[Importance of antiproteases in the treatment of microsporidia and/or cryptosporidia infections in HIV-seropositive patients].
Diarrhea due to infection with Microsporidium (M) or Cryptosporidium (C) raises significant therapeutic challenges in HIV-infected patients. The usefulness of protease inhibitor therapy was evaluated in 20 HIV-positive patients with positive tests for M and/or C. There were 17 men and three women with a mean age of 42.5 years (range, 26-64 years). Two patients had category B disease and 18 category C disease according to the 1993 CDC classification scheme (CD4 count before therapy, 72/mm3; mean viral burden, 4.6 log). Seventeen patients had chronic diarrhea (due to M in 12 cases and to C in five), and the remaining three patients were asymptomatic M carriers. Clinical symptoms resolved after addition to the antiretroviral regimen of indinavir (n = 17) or saquinavir (n = 3). Mean weight gain was 10.5 kg. Karnofsky's index improved. Twelve patients, including one of the three who were asymptomatic at baseline, had negative follow-up stool cultures. The mean CD4 count increase was 125/mm3, and the mean viral burden decrease was 1.285 log. These data suggest that protease inhibitors may be capable of eradicating M and/or C infection refractory to other treatments. The reason for this effect may involve partial restoration of immune function due to inhibition of HIV replication.
Service des Maladies Infectieuses et Tropicales, Hôpital Croix-Rousse, Lyon, France.
S
S
Bobin
D
D
Bouhour
S
S
Durupt
A
A
Boibieux
V
V
Girault
D
D
Peyramond
D017088:AIDS-Related Opportunistic Infections / Q000276:immunology / Q000469:parasitology; D000328:Adult; D000818:Animals; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D003457:Cryptosporidiosis / Q000276:immunology / Q000469:parasitology; D003967:Diarrhea / Q000469:parasitology* / Q000628:therapy; D004359:Drug Therapy, Combination; D005243:Feces / Q000469:parasitology; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000276:immunology; D017320:HIV Protease Inhibitors / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D007121:Immunocompetence / Q000187:drug effects; D019469:Indinavir / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D008297:Male; D016816:Microsporida; D016881:Microsporidiosis / Q000276:immunology / Q000469:parasitology; D008875:Middle Aged; D018894:Reverse Transcriptase Inhibitors / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D019258:Saquinavir / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D016896:Treatment Outcome
D019380:Anti-HIV Agents; D017320:HIV Protease Inhibitors; D018894:Reverse Transcriptase Inhibitors; D019469:Indinavir; D019258:Saquinavir
Intérêt des antiprotéases dans le traitement des infections à microsporidies et/ou cryptosporidies chez des patients VIH-séropositifs.