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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] [What about the content of this article? (0)] [Affiliation(s)] [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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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Prates G, Assone T, Corral M, Baldassin MPM, Mitiko T, Silva Sales FC, Haziot ME, Smid J, Fonseca LAM, de Toledo Gonçalves F, Penalva de Oliveira AC, Casseb J. Prognosis Markers for Monitoring HTLV-1 Neurologic Disease. Neurol Clin Pract 2020; 11:134-140. [PMID: 33842066 DOI: 10.1212/cpj.0000000000000866] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 04/20/2020] [Indexed: 12/24/2022]
Abstract
Background Human T-cell lymphotropic virus type 1 (HTLV-1) infection is associated not only with some severe manifestations, such as HTLV-1-associated myelopathy (HAM) and ATLL, but also with other, less severe conditions. Some studies have reported neurologic manifestations that did not meet all the criteria for the diagnosis of HAM in individuals infected with HTLV-1; these conditions may later progress to HAM or constitute an intermediate clinical form, between asymptomatic HTLV-1 carriers and those with full myelopathy. This study evaluated the prognostic value and looked for a possible association of those parameters with the intermediate syndrome (IS) status and HAM status. Methods Proviral load (PVL), spontaneous lymphoproliferation, interferon (IFN)-γ spontaneous production was quantified in samples of asymptomatic and HAM patients, as well as patients with IS. Results The critical age range was 50-60 years for IS outcome and more of 60 years for HAM outcome, with an increased risk of 2.5-fold for IS and 6.8-fold for HAM. IFN-γ was increased in patients with IS compared with asymptomatic carriers (ACs) (p = 0.007) and in patients with HAM compared with ACs (p = 0.03). Lymphoproliferation was increased in patients with HAM vs ACs (p = 0.0001) and patients with IS (p = 0.0001). PVL was similar between groups. Conclusion IFN-γ has high specificity of prediction of subject remain asymptomatic compared with PVL and lymphoproliferation assay tests. IFN-γ has been shown to be a biomarker of progression to intermediate stage and to HAM. The association of other markers with manifestations associated with HTLV-1 infection that does not meet the HAM criteria should be verified.
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Affiliation(s)
- Gabriela Prates
- Faculty of Medicine-University of São Paulo (GP, TA, MC, MPMB, TM, FCSS, LAMF, JC); Institute of Infectious Diseases "Emilio Ribas" (MEH, JS, ACPdO); and Departamento de Medicina Legal, Ética Médica e Medicina Social e do Trabalho, Faculdade de Medicina FMUSP (FdTG), University of São Paulo, Brazil
| | - Tatiane Assone
- Faculty of Medicine-University of São Paulo (GP, TA, MC, MPMB, TM, FCSS, LAMF, JC); Institute of Infectious Diseases "Emilio Ribas" (MEH, JS, ACPdO); and Departamento de Medicina Legal, Ética Médica e Medicina Social e do Trabalho, Faculdade de Medicina FMUSP (FdTG), University of São Paulo, Brazil
| | - Marcelo Corral
- Faculty of Medicine-University of São Paulo (GP, TA, MC, MPMB, TM, FCSS, LAMF, JC); Institute of Infectious Diseases "Emilio Ribas" (MEH, JS, ACPdO); and Departamento de Medicina Legal, Ética Médica e Medicina Social e do Trabalho, Faculdade de Medicina FMUSP (FdTG), University of São Paulo, Brazil
| | - Maíra P M Baldassin
- Faculty of Medicine-University of São Paulo (GP, TA, MC, MPMB, TM, FCSS, LAMF, JC); Institute of Infectious Diseases "Emilio Ribas" (MEH, JS, ACPdO); and Departamento de Medicina Legal, Ética Médica e Medicina Social e do Trabalho, Faculdade de Medicina FMUSP (FdTG), University of São Paulo, Brazil
| | - Tatiane Mitiko
- Faculty of Medicine-University of São Paulo (GP, TA, MC, MPMB, TM, FCSS, LAMF, JC); Institute of Infectious Diseases "Emilio Ribas" (MEH, JS, ACPdO); and Departamento de Medicina Legal, Ética Médica e Medicina Social e do Trabalho, Faculdade de Medicina FMUSP (FdTG), University of São Paulo, Brazil
