RESUMO
One hundred eighty-one antiretroviral-experienced, protease inhibitor-naive, clinically stable HIV-infected children between 4 months and 17 years of age were randomly assigned to receive one of four combination regimens to evaluate the change in plasma HIV RNA, safety, and tolerance when changing antiretroviral therapy to a protease inhibitor-containing combination regimen. All four regimens contained stavudine; in addition children received nevirapine plus ritonavir, lamivudine plus nelfinavir, nevirapine plus nelfinavir, or lamivudine plus nevirapine plus nelfinavir. Twelve additional children chose to receive stavudine plus lamivudine plus nelfinavir, with nelfinavir given bid, rather than tid as for the main regimens. Overall, 51% (89/176; 95% CI 43-58%) of the children on the randomized portion of the study had an HIV RNA response (< or =400 copies/ml) on at least two of the three HIV RNA determinations taken at Weeks 8, 12, and 16. At Week 24 the proportion of children with an HIV RNA response still on initial therapy was 47% (83/176; 95% CI 40-55%) and ranged from 41 to 61% for the four randomized treatment arms. Rash was frequently seen (27%) on the treatment arms containing nevirapine. At Week 24 64% (7/11, 95% CI 31-89%) of the children on the bid nelfinavir combination regimen were still on initial therapy with an HIV RNA response as compared with 46% (23/50; 95% CI 32-61%) on the corresponding tid nelfinavir combination regimen. A change in antiretroviral therapy to a protease inhibitor-containing regimen was associated with a virological response rate of approximately 50% for this patient population.
Assuntos
Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/tratamento farmacológico , Nelfinavir/uso terapêutico , Nevirapina/uso terapêutico , Inibidores da Transcriptase Reversa/uso terapêutico , Ritonavir/uso terapêutico , Estavudina/uso terapêutico , Criança , Pré-Escolar , Quimioterapia Combinada , Etnicidade , Feminino , Humanos , Lactente , Masculino , Porto Rico , RNA Viral/sangue , Grupos Raciais , Fatores de Tempo , Estados Unidos , Carga ViralRESUMO
Las alteraciones sel Sistema Nervioso ocurren frecuentemente en pacientes infectados con el virus de inmunodeficiencia humana (VIH). Estas alteraciones pueden afectar tanto al Sistema Nervioso Central como al Periférico y pueden ser la manifestación inicial de la Enfermedad Relacionada con el VIH. Las infecciones oportunistas y linfomas son las principales causas de enfermedad del S.N.C., sin embargo el aumento de las infecciones del S.N.C. por VIH ha sido reconocido y se le asocia en la actualidad con un Síndrome de Demencia Progresiva en adultos, denominado como Complejo de Demencia relacionado con SIDA. También se le asocia con una encefalopatía en recién nacidos de madres infectadas con el VIH. Si la enfermedad cerebral relacionada al VIH responderá a las drogas antirretrovirales será el punto de mayor interés en investigaciones futuras. Aunque menos frecuente que la enfermedad del S.N.C., las alteraciones del Sistema Nervioso Periférico están siendo reconocidas cada día más, incluyendo casos que tendrían una base autoinmune.
Assuntos
Humanos , Masculino , Feminino , Síndrome da Imunodeficiência Adquirida/complicações , Manifestações Neurológicas/etiologia , Infecções Oportunistas/etiologiaRESUMO
Two patients from Martinique with tropical spastic paraparesis had antibodies to human T-lymphotropic virus type I (HTLV-I) in serum and spinal fluid but no antibodies to other retroviruses tested. They presented with spastic weakness of both lower extremities, hyperreflexia with upgoing toes, sphincteric dysfunction, and normal sensation. By means of agarose isoelectric focusing and selective immunoblotting we demonstrated an increased intrathecal synthesis of IgG antibodies to HTLV-I in the spinal fluid. Unique oligoclonal bands of IgG antibodies to HTLV-I were present in the cerebrospinal fluid. Using a battery of monoclonal antibodies we also found in these patients an increased number of circulating T cells that expressed activation markers. We conclude that the HTLV-I retrovirus associated with tropical spastic paraparesis has both lymphocytotropic and neurotropic properties.
Assuntos
Paraplegia/imunologia , Medicina Tropical , Adulto , Anticorpos Anti-Idiotípicos/análise , Anticorpos Anti-Idiotípicos/líquido cefalorraquidiano , Anticorpos Antivirais/análise , Anticorpos Antivirais/líquido cefalorraquidiano , Anticorpos Antideltaretrovirus , Feminino , Humanos , Imunoglobulina G/imunologia , Imunoglobulinas/análise , Imunoglobulinas/líquido cefalorraquidiano , Linfócitos/classificação , Imageamento por Ressonância Magnética , Martinica , Pessoa de Meia-Idade , Espasticidade Muscular/complicações , Espasticidade Muscular/imunologia , Espasticidade Muscular/microbiologia , Espasticidade Muscular/patologia , Bandas Oligoclonais , Paraplegia/complicações , Paraplegia/microbiologia , Paraplegia/patologiaAssuntos
Infecções por Coxsackievirus/complicações , Diabetes Mellitus Tipo 1/etiologia , Caxumba/complicações , Gravidez em Diabéticas/etiologia , Infecções por Respirovirus/complicações , Adolescente , Adulto , Anticorpos Antivirais/análise , Diabetes Mellitus Tipo 1/imunologia , Enterovirus/imunologia , Feminino , Humanos , Vírus da Caxumba/imunologia , Gravidez , Gravidez em Diabéticas/imunologia , Vírus Sinciciais Respiratórios/imunologiaRESUMO
Rhesus monkey fetuses were inoculated with Venezuelan Equine Encephalitis (VEE) vaccine virus by the direct intracerebral route at approximately 100 days gestation to determine possible teratogenicity of the virus. Congenital micrencephaly, hydrocephalus and cataracts were found in all animals and porencephaly in 67 percent of the cases. The virus replicated in the brain and other organs of the fetus. VEE vaccine virus is teratogenic for non-human primates and must be considered a potential teratogen of man.
Assuntos
Encéfalo/anormalidades , Encefalomielite Equina/complicações , Encefalomielite Equina Venezuelana/complicações , Anormalidades do Olho , Complicações Infecciosas na Gravidez , Animais , Anticorpos Antivirais/análise , Vírus da Encefalite Equina Venezuelana/imunologia , Encefalomielite Equina Venezuelana/microbiologia , Feminino , Feto/microbiologia , Haplorrinos , Troca Materno-Fetal , Gravidez , Complicações Infecciosas na Gravidez/microbiologiaRESUMO
The immunological responses of patients with clinical signs of SSPE were examined by the direct migration inhibition, complement-mediated antibody cytoxicity and the lymphocyte-mediated cytotoxicity assay techniques. Peripheral lymphocytes migrated similarly to controls when exposed to measles antigen. Lymphocytes from SSPE patients responded to a SSPE strain of measles infected cells in a manner similar to lymphocytes from controls. A factor which interfered with the expected activity of sensitized lymphocytes to measles virus was detected in some cerebral spinal fluid obtained from SSPE patients. The blocking activity varied from 100% in 4 of 20 patients with SSPE to no blocking in 2 of the SSPE patients. The occurrence of blocking factor in SSPE patients could not be related to sex or age of the patient, serum of CSF antibody levels, and duration of disease or outcome.