MARIO GUIMARAES PESSOA
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
5 resultados
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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.- The presence of resistance mutations to protease and polymerase inhibitors in Hepatitis C virus sequences from the Los Alamos databank(2013) ALVES, R.; QUEIROZ, A. T. L.; PESSOA, M. G.; SILVA, E. F. da; MAZO, D. F. C.; CARRILHO, F. J.; CARVALHO-FILHO, R. J.; CARVALHO, I. M. V. G. deSeveral new direct-acting antiviral (DAA) drugs are in development for chronic hepatitis C viral (HCV) infection, and NS3-NS4A serine protease and the NS5B RNA-dependent RNA polymerase have been the major targets. HCV variants displaying drug-resistant phenotypes have been observed both in vitro and during clinical trials. Our aim was to characterize amino acid changes at positions previously associated with resistance in protease (NS3) and polymerase (NS5B) regions from treatment-naive HCV patients infected with genotypes 1a, 1b and 3a. All 1383 NS3 protease sequences (genotype 1a=680, 1b=498 and 3a=205) and 806 NS5B polymerase sequences (genotypes 1a=471, 1b=329, 3a=6) were collected from Los Alamos databank. Genotype 3a protease sequences showed the typical low-level resistance mutation V36L. NS3 sequences from other genotypes presented mutations on positions 36, 39, 41, 43, 54, 80, 109, 155 and 168 in a frequency lower than 2%, except for the mutation Q80R found in 35% of genotype 1a isolates. Polymerase sequences from genotype 3a patients showed five typical mutations: L419I, I424V, I482L, V499A and S556G. Two positions presented high polymorphism in the NS5B region from genotype 1a (V499A) and genotype 1b (C316N) subjects. Our results demonstrated a natural profile of genotype 3a that can be associated with the pre-existence of HCV variants resistant to first-generation protease inhibitors and to non-nucleoside polymerase inhibitors. Likewise, genotype 1b isolates and genotype 1a sequences exhibited pre-existing mutations associated with resistance to Palm II and Thumb I polymerase inhibitors, respectively.
conferenceObject Evidence of Hepatitis E Virus Infection in Liver Transplant Recipients from Brazil(2013) GOMES-GOUVEA, Michele S.; FERREIRA, Ariana C.; FEITOZA, Bruna; PESSOA, Mario G.; ABDALA, Edson; TERRABUIO, Deborah R.; MORAES, Adriano C.; BONAZZI, Patricia R.; D'ALBUQUERQUE, Luiz C.; CARRILHO, Flair J.; PINHO, Joao R.- 52-Week Efficacy and Safety of Telbivudine with Conditional Tenofovir Intensification at Week 24 in HBeAg-Positive Chronic Hepatitis B(2013) PIRATVISUTH, Teerha; KOMOLMIT, Piyawat; TANWANDEE, Tawesak; SUKEEPAISARNJAROEN, Wattana; CHAN, Henry L. Y.; PESSOA, Mario G.; FASSIO, Eduardo; ONO, Suzane K.; BESSONE, Fernando; DARUICH, Jorge; ZEUZEM, Stefan; CHEINQUER, Hugo; PATHAN, Rashidkhan; DONG, Yuhong; TRYLESINSKI, AldoBackground and Aims: The Roadmap concept is a therapeutic framework in chronic hepatitis B for the intensification of nucleoside analogue monotherapy based on early virologic response. The efficacy and safety of this approach applied to telbivudine treatment has not been investigated. Methods: A multinational, phase IV, single-arm open-label study (ClinicalTrials.gov ID NCT00651209) was undertaken in HBeAg-positive, nucleoside-naive adult patients with chronic hepatitis B. Patients received telbivudine (600 mg once-daily) for 24 weeks, after which those with undetectable serum HBV DNA (<300 copies/mL) continued to receive telbivudine alone while those with detectable DNA received telbivudine plus tenofovir (300 mg once-daily). Outcomes were assessed at Week 52. Results: 105 patients commenced telbivudine monotherapy, of whom 100 were included in the efficacy analysis. Fifty-five (55%) had undetectable HBV DNA at Week 24 and continued telbivudine monotherapy; 45 (45%) received tenofovir intensification. At Week 52, the overall proportion of undetectable HBV DNA was 93% (93/100) by last-observation-carried-forward analysis (100% monotherapy group, 84% intensification group) and no virologic breakthroughs had occurred. ALT normalization occurred in 77% (87% monotherapy, 64% intensification), HBeAg clearance in 43% (65% monotherapy, 16% intensification), and HBeAg seroconversion in 39% (62% monotherapy, 11% intensification). Six patients had HBsAg clearance. Myalgia was more common in the monotherapy group (19% versus 7%). No decrease in the mean glomerular filtration rate occurred in either treatment group at Week 52. Conclusions: Telbivudine therapy with tenofovir intensification at Week 24, where indicated by the Roadmap strategy, appears effective and well tolerated for the treatment of chronic hepatitis B.
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.