SORAIA MAFRA MACHADO
Projetos de Pesquisa
Unidades Organizacionais
LIM/52 - Laboratório de Virologia, Hospital das Clínicas, Faculdade de Medicina
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conferenceObject HEPATITIS C TREATMENT AMONG HCV-HIV CO-INFECTED PATIENTS IN BRAZIL: A MULTICENTER STUDY ON BASELINE RESISTANCE ANALYSES AND SUSTAINED VIROLOGIC RESPONSE RATE(2019) CORREA, Maria Cassia Mendes; MACHADO, Soraia Mafra; LEITE, Andrea Gurgel Batista; VIGANI, Aline; DIAZ, Ana Claudia Marques Barbosa; FERREIRA, Paulo; CARNAUBA JUNIOR, Dimas; TENORE, Simone; SR., Carlos Eduardo Brandao-Mello; GONZALEZ, Mario; SIROMA, Fabiana; PRADO, Kleber D.; GONGORA, Delzi Vigna Nunes; NETO, Gaspar Lisboa; PINHO, Joao Renato R.; MALTA, Fernanda- Hepatitis C among blood donors: cascade of care and predictors of loss to follow-up(2017) MACHADO, Soraia Mafra; ALMEIDA-NETO, Cesar de; PINHO, Joao Renato Rebello; MALTA, Fernanda de Mello; CAPUANI, Ligia; CAMPOS, Aleia Faustina; ABREU, Fatima Regina Marques; NASTRI, Ana Catharina de Seixas Santos; SANTANA, Rbia Anita Ferraz; SABINO, Ester Cerdeira; MENDES-CORREA, Maria CassiaOBJECTIVE: To investigate the HCV cascade of care and to identify the factors associated with loss or absence to follow-up of patients identified as infected with hepatitis C through blood donation. METHODS: Blood donors from 1994 to 2012, identified with positive anti-HCV by enzyme immunoassay and immunoblot tests were invited to participate in the study, through letters or phone calls. Patients who agreed to participate were interviewed and their blood samples were collected for further testing. The following variables were investigated: demographic data, data on comorbidities and history concerning monitoring of hepatitis C. Multiple regression analysis by Poisson regression model was used to investigate the factors associated with non-referral for consultation or loss of follow-up. RESULTS: Of the 2,952 HCV-infected blood donors, 22.8% agreed to participate: 394 (58.2%) male, median age 48 years old and 364 (53.8%) Caucasian. Of the 676 participants, 39.7% did not receive proper follow-up or treatment after diagnosis: 45 patients referred not to be aware they were infected, 61 did not seek medical attention and 163 started a follow-up program, but were non-adherent. The main reasons for inadequate follow-up were not understanding the need for medical care (71%) and health care access difficulties (14%). The variables showing a significant association with inadequate follow-up after multiple regression analysis were male gender (PR = 1.40; 95% CI 1.15-1.71), age under or equal to 50 years (PR = 1.36; 95% CI 1.12-1.65) and non-Caucasians (PR = 1.53; 95% CI 1.27-1.84). CONCLUSIONS: About 40.0% of patients did not receive appropriate follow-up. These data reinforce the need to establish strong links between primary care and reference centers and the need to improve access to specialists and treatments.
- Effectiveness of direct-acting antivirals for hepatitis C virus infection in hepatitis C/HIV coinfected individuals A multicenter study(2020) MACHADO, Soraia M.; VIGANI, Aline G.; LEITE, Andrea G.; DIAZ, Ana Claudia M.; FERREIRA, Paulo Roberto A.; CARNAUBA-JUNIOR, Dimas; TENORE, Simone B.; BRANDAO-MELLO, Carlos Eduardo; GONZALEZ, Mario P.; SIROMA, Fabiana; PRADO, Kleber D.; V, Delzi Nunes; LISBOA-NETO, Gaspar; PINHO, Joao Renato R.; MALTA, Fernanda M.; AZEVEDO, Raymundo S.; WITKIN, Steven S.; MENDES-CORREA, Maria CassiaIn a hepatitis C virus (HCV)/HIV-positive Brazilian cohort, evaluate the safety and efficacy of HCV DAAs, the frequency of resistance substitutions in the HCV NS5A and NS5B genes and identify predictors of treatment failure. Retrospective multicenter study of HCV/HIV patients treated with sofosbuvir (SOF)-based regimens at 10 reference centers in Brazil. Clinical and virological data were collected. Genetic diversity in the NS5A and NS5B genes was assessed by direct nucleotide sequencing. The primary outcome was sustained virological response (SVR) 12 weeks after DAA completion. Of 643 HCV/HIV patients analyzed, 74.7% were male, median CD4+ T cell count was 617 cells/mm(3), 90% had an undetectable HIV viral load. HCV genotype 1 was detected in 80.2%, and 60% were taking at least 1 medication other than antiretroviral drugs during their DAA therapy. Cirrhosis was present in 42%. An SOF/daclatasvir (DCV) regimen was used in most patients (98%). The frequency of NS5A polymorphisms associated with clinically relevant resistance to DCV was 2%; no relevant NS5B variants were identified. The SVR12 rate was 92.8% in an intention to treat (ITT) analysis and 96% in a modified ITT (m-ITT) analysis. AE occurred in 1.6% of patients. By multivariate analysis, therapeutic failure was associated, in the m-ITT analysis, with concomitant use of anticonvulsant drugs (P = .001), age (P = .04), and female gender (P = .04). SOF/DCV regimens were associated with a high SVR rate in an HCV/HIV population. The use of concurrent anticonvulsant drugs and DAAs decreases the chances of achieving an SVR.