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Hyperlipidemia has been frequently recorded as a side effect of treating HIV patients with protease inhibitors (PI). This study was initiated to analyze the modifications on blood lipids in HIV-patients receiving PI and the safety and efficacy of the treatment with fenofibrate. Total (TC) and HDL-cholesterol, triglycerides (TG), and CD4+ T-cell counts were measured in 30 HAART-naive patients (Group I) before and after PI introduction. In a second phase of the study, the effects of fenofibrate on lipids, CPK, CD4+, and viral load were determined in 13 patients (Group II) with elevated TC or TG. In Group I, 60% of the patients showed TC or TG elevations. Average increments of 31% and 146% in TC and TG respectively (p

Nas formas cardíacas da doença de Chagas que evoluem com insuficiência cardíaca refratária ao tratamento clínico, o transplante é a única alternativa, ao lado da cardiomioplastia. Os autores apresentam a evolução tardia de seis pacientes com miocardiopatia chagásica terminal submetidos a transplante cardíaco ortotópico. O período médio de observação foi de 25,2 meses. O diagnóstico de reativação da doença de Chagas apoiou-se na observação clínica, na investigação laboratorial do parasita, nas biópsias endomiocárdicas e dos nódulos de subcutâneo. A análise dos resultados demonstra que: 1) os testes laboratoriais mostraram-se ineficazes no diagnóstico da reativação da doença, sendo que as biópsias mostraram maior índice de positividade; 2) a pulsoterapia com corticóide predispõe à reativação; 3) a doença linfoproliferativa apresenta alta incidência na doença de Chagas, sendo a principal complicação tardia. Possivelmente, o benzonidazol apresente seu efeito oncogênico potencializado. Tendo em vista o caráter endêmico da doença e a falta de alternativa terapêutica, tornou-se obrigatória a analise do esquema imunossupressor, do tratamento da reativação e a maior experiência clínica, para posições mais definidas.In the cardiac forms of Chagas' Disease that develop with refractory cardiac failure under clinical treatment, the transplant is the only alternative along with the cardiomyoplasty. The authors present the six patient late evolution with terminal chagasic myocardiopathy submitted under on orthopic heart transplantation. The average period of observation was of 25.2 months. The diagnosis of Chagas' Disease reativation relies on the clinical observation, laboratory investigation of parasito, endomyocardial biopsy and subcutaneous nodules. The analyses of the results show that: 1) the laboratory exams were useless in the diagnosis of the disease reativation, but the biopsy presented hight positivity; 2) the pulse therapy with steroid predisposes the reativation; 3) the lymphoproliferative disease presents hight incidence in the Chagas' Disease which is the main late complication; possibly the benzonidazol shows its potentially oncogenic effect. Having in mind the endemic character of the disease, the lack of alternative therapy becomes compulsory the analysis of immunosuppressive therapy, reativation treatment and increases the clinical experience to more defined position.