Lopinavir/ritonavir dosing during pregnancy in Brazil and maternal/infant laboratory abnormalities

OBJECTIVES: To describe laboratory abnormalities among HIV-infected women and their infants with standard and increased lopinavir/ritonavir (LPV/r) dosing during the third trimester of pregnancy. METHODS: We evaluated data on pregnant women from NISDI cohorts (2002-2009) enrolled in Brazil, who received at least 28 days of LPV/r during the third pregnancy trimester and gave birth to singleton infants. RESULTS: 164 women received LPV/r standard dosing [(798/198 or 800/200 mg/day) (Group 1)] and 70 increased dosing [(> 800/200 mg/day) (Group 2)]. Group 1 was more likely to have advanced clinical disease and to use ARVs for treatment, and less likely to have CD4 counts > 500 cells/mm³. Mean plasma viral load was higher in Group 2. There were statistically significant, but not clinically meaningful, differences between groups in mean AST, ALT, cholesterol, and triglycerides. The proportion of women with Grade 3 or 4 adverse events was very low, with no statistically significant differences between groups in severe adverse events related to ALT, AST, total bilirubin, cholesterol, or triglycerides. There were statistically significant, but not clinically meaningful, differences between infant groups in ALT and creatinine. The proportion of infants with Grade 3 or 4 adverse events was very low, and there were no statistically significant differences in severe adverse events related to ALT, AST, BUN, or creatinine. CONCLUSION: The proportions of women and infants with severe laboratory adverse events were very low. Increased LPV/r dosing during the third trimester of pregnancy appears to be safe for HIV-infected women and their infants.Eunice Kennedy Shriver - National Institute of Child Health and Human Development (NIH

Retrospective analysis of risk factors and gaps in prevention strategies for mother-to-child HIV transmission in Rio de Janeiro, Brazil

Background Despite great progress made in methods to prevent mother-to-child transmission of HIV (MTCT), delivery and uptake of these measures remains a challenge in many countries. Although the Brazilian Ministry of Health aimed to eliminate MTCT by 2015, infection still occured in 15–24% of infants born to HIV-infected mothers. We sought to identify remaining factors that constrain MTCT elimination. Methods We conducted a retrospective, matched case-control study by reviewing hospital charts of infants born to HIV-infected mothers between 1997 and 2014 at three MTCT reference hospitals in the Rio de Janeiro metropolitan area. Cases were defined as HIV-exposed children with two positive HIV tests before 18 months of age; controls were defined as HIV-exposed children with two negative HIV tests before 18 months of age. We performed bivariate and MTCT cascade analyses to identify risk factors for MTCT and gaps in prevention services. Results We included 435 infants and their mothers (145 cases, 290 controls). Bivariate analyses of MTCT preventative care (PMTCT) indicated that cases were less likely to complete all individual measures in the antenatal, delivery, and postnatal period (p < 0.05). Assessing completion of the PMTCT cascade, the sequential steps of PMTCT interventions, we found inadequate retention in care among both cases and controls, and cases were significantly less likely than controls to continue receiving care throughout the cascade (p < 0.05). Motives for incompletion of PMTCT measures included infrastructural issues, such as HIV test results not being returned, but were most often due to lack of care-seeking. Over the course of the study period, PMTCT completion improved, although it remained below the 95% target for antenatal care, HIV testing, and antenatal ART set by the WHO. Adding concern, evaluation of co-infections indicated that case infants were also more likely to have congenital syphilis (OR: 4.29; 95% CI: 1.66 to 11.11). Conclusions While PMTCT coverage has improved over the years, completion of services remains insufficient. Along with interventions to promote care-seeking behaviour, increased infrastructural support for PMTCT services is needed to meet the HIV MTCT elimination goal in Brazil as well as address rising national rates of congenital syphilis

Understanding the relation between Zika virus infection during pregnancy and adverse fetal, infant and child outcomes: a protocol for a systematic review and individual participant data meta-analysis of longitudinal studies of pregnant women and their infants and children

IntroductionZika virus (ZIKV) infection during pregnancy is a known cause of microcephaly and other congenital and developmental anomalies. In the absence of a ZIKV vaccine or prophylactics, principal investigators (PIs) and international leaders in ZIKV research have formed the ZIKV Individual Participant Data (IPD) Consortium to identify, collect and synthesise IPD from longitudinal studies of pregnant women that measure ZIKV infection during pregnancy and fetal, infant or child outcomes.Methods and analysisWe will identify eligible studies through the ZIKV IPD Consortium membership and a systematic review and invite study PIs to participate in the IPD meta-analysis (IPD-MA). We will use the combined dataset to estimate the relative and absolute risk of congenital Zika syndrome (CZS), including microcephaly and late symptomatic congenital infections; identify and explore sources of heterogeneity in those estimates and develop and validate a risk prediction model to identify the pregnancies at the highest risk of CZS or adverse developmental outcomes. The variable accuracy of diagnostic assays and differences in exposure and outcome definitions means that included studies will have a higher level of systematic variability, a component of measurement error, than an IPD-MA of studies of an established pathogen. We will use expert testimony, existing internal and external diagnostic accuracy validation studies and laboratory external quality assessments to inform the distribution of measurement error in our models. We will apply both Bayesian and frequentist methods to directly account for these and other sources of uncertainty.Ethics and disseminationThe IPD-MA was deemed exempt from ethical review. We will convene a group of patient advocates to evaluate the ethical implications and utility of the risk stratification tool. Findings from these analyses will be shared via national and international conferences and through publication in open access, peer-reviewed journals.Trial registration numberPROSPERO International prospective register of systematic reviews (CRD42017068915).</jats:sec

