Navegando por Palavras-chave "HAART"

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    Factors associated with clinical, immunological and virological responses in protease-inhibitor-experienced brazilian children receiving highly active antiretroviral therapy containing Lopinavir-Ritonavir
    (Brazilian Society of Infectious Diseases, 2007-02-01) Machado, Daisy Maria [UNIFESP]; Gouvêa, Aida de Fátima Thomé Barbosa [UNIFESP]; Cardoso, Maria Regina; Beltrão, Suênia Vasconcelos [UNIFESP]; Cunegundes, Kelly Simone [UNIFESP]; Bononi, Fabiana [UNIFESP]; Almeida, Fernanda [UNIFESP]; Cavalheiro, Kaline [UNIFESP]; Angelis, Daniela Souza Araújo de; Succi, Regina Célia de Menezes [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); São Paulo University Faculty of Public Health; Universidade de São Paulo (USP)
    This study evaluates clinical, virological and immunological responses to antiretroviral (ARV) therapy based on Lopinavir/ritonovir (LPV/r) in previously protease -inhibitor-experienced children. The study included 29 Brazilian children (median age = 5.91 years) who had failed previous ARV therapy and had begun a regimen based on LPV/r. At 12 months follow-up, a good virological response to LPV/r therapy was defined as achieving an undetectable viral load or as a decrease in plasma HIV RNA levels to > 1 log. A good immunological response was defined as an increase in CD4+ cell count from baseline sufficient to attain a better CDC immune stage classification. The number of infectious episodes 12 months before and 12 months after beginning LPV/r was assessed. Sixteen (55.2%) and 19 (65.5%) of 29 patients exhibited good virological and immunological responses, respectively. Baseline CD4+ values (>500) predicted both virological and immunological responses (p<0.05). Older children were less likely to develop an immunological response (p<0.001) than younger children. Nine children receiving 3 ARV drugs plus LPV/r showed an immunological response (100%) compared to 10/20 (50%) children receiving 2 drugs plus LPV/r (p=0.01). A lower number (n<5) of infectious episodes was noted after 12 months follow-up in children using the LPV/r regimen (p=0.006). There was a positive correlation between children whose baseline CD4+ values were greater than 500 cells/mm³ and virological responses. Although virological responses to therapy were seen in about half the children (55.2%), the use of HAART containing LPV/r provided clinical and immmunological benefits.
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    Fatores de saúde mental relacionados à qualidade de vida de pacientes com síndrome da imunodeficiência adquirida e portadores do vírus da imunodeficiência humana
    (Universidade Federal de São Paulo (UNIFESP), 2009-11-25) Geocze, Luciana [UNIFESP]; Cítero, Vanessa de Albuquerque [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Introdução: Com o advento da terapia anti-retroviral (TARV) houve um aumento significativo do tempo de vida e da necessidade de maior qualidade de vida (QV) para o paciente com infecção pelo Vírus da Imunodeficiência Humana (HIV). Objetivo: Avaliar a influência de características clínicas, sintomas psiquiátricos, uso de estratégias de enfrentamento, adesão terapêutica e expectativa de auto-eficácia para seguir a TARV, sobre QV do paciente portador de HIV em uso da TARV. Método: em um primeiro momento foi realizado um estudo de revisão sistemática sobre a relação da QV do paciente com HIV e a adesão terapêutica ao anti-retroviral; em um segundo momento foi desenvolvido um estudo de corte transversal, com amostra randomizada de 200 pacientes do Central de distribuição de medicamentos da UNIFESP (CCDI) que responderam ao Hospital Anxiety and Depression Scale, ao WHOQOLHIV, ao Inventário de Estratégias de Enfrentamento e à Escala de Auto-Eficácia para Adesão ao Tratamento Anti-Retroviral. Resultados: doze artigos foram revisados, mostrando que os estudos descritivos apontam a associação entre maior adesão terapêutica e maior QV, porém os ensaios clínicos não confirmam este dado. A pesquisa mostrou que, controlados para tempo de diagnostico de HIV, contagem de CD4+ e escore de sintomas depressivos, a diminuição dos domínios de QV foram preditas por estratégias de enfrentamento focadas na emoção e auto-eficácia prejudicada por experiências negativas com a medicação e com situação que exija planejamento. Conclusão: A identificação dos fatores preditores de maior QV podem ajudar o infectologista a lidar melhor com as dificuldades apresentadas por seus pacientes. O manejo terapêutico, primordialmente multiprofissional, deve incluir a abordagem emocional do paciente.
