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  • article 26 Citação(ões) na Scopus
    HCV Genotypes, Characterization of Mutations Conferring Drug Resistance to Protease Inhibitors, and Risk Factors among Blood Donors in Sao Paulo, Brazil
    (2014) NISHIYA, Anna S.; ALMEIDA-NETO, Cesar de; FERREIRA, Suzete C.; ALENCAR, Cecilia S.; DI-LORENZO-OLIVEIRA, Claudia; LEVI, Jose E.; SALLES, Nanci A.; MENDRONE JR., Alfredo; SABINO, Ester C.
    Background: Hepatitis C virus (HCV) infection is a global health problem estimated to affect almost 200 million people worldwide. The aim of this study is to analyze the subtypes and existence of variants resistant to protease inhibitors and their association with potential HCV risk factors among blood donors in Brazil. Methods: Repeat anti-HCV reactive blood donors are systematically asked to return for retest, notification, and counseling in which they are interviewed for risk factors for transfusion-transmitted diseases. We analyzed 202 donors who returned for counseling from 2007 to 2010 and presented enzyme immunoassay-and immunoblot-reactive results. The HCV genotypes and resistance mutation analyses were determined by the direct sequencing of the NS5b and NS3 regions, respectively. The HCV viral load was determined using an in-house real-time PCR assay targeting the 5'-NCR. Results: HCV subtypes 1b, 1a, and 3a were found in 45.5%, 32.0%, and 18.0% of the donors, respectively. The mean viral load of genotype 1 was significantly higher than that of the genotype 3 isolates. Subtype 1a was more frequent among young donors and 3a was more frequent among older donors. Protease inhibitor-resistant variants were detected in 12.8% of the sequenced samples belonging to genotype 1, and a higher frequency was observed among subtype 1a (20%) in comparison to 1b (8%). There was no difference in the prevalence of HCV risk factors among the genotypes or drug-resistant variants. Conclusions: We found a predominance of subtype 1b, with an increase in the frequency of subtype 1a, in young subjects. Mutations conferring resistance to NS3 inhibitors were frequent in treatment-naive blood donors, particularly those infected with subtype 1a. These variants were detected in the major viral population of HCV quasispecies, have replicative capacities comparable to nonresistant strains, and could be important for predicting the response to antiviral triple therapy.
  • article 15 Citação(ões) na Scopus
    Number of recent sexual partners among blood donors in Brazil: associations with donor demographics, donation characteristics, and infectious disease markers
    (2012) PATAVINO, Giuseppina Maria; ALMEIDA-NETO, Cesar de; LIU, Jing; WRIGHT, David J.; MENDRONE-JUNIOR, Alfredo; FERREIRA, Maria Ines Lopes; CARNEIRO, Anna Barbara de Freitas; CUSTER, Brian; FERREIRA, Joao Eduardo; BUSCH, Michael P.; SABINO, Ester Cerdeira
    BACKGROUND: Brazilian blood centers ask candidate blood donors about the number of sexual partners in the past 12 months. Candidates who report a number over the limit are deferred. We studied the implications of this practice on blood safety. STUDY DESIGN AND METHODS: We analyzed demographic characteristics, number of heterosexual partners, and disease marker rates among 689,868 donations from three Brazilian centers between July 2007 and December 2009. Donors were grouped based on maximum number of partners allowed in the past 12 months for each center. Chi-square and logistic regression analysis were conducted to examine associations between demographic characteristics, number of sex partners, and individual and overall positive markers rates for human immunodeficiency virus (HIV), human T-lymphotropic virus Types 1 and 2, hepatitis B virus, hepatitis C virus, and syphilis. RESULTS: First-time, younger, and more educated donors were associated with a higher number of recent sexual partners, as was male sex in Sao Paulo and Recife (p < 0.001). Serologic markers for HIV and syphilis and overall were associated with multiple partners in Sao Paulo and Recife (p < 0.001), but not in Belo Horizonte (p = 0.05, p = 0.94, and p = 0.75, respectively). In logistic regression analysis, number of recent sexual partners was associated with positive serologic markers (adjusted odds ratio [AOR], 1.2-1.5), especially HIV (AOR, 1.9-4.4). CONCLUSIONS: Number of recent heterosexual partners was associated with HIV positivity and overall rates of serologic markers of sexually transmitted infections. The association was not consistent across centers, making it difficult to define the best cutoff value. These findings suggest the use of recent heterosexual contacts as a potentially important deferral criterion to improve blood safety in Brazil.