| | - Flávia C Silva Sales
- Faculty of Medicine-University of São Paulo (GP, TA, MC, MPMB, TM, FCSS, LAMF, JC); Institute of Infectious Diseases "Emilio Ribas" (MEH, JS, ACPdO); and Departamento de Medicina Legal, Ética Médica e Medicina Social e do Trabalho, Faculdade de Medicina FMUSP (FdTG), University of São Paulo, Brazil
| | - Michel E Haziot
- Faculty of Medicine-University of São Paulo (GP, TA, MC, MPMB, TM, FCSS, LAMF, JC); Institute of Infectious Diseases "Emilio Ribas" (MEH, JS, ACPdO); and Departamento de Medicina Legal, Ética Médica e Medicina Social e do Trabalho, Faculdade de Medicina FMUSP (FdTG), University of São Paulo, Brazil
| | - Jerusa Smid
- Faculty of Medicine-University of São Paulo (GP, TA, MC, MPMB, TM, FCSS, LAMF, JC); Institute of Infectious Diseases "Emilio Ribas" (MEH, JS, ACPdO); and Departamento de Medicina Legal, Ética Médica e Medicina Social e do Trabalho, Faculdade de Medicina FMUSP (FdTG), University of São Paulo, Brazil
| | - Luiz A M Fonseca
- Faculty of Medicine-University of São Paulo (GP, TA, MC, MPMB, TM, FCSS, LAMF, JC); Institute of Infectious Diseases "Emilio Ribas" (MEH, JS, ACPdO); and Departamento de Medicina Legal, Ética Médica e Medicina Social e do Trabalho, Faculdade de Medicina FMUSP (FdTG), University of São Paulo, Brazil
| | - Fernanda de Toledo Gonçalves
- Faculty of Medicine-University of São Paulo (GP, TA, MC, MPMB, TM, FCSS, LAMF, JC); Institute of Infectious Diseases "Emilio Ribas" (MEH, JS, ACPdO); and Departamento de Medicina Legal, Ética Médica e Medicina Social e do Trabalho, Faculdade de Medicina FMUSP (FdTG), University of São Paulo, Brazil
| | - Augusto C Penalva de Oliveira
- Faculty of Medicine-University of São Paulo (GP, TA, MC, MPMB, TM, FCSS, LAMF, JC); Institute of Infectious Diseases "Emilio Ribas" (MEH, JS, ACPdO); and Departamento de Medicina Legal, Ética Médica e Medicina Social e do Trabalho, Faculdade de Medicina FMUSP (FdTG), University of São Paulo, Brazil
| | - Jorge Casseb
- Faculty of Medicine-University of São Paulo (GP, TA, MC, MPMB, TM, FCSS, LAMF, JC); Institute of Infectious Diseases "Emilio Ribas" (MEH, JS, ACPdO); and Departamento de Medicina Legal, Ética Médica e Medicina Social e do Trabalho, Faculdade de Medicina FMUSP (FdTG), University of São Paulo, Brazil
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Sabino TE, Avelino-Silva VI, Cavalcantte C, Goulart SP, Luiz OC, Fonseca LAM, Casseb JS. Adherence to antiretroviral treatment and quality of life among transgender women living with HIV/AIDS in São Paulo, Brazil. AIDS Care 2020; 33:31-38. [PMID: 31906696 DOI: 10.1080/09540121.2019.1710449] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This study focused on factors associated with antiretroviral therapy (ART) adherence and quality of life among transgenderwomen in Sao Paulo, Brazil, using univariable and adjusted analysis. Adherence was evaluated with a self-report tool and with HIV viral load (VL) measurement. PROQOL-HIV was used to assess quality of life. 106 TGW with median 41 years old were included; most were white (56%) and had >10 years of education (57%). Median time since HIV/AIDS diagnosis was 10 years. Overall, participants had high T CD4+ counts (median 659 cells/mm3) and most (75%) had undetectable HIV VL. 85% were considered adherent using self-report (95%CI 77-91), whereas 72% (95%CI 62-80) were considered adherent when self-report and undetectable HIV VL were analyzed jointly. Older age was associated with higher ART adherence; each year increase in age was associated with 5% higher odds of adherence (p = 0.021). Quality of life ranged from good-excellent in 5 of 8 domains. Younger age, lower education, higher time since HIV diagnosis, comorbidities, illicit drugs use and depression were associated with lower PROQOL scores in specific domains in univariable analysis, while depression was also associated with lower total PROQOL score even after adjustment for age, comorbidities and time since HIV diagnosis (p = 0.048).
