Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 24
Filtrar
1.
Vaccines (Basel) ; 11(12)2023 Dec 10.
Artigo em Inglês | MEDLINE | ID: mdl-38140239

RESUMO

Long-term analyses of the immune response following SARS-CoV-2 mRNA vaccines are essential to determining its characteristics and providing the basis for vaccination strategies. We conducted a prospective study in a cohort of 268 healthy adults followed for >2 years after two doses of BNT162b2. Antibodies targeting the receptor-binding domain of the S1 subunit of the spike of SARS-CoV-2 (anti-RBD) were measured at eight time points; T cell response was analyzed using an interferon-γ release assay. A total of 248 (93%) subjects received mRNA-1273 on month 9; 93 (35%) received the bivalent Omicron-adapted BNT162b2 vaccine between months 19 and 26. Breakthrough infections occurred in 215 (80%) participants, with frequencies unaffected by the additional vaccines. Anti-RBD declined over the initial 9 months, increased after mRNA-1273, and declined gradually thereafter. In 50 (17%) previously infected subjects, anti-RBD levels were significantly higher up to month 9 (p < 0.05) but subsequently declined below those of uninfected individuals. Anti-RBD titers protective against SARS-CoV-2 could not be defined. Most subjects developed a positive T cell response that remained after 26 months. Waning of protection against SARS-CoV-2 infection occurred over time, resulting in non-severe breakthrough infections in most participants. The evolution of anti-RBD suggests modulation of the immune response through immune imprinting.

3.
Clin Microbiol Infect ; 28(1): 139.e1-139.e4, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34508885

RESUMO

OBJECTIVE: To assess the antibody response in non-immunocompromised adults after two doses of BNT162b2. METHODS: Prospective, single-centre observational study in non-immunocompromised adults aged 18 years or more who received two doses of BNT162b2. The study contemplates analyses of serum samples collected 1.5, 3, 6, 9 and 12 months after the second dose of BNT162b2; results of the 1.5- and 3-month time-points are presented in this report. Antibodies against the receptor binding domain of the S1 subunit of the spike protein of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (anti-RBD antibodies) were measured using a commercial quantitative immunoassay. A threshold of 4160 AU/mL (corresponding to an ID50 of 1:250) was used as surrogate marker for serum neutralizing activity. RESULTS: Of 273 hospital workers who received two doses of BNT162b2, 260 (95%) agreed to participate in the study; 2/260 (0.8%) were excluded because of immunocompromised conditions. At the time of this report, 230/258 (89%) participants (mean age 46.0 years (SD 11.4 years); 143/230 (62%) female; 87/230 (38%) male) had completed 3 months of follow up after the second dose of BNT162b2. Thirty-six (16%) of the 230 had documented mild SARS-CoV-2 infection before receiving the first dose of BNT162b2. Median (interquartile range (IQR)) anti-RBD titres 1.5 months after vaccination were 9356 (5844-16 876) AU/mL; 3 months after vaccination, median anti-RBD titres had declined to 3952 (2190-8561) AU/mL (p < 0.001). Of 199/230 (86.5%) participants who had anti-RBD titres above 4160 AU/mL 1.5 months after the second dose of BNT162b2, only 95/230 (41%) maintained anti-RBD titres above this level 3 months after vaccination (p < 0.001). CONCLUSIONS: The decline of anti-RBD antibodies 3 months after the second dose of BNT162b2 is of concern because it raises the possibility of a short-lived humoral immunity after vaccination. Booster doses of BNT162b2 might be required to maintain high titres of anti-RBD antibodies over time.


Assuntos
Anticorpos Antivirais/sangue , Vacina BNT162 , COVID-19 , Adulto , Vacina BNT162/imunologia , COVID-19/imunologia , Feminino , Humanos , Imunização Secundária , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Glicoproteína da Espícula de Coronavírus/imunologia
7.
Enferm. infecc. microbiol. clín. (Ed. impr.) ; 36(6): 336-341, jun.-jul. 2018. tab
Artigo em Espanhol | IBECS | ID: ibc-176583

