VIVIAN HELENA IIDA AVELINO DA SILVA
Projetos de Pesquisa
Unidades Organizacionais
LIM/49 - Laboratório de Protozoologia, Hospital das Clínicas, Faculdade de Medicina
LIM/38 - Laboratório de Epidemiologia e Imunobiologia, Hospital das Clínicas, Faculdade de Medicina
LIM/38 - Laboratório de Epidemiologia e Imunobiologia, Hospital das Clínicas, Faculdade de Medicina
16 resultados
Resultados de Busca
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- Natural experiment of syphilis treatment with doxycycline or benzathine penicillin in HIV-infected patients(2019) ANTONIO, Marilia B.; CUBA, Gabriel T.; VASCONCELOS, Ricardo P.; ALVES, Ana Paula P. S.; SILVA, Bruna Oliveira da; AVELINO-SILVA, Vivian IidaBackground: Although doxycycline is widely used as an alternative to benzathine penicillin for the treatment of early and late latent syphilis, data on serological response following treatment with doxycycline among HIV-infected patients are limited. Methods: In this study, we analysed serological response to syphilis treatment with doxycycline among HIV-infected patients treated during a benzathine penicillin shortage period and compared with treatment response among patients treated with benzathine penicillin. Cases with neurosyphilis and those treated with suboptimal doses or with concurrent medications in association with benzathine penicillin or doxycycline were excluded. Results: Fifty patients treated with doxycycline from September 2014 to December 2016 were compared with 115 patients treated with benzathine penicillin for early, late latent or latent syphilis of unknown duration. Patients treated with doxycycline were slightly older [(median 49 years old, 95% confidence interval (95% CI) 43-56] than those in the penicillin group (median 44 years old, 95% CI 37-50; P = 0.007). Groups had no statistically significant differences regarding sex, HIV suppression under treatment and syphilis stages. Serological response to treatment, defined as a nonreagent Venereal Disease Research Laboratory (VDRL) or at least a four-fold reduction in VDRL titres measured 6-12 months after treatment, was seen in 72% (95% CI 58-84) of patients treated with doxycycline and 70% (95% CI 60-78) of patients treated with penicillin (P = 0.753). Conclusion: We found no statistically significant differences in serological response to treatment with doxycycline or benzathine penicillin among HIV-infected patients with early, late latent or latent syphilis of unknown duration. Our findings suggest that doxycycline is an acceptable treatment to HIV-infected patients with nontertiary stages of syphilis.
- Comparison of cumulative viraemia following treatment initiation with different antiretroviral regimens: a real-life study in Brazil(2019) PASCOM, Ana R.; PINHO, Rosana E. G. G.; RICK, Fernanda; VERAS, Nazle M. C.; PERINI, Filipe de Barros; MEIRELES, Mariana V.; PEREIRA, Gerson F.; BENZAKEN, Adele S.; AVELINO-SILVA, Vivian I.Introduction The relative efficacy of different antiretroviral (ART) regimens has been extensively evaluated in the context of clinical trials, using HIV viral load (VL) measurements at pre-specified timepoints after ART onset. However, data from real-life studies using combined longitudinal measurements of cumulative viraemia are scarce. This study aimed to address the independent effect of different ART regimens on HIV cumulative viraemia over the first 12 months after treatment initiation, using programmatic data from the Ministry of Health of Brazil. Methods Retrospective cohort study analysing cumulative viraemia under the most frequently used ART regimens in Brazil (tenofovir, lamivudine and dolutegravir (regimen 1); tenofovir, lamivudine and efavirenz (regimen 2); tenofovir, lamivudine and ritonavir-boosted atazanavir (regimen 3)). Results and Discussion We included 112,243 patients >12 years old who received their first ART prescription between January 2014 and August 2017. Univariate analysis indicated that cumulative viraemia was significantly lower in patients receiving regimen 1 as compared with those receiving regimens 2 or 3 (p<0.0001 for both pairwise comparisons). In a multivariable analysis adjusted for age, sex, baseline T CD4+ counts and baseline HIV VL, ART regimen persisted with statistically significant effect on 12-month cumulative viraemia. The model predicted a 45-unit increase in log(10) copy-days/mL cumulative viraemia for regimen 2 as compared with regimen 1, and a 70-unit increase in log(10) copy-days/mL cumulative viraemia for regimen 3 as compared with regimen 1 (95%CI 41 to 49 and 61 to 79 respectively; p<0.001 for both comparisons). In models restricted to youths (13 to 24 years old) and female patients, ART regimen had similar effects. ART regimen with dolutegravir in association with a tenofovir-lamivudine backbone was superior to regimens containing efavirenz or boosted atazanavir in reducing HIV VL, as shown by cumulative viraemia over the first 12 months after treatment initiation. The superiority persisted even after adjusting the analysis for potential confounders. Conclusions Our findings could bring direct benefits to patients as suggested by lower viral replication during treatment, lower risk of HIV transmission, and a potential reduction in resistance mutations in the initial 12 months under ART.