  • article 6 Citação(ões) na Scopus
    10-year analysis of human immunodeficiency virus incidence in first-time and repeat donors in Brazil
    (2021) MATEOS, Sheila de Oliveira Garcia; PREISS, Liliana; GONCALEZ, Thelma T.; OLIVEIRA, Claudia Di Lorenzo; GREBE, Eduard; GERMANIO, Clara Di; STONE, Mars; AMORIM FILHO, Luiz; PROIETTI, Anna Barbara Carneiro; BELISARIO, Andre Rolim; ALMEIDA-NETO, Cesar de; MENDRONE-JUNIOR, Alfredo; LOUREIRO, Paula; BUSCH, Michael P.; CUSTER, Brian; SABINO, Ester Cerdeira
    Background and objectives Incidence in first-time and repeat blood donors is an important measure of transfusion-transmitted HIV infection (TT-HIV) risk. This study assessed HIV incidence over time at four large blood centres in Brazil. Materials and methods Donations were screened and confirmed using serological assays for HIV from 2007 to 2016, and additionally screened by nucleic acid testing from 2011 forward. Limiting antigen (LAg) avidity testing was conducted on HIV seroreactive samples from first-time donors to classify whether an infection was recently acquired. We calculated incidence in first-time donors using the mean duration of recent infection and in repeat donors using classical methods. Time and demographic trends were assessed using Poisson regression. Results Over the 10-year period, HIV incidence in first-time donors was highest in Recife (45 center dot 1/100 000 person-years (10(5)py)) followed by Sao Paulo (32 center dot 2/10(5)py) and then Belo Horizonte (23 center dot 3/10(5)py), and in repeat donors was highest in Recife (33 center dot 2/10(5)py), Belo Horizonte (27 center dot 5/10(5)py) and Sao Paulo (17 center dot 0/10(5)py). Results from Rio de Janeiro were available from 2013 to 2016 with incidence in first-time donors of 35 center dot 9/10(5)py and repeat donors from 2011 to 2016 of 29 center dot 2/10(5)py. Incidence varied by other donor demographics. When incidence was considered in 2-year intervals, no significant trend was evident. Overall residual risk of TT-HIV was 5 center dot 46 and 7 center dot 41 per million units of pRBC and FFP transfused, respectively. Conclusion HIV incidence in both first-time and repeat donors varied by region in Brazil. Clear secular trends were not evident.
  • article 4 Citação(ões) na Scopus
    Prevalence and Risk Factors for Human T-Cell Lymphotropic Virus (HTLV) in Blood Donors in Brazil-A 10-Year Study (2007-2016)
    (2022) MIRANDA, Carolina; UTSCH-GONCALVES, Denise; PIASSI, Fabiana Chagas Camargos; LOUREIRO, Paula; GOMES, Isabel; RIBEIRO, Maisa Aparecida; ALMEIDA-NETO, Cesar de; BLATYTA, Paula; AMORIM, Luiz; MATEOS, Sheila Oliveira Garcia; MURPHY, Edward L.; CUSTER, Brian; CARNEIRO-PROIETTI, Anna Barbara F.; SABINO, Ester C.
    It is unknown whether HTLV-1/2 prevalence has been stable or changing with time in Brazil. We present a 10-year (2007-2016) analysis of HTLV-1/2 infection in first-time blood donors from four blood banks in Brazil. The Brazilian blood centers participating in this multicenter Recipient Epidemiology and Donor Evaluation Study (REDS) are located in Recife in the Northeast and in Sao Paulo, Rio de Janeiro and Belo Horizonte located in the Southeast of the country. A previous REDS study using the same database from 2007 to 2009 showed that the prevalence per 100,000 donors was 222 in Recife, 83 in Belo Horizonte and 101 in Sao Paulo. From 2007 to 2016, HTLV-1/2 prevalence was calculated by year, blood center and birth cohort. Covariates included age, gender, schooling, self-reported skin color and type of donation. From 1,092,174 first-blood donations, in the general analysis, HTLV-1/2 infection predominated in females, donors over 50 years of age, black skin color and less educated. The average prevalence was 228 per 100,000 donors in Recife, 222 in Rio de Janeiro, 104 in Belo Horizonte and 103 in Sao Paulo. In the 10-year analysis, HTLV-1/2 prevalence was stable, but a trend was observed toward an increase in HTLV-1/2 infection among younger people (p < 0.001), males (p = 0.049), those with white skin color (p < 0.001), and higher education (p = 0.014). Therefore, this 10-year surveillance of the infection showed stable HTLV-1/2 prevalence overall but a trend toward increased prevalence among the younger and more educated donors despite Brazilian policies to control sexually transmitted infections being in place for more than 10 years.
