CAMILA DE MELO PICONE
Projetos de Pesquisa
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P ICHC, Hospital das Clínicas, Faculdade de Medicina
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- Facilitating access to pneumococcal vaccine for people living with HIV: an experience report(2022) PARMEJANI, Patricia da Silva Spindola; PICONE, Camila de Melo; ALVES, Ana Paula Pereira da Silva; SARTORI, Ana Marli Christovam; IBRAHIM, Karim YaqubThe article describes a strategy to facilitate access to pneumococcal conjugate vaccine 13 (PCV-13) for people living with HIV/AIDS (PLHIV) during the COVID-19 pandemic. Method: report on the experience regarding the organization of a care service for PLHIV in the city of Sao Paulo to facilitate access to PCV-13 in the framework of the 2020 influenza vaccination campaign during the COVID-19 pandemic. Results: through the integration between a PLHIV care service and an Immunization Center (CRIE in Portuguese), it was possible to offer PCV-13 to PLHIV at the point of care, reducing physical barriers to access to immunization. Thus, of the 1,906 PLHIV who passed through the service during the period March 23-July 31, 2020, 84.4% (1,609) received the influenza vaccine, PCV-13 or both. Of the 1609 vaccinated, 50.6% (814) were eligible and received PCV-13. Conclusion: offering the vaccine at the point of care and orienting PLHIV on the importance of vaccination as a disease prevention strategy, identifying those eligible to receive it, was an important action carried out by the institution together with the nursing team, as a strategy to facilitate access to vaccination.
- Human Papillomavirus (HPV) seroprevalence, cervical HPV prevalence, genotype distribution and cytological lesions in solid organ transplant recipients and immunocompetent women in Sao Paulo, Brazil(2022) MIYAJI, Karina Takesaki; INFANTE, Vanessa; PICONE, Camila de Melo; LEVI, Jose Eduardo; OLIVEIRA, Ana Carolina Soares de; LARA, Amanda Nazareth; TACLA, Maricy; DILLNER, Joakim; KANN, Hanna; EKLUND, Carina; CASTANHEIRA, Cristina Paula; MAYAUD, Philippe; SARTORI, Ana Marli ChristovamIntroduction Solid organ transplant (SOT) recipients are at increased risk of Human Papillomavirus (HPV) persistent infection and disease. This study aimed to evaluate HPV seroprevalence, cervical HPV prevalence, genotype distribution, and frequency of HPV-related cervical lesions in SOT recipients in comparison to immunocompetent women. Methods Cross-sectional study including SOT and immunocompetent women aged 18 to 45 years who denied previous HPV-related lesions. Cervical samples were screened for HPV-DNA by a polymerase chain reaction (PCR)-based DNA microarray system (PapilloCheck (R)) and squamous intraepithelial lesions (SIL) by liquid-based cytology. A multiplexed pseudovirion-based serology assay (PsV-Luminex) was used to measure HPV serum antibodies. Results 125 SOT and 132 immunocompetent women were enrolled. Cervical samples were collected from 113 SOT and 127 immunocompetent women who had initiated sexual activity. HPV-DNA prevalence was higher in SOT than in immunocompetent women (29.6% vs. 20.2%, p = 0.112), but this difference was not statistically significant. High-risk (HR)-HPV was significantly more frequent in SOT than in immunocompetent women (19.4% vs. 7.9%, p = 0.014). Simultaneous infection with >= 2 HR-HPV types was found in 3.1% of SOT and 0.9% of immunocompetent women. HPV seropositivity for at least one HPV type was high in both groups: 63.8% of 105 SOT and 69.7% of 119 immunocompetent women (p = 0.524). Low-grade (LSIL) and high-grade SIL (HSIL) were significantly more frequent in SOT (9.7% and 5.3%, respectively) than in immunocompetent women (1.6% and 0.8%, respectively) (p= 0.001). Conclusions These results may reflect the increased risk of HPV persistent infection and disease progression in SOT women due to chronic immunosuppression.
