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Prates GDS, Monteiro MA, Oliveira ÉC, Nascimento NADL, Veiga APR, Ferreira MD, Polis TJB, Caetano GP, Soares BRP, Magri MMC, Pereira LO, Fonseca LAM, Alves WS, Duarte AJDS, Casseb JSDR. Incomplete recovery of the CD4+/CD8+ ratio is associated with the late introduction of antiretroviral therapy among people living with HIV infection. Rev Inst Med Trop Sao Paulo 2024; 66:e7. [PMID: 38324873 PMCID: PMC10846540 DOI: 10.1590/s1678-9946202466007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 11/07/2023] [Indexed: 02/09/2024] Open
Abstract
Despite being subject to lower AIDS-related mortality rates and having a higher life expectancy, patients with HIV are more prone to develop non-AIDS events. A low CD4+/CD8+ ratio during antiretroviral therapy identifies people with heightened immune senescence and increased risk of mortality. In clinical practice, finding determinants of a low CD4+/CD8+ ratio may be useful for identifying patients who require close monitoring due to an increased risk of comorbidities and death. We performed a prospective study on the evolution of the CD4+/CD8+ ratio in 60 patients infected with HIV (80% males), who were subjected to two different antiretroviral regimens: early and deferred therapy. The initial CD4+/CD8+ ratio was ≤1 for 70% of the patients in both groups. Older age, CD4+ cell count at inclusion, Nadir CD8+T-cell count, and Initial CD4+/CD8+ ratio ≤ 1 were risk factors for lack of ratio recovery. In the multivariate analysis, a CD4+/CD8+ ratio > 1 at the start of the treatment was found to be a determinant factor in maintaining a CD4+/CD8+ ratio > 1. The nadir CD4+T-cell count was lower in the deferred therapy group (p=0.004), and the last CD4+/CD8+ ratio ≤1 was not associated with comorbidities. Ratio recovery was not associated with the duration of HIV infection, time without therapy, or absence of AIDS incidence. A greater improvement was observed in patients treated early (p=0.003). In contrast, the slope of increase was slower in patients who deferred treatment. In conclusion, the increase in the CD4+/CD8+ ratio occurred mostly for patients undergoing early strategy treatment and its extension did not seem to be related to previous HIV-related factors.
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Affiliation(s)
- Gabriela da Silva Prates
- Universidade de São Paulo, Faculdade de Medicina, Instituto de Medicina Tropical de São Paulo, São Paulo, São Paulo, Brazil
| | - Mariana Amelia Monteiro
- Universidade de São Paulo, Faculdade de Medicina, Instituto de Medicina Tropical de São Paulo, São Paulo, São Paulo, Brazil
- Universidade de São Paulo, Hospital das Clínicas, Departamento de Dermatologia, Ambulatório de Imunodeficiências Secundárias, São Paulo, São Paulo, Brazil
| | - Éricka Constantinov Oliveira
- Universidade de São Paulo, Faculdade de Medicina, Instituto de Medicina Tropical de São Paulo, São Paulo, São Paulo, Brazil
| | - Najara Ataide de Lima Nascimento
- Universidade de São Paulo, Faculdade de Medicina, Instituto de Medicina Tropical de São Paulo, São Paulo, São Paulo, Brazil
- Universidade de São Paulo, Hospital das Clínicas, Departamento de Dermatologia, Ambulatório de Imunodeficiências Secundárias, São Paulo, São Paulo, Brazil
| | - Ana Paula Rocha Veiga
- Universidade de São Paulo, Hospital das Clínicas, Departamento de Dermatologia, Ambulatório de Imunodeficiências Secundárias, São Paulo, São Paulo, Brazil
| | - Mauricio Domingues Ferreira
- Universidade de São Paulo, Hospital das Clínicas, Departamento de Dermatologia, Ambulatório de Imunodeficiências Secundárias, São Paulo, São Paulo, Brazil
| | - Thales José Bueno Polis
- Universidade de São Paulo, Faculdade de Medicina, Instituto de Medicina Tropical de São Paulo, São Paulo, São Paulo, Brazil
| | - Gabriela Prandi Caetano