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    Immunologic features of HIV-1-infected women on HAART at delivery
    (Wiley-Blackwell, 2008-07-01) Ono, Erika [UNIFESP]; Dos Santos, Amelia Miyashiro [UNIFESP]; Machado, Daisy Maria [UNIFESP]; Succi, Regina Célia de Menezes [UNIFESP]; Amed, Abes Mahmed [UNIFESP]; Salomão, Reinaldo [UNIFESP]; Kallas, Esper Georges [UNIFESP]; De Moraes-Pinto, Maria Isabel [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Background: the conjoint effect of HIV infection and pregnancy on the immune system of women submitted to the prophylactic antiretroviral therapy presently recommended is still poorly understood.Methods: We evaluated 44 HIV-infected women (HIV) and 45 HIV-negative women (CT) at parturition and we compared them to 20 healthy nonpregnant women (NP). Immunophenotyping of lymphocytes was done by four-color flow cytometry.Results: All HIV-infected women received HAART during pregnancy and 56.8% had viral load <50 copies/mL at delivery. CD4+T cells/mm(3) were lower in HIV (447) than CT (593) and NP (738) (P < 0.05). CD8+T cells/mm(3) were higher in HIV (799) than CT (384) and NP (395) (P < 0.05). NK cells/mm(3) were lower in HIV (146) than in CT (253) and NP (198) (P < 0.05). CD38 expression on CD4+T and on CD8+T cells was higher in HIV (CD4:12.1; CD8:14.9) than in CT(CD4:9.2; CD8:10.2) and NP(CD4:8.6; CD8:6.0) (P < 0.05). However, CD56 expression on CD8+T cells (a marker of cytolytic effector function) was lower in HIV(7%) than in CT(12%) and NP(9%) (P < 0.05).Conclusions: Even with low levels of viremia, HIV-infected women at delivery showed a different immunologic profile from both healthy non-HIV-infected women in the puerperium and nonpregnant women, with lower CD4+T and higher CD8+T cells, high levels of CD38 expression, but low CD56 expression on CD8+T cells and low NK cell numbers. (C) 2008 Clinical Cytometry Society.
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    Retinite por citomegalovírus em pacientes pediátricos infectados pelo vírus da imunodeficiência humana em tratamento com highly active antiretrovirus therapy
    (Associação Médica Brasileira, 2004-09-01) Dimantas, Maria Angélica [UNIFESP]; Finamor, Luciana Peixoto [UNIFESP]; Ewert, Vânia [UNIFESP]; Nakanami, Célia [UNIFESP]; Muccioli, Cristina [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    BACKGROUND: To describe three cases of cytomegalovirus retinitis occurring in HIV-infected children taking protease inhibitors combined with transcriptase inhibitors (HAART). METHODS: Three cases of HIV-infected children taking highly active antiretrovirus therapy (HAART) underwent an ocular examination at a university referral center - UNIFESP. RESULTS: The average age was 6 years (10 months to 13 years old), and all of them were C3 (CDC - Atlanta - EUA 1994). Median CD4 cell count and plasma HIV RNA were 67 cells/mm³ (43 - 98 cells/ mm³) and 190.000 copies/ml (53.600 - 460.000 copies/ml). The three patients presented HAART failure and all of them were treated with anti-CMV agents without success. CONCLUSION: The unprecedented benefits resulting from highly active antiretroviral therapy (HAART) have been well described. However, treatment failure has become increasingly complex, because of the aggressive forms of opportunistic diseases like CMV retinitis, despite anti-CMV agents. Prompt diagnosis and treatment are essential to minimize the risk of long-term loss of vision for these infected children.
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    Sexual transmission of HIV-1 isolate showing G -> A hypermutation
    (Elsevier B.V., 2002-01-01) Caride, E.; Brindeiro, R. M.; Kallas, Esper Georges [UNIFESP]; Sa, CAM de; Eyer-Silva, W. A.; Machado, E.; Tanuri, A.; Universidade Federal do Rio de Janeiro (UFRJ); Universidade Federal de São Paulo (UNIFESP); Hosp Univ Gaffree & Guinle
    Retroviral genomes with a high frequency of G --> A mutations are thought to originate during reverse transcription (RT). Here we present a case report of an AIDS patient infected with a subtype F variant where extensive G --> A hypermutation (G --> A Hypm) sequences were found in the protease gene. This patient was failing HAART at the time the hypermutation was found. These sequences were basically encountered in the proviral compartment on two occasions and were persistently absent in the plasma viral population. the patient's viral genotype showed several mutations related to antiretroviral drug resistance in RT (T69N, N184V, T215F, K219Q) and protease (M36I, G48V, I54V, T63L, V82A) genes. the drug regimen was changed and the viral load dropped 0.9 Logs and CD4 count increased by 200 cells/ml. the hypermutation was not found any more in a 1-year follow up. the patient's wife was infected with a similar virus strain and G A Hypm sequences were also detected in the RT gene. This is the first report of sexual transmitted G --> A Hypermutation in HIV-1 and suggest that this phenomenon can be genetically coded by the viral RT molecule. (C) 2002 Elsevier Science B.V. All rights reserved.