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Affiliation(s)
- Thiago E Sabino
- Institute of Tropical Medicine, Universidade de São Paulo, São Paulo, USA
| | - Vivian I Avelino-Silva
- Department of Infectious and Parasitic Diseases, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Clara Cavalcantte
- School of Public Health, Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, Brazil
| | - Silvia P Goulart
- HIV/AIDS Reference and Treatment Center in São Paulo, Centro de Referência e Tratamento de DST Aids, São Paulo, Brazil
| | - Olinda C Luiz
- Departament of Preventive Medicine, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Luiz A M Fonseca
- Institute of Tropical Medicine, Universidade de São Paulo, São Paulo, USA
| | - Jorge S Casseb
- Institute of Tropical Medicine, Universidade de São Paulo, São Paulo, USA
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5
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Faria DK, Taniguchi LU, Fonseca LAM, Ferreira-Junior M, Aguiar FJB, Lichtenstein A, Sumita NM, Duarte AJS, Sales MM. Improving serum calcium test ordering according to a decision algorithm. Clin Mol Pathol 2019; 72:232-236. [DOI: 10.1136/jclinpath-2018-205026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 03/09/2018] [Accepted: 03/20/2018] [Indexed: 11/04/2022]
Abstract
AimTo detect differences in the pattern of serum calcium tests ordering before and after the implementation of a decision algorithm.MethodsWe studied patients admitted to an internal medicine ward of a university hospital on April 2013 and April 2016. Patients were classified as critical or non-critical on the day when each test was performed. Adequacy of ordering was defined according to adherence to a decision algorithm implemented in 2014.ResultsTotal and ionised calcium tests per patient-day of hospitalisation significantly decreased after the algorithm implementation; and duplication of tests (total and ionised calcium measured in the same blood sample) was reduced by 49%. Overall adequacy of ionised calcium determinations increased by 23% (P=0.0001) due to the increase in the adequacy of ionised calcium ordering in non-critical conditions.ConclusionsA decision algorithm can be a useful educational tool to improve adequacy of the process of ordering serum calcium tests.
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Chaba DCDS, Soares LR, Pereira RMR, Rutherford GW, Assone T, Takayama L, Fonseca LAM, Duarte AJS, Casseb J. Low bone mineral density among HIV-infected patients in Brazil. Rev Inst Med Trop Sao Paulo 2017; 59:e89. [PMID: 29267597 PMCID: PMC5738774 DOI: 10.1590/s1678-9946201759089] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 10/10/2017] [Indexed: 11/28/2022] Open
Abstract
Decrease in bone mineral density (BMD) has been a complication among people living with HIV/AIDS. To investigate the prevalence of osteopenia/osteoporosis among HIV-infected people living in São Paulo city, we studied 108 HIV-infected patients (79 men and 29 women). We extracted data from patients’ medical records and BMD was measured by dual-energy X-ray absorptiometry (DXA). Median age of participants was 42 years (interquartile range [IQR] 36-48 years), and the median time since HIV diagnosis was 4.01 years (IQR 2-11 years). Patients had acquired HIV primarily by the sexual route (men who have sex with men 44%, heterosexual 49%). Median age, duration of HIV infection, duration of ART and CD4 nadir were similar for men and women. Plasma viral load was undetectable for 53 patients (49%). Median CD4 T cell count was 399 cells/µL (IQR 247 - 568). Twenty five patients (23%) had LBMD, and there was no statistically significant difference between men and women (<-1). The associated risk factors for LBMD were older age (≥ 50 years old) and smoking with a RR of 3.87 and 2.80, respectively. Thus, despite the lack of statistically significant relationship between the use of ART and LBMD or between duration of ART and LBMD, these factors should be addressed in larger studies.