- The impact of dark chocolate intake on arterial elasticity in individuals with HIV/AIDS undergoing ART: a randomized, double-blind, crossover trial(2017) TEIXEIRA, Andrea Mariana Nunes da Costa; LUZIA, Liania Alves; SOUZA, Suelen Jorge de; PETRILLI, Aline de Almeida; PONTILHO, Patricia de Moraes; SOUZA, Jose Maria Pacheco de; SEGURADO, Aluisio Augusto Cotrim; EFRAIM, Priscila; PICONE, Camila de Melo; RONDO, Patricia Helen de CarvalhoAn increase in the frequency of cardiovascular diseases has been observed in the HIV/AIDS population. Studies involving healthy subjects or subjects with other diseases have shown benefits of chocolate supplementation on endothelial function and vasodilation. We evaluate the impact of chocolate consumption on arterial elasticity in people living with human immunodeficiency virus - PLHIV. A double-blind, crossover trial including 110 PLHIV (19 to 59 years) on antiretroviral therapy - ART for at least 6 months and with a viral load of < 500 copies per mL was conducted. All subjects were randomly assigned to 15-d dietary supplements containing dark chocolate or placebo with a 15-d washout period. Each participant received one of the two sequences: A (dark chocolate, placebo chocolate); B (placebo chocolate, dark chocolate). Arterial elasticity was measured using the HDI/PulseWave (TM) CR-2000 CardioVascular Profiling System (R). Body composition, lipid profile, C-reactive protein, and thiobarbituric acid reactive substances were also assessed. Analysis of variance (ANOVA) for repeated measures using the Stata 11.0 (R) program was used for cross-over analysis. Most subjects were men (59.0%) and Caucasian (46.1%) and the mean age was 44.6 +/- 7.1 years. The mean time since diagnosis of HIV infection was 13.7 +/- 5.3 years and the mean duration of ART was 12.9 +/- 4.2 years. Chocolate consumption resulted in significant alterations in the large artery elasticity index - LAEI (p = 0.049) and the mean concentration of HDL-c was higher after supplementation with dark chocolate (p = 0.045). This is the first study to evaluate the effect of chocolate on arterial elasticity in PLHIV. The results showed that dark chocolate consumption for 15 days improved the elastic properties of the LAEI in PLHIV. These findings, added to the noninvasive method used, may expand the knowledge of CVDs in this population.
- Measuring Adherence to Antiretroviral Treatment: The Role of Pharmacy Records of Drug Withdrawals(2012) GUTIERREZ, Eliana Battaggia; SARTORI, Ana Marli Christovam; SCHMIDT, Ana Lucia; PILOTO, Bruna Mamprim; FRANCA, Bruna Biagi; OLIVEIRA, Adriana Santos de; POUZA, Adriana Rodrigues; MORENO, Roberta Vilela; PICONE, Camila de Melo; RIBEIRO, Manoel Carlos Sampaio de AlmeidaThis study aimed to evaluate adherence to anti-retroviral treatment (ART) among HIV + adults, assess its association with HIV viral load (VL) and identify factors associated to adherence. A survey involving a random sample of adults followed at a HIV/AIDS reference center in Sao Paulo city, Brazil, from 2007 to 2009 was done. A questionnaire was applied and data were retrieved from the pharmacy and medical records. The study involved 292 subjects: 70.2% men; median age: 43 years; median duration of ART: 8 years. 89.3% self-reported taken all prescribed pills in the last 3 days but only 39.3% picked up >= 95% of the prescribed ART from the pharmacy in the last 12 months. At the multivariate analysis having symptoms prior to ART, taking fewer ART pills, and not missing medical appointments were independently associated to higher adherence. Adherence was strongly associated with undetectable HIV VL. Rates of undetectable HIV VL did not differ from 80 to >= 95% of adherence.
