Líbia Cristina Rocha Vilela Moura - Ricardo Arraes de Alencar Ximenes - Heloísa Ramos Lacerda - Demócrito Barros Miranda-Filho - Maria Tereza Barbosa - Maria Rita Byington - Maria de Fátima Pessoa Militão Albuquerque
Publicado na Revista Panamericana de Salud Pública em 2012.
Resumo
Objective. The outcome of interest was repetition of the tuberculin skin test (TST) and the objectives were to estimate the rate of TST repetition, the probability of no TST repetition after 1 year, and the probability of no TST repetition at the end of the follow-up period in patients whose initial test was nonreactive. The study also set out to analyze factors associated with the time until TST repetition at two HIV/AIDS referral services that carry out the TST on a routine basis in Recife, Pernambuco, Brazil. Methods. A cohort of HIV-positive patients who initially tested nonreactive on the TST were followed from November 2007 to February 2010. The Kaplan–Meier method was used to estimate the probability of not repeating the TST, and Cox’s regression analysis was used to analyze the factors associated with time until repeating the TST. Cox’s multivariate analysis was stratified according to each hospital where patients were followed, because this variable did not respect the principle of proportionality of risk. Results. The probability of not repeating the TST for 1 year was 80.0% and at the end of the follow-up period it was 42.0%. The variables that remained associated with TST repetition in the final Cox multivariate model were an age of 40 years or older, body mass index between 18.0 and 24.9, being female, and years of schooling. Conclusions. This study encountered a very low TST repetition rate after 1 year of follow-up and identified groups of individuals who should be the target of interventions aimed at repeating the TST.
Inglês
Marilia Santini-Oliveira - Rita de Cássia Elias Estrela - Valdiléa Gonçalves Veloso - Vitória Berg Cattani - Carolyn Yanavich - Luciane Velasque - Thiago Silva Torres - Luana Monteiro Spindola Marins - José Henrique Pilotto - Esaú Custódio João - José Carlos Saraiva Gonçalves - Beatriz Grinsztejn
Publicado na Antimicrobial Agents and Chemotherapy em 2014.
Resumo
A lopinavir-ritonavir (LPV/r)-based regimen is recommended during pregnancy to reduce the risk of HIV mother-to-child transmission, but the appropriate dose is controversial. We compared the pharmacokinetics of standard and increased LPV/r doses during pregnancy. This randomized, open-label prospective study enrolled 60 pregnant women between gestational weeks 14 and 30. The participants received either the standard dose (400/100 mg twice a day [BID]) or increased dose (600/150 mg BID) of LPV/r tablets during pregnancy and the standard dose for 6 weeks after childbirth. Pharmacokinetics analysis was performed using a high-performance liquid chromatography-tandem mass spectrometry method. Adherent participants who received the standard dose presented minimum LPV concentrations of 4.4, 4.3, and 6.1 μg/ml in the second and third trimesters and postpartum, respectively. The increased-dose group exhibited values of 7.9, 6.9, and 9.2 μg/ml at the same three time points. Although LPV exposure was significantly higher in the increased-dose group, the standard dose produced therapeutic levels of LPV against wild-type virus in all adherent participants, except one patient in the third trimester; 50%, 37.5%, and 25%, and 0%, 15%, and 0% of the participants in the standard- and increased-dose groups failed to achieve therapeutic levels against resistant viruses during the second and third trimesters and after childbirth, respectively. After 12 weeks of treatment and after childbirth, all adherent participants achieved undetectable HIV viral loads, and their babies (49/54) were uninfected. No serious drug-related adverse events were observed. We conclude that the standard dose is appropriate for use during pregnancy and that an increased dose may be necessary for women harboring resistant HIV. (This study has been registered at ClinicalTrials.gov under registration no. NCT00605098.)
Inglês
Guilherme Amaral Calvet - Luciane Velasque - Paula Mendes Luz - Sandra Wagner Cardoso - Monica Derrico - Ronaldo Ismério Moreira - Angela Cristina Vasconcelos de Andrade - Andrea Cytryn - Elaine Pires - Valdiléa Gonçalves Veloso - Beatriz Grinsztejn - Ruth Khalili Friedman
Publicado no PLOS ONE em 2014.
