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1.
J Antimicrob Chemother ; 78(1): 117-121, 2022 12 23.
Artigo em Inglês | MEDLINE | ID: mdl-36272137

RESUMO

OBJECTIVES: We aimed to investigate and compare the efficacy and safety of two dolutegravir-based two-drug regimens: dolutegravir + lamivudine versus dolutegravir + rilpivirine. METHODS: We analysed a cohort of people living with HIV (PLWHIV) switching to dolutegravir + lamivudine or dolutegravir + rilpivirine. We excluded from the analysis PLWHIV with no available pre-switch genotypic test or with a known resistance mutation to one of the study drugs. We evaluated incidence of virological failure (VF) and treatment discontinuation (TD), as well as changes in immunological and metabolic parameters. RESULTS: We enrolled 592 PLWHIV: 306 in the lamivudine group and 286 in the rilpivirine group. We observed nine VFs in the lamivudine group [1.4 VF per 100 patient-years of follow-up (PYFU)] and four VFs in the rilpivirine group (0.6 VF per 100 PYFU). Subsequent genotypic analysis showed no acquired resistance-associated mutations in those experiencing VF. Estimated probability of maintaining virological suppression at 144 and 240 weeks were 96.6% and 92.7%, respectively, in the lamivudine group and 98.7% and 98.7%, respectively, in the rilpivirine group (log-rank P = 0.172). The estimated probability of maintaining study regimen at Week 240 was 82.3% in the lamivudine group and 85.9% in the rilpivirine group (log-rank P = 0.018). We observed a significant improvement in CD4+ cell count at Week 240 in the lamivudine group (P = 0.012); in the rilpivirine group we registered a significant increase in CD4/CD8 ratio (P = 0.014). CONCLUSIONS: Both analysed strategies are effective and safe as switch strategies in clinical practice, with a low incidence of VF and a favourable immunological recovery, even in the long term.


Assuntos
Fármacos Anti-HIV , Infecções por HIV , Humanos , Lamivudina/efeitos adversos , Infecções por HIV/tratamento farmacológico , Fármacos Anti-HIV/efeitos adversos , Rilpivirina/efeitos adversos , Compostos Heterocíclicos com 3 Anéis/efeitos adversos , Piridonas/uso terapêutico , Oxazinas/uso terapêutico
3.
Clin Microbiol Infect ; 24(12): 1340.e1-1340.e6, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29555394

RESUMO

OBJECTIVES: We aimed to assess the prevalence and risk factors for Chagas disease (CD) in Latin American immigrants and to evaluate the accuracy of diagnostic tests. Moreover, we offered to all positive subjects a complete free-of-charge clinical/instrumental evaluation as well as benznidazole treatment in order to stage the disease and verify drug tolerability. METHODS: A cross-sectional survey of CD among Latin Americans living in Milan and its metropolitan area was conducted between July 2013 and July 2014. Blood samples were tested for serologic evidence of CD together with a questionnaire covering demographic and clinical-epidemiological information. RESULTS: Forty-eight (9.6%) of the 501 tested subjects were conclusively diagnosed as having CD. The highest prevalence of CD was among those from Bolivia (43/169, 25.4%) and El Salvador (4/68, 5.9%). Older age (adjusted odds ratio (aOR)] 1.05, p =0.004), a Bolivian origin (aOR 8.80; p =0.003), being born in the department of Santa Cruz (aOR 3.72, p =0.047), having lived in mud houses (aOR 2.68; p =0.019), and having an affected relative (aOR 12.77, p =0.001) were independently associated with CD. The ARCHITECT Chagas test showed the highest sensitivity (100%) and specificity (99.8%). Twenty-nine of the subjects with CD (60.4%) underwent disease staging, 10 of whom (35.7%) showed cardiac and/or digestive involvement. Benznidazole treatment was associated with high frequency of adverse reactions (19/27, 70.4%) and permanent discontinuation (8/27, 29.6%). CONCLUSIONS: CD is highly prevalent among Bolivians and Salvadorans living in Milan. Regions with a large Latin American immigrant population should implement programmes of active detection and treatment.