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Affiliation(s)
- Daniela Cardeal da Silva Chaba
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Ambulatório de Imunodeficiência Secundária, São Paulo, São Paulo, Brazil.,Universidade de São Paulo, Faculdade de Medicina, Laboratório de Investigação Médica em Neurologia (LIM 56), São Paulo, São Paulo, Brazil.,University of California, Global Health Sciences, San Francisco, California, USA
| | - Lisméia R Soares
- Universidade Federal do Rio de Janeiro, Cursos de Nutrição, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rosa M R Pereira
- Universidade de São Paulo, Faculdade de Medicina, Disciplina de Reumatologia, Laboratório de Metabolismo Ósseo São Paulo, São Paulo, Brazil
| | - George W Rutherford
- University of California, Global Health Sciences, San Francisco, California, USA
| | - Tatiane Assone
- Universidade de São Paulo, Faculdade de Medicina, Laboratório de Investigação Médica em Neurologia (LIM 56), São Paulo, São Paulo, Brazil
| | - Liliam Takayama
- Universidade de São Paulo, Faculdade de Medicina, Disciplina de Reumatologia, Laboratório de Metabolismo Ósseo São Paulo, São Paulo, Brazil
| | - Luiz A M Fonseca
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Medicina Preventiva, (LIM 38), São Paulo, São Paulo, Brazil
| | - Alberto J S Duarte
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Ambulatório de Imunodeficiência Secundária, São Paulo, São Paulo, Brazil
| | - Jorge Casseb
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Ambulatório de Imunodeficiência Secundária, São Paulo, São Paulo, Brazil.,Universidade de São Paulo, Faculdade de Medicina, Laboratório de Investigação Médica em Neurologia (LIM 56), São Paulo, São Paulo, Brazil.,Universidade de São Paulo, Instituto de Medicina Tropical de São Paulo, São Paulo, São Paulo, Brazil
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Paiva A, Smid J, Haziot MEJ, Assone T, Pinheiro S, Fonseca LAM, de Oliveira ACP, Casseb J. High risk of heterosexual transmission of human T-cell lymphotropic virus type 1 infection in Brazil. J Med Virol 2016; 89:1287-1294. [PMID: 27935065 DOI: 10.1002/jmv.24745] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 11/21/2016] [Accepted: 11/22/2016] [Indexed: 12/28/2022]
Abstract
Human T-cell lymphotropic virus type 1 is transmitted primarily either through sexual intercourse or from mother to child. The current study investigated sexual transmission and compared the HTLV-1 proviral load between seroconcordant and serodiscordant couples by examining both men and women among the index partners without using subjective criteria to establish the direction of sexual transmission. Between January 2013 and May 2015, 178 HTLV-1-positive patients had spouses, 107 of which had tested partners, thus increasing the initial sample size (46 men and 61 women). Individuals co-infected with HTLV-2 or human immunodeficiency virus were not included in the analysis. From among the included participants, 26 men and 26 women were paired with each other, resulting in 26 seroconcordant couples; 12 seroconcordant couples were formed from another four men and eight women. Forty-three serodiscordant couples were formed from 16 men and 27 women. The rate of seroconcordance was 46.9%. The HTLV-1 proviral load was compared between 19 and 37 seroconcordant and serodiscondant couples, respectively, and the concordant couples showed higher proviral loads (P = 0.03). There were no differences between the groups according to age, relationship length, having a mother or sibling with HTLV-1, race, ethnicity, nationality, education, history of blood transfusion, HAM/TSP, ALT, or hepatitis C virus status. In multivariate analysis, relationship time was shown associated with ocurrence of seroconcordance status. The apparent association between high circulating levels of provirus and seroconcordance rate among couples suggests that proviral loads contribute markedly to the risk of sexual transmission, regardless of gender index.
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Affiliation(s)
- Arthur Paiva
- Institute of Tropical Medicine of São Paulo, São Paulo, São Paulo, Brazil.,Department of Dermatology, Laboratory of Dermatology and Immunodeficiencies, University of São Paulo Medical School, Butantã, São Paulo, Brazil
| | - Jerusa Smid
- Institute of Infectious Diseases "Emilio Ribas" (IIER), São Paulo, São Paulo, Brazil
| | - Michel E J Haziot
- Institute of Infectious Diseases "Emilio Ribas" (IIER), São Paulo, São Paulo, Brazil
| | - Tatiane Assone
- Institute of Tropical Medicine of São Paulo, São Paulo, São Paulo, Brazil.,Department of Dermatology, Laboratory of Dermatology and Immunodeficiencies, University of São Paulo Medical School, Butantã, São Paulo, Brazil
| | - Samara Pinheiro
- Department of Dermatology, Laboratory of Dermatology and Immunodeficiencies, University of São Paulo Medical School, Butantã, São Paulo, Brazil
| | - Luiz A M Fonseca
- Department of Preventive Medicine, University of São Paulo Medical School, Butantã, São Paulo, Brazil
| | | | - Jorge Casseb
- Institute of Tropical Medicine of São Paulo, São Paulo, São Paulo, Brazil.,Department of Dermatology, Laboratory of Dermatology and Immunodeficiencies, University of São Paulo Medical School, Butantã, São Paulo, Brazil
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Sales MM, Taniguchi LU, Fonseca LAM, Ferreira-Junior M, Aguiar FJB, Sumita NM, Lichtenstein A, Duarte AJS. Laboratory Tests Ordering Pattern by Medical Residents From a Brazilian University Hospital. Am J Clin Pathol 2016; 146:694-700. [PMID: 27940426 DOI: 10.1093/ajcp/aqw188] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The adequacy of laboratory test orders by medical residents is a longstanding issue. The aim of this study is to analyze the number, types, and pattern of repetition of tests ordered by medical residents. METHODS We studied all tests ordered over a 1-year period for inpatients of an internal medicine ward in a university hospital. Types, results, and repetition pattern of tests were analyzed in relation to patients' diagnoses. RESULTS We evaluated 117,666 tests, requested for 1,024 inpatients. The mean number of tests was 9.5 per day. The test repetition pattern was similar, regardless of patients' diagnoses, previous test results, or duration of stay. The probability of an abnormal result after a sequence of three normal tests was lower than 25%, regardless of the diagnosis. CONCLUSIONS Number of tests and repetition were both high, imposing costs, discomfort, and risks to patients, thus warranting further investigation.