Resumo
Objective: To compare the effectiveness of first-line combination antiretroviral therapy (cART) between premenopausal and postmenopausal women. Methods: ART-naïve women initiating cART between January 2000/June 2010 at the Instituto de Pesquisa Clínica Evandro Chagas Cohort were studied. Women were defined as postmenopausal after 12 consecutive months of amenorrhea. CD4 cell counts and HIV-1 RNA viral load (VL) measurements were compared between pre- and postmenopausal at 6, 12 and 24 months after cART initiation. Women who modified/discontinued a drug class or died due to an AIDS defining illness were classified as ART-failures. Variables were compared using Wilcoxon test, x2 or Fisher’s exact test. The odds of cART effectiveness (VL,400 copies/mL and/or no need to change cART) were compared using logistic regression. Linear model was used to access relationship between CD4 change and menopause. Results: Among 383 women, 328 (85%) were premenopausal and 55 (15%) postmenopausal. Median pre cART CD4 counts were 231 and 208 cells/mm3 (p = 0.14) in pre- and postmenopausal women, respectively. No difference in the median pre cART VL was found (both 4.8 copies/mL). Median CD4 changes were similar at 6 and 12 months. At 24 months after cART initiation, CD4 changes among postmenopausal women were significantly lower among premenopausal women (p = 0.01). When the analysis was restricted to women with VL,400 copies/mL, no statistical difference was observed. Overall, 63.7% achieved cART effectiveness at 24 months without differences between groups at 6, 12 and 24 months. Conclusion: Menopause status at the time of first-line cART initiation does not impact CD4 cell changes at 24 months among women with a virologic response. No relationship between menopause status and virologic response was observed.
Inglês
Paula M. Luz - Beatriz Grinsztejn - Luciane Velasque - Antonio G. Pacheco - Valdilea G. Veloso - Richard D. Moore - Claudio J. Struchiner
Publicado no PLOS ONE em 2014.
Resumo
Objective: There is a continuous debate on how to adequately evaluate long-term CD4+ cell count in response to combination antiretroviral therapy (ART) among human immunodeficiency virus (HIV)-infected individuals. Our study evaluated the long-term CD4+ cell count response (up to ten years) after initiation of ART and described the differences in the CD4+ cell count response stratified by pretreatment CD4+ cell count, and other socio-demographic, behavioral, and clinical factors. Methods: The study population included patients starting ART in the clinical cohorts of Rio de Janeiro, Brazil, and Baltimore, United States. Inverse probability of censoring weighting was used to estimate mean annual CD4+ cell counts while adjusting for choice of initial ART regimen, ART discontinuation and losses-to-follow-up. Results: From 1997 to 2011, 3116 individuals started ART; preferred initial regimen was NNRTI-based (63%). The median follow-up time was 5 years, 10% of the individuals had nine or more years of follow-up. Observed CD4+ cell counts increased throughout the ten years of follow-up. Weighted results, in contrast, increased up to year four and plateaued thereafter with 50% of the population reaching CD4+ cell counts of 449/mL or more. Out of all stratification variables considered, only individuals with pre-treatment CD4+ cell counts $350/mL showed increasing CD4+ cell counts over time with 76% surpassing the CD4+ cell count .500/mL threshold at year ten. Conclusion: The present study corroborates the growing body of knowledge advocating early start of ART by showing that only patients who start ART early fully recover to normal CD4+ cell counts.
Inglês
M. Maruza - M. F. P. M. Albuquerque - M. C. Braga - M. T. S. Barbosa - R. Byington - I. Coimbra - L. V. Moura - J. D. L. Batista - G. T. N. Diniz - D. B. Miranda-Filho - H. R. Lacerda - L. C. Rodrigues - R. A. A. Ximenes
Publicado no International Journal of Tuberculosis and Lung Disease em 2012.
Resumo
Objective: To estimate the probability of survival and to evaluate risk factors for death in a cohort of persons living with human immunodeficiency virus (PLHIV) who had started tuberculosis (TB) treatment. Methods: A prospective cohort study was conducted between June 2007 and December 2009 with HIV-infected patients who had started anti-tuberculosis treatment in the State of Pernambuco, Brazil. Survival data were analysed using the Kaplan-Meier estimator, the log-rank test and the Cox model. Hazard ratios and their respective 95%CIs were estimated. Results: Of a cohort of 2310 HIV-positive individuals, 333 patients who had commenced treatment for TB were analysed. The mortality rate was 5.25 per 10 000 person-years (95%CI 4.15–6.63). The probability of survival at 30 months was 74%. Risk factors for death in the study population were being female, age ≥30 years, having anaemia, not using highly active antiretroviral therapy (HAART) during treatment for TB and disseminated TB. Protective factors for death were a CD4 lymphocyte count >200 cells/mm3 and treatment for TB having started in an out-patient clinic. Conclusion: The use of HAART can prevent deaths among HIV-TB patients, corroborating the efficacy of starting HAART early in individuals with TB.
Inglês
