RESUMO
The WHO recommends antiretroviral therapy (ART) for most HIV-infected tuberculosis patients. To assess the impact of ART on tuberculosis case-fatality rates in Cambodia, we compared treatment outcomes of patients newly diagnosed with tuberculosis in 2004 (before implementation of ART clinics) with outcomes of patients diagnosed in 2005 (after these clinics opened). In 2004, 37% of HIV-infected tuberculosis patients died during TB treatment compared with 5% of HIV-uninfected tuberculosis patients. In 2005, 18% of HIV-infected tuberculosis patients died compared with 5% of HIV-uninfected tuberculosis patients. The case-fatality rate for HIV-associated tuberculosis decreased from 2004 to 2005, coincident with the introduction of ART.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/tratamento farmacológico , Infecções por HIV/mortalidade , Tuberculose Pulmonar/mortalidade , Infecções Oportunistas Relacionadas com a AIDS/complicações , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Camboja/epidemiologia , Criança , Pré-Escolar , Feminino , Infecções por HIV/complicações , HIV-1 , Humanos , Masculino , Pessoa de Meia-Idade , Saúde Pública , Fatores de Risco , Resultado do Tratamento , Tuberculose Pulmonar/complicações , Adulto JovemRESUMO
This study explores amino acid changes of the reverse transcriptase (rt) of CRF01_AE isolates from pregnant women naive to antiretroviral drugs before and 2, 6, and 52 weeks after exposure to single dose nevirapine (sdNVP). Results based on 51 observations showed that the proportion of isolates with nonnucleoside reverse transcriptase inhibitor (NNRTI) RMs in the group treated with sdNVP (n = 35) increased from 0% pre-NVP to 22.9% at week 2 postpartum (pp) and 22.9% at week 6 pp. In the group treated with zidovudine + sdNVP (n = 16), the proportion with RM was 31.3% and 18.8% at weeks 2 and 6 pp, respectively. Only a few RMs were still detected at week 52 pp. No apparent subtype-specific treatment-related mutations were detected. NNRTI RM occurrence in CRF01_AE strains is similar to subtype A, D, and CRF02_AG strains after exposure to antiretroviral drugs for PMTCT.
Assuntos
Infecções por HIV/tratamento farmacológico , Transcriptase Reversa do HIV/genética , HIV-1/genética , Mutação , Nevirapina/uso terapêutico , Complicações Infecciosas na Gravidez/tratamento farmacológico , Inibidores da Transcriptase Reversa/uso terapêutico , Fármacos Anti-HIV/uso terapêutico , Terapia Antirretroviral de Alta Atividade , Camboja , Feminino , Infecções por HIV/prevenção & controle , Infecções por HIV/transmissão , Infecções por HIV/virologia , HIV-1/enzimologia , Humanos , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Dados de Sequência Molecular , Gravidez , Zidovudina/uso terapêuticoRESUMO
A baseline study has been conducted to determine the polymorphism of reverse transcriptase, protease, and envelope genes of HIV-1 isolates from 146 antiretroviral drug-naive Cambodian patients including 22 seroconverters and 124 pregnant women having been diagnosed HIV positive for less than 1 year. Amplification of at least one gene was successful for 144 isolates. All three genes were obtained for 136 isolates. Subtyping showed that CRF01_AE was predominant (130 cases). According to the ANRS September 2004 list, polymorphism substitutions (>50% versus the subtype B consensus) of CRF01_AE at drug resistance positions were observed only in protease: I13V (81%), E35D (87%), M36I (100%), R41K (96%), and H69K (100%). Two strains bore one major resistance mutation to PIs: M46I and N88D. Five other strains carried drug resistance mutations to RTIs: K70R (one strain), V75M (three strains), and K101E (one strain). Of the isolates 4.9% had drug resistance mutations to antiretroviral drugs.
