Instituto Nacional Of Infectologia Evandro Chagas Ini Fiocruz

Rio de Janeiro, Brazil

Instituto Nacional Of Infectologia Evandro Chagas Ini Fiocruz

Rio de Janeiro, Brazil
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Eshleman S.H.,Johns Hopkins University | Wilson E.A.,Fred Hutchinson Cancer Research Center | Zhang X.C.,Fred Hutchinson Cancer Research Center | Ou S.-S.,Fred Hutchinson Cancer Research Center | And 20 more authors.
HIV Clinical Trials | Year: 2017

Introduction: The HIV Prevention Trials Network (HPTN) 052 trial demonstrated that early antiretroviral therapy (ART) prevented 93% of HIV transmission events in serodiscordant couples. Some linked infections were observed shortly after ART initiation or after virologic failure. Objective: To evaluate factors associated with time to viral suppression and virologic failure in participants who initiated ART in HPTN 052. Methods: 1566 participants who had a viral load (VL) > 400 copies/mL at enrollment were included in the analyses. This included 832 in the early ART arm (CD4 350–550 cells/mm3 at ART initiation) and 734 in the delayed ART arm (204 with a CD4 < 250 cells/mm3 at ART initiation; 530 with any CD4 at ART initiation). Viral suppression was defined as two consecutive VLs ≤ 400 copies/mL after ART initiation; virologic failure was defined as two consecutive VLs > 1000 copies/mL > 24 weeks after ART initiation. Results: Overall, 93% of participants achieved viral suppression by 12 months. The annual incidence of virologic failure was 3.6%. Virologic outcomes were similar in the two study arms. Longer time to viral suppression was associated with younger age, higher VL at ART initiation, and region (Africa vs. Asia). Virologic failure was strongly associated with younger age, lower educational level, and lack of suppression by three months; lower VL and higher CD4 at ART initiation were also associated with virologic failure. Conclusions: Several clinical and demographic factors were identified that were associated with longer time to viral suppression and virologic failure. Recognition of these factors may help optimize ART for HIV treatment and prevention. © 2017 Informa UK Limited, trading as Taylor & Francis Group


Oliveira-Ribeiro C.,Instituto Oswaldo Cruz IOC FIOCRUZ | Oliveira-Ribeiro C.,Instituto Nacional Of Infectologia Evandro Chagas Ini Fiocruz | Pimentel M.I.F.,Instituto Nacional Of Infectologia Evandro Chagas Ini Fiocruz | Oliveira R.V.C.,Instituto Nacional Of Infectologia Evandro Chagas Ini Fiocruz | And 14 more authors.
BMC Infectious Diseases | Year: 2017

Background: Skin ulcers in American cutaneous leishmaniasis (ACL) may heal spontaneously after months/years. However, few cases may present quick heal even during diagnosis procedure (early spontaneous healing- ESH). The main objective of this study was to compare ESH patients with cases requiring specific treatment [non-ESH (NESH)]. Methods: A historical cohort study of ACL patients (n=445) were divided into 2 groups: ESH - spontaneously healed patients (n=13; 2.90%), and NESH- treated patients (n=432; 97.10%). We compared clinical and laboratorial findings at diagnosis, including the lesion healing process. Results: ESH patients had a higher percentage of single lesions (p=0.027), epithelialized lesion on initial examination (p=0.001), lesions located in the dorsal trunk (p=0.017), besides earlier healing (p<0.001). NESH presents higher frequency of ulcerated lesions (p=0.002), amastigotes identified in histopathology exams (p=0.005), positive cultures (p=0.001), and higher positivity in ≥3 parasitological exams (p=0.030). All ESH cases were positive in only a single exam, especially in PCR. Conclusions: ESH group apparently presented a lower parasitic load evidenced by the difficulty of parasitological confirmation and its positivity only by PCR method. The absence or deficiency of specific treatment is commonly identified as predisposing factors for recurrence and metastasis in ACL. However, due to the drugs toxicity, the treatment of cases which progress to early spontaneous healing is controversial. ESH patients were followed for up to 5years after cure, with no evidence of recrudescence, therefore suggesting that not treating these patients is justifiable, but periodic dermatological and otorhinolaryngological examinations are advisable to detect a possible relapse. © 2017 The Author(s).


