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- Characterization of HIV risks in a Brazilian sickle cell disease population(2020) BLATYTA, P. F.; KELLY, S.; GONCALEZ, T. T.; CARNEIRO-PROIETTI, A. B.; SALOMON, T.; MIRANDA, C.; SABINO, E.; PREISS, L.; MAXIMO, C.; LOUREIRO, P.; CUSTER, B.; ALMEIDA-NETO, C. deBackground A low prevalence of HIV in sickle cell disease (SCD) patients has been reported in the literature though mechanisms for this are not understood. Methods HIV risk behaviors were compared between SCD cases and non-SCD controls using a self-administered audio computer-assisted self-interview. SCD cases were recruited from a multi-center SCD cohort established in Brazil; controls were recruited from SCD social contacts. Categorical variables were analyzed using Chi-Square or Fisher exact test. Continuous variables were compared using the Mann-Whitney U test. Results There were 152 SCD cases and 154 age/location matched controls enrolled at three participating Brazilian centers during 2016-17. No significant differences in number of sexual partners (lifetime or previous 12 months), male-to-male sex partners or intravenous drug use were observed. Cases received more transfusions, surgeries, and acupuncture treatment. Conclusions Besides the risk of transfusion-transmitted HIV, which is now exceedingly rare, SCD and non-SCD participants demonstrated similar HIV risk behaviors. Causes other than risk behaviors such as factors inherent to SCD pathophysiology may explain the reported low prevalence of HIV in SCD.
- Prevalence of serologic markers of transfusion and sexually transmitted infections and their correlation with clinical features in a large cohort of Brazilian patients with sickle cell disease(2020) BLATYTA, Paula F.; KELLY, Shannon; SABINO, Ester; PREISS, Liliana; MENDES, Franciane; CARNEIRO-PROIETTI, Anna B.; RODRIGUES, Daniela de Oliveira Werneck; MOTA, Rosimere; LOUREIRO, Paula; MAXIMO, Claudia; PARK, Miriam; MENDRONE-JR, Alfredo; GONCALEZ, Thelma T.; ALMEIDA NETO, Cesar de; CUSTER, BrianBACKGROUND: Patients with sickle cell disease (SCD) often require red blood cell (RBC) transfusion for clinical complications, so may be exposed to transfusion-transmitted infections (TTIs). The prevalence of markers for human immunodeficiency virus (HIV), hepatitis C virus (HCV) and B (HBV), human T-cell lymphotropic virus (HTLV-1/2), Chagas disease, and syphilis in an SCD cohort in Brazil were studied. STUDY DESIGN AND METHODS: Clinical history, interview data, blood samples, and medical chart review data were collected during cohort enrollment from November 2013 to May 2015. Serologic markers of infection were assessed. Standard measures of statistical association were calculated, and multivariable models were developed for the most prevalent infections to identify associated factors. RESULTS: Infectionmarkers were evident in 5.2% (144/2779) of the enrolled cohort. Anti-HCV was detected in 69 (2.5%), syphilis antibodies in 34 (1.2%), anti-HTLV-1/2 in 17 (0.6%), HBV surface antigen in 13 (0.5%), Chagas disease antibodies in 13 (0.5%), and anti-HIV in 8 (0.3%) of participants. Factors associated with increased odds of being anti-HCV reactive were older age, illegal drug use, increasing number of RBCs, more than three pain crises in the previous year, and geographic location. Syphilis was associated with older age, females, and smoking history. CONCLUSION: HCV infection was more common in older patients who may have received RBCs before testing was performed on donations, suggesting possible historic transfusion transmission. The cohort showed decreasing rates of infections and a reduction in transfusion transmission markers in younger patients compared to historical literature except for syphilis, indicating contemporary reduced risk of TTI.