RESUMO

INTRODUCCIÓN: La rotura de los ligamentos cruzados de la rodilla es frecuente y se repara mediante ligamentoplastia artroscópica. Entre sus complicaciones está la artritis séptica. El objetivo de este trabajo es describir las características clínicas y microbiológicas de esta entidad. MÉTODOS: Revisión retrospectiva de casos de artritis séptica tras ligamentoplastia de rodilla ocurridos en una institución durante los años 2000-2015. Según los días transcurridos desde la ligamentoplastia, la infección se consideró aguda (< 14 días), subaguda (> 14 días y < 30 días) o tardía (> 30 días). Se realizó un análisis descriptivo y comparativo, estratificado según el tipo de infección y microorganismo causante. RESULTADOS: Se intervinieron 3.219 pacientes; 30 (0,9%) desarrollaron artritis séptica. Diecisiete (57%) infecciones fueron agudas, 12 (40%) subagudas y una tardía. Los microorganismos causantes fueron Staphylococcus coagulasa-negativos (n = 13; 43%), Staphylococcus aureus (n = 12; 40%), otros cocos grampositivos (n = 3; 10%) y bacilos gramnegativos (n = 2; 7%). Se realizó desbridamiento artroscópico en todos los casos; en ninguno fue necesario retirar la plastia. Los pacientes recibieron tratamiento antibiótico durante una mediana de 23,5 días (rango, 14 - 78 días); todas las infecciones se curaron. No se evidenciaron diferencias significativas en ninguna de las variables analizadas entre el tipo de infección o el microorganismo responsable. CONCLUSIONES: La artritis séptica es una complicación poco frecuente de la ligamentoplastia de rodilla. Se manifiesta generalmente dentro de las 4 semanas después de la cirugía y está causada por Staphylococcus. El tratamiento consiste en desbridamiento artroscópico precoz (pudiendo no ser necesario retirar la plastia) y antibioterapia


INTRODUCTION: Rupture of cruciate ligaments of the knee is a common injury that is repaired by arthroscopic reconstruction, which can give rise to septic arthritis. The objective of this article is to describe the clinical and microbiological aspects of this entity. METHODS: Retrospective review of cases of septic arthritis following arthroscopic reconstruction of cruciate ligaments of the knee that occurred at a single institution from 2000-2015. According to time elapsed from surgery, infections were classified as acute (< 14 days), subacute (> 14 days and < 30 days), and late (> 30 days). A descriptive and comparative analysis stratified by type of infection and causative microorganism was performed. RESULTS: 3,219 patients underwent arthroscopic reconstruction of cruciate ligaments of the knee and 30 (0.9%) developed septic arthritis. Seventeen (57%) were acute infections and 12 (40%) subacute; there was one late infection. The causative microorganisms were coagulase-negative Staphylococci (n = 13; 43%), Staphylococcus aureus (n = 12; 40%), other grampositive cocci (n = 3; 10%), and gramnegative bacilli (n = 2; 7%). All patients underwent arthroscopic debridement; no grafts were removed. All patients received antibiotic therapy for a median of 23.5 days (range: 14 - 78 days); all infections were cured. No significant differences were found in any of the variables analysed among the infection type or the causative microorganism. CONCLUSIONS: Septic arthritis after arthroscopic reconstruction of cruciate ligaments of the knee is uncommon. It generally presents within 4 weeks of surgery and is caused by Staphylococci. Its treatment consists of arthroscopic debridement (without necessarily removing the graft) and antibiotic therapy


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Artrite Infecciosa/etiologia , Artroscopia/efeitos adversos , Lesões do Ligamento Cruzado Anterior/cirurgia , Antibacterianos/uso terapêutico , Estudos Retrospectivos , Complicações Pós-Operatórias , Artrite Infecciosa/tratamento farmacológico
8.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-28651785