- Universidade de São Paulo, Faculdade de Medicina, Instituto de Medicina Tropical de São Paulo, São Paulo, São Paulo, Brazil
| | - Beatriz Rodrigues Pellegrina Soares
- Universidade de São Paulo, Hospital das Clínicas, Departamento de Dermatologia, Ambulatório de Imunodeficiências Secundárias, São Paulo, São Paulo, Brazil
| | - Marcello Mihailenko Chaves Magri
- Universidade de São Paulo, Hospital das Clínicas, Departamento de Dermatologia, Ambulatório de Imunodeficiências Secundárias, São Paulo, São Paulo, Brazil
| | - Luisa Oliveira Pereira
- Universidade de São Paulo, Faculdade de Medicina, Instituto de Medicina Tropical de São Paulo, São Paulo, São Paulo, Brazil
- Universidade de São Paulo, Hospital das Clínicas, Departamento de Dermatologia, Ambulatório de Imunodeficiências Secundárias, São Paulo, São Paulo, Brazil
| | - Luiz Augusto Marcondes Fonseca
- Universidade de São Paulo, Faculdade de Medicina, Instituto de Medicina Tropical de São Paulo, São Paulo, São Paulo, Brazil
| | - Wagner Silva Alves
- Universidade de São Paulo, Faculdade de Medicina, Instituto de Medicina Tropical de São Paulo, São Paulo, São Paulo, Brazil
| | - Alberto José da Silva Duarte
- Universidade de São Paulo, Faculdade de Medicina, Instituto de Medicina Tropical de São Paulo, São Paulo, São Paulo, Brazil
| | - Jorge Simão do Rosário Casseb
- Universidade de São Paulo, Faculdade de Medicina, Instituto de Medicina Tropical de São Paulo, São Paulo, São Paulo, Brazil
- Universidade de São Paulo, Hospital das Clínicas, Departamento de Dermatologia, Ambulatório de Imunodeficiências Secundárias, São Paulo, São Paulo, Brazil
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Monteiro MA, Prates GS, de Lima Nascimento NA, Veiga APR, Magri MMC, Polis TJB, Gascon MRP, Ferreira MD, Tiberto L, Pereira LO, Alves W, Fonseca LAM, Duarte AJS, Casseb J. SARS-CoV-2/COVID-19: Clinical Course Among Subjects HIV-1-Infected in Sao Paulo. Curr HIV Res 2022; 20:457-462. [PMID: 35748552 DOI: 10.2174/1570162x20666220624100248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 04/18/2022] [Accepted: 05/05/2022] [Indexed: 01/27/2023]
Abstract
INTRODUCTION People living with Human Immunodeficiency Virus (HIV) are under risk for co-infection with SARS-CoV-2. This population may be more prone to complications from COVID-19 due to persistent inflammation caused by HIV and higher incidence of metabolic syndromes, cardiovascular diseases, and malignancies, as well as being considered elderly at 50 years of age. The objective of this study was to report SARS-CoV-2 infection frequency, clinical evolution, and mortality in HIV-positive patients on antiretroviral therapy. METHODS The period of inquiry ranged from January to September 2020. Due to the social distance and the suspension of in-person medical care during the time of the investigation, we sent electronic questions about demographic, epidemiological, and clinical data to 403 HIV-infected patients. RESULTS Among 260 patients who answered the questionnaire, thirty-nine patients (15%) had suggestive symptoms and were tested for SARS-CoV-2 infection. Of this, 11 had positive results (32.4%) and no patient died of COVID-19 complications. Nine were male (3.4%), and the mean age of the patients with positive results was 43.2 years (± 9.6). 107 patients (41.1%) were over 50 years of age and their mean T-CD4+ cell count was 768. Eleven patients (4.2%) had a detectable HIV RNA viral load and 127 (48.8%) had comorbidities. These variables were not associated with an increased risk for infection. CONCLUSION The frequency of SARS-COV2 infection among HIV-infected is similar to the general population, and the clinical course is associated with the presence of comorbidities and not due to the HIV infection. However, new studies should be done to assess if this vulnerable population could answer the vaccine anti-SARS-Cov2.
