Prevention du paludisme chez l'adulte

in Revue Médicale de Liège (2003), 58(6), 382-7

Great scourge of poor countries, malaria is the most important tropical parasitic disease. It is responsible for a large number of deaths in concerned countries and represents a real danger for travellers ... [more ▼]

Great scourge of poor countries, malaria is the most important tropical parasitic disease. It is responsible for a large number of deaths in concerned countries and represents a real danger for travellers going to endemic regions. So, prophylactic measures are essential. On the one hand protective measures against mosquito bites, by wearing covering clothes, by using repellents and bed net (eventually impregnated with insecticide) will be useful. On the other hand, chemoprophylaxis is most often necessary, adapted to the possibility of chloroquine resistant P. falciparum, to the length or conditions of travel, and to the traveller's antecedents and age. Special concern about pregnant woman is necessary, due to potential severity of malaria. Chemoprophylaxis needs to be continued after coming back, for a duration depending on the drug used. Unfortunately, no prophylaxis is 100% effective, and the appearance of fever during the travel or two to three months after return requires medical advice. In some circumstances, it is necessary to prescribe a stand-by emergency treatment, if no quick medical advice is possible. [less ▲]

Les anomalies morphologiques et metaboliques liees aux traitements antiretroviraux

in Revue Médicale de Liège (2002), 57(1), 23-8

The long term use of antiretroviral therapy is associated with metabolic and morphological abnormalities named lipodystrophy. The understanding of its epidemiology is in progress. NRTIs and Pls are ... [more ▼]

The long term use of antiretroviral therapy is associated with metabolic and morphological abnormalities named lipodystrophy. The understanding of its epidemiology is in progress. NRTIs and Pls are involved in the origin of these abnormalities. So, NRTIs inhibit mitochondrial gamma polymerase and induce body fat distribution disorders. PIs interfere with lipid metabolism, leading to hyperlipidaemia and insulin resistance symptomatology. The diagnosis is made by clinical (far wasting or accumulation, or mixed syndrome) and biological signs (hyperlipidaemia, hyperglycaemia, hyperlactacidaemia). Radiological exams can quantify morphological abnormalities. The management consists in drug substitution, diet and exercise, and corrective drugs. Plastic surgery can be useful. [less ▲]

Pharma-clinics comment je traite ... une infection par le VIH. IV. Les inhibiteurs de protease

in Revue Médicale de Liège (2001), 56(11), 739-44

Protease inhibitors constitute the last class of antiretroviral drugs appeared on the market. They raised an enormous enthusiasm, reinforced by recent studies results. These molecules prevent the ... [more ▼]

Protease inhibitors constitute the last class of antiretroviral drugs appeared on the market. They raised an enormous enthusiasm, reinforced by recent studies results. These molecules prevent the formation of infectious viral particles, while inhibiting a viral enzyme that plays a key role in the cycle of replication of the HIV. Their efficiency, especially in association, is recognized for all stages of the infection and the intervening of a resistance often requires many mutations. However, the unexpected adverse events such as lipodystrophy and some interactions can limit their utilization in first intention. [less ▲]

Hydroxyuree et infection par le VIH

in Revue Médicale de Liège (2000), 55(7), 721-4

Hydroxyurea is an anticancerous product, used recently in the treatment of HIV-1 infection thanks to its inhibitory action in viral replication, potentialization of the nucleosides activity (particularly ... [more ▼]

Hydroxyurea is an anticancerous product, used recently in the treatment of HIV-1 infection thanks to its inhibitory action in viral replication, potentialization of the nucleosides activity (particularly ddI or didanosine) and its cytostatic properties on CD4 and CD8 lymphocytes. Many studies showed its efficiency, as further drug, in initial regimen of a tritherapy (containing ddI) and salvage therapy. The dosage of 500 mg bid seems tolerated well by adults, and 20 mg/kg by children. Long-term tolerance remains unknown. With ddI, it could be proposed in developing countries. [less ▲]

Pharma-clinics comment je traite ... une infection par le VIH. III. Les inhibiteurs non nucléosidiques de la transcriptase inverse

in Revue Médicale de Liège (1999), 54(12), 909-11

Non nucleoside reverse transcriptase inhibitors (NNRTI) are a new arm in the treatment of the HIV infection. They inhibit the replication by direct non competitive binding to the enzyme, and do not ... [more ▼]

Non nucleoside reverse transcriptase inhibitors (NNRTI) are a new arm in the treatment of the HIV infection. They inhibit the replication by direct non competitive binding to the enzyme, and do not require phosphorylation. The fast emergence of resistance in monotherapy obliges to use them in a triple association. The 103 mutation confers a cross-resistance. The most common adverse event is rash. Association with nucleoside analogues is additive or even synergistic. They are metabolized by the cytochrome P450. Within a combined therapy, their efficiency is comparable to protease inhibitors, notably in patients with low viral load. [less ▲]

Comment je traite ... une infection par le VIH. I. Bases pathogéniques des choix thérapeutiques

in Revue Médicale de Liège (1997), 52(10), 622-4