ABSTRACT
O uso do cidofovir para papilomatose respiratória recorrente juvenil (PRRJ) ainda não tem estudos caso-controle suficientes que comprovem sua eficácia em literatura. OBJETIVO: Avaliar fatores que influenciem o prognóstico da PRRJ, e observar a atuação do cidofovir na erradicação da PRRJ. DESENHO DO ESTUDO: Retrospectivo. MATERIAIS E MÉTODOS: 22 crianças com PRRJ foram avaliadas num centro terciário. Todas as crianças foram submetidas ao tratamento cirúrgico, seguido (Grupo 2) ou não (Grupo 1) pelo uso do cidofovir. A idade ao diagnóstico foi correlacionada ao escore de Derkay e à evolução da doença. Os Grupos 1 e 2 tiveram suas evoluções comparadas entre si. RESULTADOS: Quinze crianças foram consideradas curadas, 8 no Grupo 2 e 7 no Grupo 1. Houve uma correlação negativa entre idade e Escores Total e Clínico (P<0,05). O número médio de cirurgias necessárias para controlar a doença foi semelhante entre os Grupos, mas a duração do tratamento até remissão foi significativamente maior no Grupo 1 quando comparado ao Grupo 2 (P<0,05). CONCLUSÕES: A PRRJ é mais agressiva quanto mais nova a idade do paciente ao diagnóstico. Pacientes tratados com cidofovir apresentaram duração significativamente menor de tratamento até erradicação da PRRJ do que os submetidos apenas ao tratamento cirúrgico.
The efficacy of cidofovir in juvenile recurrent respiratory papillomatosis (JRRP) remains uncertain due to the lack of published case-control studies. AIM: To establish factors affecting the progression of JRRP prognosis, and to evaluate cidofovir for eradicating JRRP. STUDY DESIGN: Retrospective. METHODS: 22 children with JRRP were evaluated at a referral center. All children underwent surgical debulking, followed by cidofovir injection (Group 2) or not (Group 1). Age at diagnosis was correlated with the Derkay score and disease outcome. Disease progression was compared between groups 1 and 2. RESULTS: fifteen children were considered disease-free; 8 were in Group 2 and 7 in Group 1. Age and total and clinical scores (P<0.05) were negatively correlated. The mean number of surgeries required to control the disease was identical in both groups; the duration of treatment until remission was significantly higher in Group 1 (P<0,05). CONCLUSION: JRRP is more aggressive in earlier onset disease. The duration of treatment was significantly lower in patients treated with cidofovir until eradication of JRRP compared to patients treated with surgery only.
Subject(s)
Child , Child, Preschool , Female , Humans , Infant , Male , Antiviral Agents/therapeutic use , Cytosine/analogs & derivatives , Phosphorous Acids , Papillomavirus Infections/therapy , Respiratory Tract Infections/therapy , Age Factors , Case-Control Studies , Cytosine/therapeutic use , Papillomavirus Infections/diagnosis , Recurrence , Retrospective Studies , Respiratory Tract Infections/diagnosis , Statistics, Nonparametric , Time Factors , Treatment OutcomeABSTRACT
La Papilomatosis Respiratoria Recurrente (PRR) es una enfermedad causada por el virus papiloma humano (VPH) que se caracteriza por la presencia de tumores epiteliales en la vía aérea. Su principal mecanismo de contagio es por contacto directo, la zona más frecuentemente afectada es la laringe, pero puede comprometer cualquier lugar de la vía aéreo-digestiva. Sus manifestaciones van desde la disfonía a la obstrucción completa de la vía aérea, causando incluso la muerte. En algunas ocasiones los papilomas pueden malignizarse y transformarse en carcinoma epidermoide. El tratamiento existente es sólo paliativo y consiste en la excisión quirúrgica de los papilomas para mantener la vía aérea sin obstrucción y mejorar la calidad de la voz, pero tiene una alta tasa de recidiva y habitualmente se requieren múltiples intervenciones quirúrgicas, resultando un tratamiento de alto costo. En los últimos tiempos se ha usado el cidofovir, un nucleósido fosfanato acíclico, administrado en forma intralesional para el tratamiento de la papilomatosis laríngea obteniéndose promisorios resultados, observándose remisión completa en un alto porcentaje de los casos y disminución de las recidivas.
Recurrent respiratory papillomatosis (RRP) is a disease caused by infection with the human papillomavirus (HPV), and is characterized by the presence of epithelial tumors in the airway. It is most commonly spread by direct contact, and it usually affects the larynx, but it may involve any region of the airway. Its symptoms vary from dysphonia to complete obstruction of the airway, and it may even cause death. in some cases, papillomas can become malignant and transform into epidermoid carcinoma. Current treatments are only palliative, and consist of the papillomas surgical resection in order to maintain the airway unobstructed and to improve voice quality; but it has a high recurrency rate, and usually several surgical procedures are needed, resulting in a high-cost treatment. Recently, cidofovir, an acyclic nucleoside phosphonate, has been used for the intralesional treatment of laryngeal papillomatosis with promising results, including complete remission in a high percentage of cases, and decreased recurrence.
Subject(s)
Humans , Antiviral Agents/therapeutic use , Papilloma/drug therapy , Neoplasm Recurrence, Local/drug therapy , Cytosine/analogs & derivatives , Cytosine/therapeutic use , PapillomaviridaeABSTRACT
El SIDA es causado por un Retrovirus llamado HIV. Se distinguen 2 tipos de Retrovirus: HIV I y HIV II; el primero se encuentra en Europa, U.S.A. y Africa Central, especialmente en Zaire, Burundi, Rouana, Uganda y recientemente en Kenya. El HIV II, se encuentra fundamentalmente en Africa Occidental: Senegal, Costa de Marfil, etc.