RESUMEN
PURPOSE OF REVIEW: Takayasu arteritis (TA) is a granulomatous inflammatory disorder that affects large vessels, especially aorta and its proximal branches. Its diagnosis can be extremely challenging due to the non-specificity of the systemic inflammatory manifestations during the early phase of the disease and usually follows an insidious clinical course until the emergence of vascular ischemic complications. RECENT FINDINGS: Its pathogenesis has been better delineated in recent years, especially the role of HLA-B*52 allele in certain ethnic groups, as well as the use of biological therapy, and surgical revascularization. Recent findings are discussed in depth. Clinical and epidemiological aspects of TA, recent developments in pathogenesis, and therapy are presented.
Asunto(s)
Antirreumáticos/uso terapéutico , Glucocorticoides/uso terapéutico , Arteritis de Takayasu/terapia , Procedimientos Quirúrgicos Vasculares , Angiografía , Angioplastia , Anticuerpos Monoclonales Humanizados , Angiografía por Tomografía Computarizada , Procedimientos Endovasculares , Antígeno HLA-B52/genética , Antígeno HLA-B52/inmunología , Humanos , Inmunosupresores/uso terapéutico , Angiografía por Resonancia Magnética , Tomografía Computarizada por Tomografía de Emisión de Positrones , Rituximab , Stents , Arteritis de Takayasu/diagnóstico , Arteritis de Takayasu/genética , Inhibidores del Factor de Necrosis Tumoral/uso terapéutico , Ultrasonografía , Injerto VascularRESUMEN
Several human leukocyte antigen (HLA) class I alleles are associated with the susceptibility to human immunodeficiency virus-1 (HIV-1) infection and/or AIDS progression. Of these, the HLA-B alleles are considered the strongest genetic determinant of disease outcome. We evaluated the influence of the HLA-B alleles on AIDS progression among HIV-1-positive individuals from Rio de Janeiro, Brazil, who were categorized as rapid progressors (RPs), typical progressors (TPs) or long-term non-progressors (LTNPs). In this study, significant differences in HLA-B allele frequencies were observed among the three progression groups for the B*48, B*49 and B*52 alleles. After controlling for other factors associated with AIDS progression, the presence of the B*52 allele was shown to be a significant protective factor (hazard ratio (HR) 0.49 (95% confidence interval (CI) 0.27-0.90) P<0.03). Although no direct association was observed between the presence of the B*27 or B*57 allele and the LTNP profile compared with the TP or RP groups, the adjusted model confirmed that these alleles are protective factors against AIDS progression (HR 0.62 (95% CI 0.38-0.99) P<0.05), as previously described. These data corroborate the existence of significant differences in HLA-B allele frequencies among the distinct AIDS progression profiles and further elucidate the role of HLA alleles in the outcome of HIV infections in diverse populations.