Assuntos
Doença de Chagas/diagnóstico , Doença de Chagas/epidemiologia , Emigrantes e Imigrantes , Hispânico ou Latino/estatística & dados numéricos , Adolescente , Adulto , Bolívia/epidemiologia , Doença de Chagas/sangue , Doença de Chagas/imunologia , Criança , Estudos Transversais , Confiabilidade dos Dados , Tolerância a Medicamentos , El Salvador/epidemiologia , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Imunoensaio/métodos , Itália/epidemiologia , América Latina/epidemiologia , Masculino , Pessoa de Meia-Idade , Nitroimidazóis/efeitos adversos , Nitroimidazóis/uso terapêutico , Prevalência , Fatores de Risco , Inquéritos e Questionários , Trypanosoma cruzi/efeitos dos fármacos , Trypanosoma cruzi/imunologia , Trypanosoma cruzi/isolamento & purificação
4.
J Viral Hepat ; 25(4): 381-390, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29091327

RESUMO

HBV eradication in chronic hepatitis B (CHB) subjects is rarely achieved with either nucleos(t)ide analogues (NA) or pegylated interferon (Peg-IFN), which both have a limited effect in restoring immune responses. Thirty CHB subjects on long-term treatment with tenofovir (TDF) and HBV suppression were enrolled and randomized 1:2 to either receive Peg-IFN-α-2a add-on therapy or continue TDF alone. We studied γδ T and iNKT frequency and function (by flow cytometry) at baseline, at 12 weeks and 12 weeks after the end of treatment. A higher reduction in qHBsAg occurred in the add-on group compared with the NA group at W12 (P = .016) and at W24 (P = .012). A decline of qHBsAg ≥0.5 log10 at week 24 occurred in 4 of 10 patients in the add-on arm and 1 of 20 in the NA arm, respectively (P = .03). HBsAg loss was seen in 20% of subjects in the add-on group and in none of the NA group. Compared to HBV negative, CHB on TDF showed lower frequency of iNKT (P = .03) and γδ T cells (P = .03) as well as fewer γδ T cells expressing Vδ2 T-cell receptors (P = .005). No changes in unconventional T-cell frequency and function were shown in both add-on and NA patients nor were differences detected between the two treatment groups. We report persistent impairment of unconventional T cells in CHB. Despite a greater qHBsAg decline of add-on patients, our data failed to detect any effect of Peg-IFN treatment on unconventional T cells.


Assuntos
Antivirais/administração & dosagem , Hepatite B Crônica/tratamento farmacológico , Interferon-alfa/administração & dosagem , Polietilenoglicóis/administração & dosagem , Subpopulações de Linfócitos T/imunologia , Tenofovir/administração & dosagem , Adulto , Idoso , Citometria de Fluxo , Antígenos de Superfície da Hepatite B/sangue , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos , Proteínas Recombinantes/administração & dosagem , Resposta Viral Sustentada , Resultado do Tratamento
5.
Br J Pharmacol ; 174(19): 3333-3345, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28718892

RESUMO

BACKGROUND AND PURPOSE: Methoxetamine (MXE) is a novel psychoactive substance that is emerging on the Internet and induces dissociative effects and acute toxicity. Its pharmacological effects have not yet been adequately investigated. EXPERIMENTAL APPROACH: We examined a range of behavioural effects induced by acute administration of MXE (0.5-5 mg·kg-1 ; i.p.) in rats and whether it causes rapid neuroadaptive molecular changes. KEY RESULTS: MXE (0.5-5 mg·kg-1 ) affected motor activity in a dose- and time-dependent manner, inducing hypermotility and hypomotility at low and high doses respectively. At low and intermediate doses (0.5 and 1 mg·kg-1 ), MXE induced anxious and/or obsessive-compulsive traits (marble burying test), did not significantly increase sociability (social interaction test) or induce spatial anxiety (elevated plus maze test). At a high dose (5 mg·kg-1 ), MXE induced transient analgesia (tail-flick and hot-plate test), decreased social interaction time (social interaction test) and reduced immobility time while increasing swimming activity (forced swim test), suggesting an antidepressant effect. Acute MXE administration did not affect self-grooming behaviour at any dose tested. Immunohistochemical analysis showed that behaviourally active doses of MXE (1 and 5 mg·kg-1 ) increased phosphorylation of ribosomal protein S6 in the medial prefrontal cortex and hippocampus. CONCLUSIONS AND IMPLICATIONS: MXE differentially affected motor activity, behaviour and emotional states in rats, depending on the dose tested. As reported for ketamine, phosphorylation of the ribosomal protein S6 was increased in MXE-treated animals, thus providing a 'molecular snapshot' of rapid neuroadaptive molecular changes induced by behaviourally active doses of MXE.