Palumbo P.J.,Johns Hopkins University | Wilson E.A.,Fred Hutchinson Cancer Research Center | Piwowar-Manning E.,Johns Hopkins University | McCauley M.,FHI | And 15 more authors.
PLoS ONE | Year: 2017

Higher HIV diversity has been associated with virologic outcomes in children on antiretroviral treatment (ART). We examined the association of HIV diversity with virologic outcomes in adults from the HPTN 052 trial who initiated ART at CD4 cell counts of 350-550 cells/mm3. A high resolution melting (HRM) assay was used to analyze baseline (pre-treatment) HIV diversity in six regions in the HIV genome (two in gag, one in pol, and three in env) from 95 participants who failed ART. We analyzed the association of HIV diversity in each genomic region with baseline (pre-treatment) factors and three clinical outcomes: Time to virologic suppression after ART initiation, time to ART failure, and emergence of HIV drug resistance at ART failure. After correcting for multiple comparisons, we did not find any association of baseline HIV diversity with demographic, laboratory, or clinical characteristics. For the 18 analyses performed for clinical outcomes evaluated, there was only one significant association: Higher baseline HIV diversity in one of the three HIV env regions was associated with longer time to ART failure (p = 0.008). The HRM diversity assay may be useful in future studies exploring the relationship between HIV diversity and clinical outcomes in individuals with HIV infection. © 2017 Palumbo et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Fogel J.M.,Johns Hopkins University | Hudelson S.E.,Johns Hopkins University | Ou S.-S.,Fred Hutchinson Cancer Research Center | Hart S.,Frontier Science and Technology Research Foundation | And 29 more authors.
Journal of Acquired Immune Deficiency Syndromes | Year: 2016

Early initiation of antiretroviral treatment (ART) reduces HIV transmission and has health benefits. HIV drug resistance can limit treatment options and compromise use of ART for HIV prevention. We evaluated drug resistance in 85 participants in the HIV Prevention Trials Network 052 trial who started ART at CD4 counts of 350-550 cells per cubic millimeter and failed ART by May 2011; 8.2% had baseline resistance and 35.3% had resistance at ART failure. High baseline viral load and less education were associated with emergence of resistance at ART failure. Resistance at ART failure was observed in 7 of 8 (87.5%) participants who started ART at lower CD4 cell counts. © Copyright 2016 Wolters Kluwer Health, Inc. All rights reserved.


Morgado F.N.,Instituto Oswaldo Cruz IOC FIOCRUZ | Nascimento M.T.C.,Federal University of Rio de Janeiro | Saraiva E.M.,Federal University of Rio de Janeiro | De Oliveira-Ribeiro C.,Instituto Oswaldo Cruz IOC FIOCRUZ | And 8 more authors.
PLoS ONE | Year: 2015

Neutrophil extracellular traps (NETs) have been described as a network of extracellular fibers composed by DNA, histones and various proteins/enzymes. Studies have demonstrated that NETs could be responsible for the trapping and elimination of a variety of infectious agents. In order to verify the presence of NETs in American tegumentary leishmaniasis (ATL) and their relationship with the presence of amastigotes we evaluated active cutaneous lesions of 35 patients before treatment by the detection of parasites, neutrophils (neutrophil elastase) and histones through immunohistochemistry and confocal immunofluorescence. Intact neutrophils could be detected in all ATL lesions. NETs were present in 27 patients (median 1.1; range from 0.1 to 23.5/mm2) with lesion duration ranging from one to seven months. NETs were in close proximity with neutrophils (r = 0.586; p = 0.0001) and amastigotes (r = 0.710; p = 0.0001). Two patterns of NET formation were detected: small homogeneously distributed networks observed in all lesions; and large structures that could be visualized at a lower magnification in lesions presenting at least 20% of neutrophils. Lesions presenting the larger NET formation showed high parasite detection. A correlation between NET size and the number of intact amastigotes was observed (p=0.02). As we detected an association between NET and amastigotes, our results suggest that neutrophil migration and NET formation could be stimulated and maintained by stimuli derived from the parasite burden/parasite antigen in the extracellular environment. The observation of areas containing only antigens not intermingled with NETs (elastase and histone) suggests that the involvement of these structures in the control of parasite burden is a dynamic process in which the formation of NETs is exhausted with the destruction of the parasites. Since NETs were also associated with granulomas, this trapping would favor the activity of macrophages in order to control the parasite burden. © 2015 Morgado et al.