RESUMO

INTRODUCTION: Rupture of cruciate ligaments of the knee is a common injury that is repaired by arthroscopic reconstruction, which can give rise to septic arthritis. The objective of this article is to describe the clinical and microbiological aspects of this entity. METHODS: Retrospective review of cases of septic arthritis following arthroscopic reconstruction of cruciate ligaments of the knee that occurred at a single institution from 2000-2015. According to time elapsed from surgery, infections were classified as acute (< 14 days), subacute (> 14 days and<30 days), and late (> 30 days). A descriptive and comparative analysis stratified by type of infection and causative microorganism was performed. RESULTS: 3,219 patients underwent arthroscopic reconstruction of cruciate ligaments of the knee and 30 (0.9%) developed septic arthritis. Seventeen (57%) were acute infections and 12 (40%) subacute; there was one late infection. The causative microorganisms were coagulase-negative Staphylococci (n=13; 43%), Staphylococcus aureus (n=12; 40%), other grampositive cocci (n=3; 10%), and gramnegative bacilli (n=2; 7%). All patients underwent arthroscopic debridement; no grafts were removed. All patients received antibiotic therapy for a median of 23.5 days (range: 14 - 78 days); all infections were cured. No significant differences were found in any of the variables analysed among the infection type or the causative microorganism. CONCLUSIONS: Septic arthritis after arthroscopic reconstruction of cruciate ligaments of the knee is uncommon. It generally presents within 4 weeks of surgery and is caused by Staphylococci. Its treatment consists of arthroscopic debridement (without necessarily removing the graft) and antibiotic therapy.


Assuntos
Reconstrução do Ligamento Cruzado Anterior , Artrite Infecciosa/etiologia , Artroscopia , Articulação do Joelho/microbiologia , Reconstrução do Ligamento Cruzado Posterior , Infecção da Ferida Cirúrgica/etiologia , Adulto , Antibacterianos/uso terapêutico , Artrite Infecciosa/tratamento farmacológico , Artrite Infecciosa/microbiologia , Artrite Infecciosa/cirurgia , Bacteriemia/tratamento farmacológico , Bacteriemia/etiologia , Bacteriemia/cirurgia , Terapia Combinada , Desbridamento , Feminino , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Infecções por Bactérias Gram-Negativas/etiologia , Infecções por Bactérias Gram-Negativas/microbiologia , Infecções por Bactérias Gram-Negativas/cirurgia , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Infecções por Bactérias Gram-Positivas/etiologia , Infecções por Bactérias Gram-Positivas/microbiologia , Infecções por Bactérias Gram-Positivas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Infecção da Ferida Cirúrgica/tratamento farmacológico , Infecção da Ferida Cirúrgica/microbiologia , Infecção da Ferida Cirúrgica/cirurgia , Líquido Sinovial/microbiologia , Adulto Jovem
9.
J Acquir Immune Defic Syndr ; 66(1): 25-32, 2014 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-24378728

RESUMO

OBJECTIVES: Cytomegalovirus (CMV)-specific T-cell effectors (CMV-Teff) protect against CMV end-organ disease (EOD). In HIV-infected individuals, their numbers and function vary with CD4 cell numbers and HIV load. The role of regulatory T cells (Treg) in CMV-EOD has not been extensively studied. We investigated the contribution of Treg and Teff toward CMV-EOD in HIV-infected individuals independently of CD4 cell numbers and HIV load and controlling for CMV reactivations. DESIGN: We matched 43 CMV-EOD cases to 93 controls without CMV-EOD, but with similar CD4 cell numbers and HIV plasma RNA. CMV reactivation was investigated by blood DNA polymerase chain reaction over 32 weeks preceding the CMV-EOD in cases and preceding the matching point in controls. METHODS: CMV-Teff and Treg were characterized by the expression of interferon-γ (IFN-γ), interleukin 2, tumor necrosis factor α (TNFα), MIP1ß, granzyme B (GrB), CD107a, TNFα, FOXP3, and CD25. RESULTS: Sixty-five percent cases and 20% controls had CMV reactivations. In multivariate analyses that controlled for CMV reactivations, none of the CMV-Teff subsets correlated with protection, but high CMV-GrB enzyme-linked immunosorbent spot responses and CMV-specific CD4FOXP3+%, CD4TNFα+%, and CD8CD107a% were significant predictors of CMV-EOD. CONCLUSIONS: Because both FOXP3 and GrB have been previously associated with Treg activity, we conclude that CMV-Treg may play an important role in the development of CMV-EOD in advanced HIV disease. We were not able to identify a CMV-Teff subset that could be used as a surrogate of protection against CMV-EOD in this highly immunocompromised population.