Assuntos
Encéfalo/efeitos dos fármacos , Cicloexanonas/farmacologia , Cicloexilaminas/farmacologia , Drogas Ilícitas/farmacologia , Psicotrópicos/farmacologia , Animais , Ansiedade/induzido quimicamente , Comportamento Animal/efeitos dos fármacos , Encéfalo/metabolismo , Emoções/efeitos dos fármacos , Temperatura Alta , Locomoção/efeitos dos fármacos , Masculino , Comportamento Obsessivo/induzido quimicamente , Ratos , Ratos Sprague-Dawley , Proteínas Quinases S6 Ribossômicas/metabolismo , Comportamento Social
6.
HIV Med ; 18(4): 284-291, 2017 04.
Artigo em Inglês | MEDLINE | ID: mdl-27477612

RESUMO

OBJECTIVES: Clinical trials of all-oral direct-acting antivirals (DAAs) for chronic hepatitis C virus (HCV) infection reported high response rates in HCV/HIV coinfection, similar to those obtained in HCV monoinfection. We evaluated the safety and efficacy of these regimens in a clinical practice setting. METHODS: In this prospective observational study, all the HCV-monoinfected and HCV/HIV-coinfected patients undergoing HCV treatment with all-oral DAA regimens in a routine clinical setting from December 2014 to December 2015 were included in the analysis. Sustained virological response 12 weeks after the end of therapy (SVR12) and reported adverse events (AEs) were evaluated. Resistance-associated variants (RAVs) were analysed in a subgroup of patients at baseline and at the time of viral rebound in those with virological failure. RESULTS: One-hundred and nine patients (51 HCV-infected and 58 HCV/HIV-coinfected) were enrolled in the study. Sixty per cent had cirrhosis and 52% were pegylated interferon and ribavirin (pegIFN/RBV)-experienced. Thirty-six per cent received ombitasvir + paritaprevir/ritonavir + dasabuvir, 25% sofosbuvir + daclatasvir, 16% sofosbuvir + simeprevir, 17% sofosbuvir + ribavirin and 6% sofosbuvir + ledipasvir; ribavirin was used in 57% of subjects. The SVR12 rate was 91% and 96% in HIV-infected and uninfected patients, respectively (P = 0.44). The 4-week HCV viral decline was similar in the two groups. RAVs were found at baseline in 23 of 49 patients and did not affect SVR12. No predictors of SVR12 were identified in our cohort. CONCLUSIONS: Treatment with all-oral DAA combinations of patients infected with HCV and with HCV/HIV under real-life conditions led to high and similar rates of SVR12. Moreover, the historical factors associated with a sustained virological response to pegIFN/RBV were not predictive of the response to all-oral DAAs.


Assuntos
Antivirais/administração & dosagem , Antivirais/efeitos adversos , Coinfecção/tratamento farmacológico , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Hepatite C Crônica/complicações , Hepatite C Crônica/tratamento farmacológico , Administração Oral , Idoso , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento , Carga Viral
7.
Eur J Clin Microbiol Infect Dis ; 31(2): 109-18, 2012 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-21533874