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Affiliation(s)
- Maria M Sales
- From the Division of Clinical Pathology, Department of Pathology,
| | | | - Luiz A M Fonseca
- Department of Internal Medicine, Clinical Immunology and Allergy Service
| | - Mario Ferreira-Junior
- Department of Internal Medicine, General Practice and Propedeutic Service, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | - Nairo M Sumita
- From the Division of Clinical Pathology, Department of Pathology
| | - Arnaldo Lichtenstein
- Department of Internal Medicine, General Practice and Propedeutic Service, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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Fontes A, Andreoli MA, Villa LL, Assone T, Gaester K, Fonseca LAM, Duarte AJ, Casseb J. High specific immune response to a bivalent anti-HPV vaccine in HIV-1-infected men in São Paulo, Brazil. Papillomavirus Res 2016; 2:17-20. [PMID: 29074177 PMCID: PMC5886862 DOI: 10.1016/j.pvr.2016.01.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 01/04/2016] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Infection with Human papillomavirus (HPV) has been reported as one of the most prevalent agent sexually transmitted diseases, but its true prevalence in men is not precisely known, mainly due to the near absence of symptoms. Moreover, few studies evaluating the post-vaccination immune response have been performed to date in men, hence the hypotheses tested in this study can be important to enable a better understanding of both the immunopathogenesis and the response to vaccination in HIV-infected patients, and to help in the elaboration of strategies of vaccination against HPV in the HIV-infected population. OBJECTIVES To analyze the specific response to antigens of HPV vaccine in HIV-infected men. METHODS A total of 25 HIV-infected male patients who met the inclusion criteria during the data collection period were vaccinated; however, six (30%) had anti-HPV at baseline, and were not considered further in the analysis. Therefore, 19 HIV-infected individuals were included in the study, along with five healthy, HPV-seronegative controls. RESULTS Patients infected with HIV-1 were subdivided into two groups, A and B, according to their T CD4 cells count at the time of vaccination, namely: Group A: CD4>500; Group B: CD4<500. The proportion of seroconversion after immunization with three doses of a bivalent anti-HPV vaccine was 92%. CONCLUSION HIV-infected patients as well as HIV negative controls responded to anti-HPV vaccination, regardless of their T CD4 cells count and HIV plasma viral load. These results demonstrate that anti-HPV immunization in HIV-infected males is effective and should be encouraged, thus helping to decrease the risk of infection, mortality and morbidity of diseases associated with HPV in men.
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Affiliation(s)
- Adriele Fontes
- Laboratório de Dermatologia e Imunodeficiências, Departamento de Dermatologia, Faculdade de Medicina da Universidade de São Paulo, Brazil; Instituto de Medicina Tropical de São Paulo, São Paulo, SP, Brazil.
| | | | - Luisa Lina Villa
- Departamento de Radiologia e Oncologia, Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - Tatiane Assone
- Laboratório de Dermatologia e Imunodeficiências, Departamento de Dermatologia, Faculdade de Medicina da Universidade de São Paulo, Brazil; Instituto de Medicina Tropical de São Paulo, São Paulo, SP, Brazil
| | - Karen Gaester
- Laboratório de Dermatologia e Imunodeficiências, Departamento de Dermatologia, Faculdade de Medicina da Universidade de São Paulo, Brazil; Instituto de Medicina Tropical de São Paulo, São Paulo, SP, Brazil
| | - Luiz A M Fonseca
- Departamento de Medicina Preventiva, Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - Alberto Js Duarte
- Laboratório de Dermatologia e Imunodeficiências, Departamento de Dermatologia, Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - Jorge Casseb
- Laboratório de Dermatologia e Imunodeficiências, Departamento de Dermatologia, Faculdade de Medicina da Universidade de São Paulo, Brazil; Instituto de Medicina Tropical de São Paulo, São Paulo, SP, Brazil.