- Prevalence and Associated Factors of Cryptococcal Antigenemia in HIV-Infected Patients with CD4 < 200 Cells/mu L in Sao Paulo, Brazil: A Bayesian Analysis(2022) MIMICOS, Evanthia Vetos; FOSSALUZA, Victor; PICONE, Camila de Melo; SENA, Camila Caroline de; GOMES, Helio Rodrigues; LAZARI, Carolina dos Santos; SILVA, Fernanda Ferreira da; NAKANISHI, Erika Shimoda; NISIDA, Isabelle Vichr; FREITAS, Angela Carvalho; GRYSCHEK, Ronaldo Borges; LAGONEGRO, Eduardo Ronner; LAZERA, Marcia; SHIKANAI-YASUDA, Maria AparecidaCryptococcosis is a severe life-threatening disease and a major cause of mortality in people with advanced AIDS and CD4 <= 100 cells/ mu L. Considering the knowledge gap regarding the benefits of routine application of antigenemia tests in HIV-infected patients with 100-200 CD4 cells/mu L for the prevention of cryptococcal meningitis (CM), we aimed to evaluate the prevalence of positive antigenemia through lateral flow assay (LFA) and associated factors in HIV-infected patients with CD4 < 200 cells/ mu L. Our findings of 3.49% of positive LFA (LFA+) patients with CD4 < 100 cells/mu L and 2.24% with CD4 between 100-200 cells/mu L have been included in a Bayesian analysis with 12 other studies containing similar samples worldwide. This analysis showed a proportion of 3.6% LFA+ patients (95% credible interval-Ci [2.5-5.7%]) with CD4 < 100 cells/mu L and 1.1% (95%Ci [0.5-4.3%]) with CD4 between 100-200 cells/mu L, without statistical difference between these groups. The difference between mortality rates in LFA+ and negative LFA groups was e = 0.05013. Cryptococcoma and CM were observed in the LFA+ group with 100-200 and <100 CD4 cells/mu L, respectively. Considering the benefits of antifungal therapy for LFA+ patients, our data reinforced the recommendation to apply LFA as a routine test in patients with 100-200 CD4 cells/ mu L aiming to expand cost-effectiveness studies in this group.
- Hepatitis B viremia in HIV-coinfected individuals under antiretroviral therapy(2019) WEISSMANN, Leonardo; PICONE, Camila de Melo; GOUVEA, Michele Soares Gomes; FERREIRA, Paulo Roberto Abrao; VIANA, Monica Salum Valverde Borsoi; PINHO, Joao Renato Rebello; CASSENOTE, Alex Jones Flores; SEGURADO, Aluisio CotrimBackground: Antiretroviral therapy (ART) has decreased AIDS incidence and mortality, rendering comorbidities, such as hepatitis B more relevant for people living with human immunodeficiency virus (HIV). Since antiretroviral drugs may also inhibit hepatitis B virus (HBV) replication, analyzing the impact of ART on management of hepatitis B in this population is important. Objective: To assess HBV viremia among HIV/HBV coinfected individuals on ART and its associated factors. Method: For this cross-sectional study, HIV/HBV-coinfected individuals, aged over 18 years, who were on ART for over six months and receiving care at an outpatient clinic in Sao Paulo were recruited. Sociodemographic characteristics, information about viral exposure, clinical and laboratory data, including evaluation of liver fibrosis were obtained. Plasma HBV DNA was measured by polymerase chain reaction. Viral genome sequencing was conducted for genotyping and identification of drug resistance-conferring mutations if viral load exceeded 900 IU/mL. Results: Out of 2,946 patients who attended the clinic in 2015, 83 were eligible and 56 evaluated. Plasma HBV DNA was detected in 16 (28.6%) (95% CI: 18.0-41.3%), all on lamivudine and tenofovir treatment. HBV DNA detection was associated with lower education (p = 0.015), higher international normalized ratios (p = 0.045), history of an AIDS-defining illness [OR: 3.43 (95% CI: 1.10-11.50)], and HBeAg detection [OR: 6.60 (95% CI: 1.84-23.6)]. In contrast, a last CD4+ count above 500 cells/mm(3) in the year prior to inclusion [OR: 0.18 (95% CI: 0.04-0.71)] and detection of anti-HBe [OR: 0.21 (95% CI: 0.04-0.99)] were negatively associated. Patients with HBV DNA above 900 IU/mL were infected with subgenotypes A1 (n = 3) and D2 (n = 1), and exhibited viral mutations associated with total resistance to lamivudine and partial resistance to entecavir. Conclusions: Despite being on ART, a significant proportion of HIV/HBV-coinfected individuals present HBV viremia. Characterization of factors that are associated with this finding may help professionals provide better management to these patients. (C) 2019 Sociedade Brasileira de Infectologia.
