Costa CR. Oral manifestations of AIDS and the profile of HIV mutations and resistance in patients undergoing treatment failure [thesis]. São Paulo: Universidade de São Paulo, Faculdade de Odontologia; 2013. Reviwed Version. Oral manifestation of AIDS have been associated with several clinical characteristics of HIV infection such as reduction in T CD4+ cells, increase in viral load and treatment failure, among others. Recent advances have shown that treatment failure in these patients is directly linked to mutations in reverse transcriptases (RT) and in proteases (PR). The objective of the present study was to describe the profile of virus mutations and of resistance to antiretroviral drugs in HIV+ patients in treatment failure, and to correlate mutations to the oral manifestations of the immunodeficiency. Patient charts, genotyping results and information from digital databases of AIDS patients, who underwent genotyping at the Sexually Transmissible Diseases and AIDS Training and Reference Center (CRT-DST/AIDS) between 2003 and 2010, were accessed. Data were transferred to the Epiinfo program, in which a computerized database was built for statistical analysis. The event "oral lesions" was chosen as a dependent variable. Odds ratio for each independent variable was calculated, using a 95% confidence interval. Data found on virus mutations and drug resistance was analyzed to check for correlation with presence and type of oral manifestations. The Bartlett test was used to test normality of data. Mann-Whitney or Kruskal-Wallis tests were used for variables without a normal distribution. The Fisher Exact or Chi-square Tests were used to compare frequencies and proportions. A 0.05 or 5% significance level was established. The analysis of socio-behavioral and clinical-laboratorial characteristics allowed concluding that the presence of oral lesions may be related to statistically low CD4 rates (p<0.05), viral load range (p=0.048) and previous use of more than five different antiretroviral regimens (p=0.021). A higher prevalence of viral (75%) and bacterial (66.7%) lesions in relation to fungal lesions (37.3%) was observed only in patients who were resistant to protease inhibitors (PI) (p=0.02). We found 146 different mutations in patients with oral lesions, among which, four (101E, 20T, 188L, 93L) with a negative correlation with the presence of oral lesions (p=0.01, p=0.01, p=0.03, p=0.03, respectively) and eight (215Y, 118I, 20R, 44D, 71I, 82I E 84V) with a positive correlation (p=0.04, p=0.05, p=0.03, p=0.01, p=0.01, p=0.04, p=0.0004, respectively). Subsequently, mutations with a positive correlation with the presence of oral lesions were assessed to check if their presence would really be associated with resistance to ARVs (to which they supposedly would be resistant to). Mutations 71I and 82I were excluded from this assessment because they had an extremely low frequency. All mutations had a statistically positive correlation for resistance to their respective antiretroviral drugs (p<0.05). Mutations 84V and 20R ...
One hundred and forty-four Brazilian AIDS patients presenting with Kaposi’s sarcoma (KS) were evaluated with respect to the frequency of oral neoplasms and their clinical features. The majority of the patients were young male adults (age range: 21-40 years old), from which 11.1 % presented with oral KS (OKS) exclusively. Oral and skin lesions were associated in 25% of the cases, while only four patients showed association between oral and visceral KS; 49.3% of the cases were exclusively dermatological. The hard palate was the main site affected, followed by the oropharynx. The localization of KS was found to be similarly frequent in the tongue, gingiva and other sites of the oral mucosa. Candidosis was the prevailing fungal disease; in 20% of the cases it was restricted to the oral mucosa and in 80% it was systemic. No high frequency of paracoccidioidomicosis and cryptococcosis was detected. The prevailing bacterial disease was Tuberculosis and there was only one case of syphilis. Among the viral diseases, the most frequently detected was herpes simplex, followed by molusco contagiosum, condiloma acuminatum and cytomegaloviroses at lower frequencies. Pneumonia caused by Pneumocystes carinii and toxoplasmosis were also identified. The authors emphasise the importance of oral examination in HIV-infected patients bearing in mind several aspects related especially to KS, and stress the need for an interdisciplinary team in the management of these patients, in order to provide better quality of life as well as rapid diagnosis and treatment.
Com o objetivo de avaliar o estado atual das pacientes submetidas ao tratamento conservador do câncer inicial de mama no CGLGL, foi realizado um estudo retrospectivo do período de 1983 a 1991. De um total de 192 casos levantados, 140 foram considerados adequados para a avaliação da sobrevida global e sobrevida livre de doença local e a distância. Foram analisados o tamanho tumoral, o tipo histológico, o status menopausal, o comprometimento axilar e o tratamento adjacente, entre outros fatores. Os resultados de sobrevida global (93%), sobrevida livre de doença local (91%) e a distância (89%) em cinco anos, comparam-se àqueles descritos na literatura. Foram considerados fatores clínicos determinantes do prognóstico o grau de comprometimento axilar, o tamanho tumoral e os tumores classificados histologicamente como medulares.
Os autores descrevem os Milan Trials I, II e III realizados no Istituto Nazionale per Io Studio e Ia Cura dei Tumori, em Milão, e fazem uma análise comparativa com estudos que trataram da abordagem cirúrgica conservadora do câncer de mama através de revisão bibliográfica dos estudos clínicos randomizados, prospectivos, com amostragem adequada e informações detalhadas sobre follow-up. O primeiro estudo (Milan I) comparou a cirurgia radical com a quadrantectomia associada à dissecção axilar e radioterapia (QUART) em pacientes estadiados clinicamente com TiNoMo. As conclusões finais deste estudo, após 16 anos, mostram taxas de sobrevida global e sobrevida livre de doenças semelhantes entre os grupos. A incidência de recorrência local e segundo tumor primário no braço QUART não apresentou relevância estatística. Entre 1985 e 1987, o Milan Trial II comparou o QUARTe a lumpectomia com dissecção axilar e radioterapia externa e reforço intersticial de 192Ir. Este trial apresentou, após quatro anos de seguimento, curvas de sobrevida global superponíveis. A lumpectomia apresentou maiores taxas de recorrência local, apesar do melhor resultado estético. Q último estudo de Milão concluiu o recrutamento das pacientes em 1989 e não apresentou resultados. Teve como objetivo comparar o QUART com a quadrantectomia com dissecção axilar, sem radioterapia. Os estudos clínicos comparando a cirurgia radical com o tratamento conservador mostraram que, no câncer de mama estágios I e II, a cirurgia conservadora com radioterapia é tão eficaz quanto a mastectomia radical ou radical modificada.
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