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Gaester K, Fonseca LAM, Luiz O, Assone T, Fontes AS, Costa F, Duarte AJS, Casseb J. Human papillomavirus infection in oral fluids of HIV-1-positive men: prevalence and risk factors. Sci Rep 2014; 4:6592. [PMID: 25322857 PMCID: PMC5377573 DOI: 10.1038/srep06592] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 08/12/2014] [Indexed: 02/07/2023] Open
Abstract
Human papillomavirus is one of the most common sexually transmitted diseases worldwide. The natural history of oral HPV infection is unclear, and its risk factors have not been explored. Immunocompromised individuals, as exemplified by HIV patients, are at high risk for HPV-related diseases. The mean of this study is to determine the prevalence of HPV in the oral tract of HIV-1-positive male subjects and its association with risk factors. A total of 283 oral wash samples from HIV-1-positive men were tested. The oral fluid samples were used for DNA extraction and conventional PCR amplification; HPV genotyping was performed by hybridization. HPV genotyping revealed that nine samples (3.5%) were positive for HPV DNA; the major high-risk HPV types identified were 51 and 66. Worldwide studies have shown a variable prevalence of oral HPV. The diversity of genotypes and the high prevalence of multiple infections in HIV-infected subjects can be better explained by the effects of HIV-induced immunosuppression. The most important risk factors are unprotected sexual intercourse, but other factors for this infection have been described elsewhere including smoking, age and HIV-positive serostatus. In this study, smoking was the most important risk factor for acquiring oral HPV in HIV-1-infected subjects in Brazil.
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Affiliation(s)
- Karen Gaester
- Laboratory of Dermatology and Immunodeficiencies, Department of Dermatology, University of São Paulo Medical School, Brazil
- Institute of Tropical Medicine of São Paulo, São Paulo, SP, Brazil
| | - Luiz A. M. Fonseca
- Department of Preventive Medicine, University of São Paulo Medical School, Brazil
| | - Olinda Luiz
- Department of Preventive Medicine, University of São Paulo Medical School, Brazil
| | - Tatiane Assone
- Laboratory of Dermatology and Immunodeficiencies, Department of Dermatology, University of São Paulo Medical School, Brazil
- Institute of Tropical Medicine of São Paulo, São Paulo, SP, Brazil
| | - Adriele Souza Fontes
- Laboratory of Dermatology and Immunodeficiencies, Department of Dermatology, University of São Paulo Medical School, Brazil
- Institute of Tropical Medicine of São Paulo, São Paulo, SP, Brazil
| | - Fernando Costa
- Laboratory of Dermatology and Immunodeficiencies, Department of Dermatology, University of São Paulo Medical School, Brazil
- Institute of Tropical Medicine of São Paulo, São Paulo, SP, Brazil
| | - Alberto J. S. Duarte
- Laboratory of Dermatology and Immunodeficiencies, Department of Dermatology, University of São Paulo Medical School, Brazil
- Institute of Tropical Medicine of São Paulo, São Paulo, SP, Brazil
| | - Jorge Casseb
- Laboratory of Dermatology and Immunodeficiencies, Department of Dermatology, University of São Paulo Medical School, Brazil
- Institute of Tropical Medicine of São Paulo, São Paulo, SP, Brazil
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Aguiar FJB, Ferreira-Júnior M, Sales MM, Cruz-Neto LM, Fonseca LAM, Sumita NM, Duarte NJC, Lichtenstein A, Duarte AJS. C-reactive protein: clinical applications and proposals for a rational use. Rev Assoc Med Bras (1992) 2013; 59:85-92. [PMID: 23440147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Accepted: 07/10/2012] [Indexed: 06/01/2023]
Abstract
C-reactive protein (CRP) is an acute-phase protein whose requests have been growing exponentially in several countries, including Brazil. In this study, the use of CRP in several clinical situations was reviewed by a group of physicians comprised by specialists in internal medicine, medical emergencies, intensive care, screening, and laboratory medicine, aiming to analyze the applicable literature and to propose guidelines for a more rational use of this laboratory test. The result was the creation of flowcharts guiding CRP request, adjusted to four different healthcare environments, namely, intensive care units, emergency room, wards, and outpatient clinics. These flowcharts, as well as a more detailed discussion on several clinical recommendations for the test, are presented in this study.
