RESUMO
The routine use of granulocyte-colony stimulating factor (G-CSF) for 10 days during full-dose cyclophosphamide-doxorubicin-vincristine-prednisone (CHOP) chemotherapy in HIV-associated diffuse non-Hodgkin's lymphoma (NHL) patients is very expensive in developing countries. We treated 22 HIV-associated diffuse NHL patients with standard-dose CHOP and used G-CSF after an episode of febrile neutropenia until neutrophil count reached 1000/mm3. The clinical response was: complete response (36%), partial response (32%), stable disease (14%) and progression (18%). There were no toxicity-related deaths. Grade 3 or 4 neutropenia was observed in 16% of cycles, but only 8% were complicated with febrile neutropenia. Seventeen patients died (median survival 15 months; range 2-70). There are five patients alive (median survival 24+ months; range 17-36+). Our experience showed that we can treat HIV-related NHL patients with full-dose CHOP, achieve good responses and have an acceptable toxicity profile, with the use of G-CSF as needed.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Linfoma Relacionado a AIDS/tratamento farmacológico , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Ciclofosfamida/administração & dosagem , Ciclofosfamida/efeitos adversos , Doxorrubicina/administração & dosagem , Doxorrubicina/efeitos adversos , Feminino , Febre/induzido quimicamente , Febre/prevenção & controle , Fator Estimulador de Colônias de Granulócitos/administração & dosagem , Humanos , Masculino , Dose Máxima Tolerável , Pessoa de Meia-Idade , Neutropenia/induzido quimicamente , Neutropenia/prevenção & controle , Prednisona/administração & dosagem , Prednisona/efeitos adversos , Estudos Prospectivos , Resultado do Tratamento , Vincristina/administração & dosagem , Vincristina/efeitos adversosRESUMO
This study estimated the frequency and assessed the clinical value of nine primitive reflexes (PR) in 78 AIDS cases, comparing them with 81 matched, seronegative controls. All subjects were evaluated with a standardized neurologic examination that included a Mini-Mental State Exam (MMSE). Fifty-six percent had cognitive impairment and PR. Overall, PR were 2-36 times more frequent in cases. Such association was univariately stronger for the glabellar, snout, and Rossolimo signs. Ninety-two percent of cases had > or = 2 PR vs. 8% of controls, who had up to 2 PR (p < 0.0001; 95 CI: 68% to 100%). We were able isolate or show opportunistic pathogens in CSF of 4 out of 43 cases. This study supports the association of PR to cognitive decline in patients with AIDS. Larger, long term follow-up studies with multivariate analysis in Latin America are needed to identify the PR that can serve as reliable indicators of human immunodeficiency virus type 1 (HIV-1)-associated cognitive/motor complex.
Assuntos
Síndrome da Imunodeficiência Adquirida/fisiopatologia , Transtornos Cognitivos/etiologia , Reflexo/fisiologia , Síndrome da Imunodeficiência Adquirida/complicações , Adolescente , Adulto , Estudos de Casos e Controles , Transtornos Cognitivos/diagnóstico , Interpretação Estatística de Dados , Feminino , Soropositividade para HIV , Humanos , Masculino , Entrevista Psiquiátrica Padronizada , Exame Neurológico , Reflexo Anormal/fisiologia , Reflexo de Babinski/fisiologiaRESUMO
BACKGROUND: Systemic chemotherapy is a treatment modality in the management of epidemic Kaposi's sarcoma (EKS). We conducted a prospective trial to compare bleomycin as a single agent with a regimen of low-dose doxorubicin, bleomycin, and vincristine (ABV) in patients with advanced EKS. METHODS: Twenty-four homosexual or bisexual patients, between 21 and 40 years old, with positive enzyme-linked immunosorbent assay (ELISA) test for HIV and extensive EKS were included in the study. Half of the patients received bleomycin alone and the other half ABV. RESULTS: A total of seven patients achieved stable disease (SD) and five progressed during bleomycin treatment. A total of four patients achieved partial remission and eight SD during ABV treatment. There was no survival benefit between either arm of treatment. CONCLUSIONS: Bleomycin alone is not a good starting agent for EKS, whereas ABV seems to be a good choice, because it can produce an acceptable palliation of advanced EKS without major toxicity.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Bleomicina/administração & dosagem , Bleomicina/uso terapêutico , Doxorrubicina/administração & dosagem , Sarcoma de Kaposi/tratamento farmacológico , Vincristina/administração & dosagem , Adulto , Humanos , Masculino , Estudos Prospectivos , Sarcoma de Kaposi/mortalidade , Taxa de SobrevidaAssuntos
Infecções Oportunistas Relacionadas com a AIDS/complicações , Leishmania/genética , Leishmaniose Visceral/complicações , Infecções Oportunistas Relacionadas com a AIDS/parasitologia , Adulto , Animais , Sequência de Bases , Primers do DNA/genética , DNA de Protozoário/genética , Feminino , Variação Genética , Humanos , Leishmania/classificação , Leishmania braziliensis/genética , Leishmania mexicana/genética , Leishmaniose Visceral/parasitologia , Dados de Sequência Molecular , Reação em Cadeia da PolimeraseAssuntos
Síndrome da Imunodeficiência Adquirida/complicações , Leishmania braziliensis/isolamento & purificação , Leishmaniose Cutânea/complicações , Leishmaniose Visceral/complicações , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Síndrome da Imunodeficiência Adquirida/imunologia , Adulto , Animais , Antineoplásicos/uso terapêutico , Antiprotozoários/uso terapêutico , Fator Estimulador de Colônias de Granulócitos e Macrófagos/uso terapêutico , Humanos , Leishmaniose Cutânea/diagnóstico , Leishmaniose Cutânea/tratamento farmacológico , Leishmaniose Visceral/diagnóstico , Leishmaniose Visceral/tratamento farmacológico , Masculino , Meglumina/uso terapêutico , Antimoniato de Meglumina , Compostos Organometálicos/uso terapêutico , Proteínas Recombinantes/uso terapêutico , Doenças Retais/complicações , Doenças Retais/microbiologiaRESUMO
In the present study, 11 patients with epidemic Kaposi sarcoma were evaluated; 55% were in stage IV and 45% in stage II; in addition, 75% had systemic symptoms, 89% had low total and T-lymphocyte counts, and all of them had not only low T-helper lymphocyte counts but also T-helper/T-suppressor ratios. The majority of patients (89%) had low proliferative responses with phytohemagglutinin (PHA). Nine patients were treated with: alpha-2 interferon (five patients), zidovudine (two patients), doxorubicin and zidovudine (one patient), and radiotherapy (one patient). There were only five patients with stable disease, three treated with alpha-2 interferon, one with doxorubicin, and one with doxorubicin plus azidothymidine. Two patients (one with doxorubicin and one with doxorubicin plus zidovudine) needed lithium to increase leukocyte and platelet counts. In May 1989, 73% of patients were dead (median survival 8 +/- 2 months). It is concluded that: (1) it is important to select the patients who have the best chance to improve with treatment; (2) the response with alpha-2 interferon or monochemotherapy is low and there is no change in overall survival; (3) a low helper cell count, low T-helper/T-suppressor ratio, and low proliferative response with mitogens are features of poor prognosis; (4) toxicity with treatment was acceptable; and (5) lithium increased neutrophil and platelet counts.