  • article 22 Citação(ões) na Scopus
    Risk factors for human immunodeficiency virus infection among Brazilian blood donors: a multicentre case-control study using audio computer-assisted structured interviews
    (2013) ALMEIDA-NETO, C. de; GONCALEZ, T. T.; BIRCH, R. J.; CARVALHO, S. M. F. de; CAPUANI, L.; LEAO, S. C.; MIRANDA, C.; ROCHA, P. C.; CARNEIRO-PROIETTI, A. B.; JOHNSON, B. R.; WRIGHT, D. J.; MURPHY, E. L.; CUSTER, B.
    Background Although risk factors for HIV infection are known, it is important for blood centres to understand local epidemiology and disease transmission patterns. Current risk factors for HIV infection in blood donors in Brazil were assessed. Methods A case-control study was conducted at large public blood centres located in four major cities between April 2009 and March 2011. Cases were persons whose donations were confirmed positive by enzyme immunoassays followed by Western blot confirmation. Audio computer-assisted structured interviews (ACASI) were completed by all cases and controls. Multivariable logistic regression was used to estimate adjusted odds ratios (AORs) and associated 95% confidence intervals (CIs). Results There were 341 cases, including 47 with recently acquired infection, and 791 controls. Disclosed risk factors for both females and males were sex with an HIV-positive person AOR 11.3, 95% CI (4.1, 31.7) and being an IVDU or sexual partner of an IVDU [AOR 4.65 (1.8, 11.7)]. For female blood donors, additional risk factors were having male sex partners who also are MSM [AOR 13.5 (3.1, 59.8)] and having unprotected sex with multiple sexual partners [AOR 5.19 (2.1, 12.9)]. The primary risk factor for male blood donors was MSM activity [AOR 21.6 (8.8, 52.9)]. Behaviours associated with recently acquired HIV were being a MSM or sex partner of MSM [13.82, (4.7, 40.3)] and IVDU [11.47, (3.0, 43.2)]. Conclusion Risk factors in blood donors parallel those in the general population in Brazil. Identified risk factors suggest that donor compliance with selection procedures at the participating blood centres is inadequate.
  • article 289 Citação(ões) na Scopus
    Three-quarters attack rate of SARS-CoV-2 in the Brazilian Amazon during a largely unmitigated epidemic
    (2021) BUSS, Lewis F.; JR, Carlos A. Prete; ABRAHIM, Claudia M. M.; JR, Alfredo Mendrone; SALOMON, Tassila; ALMEIDA-NETO, Cesar de; FRANCA, Rafael F. O.; BELOTTI, Maria C.; CARVALHO, Maria P. S. S.; COSTA, Allyson G.; CRISPIM, Myuki A. E.; FERREIRA, Suzete C.; FRAIJI, Nelson A.; GURZENDA, Susie; WHITTAKER, Charles; KAMAURA, Leonardo T.; TAKECIAN, Pedro L.; PEIXOTO, Pedro da Silva; OIKAWA, Marcio K.; NISHIYA, Anna S.; ROCHA, Vanderson; SALLES, Nanci A.; SANTOS, Andreza Aruska de Souza; SILVA, Martirene A. da; CUSTER, Brian; V, Kris Parag; BARRAL-NETTO, Manoel; KRAEMER, Moritz U. G.; PEREIRA, Rafael H. M.; PYBUS, Oliver G.; BUSCH, Michael P.; CASTRO, Marcia C.; DYE, Christopher; NASCIMENTO, Vitor H.; FARIA, Nuno R.; SABINO, Ester C.
    Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spread rapidly in Manaus, the capital of Amazonas state in northern Brazil. The attack rate there is an estimate of the final size of the largely unmitigated epidemic that occurred in Manaus. We use a convenience sample of blood donors to show that by June 2020, 1 month after the epidemic peak in Manaus, 44% of the population had detectable immunoglobulin G (IgG) antibodies. Correcting for cases without a detectable antibody response and for antibody waning, we estimate a 66% attack rate in June, rising to 76% in October. This is higher than in Sao Paulo, in southeastern Brazil, where the estimated attack rate in October was 29%. These results confirm that when poorly controlled, COVID-19 can infect a large proportion of the population, causing high mortality.
  • article 8 Citação(ões) na Scopus
    Knowledge of HIV testing and attitudes towards blood donation at three blood centres in Brazil
    (2014) MIRANDA, C.; MORENO, E.; BRUHN, R.; LARSEN, N. M.; WRIGHT, D. J.; OLIVEIRA, C. D. L.; CARNEIRO-PROIETTI, A. B. F.; LOUREIRO, P.; ALMEIDA-NETO, C. de; CUSTER, B.; SABINO, E. C.; GONCALEZ, T. T.
    Background Reducing risk of HIV window period transmission requires understanding of donor knowledge and attitudes related to HIV and risk factors. Study Design and Methods We conducted a survey of 7635 presenting blood donors at three Brazilian blood centres from 15 October through 20 November 2009. Participants completed a questionnaire on HIV knowledge and attitudes about blood donation. Six questions about blood testing and HIV were evaluated using maximum likelihood chi-square and logistic regression. Test seeking was classified in non-overlapping categories according to answers to one direct and two indirect questions. Results Overall, respondents were male (64%) repeat donors (67%) between 18 and 49years old (91%). Nearly 60% believed blood centres use better HIV tests than other places; however, 42% were unaware of the HIV window period. Approximately 50% believed it was appropriate to donate to be tested for HIV, but 67% said it was not acceptable to donate with risk factors even if blood is tested. Logistic regression found that less education, Hemope-Recife blood centre, replacement, potential and self-disclosed test-seeking were associated with less HIV knowledge. Conclusion HIV knowledge related to blood safety remains low among Brazilian blood donors. A subset finds it appropriate to be tested at blood centres and may be unaware of the HIV window period. These donations may impose a significant risk to the safety of the blood supply. Decreasing test-seeking and changing beliefs about the appropriateness of individuals with behavioural risk factors donating blood could reduce the risk of transfusing an infectious unit.
  • article 0 Citação(ões) na Scopus
    Knowledge of Hepatitis C virus vertical transmission and subsequent pregnancy outcome in virus-positive female blood donors
    (2022) MENEZES FILHO, Helio Ranes de; MAIA, Ludmila Grego; MACHADO, Soraia Mafra; SILVA, Iasmin Ramos da; ALMEIDA-NETO, Cesar de; SABINO, Ester Cerdeira; WITKIN, Steven S.; MENDES-CORREA, Maria Cassia
    Introduction: Hepatitis C virus (HCV) can be vertically transmitted from mother to fetus. We evaluated knowledge about HCV vertical transmission in female blood donors who became pregnant following detection of HCV in their donated blood. Methods: This was a retrospective descriptive study of females seen at a single blood bank in Sao Paulo, Brazil who were diagnosed with HCV infection in their donated blood. HCV-infected donors who subsequently became pregnant were invited to participate through letters or phone calls. Individuals who agreed to participate were interviewed by questionnaire to evaluate their knowledge on HCV vertical transmission. Results: Among 282 HCV-positive female blood donors, 69 reported becoming pregnant after their HCV diagnosis in donated blood. While 24 of these women were successful treated for their infection prior to becoming pregnant, 45 (65.2%) were at risk for vertical HCV transmission either because they had never been treated for HCV, were pregnant before treatment or became pregnant after unsuccessful treatment. Of the 59 women who responded to the question of whether they were informed about the risk of HCV vertical transmission, 58 (98.3%) reported never receiving this information either after obtaining their blood donation results or during their pregnancy. Conclusion: The lack of knowledge of HCV-infected women on the possibility for mother-to-child transmission of this virus highlights the critical need to improve communication about pregnancy-related risks between health professionals and HCV-infected women of childbearing age. (C) 2022 Sociedade Brasileira de Infectologia.
