CHRISTINA TERRA GALLAFRIO NOVAES

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3
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Instituto Central, Hospital das Clínicas, Faculdade de Medicina

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  • article 0 Citação(ões) na Scopus
    Quantitative PCR as a marker for preemptive therapy and its role in therapeutic control in Trypanosoma cruzi/HIV coinfection
    (2024) FREITAS, Vera Lucia Teixeira de; NOVAES, Christina Terra Gallafrio; SARTORI, Ana Marli Christovam; CARVALHO, Noemia Barbosa; SILVA, Sheila Cristina Vicente da; NAKANISHI, erika Shimoda; SALVADOR, Fernando; CASTRO, Cleudson Nery de; BEZERRA, Rita Cristina; WESTPHALEN, Elizabeth Visone Nunes; OLIVEIRA, Caroline Medeji Ramos de; BUSSER, Felipe Delatorre; HO, Yeh-Li; BUCCHERI, Renata; BONILLA, Carolina; SHIKANAI-YASUDA, Maria Aparecida
    Background Trypanosoma cruzi and HIV coinfection can evolve with depression of cellular immunity and increased parasitemia. We applied quantitative PCR (qPCR) as a marker for preemptive antiparasitic treatment to avoid fatal Chagas disease reactivation and analyzed the outcome of treated cases. Methodology This mixed cross-sectional and longitudinal study included 171 Chagas disease patients, 60 coinfected with HIV. Of these 60 patients, ten showed Chagas disease reactivation, confirmed by parasites identified in the blood, cerebrospinal fluid, or tissues, 12 exhibited high parasitemia without reactivation, and 38 had low parasitemia and no reactivation. Results We showed, for the first time, the success of the timely introduction of benznidazole in the non-reactivated group with high levels of parasitemia detected by qPCR and the absence of parasites in reactivated cases with at least 58 days of benznidazole. All HIV+ patients with or without reactivation had a 4.0-5.1 higher chance of having parasitemia than HIV seronegative cases. A positive correlation was found between parasites and viral loads. Remarkably, treated T. cruzi/HIV-coinfected patients had 77.3% conversion from positive to negative parasitemia compared to 19.1% of untreated patients. Additionally, untreated patients showed similar to 13.6 times higher Odds Ratio of having positive parasitemia in the follow-up period compared with treated patients. Treated and untreated patients showed no differences regarding the evolution of Chagas disease. The main factors associated with all-cause mortality were higher parasitemia, lower CD4 counts/mu L, higher viral load, and absence of antiretroviral therapy. Conclusion We recommend qPCR prospective monitoring of T. cruzi parasitemia in HIV+ coinfected patients and point out the value of pre-emptive therapy for those with high parasitemia. In parallel, early antiretroviral therapy introduction is advisable, aiming at viral load control, immune response restoration, and increasing survival. We also suggest an early antiparasitic treatment for all coinfected patients, followed by effectiveness analysis alongside antiretroviral therapy.
  • article 1 Citação(ões) na Scopus
    Clinical profile and mortality in patients with T. cruzi/HIV co-infection from the multicenter data base of the ""Network for healthcare and study of Trypanosoma cruzi/HIV co-infection and other immunosuppression conditions"" (vol 15, e0009809, 2021)
    (2023) SHIKANAI-YASUDA, Maria Aparecida; MEDIANO, Mauro Felippe Felix; NOVAES, Christina Terra Gallafrio; SOUSA, Andrea Silvestre de; SARTORI, Ana Marli Christovam; SANTANA, Rodrigo Carvalho; CORREIA, Dalmo; CASTRO, Cleudson Nery de; SEVERO, Marilia Maria dos Santos; HASSLOCHER-MORENO, Alejandro Marcel; FERNANDEZ, Marisa Liliana; SALVADOR, Fernando; PINAZO, Maria Jesus; BOLELLA, Valdes Roberto; FURTADO, Pedro Carvalho; CORTI, Marcelo; PINTO, Ana Yece Neves; FICA, Alberto; MOLINA, Israel; GASCON, Joaquim; VINAS, Pedro Albajar; CORTEZ-ESCALANTE, Juan; RAMOS JR., Alberto Novaes; ALMEIDA, Eros Antonio de
  • article 0 Citação(ões) na Scopus
    Guidelines for Trypanosoma cruzi-HIV Co-infection and other Immunosuppressive Conditions: Diagnosis, Treatment, Monitoring, and Implementation from the International Network of Care and Studies-2023
    (2023) ALMEIDA, Eros Antonio de; MENDES, Fernanda de Souza Nogueira Sardinha; RAMOS, Alberto Novaes; SOUSA, Andrea Silvestre de; PAVAN, Tycha Bianca Sabaini; MEDIANO, Mauro Felippe Felix; OSTERMAYER, Alejandro Luquetti; HASSLOCHER-MORENO, Alejandro Marcel; BRITTO, Constanca Felicia De Paoli de Carvalho; NOVAES, Christina Gallafrio; CORREIA, Dalmo; SANTOS, Fred Luciano Neves; SILVA, Gilberto Marcelo Sperandio da; FERNANDEZ, Marisa Liliana; LIMA, Mayara Maia; CARVALHO, Noemia Barbosa de; MOREIRA, Otacilio da Cruz; ALBAJAR-VINAS, Pedro; LEITE, Ruth Moreira; PALMEIRA, Swamy Lima; COSTA, Veruska Maia da; YASUDA, Maria Aparecida Shikanai