RESUMO
Treatment of chronic hepatitis C is still unspecific. However, there is great expectancy concerning the new pegylated interferons. As there has been much controversy about the best parameters to determine whether treatment is effective, we analyzed several criteria currently used for evaluation, including serum alanine aminotransferase (ALT) normalization, viral load reduction and improvement of hepatic histology.
Assuntos
Avaliação de Medicamentos/métodos , Avaliação de Medicamentos/normas , Hepatite C Crônica/sangue , Hepatite C Crônica/tratamento farmacológico , Alanina Transaminase/sangue , Antivirais/uso terapêutico , Hepacivirus/genética , Hepacivirus/isolamento & purificação , Hepatite C Crônica/virologia , Humanos , Interferons/uso terapêutico , Fígado/patologia , Fígado/virologia , Carga ViralRESUMO
Treatment of chronic hepatitis C is still unspecific. However, there is great expectancy concerning the new pegylated interferons. As there has been much controversy about the best parameters to determine whether treatment is effective, we analyzed several criteria currently used for evaluation, including serum alanine aminotransferase (ALT) normalization, viral load reduction and improvement of hepatic histology.
Assuntos
Humanos , Avaliação de Medicamentos/métodos , Avaliação de Medicamentos/normas , Hepatite C Crônica/sangue , Hepatite C Crônica/tratamento farmacológico , Antivirais , Interferons , Hepacivirus , Carga Viral , Alanina Transaminase , Fígado/patologia , Fígado/virologia , Hepatite C Crônica/virologiaRESUMO
UNLABELLED: Lamivudine and zidovudine are proving to be an important antiretroviral combination against HIV that is superior to monotherapy. Recently, with the appearance of protease inhibitors, ritonavir has been shown to be a powerful drug when used in combination with reverse transcriptase inhibitors. The objective of this study was to observe the efficacy, adverse events, and changes in the quality of life of AIDS patients receiving treatment for the first time using AZT, 3TC and ritonavir as combination therapy. We selected 36 patients diagnosed with AIDS due to opportunistic infections and evaluated them by assessing their score on quality of life scales (Karnofsky, uniscale - Quality of Life, and Quality of Life Scale), T CD(4) and CD(8) lymphocyte counts, bodyweight and symptoms during a 6 month period. Assessments were made at 2 month intervals. One patient was excluded from the trial, therefore, 35 were assessed during 6 months. RESULTS: Bodyweight increased an average of 7.2%, CD(4) increased 260 cells/mm(3) and CD(8) increased 198 cells/mm(3). The Karnofsky and uniscale QOL scales reached 100% on the fourth visit. The Quality of Life Scale showed an important increase during this study from 5.5+/-2.3 to 9.7+/-0.5. Adverse events were observed in 25.0% of the patients, most being slight. One patient had to stop taking ritonavir due to nausea and vomiting. We conclude that AZT, 3TC, and ritonavir restored the quality of life for the AIDS patients studied in terms of psychosocial aspects and overall health conditions during 6 months of treatment. The adverse events were probably related to ritonavir, but they were slight and disappeared after 2 weeks. There was a significant increase in the average number of CD(4) lymphocytes during 6 months of treatment.
Assuntos
Síndrome da Imunodeficiência Adquirida/tratamento farmacológico , Síndrome da Imunodeficiência Adquirida/psicologia , Fármacos Anti-HIV/uso terapêutico , Qualidade de Vida , Adulto , Peso Corporal , Contagem de Linfócito CD4 , Quimioterapia Combinada , Feminino , Humanos , Lamivudina/administração & dosagem , Masculino , Ritonavir/administração & dosagem , Carga Viral , Zidovudina/administração & dosagemRESUMO
It has been suggested that HIV plays a role in the generation of myeloproliferative disorders, including polycythemia vera (PV). Seven cases of polycythemia in HIV patients have been described in the literature, but only 3 of these met criteria for determining a primary origin (vera) of polycythemia. We report a case of PV in a patient infected with HIV. A 45 year old non-smoking homosexual male presented with 15.7 g/dl hemoglobin in 1991, and was diagnosed with HIV. After 7 years, he presented with plethora, splenomegaly, an erythrocyte mass of 71 ml/kg, and an oxygen saturation of 93.9% (the latter three constituting the major criteria for the diagnosis of PV). Erythrocytes 7.35 x 10(6)/ml hemoglobin, 21.4 g/dl, hematocrit 63%, leukocytes 12,400, erythropoietin < 5 nmoll/ml. These values are all compatible with a diagnosis of PV. The CD4 count was 321 cells/mm(3) and HIV viral load was undetectable. The patient was initially treated with zidovudine. He was then treated with didanosine, lamivudine, and saquinavir, but all of them failed to slow the increase in erythrocyte levels. After a diagnosis of PV, he was treated with hydroxyurea and phlebotomy, which normalized the hemogram. CD4 count rose to 474 cells/mm(3) and HIV viral load remained at undetectable levels. The patient remains in stable condition with combination treatment after 1 year. We suggest that this is a case of HIV infection which may have led to the emergence of polycythemia vera. Treatment of the HIV did not prevent the appearance of the myeloproliferative disorder.