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Affiliation(s)
- Mariana A Monteiro
- Departamento de Dermatologia do Hospital das Clínicas da Universidade de São Paulo, Ambulatório de Imunodeficiência Secundária (ADEE3002), São Paulo, Brazil
| | - Gabriela S Prates
- Departamento de Dermatologia do Hospital das Clínicas da Universidade de São Paulo, Ambulatório de Imunodeficiência Secundária (ADEE3002), São Paulo, Brazil
| | - Najara A de Lima Nascimento
- Departamento de Dermatologia do Hospital das Clínicas da Universidade de São Paulo, Ambulatório de Imunodeficiência Secundária (ADEE3002), São Paulo, Brazil
| | - Ana Paula R Veiga
- Departamento de Dermatologia do Hospital das Clínicas da Universidade de São Paulo, Ambulatório de Imunodeficiência Secundária (ADEE3002), São Paulo, Brazil
| | - Marcello M C Magri
- Departamento de Dermatologia do Hospital das Clínicas da Universidade de São Paulo, Ambulatório de Imunodeficiência Secundária (ADEE3002), São Paulo, Brazil
| | - Thales J B Polis
- Departamento de Dermatologia do Hospital das Clínicas da Universidade de São Paulo, Ambulatório de Imunodeficiência Secundária (ADEE3002), São Paulo, Brazil
| | - Maria R P Gascon
- Departamento de Dermatologia do Hospital das Clínicas da Universidade de São Paulo, Ambulatório de Imunodeficiência Secundária (ADEE3002), São Paulo, Brazil
| | - Mauricio D Ferreira
- Departamento de Dermatologia do Hospital das Clínicas da Universidade de São Paulo, Ambulatório de Imunodeficiência Secundária (ADEE3002), São Paulo, Brazil
| | - Larissa Tiberto
- Departamento de Dermatologia do Hospital das Clínicas da Universidade de São Paulo, Ambulatório de Imunodeficiência Secundária (ADEE3002), São Paulo, Brazil
| | - Luisa O Pereira
- Departamento de Dermatologia do Hospital das Clínicas da Universidade de São Paulo, Ambulatório de Imunodeficiência Secundária (ADEE3002), São Paulo, Brazil
| | - Wagner Alves
- Departamento de Dermatologia do Hospital das Clínicas da Universidade de São Paulo, Ambulatório de Imunodeficiência Secundária (ADEE3002), São Paulo, Brazil
| | - Luiz A M Fonseca
- Departamento de Dermatologia do Hospital das Clínicas da Universidade de São Paulo, Ambulatório de Imunodeficiência Secundária (ADEE3002), São Paulo, Brazil
| | - Alberto J S Duarte
- Departamento de Dermatologia do Hospital das Clínicas da Universidade de São Paulo, Ambulatório de Imunodeficiência Secundária (ADEE3002), São Paulo, Brazil
| | - Jorge Casseb
- Departamento de Dermatologia do Hospital das Clínicas da Universidade de São Paulo, Ambulatório de Imunodeficiência Secundária (ADEE3002), São Paulo, Brazil
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da Silva Prates G, Malta FM, de Toledo Gonçalves F, Monteiro MA, Fonseca LAM, R Veiga AP, M C Magri M, Duarte AJS, Casseb J, Assone T. AIDS incidence and survival in a hospital-based cohort of HIV-positive patients from São Paulo, Brazil: The role of IFN-λ4 polymorphisms. J Med Virol 2021; 93:3601-3606. [PMID: 32449798 DOI: 10.1002/jmv.26054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 05/06/2020] [Accepted: 05/20/2020] [Indexed: 11/10/2022]
Abstract
Few studies have reported the prognosis of human immunodeficiency virus (HIV)-positive patients followed for a long time in Brazil, particularly those including pre and post-HAART eras. The polymorphisms of interferon (IFN)-λ4 have been postulated as possibly associated with the pathogenesis of HIV infection. The aim of this study was to describe the incidence and mortality from a cohort of HIV-positive patients as well as whether IFN-λ4 gene polymorphisms (SNP rs8099917 and SNP rs12979860) were associated with HIV/acquired immune deficiency syndrome (AIDS) progression. We followed 402 patients for up to 30 years; 347 of them began follow-up asymptomatic, without any AIDS-defining opportunistic disease and/or a lymphocytes T CD4+ count of 350 cells/mm3 or lower. We determined