  • article 14 Citação(ões) na Scopus
    Relationship between social capital and test seeking among blood donors in Brazil
    (2013) OLIVEIRA, C. D. L.; GONCALEZ, T.; WRIGHT, D.; ROCHA, P. C.; MIRANDA, C.; CAPUANI, L.; CARNEIRO-PROIETTI, A. B.; PROIETTI, F. A.; ALMEIDA-NETO, C. de; LARSEN, N. M.; SAMPAIO, D.; CUSTER, B.
    Background and Objectives Higher risk of HIV infection could be associated with test seeking, which is one motivation for donating blood. Cognitive social capital is defined as the social support, trust and co-operation that guide community behaviour. Structural social capital refers to an individuals participation in institutions and organizations. The association between social capital and test seeking was assessed. Materials and Methods A survey of over 7500 donors in three Brazilian blood centres was conducted. Test seeking was classified into four non-overlapping categories (non-test seeker, possible, presumed and self-disclosed test seekers) using one direct and two indirect questions. Social capital was summarized into cognitive and structural categorizations. Multivariable logistic regression analysis was performed. Results Compared with non-test seekers (62% of survey respondents), cognitive social capital was higher for each category of test seeking (OR = 1.1, 7.4, 7.1, P < 0.05 respectively). Male gender, lower education and lower income were also significantly associated with test seeking. Conclusion As test seekers appear to have strong social networks, blood banks may leverage this to convince them to seek testing at other locations.
  • article 6 Citação(ões) na Scopus
    Phylogenetic analysis of the emergence of main hepatitis C virus subtypes in Sao Paulo, Brazil
    (2015) NISHIYA, Anna Shoko; ALMEIDA-NETO, Cesar de; ROMANO, Camila Malta; ALENCAR, Ceclia Salete; FERREIRA, Suzete Cleusa; DI-LORENZO-OLIVEIRA, Claudia; LEVI, Jose Eduardo; SALLES, Nanci Alves; MENDRONE-JUNIOR, Alfredo; SABINO, Ester Cerdeira
    Background: It is recognized that hepatitis C virus subtypes (1a, 1b, 2a, 2b, 2c and 3a) originated in Africa and Asia and spread worldwide exponentially during the Second World War (1940) through the transfusion of contaminated blood products, invasive medical and dental procedures, and intravenous drug use. The entry of hepatitis C virus subtypes into different regions occurred at distinct times, presenting exponential growth rates of larger or smaller spread. Our study estimated the growth and spread of the most prevalent subtypes currently circulating in Sao Paulo. Methods: A total of 465 non-structural region 5B sequences of hepatitis C virus covering a 14-year time-span were used to reconstruct the population history and estimate the population dynamics and Time to Most Recent Common Ancestor of genotypes using the Bayesian Markov Chain Monte Carlo approach implemented in BEAST (Bayesian evolutionary analysis by sampling tree software/program). Results: Evolutionary analysis demonstrated that the different hepatitis C virus subtypes had distinct growth patterns. The introduction of hepatitis C virus-la and -3a were estimated to be circa 1979 and 1967, respectively, whereas hepatitis C virus-1b appears to have a more ancient entry, circa 1923. Hepatitis C virus-1b phylogenies suggest that different lineages circulate in Sao Paulo, and four well-supported groups (i.e., G1, G2, G3 and G4) were identified. Hepatitis C virus-la presented the highest growth rate (r=0.4), but its spread became less marked after the 2000s. Hepatitis C virus-3a grew exponentially until the 1990s and had an intermediate growth rate (r=0.32). An evident exponential growth (r=0.26) was found for hepatitis C virus-1b between 1980 and the mid-1990s. Conclusions: After an initial period of exponential growth, the expansion of the three main subtypes began to decrease. Hepatitis C virus-1b presented inflated genetic diversity, and its transmission may have been sustained by different generations and transmission routes other than blood transfusion. Hepatitis C virus-1a and -3a showed no group stratification, most likely due to their recent entry.