RESUMEN
Limited data exist on human immunodeficiency virus type 1 (HIV-1) resistance in patients who are not responding to protease inhibitor (PI)-based regimens in resource-limited settings. This study assessed resistance profiles in adults across South Africa who were not responding to PI-based regimens. pol sequencing was undertaken and submitted to the Stanford HIV Drug Resistance Database. At least 1 major PI mutation was detected in 16.4% of 350 participants. A total of 53.4% showed intermediate resistance to darunavir/ritonavir, whereas high-level resistance was not observed. Only 5.2% and 32.8% of participants showed high-level and intermediate resistance to etravirine, respectively. Although the prevalence of major PI mutations was within previously reported ranges, most patients will likely experience virological suppression during receipt of currently available South African third-line regimens.
Asunto(s)
Antirretrovirales/uso terapéutico , Farmacorresistencia Viral , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/virología , Inhibidores de la Proteasa del VIH/uso terapéutico , VIH-1/efectos de los fármacos , Adolescente , Adulto , Anciano , Antirretrovirales/farmacología , Estudios Transversales , Productos del Gen pol/genética , Inhibidores de la Proteasa del VIH/farmacología , VIH-1/aislamiento & purificación , Humanos , Persona de Mediana Edad , Mutación Missense , Prevalencia , Análisis de Secuencia de ADN , Sudáfrica/epidemiología , Insuficiencia del Tratamiento , Adulto JovenRESUMEN
INTRODUCTION: Acute myeloid leukemia (AML) is a heterogeneous clonal disorder of hemopoietic progenitor cells diagnosed in individuals of any age, but with a median age of 67 years at presentation in adults. Assessment of the mutation status of nucleophosmin protein-1 (NPM1) and FMS-like tyrosine kinase 3 internal tandem duplication (FLT3-ITD) is essential for the prognosis, and treatment of AML. METHODS: A total of 160 de novo AML cases, both cytogenetically normal and abnormal, were analyzed for the presence of NPM1 and FLT3-ITD mutations, and the results assessed in conjunction with epidemiological, clinical, and laboratory findings. RESULTS: Nucleophosmin protein-1 mutations were found in 7.5%, while FLT3-ITD was present in 12% of these cases. Both of these were lower than expected. The median age at diagnosis of AML was 41 years, and for the FLT3-ITD only cases, median age was 33 years; these ages were younger than expected. CONCLUSION: The lower reported frequencies and younger median age at diagnosis of AML and these specific mutations may be contributed to by a number of factors including effects of race on age of presentation, inclusion of patients diagnosed with de novo AML only, and a generally younger median age of the South African population.
Asunto(s)
Leucemia Mieloide Aguda/genética , Tasa de Mutación , Proteínas Nucleares/genética , Tirosina Quinasa 3 Similar a fms/genética , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Antineoplásicos/uso terapéutico , Niño , Estudios de Cohortes , Femenino , Expresión Génica , Humanos , Leucemia Mieloide Aguda/diagnóstico , Leucemia Mieloide Aguda/tratamiento farmacológico , Leucemia Mieloide Aguda/mortalidad , Masculino , Persona de Mediana Edad , Nucleofosmina , Pronóstico , Estructura Terciaria de Proteína , Sudáfrica , Análisis de SupervivenciaRESUMEN
Se presenta nuestra experiencia inicial con un protocolo de Papaverina I.C., efectuado en 70 pacientes impotentes, que clasificados según su respuesta a la papaverina son manejados con diferentes alternativas de terapia o estudio. El 54% de los pacientes, recuperó erecciones espontáneas. El 20% de la serie, logra erecciones con papaverina I.C., y puede beneficiarse con programa de auto inyección. El 26% restante (No Respondedores), fue sometido a evaluación arterial y venosa. Se consignó "escape venoso" en el 33% de los pacientes que complementaron este estudio, y de 4 enfermos sometidos a Cirugía uno recupera erecciones espontáneas