RESUMO
We investigated human immunodeficiency virus (HIV) type 1 RNA, proviral DNA, and antiretroviral drug-resistant variants in cervicovaginal secretions of HIV-1-infected women receiving antiretroviral therapy. The prevalence of detectable HIV-1 RNA in genital secretions was inversely related to the number of antiretroviral drugs taken by the patients. Proviral DNA was detected in approximately half of all samples of cervicovaginal secretions from HIV-1-infected women, regardless of the presence or absence of HIV-1 RNA in cervicovaginal secretions and of the antiretroviral regimen. In cervicovaginal secretions of most women with persisting genital viral replication, HIV variants exhibiting mutations associated with drug resistance against protease and reverse-transcriptase pol genes were found. Our observations indicate that antiretroviral therapy is not effective in purging the female genital tract of cell-associated provirus and that antiretroviral drugs that penetrate the female genital tract at suboptimal concentrations exert a potent selective pressure on genital HIV variants when local replication of free HIV-1 RNA persists.
Assuntos
Doenças dos Genitais Femininos/virologia , Infecções por HIV/virologia , HIV-1/efeitos dos fármacos , HIV-1/genética , Adulto , Fármacos Anti-HIV/sangue , Fármacos Anti-HIV/uso terapêutico , Estudos Transversais , DNA Viral/análise , DNA Viral/efeitos dos fármacos , DNA Viral/genética , Resistência Microbiana a Medicamentos , Feminino , Doenças dos Genitais Femininos/tratamento farmacológico , Genótipo , Infecções por HIV/sangue , Infecções por HIV/tratamento farmacológico , HIV-1/classificação , Humanos , Pessoa de Meia-Idade , Mutação , Filogenia , Provírus/efeitos dos fármacos , Provírus/genética , RNA Viral/análise , RNA Viral/efeitos dos fármacosRESUMO
METHODS: Test-of-cure of 19 patients with Chlamydia trachomatis genital infection was assessed by daily collection of first void urine for 7 days just after treatment by azithromycin single-dose. RESULTS: Detection by PCR and TMA of C. trachomatis showed a good correlation between both methods. The observation that post-therapy chlamydial nucleic acid detection is associated to bacterial clearance suggests that all the patients were cured.
Assuntos
Antibacterianos/uso terapêutico , Azitromicina/uso terapêutico , Infecções por Chlamydia/tratamento farmacológico , Chlamydia trachomatis , Infecções por Chlamydia/microbiologia , Infecções por Chlamydia/urina , DNA Bacteriano/urina , Feminino , Seguimentos , Amplificação de Genes , Humanos , Masculino , Reação em Cadeia da Polimerase , Transcrição GênicaRESUMO
OBJECTIVE: To evaluate the safety and efficacy of two intralesional doses of recombinant human interferon-beta (r-hIFN-beta: Rebif, Ares Serono), given 3 times a week for 3 weeks, in the treatment of condyloma acuminatum. DESIGN: A randomised, double-blind, within-patient, placebo-controlled study. SUBJECTS: 25 patients (24 males, 1 female) with a history of condyloma acuminatum. Twenty had failed previous treatment for condyloma acuminatum. In each patient, 3 distinct lesions were selected for treatment. Each selected lesion was randomly assigned to receive intralesionally one of the following: r-hIFN-beta 33,000 IU/day, r-hIFN-beta 1 x 10(6) IU/day, or matching placebo. SETTING: Institut Alfred Fournier, Paris, France. OUTCOME MEASURES: Response was evaluated colposcopically at the end of treatment (day 22) and 5 weeks later (month 2). Complete response (CR) was defined as disappearance of the treated lesion. Partial response (PR) was defined as at least a 50% reduction in size, but not disappearance of the treated lesion. RESULTS: The higher dose of 1 x 10(6) IU achieved significantly more complete and partial remissions than placebo, both by the end of treatment, and 5 weeks later. CONCLUSIONS: r-hIFN-beta appears to be safe and effective when administered intralesionally to patients with condyloma acuminatum. Most of the treated patients had failed previous treatments and were therefore a resistant population.
