MARIA CASSIA JACINTHO MENDES CORREA

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Departamento de Moléstias Infecciosas e Parasitárias, Faculdade de Medicina - Docente
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/52 - Laboratório de Virologia, Hospital das Clínicas, Faculdade de Medicina - Líder

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  • article 4 Citação(ões) na Scopus
    Viral hepatitis and HIV: update and management
    (2013) NUNEZ, Marina; MENDES-CORREA, Maria C.
    HCV-related liver disease is an important contributor to morbidity and mortality in the HIV-infected population. Successful treatment of HIV-HCV-coinfected patients is followed by favourable clinical outcomes. While the combination of pegylated interferon and ribavirin remains the mainstay in the treatment of non-1 HCV genotypes, the first generation of HCV protease inhibitors are being incorporated into existing HCV genotype-1 (HCV-1) treatment protocols. Although data are limited, the triple combination does improve the sustained virological response in HIV-HCV-1-coinfected subjects. However, with still very limited data in this setting, clinical decisions for triple therapy have to be individualized and made based on multiple considerations. Chronic HBV infection increases mortality in HIV-infected subjects. In the treatment of HIV-HBV coinfection, it is very important to coordinate HBV and HIV therapies. HBV-active HAART improves the outcome of patients with HIV-HBV coinfection and tenofovir has become a key component of the treatment for these patients, although a number of clinical situations require a case-by-case approach.
  • article 1 Citação(ões) na Scopus
    Response predictors and clinical benefits of hepatitis C retreatment with pegylated interferon and ribavirin in HIV/HCV coinfection
    (2013) PERIBANEZ-GONZALEZ, Mario; SILVA, Mariliza Henrique da; VILAR, Fernando Crivelenti; NASTRI, Ana Catharina Seixas-Santos; FERREIRA, Paulo Abrao; FOCACCIA, Roberto; CORREA, Maria Cassia Mendes
    Background. Hepatitis C is a leading cause of mortality among HIV-infected individuals. Therefore, eradication of HCV in this population is a priority. There are scarce data regarding retreatment efficacy of HIV/HCV coinfected patients. The aim of our study was to evaluate efficacy, predictors of response, and long term clinical benefits of sustained virological response (SVR) after hepatitis C retreatment in a population of HIV/HCV coinfected patients. Material and methods. We evaluated efficacy, safety, and clinical benefits of peginterferon(alfa-2a or alfa-2b) and ribavirin in a restrospective, observational, multicentric study, including 47 HIV/HCV coinfected patients, non-responders to previous treatment with conventional interferon alfa-2a and ribavirin. The primary endpoint of efficacy was SVR, defined as undetectable viral toad 24 weeks after end of treatment. Death, liver disease progression, CD4 counts, and AIDS defining illness were the endpoints to access clinical benefits of treatment response. Results. In our analysis, 31.9% patients reached SVR. Genotypes 2/3 had a significant better SVR (66.7%) compared to genotypes 1/4 (33.3%) (p = 0.022). During follow-up, deaths (6.89%) and hepatic decompensation (28.6%) occurred only in the nonresponder group, while there were no cases of death or hepatic deconnpensation among the responder group(p = 0.037). Conclusion. Nearly one third of patients (mainly those with genotypes 2/3) reached SVR after hepatitis C retreatment in this group of HIV/HCV coinfected patients. SVR was protective against hepatic decompensation and death in a two-year follow-up period. Retreatment may be an effective and safe way to eradicate HCV until new anti-HCV drugs become available to this group of patients.
  • conferenceObject
    INSULIN RESISTANCE AND HIGH CHOLESTEROL LEVELS ARE ASSOCIATED WITH VITAMIN D DEFICIENCY IN HCV, HIV AND HIV/HCV COINFECTED PATIENTS
    (2013) GONZALEZ, M. P.; KLAUTAU, G. B.; MAZO, D. F.; NOGUEIRA, R. S.; MENDES-CORREA, M. C. J.; CARRILHO, F. J.; PESSOA, M. G.
    Background and Aims: Vitamin D plays a role in metabolic syndrome and has also been suggested as an immunomodulator. Lower levels are correlated with severe fibrosis in HCV and HIV/HCV coinfected patients and predict lower response to treatment in those individuals. The aim is to evaluate levels of 25(OH)vitamin D among a population of HCV, HIV and HIV/HCV coinfected patients and describe associated factors. Patients and Methods: We collected 25(OH)vitamin D samples, demographic data, clinical information and laboratory tests including liver function and metabolic assessment of four groups of patients; 1 – HCV monoinfected, 2 – HIV monoinfected, 3 – HIV/HCV coinfected, followed at reference centres of São Paulo-Brazil and 4 – Healthy Volunteers Control Group. Results: 422 patients were included for analysis, (129) Group 1, (118) Group 2, (53) Group 3 and (122) Group 4. Mean levels of Vitamin D were similarly insufficient in all groups (Table 1). Table 1. Mean Levels of Vitamin D in the 4 groups Groups n Mean (ng/mL) St. D. St. E. Median (ng/mL) IQ.D Min (ng/mL) Max (ng/mL) 1– HCV 129 23.4 10.1 0.89 23 13 5 55 2– HIV 118 19.5 9.2 0.85 18 12 4 50 3– HIV/HCV 53 24.1 12.9 1.77 22 15 3 66 4– Control 122 17.1 5.9 0.54 17 8.75 6 32 In an overall analysis, Vitamin D deficiency (serum levels < 20ng/mL) was associated with higher HOMA index (Graph 1 – p=0.02 Fisher test) and total cholesterol levels > 200 (p=0.004 Fisher test). When analyzed by Groups, Vitamin D deficiency was associated with: 1. Higher HOMA levels in HCV patients (Grap h 2 – p=0.004 Fisher test), 2. Use of Efavirenz both in HIV (Graph 3 – p=0.03 OR=6.69 95%CI: 1.17–38.3) and Coinfected Patients (p=0.04 OR=15.0 95%CI: 1.22–184). Conclusion: This study found high prevalence of vitamin D deficiency, even in healthy volunteers. The association between Insulin Resistance (IR) and Vitamin D deficiency has been demonstrated in other populations, but not previously described in HCV patients. This finding is relevant because both IR and Vitamin D deficiency are related to poor treatment outcomes of Interferon-based regimens.
