MARIANA AMELIA MONTEIRO
Projetos de Pesquisa
Unidades Organizacionais
LIM/56 - Laboratório de Investigação em Dermatologia e Imunodeficiências, Hospital das Clínicas, Faculdade de Medicina
7 resultados
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- AIDS incidence and survival in a hospital-based cohort of HIV-positive patients from Sao Paulo, Brazil: The role of IFN-lambda 4 polymorphisms(2021) PRATES, Gabriela da Silva; MALTA, Fernanda M.; GONCALVES, Fernanda de Toledo; MONTEIRO, Mariana A.; FONSECA, Luiz Augusto M.; VEIGA, Ana Paula R.; MAGRI, Marcello M. C.; DUARTE, Alberto J. S.; CASSEB, Jorge; ASSONE, TatianeFew 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)-lambda 4 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-lambda 4 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/mm(3)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-lambda 4, variants rs8099917 and rs12979860. The follow-up time of the 347 asymptomatic-at-entry subjects was 3687 person-years. IFN-lambda 4 rs8099917 polymorphisms were not associated with AIDS progression, but IFN-lambda 4 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-lambda 4 on rs12979860 polymorphisms in HIV-infected patients may drive mortality risk.
- Prevalence of Antiretroviral Drug Resistance Mutations in HIV Seropositive Patients from an Outpatient Clinic of a Large University Hospital from Sao Paulo, Brazil(2020) CONSTANTINOV, Ericka Oliveira; BRIGIDO, Luis Fernando de Macedo; FONSECA, Luiz Augusto M.; CASSEB, Jorge; VEIGA, Ana Paula R.; MAGRI, Marcello M. C.; MONTEIRO, Mariana A.; ROCHA, Rosana C.; GASCON, Maria R. P.; FERREIRA, Mauricio D.; POLIS, Thales J. B.; NASCIMENTO, Najara A. de Lima; LIMONGELLI, Isadora Id; OLIVEIRA, Caro S.; FONSECA, Luiz A. M.; DUARTE, Alberto J. S.Drug resistance mutations (DRMs) can affect the success of the therapy and compromise new prevention strategies. Increasing rates of resistance to antiretroviral (ARV) drugs have been reported in some areas. This study evaluated the DRMs prevalence among patients at Hospital das Clinicas (Sao Paulo). Among treatment-naive patients, the prevalence of transmitted DRMs (Stanford Calibrated Population Resistance) was 8.4% (21/249), with 69% (75/109) of acquired resistance among treatment-experienced patients. Rates of transmitted DRM showed an increase (6.6% in 2002-2009 vs. 15.1% in 2010-2015, p = .05), from the first to the second decade, mainly due to mutations to the NNRTI (non-nucleoside reverse transcriptase inhibitor) class. Among treatment-experienced cases, a nonsignificant decrease overall, significant for the protease inhibitors (PIs) class, was documented. Subtype B predominated in both groups (78%), followed by subtype F, BF recombinants, and subtype C. Our results add to the growing evidence of an increase in transmitted DRM, document extensive DRM among experienced patients, and a decrease in resistance to PIs class that may reflect the increased use of boosted PIs and newer ARV classes in more recent years.
- Incomplete recovery of the CD4+/CD8+ratio is associated with the late introduction of antiretroviral therapy among people living with HIV infection(2024) PRATES, Gabriela da Silva; MONTEIRO, Mariana Amelia; OLIVEIRA, Ericka Constantinov; NASCIMENTO, Najara Ataide de Lima; VEIGA, Ana Paula Rocha; FERREIRA, Mauricio Domingues; POLIS, Thales Jose Bueno; CAETANO, Gabriela Prandi; SOARES, Beatriz Rodrigues Pellegrina; MAGRI, Marcello Mihailenko Chaves; PEREIRA, Luisa Oliveira; FONSECA, Luiz Augusto Marcondes; ALVES, Wagner Silva; DUARTE, Alberto Jose da Silva; CASSEB, Jorge Simao do RosarioDespite 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.