Assuntos
Infecções por Citomegalovirus/epidemiologia , Infecções por Citomegalovirus/imunologia , Infecções por HIV/complicações , Infecções por HIV/imunologia , Subpopulações de Linfócitos T/imunologia , Linfócitos T Reguladores/imunologia , Adulto , Estudos de Casos e Controles , Feminino , Humanos , Leucócitos Mononucleares/imunologia , Masculino , Pessoa de Meia-Idade , Medição de Risco
12.
J Med Virol ; 79(12): 1818-20, 2007 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-17935188

RESUMO

Chronic infection with hepatitis C virus (HCV) is associated with several extrahepatic manifestations, including neuromuscular and joint disorders, and HCV RNA has been detected in muscle fibers of patients with myosistis and chronic hepatitis C. However, whether HCV infects muscle cells in patients without myosistis is unknown. The presence of HCV in other sites of the musculoskeletal system has not been investigated. In the present study the presence of HCV RNA was sought in muscle (2 cases), intervertebral disk (1 case) and meniscus (1 case) samples from patients with chronic hepatitis C. HCV RNA was not detected by reverse transcription and real-time polymerase chain reaction in any of the samples tested. In conclusion, the results do not support a direct role of HCV in musculoskeletal disorders associated with chronic hepatitis C.


Assuntos
Hepacivirus/isolamento & purificação , Hepatite C Crônica/virologia , Disco Intervertebral/virologia , Meniscos Tibiais/virologia , Músculo Esquelético/virologia , Humanos
13.
Arch Intern Med ; 167(6): 597-605, 2007 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-17389292

RESUMO

BACKGROUND: Interleukin 2 (IL-2) administration increases CD4 counts in persons with higher counts. This study investigated persons with moderately advanced human immunodeficiency virus infection receiving highly active antiretroviral therapy (HAART). METHODS: Two hundred four patients with CD4 T-cell counts from 50/microL to 350/microL who were treatment naive or had been treated only with reverse transcriptase inhibitors began a specified protease inhibitor HAART regimen. Virologic responders (< or =5000 copies/mL) at 12 weeks were randomized to open-label continuous-infusion IL-2 (IV IL-2), subcutaneous IL-2 (SC IL-2), or HAART alone. Thirty were not randomized and 15 enrolled in a substudy, leaving 159 for analysis. Subjects continued HAART alone for 72 weeks (n = 52) or with IV IL-2 (n = 53) or SC IL-2 (n = 54) for 5 days every 8 weeks. The IV IL-2 subjects could switch to SC IL-2 if their CD4 T-cell count increased by 100/microL or by 25%. RESULTS: Patients receiving IV or SC IL-2 had greater increases in CD4 cell counts. At week 84, median increases were 459/microL, 312/microL, and 102/microL. Increases of greater than 50% at week 60 (primary end point) were achieved in 39 patients (81%) and 32 (67%) in the IV and SC IL-2 arms, respectively, compared with 13 (29%) in the HAART arm (P<.001 for both). Treatment with IL-2 did not increase plasma human immunodeficiency virus RNA levels. There were fewer new AIDS-defining events in the IV (P = .006) and SC (P = .03) IL-2 groups than in the HAART group (0, 1, and 7, respectively). Drug-related adverse events were more frequent with IL-2 treatment. CONCLUSION: Addition of IL-2 to HAART can significantly expand CD4 T-cell counts in moderately advanced human immunodeficiency virus infection, without loss of virologic control.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Terapia Antirretroviral de Alta Atividade , Infecções por HIV/tratamento farmacológico , Interleucina-2/uso terapêutico , Adolescente , Adulto , Idoso , Contagem de Linfócito CD4 , Esquema de Medicação , Feminino , Infecções por HIV/mortalidade , Infecções por HIV/virologia , Humanos , Infusões Intravenosas , Injeções Subcutâneas , Masculino , Pessoa de Meia-Idade , RNA Viral/sangue , Fatores de Tempo
14.
AIDS ; 20(2): 285-7, 2006 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-16511424

RESUMO

We describe a probable case of HIV-1 transmission from a healthcare worker (HCW) to a patient during a caesarean section. Genetic distance comparisons of the viral sequence of the C2V4 region of the viruses from the patient and the obstetrician showed an average nucleotide sequence divergence of 3% (2.8-3.1). HIV can be transmitted from an infected HCW to a patient when percutaneous injuries with subsequent exposure of the patient to the blood of the HCW can occur.