the probability of the asymptomatic subjects to remain AIDS-free, and the risk of death for those entering the study already with an AIDS diagnosis, as well as for subjects developing AIDS during follow-up. We compared the prognosis of patients with two different polymorphisms for the genes encoding for IFN-λ4, variants rs8099917 and rs12979860. The follow-up time of the 347 asymptomatic-at-entry subjects was 3687 person-years. IFN-λ4 rs8099917 polymorphisms were not associated with AIDS progression, but IFN-λ4 rs12979860 wild type genotype (CC) was associated with higher mortality compared to CT and TT, with an increased probability of death from AIDS (P = .01). In conclusion, genetic variations in IFN-λ4 on rs12979860 polymorphisms in HIV-infected patients may drive mortality risk.
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Affiliation(s)
- Gabriela da Silva Prates
- Faculdade de Medicina FMUSP/Instituto de Medicina Tropical de São Paulo, Universidade de São Paulo, São Paulo, Brazil
| | - Fernanda M Malta
- Departamento de Gastroenterologia, Laboratório de Gastroenterologia e Hepatologia Tropical, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Fernanda de Toledo Gonçalves
- Departamento de Medicina Legal, Ética Médica e Medicina Social e do Trabalho, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Mariana A Monteiro
- Faculdade de Medicina FMUSP/Instituto de Medicina Tropical de São Paulo, Universidade de São Paulo, São Paulo, Brazil
- Ambulatório de Dermatologia e Imunodeficiências (ADEE 3002), Hospital das Clínicas, Departamento de Dermatologia, Faculdade de Medicina FMUSP, Universidade de São Paulo, Rua Dr. Eneas de Carvalho Aguiar 500, São Paulo, SP, 05403-000, Brazil
| | - Luiz Augusto M Fonseca
- Faculdade de Medicina FMUSP/Instituto de Medicina Tropical de São Paulo, Universidade de São Paulo, São Paulo, Brazil
| | - Ana Paula R Veiga
- Ambulatório de Dermatologia e Imunodeficiências (ADEE 3002), Hospital das Clínicas, Departamento de Dermatologia, Faculdade de Medicina FMUSP, Universidade de São Paulo, Rua Dr. Eneas de Carvalho Aguiar 500, São Paulo, SP, 05403-000, Brazil
| | - Marcello M C Magri
- Ambulatório de Dermatologia e Imunodeficiências (ADEE 3002), Hospital das Clínicas, Departamento de Dermatologia, Faculdade de Medicina FMUSP, Universidade de São Paulo, Rua Dr. Eneas de Carvalho Aguiar 500, São Paulo, SP, 05403-000, Brazil
| | - Alberto J S Duarte
- Faculdade de Medicina FMUSP/Instituto de Medicina Tropical de São Paulo, Universidade de São Paulo, São Paulo, Brazil
- Ambulatório de Dermatologia e Imunodeficiências (ADEE 3002), Hospital das Clínicas, Departamento de Dermatologia, Faculdade de Medicina FMUSP, Universidade de São Paulo, Rua Dr. Eneas de Carvalho Aguiar 500, São Paulo, SP, 05403-000, Brazil
| | - Jorge Casseb
- Faculdade de Medicina FMUSP/Instituto de Medicina Tropical de São Paulo, Universidade de São Paulo, São Paulo, Brazil
- Ambulatório de Dermatologia e Imunodeficiências (ADEE 3002), Hospital das Clínicas, Departamento de Dermatologia, Faculdade de Medicina FMUSP, Universidade de São Paulo, Rua Dr. Eneas de Carvalho Aguiar 500, São Paulo, SP, 05403-000, Brazil
| | - Tatiane Assone
- Faculdade de Medicina FMUSP/Instituto de Medicina Tropical de São Paulo, Universidade de São Paulo, São Paulo, Brazil
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Casseb J, Marcusso RMN, Monteiro M, Assone T, Haziot MEY, Peribanez-Gonzalez M, Fonseca LAM, Smid J, Luisi de Moura JV, Dahy FE, de Oliveira AP. Human T-Cell Lymphotropic Virus/Human Immunodeficiency Virus, and Hepatitis C Virus Coinfection: Clinical Outcomes After 22 Years of Follow-up in São Paulo City. Clin Infect Dis 2021; 72:1865-1866. [PMID: 33677536 DOI: 10.1093/cid/ciaa1008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 02/26/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jorge Casseb