Domingues R.M.S.M.,Instituto Nacional Of Infectologia Evandro Chagas Ini Fiocruz | Szwarcwald C.L.,Institute Comunicao e Informao Cientifica e Tecnologica em Saude Icict Fiocruz | Borges Souza P.R.,Institute Comunicao e Informao Cientifica e Tecnologica em Saude Icict Fiocruz | Leal M.C.,Escola Nacional de Saude Publica Sergio Arouca Fiocruz
BMC Infectious Diseases | Year: 2015

Background: The rate of vertical HIV transmission has decreased in Brazil, but regional inequalities suggest problems in implementing control measures during pregnancy and delivery. The aims of this study were to ascertain the coverage of HIV testing during prenatal care and estimate the prevalence of HIV infection during pregnancy in Brazil. Methods: This was a national hospital-based study of 23,894 women that was conducted in 2011-2012. The data came from interviews with mothers during postpartum hospitalization, from hospital medical files and from prenatal cards. All the pregnant women with reactive serological results for HIV infection marked on their cards or with diagnoses of HIV infection during the hospital stay for delivery were considered cases of HIV infection. Univariate and multivariable logistic regression were performed to investigate factors associated with the prevalence of HIV infection and with performing at least one HIV test during pregnancy. Results: Among participating women, the coverage of testing for HIV infection was 81.7% among those who presented with prenatal card and the prevalence of HIV infection among pregnant women was 0.4% (95% CI: 0.32-0.51%). In the adjusted analysis, there was higher coverage of testing among women living in the South and Southeast regions; of women aged 35 years and over; with greater schooling levels; who self-reported as white; with prenatal care provided in private services; with an early start to prenatal care; and with an adequate number of consultations, defined as a minimum of six for a term pregnancy. In the adjusted analyses there was a greater odds ratio of HIV infection among women living in the South region, aged 35 years and over, with schooling of less than 8 years, who self-reported race as black, without a partner, with syphilis coinfection and who were attended by public services. Conclusions: The prevalence of HIV infection among pregnant women in Brazil remains below 1% and the coverage of testing for HIV infection is over 80%. However, the regional and social inequalities in access to healthcare services and the missed opportunities for diagnoses of HIV infection indicate the importance of strengthening HIV infection control programs during pregnancy. © Domingues et al.


PubMed | Rua Leopoldo Bulhoes, Institute Comunicacao e Informacao Cientifica e Tecnologica em Saude Icict Fiocruz and Instituto Nacional Of Infectologia Evandro Chagas Ini Fiocruz
Type: | Journal: BMC infectious diseases | Year: 2015

The rate of vertical HIV transmission has decreased in Brazil, but regional inequalities suggest problems in implementing control measures during pregnancy and delivery. The aims of this study were to ascertain the coverage of HIV testing during prenatal care and estimate the prevalence of HIV infection during pregnancy in Brazil.This was a national hospital-based study of 23,894 women that was conducted in 2011-2012. The data came from interviews with mothers during postpartum hospitalization, from hospital medical files and from prenatal cards. All the pregnant women with reactive serological results for HIV infection marked on their cards or with diagnoses of HIV infection during the hospital stay for delivery were considered cases of HIV infection. Univariate and multivariable logistic regression were performed to investigate factors associated with the prevalence of HIV infection and with performing at least one HIV test during pregnancy.Among participating women, the coverage of testing for HIV infection was 81.7% among those who presented with prenatal card and the prevalence of HIV infection among pregnant women was 0.4% (95% CI: 0.32-0.51%). In the adjusted analysis, there was higher coverage of testing among women living in the South and Southeast regions; of women aged 35 years and over; with greater schooling levels; who self-reported as white; with prenatal care provided in private services; with an early start to prenatal care; and with an adequate number of consultations, defined as a minimum of six for a term pregnancy. In the adjusted analyses there was a greater odds ratio of HIV infection among women living in the South region, aged 35 years and over, with schooling of less than 8 years, who self-reported race as black, without a partner, with syphilis coinfection and who were attended by public services.The prevalence of HIV infection among pregnant women in Brazil remains below 1% and the coverage of testing for HIV infection is over 80%. However, the regional and social inequalities in access to healthcare services and the missed opportunities for diagnoses of HIV infection indicate the importance of strengthening HIV infection control programs during pregnancy.

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