- Are different motivations and social capital score associated with return behaviour among Brazilian voluntary non-remunerated blood donors?(2020) ESTRADA, Fernanda G. M. D.; OLIVEIRA, Claudia D. L.; SABINO, Ester C.; CUSTER, Brian; GONCALEZ, Thelma T.; MURPHY, Edward L.; TELES, Dahra; MENDRONE-JUNIOR, Alfredo; WITKIN, Steve S.; ALMEIDA-NETO, Cesar deBackground We examined the association between social capital score, motivator factors and demographic and donation characteristics and donor return at three Brazilian blood centres in Recife, Sao Paulo and Belo Horizonte. Material and methods A total of 5974 donors were interviewed about motivation factors to donate and cognitive and structural social capital just before an effective donation in three Brazilians blood centres in 2009. We assessed the return to a new donation within 2 years for each of these donors. Demographic and donation characteristics, motivators and scores of social capital and their association with donors' return were assessed. Results Overall, 3123 (52.3%) of the study subjects returned for a blood donation at least once. Predictors of donors' return were male gender (adjusted odds ratio [AOR] = 1.6, 1.3-1.9, for replacement and AOR = 1.3, 1.2-1.6, for community donors), previous donation (AOR = 2.7, 2.3-3.3, for replacement and AOR = 2.9, 2.5-3.5, for community donors) and high altruism (AOR = 1.3, 1.1-1.7, for replacement and AOR = 1.2, 1.0-1.5, for community donors). Altruism was the only motivator associated with return behaviour. Donors from Recife and Sao Paulo were more likely to return for replacement and/or for community donations than donors from Belo Horizonte. There was no association between social capital score and donor return behaviour. Conclusion The likelihood to return for a subsequent blood donation is dependent upon characteristics of individual donors and also varies in different regions of Brazil. However, social capital was not associated with the likelihood of return behaviour. A better understanding of altruistic categories and appeals may help to improve donor recruitment and retention.
- Declining antibody levels to Trypanosoma cruzi correlate with polymerase chain reaction positivity and electrocardiographic changes in a retrospective cohort of untreated Brazilian blood donors(2020) BUSS, Lewis F.; SILVA, Lea Campos de Oliveira-da; MOREIRA, Carlos H. V.; MANULI, Erika R.; SALES, Flavia C.; MORALES, Ingra; GERMANIO, Clara Di; ALMEIDA-NETO, Cesar de; BAKKOUR, Sonia; CONSTABLE, Paul; PINTO-FILHO, Marcelo M.; RIBEIRO, Antonio L.; BUSCH, Michael; SABINO, Ester C.Author summary Infection with the single-celled parasite Trypanosoma cruzi (Chagas disease) is thought to be lifelong. However, only a third of infected people develop Chagas cardiomyopathy-the main disease manifestation. This may reflect the different extent to which individuals control the parasite, with some potentially clearing it entirely. In chronically infected immunocompetent patients, a marker of parasite burden is the quantity of antibody against T. cruzi in the blood: more parasite, more immune stimulation, more antibody. In this study we show how antibody levels change over many years in a cohort of untreated patients with Chagas disease. We find that among individuals with falling or low/borderline antibody levels there was a lower rate of parasite detection in the blood and a lower rate of cardiomyopathy. 60% of subjects with falling antibody levels had no evidence of active disease, twice as many as among patients with other antibody trajectories (stable or rising). Our findings support an account of the natural history of Chagas disease in which a proportion of those infected achieve a greater control of the parasite, with some individuals potentially clearing it completely. Background Although infection with Trypanosoma cruzi is thought to be lifelong, less than half of those infected develop cardiomyopathy, suggesting greater parasite control or even clearance. Antibody levels appear to correlate with T. cruzi (antigen) load. We test the association between a downwards antibody trajectory, PCR positivity and ECG alterations in untreated individuals with Chagas disease. Methodology/Principal findings This is a retrospective cohort of T. cruzi seropositive blood donors. Paired blood samples (index donation and follow-up) were tested using the VITROS Immunodiagnostic Products Anti-T.cruzi (Chagas) assay (Ortho Clinical Diagnostics, Raritan NJ) and PCR performed on the follow-up sample. A 12-lead resting ECG was performed. Significant antibody decline was defined as a reduction of > 1 signal-to-cutoff (S/CO) unit on the VITROS assay. Follow-up S/CO of < 4 was defined as borderline/low. 276 untreated seropositive blood donors were included. The median (IQR) follow-up was 12.7 years (8.5-16.9). 56 (22.1%) subjects had a significant antibody decline and 35 (12.7%) had a low/borderline follow-up result. PCR positivity was lower in the falling (26.8% vs 52.8%, p = 0.001) and low/borderline (17.1% vs 51.9%, p < 0.001) antibody groups, as was the rate of ECG abnormalities. Falling and low/borderline antibody groups were predominantly composed of individuals with negative PCR and normal ECG findings: 64% and 71%, respectively. Conclusions/Significance Low and falling antibody levels define a phenotype of possible spontaneous parasite clearance.