QUALIDADE DE VIDA E CONDICIONAMENTO CARDIORRESPIRATÓRIO EM IDOSAS PRATICANTES E NÃO PRATICANTES DE ATIVIDADE FÍSICA

O presente estudo teve como objetivo avaliar o condicionamento cardiorrespiratório e a qualidade de vida em idosas praticantes e não praticantes de atividade física. Foi realizado um estudo analítico, de corte transversal. A amostra foi constituída de 40 idosas do sexo feminino provenientes do projeto de convivência da longevidade de Teresina-PI, com idades entre 60 e 80 anos, ativas fisicamente e sedentárias conforme o questionário internacional de atividade física. Foram convidadas a compor os grupos igualmente de idosas praticantes de atividade física (IPAF) e não praticantes de atividade física (INPAF). Foi utilizado o Teste de caminhada de 6 minutos (TC6), para avaliação do condicionamento cardiorrespiratório, sendo mensurados distância percorrida e alcance do limite inferior de normalidade de 139 metros, e o questionário SF-36 para analisar qualidade de vida. A comparação estatística entre grupos foi realizada através do Teste Mann – Whitney ou teste t student, com nível de significância de 95%. Encontrou-se diferença significativa (p&lt;0,05) nos domínios capacidade funcional, dor, estado geral da saúde, vitalidade, aspectos sociais e saúde mental do questionário SF-36 na comparação entre as IPAF e INPAF. No TC6, as IPAF também mostraram resultados significativos superiores (p&lt;0,05) na distância percorrida em relação ao INPAF. Além do que, as IPAF apresentaram maior limite inferior de normalidade do TC6 em comparação ao outro grupo (p&lt;0,05). Os resultados permitem concluir que houve melhor qualidade de vida e condicionamento cardiorrespiratório nas idosas praticantes de atividade física, desfechos que contribuem para ampliação dos conhecimentos da importância da atividade física em idosos.

QUALIDADE DE VIDA E CONDICIONAMENTO CARDIORRESPIRATÓRIO EM IDOSAS PRATICANTES E NÃO PRATICANTES DE ATIVIDADE FÍSICA

O presente estudo teve como objetivo avaliar o condicionamento cardiorrespiratório e a qualidade de vida em idosas praticantes e não praticantes de atividade física. Foi realizado um estudo analítico, de corte transversal. A amostra foi constituída de 40 idosas do sexo feminino provenientes do projeto de convivência da longevidade de Teresina-PI, com idades entre 60 e 80 anos, ativas fisicamente e sedentárias conforme o questionário internacional de atividade física. Foram convidadas a compor os grupos igualmente de idosas praticantes de atividade física (IPAF) e não praticantes de atividade física (INPAF). Foi utilizado o Teste de caminhada de 6 minutos (TC6), para avaliação do condicionamento cardiorrespiratório, sendo mensurados distância percorrida e alcance do limite inferior de normalidade de 139 metros, e o questionário SF-36 para analisar qualidade de vida. A comparação estatística entre grupos foi realizada através do Teste Mann – Whitney ou teste t student, com nível de significância de 95%. Encontrou-se diferença significativa (p&lt;0,05) nos domínios capacidade funcional, dor, estado geral da saúde, vitalidade, aspectos sociais e saúde mental do questionário SF-36 na comparação entre as IPAF e INPAF. No TC6, as IPAF também mostraram resultados significativos superiores (p&lt;0,05) na distância percorrida em relação ao INPAF. Além do que, as IPAF apresentaram maior limite inferior de normalidade do TC6 em comparação ao outro grupo (p&lt;0,05). Os resultados permitem concluir que houve melhor qualidade de vida e condicionamento cardiorrespiratório nas idosas praticantes de atividade física, desfechos que contribuem para ampliação dos conhecimentos da importância da atividade física em idosos.