- Faculdade de Medicina da Universidade de São Paulo/Tropical Medicine Institute of São Paulo, São Paulo, Brazil.,Laboratory of Dermatology and Immunodeficiencies, Department of Dermatology, University of São Paulo Medical School, São Paulo, Brazil.,Human Immunodeficiency Virus Outpatient Clinic-Secondary Immunodeficiencies Service (ADEE3002), Department of Dermatology of Hospital das Clínicas, University of São Paulo Medical School, Av. Dr. Enéas de Carvalho Aguiar, São Paulo, Brazil
| | | | - Mariana Monteiro
- Human Immunodeficiency Virus Outpatient Clinic-Secondary Immunodeficiencies Service (ADEE3002), Department of Dermatology of Hospital das Clínicas, University of São Paulo Medical School, Av. Dr. Enéas de Carvalho Aguiar, São Paulo, Brazil
| | - Tatiane Assone
- Faculdade de Medicina da Universidade de São Paulo/Tropical Medicine Institute of São Paulo, São Paulo, Brazil.,Laboratory of Dermatology and Immunodeficiencies, Department of Dermatology, University of São Paulo Medical School, São Paulo, Brazil
| | - Michel E Y Haziot
- Institute of Infectious Diseases "Emilio Ribas" of São Paulo, São Paulo, Brazil
| | | | - Luiz Augusto M Fonseca
- Faculdade de Medicina da Universidade de São Paulo/Tropical Medicine Institute of São Paulo, São Paulo, Brazil.,Laboratory of Dermatology and Immunodeficiencies, Department of Dermatology, University of São Paulo Medical School, São Paulo, Brazil
| | - Jerusa Smid
- Institute of Infectious Diseases "Emilio Ribas" of São Paulo, São Paulo, Brazil
| | | | - Flávia E Dahy
- Institute of Infectious Diseases "Emilio Ribas" of São Paulo, São Paulo, Brazil
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Casseb J, Veiga APR, Magri MMC, Monteiro MA, Rocha RC, Gascon MRP, Domingues-Ferreira M, Polis TJB, Nascimento NADL, Limongelli I, Oliveira ÍS, Prandi GC, Costa LMCBV, Fonseca LAM, Duarte AJS. Fighting HIV/AIDS in a developing country: lessons from a small cohort from the largest Brazilian city. Rev Inst Med Trop Sao Paulo 2020; 62:e58. [PMID: 32876298 PMCID: PMC7458075 DOI: 10.1590/s1678-9946202062058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 03/20/2020] [Indexed: 01/22/2023] Open
Affiliation(s)
- Jorge Casseb
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil.,LIM-56, Instituto de Medicina Tropical de São Paulo, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Ana Paula R Veiga
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil.,LIM-56, Instituto de Medicina Tropical de São Paulo, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Marcello M C Magri
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil.,LIM-56, Instituto de Medicina Tropical de São Paulo, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Mariana A Monteiro
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil.,LIM-56, Instituto de Medicina Tropical de São Paulo, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Rosana C Rocha
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil.,LIM-56, Instituto de Medicina Tropical de São Paulo, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Maria Rita P Gascon
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil.,LIM-56, Instituto de Medicina Tropical de São Paulo, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Mauricio Domingues-Ferreira
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil.,LIM-56, Instituto de Medicina Tropical de São Paulo, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Thales J B Polis
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil.,LIM-56, Instituto de Medicina Tropical de São Paulo, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Najara A de Lima Nascimento
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil.,LIM-56, Instituto de Medicina Tropical de São Paulo, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Isadora Limongelli
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil.,LIM-56, Instituto de Medicina Tropical de São Paulo, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Ícaro S Oliveira