- SARS-CoV-2/COVID-19: Clinical Course Among Subjects HIV-1-Infected in Sao Paulo(2022) MONTEIRO, Mariana A. A.; PRATES, Gabriela S. S.; NASCIMENTO, Najara A. A. de Lima; VEIGA, Ana Paula R.; MAGRI, Marcello M. C.; POLIS, Thales J. B.; GASCON, Maria R. P.; FERREIRA, Mauricio D. D.; TIBERTO, Larissa; PEREIRA, Luisa O. O.; ALVES, Wagner; FONSECA, Luiz A. M.; DUARTE, Alberto J. S.; CASSEB, JorgeIntroduction: 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.
- Human T-Cell Lymphotropic Virus/Human Immunodeficiency Virus, and Hepatitis C Virus Coinfection: Clinical Outcomes After 22 Years of Follow-up in Sao Paulo City(2021) CASSEB, Jorge; MARCUSSO, Rosa Maria N.; MONTEIRO, Mariana; ASSONE, Tatiane; HAZIOT, Michel E. Y.; PERIBANEZ-GONZALEZ, Mario; FONSECA, Luiz Augusto M.; SMID, Jerusa; MOURA, Joao V. Luisi de; DAHY, Flavia E.; OLIVEIRA, Augusto Penalva de
- Fighting HIV/AIDS in a developing country: lessons from a small cohort from the largest Brazilian city(2020) CASSEB, Jorge; VEIGA, Ana Paula R.; MAGRI, Marcello M. C.; MONTEIRO, Mariana A.; ROCHA, Rosana C.; GASCON, Maria Rita P.; DOMINGUES-FERREIRA, Mauricio; POLIS, Thales J. B.; NASCIMENTO, Najara A. de Lima; LIMONGELLI, Isadora; OLIVEIRA, Icaro S.; PRANDI, Gabriela Caetano; COSTA, Livia M. C. B. Villares; FONSECA, Luiz A. M.; DUARTE, Alberto J. S.
- Efficacy of vitamin D supplementation among persons living with HIV/AIDS in Sao Paulo city, Brazil(2021) ALMEIDA-AFONSO, Rosa; FINAMOR, Danilo; FONSECA, Luiz Augusto M.; VEIGA, Ana P. Rocha; MONTEIRO, Mariana A.; MAGRI, Marcello; DUARTE, Alberto J. S.; CASSEB, JorgeHypovitaminosis D is now considered a pandemic, especially among more vulnerable populations and in HIV-infected subjects, with 80% presenting levels below 30 ng/mL. As there is no consensus on the more adequate dosage needed to correct such deficiency, the objective of this study was to evaluate 25 (OH) vitamin D supplementation in HIV-1 patients deficient of vitamin D. A total of 73 HIV-1-infected patients were included, drawn from a cohort of 435 patients; 37 patients were randomized to the active group, supplemented once a week with 50,000 UI vitamin D by mouth (group 1) and 36 to the placebo group (group 2). The study period ranged from June 2016 to September 2017. Variables involved in vitamin D metabolism and risk factors associated with hypovitaminosis were evaluated. The mean age was 45 years and 31.5 % were women. Vitamin D supplementation was effective in normalizing serum levels after six months in group 1 (mean 35 ng/mL compared to 21 ng/mL for the placebo group; p = 0.04). No patient reached blood levels considered toxic (>100 UI). Efavirenz use can negatively influence vitamin D levels and supplementation is necessary as a likely adjunct to improving CD4+ T cells, resulting in greater effectiveness of the treatment. A weekly oral dose of 50,000 IU of vitamin D was sufficient to normalize the vitamin deficiency, safely and with good adherence among persons living with HIV/AIDS in Brazil. (C) 2021 Sociedade Brasileira de Infectologia.