Viral suppression and resistance in a cohort of perinatally-HIV infected (PHIV+) pregnant women

Maria Isabel Fragoso da Silveira Gouvêa. Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Documento produzido em parceria ou por autor vinculado à Fiocruz, mas não consta a informação no documento.Submitted by Janaína Nascimento ([email protected]) on 2019-04-10T13:02:26Z No. of bitstreams: 1 ve_Cruz_Maria_etal_INI_2016.pdf: 256405 bytes, checksum: 928a217be0bb8bf1f41e2c69142ebb0d (MD5)Approved for entry into archive by Janaína Nascimento ([email protected]) on 2019-04-11T13:02:17Z (GMT) No. of bitstreams: 1 ve_Cruz_Maria_etal_INI_2016.pdf: 256405 bytes, checksum: 928a217be0bb8bf1f41e2c69142ebb0d (MD5)Made available in DSpace on 2019-04-11T13:02:17Z (GMT). No. of bitstreams: 1 ve_Cruz_Maria_etal_INI_2016.pdf: 256405 bytes, checksum: 928a217be0bb8bf1f41e2c69142ebb0d (MD5) Previous issue date: 2016Hospital Federal dos Servidores do Estado. Rio de Janeiro, RJ, Brasil.Hospital Federal dos Servidores do Estado. Rio de Janeiro, RJ, Brasil.Hospital Federal dos Servidores do Estado. Rio de Janeiro, RJ, Brasil.Hospital Federal dos Servidores do Estado. Rio de Janeiro, RJ, Brasil.Hospital Federal dos Servidores do Estado. Rio de Janeiro, RJ, Brasil.Hospital Federal dos Servidores do Estado. Rio de Janeiro, RJ, Brasil.University of California. David Geffen School of Medicine. Los Angeles, CA, USA.Hospital Federal dos Servidores do Estado. Rio de Janeiro, RJ, Brasil.Our objective was to describe viral suppression and antiretroviral (ARV) resistance mutations in an ongoing cohort of perinatally-infected HIV+ (PHIV+) pregnant women. Descriptive analysis was performed using SPSS 18.0. From 2011 to 2014, we followed 22 PHIV+ pregnant women. Median age at prenatal entry was 19 years (Interquartile range (IQR) 17.6-21.0); 86% had an AIDS diagnosis; 81% had disclosed their HIV status to partner 11. The median age at HIV diagnosis was 8.3 y (IQR 4.0-13.6), the median age at sexual debut was 16 years (IQR 14-18). At the time of prenatal care initiation, four (18%) were on their first antiretroviral treatment (ART), eight (36%) in their second regimen and nine (41%) in their third regimen or beyond, and one had no data. Seventeen of 22 (77%) had HIV-viral load (VL) > 50 copies/mL at prenatal care entry, 16 had a genotyping exam performed. Seventeen of 22 PHIV+ had VL results near delivery: 7/17 (41%) had VL < 50 copies/mL. Among those who had genotyping at prenatal entry, 11/16 (69%) had mutations associated with ARV resistance. The most frequent major mutations were K103N, M184V, T215, M41L, D67N at reverse transcriptase gene and M46, I54V and V82A at protease gene. No vertical transmissions occurred. Management of pregnancy among PHIV+ is challenging. Individualized ART are needed to achieve viral suppression in a highly ART-exposed subpopulation

Neutralization of primary HIV-1 isolated from individuals residing in Rio de Janeiro

HEC/FIOCRUZ AIDS Clinical Research Group: S Cavalcante, MCG Galhardo, MRC Guimarães, VC Rolla, VG Veloso.Submitted by Fábio Marques ([email protected]) on 2019-02-11T18:27:54Z No. of bitstreams: 1 Neutralization_Beatriz_Grinsztejn_etal_INI_1996.pdf: 62065 bytes, checksum: 040632517254d67b67b8cbad268d14f8 (MD5)Approved for entry into archive by Regina Costa ([email protected]) on 2019-02-14T16:04:40Z (GMT) No. of bitstreams: 1 Neutralization_Beatriz_Grinsztejn_etal_INI_1996.pdf: 62065 bytes, checksum: 040632517254d67b67b8cbad268d14f8 (MD5)Made available in DSpace on 2019-02-14T16:04:40Z (GMT). No. of bitstreams: 1 Neutralization_Beatriz_Grinsztejn_etal_INI_1996.pdf: 62065 bytes, checksum: 040632517254d67b67b8cbad268d14f8 (MD5) Previous issue date: 1996WHO/GPA/VDU, UNDP/World Bank, PIAF/Brazilian Ministry of Health DST/AIDS and CNPq.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Departamento de Imunologia. Laboratório de AIDS e Imunologia Molecular. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Departamento de Imunologia. Laboratório de AIDS e Imunologia Molecular. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa Clínica em DST/AIDS. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil.Hospital dos Servidores do Estado do Rio de Janeiro. Rio de Janeiro, RJ, BrasilHospital Geral de Nova Iguaçu. Nova Iguaçu, RJ, Brasil