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Affiliation(s)
- Francisco J B Aguiar
- Serviço de Emergências Clínicas, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
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Cabral NL, Franco S, Longo A, Moro C, Buss TA, Collares D, Werlich R, Dadan DD, Fissmer CS, Aragão A, Ferst P, Palharini FG, Eluf-Neto J, Fonseca LAM, Whiteley WN, Gonçalves ARR. The Brazilian Family Health Program and secondary stroke and myocardial infarction prevention: a 6-year cohort study. Am J Public Health 2012; 102:e90-5. [PMID: 23078478 PMCID: PMC3519315 DOI: 10.2105/ajph.2012.301024] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2012] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We compared the incidence of recurrent or fatal cardiovascular disease in patients using Brazil's government-run Family Health Program (FHP) with those using non-FHP models of care. METHODS From 2005 to 2010, we followed outpatients discharged from city public hospitals after a first ever stroke for stroke recurrence and myocardial infarction, using data from all city hospitals, death certificates, and outpatient monitoring in state-run and private units. RESULTS In the follow-up period, 103 patients in the FHP units and 138 in the non-FHP units had exclusively state-run care. Stroke or myocardial infarction occurred in 30.1% of patients in the FHP group and 36.2% of patients in non-FHP care (rate ratio [RR] = 0.85; 95% confidence interval [CI] = 0.61, 1.18; P = .39); 37.9% of patients in FHP care and 54.3% in non-FHP care (RR = 0.68; 95% CI = 0.50, 0.92; P = .01) died. FHP use was associated with lower hazard of death from all causes (hazard ratio [HR] = 0.58; P = .005) after adjusting for age and stroke severity. The absolute risk reduction for death by all causes was 16.4%. CONCLUSIONS FHP care is more effective than is non-FHP care at preventing death from secondary stroke and myocardial infarction.
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Affiliation(s)
- Norberto L Cabral
- Department of Medicine, University of Região de Joinville, Univille, Santa Catarina, Brazil.
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Alcalde R, Nishiya A, Casseb J, Inocêncio L, Fonseca LAM, Duarte AJS. Prevalence and distribution of the GBV-C/HGV among HIV-1-infected patients under anti-retroviral therapy. Virus Res 2010; 151:148-52. [PMID: 20420864 DOI: 10.1016/j.virusres.2010.04.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2010] [Revised: 04/12/2010] [Accepted: 04/15/2010] [Indexed: 12/01/2022]
Abstract
Infection with GB virus C (GBV-C) or hepatitis G virus (HGV) is highly prevalent among HIV/AIDS patients. GBV-C/HGV viremia has not been associated with liver disease and seems to slow HIV disease progression. To study the GBV-C/HGV genotypes prevalence among HIV/AIDS patients and its association with HIV viral load (VL) and CD4+ lymphocyte counts. From February 2003 to February 2004, we analyzed 210 HIV-1-infected subjects who were on anti-retroviral therapy (ART). For 63 of them a PCR-nested to the non-coding 5' (5'NCR) region of the GBV-C/HGV was done, and for 49 a DNA direct sequencing was done. A phylogenetic analysis was performed by PHYLIP program. 63 (30%) of the HIV-1-infected patients were co-infected with GBV-C/HGV. The phylogenetic analysis revealed the following genotypes (and respective relative frequencies): 1 (10%), 2a (41%), 2b (43%), and 3 (6%). Co-infected patients presented lower HIV-1 VL and higher T CD4+ lymphocyte cells counts as compared with patients negative for GBV-C/HGV sequences (log=4.52 vs. 4.71, p=0.036), and T CD4+ lymphocyte counts (cells/mm(3)=322.6 vs. 273.5, p=0.081, respectively). T CD4+ cells counts equal to, or higher than, 200/mm(3) were significantly more common among co-infected patients than among HIV-infected-only patients (p=0.042). The lowest T CD4+ cells counts were associated with genotype 1 and the highest with genotype 2b (p=0.05). The GBV-C/HGV infection prevalence was 30% among HIV-1-infected subjects, and was associated with lower VL and higher CD4+ lymphocyte counts. GBV-C/HGV genotype 2b may be associated with better immunological response.