RESUMO

Leishmaniases are a clinically heterogeneous group of diseases caused by protozoa of the genus Leishmania. There is growing evidence that the true incidence of the disease is underestimated, especially in hyperendemic regions. Moreover, climate changes together with the increasing movement of humans and animals raise concerns about the possible introduction of Leishmania infection in previously spared areas. The disease is emerging in immunocompromised patients undergoing bone marrow or solid organ transplantation or treatment with biologic drugs. Furthermore, the deployment of military troops and travel to endemic areas are associated with the observation of a growing number of patients with cutaneous disease. Improvement in diagnostic methods, both in the field and in specialized laboratories, has been obtained through the implementation of molecular amplification methods and using the rK39 antigen as the substrate. Finally, new therapeutic approaches are gaining attention, such as the use of miltefosine for cutaneous leishmaniasis and paromomycin for visceral leishmaniasis, as well as the use of various antileishmanial drugs in combination.


Assuntos
Antiprotozoários/uso terapêutico , Leishmaniose Cutânea , Leishmaniose Visceral , Doenças Negligenciadas , Animais , Humanos , Hospedeiro Imunocomprometido , Leishmania/classificação , Leishmania/efeitos dos fármacos , Leishmania/isolamento & purificação , Leishmaniose Cutânea/diagnóstico , Leishmaniose Cutânea/tratamento farmacológico , Leishmaniose Cutânea/epidemiologia , Leishmaniose Cutânea/parasitologia , Leishmaniose Visceral/diagnóstico , Leishmaniose Visceral/tratamento farmacológico , Leishmaniose Visceral/epidemiologia , Leishmaniose Visceral/parasitologia , Doenças Negligenciadas/diagnóstico , Doenças Negligenciadas/tratamento farmacológico , Doenças Negligenciadas/epidemiologia , Doenças Negligenciadas/parasitologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
8.
Transpl Infect Dis ; 14(1): 95-8, 2012 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-21749588

RESUMO

Prophylaxis with lamivudine (LAM) is recommended for hepatitis B core antibody-positive allogenic hematopoietic stem cell transplant (HSCT) recipients, but the optimal timing for the institution and duration of the prophylaxis is still unknown. Furthermore, considering the high rate of mortality associated with hepatitis B virus reactivation (HBV-R), the most potent and long-term effective antiviral regimen should be considered. We report here a case of late onset of HBV-R after a long-term prophylaxis with LAM in a patient who underwent HSCT for non-Hodgkin lymphoma and who was successfully treated with a combination antiviral regimen including entecavir and tenofovir disoproxil fumarate.


Assuntos
Adenina/análogos & derivados , Antivirais/uso terapêutico , Guanina/análogos & derivados , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Vírus da Hepatite B/fisiologia , Hepatite B/tratamento farmacológico , Organofosfonatos/uso terapêutico , Ativação Viral/fisiologia , Adenina/uso terapêutico , Idade de Início , Quimioterapia Combinada , Feminino , Guanina/uso terapêutico , Humanos , Pessoa de Meia-Idade , Tenofovir , Transplante Homólogo/efeitos adversos , Resultado do Tratamento
9.
Transpl Infect Dis ; 13(4): 397-406, 2011 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-21281418

RESUMO

The characteristics of 8 episodes of leishmaniasis with atypical manifestations in 2 Italian kidney transplant recipients are analyzed and contextualized among those of 52 other episodes of leishmaniasis observed in 19 transplant recipients found through a systematic review of the international literature. In all the patients, the initial episode was visceral leishmaniasis, which was associated with mucocutaneous involvement in 2 cases. With the exception of 1 case of post kala-azar dermal leishmaniasis, 2 episodes of Leishmania endophthalmitis, and 3 episodes of mucocutaneous leishmaniasis, all the recurrences were characterized by visceral involvement. The potential role of polymerase chain reaction in monitoring the infection, the importance of a long follow-up, the potential benefit of chemoprophylaxis, and the therapeutic challenges are discussed.


