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
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- Say it right: measuring the impact of different communication strategies on the decision to get vaccinated(2023) AVELINO-SILVA, Vivian I.; FERREIRA-SILVA, Sofia Natalia; SOARES, Maria Eduarda Muniz; VASCONCELOS, Ricardo; FUJITA, Luiz; MEDEIROS, Tainah; BARBIERI, Carolina Luisa Alves; COUTO, Marcia TherezaBackgroundVaccine hesitancy is a concerning menace to the control of vaccine-preventable diseases. Effective health communication could promote an overall understanding of the importance, risks, and benefits of vaccination and reduce vaccine hesitancy.MethodsIn this survey, four fictitious newspaper articles addressing an emerging bogus disease and its vaccine were randomly assigned to participants. The first version focused on information about the disease; the second was akin to the first, including a case description and image. The third version focused on vaccine safety/efficacy; the fourth version was like the third, including a case description and image. After reading a single version of the article, participants responded if they would take the vaccine and if they would vaccinate their children. We used chi-squared tests for comparisons and investigated interactions with vaccine-hesitant attitudes.ResultsWe included 5233 participants between August/2021 and January/2022; 790 were caregivers of a child <= 5 years old, and 15% had prior vaccine hesitancy. Although most declared intention to take the vaccine, the percentage was highest among those exposed to the newspaper article focusing on the vaccine safety/efficacy with the case description and picture (91%; 95% confidence interval 89-92%), and lowest among participants exposed to the article focusing on the disease with no case description (84%; 95% confidence interval 82-86%). Similar trends were observed in the intention of offspring vaccination. We found evidence of effect modification by vaccine-hesitant attitudes, with a higher impact of communication focusing on vaccine safety/efficacy compared to that focusing on disease characteristics among hesitant participants.ConclusionCommunication strategies focusing on different aspects of the disease-vaccine duet may impact vaccine hesitancy, and storytelling/emotive imagery descriptions may improve risk perception and vaccine uptake. Moreover, the effect of message framing strategies may differ according to previous vaccine hesitant attitudes.
- 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.
- The Effect of Depressive Symptoms on Adherence to Daily Oral PrEP in Men who have Sex with Men and Transgender Women: A Marginal Structural Model Analysis of The iPrEx OLE Study(2016) MEHROTRA, Megha L.; GLIDDEN, David V.; MCMAHAN, Vanessa; AMICO, K. Rivet; HOSEK, Sybil; DEFECHEREUX, Patricia; MAYER, Kenneth H.; VELOSO, Valdilea G.; BEKKER, Linda-Gail; AVELINO-SILVA, Vivian I.; SCHECHTER, Mauro; GRANT, Robert M.We assessed the role of depressive symptoms on adherence to daily oral FTC/TDF for HIV PrEP in cis-gender men who have sex with men (MSM) and transgender women who have sex with men (TGW) using data from the iPrEx OLE study. A marginal structural logistic regression model was used to estimate the effect of time-varying CES-D scores on having protective levels of drug concentration, adjusting for confounding by sexual practices over time, prior adherence, and baseline demographic characteristics. We found a non-monotonic relationship between CES-D score and odds of protective FTC/TDF levels in MSM. We found evidence that the effect of depression on adherence varied between MSM and TGW, and that depressive symptoms did not contribute greatly to decreased adherence on a population scale. We recommend that depressive symptoms not preclude the prescription of PrEP, and that MSM and TGW be studied separately.
- 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.
- Demographics and serological profile of blood donors who opt for the confidential unit exclusion in a blood bank in Sao Paulo, Brazil(2021) DELATORRE, Marcella Vizcaya Val; BATALHA, Kalyne M.; SANTOS, Leandro Dinalli; BONET-BUB, Carolina; AVELINO-SILVA, Vivian IidaBlood transfusion is still an irreplaceable therapeutic modality, widely applied to medical care. Clinical interviews and laboratory testing for transfusion-transmitted infections (TTI) are routinely performed to prevent TTI among the recipients. However, there is still a residual risk of TTI, and some blood banks have adopted the confidential unit exclusion (CUE) as an additional safety strategy. In this study, we investigated the demographic characteristics and laboratory results of the screening of TTI among blood donors who opted for the CUE, compared to blood donors who did not opt for the CUE. In this study, we included 32,261 blood donations collected in a single blood bank in Sao Paulo, Brazil. A very small proportion of donors (0.25%) opted for the CUE. They were mainly single males and were more likely to have HBV, syphilis, and other positive results in the combined screening for TTI, in comparison with those who did not opt for the CUE. This difference was statistically significant in both the univariable and the multivariable analysis adjusted for age, gender , marital status and years of schooling. Our findings highlight that CUE may be a useful tool to improve the safety for blood recipients, but its efficiency is context-dependent.