- Attitudes and Knowledge About Human Immunodeficiency Virus Pre-Exposure Prophylaxis Among Brazilian Infectious Disease Physicians(2020) CERQUEIRA, Natalia Barros; VASCONCELOS, Ricardo; HOJILLA, J. Carlo; KALLAS, Esper Georges; I, Vivian Avelino-SilvaThe objective was to describe levels and predictors of knowledge, attitudes, and willingness to prescribe pre-exposure prophylaxis (PrEP) among Brazilian Infectious Disease (ID) Physicians. The design was a cross-sectional study. We collected information on demographics and attitudes/knowledge about PrEP using an anonymous electronic survey. Willingness to prescribe PrEP, fear of adherence issues, and concerns about risk compensation were addressed in three case vignettes that varied by a single characteristic (i.e., by gender identity, drug use, and socioeconomic status) randomly assigned to physicians. Three hundred seventy ID physicians responded to the survey. Although most identified as informed/well informed about PrEP (75%) and believed PrEP availability to be necessary (38%), concerns with adherence (49%), side effects (38%), risk compensation (28%), and increase in sexually transmitted infection incidence (38%) were raised. We found no statistically significant differences in willingness to prescribe PrEP and concerns around risk compensation across the three case vignettes. ID physicians who declared having a religion reported more concerns about risk compensation compared to those self-identified as atheists (72% vs. 46%,p < .001). Most Brazilian ID physicians reported a positive attitude toward PrEP. Patients' gender identity, drug use, and socioeconomic status were not associated with willingness to prescribe PrEP. However, ID physicians who declared having a religion were more frequently concerned about risk compensation among PrEP users, suggesting that personal beliefs can influence PrEP implementation.
- Persistence of Yellow Fever vaccine-induced antibodies after cord blood stem cell transplant(2016) AVELINO-SILVA, Vivian Iida; FREIRE, Marcos da Silva; ROCHA, Vanderson; RODRIGUES, Celso Arrais; NOVIS, Yana Sarkis; SABINO, Ester C.; KALLAS, Esper GeorgesWe report the case of a cord blood haematopoietic stem cell transplant recipient who was vaccinated for Yellow Fever (YF) 7days before initiating chemotherapy and had persistent YF antibodies more than 3years after vaccination. Since the stem cell donor was never exposed to wild YF or to the YF vaccine, and our patient was not exposed to YF or revaccinated, this finding strongly suggests the persistence of recipient immunity. We briefly discuss potential consequences of incomplete elimination of recipient's leukocytes following existing haematopoietic cancer treatments.
