3 research outputs found
Antiretroviral resistance mutations in human immunodeficiency virus type 1 infected patients enrolled in genotype testing at the Central Public Health Laboratory, São Paulo, Brazil: preliminary results
Advantages and Pitfalls of the Polymerase Chain Reaction in the Diagnosis of Esophageal Ulcers in AIDS Patients
HIV-1-infected patients frequently have opportunistic esophageal infections which, when associated with severe immunodeficiency, can be attributed to unusual pathogens. The clinical presentation of several esophageal diseases is similar and the best method for a specific diagnosis of these patients has not been well defined. To evaluate the role of the polymerase chain reaction (PCR) in the etiologic definition of esophageal ulcers in HIV-1-infected patients, 96 esophageal biopsies from 79 HIV-1-infected patients were processed by PCR using specific primers for cytomegalovirus (CMV), herpes virus (HSV), human papilloma virus (HPV), HIV-1, Mycobacterium tuberculosis, Mycobacterium avium, Mycobacterium intracellulare, Treponema pallidum, and Haemophilus ducreyi. The PCR results were compared to the histopathologic results. Seventy-nine patients were studied (mean age: 34 years; 62% men; median CD4 + T cell = 103.59 cells/mu l (range 1-795.2 cells/mu l). The most common endoscopic findings were as follows: esophageal candidiasis (37.1%), esophageal ulcers (24.7%), esophagitis (11.2%), and lugol-negative areas (10.1%). The histopathologic findings in the esophageal ulcers (22 biopsies) were non-specific inflammation (31.8%), HSV (36.4%), Candida (13.6%), CMV (13.6%), or HPV disease (4.5%). In the esophageal ulcer biopsies, the PCR results were negative in 27.6% of cases, and positive for HIV (65.5%), CMV (31%), HPV (20.7%), HSV (10.3%), and H. ducreyi (6.9%). The histopathologic examination did not identify a pathogen or identified only Candida in 15 biopsies of esophageal ulcers. PCR was positive in ten (66.7%) and negative in five (33.3%) of these biopsies (idiopathic ulcers). PCR detected: HIV (53.3%), CMV (20%), HPV (13.3%), and H. ducreyi (6,7%). PCR detected more etiologic agents in esophageal ulcers than histopathology and was able to detect unusual pathogens. On the other hand, sometimes more than one pathogen was detected in the esophageal ulcers, making it difficult to reach an accurate diagnosis. This finding indicates the need for more studies to evaluate the benefit of this method in the routine evaluation of esophageal ulcer biopsies in HIV-1-infected patients
Antiretroviral resistance mutations in human immunodeficiency virus type 1 infected patients enrolled in genotype testing at the Central Public Health Laboratory, São Paulo, Brazil: preliminary results
Antiretroviral resistance mutations (ARM) are one of the major
obstacles for pharmacological human immunodeficiency virus (HIV)
suppression. Plasma HIV-1 RNA from 306 patients on antiretroviral
therapy with virological failure was analyzed, most of them (60%)
exposed to three or more regimens, and 28% of them have started therapy
before 1997. The most common regimens in use at the time of genotype
testing were AZT/3TC/nelfinavir, 3TC/D4T/nelfinavir and
AZT/3TC/efavirenz. The majority of ARM occurred at protease (PR) gene
at residue L90 (41%) and V82 (25%); at reverse transcriptase (RT) gene,
mutations at residue M184 (V/I) were observed in 64%. One or more
thymidine analogue mutations were detected in 73%. The number of ARM at
PR gene increased from a mean of four mutations per patient who showed
virological failure at the first ARV regimens to six mutations per
patient exposed to six or more regimens; similar trend in RT was also
observed. No differences in ARM at principal codon to the three drug
classes for HIV-1 clades B or F were observed, but some polymorphisms
in secondary codons showed significant differences. Strategies to
improve the cost effectiveness of drug therapy and to optimize the
sequencing and the rescue therapy are the major health priorities