ERIQUE JOSE PEIXOTO DE MIRANDA
Projetos de Pesquisa
Unidades Organizacionais
SCPACEX-62, Hospital Universitário
LIM/20 - Laboratório de Terapêutica Experimental, Hospital das Clínicas, Faculdade de Medicina
LIM/20 - Laboratório de Terapêutica Experimental, Hospital das Clínicas, Faculdade de Medicina
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- Erratum in «High rate of virologic supression with darunavir/ritonavir plus optimazed background therapy among highly antiretroviral-experienced HIV-infected patients: results of a prospective cohort study in São Paulo, Brazil»(2013) VIDAL, José Ernesto; SONG, Alice Tung Wan; MATOS, Maria Laura; BARTMANN, Daniel; ANJOS, Guilherme dos; MIRANDA, Érique José Peixoto de; FREITAS, Ângela Carvalho; DALBEN, Mirian de Freitas; SANTANA, Claudinei; SEGURADO, Aluísio Cotrim; BARRETO, Cláudia Cortese; HERNÁNDEZ, Adrián Vladimir
- Role of quantitative CSF microscopy to predict culture status and outcome in HIV-associated cryptococcal meningitis in a Brazilian cohort(2012) VIDAL, Jose E.; GERHARDT, Juliana; MIRANDA, Erique J. Peixoto de; DAUAR, Rafi F.; OLIVEIRA FILHO, Gilberto S.; OLIVEIRA, Augusto C. Penalva de; BOULWARE, David R.This retrospective study aimed to evaluate the clinical, laboratory, and quantitative cerebrospinal fluid (CSF) cryptococcal cell counts for associations with in-hospital outcomes of HIV-infected patients with cryptococcal meningitis. Ninety-eight HIV-infected adult patients with CSF culture-proven cryptococcal meningitis were admitted between January 2006 and June 2008 at a referral center in Sao Paulo, Brazil. Cryptococcal meningitis was the first AIDS-defining illness in 69%, of whom 97% (95/98) had known prior HIV infection. The median CD4+ T-cell count was 39 cells/mu L (interquartile range 17-87 cells/mu L). Prior antiretroviral therapy was reported in 50%. Failure to sterilize the CSF by 7-14 days was associated with baseline fungal burden of >= 10 yeasts/mu L by quantitative CSF microscopy (odds ratio [OR] = 15.3, 95% confidence interval [CI] 4.1-56.7; P < 0.001) and positive blood cultures (OR = 11.5,95% CI 1.2-109; P = 0.034). At 7-14 days, 10 yeasts/mu L CSF was associated with positive CSF cultures in 98% versus 36% with <10 yeasts/mu L CSF (P < 0.001). In-hospital mortality was 30% and was associated with symptoms duration for >14 days, altered mental status (P< 0.001), CSF white blood cell counts <5 cells/mu L (P = 0.027), intracranial hypertension (P = 0.011), viral loads >50,000 copies/mL (P = 0.036), >= 10 yeasts/mu L CSF at 7-14 days (P = 0.038), and intracranial pressure >50 cmH(2)O at 7-14 days (P = 0.007). In conclusion, most patients were aware of their HIV status. Fungal burden of >= 10 yeasts/mu L by quantitative CSF microscopy predicted current CSF culture status and may be useful to customize the induction therapy. High uncontrolled intracranial pressure was associated with mortality.
- High rate of virologic suppression with darunavir/ritonavir plus optimized background therapy among highly antiretroviral-experienced HIV-infected patients: results of a prospective cohort study in Sao Paulo, Brazil(2013) VIDAL, Jose Ernesto; SONG, Alice Tung Wan; MATOS, Maria Laura; BARTMANN, Daniel; ANJOS, Guilherme dos; MIRANDA, Erique Jose Peixoto de; FREITAS, Angela Carvalho; DALBEN, Mirian de Freitas; SANTANA, Claudinei; SEGURADO, Aluisio Cotrim; BARRETO, Claudia Cortese; HERNANDEZ, Adrian VladimirObjectives: To assess the virologic and immunological response of darunavir/ritonavir plus optimized background therapy in highly antiretroviral-experienced HIV-infected patients in Brazil. Methods: Prospective cohort study carried out in a tertiary center in Sao Paulo, Brazil. Three-class antiretroviral-experienced patients with confirmed virologic failure began darunavir/ritonavir plus optimized background therapy (nucleoside/tide reverse transcriptase inhibitors +/- raltegravir +/- enfuvirtide +/- maraviroc) after performing a genotypic resistance assay. Clinical evaluation and laboratory tests were collected at baseline and at weeks 12, 24, and 48. Multivariate analysis was performed to identify predictors of virologic response at 48 weeks. Results: Ninety-two patients were included. The median of darunavir resistant mutation was 1 (range 0-6). The median genotypic sensitivity score in the optimized background therapy was 2 (interquartile range 1-2). At week 48, 83% (95% CI: 75-90%) had an HIV RNA level <50 copies/mL and the median CD4 cell count was 301 (interquartile range 224-445) cells/mm(3). Baseline HIV RNA >100 000 copies/mL was inversely associated with virologic success at week 48 (HR: 0.22, 95% CI: 0.06-0.85, p=0.028). Conclusions: Darunavir/ritonavir plus optimized background therapy was a highly effective salvage regimen under clinical routine conditions in a referral center in Brazil, which is similar to the reported in high-income countries.
- Is it possible to differentiate tuberculous and cryptococcal meningitis in HIV-infected patients using only clinical and basic cerebrospinal fluid characteristics?(2017) VIDAL, J. E.; MIRANDA, E. J. F. Peixoto de; GERHARDT, J.; CRODA, M.; BOULWARE, D. R.Background. Tuberculous and cryptococcal meningitis (TBM and CM) are the most common causes of opportunistic meningitis in HIV infected patients from resource-limited settings. and the differential diagnosis is challenging. Objective. To compare clinical and basic cerebrospinal fluid (CSF) characteristics between TBM and CM in HIV-infected patients. Methods. A retrospective analysis was conducted of clinical, radiological and laboratory records of 108 and 98 HIV-infected patients with culture-proven diagnosis of TBM and CM, respectively. The patients were admitted at a tertiary centre in wSao Paulo, Brazil. A logistic regression model was used to distinguish TBM from CM and derive a diagnostic index based on the adjusted odds ratio (OR) to differentiate these two diseases. Results. In multivariate analysis, TBM was independently associated with: CSF with neutrophil predominance (odds ratio (OR) 35.81, 95% confidence interval (CI) 3.80- 341.30, p=0.002), CSF pleocytosis (OR 9.43, 95% CI 1.30- 68.70, p=0.027), CSF protein >1.0 g/L (OR 5.13, 95% CI 1.38-19.04, p=0.032) and Glasgow Coma Scale <15 (OR 3.10, 95% CI 1.03-9.34, p=0.044). Nausea and vomiting (OR 0.27, 95% CI 0.08- 0.90, p=0.033) were associated with CM. Algorithm-related area under the receiver operating characteristics curve was 0.815 (95% CI 0.758- 0.873, p<0.0001), but an accurate cut-off was not derived. Conclusion. Although some clinical and basic CSF characteristics appear useful in the differential diagnosis of TBM and CM in HIV infected patients, an accurate algorithm was not identified. Optimised access to rapid, sensitive and specific laboratory tests is essential.