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil.,LIM-56, Instituto de Medicina Tropical de São Paulo, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Gabriela Caetano Prandi
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | | | - Luiz A M Fonseca
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil.,LIM-56, Instituto de Medicina Tropical de São Paulo, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Alberto J S Duarte
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brazil.,LIM-56, Instituto de Medicina Tropical de São Paulo, Universidade de São Paulo, São Paulo, São Paulo, Brazil
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6
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Marcusso RMN, Van Weyenbergh J, de Moura JVL, Dahy FE, de Moura Brasil Matos A, Haziot MEJ, Vidal JE, Fonseca LAM, Smid J, Assone T, Casseb J, de Oliveira ACP. Dichotomy in Fatal Outcomes in a Large Cohort of People Living with HTLV-1 in São Paulo, Brazil. Pathogens 2019; 9:pathogens9010025. [PMID: 31888093 PMCID: PMC7168659 DOI: 10.3390/pathogens9010025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 11/30/2019] [Accepted: 12/24/2019] [Indexed: 11/30/2022] Open
Abstract
Background: Despite its relatively low incidence of associated diseases, Human T-cell Leukemia Virus-1 (HTLV-1) infection was reported to carry a significant risk of mortality in several endemic areas. HTLV-1-associated diseases, adult T-cell leukemia/lymphoma (ATLL) and HTLV-1-associated myelopathy/tropical spastic paraperesis (HAM/TSP), as well as frequent coinfections with human immunodeficiency virus (HIV), hepatitis C virus (HCV), and Strongyloides stercoralis were associated to increased morbidity and mortality of HTLV-1 infection. Objective: To determine the mortality rate and its associated variables from an open cohort started in July 1997 at the HTLV Clinic, Emilio Ribas Institute (IIER), a major infectious disease hospital in São Paulo, Brazil. Methods: Since inception up to September 2018, we admitted 727 HTLV-1-infected individuals, with a rate of 30–50 new admissions per year. All patient data, including clinical and laboratory data, were regularly updated throughout the 21-year period, using a dedicated REDCap database. The Ethical Board of IIER approved the protocol. Results: During 21 years of clinical care to people living with HTLV-1 in the São Paulo region, we recruited 479 asymptomatic HTLV-1-infected individuals and 248 HAM/TSP patients, of which 632 remained under active follow-up. During a total of 3800 person-years of follow-up (maximum follow-up 21.5 years, mean follow-up 6.0 years), 27 individuals died (median age of 51.5 years), of which 12 were asymptomatic, one ATLL patient and 14 HAM/TSP patients. HAM/TSP diagnosis (but neither age nor gender) was a significant predictor of increased mortality by univariate and multivariate (hazard ratio (HR) 5.03, 95% CI [1.96–12.91], p = 0.001) Cox regression models. Coinfection with HIV/HCV was an independent predictor of increased mortality (HR 15.08; 95% CI [5.50–41.32]; p < 0.001), with AIDS-related infections as a more frequent cause of death in asymptomatics (6/13; p = 0.033). HIV/HCV-negative fatal HAM/TSP cases were all female, with urinary tract infection and decubitus ulcer-associated sepsis as the main cause of death (8/14, p = 0.002). Conclusions: All-cause mortality among people living with HTLV-1 in São Paulo differs between asymptomatic (2.9%) and HAM/TSP patients (7.3%), independent of age and gender. We observe a dichotomy in fatal cases, with HAM/TSP and HIV/HCV coinfection as independent risk factors for death. Our findings reveal an urgent need for public health actions, as the major causes of death, infections secondary to decubitus ulcers, and immune deficiency syndrome (AIDS)-related infections, can be targeted by preventive measures.
