[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.
Bobin
S
S
Service des Maladies Infectieuses et Tropicales, Hôpital Croix-Rousse, Lyon, France.
Bouhour
D
D
Durupt
S
S
Boibieux
A
A
Girault
V
V
Peyramond
D
D
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.