Assuntos
Transplante de Rim/efeitos adversos , Leishmania donovani/isolamento & purificação , Leishmania/isolamento & purificação , Leishmaniose Cutânea/diagnóstico , Leishmaniose Visceral/diagnóstico , Anticorpos Antiprotozoários/sangue , Feminino , Humanos , Úlcera da Perna/parasitologia , Úlcera da Perna/patologia , Leishmania/genética , Leishmania/imunologia , Leishmania donovani/genética , Leishmania donovani/imunologia , Leishmaniose Cutânea/parasitologia , Leishmaniose Cutânea/patologia , Leishmaniose Mucocutânea/diagnóstico , Leishmaniose Mucocutânea/parasitologia , Leishmaniose Mucocutânea/patologia , Leishmaniose Visceral/parasitologia , Leishmaniose Visceral/patologia , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase , Recidiva , Língua/parasitologia , Língua/patologia
10.
Int J STD AIDS ; 21(11): 783-5, 2010 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-21187364

RESUMO

Raltegravir (RAL), an HIV integrase inhibitor, may uncommonly induce an increase of serum creatine kinase (CK) both in naïve and antiretroviral (ARV)-experienced HIV-positive patients. We report the case of severe rhabdomyolysis requiring hospitalization in an ARV-experienced HIV/hepatitis C co-infected patient treated with a RAL-containing drug regimen. Factors favouring a severe clinical occurrence of RAL-induced rhabdomyolysis from cases reported in literature are described.


Assuntos
Inibidores de Integrase de HIV/efeitos adversos , Pirrolidinonas/efeitos adversos , Rabdomiólise/induzido quimicamente , Alanina Transaminase/sangue , Aspartato Aminotransferases/sangue , Creatina Quinase/sangue , Feminino , Infecções por HIV/sangue , Infecções por HIV/tratamento farmacológico , Inibidores de Integrase de HIV/uso terapêutico , Humanos , L-Lactato Desidrogenase/sangue , Pessoa de Meia-Idade , Pirrolidinonas/uso terapêutico , Raltegravir Potássico , Rabdomiólise/sangue , Rabdomiólise/diagnóstico
12.
Transpl Infect Dis ; 12(1): 64-8, 2010 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-19793067

RESUMO

We describe an autologous stem cell transplant recipient who developed immune reconstitution inflammatory syndrome (IRIS) associated with Aspergillus terreus invasive pulmonary infection after recovery from neutropenia. Clinical and radiological worsening of pulmonary invasive aspergillosis coincident with a robust decline of serum galactomannan values and rising neutrophil counts should be interpreted as IRIS and should not require changes to antifungal therapy.


Assuntos
Síndrome Inflamatória da Reconstituição Imune/complicações , Aspergilose Pulmonar Invasiva/complicações , Pneumopatias Fúngicas/complicações , Pneumopatias Fúngicas/microbiologia , Transplante de Células-Tronco/efeitos adversos , Transplante Autólogo/efeitos adversos , Aspergillus/classificação , Humanos , Aspergilose Pulmonar Invasiva/microbiologia , Masculino , Pessoa de Meia-Idade
14.
HIV Med ; 10(9): 580-5, 2009 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-19785667

RESUMO

OBJECTIVES: High serum total cholesterol and low-density lipoprotein (LDL) levels have been demonstrated to increase the probability of a sustained viral response (SVR) in chronic hepatitis C. Conversely, insulin resistance reduces SVR rates. We investigated the influence of baseline glucose and lipid values on the outcome of hepatitis C virus (HCV) treatment in HIV-1 infected subjects. METHODS: We retrospectively reviewed the charts of HIV/HCV-coinfected patients treated with an interferon-based regimen from 2002 to 2008. Fasting glucose levels and total cholesterol, LDL and triglyceride levels were recorded prior to the initiation of treatment. RESULTS: Of the 96 patients enrolled in the study, 36 (37.5%) had genotype 1, 48 (50%) genotype 2 or 3 and 12 (12.5%) genotype 4. SVR was obtained in 25% (nine of 36) and 70% (42 of 60) of patients with genotype 1 and other genotypes, respectively. In the multivariate analysis, the independent predictors of SVR were: genotype other than genotype 1 [adjusted odds ratio 9.64, confidence interval (CI) 2.7-34.3; P<0.0001], HCV viraemia [adjusted odds ratio 0.36, CI 0.15-0.9; P=0.028], fasting glucose > or =100 mg/dL [adjusted odds ratio 0.13, CI 0.034-0.51; P=0.003], and cholesterol level > or =190 mg/dL [adjusted odds ratio 5.96, CI 1.6-22.3; P=0.008]. CONCLUSIONS: Higher baseline serum glucose and cholesterol levels may be significant prognostic indicators for anti-HCV treatment outcome in HIV/HCV-coinfected patients.