Assuntos
Infecções por HIV/complicações , Policitemia Vera/diagnóstico , Fármacos Anti-HIV/administração & dosagem , Antineoplásicos/administração & dosagem , Diagnóstico Diferencial , Esquema de Medicação , Quimioterapia Combinada , Humanos , Hidroxiureia/administração & dosagem , Masculino , Pessoa de Meia-Idade , Policitemia Vera/tratamento farmacológico , Policitemia Vera/etiologiaRESUMO
In Brazil, only 35 cases of human fascioliasis have been reported. Several drugs have been used to treat Fasciola hepatica in humans, including praziquantel, and, more recently, triclabendazole. After three patients were diagnosed as having human fascioliasis by routine stool parasitological examinations done at Hospital de Clínicas UFPR, a study was done to determine the frequency of the infection in people and cattle from the surrounding area. Stool samples from 185 people and from 20 bovines were examined. Nine bovines' exams were positive for Fasciola hepatica and six new diagnoses of human fascioliasis were made. After taking a medical history, physical examination, routine blood examinations and biliary imaging in the 9 patients, therapy was given with praziquantel 75mg/Kg daily for 5 days. After 30 and 60 days stool examinations were made to evaluate the therapy's efficacy. All patients were asymptomatic. Hematological examinations were normal, and only one patient had an abnormal biliary system on the image study (echography). In the nine patients, praziquantel did not eliminate the fasciola eggs. Triclabendazole (a benzimidazole licensed for veterinary use) was therefore tested, 10mg/Kg one oral dose. Triclabendazole was effective and well tolerated in all patients. We conclude that fascioliasis is more common in some regions of Brazil than previously reported, and that single dose triclabendazole is effective and well tolerated in treating human fascioliasis.
RESUMO
Studies have demonstrated that HIV infection negatively affects the immune response to hepatitis B vaccine. The present study evaluated the seroconversion to the recombinant vaccine against hepatitis B applied in HIV patients. Twenty-two patients were included in the study group all with confirmed HIV infection and with negative serum markers to hepatitis B. The control group was composed of 18 healthy individuals with negative markers for hepatitis B. All subjects were vaccinated with 20µg of ENGERIX B((R)) at 0, 1 and 6 months (3 doses). The antibody response was quantitatively assessed 1 month after the third dose of recombinant vaccine. CD4 T lymphocyte counts were also performed in those beginning vaccination. Of 22 patients in the study group, only 10 (45.5%) responded to vaccination with protective levels (over 10mIU/ml). In the control group, all of the subjects responded (p=0.005). Seventeen patients in the study group had their CD4 lymphocytes measured. The results suggested a direct relationship between the level of CD4 lymphocyte counts and response to the vaccine. The rate of response to hepatitis B recombinant vaccine with 3 doses of 20µg of HBsAg in patients infected by the human immunodeficiency virus was significantly lower than in the control group. Patients with low CD4 T lymphocyte counts are likely to have an inadequate response to the current method of hepatitis B vaccination.
RESUMO
Peptides present in a methanol extract prepared from skin of the Costa Rican frog Agalychnis callidryas of the Phyllomedusinae subfamily were studied by sequence analysis and pharmacological tests. Members of five different peptide families-tachykinins, bradykinins, caerulein, opioid peptides and sauvagine-were found. In particular, the extract contained a number of tachykinins with the following sequences: Gly-Pro-Pro-Asp-Pro-Asn-Lys-Phe-Ile-Gly-Leu-Met-NH2, Gly-Pro-Pro-Asp-Pro-Asp-Arg(Lys)-Phe-Tyr-Pro-Gly-Met-NH2, pGlu-Pro-Asp-Pro-Asp-Arg-Phe-Tyr-Pro-Gly-Met-NH2, Gly-Pro-Pro-Asp-Pro-Asn-Lys-Phe-Tyr-Pro-Val-Met. The latter three peptides have the unusual C-terminal sequence Pro-Gly(or Val)-Met-NH2 rather than Gly-Leu-Met-NH2 found in many other members of the tachykinin family. The observed amino acid substitutions may be the reason for the marked decrease in the biological activity observed in all in vitro and in vivo tests, even through the spectrum of tachykinin activities was retained. A kassinin-like peptide, with the sequence Gly-Pro-Pro-Asp-Pro-Asn-Lys-Phe-Ile-Gly-Leu-Met-NH2, was also found in the A. callidryas skin. While kassinin has a much higher affinity for NK-3 than for NK-1 receptors, the opposite is true for this A. callidryas peptide. The extract from A. callidryas skin also contained a new caerulein (pGlu-Asp-Tyr(HSO3)-Lys-Gly-Trp-Met-Asp-Phe-NH2) and a phyllokinin (Arg-Pro-Hyp-Gly-Phe-Ser-Pro-Phe-Arg-Ile-Tyr), as well as the opioid peptides dermorphin and [Hyp6]dermorphin, both previously isolated from different Phyllomedusa species.