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Affiliation(s)
- Rosa Maria N. Marcusso
- Institute of Infectious Diseases “Emilio Ribas” (IIER) of São Paulo, São Paulo 01246-000, Brazil; (J.V.L.d.M.); (F.E.D.); (M.E.J.H.); (J.E.V.); (J.S.)
- Correspondence: (R.M.N.M.); (A.C.P.d.O.)
| | - Johan Van Weyenbergh
- Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, KU Leuven, 3000 Leuven, Belgium;
| | - João Victor Luisi de Moura
- Institute of Infectious Diseases “Emilio Ribas” (IIER) of São Paulo, São Paulo 01246-000, Brazil; (J.V.L.d.M.); (F.E.D.); (M.E.J.H.); (J.E.V.); (J.S.)
| | - Flávia Esper Dahy
- Institute of Infectious Diseases “Emilio Ribas” (IIER) of São Paulo, São Paulo 01246-000, Brazil; (J.V.L.d.M.); (F.E.D.); (M.E.J.H.); (J.E.V.); (J.S.)
| | | | - Michel E. J. Haziot
- Institute of Infectious Diseases “Emilio Ribas” (IIER) of São Paulo, São Paulo 01246-000, Brazil; (J.V.L.d.M.); (F.E.D.); (M.E.J.H.); (J.E.V.); (J.S.)
| | - Jose E. Vidal
- Institute of Infectious Diseases “Emilio Ribas” (IIER) of São Paulo, São Paulo 01246-000, Brazil; (J.V.L.d.M.); (F.E.D.); (M.E.J.H.); (J.E.V.); (J.S.)
- Institute of Tropical Medicine of São Paulo, São Paulo 05403-000, Brazil; (A.d.M.B.M.); (L.A.M.F.); (J.C.)
| | - Luiz Augusto M. Fonseca
- Institute of Tropical Medicine of São Paulo, São Paulo 05403-000, Brazil; (A.d.M.B.M.); (L.A.M.F.); (J.C.)
| | - Jerusa Smid
- Institute of Infectious Diseases “Emilio Ribas” (IIER) of São Paulo, São Paulo 01246-000, Brazil; (J.V.L.d.M.); (F.E.D.); (M.E.J.H.); (J.E.V.); (J.S.)
| | - Tatiane Assone
- Institute of Tropical Medicine of São Paulo, São Paulo 05403-000, Brazil; (A.d.M.B.M.); (L.A.M.F.); (J.C.)
- Laboratory of Dermatology and Immunodeficiencies, Department of Dermatology, Medical School, University of São Paulo Brazil, São Paulo 05403-000, Brazil
| | - Jorge Casseb
- Institute of Tropical Medicine of São Paulo, São Paulo 05403-000, Brazil; (A.d.M.B.M.); (L.A.M.F.); (J.C.)
- Laboratory of Dermatology and Immunodeficiencies, Department of Dermatology, Medical School, University of São Paulo Brazil, São Paulo 05403-000, Brazil
| | - Augusto César Penalva de Oliveira
- Institute of Infectious Diseases “Emilio Ribas” (IIER) of São Paulo, São Paulo 01246-000, Brazil; (J.V.L.d.M.); (F.E.D.); (M.E.J.H.); (J.E.V.); (J.S.)
- Correspondence: (R.M.N.M.); (A.C.P.d.O.)
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