conferenceObject Sexual health and sexually transmitted infections prevention among people who have sex between vulvas: a Brazilian analysis(2024) BARTOLLETI, Flavia; AVELINO-SILVA, Vivian I.; HANITZSCH, Eugenia; SOUZA, Athos- The Zika Virus Individual Participant Data Consortium: A Global Initiative to Estimate the Effects of Exposure to Zika Virus during Pregnancy on Adverse Fetal, Infant, and Child Health Outcomes(2020) ALGER, Jackeline; XIMENES, Ricardo Arraes de Alencar; I, Vivian Avelino-Silva; BARDAJI, Azucena; MOJICA, Carlos Hernan Becerra; BENEDETTI, Andrea; TEIXEIRA, Maria de Lourdes Benamor; BETHENCOURT, Sarah; ABURTO, Victor Hugo Borja; BRANT, Fatima; BRASIL, Patricia; SILVA, Antonio A.; SIQUEIRA, Isadora C. de; SOHAN, Karen; SORIA-SEGARRA, Carmen; SORIANO-ARANDES, Antoni; SOUSA, Patricia; SOUZA, Joao Paulo; FRANCH, Anna Suy; TAMI, Adriana; TEIXEIRA, Mauro; TONG, Van T.; THWIN, Soe Soe; TURCHI, Marilia Dalva; MARTELLI, Celina Maria Turchi; VALENCIA, Diana; KERKHOVE, Maria D. Van; ARAUJO, Thalia Velho Barreto de; VILLAR, Luis Angel; BENEITEZ, Carmen Vinuela; WEI, Yinghui; WIDDOWSON, Marc-Alain; BRICKLEY, Elizabeth B.; WILDER-SMITH, Annelies; BROUTET, Nathalie; BUEKENS, Pierre; CAFFERATA, Maria Luisa; CALVET, Guilherme; CAMPBELL, Harlan; CARABALI, Mabel; CHAN, Derrick; COSTA, Federico; FERREIRA, Orlando da Costa; COUTINHO, Conrado Milani; CUNHA, Antonio Jose; CURE, Carlos Cure; DAMEN, Johanna A. A.; JONG, Valentijn M. T. de; DEBRAY, Thomas P.; DEBIASI, Roberta L.; DIAZ-MARTINEZ, Luis Alfonso; DUARTE, Geraldo; FERRIOL, Diana Maria; GANZ, Jucelia S.; GERARDIN, Patrick; GILBOA, Suzanne M.; GONZALEZ, Maritza; MUNIZ, Concepcion Grajales; GUSTAFSON, Paul; SANCHEZ, Luz Angela Gutierrez; GUZMAN, Maria G.; HOFER, Cristina; HOLBAND, Natanael; INWANI, Irene; JAENISCH, Thomas; JOAO, Esau; JULIANA, Amadu; KARA, Edna; KIM, Caron; I, Albert Ko; KOOPMANS, Marion; LABEAUD, Angelle Desiree; LASH, Maura; LEE, Ellen H.; LEO, Yee-Sin; LEVIS, Brooke; LOW, Nicola; MACPHERSON, Calum N. L.; MARBAN-CASTRO, Elena; MATTAR, Salim; MAXWELL, Lauren; MAYAUD, Philippe; MELO, Adriana; MENENDEZ, Clara; REYES, Marcela Mercado; MONTOYA, Maria Consuelo Miranda; MIRANDA-FILHO, Democrito de Barros; MOONS, Karel G. M.; MORALES, Ivonne; MOREIRA, Maria Elisabeth; MULKEY, Sarah B.; MEDINA, Jose Esteban Munoz; MUSSI-PINHATA, Marisa Marcia; NATRAJAN, Muktha S.; NJENGA, M. Kariuki; NOEL, Trevor P.; NOGUEIRA, Mauricio; OSORO, Eric; MARTINEZ, Martha Lucia Ospina; PALADINI, Marc; PASSOS, Saulo; PEREZ, Freddy; POMAR, Leo; PRATA-BARBOSA, Arnaldo; REIS, Mitermayer; REVEIZ, Ludovic; RODO, Carlota; ROSADO, Luiza Emylce Pela; ROSENBERGER, Kerstin D.; CLEMENTE, Nuria Sanchez; SAYERS, Janet L.This commentary describes the creation of the Zika Virus Individual Participant Data Consortium, a global collaboration to address outstanding questions in Zika virus (ZIKV) epidemiology through conducting an individual participant data meta-analysis (IPD-MA). The aims of the IPD-MA are to (1) estimate the absolute and relative risks of miscarriage, fetal loss, and short- and long-term sequelae of fetal exposure; (2) identify and quantify the relative importance of different sources of heterogeneity (e.g., immune profiles, concurrent flavivirus infection) for the risk of adverse fetal, infant, and child outcomes among infants exposed to ZIKV in utero; and (3) develop and validate a prognostic model for the early identification of high-risk pregnancies and inform communication between health care providers and their patients and public health interventions (e.g., vector control strategies, antenatal care, and family planning programs). By leveraging data from a diversity of populations across the world, the IPD-MA will provide a more precise estimate of the risk of adverse ZIKV-related outcomes within clinically relevant subgroups and a quantitative assessment of the generalizability of these estimates across populations and settings. The ZIKV IPD Consortium effort is indicative of the growing recognition that data sharing is a central component of global health security and outbreak response.