- Validation of a formula predictive of peripheral blood stem cell yield and successful collection in healthy allogeneic donors(2020) ALMEIDA-NETO, Cesar de; ROCHA, Vanderson; MOREIRA, Frederico Rafael; HAMASAKI, Debora Toshie; FARIAS, Madson Correia de; ARRIFANO, Ana Maria; WITKIN, Steven S.; MENDRONE-JUNIOR, AlfredoBackground: An efficient mobilization and collection of peripheral blood stem cells (PBSCs) are crucial to optimize engraftment in the recipient. We aim to validate a formula that predicted CD34(+) cell yield and to describe variables that correlated with high yield mobilization and collection in healthy donors. Methods: We retrospectively analyzed clinical and laboratory data from healthy donors who underwent PBSC collection from 2006 to 2015. The predicted number of collected cells was calculated using the following formula: Total number of CD34(+) (cells x 10(6)/kg) yield = [(peripheral CD34(+) cells/mu L) x (0.43)/recipient body weight (kg)] x total liters processed. Results: We evaluated 338 collections from 307 allogeneic PBSC donors. The predicted versus the observed number of CD34(+) cells/kg collected yielded an r-value of 0.775 (0.726-0.816; p <0.0001). Overall, 55.7% donors had an acceptable mobilization level. Donors with a body weight <67 kg were less likely to yield a satisfactory CD34(+) cell count (OR= 0.44; 95% CI 0.24-0.81), while a white blood cell (WBC) count >= 40 x 10(9)/L (OR = 3.69; 2.11-6.46) and platelet count >= 200 x 10(9)/L (OR= 2.09; 1.26-3.47) on the day of collection predicted a good level of mobilization. Predictors of a CD34+ cell yield/kg of >4 x 106 with only one apheresis session were: circulating CD34(+) cells/mu L >40 (OR= 16; 6.94-36.93), hemoglobin mu 14 g/dL (OR= 3.40; 1.53-7.57), WBC >40 x 10(9)/L (OR= 4.61; 2.10-10.10) on the first collection day, and a positive delta weight between donor and recipient (OR= 3.10; 1.36-7.06). Conclusion: The formula for predicting CD34(+) cell yield is accurate and suggests the optimal length of time for successful leukapheresis. Validation of the predictors of successful mobilization will help to further refine PBSC leukapheresis procedures. (C) 2019 Associacao Brasileira de Hematologia, Hemoterapia e Terapia Celular.
- Association of HIV infection with clinical and laboratory characteristics of sickle cell disease(2020) BELISARIO, Andre Rolim; BLATYTA, Paula F.; VIVANCO, Diana; OLIVEIRA, Claudia Di Lorenzo; CARNEIRO-PROIETTI, Anna Barbara; SABINO, Ester Cerdeira; ALMEIDA-NETO, Cesar de; LOUREIRO, Paula; MAXIMO, Claudia; MATEOS, Sheila de Oliveira Garcia; V, Miriam Flor-Park; RODRIGUES, Daniela de Oliveira Werneck; MOTA, Rosimere Afonso; GONCALEZ, Thelma T.; HOFFMANN, Thomas J.; KELLY, Shannon; CUSTER, BrianBackground Sickle cell disease (SCD) is a multisystem disorder characterized by a wide spectrum of clinical manifestations and severity. Studies investigating potential effects of co-morbid human immunodeficiency virus (HIV) and SCD have produced conflicting results, and additional investigations are needed to elucidate whether the interaction between the two disease states might impact both HIV and SCD clinical outcomes. The association of HIV infection with clinical and laboratory characteristics of patients with SCD was assessed. Methods This nested case-control study included individuals with SCD with HIV treated at six Brazilian SCD centers. Clinical and laboratory data were abstracted from medical records. HIV positive participants were compared to age, gender, center, and SCD genotype matched HIV negative participants (ratio 1:4). Individual clinical outcomes as well as a composite outcome of any SCD complication and a composite outcome of any HIV-related complication were compared between the two groups. Results Fifteen HIV positive participants were included, 12 (80%) alive and 3 (20%) deceased. Most of the HIV positive patients had HbSS (60%;n = 9), 53% (n = 8) were female, and mean age was 30 +/- 13 years. The frequency of individual SCD complications of acute chest syndrome/pneumonia, sepsis/bacteremia, pyelonephritis, ischemic stroke, hemorrhagic stroke, abnormal transcranial Doppler (TCD), and pulmonary hypertension was higher in HIV positive participants when compared to HIV negative, although analyzed individually none were statistically significant. HIV positive participants had significantly higher risk of any SCD complication and of a composite HIV-related complication compared to the HIV negative group (HR = 4.6; 95%CI 1.1-19.6;P = 0.04 and HR = 7.7; 95%CI 1.5-40.2;P = 0.02, respectively). There was a non-significant trend towards higher risk of any infections in participants with HIV positive (HR = 3.5; 95%CI 0.92-13.4;P = 0.07). Laboratory parameters levels were not significantly different in individuals with and without HIV. Conclusions In summary, our study in SCD patients shows that those with HIV have an increased risk of any SCD complication and HIV-related complications, as well as a suggestive but not significantly increased risk of infections.