Assuntos
Cesárea , Infecções por HIV/transmissão , HIV-1 , Transmissão de Doença Infecciosa do Profissional para o Paciente , Adulto , Feminino , Humanos , Corpo Clínico Hospitalar , Ferimentos Penetrantes Produzidos por Agulha , Inabilitação do Médico , Complicações Pós-Operatórias , Gravidez
16.
J Infect Dis ; 193(4): 488-93, 2006 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-16425127

RESUMO

To define the immune correlates of protection against cytomegalovirus (CMV) end-organ disease, CMV-specific interferon (IFN)- gamma enzyme-linked immunospot (ELISPOT) and CD8(+) and CD4(+) intracellular IFN- gamma synthesis assays were performed for subjects with CD4(+) cell counts of < or =50 cells/ microL who were enrolled in a prospective observational study of CMV infection in the era of highly active antiretroviral therapy. Of 87 subjects, 46 developed viremia, 14 developed end-organ disease, and 20 died. Positive ELISPOT assay results, but not positive results for CD4(+) or CD8(+) intracellular IFN- gamma synthesis, were associated with delayed development of viremia and CMV end-organ disease or death. CMV viremia did not appear to boost CMV-specific immunity. ELISPOT assays may be used to identify HIV-infected patients who might benefit from anti-CMV prophylactic interventions.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/virologia , Infecções por Citomegalovirus/imunologia , Citomegalovirus/imunologia , Infecções por HIV/complicações , HIV-1/imunologia , Infecções Oportunistas Relacionadas com a AIDS/imunologia , Adulto , Terapia Antirretroviral de Alta Atividade/métodos , Linfócitos T CD4-Positivos/imunologia , Linfócitos T CD8-Positivos/imunologia , Infecções por Citomegalovirus/epidemiologia , Infecções por Citomegalovirus/mortalidade , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Infecções por HIV/mortalidade , Infecções por HIV/virologia , Humanos , Interferon gama/imunologia , Masculino , Estudos Multicêntricos como Assunto , Estudos Prospectivos , Viremia/epidemiologia , Viremia/mortalidade
17.
Scand J Infect Dis ; 37(6-7): 526-8, 2005.
Artigo em Inglês | MEDLINE | ID: mdl-16012021

RESUMO

A case is reported of cryptococcal meningitis in a 27-y-old male suffering from X-linked hyper-IgM1 syndrome. This congenital disorder is characterized by multiple infections of the respiratory and gastrointestinal tracts, but also opportunistic infections commonly seen in patients with cell-mediated immunity. His clinical recovery was good but the need for life-long secondary chemoprophylaxis to prevent relapses is unknown.


Assuntos
Doenças Genéticas Ligadas ao Cromossomo X/complicações , Hipergamaglobulinemia/complicações , Imunoglobulina M/sangue , Meningite Criptocócica/imunologia , Adulto , Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , Ácido Desoxicólico/uso terapêutico , Combinação de Medicamentos , Fluconazol/uso terapêutico , Humanos , Hipergamaglobulinemia/genética , Masculino , Meningite Criptocócica/tratamento farmacológico
18.
AIDS Res Hum Retroviruses ; 20(11): 1183-8, 2004 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-15588340

RESUMO

HIV-1 protease activity is essential for viral replication. In spite of the high rates of HIV mutation, the active site of protease (residues 24-29) is a conserved site, where mutations have not been previously described. To determine the effect of mutations at positions T26 and A29 of the viral protease and its viability in recombinant HIV-1 strains, Sup-t1 cells were transfected by electroporation with PCR products from a protease containing the 26X or 29X mutation. These mutations were constructed by mutagenesis site directed with degenerative primers. Both changes modified the replicative capacity of the virus: viruses containing the 26X mutation have delayed replication as compared to the control virus HTLVIII B; the presence of the 29X mutation in the viral protease results in the absence of HIV-1 replication. These findings confirm that this region of the viral protease appears to be necessary for the viability of HIV-1, and it could be a good target for antiviral therapy.


