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      Alterações hematológicas em pacientes infectados pelo vírus da imunodeficência humana submetidos à terapia antirretroviral com e sem inibidor de protease Translated title: Hematological abnormalities in patients infected with human immunodeficiency virus on antiretroviral therapy with and without protease inhibitors


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          A anemia é uma anormalidade hematológica comumente encontrada em pacientes infectados pelo vírus da imunodeficiência humana (HIV) e sua prevalência estimada entre 63% a 95%. O objetivo deste estudo foi avaliar as alterações hematológicas e o Índice de Massa Corporal (IMC) de pacientes HIV soropositivos com ou sem uso de terapia antirretroviral com e sem inibidor de protease. Os pacientes HIV soropositivos foram diagnosticados pelo teste de enzimaimunoensaio (ELISA) e confirmados por imunofluorescência. As alterações hematológicas foram determinadas por aparelho de automação Coulter Maxim Autoloader®, contagem de células CD4+ e CD8+ por citometria de fluxo FACSCount® e carga viral por amplificação baseada na sequência do ácido nucleico - Nucleic Acid Sequence Based Amplification (NASBA®). A avaliação dos dados hematológicos demonstrou níveis diminuídos no número de leucócitos e hemoglobina no grupo de estudo que fazia uso de terapia antirretrovial, quando comparado ao grupo controle sem uso desta terapia; resultado semelhante verificou-se também para o IMC dos pacientes HIV soropositivos (p<0,0001, p=0,006 e p<0,0001) respectivamente. Não houve diferença significativa entre os grupos que faziam uso de terapia antirretrovial com e sem inibidores de protease (IP). A avaliação dos dados hematológicos associada à contagem de células CD4+ e quantificação da carga viral pode contribuir para o monitoramento da infecção e auxiliar na tomada de decisão a respeito da intervenção clínica mais adequada nestes pacientes. Rev. Bras. Hematol. Hemoter.

          Translated abstract

          Anemia is the most commonly encountered hematologic abnormality in from 63% to 95% of human immunodeficiency virus (HIV)-positive patients. This study intends to evaluate hematological alterations and changes in the body mass index of HIV-positive patients on antiretroviral therapy with or without protease inhibitors and those who are not on antiretroviral therapy. The HIV-positive patients were diagnosed by the ELISA test and confirmed by immunofluorescence. The hematological alterations were determined using a Coulter Maxim Autoloader®, CD4+ and CD8+ cell counts by FACSCount® Flux cytometry and viral load by Nucleic Acid Sequence Based Amplification (NASBA®). The evaluation of hematological alterations showed smaller numbers of leukocytes and hemoglobin in the study group who used antiretroviral therapy compared to the control group (not on antiretroviral therapy); similar results were found for the body mass index of HIV-positive patients (p<0.0001, p=0.006 and p<0.0001), respectively. There were no significant differences identified between the groups on antiretroviral therapy with or without protease inhibitors. An evaluation of the hematological alterations associated with CD4+ cell counts and measurement of the viral load may contribute to monitor HIV infection and assist in the decision of the most appropriate clinical intervention in these patients. Rev. Bras. Hematol. Hemoter.

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          Most cited references29

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          Analysis of changes in viral load after initiation of treatment with potent antiretroviral agents has provided substantial insight into the dynamics of human immunodeficiency virus type 1 (HIV-1). The concentration of HIV-1 in plasma drops by approximately 99% in the first two weeks of treatment owing to the rapid elimination of free virus with a half-life (t1/2) of < or =6 hours and loss of productively infected cells with a t1/2 of 1.6 days. Here we show that with combination therapy this initial decrease is followed by a slower second-phase decay of plasma viraemia. Detailed mathematical analysis shows that the loss of long-lived infected cells (t1/2 of 1-4 weeks) is a major contributor to the second phase, whereas the activation of latently infected lymphocytes (t1/2 of 0.5-2 weeks) is only a minor source. Based on these decay characteristics, we estimate that 2.3-3.1 years of a completely inhibitory treatment would be required to eliminate HIV-1 from these compartments. To eradicate HIV-1 completely, even longer treatment may be needed because of the possible existence of undetected viral compartments or sanctuary sites.
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            Viruses have evolved numerous mechanisms to evade the host immune system and one of the strategies developed by HIV is to activate apoptotic programmes that destroy immune effectors. Not only does the HIV genome encode pro-apoptotic proteins, which kill both infected and uninfected lymphocytes through either members of the tumour-necrosis factor family or the mitochondrial pathway, but it also creates a state of chronic immune activation that is responsible for the exacerbation of physiological mechanisms of clonal deletion. This review discusses the molecular mechanisms by which HIV manipulates the apoptotic machinery to its advantage, assesses the functional consequences of this process and evaluates how new therapeutics might counteract this strategy.
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              Anemia in HIV infection: clinical impact and evidence-based management strategies.

              Anemia in human immunodeficiency virus (HIV)-infected patients can have serious implications, which vary from functional and quality-of-life decrements to an association with disease progression and decreased survival. In 2002, 16 members of the Anemia in HIV Working Group, an expert panel of physicians involved in the care of HIV-infected patients that met first in 1998, reconvened to assess new data and to translate these data into evidence-based treatment guidelines. The group reached consensus on the prevalence of anemia in the highly active antiretroviral therapy era; the risk factors that are independently associated with the development of anemia; the impact of anemia on quality of life, physical functioning, and survival; the impact of the treatment of hepatitis C virus coinfection on anemia in HIV-infected patients; evidence-based guidelines for treatment of anemia in HIV-infected patients, including the therapeutic role of epoetin alfa; and directions for future research.

                Author and article information

                Revista Brasileira de Hematologia e Hemoterapia
                Rev. Bras. Hematol. Hemoter.
                Associação Brasileira de Hematologia e Hemoterapia e Terapia Celular (São Paulo, SP, Brazil )
                February 2010
                : 32
                : 1
                : 10-15
                [02] Florianópolis SC orgnameUniversidade Federal de Santa Catarina orgdiv1Depto. de Análises Clínicas
                [01] Florianópolis SC orgnameUniversidade Federal de Santa Catarina
                S1516-84842010000100006 S1516-8484(10)03200106

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

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                Figures: 0, Tables: 0, Equations: 0, References: 29, Pages: 6
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                HIV,inibidores de trascriptase reversa,tratamento combinado,Anemia,combined modality theraphy,reverse transcriptase inhibitor


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