Cellular Immune Responses Induced with Dose-Sparing Intradermal Administration of HIV Vaccine to HIV-Uninfected Volunteers in the ANRS VAC16 Trial

The objective was to compare the safety and cellular immunogenicity of intradermal versus intramuscular immunization with an HIV-lipopeptide candidate vaccine (LIPO-4) in healthy volunteers.A randomized, open-label trial with 24 weeks of follow-up was conducted in France at six HIV-vaccine trial sites. Sixty-eight healthy 21- to 55-year-old HIV-uninfected subjects were randomized to receive the LIPO-4 vaccine (four HIV lipopeptides linked to a T-helper-stimulating epitope of tetanus-toxin protein) at weeks 0, 4 and 12, either intradermally (0.1 ml, 100 microg of each peptide) or intramuscularly (0.5 ml, 500 microg of each peptide). Comparative safety of both routes was evaluated. CD8+ T-cell immune responses to HIV epitopes (ELISpot interferon-gamma assay) and tetanus toxin-specific CD4+ T-cell responses (lymphoproliferation) were assessed at baseline, two weeks after each injection, and at week 24.No severe, serious or life-threatening adverse events were observed. Local pain was significantly more frequent after intramuscular injection, but local inflammatory reactions were more frequent after intradermal immunization. At weeks 2, 6, 14 and 24, the respective cumulative percentages of induced CD8+ T-cell responses to at least one HIV peptide were 9, 33, 39 and 52 (intradermal group) or 14, 20, 26 and 37 (intramuscular group), and induced tetanus toxin-specific CD4+ T-cell responses were 6, 27, 33 and 39 (intradermal), or 9, 46, 54 and 63 (intramuscular). In conclusion, intradermal LIPO-4 immunization was well tolerated, required one-fifth of the intramuscular dose, and induced similar HIV-specific CD8+ T-cell responses. Moreover, the immunization route influenced which antigen-specific T-cells (CD4+ or CD8+) were induced.ClinicalTrials.gov NCT00121121

Retinopatia Diabética: Prevenção e Tratamento: Um exame das medidas de prevenção, monitoramento e opções terapêuticas para pacientes com retinopatia diabética.

Diabetic retinopathy is a prevalent and debilitating eye complication associated with diabetes mellitus. This review article addresses prevention measures, monitoring, and therapeutic options for patients with diabetic retinopathy, emphasizing its clinical importance and impact on patients' quality of life. In prevention, strict glycemic control and blood pressure management play central roles in reducing the risk and progression of diabetic retinopathy. Patient education is also crucial in promoting healthy habits. Regular retinal monitoring through fundus photography, optical coherence tomography (OCT), and OCTA angiography enables early detection of retinal changes, allowing for timely interventions. In the field of therapeutic options, intravitreal injections of anti-angiogenics, such as ranibizumab and bevacizumab, have revolutionized the treatment of diabetic macular edema (DME) and improved patients' vision. Therapies based on vascular growth factors, such as aflibercept, offer promising therapeutic alternatives. Managing diabetic retinopathy requires multidisciplinary approaches involving ophthalmologists, endocrinologists, and health educators. Personalizing treatment based on the disease stage and the individual patient's response is essential. Ongoing advances in clinical and technological research offer hope for better control and treatment of diabetic retinopathy, with the goal of preserving vision and enhancing patients' quality of life.A retinopatia diabética é uma complicação ocular prevalente e debilitante associada ao diabetes mellitus. Este artigo de revisão aborda medidas de prevenção, monitoramento e opções terapêuticas para pacientes com retinopatia diabética, enfatizando sua importância clínica e impacto na qualidade de vida dos pacientes. Na prevenção, o controle glicêmico estrito e o manejo da pressão arterial desempenham papéis centrais na redução do risco e progressão da retinopatia diabética. A educação do paciente também é crucial para promover hábitos saudáveis. O monitoramento regular da retina por meio de fotografia do fundo do olho, tomografia de coerência óptica (OCT) e angiografia por OCTA possibilita a detecção precoce de alterações retinianas, permitindo intervenções oportunas. No campo das opções terapêuticas, as injeções intravítreas de antiangiogênicos, como ranibizumabe e bevacizumabe, têm revolucionado o tratamento do edema macular diabético (EMD) e melhorado a visão dos pacientes. Terapias baseadas em fatores de crescimento vascular, como aflibercept, oferecem promissoras alternativas terapêuticas. A gestão da retinopatia diabética requer abordagens multidisciplinares, envolvendo oftalmologistas, endocrinologistas e educadores de saúde. A personalização do tratamento com base no estágio da doença e resposta individual do paciente é essencial. Avanços contínuos na pesquisa clínica e tecnológica oferecem esperança para um melhor controle e tratamento da retinopatia diabética, com o objetivo de preservar a visão e melhorar a qualidade de vida dos pacientes