Assuntos
Códon/química , Protease de HIV/genética , HIV-1/fisiologia , Mutação , Recombinação Genética , Replicação Viral , Linhagem Celular , Protease de HIV/química , HIV-1/enzimologia , HIV-1/genética , Humanos , Mutagênese Sítio-Dirigida
19.
Clin Infect Dis ; 39(4): 552-8, 2004 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-15356820

RESUMO

We evaluated phenotypic and genotypic markers of drug resistance in human immunodeficiency virus type 1 (HIV-1) at the time of virologic failure (VF) in subjects in the AIDS Clinical Trials Group Protocol 388 (ACTG 388) who received lamivudine-zidovudine (or lamivudine-stavudine) and either indinavir, efavirenz-indinavir, or nelfinavir-indinavir. At VF, phenotypically susceptible HIV-1 was found in 55% of subjects in the nelfinavir-indinavir arm, compared with 22% in the indinavir arm (P=.006). Phenotypic resistance to lamivudine was less common in the efavirenz-indinavir arm (33% of subjects; P=.002) and the nelfinavir-indinavir arm (43%; P=.003), compared with the indinavir arm (78%). Isolated phenotypic resistance to efavirenz at VF occurred in HIV-1 recovered from 33% of subjects in the efavirenz-indinavir arm; 24% of the subjects had HIV-1 with both efavirenz and lamivudine resistance. Results of genotypic tests were similar. The lower frequency of resistance in the nelfinavir-indinavir arm likely reflects decreased drug exposure that is due to intolerance, which is consistent with the lower potency and tolerability of this combination in ACTG 388. The lower frequency of lamivudine resistance in the efavirenz-indinavir arm is consistent with reports in other studies of potent regimens. Thus, although dual resistance to efavirenz and lamivudine occurred at VF in the efavirenz-indinavir arm, this risk was relatively low when evaluated in the context of the potency and tolerability of this regimen.


Assuntos
Síndrome da Imunodeficiência Adquirida/tratamento farmacológico , Terapia Antirretroviral de Alta Atividade/métodos , Farmacorresistência Viral/fisiologia , Infecções por HIV/tratamento farmacológico , HIV-1/fisiologia , Adulto , Feminino , Genótipo , Infecções por HIV/metabolismo , Transcriptase Reversa do HIV/sangue , Transcriptase Reversa do HIV/genética , HIV-1/efeitos dos fármacos , HIV-1/enzimologia , HIV-1/genética , Humanos , Indinavir/administração & dosagem , Indinavir/metabolismo , Lamivudina/administração & dosagem , Lamivudina/metabolismo , Masculino , Nelfinavir/administração & dosagem , Nelfinavir/metabolismo , Fenótipo , Estavudina/administração & dosagem , Estavudina/metabolismo , Falha de Tratamento , Zidovudina/administração & dosagem , Zidovudina/metabolismo
20.
J Infect Dis ; 188(5): 625-34, 2003 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-12934177

RESUMO

To compare long-term virologic benefits of antiretroviral regimens in persons with advanced human immunodeficiency virus (HIV) disease, a randomized, open-label study was conducted of 517 subjects with no or limited previous experience with antiretroviral therapy. Subjects received lamivudine plus zidovudine and indinavir (indinavir group), efavirenz plus indinavir (efavirenz + indinavir group), or nelfinavir plus indinavir (nelfinavir + indinavir group) and were monitored for 2.1 years. Virologic failure was lower in the efavirenz + indinavir group (P=.04) and higher in the nelfinavir + indinavir group (P=.006), compared with that in the indinavir group. No difference in grade 3 or 4 adverse event rates in the efavirenz + indinavir group (P=.97) and a trend toward an increased rate in the nelfinavir + indinavir group (P=.07), compared with the indinavir group, were noted. A 4-drug regimen containing efavirenz plus indinavir resulted in a superior virologic response, whereas one containing nelfinavir plus indinavir resulted in an inferior response and a greater likelihood of toxicity.


Assuntos
Fármacos Anti-HIV/administração & dosagem , Infecções por HIV/tratamento farmacológico , Indinavir/administração & dosagem , Nelfinavir/administração & dosagem , Oxazinas/administração & dosagem , Inibidores da Transcriptase Reversa/administração & dosagem , Adulto , Alcinos , Fármacos Anti-HIV/uso terapêutico , Terapia Antirretroviral de Alta Atividade , Benzoxazinas , Ciclopropanos , Farmacorresistência Viral/genética , Feminino , Infecções por HIV/virologia , HIV-1/efeitos dos fármacos , HIV-1/genética , Humanos , Indinavir/uso terapêutico , Masculino , Nelfinavir/uso terapêutico , Oxazinas/uso terapêutico , Cooperação do Paciente , RNA Viral/sangue , Inibidores da Transcriptase Reversa/uso terapêutico , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...