- Plasmablast Expansion Following the Tetravalent, Live-Attenuated Dengue Vaccine Butantan-DV in DENV-Naive and DENV-Exposed Individuals in a Brazilian Cohort(2022) SILVEIRA, Cassia G. T.; MAGNANI, Diogo M.; COSTA, Priscilla R.; AVELINO-SILVA, Vivian I.; RICCIARDI, Michael J.; TIMENETSKY, Maria do Carmo S. T.; GOULART, Raphaella; CORREIA, Carolina A.; MARMORATO, Mariana P.; FERRARI, Lilian; NAKAGAWA, Zelinda B.; TOMIYAMA, Claudia; TOMIYAMA, Helena; KALIL, Jorge; PALACIOS, Ricardo; PRECIOSO, Alexander R.; WATKINS, David I.; KALLAS, Esper G.An effective vaccine against the dengue virus (DENV) should induce a balanced, long-lasting antibody (Ab) response against all four viral serotypes. The burst of plasmablasts in the peripheral blood after vaccination may reflect enriched vaccine-specific Ab secreting cells. Here we characterize the acute plasmablast responses from naive and DENV-exposed individuals following immunization with the live attenuated tetravalent (LAT) Butantan DENV vaccine (Butantan-DV). The frequency of circulating plasmablasts was determined by flow cytometric analysis of fresh whole blood specimens collected from 40 participants enrolled in the Phase II Butantan-DV clinical trial (NCT01696422) before and after (days 6, 12, 15 and 22) vaccination. We observed a peak in the number of circulating plasmablast at day 15 after vaccination in both the DENV naive and the DENV-exposed vaccinees. DENV-exposed vaccinees experienced a significantly higher plasmablast expansion. In the DENV-naive vaccinees, plasmablasts persisted for approximately three weeks longer than among DENV-exposed volunteers. Our findings indicate that the Butantan-DV can induce plasmablast responses in both DENV-naive and DENV-exposed individuals and demonstrate the influence of pre-existing DENV immunity on Butantan DV-induced B-cell responses.
- Impact of antiretroviral regimen on viral suppression among pregnant women living with HIV in Brazil(2020) PASCOM, Ana R. Pati; FONSECA, Fernanda F.; PINHO, Rosana Goncalves Goncalves; PERINI, Filipe Barros; PEREIRA, Gerson; I, Vivian Avelino-SilvaHuman immunodeficiency virus (HIV) viral load (VL) during pregnancy is a critical determinant of the risk of HIV mother-to-child transmission (MTCT). Prior studies suggest that VL suppression is influenced by antiretroviral regimen. In this study, using secondary real-life data from the Ministry of Health of Brazil, we compared VL suppression at 60-180 days after the first antiretroviral therapy (ART) prescription during pregnancy and time to undetectable VL among pregnant women under treatment with double nucleoside/nucleotide regimens combined with efavirenz, boosted lopinavir, boosted atazanavir, or raltegravir, with adjustment for potential confounders in multivariable models. A total of 18,997 pregnant women living with HIV were included in the study. Compared to regimens containing lopinavir, we found that atazanavir-, efavirenz-, and raltegravir-based regimens were superior in achieving both outcomes after adjustment for age, social vulnerability index, time under ART, baseline CD4+ cell count, and baseline HIV VL. Raltegravir-containing regimens had the highest adjusted odds/rates of VL suppression compared to patients with other regimens. Elimination of HIV MTCT is still a critical public health issue in many countries. Our findings suggest that raltegravir-based regimens were superior when compared to efavirenz-, lopinavir-, and atazanavir-based antiretroviral regimens in achieving suppression of HIV VL.