- Multicomponent physical activity program to prevent body changes and metabolic disturbances associated with antiretroviral therapy and improve quality of life of people living with HIV: a pragmatic trial(2021) SANTOS, Elisabete Cristina Morandi Dos; FLORINDO, Alex Antonio; SANTOS, Ardiles Vitor; PICONE, Camila de Melo; DIAS, Tulio Gamio; SEGURADO, Aluisio CotrimOBJECTIVES: Comprehensive care for people living with human immunodeficiency virus (HIV) (PLH) includes the promotion of healthier habits, including physical activity (PA). This study aimed to describe a multicomponent pragmatic trial protocol to assess the effect of PA in preventing body changes and metabolic disturbances, improving the quality of life of PLH starting antiretroviral therapy (ART) and present cohort characteristics. METHODS: PLH undergoing ART for <= 4 months were recruited for a randomized trial. The intervention comprised three cardiorespiratory and/or strength training sessions per week at the clinic or in public spaces for 6 months under on-site or remote supervision, and educational sessions. Participants' PA levels, cardiorespiratory fitness, anthropometric measures, strength, flexibility, quality of life, and laboratory monitoring (blood glucose and lipids, CD4 counts) at baseline and post-intervention will be compared. The pragmatic design aims to enable the assessment of intervention effectiveness in real-life conditions. RESULTS: At baseline, our cohort of 38 recently diagnosed patients (mean time since HIV diagnosis and duration of ART were 3 and 2.58 months, respectively) were predominantly male, young, with high schooling and good immune status (median CD4 count=498 cells/mm(3)). Twenty-two (57.9%) patients reported a PA below the World Health Organization recommendations. We found baseline normal anthropometric measures and metabolic parameters: below-average trunk flexion and elbow extension strength, poor handgrip strength and flexibility, and high quality of life scores in all except the physical domain. CONCLUSIONS: Understanding how effective PA is in preventing body changes and metabolic disturbances, and in improving the quality of PLH starting ART may help establish guidelines to better incorporate PA in HIV care.
- The decline of measles antibody titers in previously vaccinated adults: a cross-sectional analysis(2024) CASTINEIRAS, Anna Carla Pinto; SALES, Amanda Caroline; PICONE, Camila de Melo; DIOGO, Constancia Lima; ROSSI, atila Duque; GALLIEZ, Rafael Mello; JR, Orlando da Costa Ferreira; CASTINEIRAS, Terezinha Marta Pereira Pinto; LOPES, Marta Heloisa; SARTORI, Ana Marli ChristovamThe global reemergence of measles in 2018-2019 reinforces the relevance of high coverage immunization to maintain the disease elimination. During an outbreak in the Sao Paulo State in 2019, several measles cases were reported in individuals who were adequately vaccinated according to the current immunization schedule recommends. This study aimed to assess measles IgG antibody seropositivity and titers in previously vaccinated adults. A cross-sectional study was conducted at CRIE-HC-FMUSP (Sao Paulo, Brazil) in 2019. It included healthy adults who had received two or more Measles-Mumps-Rubella vaccines (MMR) and excluded individuals with immunocompromising conditions. Measles IgG antibodies were measured and compared by ELISA (Euroimmun (R)) and chemiluminescence (LIASON (R)). The association of seropositivity and titers with variables of interest (age, sex, profession, previous measles, number of measles-containing vaccine doses, interval between MMR doses, and time elapsed since the last MMR dose) was analyzed. A total of 162 participants were evaluated, predominantly young (median age 30 years), women (69.8%) and healthcare professionals (61.7%). The median interval between MMR doses was 13.2 years, and the median time since the last dose was 10.4 years. The seropositivity rate was 32.7% by ELISA and 75.3% by CLIA, and a strong positive correlation was found between the tests. Multivariate analyses revealed that age and time since the last dose were independently associated with positivity. Despite being a single-center evaluation, our results suggest that measles seropositivity may be lower than expected in adequately immunized adults. Seropositivity was higher among older individuals and those with a shorter time since the last MMR vaccine dose.