Assuntos
Antivirais/uso terapêutico , Infecções por HIV/complicações , Hepatite C/tratamento farmacológico , Hipercolesterolemia/sangue , Hiperglicemia/sangue , Adulto , Glicemia/metabolismo , Contagem de Linfócito CD4 , Quimioterapia Combinada , Feminino , Genótipo , Infecções por HIV/sangue , Hepacivirus/genética , Hepatite C/sangue , Hepatite C/complicações , Humanos , Resistência à Insulina , Interferon alfa-2 , Interferon-alfa/uso terapêutico , Lipodistrofia/etiologia , Lipoproteínas LDL/sangue , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Polietilenoglicóis/uso terapêutico , Proteínas Recombinantes , Estudos Retrospectivos , Ribavirina/uso terapêutico , Resultado do Tratamento , Triglicerídeos/sangue , Carga Viral
15.
J Viral Hepat ; 16(7): 479-84, 2009 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-19215577

RESUMO

Fluvastatin showed anti-hepatitis C virus (HCV) activity in vitro, through the inhibition of geranylgeranylation of cellular proteins, and a synergistic effect with interferon (IFN)-alpha. Nevertheless statins up-regulate low-density lipoprotein (LDL) receptor, required for HCV cell entry, and the closely related scavenger receptors SRBI and CD36; moreover they reduce class II major histocompatibility complex expression on antigen presenting cell, modulating T-cell activation. In vivo LDL levels have been identified as prognostic indicator of sustained viral response to IFN in patients with HCV infection, suggesting that lipid-lowering agents might conversely favour HCV entry into the hepatocytes and translate into higher viral replication. We evaluated the effect of fluvastatin on HCV-RNA levels, CD36 expression and T-cell homeostasis in HCV-RNA positive patients. HCV-RNA was measured at baseline and after 4 weeks in 42 HCV/HIV-1 co-infected patients, randomized to receive either fluvastatin 80 mg qd or no treatment. CD36 expression and markers of T-cell activation were evaluated by means of flow cytometry. Plasma interleukin (IL)-10, IFN-gamma and IL-7 were measured by ELISA. Serum cholesterol and LDL decreased significantly in the treatment group (P = 0.0001 and 0.01, respectively). Surprisingly a significant increase of HCV-RNA levels was seen after 4 weeks of fluvastatin (P = 0.03). The percentages of naive/activated/apoptotic cells and CD36 expression remained unchanged. Fluvastatin did not inhibit HCV-RNA replication in vivo; conversely we observed a significant increase of HCV-RNA levels. CD36 expression on monocytes were not up-regulated by statins as previously reported in vitro. The correlation between HCV infectivity, oxidized-LDL receptor and statins in HCV infection need further evaluation.


Assuntos
Antivirais/uso terapêutico , Ácidos Graxos Monoinsaturados/uso terapêutico , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Hepacivirus/crescimento & desenvolvimento , Hepatite C Crônica/complicações , Indóis/uso terapêutico , Replicação Viral/efeitos dos fármacos , Adulto , Antígenos CD36/análise , Células Cultivadas , Colesterol/sangue , LDL-Colesterol/sangue , Ensaio de Imunoadsorção Enzimática/métodos , Feminino , Fluvastatina , Hepacivirus/efeitos dos fármacos , Humanos , Interferon gama/sangue , Interleucina-10/sangue , Interleucina-7/sangue , Masculino , Pessoa de Meia-Idade , Projetos Piloto , RNA Viral/sangue , Linfócitos T/imunologia , Resultado do Tratamento
16.
HIV Med ; 10(1): 6-11, 2009 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-19125961

