Retirada da terapia de manutenção para retinite por citomegalovírus em pacientes com aids exibindo resposta imunológica à terapia anti-retroviral altamente efetiva (HAART)

BACKGROUND: Before the introduction of highly active antiretroviral therapy (HAART), CMV retinitis was a common complication in patients with advanced HIV disease and the therapy was well established; it consisted of an induction phase to control the infection with ganciclovir, followed by a lifelong maintenance phase to avoid or delay relapses. METHODS: To determine the safety of CMV maintenance therapy withdrawal in patients with immune recovery after HAART, 35 patients with treated CMV retinitis, on maintenance therapy, with CD4+ cell count greater than 100 cells/mm³ for at least three months, but almost all patients presented these values for more than six months and viral load < 30000 copies/mL, were prospectively evaluated for the recurrence of CMV disease. Maintenance therapy was withdrawal at inclusion, and patients were monitored for at least 48 weeks by clinical and ophthalmologic evaluations, and by determination of CMV viremia markers (antigenemia-pp65), CD4+/CD8+ counts and plasma HIV RNA levels. Lymphoproliferative assays were performed on 26/35 patients. RESULTS: From 35 patients included, only one had confirmed reactivation of CMV retinitis, at day 120 of follow-up. No patient returned positive antigenemia tests. No correlation between lymphoproliferative assays and CD4+ counts was observed. CONCLUSION: CMV retinitis maintenance therapy discontinuation is safe for those patients with quantitative immune recovery after HAART.Antes da introdução da terapia anti-retroviral altamente efetiva (HAART), a retinite por CMV era uma complicação comum em pacientes com doença por HIV avançada e a terapia era bem estabelecida e consistia em uma fase de indução com ganciclovir para controlar a infecção, seguida por uma manutenção por toda a vida, para evitar e retardar as recidivas. Para determinar a segurança da retirada da terapia de manutenção para retinite por citomegalovírus em pacientes com recuperação imunológica após o HAART, 35 pacientes com retinite por CMV tratados com terapia de manutenção, com contagem de células CD4+ maiores que 100 células/mm³ por no mínimo três meses, mas a maioria dos pacientes apresentava esses valores por mais de seis meses e carga viral < 30.000 cópias/mL, foram avaliados prospectivamente para a recorrência de doença por CMV. A terapia de manutenção foi retirada na inclusão e os pacientes foram monitorados no mínimo 48 semanas por avaliações clínicas e oftalmológicas e pela determinação de marcadores de viremia para CMV (antigenemia). Contagens de CD4+ e CD8+ e níveis de RNA de HIV no plasma. Métodos linfoproliferativos foram realizados em 26/35 pacientes. RESULTADOS: Dos 35 pacientes incluídos no estudo, somente um teve reativação da retinite por CMV confirmada, no dia 120 do seguimento. Nenhum paciente teve testes de antigenemia positivos. Nenhuma correlação entre os ensaios linfoproliferativos e contagens de CD4+ foi observada. CONCLUSÃO: Descontinuação da terapia de manutenção para retinite por CMV é segura para aqueles pacientes com recuperação imune quantitativa após HAART

Withdrawal of maintenance therapy for cytomegalovirus retinitis in AIDS patients exhibiting immunological response to HAART

BACKGROUND: Before the introduction of highly active antiretroviral therapy (HAART), CMV retinitis was a common complication in patients with advanced HIV disease and the therapy was well established; it consisted of an induction phase to control the infection with ganciclovir, followed by a lifelong maintenance phase to avoid or delay relapses. METHODS: To determine the safety of CMV maintenance therapy withdrawal in patients with immune recovery after HAART, 35 patients with treated CMV retinitis, on maintenance therapy, with CD4+ cell count greater than 100 cells/mm³ for at least three months, but almost all patients presented these values for more than six months and viral load < 30000 copies/mL, were prospectively evaluated for the recurrence of CMV disease. Maintenance therapy was withdrawal at inclusion, and patients were monitored for at least 48 weeks by clinical and ophthalmologic evaluations, and by determination of CMV viremia markers (antigenemia-pp65), CD4+/CD8+ counts and plasma HIV RNA levels. Lymphoproliferative assays were performed on 26/35 patients. RESULTS: From 35 patients included, only one had confirmed reactivation of CMV retinitis, at day 120 of follow-up. No patient returned positive antigenemia tests. No correlation between lymphoproliferative assays and CD4+ counts was observed. CONCLUSION: CMV retinitis maintenance therapy discontinuation is safe for those patients with quantitative immune recovery after HAART