  • article 3 Citação(ões) na Scopus
    Strong correlation by ultrasonography of hepatomegaly and the presence of co-infection in HIV/HCV cirrhotic patients
    (2013) VEZOZZO, Denise Cerqueira Paranagua; MENDES-CORREA, Maria Cassia; CUNHA-SILVA, Marlone; ALVARADO-MORA, Monica Viviana; FRANCA, Joao Italo Dias; SEBBA, Jose Luiz; NICODEMO, Antonio Carlos; OLIVEIRA, Claudia P. M. S.; CARRILHO, Flair Jose
    Objectives: Progression of hepatic fibrosis is accelerated in patients co-infected with human immunodeficiency virus and hepatitis C virus compared to hepatitis C virus mono-infected patients. This study aimed to compare ultrasound features and selected clinical and biochemical variables between patients with human immunodeficiency virus/hepatitis C virus co-infection (n = 16) versus hepatitis C virus mono-infection (n = 16). Methods: Each patient underwent abdominal ultrasound, and a specific evaluation was performed in order to detect findings consistent with chronic liver disease. Characterization of spleen size, liver structural pattern, diameter of the portal, spleen, and mesenteric veins was based on classical ultrasound parameters. Propensity score was used for control of selection bias and performed using binary logistic regression to generate a score for each patient. The Fisher and Mann-Whitney tests were used to evaluate categorical variables and continuous variables, respectively. Results: On univariate analysis right hepatic lobe size was larger in human immunodeficiency virus/hepatitis C virus patients (157.06 +/- 17.56 mm) compared to hepatitis C virus mono-infected patients (134.94 +/- 16.95 mm) (p = 0.0011). The left hepatic lobe was also significantly larger in human immunodeficiency virus/hepatitis C virus patients (115.88 +/- 22.69 mm) versus hepatitis C virus mono-infected patients (95.06 +/- 24.18 mm) (p = 0.0177). Also, there was a strong correlation between hepatomegaly and co-infection (p = 0.005). Conclusion: Human immunodeficiency virus infection was the primary variable influencing liver enlargement in this population. Hepatomegaly on ultrasound was more common among cirrhotic human immunodeficiency virus/hepatitis C virus co-infected patients than among cirrhotic hepatitis C virus mono-infected patients. This aspect is very important in the management of human immunodeficiency virus/hepatitis C virus co-infected patients, because screening for hepatocellular carcinoma is necessary in this population.
  • conferenceObject
    Hepatic Steatosis and Insulin Resistance are associated to Vitamin D Deficiency (VDD) in Hepatitis C monoinfection and HIV/HCV coinfection
    (2013) GONZALEZ, Mario P.; KLAUTAU, Giselle B.; MENDES-CORREA, Maria Cassia; MAZO, Daniel F. C.; NOGUEIRA, Roberta S.; CARRILHO, Flair J.; PESSOA, Mario G.
  • article 2 Citação(ões) na Scopus
    Absence of anti-hepatitis B virus (HBV) core in HIV/HBV coinfection with advanced immunosuppression
    (2013) AVELINO-SILVA, V. I.; MIRAGLIA, J. L.; GOMES-GOUVEA, M. S.; PINHO, J. R. R.; MENDES-CORREA, M. C.
  • article 13 Citação(ões) na Scopus
    Thyroid disturbance related to chronic hepatitis C infection: role of CXCL10
    (2013) DANILOVIC, Debora Lucia Seguro; MENDES-CORREA, Maria Cassia; CHAMMAS, Maria Cristina; ZAMBRINI, Heverton; BARROS, Raffaelle K.; MARUI, Suemi
    Association between autoimmune thyroid diseases (AITD) and hepatitis C is controversial, but may occur or worsen during alpha-interferon treatment. The mechanism responsible for autoimmune diseases in infected patients has not been fully elucidated. This study aims to evaluate the frequency of AITD in chronic hepatitis C and the association of chemokine (CXC motif) ligand 10 (CXCL10) and AITD. One hundred and three patients with chronic hepatitis C and 96 controls were prospectively selected to clinical, hormonal, thyroid autoimmunity and ultrasound exams, besides thyroxine-binding globulin (TBG) and CXCL10 measurements and hepatic biopsies. The frequency of AITD among infected subjects was similar to controls. TT3 and TT4 distributions were right shifted, as was TBG, which correlated to both of them. Thyroid heterogeneity and hypoechogenicity were associated with AITD. Increased vascularization was more prevalent in chronic hepatitis C.CXCL10 was higher in infected patients (p=0.007) but was not related to thyroid dysfunction. Increase in CXCL10 levels were consistent with hepatic necroinflammatory activity (p=0.011). In summary, no association was found between chronic hepatitis C and AITD. Infected subjects had higher TT3 and TT4 which were correlated to TBG. Increased CXCL10 was not associated to thyroid dysfunction in HCV-infected population.