RESUMO

Objectives To assess the prevalence, clinical and immunological characteristics, risk factors and survival of patients with AIDS-related cryptococcosis in the era of highly active antiretroviral therapy (HAART). Methods All newly diagnosed cryptococcosis cases identified retrospectively from among a series of AIDS patients hospitalized consecutively at a single institution in Italy in 1985-1996 (pre-HAART period, n=165) and 1997-2006 (post-HAART period, n=40) were analysed comparatively. Results The prevalence of cryptococcosis decreased from 4.7% (165/3543) to 2.2% (40/1805) between the pre- and post-HAART periods (P=0.0001). There were no differences in the clinical features or immunological status of the patients between the two cohorts. The variables associated with the occurrence of cryptococcosis in the post-HAART era were older age (P<0.001), no previous diagnosis of HIV infection (P<0.001) and infection in homosexual males (P=0.004). During the post-HAART period, immune reconstitution inflammatory syndrome associated with cryptococcosis was observed in five patients (19.3%) a median of 15 weeks after the start of HAART. Thirty-day survival (P=0.045) and overall survival (P=0.0001) were significantly better among patients diagnosed with cryptococcosis in the post-HAART compared to those diagnosed in the pre-HAART era. Conclusions The AIDS-associated cryptococcosis observed in Western countries in the HAART era has similar clinical and immunological characteristics to that observed in the pre-HAART era, but a significantly better outcome.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/complicações , Terapia Antirretroviral de Alta Atividade , Criptococose/etiologia , HIV-1 , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Adulto , Idoso , Antifúngicos/uso terapêutico , Contagem de Linfócito CD4 , Criptococose/tratamento farmacológico , Criptococose/epidemiologia , Feminino , Hospitalização , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Análise de Sobrevida , Carga Viral , Adulto Jovem
18.
Br J Dermatol ; 157(5): 1032-6, 2007 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-17854365

RESUMO

Post-kala-azar dermal leishmaniasis (PKDL) is a complication of visceral leishmaniasis (VL) observed mainly in Sudan and India where it follows treated VL in 50% and 10% of cases, respectively. We report a 46-year-old patient with acquired immune deficiency syndrome who, 7 months after diagnosis of VL, developed PKDL and uveal leishmaniasis following HAART-induced immune recovery. In southern Europe PKDL seems to be an emerging clinical presentation among human immunodeficiency virus (HIV)-infected patients experiencing HAART-induced immune recovery after a previous diagnosis of VL. The best treatment among HIV-infected patients remains to be determined.


Assuntos
Leishmaniose Cutânea/etiologia , Leishmaniose Visceral/complicações , Síndrome da Imunodeficiência Adquirida/tratamento farmacológico , América , Antiprotozoários/uso terapêutico , Terapia Antirretroviral de Alta Atividade , Ásia , Humanos , Itália/etnologia , Leishmaniose Cutânea/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Pentamidina/uso terapêutico , Fosforilcolina/análogos & derivados , Fosforilcolina/uso terapêutico , Viagem
19.
Clin Microbiol Infect ; 11(5): 343-6, 2005 May.
Artigo em Inglês | MEDLINE | ID: mdl-15819858

RESUMO

Analysis of the literature on cutaneous leishmaniasis in low-prevalence countries suggests an increase in imported cases that is attributable to the growing phenomenon of international tourism, migration and military operations in highly endemic regions. Cases of imported cutaneous leishmaniasis are often missed initially, but diagnosis can be made non-invasively by PCR using skin scrapings of lesions as starting material. Cutaneous leishmaniasis is an emerging threat for travellers and should be considered in all patients presenting with slow-to-heal ulcers.


Assuntos
Leishmania , Leishmaniose Cutânea/epidemiologia , Viagem , Animais , Emigração e Imigração , Saúde Global , Humanos , Leishmania/genética , Leishmania/isolamento & purificação , Leishmaniose Cutânea/diagnóstico , Militares , Reação em Cadeia da Polimerase , Fatores de Risco
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