Retirada da terapia de manutenção para retinite por citomegalovirus em pacientes com Aids e resposta imunologica a terapia anti-retroviral altamente eficaz (HAART)

Orientador: Sandra Cecilia Botelho CostaDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias MedicasResumo: A fim de determinar a segurança da retirada da terapia de manutenção para retinite por CMV em pacientes com AIDS com resposta imunológica decorrente da terapia antiretroviral altamente eficaz (HAART), 35 pacientes com retinite por CMV tratada, em terapia supressiva, com CD4+ maior ou igual a 100 células/mm3 por ao menos três meses e carga viral menor que 30.000 cópias/mm3, foram estudados prospectivamente quanto à recorrência da doença pelo CMV. A terapia de manutenção foi retirada à inclusão, e os pacientes foram monitorizados por ao menos 48 semanas, através de exames clínicos e oftalmológicos, e pela determinação de marcadores de viremia para CMV (antigenemia - pp65), contagem de células CD4+/CD8+ e determinação de carga viral plasmática do IDV. Estudos de resposta linfoproliferativa foram realizados em 26 dos 35 pacientes. Dos pacientes incluídos no estudo, apenas um teve reativação da retinite pelo CMV (retinite) no dia 120 do seguimento. Nenhum paciente apresentou antigenemias positivas, mesmo na presença de doença pelo CMV. Não foi observada correlação entre os resultados de estudos linfoproliferativos e a contagem de CD4+. A partir destes resultados e, de acordo com a literatura, pode-se concluir que a retirada da terapia supressiva é segura nos pacientes com resposta imunológica quantitativa após HAARTAbstract: To determine the safety of CMV maintenance therapy withdrawal in patients with immune recovery after HAART, 35 patients with treated CMV retinitis, on maintenance therapy, with CD4+ cell count greater than 100 cells/mm3 for at least three months and viral load<30000 copies, were prospectively evaluated for the recurrence of CMV disease. Maintenance therapy was withdrawn at inclusion, and patients were monitored for at least 48 weeks by clinical and ophtalmological evaluations, and by determination of CMV viremia markers (antigenemia-pp65), CD4+/CD8+ counts and plasma mv RNA levels. Lymphoproliferative assays were performed on 26/35 patients. From 35 patients included, only one had confirmed reactivation of CMV retinitis, at day 120 of follow-up. No patient returned positive antigenemia tests, even in presence of CMV disease. No correlation between lymphoproliferative assays and CD4+ counts was observed. CMV maintenance therapy discontinuation is safe for those patients with quantitative immune recovery after HAARTMestradoClinica MedicaMestre em Clinica Medic

Influenza A/H1N1 pandêmica 2009: lições e opiniões de três infectologistas

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Observations on the biology of Apiomerus Lanipes (Fabricius) (Hemiptera, Reduviidae)

The aim of lhe presenl work is to descrihe the biological cycle of the Apiomenis lanipes (Fabricius, 1803) (Hemiptera, Reduviidae) on lahoralory conditions. Adults of Drosophila sp. (Diptera, Drosophilidae) and Ceralitis capitula (Wiedemann, 1824) (Diptera. Tephritidae) was offered for hug feeding (nymphs and adults). The developmenlal of the entire cycle (egg to adult) was 288.26 days and 294.85 days for males and females, respectively. The duration of egg stage and nymphal stage was 23.5 days and 269.02 days, respectively.283288Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq