Análise das apresentações clínicas da neurotoxoplasmose na era pós-HAART, correlacionadas com o grau de imunossupressão e ao uso ou não de profilaxia primária em pacientes HIV/AIDS ambulatoriais.

Pereira, Ivete Auto Espindola

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dc.contributor.advisor	Sa, Carlos Alberto Morais de
dc.contributor.author	Pereira, Ivete Auto Espindola
dc.date.accessioned	2018-09-06T15:56:18Z
dc.date.available	2018-09-06T15:56:18Z
dc.date.issued	2006-10-20
dc.identifier.citation	PEREIRA, Ivete Auto Espindola. Análise das apresentações clínicas da neurotoxoplasmose na era pós-HAART, correlacionadas com o grau de imunossupressão e ao uso ou não de profilaxia primária em pacientes HIV/AIDS ambulatoriais. 2006. 80 f. Dissertação (Mestrado em Neurologia) - Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, 2006.	pt_BR
dc.identifier.uri	http://hdl.handle.net/unirio/12435
dc.description.sponsorship	n/a	pt_BR
dc.language.iso	Portuguese	pt_BR
dc.rights	openAccess	pt_BR
dc.title	Análise das apresentações clínicas da neurotoxoplasmose na era pós-HAART, correlacionadas com o grau de imunossupressão e ao uso ou não de profilaxia primária em pacientes HIV/AIDS ambulatoriais.	pt_BR
dc.title.alternative	Analysis of the clinical presentations of neurotoxoplasmosis in the post-antiretroviral therapy era, correlated with the degree of immunosuppression and the use or not of prophylaxis in HIV/AIDS outpatients.	pt_BR
dc.type	masterThesis	pt_BR
dc.contributor.referee	Sa, Carlos Alberto Morais de
dc.contributor.referee	Lopes, Carlos Wilson Gomes
dc.contributor.referee	Alvarenga, Regina Maria Papais
dc.degree.department	CCBS	pt_BR
dc.degree.grantor	Universidade Federal do Estado do Rio de Janeiro - UNIRIO	pt_BR
dc.degree.level	Mestrado Acadêmico	pt_BR
dc.degree.local	Rio de Janeiro, RJ	pt_BR
dc.degree.program	Programa de Pós-Graduação em Neurologia	pt_BR
dc.subject.cnpq	CIÊNCIAS DA SAÚDE	pt_BR
dc.subject.cnpq	MEDICINA	pt_BR
dc.subject.cnpq	NEUROLOGIA	pt_BR
dc.subject.en	AIDS (Disease)	pt_BR
dc.subject.en	Neurotoxoplasmosis	pt_BR
dc.subject.en	Literature review	pt_BR
dc.description.abstracten	Toxoplasmic encephalitis (TE) is the most frequent complication and principal cause of cerebral mass lesions observed in later stages of HIV infection. It is caused by Toxoplasma gondii, an obligate intracellular protozoan and TE is due to a reactivation of a chronic infection. Since the beginning the AIDS era TE rised exclusively in HIVinfected patients with CD4+ T-cell count < 100cells/mm3 and other opportunistic diseases. Zidovudine (AZT) the first drug approved in 1987 for the treatment of HIV-1 infection did not promote enough immunological recovery in order to avoid opportunistics infections. Since then new antiretroviral drugs has been approved such didanosine (ddI), zalcitabine (ddC) and stavudine (d4T). They belong to the class of nucleoside reverse transcriptase inhibitor like AZT, but the agreement concerning the treatment was still the monotherapy, wich did not changed the situation. The clinical benefits provided by monotherapy was modest and did not change the clinical presentation of TE and did not reduced the opportunistics infections significantly. In 1996 the new treatment concept of AIDS with combination antiretroviral drugs and the introduction of the HIV-1 protease inhibitors started the Highly Active Antiretroviral Therapy era (HAART). The primary prophilaxis used associated with HAART was stablished effective to prevent TE and those measures seemed at the time to be the solution to modify the clinical picture. In fact, a significative decline of the number of the cases occurred, but the TE was still the most prevalent central nervous system disorder in advanced AIDS patients as observed in recents papers. Toxoplasma gondii strains trials has been performed to attempt understain the relationship between the cronic infection and the reactivation in AIDS pacients, because not all infected by the parasite develop TE during the AIDS advanced stages and there are cases of TE with atypical and severe course. Toxoplasma gondii seroprevalence rates vary with the age and geographic region but it is high in the most of then and it keeps this infection as a permanent clinical problem. Thus, it is very important to know the serological patient status for T. gondii infection as soon as the HIV-1 Infection is confirmed. Behavioral recommendations to prevent T. gondii contamination must be adopted for Toxoplasmaseronegative patients can contribute to decline of the TE cases. In the pos-HAART era, the usually TE clinical presentation are still being observed, specially in advanced stages of the HIV-1 infection. However, TE have been observed as a immune reconstitution syndrome (IRIS). This is related to improvements in the patients immune systems with low CD4+ T-cell count associated with strong immune recovery obtained with HAART.Toxoplasmic encephalitis (TE) is the most frequent complication and principal cause of cerebral mass lesions observed in later stages of HIV infection. It is caused by Toxoplasma gondii, an obligate intracellular protozoan and TE is due to a reactivation of a chronic infection. Since the beginning the AIDS era TE rised exclusively in HIVinfected patients with CD4+ T-cell count < 100cells/mm3 and other opportunistic diseases. Zidovudine (AZT) the first drug approved in 1987 for the treatment of HIV-1 infection did not promote enough immunological recovery in order to avoid opportunistics infections. Since then new antiretroviral drugs has been approved such didanosine (ddI), zalcitabine (ddC) and stavudine (d4T). They belong to the class of nucleoside reverse transcriptase inhibitor like AZT, but the agreement concerning the treatment was still the monotherapy, wich did not changed the situation. The clinical benefits provided by monotherapy was modest and did not change the clinical presentation of TE and did not reduced the opportunistics infections significantly. In 1996 the new treatment concept of AIDS with combination antiretroviral drugs and the introduction of the HIV-1 protease inhibitors started the Highly Active Antiretroviral Therapy era (HAART). The primary prophilaxis used associated with HAART was stablished effective to prevent TE and those measures seemed at the time to be the solution to modify the clinical picture. In fact, a significative decline of the number of the cases occurred, but the TE was still the most prevalent central nervous system disorder in advanced AIDS patients as observed in recents papers. Toxoplasma gondii strains trials has been performed to attempt understain the relationship between the cronic infection and the reactivation in AIDS pacients, because not all infected by the parasite develop TE during the AIDS advanced stages and there are cases of TE with atypical and severe course. Toxoplasma gondii seroprevalence rates vary with the age and geographic region but it is high in the most of then and it keeps this infection as a permanent clinical problem. Thus, it is very important to know the serological patient status for T. gondii infection as soon as the HIV-1 Infection is confirmed. Behavioral recommendations to prevent T. gondii contamination must be adopted for Toxoplasmaseronegative patients can contribute to decline of the TE cases. In the pos-HAART era, the usually TE clinical presentation are still being observed, specially in advanced stages of the HIV-1 infection. However, TE have been observed as a immune reconstitution syndrome (IRIS). This is related to improvements in the patients immune systems with low CD4+ T-cell count associated with strong immune recovery obtained with HAART.	pt_BR
dc.degree.country	Brasil	pt_BR
dc.description.sponsordocumentnumber	n/a	pt_BR
dc.description.abstractpt	Neurotoxoplasmose (NT) é a afecção neurológica mais freqüente e a principal causa de lesões com efeito de massa em pacientes com AIDS e contagem de células T CD4+ < 100 mm3. Desenvolve-se caracteristicamente como reativação de infecção prévia e seu agente etiológico é o protozoário intracelular obrigatório Toxoplasma gondii (T. gondii). No início da epidemia de AIDS, em 1983, a NT surgia exclusivamente no contexto da imunodepressão grave, em pacientes com outros sinais de imunodeficiência. O AZT, a primeira droga empregada para combate ao vírus, em 1987, não promovia recuperação imunológica suficiente para evitar a instalação de doenças oportunistas. A partir de então novas drogas anti-retrovirais foram sendo aprovadas, mas o consenso de tratamento era o da monoterapia, situação que em nada modificou as apresentações clínicas da NT e nem reduziu o número de casos. Em 1996, o conceito de tratamento da AIDS com antiretrovirais combinados e o surgimento de uma nova classe de medicamentos, os inibidores da protease, deu início à era do tratamento anti-retroviral de alta atividade (HAART). O uso de profilaxia primária associado à HAART foi sedimentado e essas medidas pareceram, à época, ter sido a solução para modificar esse quadro. De fato, ocorreu significativa redução no número de casos, mas a NT permanece como a mais prevalente desordem do SNC em pacientes com AIDS avançada, como recentes publicações. Estudo de cepas de T. gondii vem sendo desenvolvidos na tentativa de compreender a relação entre infecção crônica e reativação de cistos, em indivíduos com AIDS, pois nem todos cronicamente infectados pelo parasita desenvolvem NT durante o período de doença avançada e há casos de evolução excepcionalmente grave. A taxa de soropositividade ao parasita, diferente nas diversas partes do mundo, mas significativamente alta na maioria deles, mantém essa infecção como uma preocupação permanente. Portanto, é de fundamentamental importância estabelecer se o paciente é IgG+ para T. gondii tão logo o diagnóstico de infecção pelo HIV-1 seja confirmado. Adoção de medidas preventivas relacionadas à infecção pelo parasita pode contribuir para redução do número de casos de NT. Na era pós-HAART, as apresentações clínicas da neurotoxoplasmose continuam sendo observadas em sua grande maioria em ambiente de grave prejuízo às defesas imunológicas. No entanto, tem sido registrada como síndrome de reconstituição imune (SRI) e seu desenvolvimento está relacionado a baixas contagens de células T CD4+ associado à rapida recuperação da resposta imunológica obtida com os diversos esquemas HAART.	pt_BR
dc.subject.pt	AIDS (Doença)	pt_BR
dc.subject.pt	Neurotoxoplasmose	pt_BR
dc.subject.pt	Revisão de literatura	pt_BR