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Affiliation(s)
- Rosana Alcalde
- Laboratory of Dermatology and Immunedeficiencies, University of São Paulo Medical School, São Paulo, Brazil. rosana
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Cabral NL, Gonçalves ARR, Longo AL, Moro CHC, Costa G, Amaral CH, Fonseca LAM, Eluf-Neto J. Incidence of stroke subtypes, prognosis and prevalence of risk factors in Joinville, Brazil: a 2 year community based study. J Neurol Neurosurg Psychiatry 2009; 80:755-61. [PMID: 19279029 DOI: 10.1136/jnnp.2009.172098] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND There have been few population based studies on stroke risk factors and prognosis conducted in Brazil. The objective of this study was to evaluate, over a 2 year period, the incidence of the subtypes of first ever stroke, the prevalence of cardiovascular risk factors and functional prognosis in a city located in the south of Brazil. METHODS The period from January 2005 to December 2006 was evaluated prospectively by compiling data on first ever stroke cases, medications used prior to the morbidity and the incidence of traditional risk factors. The annual incidence was adjusted for age using the direct method. Patients were monitored for at least 6 months following the event. RESULTS Of 1323 stroke cases, 759 were first ever stroke cases. Of these, 610 were classified as infarctions, 94 as intracerebral haemorrhage and 55 as subarachnoid haemorrhage. The crude incidence rate per 100 000 inhabitants was 61.8 for infarction (95% CI 57.0 to 66.9), 9.5 for intracerebral haemorrhage (95% CI 7.7 to 11.6) and 5.6 for subarachnoid haemorrhage (95% CI 4.2 to 7.3). The 30 day case fatality was 19.1%. The most prevalent cardiovascular risk factor was arterial hypertension. By post-stroke month 6, 25% had died (95% CI 21.4 to 29.1) whereas 61.5% had regained their independence (95% CI 56.2 to 68.3). CONCLUSIONS Case fatality rate, prognosis and incidence adjusted for stroke subtypes were similar to those found in other population based studies. The prevalence rates of ischaemic heart disease, dyslipidaemia, arterial hypertension and diabetes suggest that Joinville presents a mixed pattern of cardiovascular risk, a pattern seen in developed and developing countries alike.
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Affiliation(s)
- N L Cabral
- Clinica Neurológica de Joinville, Rua Plácido O de Oliveira, 1244, CEP 892-02451, Joinville, Santa Catarina, Brazil.
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Brigido L, Rodrigues R, Casseb J, Custodio RM, Fonseca LAM, Sanchez M, Duarte AJS. CD4+ T-cell recovery and clinical outcome in HIV-1-infected patients exposed to multiple antiretroviral regimens: partial control of viremia is associated with favorable outcome. AIDS Patient Care STDS 2004; 18:189-98. [PMID: 15142349 DOI: 10.1089/108729104323038865] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The goal of antiretroviral therapy is clinical benefit through the suppression of viral replication and the immunologic reconstitution of HIV-1-infected patients. In spite of the availability of different highly active antiretroviral therapy only some patients sustain undetectable plasma viremia. We performed an observational study from October 1987 to February 2001 on immunologic and clinical outcome of 148 HIV-1-infected patients from an open clinical cohort at São Paulo University, Brazil. The median T CD4+ at starting first monitored regimen was 227 cells per microliter, with 65% of patients previously exposed to antiretroviral regimens, mostly dual therapy. Virologic response to antiretroviral therapy, after a median period of 179 weeks of monitored treatment, allowed classifying patients as aviremic (RNA plasma viremia below 500 copies per milliliter); viremic (current viral load at historic levels), and viremic-attenuated groups (detectable viremia, but > 1 log viral suppression). HIV RNA viral load, T CD4+ cells count, HIV-1 pol sequencing, inflammatory parameters, and clinical events were documented during a median follow-up of 251 weeks. This study observed better clinical and immunologic responses in the aviremic group, but the viremic-attenuated group showed a significant gain in CD4+ cells (p < 0.013) and a decreased number of cases progressing to an AIDS-defining clinical condition (p < 0.001) compared to the viremic group.
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Affiliation(s)
- L Brigido
- Adolfo Lutz Institute, Sao Paulo, Brazil; Brazilian AIDS Program, MS, Brazilia, Brazil.
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