El área de maíz sembrada con maíz en Perú es de 500 000 ha, aproximadamente el 50% de cada una, maíz amarillo duro (MAD) y maíz andino (MA); el MAD es utilizada por la industria de alimentos para animales y el MA para consumo humano. La superficie media plantada por los agricultores es inferior a 1,5 ha en ambos casos. La producción de maíz se ha incrementado en los últimos 60 años sin embargo no se ha satisfecho la demanda de MAD, que se cubre con la importación de más de 3 millones de toneladas de maíz por año, por un valor de mil millones de dólares. Hay un 5% de excedente de MA para exportación. Las importaciones de MAD superan el 70% de la demanda, lo que significa un problema para la seguridad alimentaria nacional; por otro lado, hay más de 500 000 unidades agrícolas sembradas con maíz y, por lo tanto, deben incluirse en las políticas de desarrollo del país para mejorar sus medios de vida. Una forma de incrementar los ingresos de los agricultores que siembran MA, es la vinculación al mercado nacional e internacional con el fin de incrementar la demanda mediante la producción de productos transformados a base de maíz como materia prima, el incremento en las exportaciones de maíz morado en los últimos años es un buen indicador. Para MAD se necesita una estrategia que incluya a todos los miembros de la cadena del maíz, públicos y privados, con el objetivo de aumentar la producción de maíz de acuerdo con los requisitos nacionales, regionales y locales. En ambos casos, las tecnologías adecuadas y las políticas gubernamentales son fundamentales para aumentar la productividad y la rentabilidad del maíz. Se debe desarrollar una estrategia de capacitación para el éxito del plan peruano de maíz destinado a aumentar la producción de maíz.
The objective of antiretroviral therapy is to obtain an almost complete and durable suppression of viral replication in all compartments to facilitate recovery of the immune system. We assessed the virologic effect in plasma, tonsillar tissue, and cerebrospinal fluid (CSF) in 94 HIV-1-infected patients with CD4 counts >500 x 106 cells per liter and viral load >5000 copies/ml randomly assigned to triple antiretroviral therapy (two nucleoside reverse transcriptase inhibitors (NRTIs) plus one protease inhibitor) versus double therapy (two NRTIs). We also analyzed the immunologic recovery in this cohort of patients. Lymphoid tissue and cerebrospinal fluid viral load, development of genotypic resistance, proliferative responses to HIV-1 specific antigens, and other immunophenotypic markers were analyzed. The proportion of patients who achieved a decrease in HIV RNA levels to <200 copies/ml was significantly greater in the triple therapy group than in the two drug groups (p =.0002 for each pair-wise difference). At week 52, tonsillar tissue HIV RNA from 5 patients treated with triple therapy was lower than the limit of detection, whereas the mean +/- standard error in patients with double therapy (n = 5) was 5.03 +/- 0.34 copies/mg/tissue. In all 10 patients, CSF viral load (VL) was <20 HIV-1 RNA copies/ml at week 52. CSF cell counts and protein levels tended to decrease after 52 weeks of antiretroviral therapy. After 1 year of therapy, 13 of 21 patients (62%) in the double-therapy groups (zidovudine plus lamivudine [n = 9] and stavudine plus lamivudine [n = 12]) had evidence of M184V mutation. None of the 10 samples of patients receiving triple therapy could be amplified because of low HIV RNA levels. The mean increase in CD4 cells at week 52 was greater in the stavudine and lamivudine and indinavir group than in the double-treatment arms (186 versus 67 and 102, respectively; p =.03). In patients treated with triple therapy, the increase in naive T cells (CD4 and CD8) was greater than in patients treated with double therapy. Markers of activation decreased further in patients treated with the regimen that included protease inhibitors. Proliferative responses to HIV-1 p24 antigen were never recovered after double or triple therapy. Our study suggests that even in very early stages of HIV-1 disease only therapy with two NRTIs and one protease inhibitor reduces plasma, lymphoid tissue, and CSF VL to undetectable levels. HIV-1-related immune system abnormalities improved but were still defective after 1 year of antiretroviral therapy.
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