Maggi P, Larocca A M, Quarto M, Serio G, Brandonisio O, Angarano G, Pastore G
Institute of Infectious Disease, University of Bari - Policlinico, Italy.
Eur J Clin Microbiol Infect Dis. 2000 Mar;19(3):213-7. doi: 10.1007/s100960050461.
To better understand whether potent antiretroviral therapies can modify the natural history of HIV-1-associated microsporidiosis and cryptosporidiosis, the response to antimicrobial treatment of these opportunistic infections was evaluated in patients with or without antiretroviral treatment. Fifty patients with diarrhoea, all positive for Cryptosporidium parvum or Enterocytozoon bieneusi, were included in the study. Retrospective data were collected concerning demographics, clinical and microbiological characteristics of the parasitic infection, antiretroviral therapy and prophylaxis against opportunistic infections. Faecal samples were prepared using the Richie formalin-ethyl acetate method and stained using the modified Ziehl-Neelsen method for detection of Cryptosporidium parvum and Isospora belli, the modified trichrome and calcofluor white technique for detection of Enterocytozoon spp., and iodine for detection of ova, cysts or vegetative forms. Diarrhoea was defined as an abnormal increase in stool liquidity, an abnormal increase in stool frequency and a daily stool weight of more than 250 g for a period of at least 4 days. Patients treated with double antiretroviral therapy or protease inhibitors demonstrated an excellent response and a sustained therapeutic effect after follow-up (range, 5-36 months). The relapse of cryptosporidiosis in two patients who discontinued antiretroviral therapy suggests that the infection might remain in a latent stage. The resolution of the diarrhoea seems to be related to an increased CD4+ cell count rather than to the viral load. In conclusion, these data strongly support the hypothesis that combination antiretroviral therapy is able to greatly modify the course of cryptosporidiosis and microsporidiosis in patients infected with HIV-1.
为了更好地了解强效抗逆转录病毒疗法是否能改变与HIV-1相关的微孢子虫病和隐孢子虫病的自然病程，我们评估了接受或未接受抗逆转录病毒治疗的患者对这些机会性感染的抗菌治疗反应。50例腹泻患者被纳入研究，所有患者的微小隐孢子虫或贝氏等孢球虫检测均为阳性。收集了有关人口统计学、寄生虫感染的临床和微生物学特征、抗逆转录病毒治疗以及机会性感染预防的回顾性数据。粪便样本采用Richie甲醛-乙酸乙酯法制备，使用改良的齐尔-尼尔森法对微小隐孢子虫和贝氏等孢球虫进行染色，使用改良的三色染色法和荧光增白剂检测肠孢子虫属，使用碘检测虫卵、包囊或滋养体。腹泻定义为粪便流动性异常增加、排便频率异常增加且每日粪便重量超过250克，持续至少4天。接受双重抗逆转录病毒治疗或蛋白酶抑制剂治疗的患者在随访（5 - 36个月）后表现出良好的反应和持续的治疗效果。两名停止抗逆转录病毒治疗的患者隐孢子虫病复发，提示感染可能处于潜伏阶段。腹泻的缓解似乎与CD4 +细胞计数增加有关，而非病毒载量。总之，这些数据有力地支持了以下假设：联合抗逆转录病毒疗法能够显著改变HIV-1感染患者的隐孢子虫病和微孢子虫病病程。