conferenceObject Attitudes and Knowledge About HIV PrEP Among Infectious Diseases Physicians in Brazil(2018) CERQUEIRA, Natalia; VASCONCELOS, Ricardo; HOJILLA, Carlo; KALLAS, Esper; AVELINO-SILVA, VivianconferenceObject Surveillance of transmitted HIV drug resistance among treatment-naive children under 18 months in Brazil (2009 to 2018)(2020) FERREIRA, A. Alberto Cunha Mendes; PINHO, R. Elisa Goncalves Goncalves; ALBUQUERQUE, R. Castro de; MORELLI, T. Cherem; BRIZOLARA, R. Vianna; KOLLING, A. Francisca; MOURA, M. Camelo Madeira de; TRESSE, A. Sposito; VERAS, N. Mendonca Collaco; AQUINO, L. Martins de; PASCOM, A. R. Pati; BARROS, T. Dahrug; SILVEIRA, L. Neves da; FONSECA, F. Fernades; MOSIMANN JUNIOR, G.; PEREIRA, G. Fernando Mendes; FREITAS, M. Araujo de; AVELINO-SILVA, V. IidaconferenceObject Number of Sexual Partners Does Not Predict HIV Status in a Brazilian STI Clinic(2018) VASCONCELOS, Ricardo; AVELINO-SILVA, Vivian; ALVES, Ana Paula; NORONHA, Nicole; PICONE, Camila; SILVA, Bruna; SEGURADO, Aluisio- Safety and immunogenicity of CoronaVac in people living with HIV: a prospective cohort study(2022) NETTO, Lucas C.; IBRAHIM, Karim Y.; PICONE, Camila M.; ALVES, Ana Paula P. S.; V, Eliane Aniceto; SANTIAGO, Mariana R.; PARMEJANI, Patricia S. S.; AIKAWA, Nadia E.; MEDEIROS-RIBEIRO, Ana C.; PASOTO, Sandra G.; YUKI, Emily F. N.; SAAD, Carla G. S.; PEDROSA, Tatiana; LARA, Amanda N.; CENEVIVA, Carina; BONFA, Eloisa; KALLAS, Esper G.; I, Vivian Avelino-SilvaBackground People living with HIV might have a poor or delayed response to vaccines, mainly when CD4 cell counts are low, and data concerning COVID-19 vaccines in this population are scarce. This prospective cohort study assessed the safety and immunogenicity of the inactivated SARS-CoV-2 vaccine CoronaVac in people with HIV compared with people with no known immunosuppression. Methods In this prospective cohort study, adults (aged >= 18 years) living with HIV who were regularly followed up at the University of Sao Paulo HIV/AIDS outpatient clinic in Sao Paulo, Brazil, were included in the study. Eligibility for people with HIV was independent of antiretroviral use, HIV viral load, or CD4 cell count. Adults with no known immunosuppression with CoronaVac vaccination history were included as a control group. CoronaVac was given intramuscularly in a two-dose regimen, 28 days apart. Blood was collected before vaccine administration and 6 weeks after the second dose (day 69). Immunogenicity was assessed at baseline (day 0), before second vaccine (day 28), and 6 weeks after second vaccine dose (day 69) through SARS-CoV-2 IgG titre and seroconversion, neutralising antibody (NAb) positivity and percentage activity, and factor increase in IgG geometric mean titres (FI-GMT). We investigated whether HIV status and CD4 count (<500 or 500 cells per mu L) were associated with CoronaVac immunogenicity by use of multivariable models adjusted for age and sex. Findings Between Feb 9, 2021, and March 4, 2021, 776 participants were recruited. Of 511 participants included, 215 (42%) were people with HIV and 296 (58%) were people with no known immunosuppression. At 6 weeks after the second vaccine dose (day 69), 185 (91%) of 204 participants with HIV and 265 (97%) of 274 participants with no known immunosuppression had seroconversion (p=0.0055). 143 (71%) of 202 participants with HIV were NAb positive compared with 229 (84%) of 274 participants with no known immunosuppression (p=0.0008). Median IgG titres were 48.7 AU/mL (IQR 26.6.88.2) in people with HIV compared with 75.2 AU/mL (50.3.112.0) in people with no known immunosuppression (p<0.0001); and median NAb activity was 46.2% (26.9.69.7) compared with 60.8% (39.8.79.9; p<0.0001). In people with HIV who had CD4 counts less than 500 cells per .L seroconversion rates, NAb positivity, and NAb activity were lower than in those with CD4 counts of at least 500 cells per .L. In multivariable models for seroconversion, NAb positivity, IgG concentration, and NAb activity after a complete two-dose regimen, adjusted for age and sex, people with HIV who had CD4 counts of at least 500 cells per .L and people with no known immunosuppression had higher immunogenicity than did people with HIV with CD4 counts less than 500 cells per .L. No serious adverse reactions were reported during the study. Interpretation Immunogenicity following CoronaVac in people with HIV seems strong but reduced compared with people with no known immunosuppression. Our findings highlight the need for strategies to improve vaccine immunogenicity in people with HIV. Funding Fundacao de Amparo a Pesquisa do Estado de S.o Paulo (FAPESP), Conselho Nacional de Desenvolvimento Cientifico e Tecnol.gico (CNPq), and B3.Bolsa de Valores do Brasil.