CHRISTINA TERRA GALLAFRIO NOVAES
Índice h a partir de 2011
3
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
5 resultados
Resultados de Busca
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- 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 AparecidaBackground 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.
- 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
- 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""(2021) 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; JR, Alberto Novaes Ramos; ALMEIDA, Eros Antonio deObjective Chagas disease (CD) globalization facilitated the co-infection with Human Immunodeficiency Virus (HIV) in endemic and non-endemic areas. Considering the underestimation of Trypanosoma cruzi (T. cruzi)-HIV co-infection and the risk of life-threatening Chagas Disease Reactivation (CDR), this study aimed to analyze the major co-infection clinical characteristics and its mortality rates. Methods This is a cross-sectional retrospective multicenter study of patients with CD confirmed by two serological or one parasitological tests, and HIV infection confirmed by immunoblot. CDR was diagnosed by direct microscopy with detection of trypomastigote forms in the blood or other biological fluids and/or amastigote forms in inflammatory lesions. Results Out of 241 patients with co-infection, 86.7% were from Brazil, 47.5% had <200 CD4(+) T cells/mu L and median viral load was 17,000 copies/mu L. Sixty CDR cases were observed. Death was more frequent in patients with reactivation and was mainly caused by CDR. Other causes of death unrelated to CDR were the manifestation of opportunistic infections in those with Acquired Immunodeficiency Syndrome. The time between the co-infection diagnosis to death was shorter in patients with CDR. Lower CD4(+) cells count at co-infection diagnosis was independently associated with reactivation. Similarly, lower CD4(+) cells numbers at co-infection diagnosis and male sex were associated with higher lethality in CDR. Additionally, CD4(+) cells were lower in meningoencephalitis than in myocarditis and milder forms. Conclusion This study showed major features on T. cruzi-HIV co-infection and highlighted the prognostic role of CD4(+) cells for reactivation and mortality. Since lethality was high in meningoencephalitis and all untreated patients died shortly after the diagnosis, early diagnosis, immediate antiparasitic treatment, patient follow-up and epidemiological surveillance are essentials in T. cruzi/HIV co-infection and CDR managements.
- Sporadic Creutzfeldt-Jakob disease in two clinically and virologically controlled Brazilian HIV patients who progressed rapidly to dementia: case reports and literature review(2021) DAHY, Flavia Esper; NOVAES, Christina T. G.; BANDEIRA, Gabriela A.; RAMIN, Lais F.; OLIVEIRA, Augusto Cesar Penalva de; SMID, JerusaHuman immunodeficiency virus (HIV)-associated neurocognitive disorders are the main cause of cognitive decline and dementia in people living with HIV (PLHIV). However, extensive workup should be done in patients with rapidly progressive dementia (RPD) and HIV, especially when secondary infection in the central nervous system (CNS) is ruled out. Sporadic Creutzfeldt-Jakob disease (sCJD) is the main cause of RPD in non-HIV patients. It is a fatal neurodegenerative condition caused by prions that mainly affects elderly patients. Our objective is to describe two cases of PLHIV presenting with controlled infections and sCJD, and to review the literature. Our patients were younger than expected for sCJD and one of them had a longer disease course. As aging is expected to occur earlier in PLHIV, sCJD must be excluded in younger PLHIV presenting with RPD and without CNS infection.
- Relapse of Intravenous Drug Use Triggered by Enfuvirtide, a Parenteral Antiretroviral Medication(2012) AVELINO-SILVA, Vivian Iida; HO, Yeh Li; NOVAES, Christina Terra GallafrioFuzeon (R) (enfuvirtide; Hoffmann-LaRoche, Nutley, NJ) is a parenteral medication prescribed to antiretroviral-experienced HIV patients. Clinicians are frequently concerned when prescribing enfuvirtide to former drug addicts because of the risk of triggering relapse, however, no previous report has described this adverse event. We describe two HIV-infected patients, previously abstinent from injection drug use, who experienced relapse or near-relapse situations after starting treatment with enfuvirtide. Along with the concerns related to adherence and to injection site reactions, clinicians who prescribe enfuvirtide should consider and discuss the risk of triggering relapse among former or recovering drug addicts.