%, 84.2% and 37%, respectively. A decline lower than 2 log(10) at week 12 (which has the highest negative predictive value of SVR) was seen in 25.5%, 19.5% and 37% of HCV genotype-1-infected patients, and in 2.1%, 2.9% and 12% of genotypes-2/3-infected patients, respectively. Prescription of high RBV doses enhances the early virological response to HCV therapy in HCV/HIV-coinfected patients, with results approaching those seen in HCV-monoinfected patients.


Assuntos
Antivirais/uso terapêutico , Infecções por HIV/tratamento farmacológico , HIV , Hepacivirus , Hepatite C/tratamento farmacológico , Interferon-alfa/uso terapêutico , Polietilenoglicóis/uso terapêutico , Ribavirina/uso terapêutico , Adulto , Antivirais/administração & dosagem , Quimioterapia Combinada , Determinação de Ponto Final , Feminino , Infecções por HIV/complicações , Hepacivirus/classificação , Hepacivirus/genética , Hepacivirus/isolamento & purificação , Hepatite C/complicações , Hepatite C/virologia , Humanos , Interferon alfa-2 , Interferon-alfa/administração & dosagem , Masculino , Polietilenoglicóis/administração & dosagem , RNA Viral/sangue , Proteínas Recombinantes , Ribavirina/administração & dosagem , Espanha , Especificidade da Espécie , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA