Search

Resume Trente et un episodes de pneumonies a Pneumocystis carinii (PPC) survenus dans le service en 1989 avant l'extension de la prophylaxie primaire et 32 episodes survenus en 1992 apres celle-ci, ont ete retrospectivement compares. Il n'a pas ete mis en evidence de difference significative en terme de presentation clinique ni de gravite. En 1992, les pneumocystoses surviennent chez des patients plus immunodeprimes. Le pourcentage de patients non suivis pour leur infection a VIH ou dont la pneumocystose revele la seropositivite reste eleve et stable a 40 % dans les deux groupes.

Resume L'objectif de cette etude ouverte prospective etait d'evaluer l'interet des aerosols d'isethionate de pentamidine a la dose quotidienne de 300 mg dans le traitement de relais de 13 episodes de pneumocystose survenus chez des patients atteints de syndrome d'immunodeficience acquise. Les aerosols de pentamidine ont ete administres dans 11 cas apres un traitement d'une duree moyenne de 10 jours par l'association trimethoprime-sulfamethoxazole, et dans 2 cas apres 6 jours de traitement par la pentamidine intraveineuse. Apres une duree totale du traitement anti-Pneumocystis de 21 jours, tous les patients ont ete consideres gueris sur les criteres cliniques. Une aggravation des anomalies radiologiques et gazometriques a ete constatee chez deux patients presentant une pathologie pulmonaire associee (tuberculose et sarcome de Kaposi). La tolerance des aerosols de pentamidine a ete bonne. Deux patients ont developpe des signes de surinfection bronchique. Au total, cette etude montre l'interet du traitement sequentiel — traitement par voie generale puis locale — des pneumocystoses non severes liees au SIDA.

Summary The aim of prophylaxis in HIV-infected patients is to ensure effective, stable and well-tolerated protection, at least against the two major opportunistic infections : Pneumocystis carinii pneumonia and toxoplasmosis. At present, the choice is limited to two drug combinations : trimethoprim-sulfamethoxazole (cotrimoxazole) and dapsone-pyrimethamine. The known efficacy of these two combinations is based on results from various sources : in the case of cotrimoxazole it involves non-randomised retrospective studies or prospective studies which failed to show efficacy in an intention-to-treat analysis. The efficacy of dapsone-pyrimethamine has been investigated in two randomised prospective trials. Although dapsone-pyrimethamine and cotrimoxazole have not been compared directly, some might argue that : a) dapsone-pyrimethamine is as effective as pentamidine aerosols in prevention of PCP ; b) cotrimoxazole is more effective than pentamidine aerosols ; c) therefore cotrimoxazole should also be more effective than dapsonepyrimethamine.

Resume HIV-2, identifie en 1986, est un lentivirus humain, responsable de SIDA, plus proche du virus Simian SIV (mac) que du HIV-1. Les premieres etudes epidemiologiques montrent que ce virus est present de facon quasi exclusive en Afrique de l'Ouest. Dans la population generale urbaine, les taux les plus eleves d'anticorps anti-HIV-2 sont retrouves en Guinee-Bissau, dans les iles du Cap Vert et au Mozamibique. Des etudes sont actuellement en cours en Afrique de l'Ouest pour preciser les caracteristiques cliniques et epidemiologiques de l'infection a HIV-2.

Resume Treize malades atteints de SIDA ont ete traites pendant une duree de un a onze mois par l'Interferon alpha-2-a humain recombinant (Roferon *** ) a dose progressivement croissante jusqu'a 20 × 10 6 Ul/m 2 /j. Cinq avaient une infection opportuniste, 3 l'association d'une infection opportuniste et d'un sarcome de Kaposi, 5 un Kaposi isole. L'analyse des resultats permet d'objectiver 2 remissions partielles, 2 stabilisations, soit une reponse dans 23 % des cas et 37,5 % des patients atteints de Sarcome de Kaposi. Des effets secondaires observes frequemment pour des fortes doses ont justifie une interruption de traitement dans 7 cas sur 13. Comme deja mentionne dans les travaux de la litterature, il apparait essentiellement que les meilleurs resultats sont observes chez les malades porteurs d'un sarcome de Kaposi, en dehors de toute notion d'infection opportuniste.

Resume Cet article a pour objectif la description des principales manifestations cliniques de l'infection par le virus HIV-2. Trente-deux dossiers ou resumes de dossiers ont ete consultes (22 de l'hopital Claude Bernard, et 10 d'autres hopitaux parisiens). Vingt patients etaient d'origine africaine et 12 etaient europeens (France, Portugal). Les caracteristiques cliniques des 14 patients atteints de SIDA etaient identiques a ce qu'il est decrit lors du SIDA HIV-1 mais cet article met en evidence une duree de vie et une periode d'incubation plus longues. Des differences de pathogenicite entre HIV-1 et HIV-2 meritent des etudes prospectives qui seules pourront repondre aux questions posees.

To examine the efficacy and tolerance of pentamidine aerosol in the prevention of Pneumocystis carinii pneumonia (PCP) relapse in patients with the acquired immunodeficiency syndrome (AIDS) being treated with zidovudine, 51 patients who had had an episode of PCP in the previous 5 months were enrolled in a randomised controlled study. 25 patients (group I) received pentamidine mesylate aerosol (4 mg/kg every 2 weeks for the first month then monthly) and zidovudine, and 26 patients (group II) zidovudine alone. 3 group I patients withdrew from pentamidine therapy prematurely and were excluded from the analysis of efficacy. Relapses of PCP occurred in 2 out of 22 (9%) group I patients and in 16 out of 26 (61%) group II patients after a mean follow-up of 10 and 8.7 months, respectively. The two groups differed significantly (p less than 0.0001) in proportions without relapse. They did not differ in proportions surviving. Bronchial intolerance was common (47%); no systemic side-effects of pentamidine were observed. Pentamidine aerosol thus seems to be effective in preventing PCP relapses in AIDS patients on zidovudine. The early termination of the trial prevented assessment of the long-term efficacy and safety of pentamidine given by aerosol.

Halofantrine is a 9-phenanthrenemethanol which is effective against multi-drug resistant strains of Plasmodium falciparum. It has been shown to be highly effective and extremely well tolerated in the treatment of imported cases of falciparum malaria in France. A total of 1,500 mg administered in three 500 mg doses at six-hour intervals results in a 100% cure rate in semi-immune subjects. This dosage should be repeated after 14 days to obtain the same cure rate in non-immune patients. Minor clinical side effects included epigastric pains, nausea and, in one case, a skin rash.

Anecdotal data suggest an Africa/Portugal connection in the global transmission of acquired immunodeficiency syndrome (AIDS). In 1986 human immunodeficiency virus (HIV)-2 was isolated from 1 man from Cape Verde and 1 man from Guinea-Bissau--both former Portuguese territories. In addition 1 of the 1st AIDS cases detected in France involved a white Portuguese man who was not from any high-risk group but had worked in Angola and Mozambique in 1968-74. This man developed seborrheic dermatitis oral thrush and mild peripheral neuropathy in February 1977 and Pneumocystis carinii in August 1977. The patient who died in March 1980 had antibodies to HIV-2 but not HIV-1. This case suggests that AIDS was present in Africa in the early 1970s. Further research is urged on the epidemiology of AIDS infection in countries such as Brazil Cuba and Japan that are historically linked to Portugal.