ABSTRACT The efficacy of direct-acting antivirals (DAAs) in the treatment of chronic hepatitis C (CHC) in liver transplant recipients is poorly understood, and several factors, including immunosuppression, drug interactions, elevated viraemia, and intolerance to ribavirin (RBV), can reduce cure rates. We conducted a real-life study on liver transplant recipients with CHC treated with a combination of sofosbuvir (SOF) and daclatasvir (DCV) or simeprevir (SIM), with or without RBV, followed-up for 12 to 24 weeks. The treatment effectiveness was assessed by determining the sustained virological response (SVR) rates at 12 or 24 weeks after the treatment cessation. Eighty-four patients were evaluated, with a mean age of 63.4 ± 7.4 years, HCV genotype 1 being the most prevalent (63.1%). Nineteen patients (22.7%) had mild fibrosis (METAVIR < F2) and 41 (48.8%) significant fibrosis (METAVIR ≥ F2). The average time between liver transplantation and the start of treatment was 4 years (2.1-6.6 years). The SOF + DCV regimen was used in 58 patients (69%). RBV in combination with DAAs was used in seven patients (8.3%). SVR was achieved in 82 patients (97.6%), and few relevant adverse events could be attributed to DAA therapy, including a patient who stopped treatment due to a headache. There was a significant reduction in ALT, AST, GGT and FA levels, or the APRI index after 4 weeks of treatment, which remained until 12/24 weeks post-treatment. DAA treatment of CHC in liver-transplanted patients achieved a high SVR rate and resulted in the normalization of serum levels of liver enzymes.

Resumo Fundamento: As pessoas que vivem com HIV têm um risco aumentado de doença cardiovascular e espessamento da carótida, devido à inflamação causada pelo vírus, à terapia antirretroviral e a outros fatores de risco. No entanto, poucos estudos observaram a ocorrência de doenças cardiovasculares e espessamento carotídeo na população soropositiva com baixo risco cardiovascular e carga viral indetectável. Objetivos: Avaliar a associação entre níveis de marcadores inflamatórios e espessura da carótida em pessoas vivendo com HIV, sob terapia antirretroviral e com baixo risco cardiovascular. Métodos: Para determinar o baixo risco cardiovascular em ambos os grupos (indivíduos infectados e não-infectados pelo HIV), foi utilizado o Escore de Risco de Framingham. Os marcadores inflamatórios (IFN-γ, TNF-α, IL-1β, IL-6, sVCAM-1 e sICAM-1) foram avaliados por citometria de fluxo. A espessura da carótida (mm) foi mensurada por meio de ultrassom com Doppler. O nível de significância foi de p < 0,05. Resultados: Em pessoas vivendo com HIV, a idade e o tabagismo foram associados a alterações da espessura da carótida. No grupo não-HIV, idade e níveis mais altos de colesterol total e LDL foram associados ao aumento da espessura da carótida. Utilizando a análise multivariada, observou-se associação significativa entre os níveis de TNF-α e IL-1β e maior chance de desenvolvimento de aterosclerose no grupo com HIV. Conclusão: Ambos os grupos têm risco semelhante de desenvolver doença cardiovascular, portanto, nosso estudo demonstra que indivíduos HIV-positivos com carga viral indetectável em terapia antirretroviral sem inibidores de protease e com baixo risco cardiovascular não apresentam diferenças na espessura da carótida em relação aos indivíduos não-infectados.

Abstract Background: People living with HIV are at increased risk of cardiovascular disease and carotid thickness, due to the inflammation caused by the virus, the antiretroviral therapy, and other risk factors. However, few studies have observed the occurrence of cardiovascular diseases and carotid thickness in HIV-positive population at low cardiovascular risk and with undetectable viral load. Objectives: To evaluate the association between levels of inflammatory markers and carotid thickness in people living with HIV, under antiretroviral therapy and at low cardiovascular risk. Methods: To determine low cardiovascular risk in both groups (HIV infected and non-infected individuals), the Framingham Risk Score was used. Inflammatory markers (IFN-γ, TNF-α, IL-1β, IL-6, sVCAM-1, and sICAM-1) were assessed using flow cytometry. Carotid thickness (mm) was measured using Doppler ultrasound. Level of significance was p < 0.05. Results: In People living with HIV, age and smoking status were associated with carotid thickness alterations. In the non-HIV group, age, higher total cholesterol, and LDL levels were associated with increased carotid thickness. Using the multivariate analysis, a significant association between TNF-α and IL- 1( levels, and a higher chance of atherosclerosis development in HIV group were observed. Conclusions: Both groups have a similar risk for developing cardiovascular disease, therefore our study demonstrates that HIV-positive individuals with undetectable viral load in antiretroviral therapy without protease inhibitors and with low cardiovascular risk do not present differences in carotid thickness in relation to uninfected individuals.

ABSTRACT BACKGROUND: Nonadherence to antiretroviral therapy (ART) may lead to viral replication and development of antiretroviral resistance. OBJECTIVE: To identify the factors associated with nonadherence to ART among people living with the human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) (PLWHA). DESIGN AND SETTING: Cross-sectional study in a tertiary-level hospital in northeastern Brazil. METHODS: Intake of less than 90% of the antiretroviral drugs prescribed in the last week prior to the interview was defined as nonadherence. Intake was evaluated using a questionnaire. Descriptive and multivariate analyses were conducted on the study population, with estimation of the respective odds ratios and 95% confidence intervals. RESULTS: The prevalence of nonadherence was 28.4%. Significant associations were found regarding the following variables: age less than 35 years, smoking, sedentary lifestyle, lack of medication and lack of knowledge regarding the patient’s HIV status, on the part of the patient’s partner or family. CONCLUSIONS: Encouragement of adherence to antiretroviral therapy is one of the fundamental pillars of treatment for HIV-infected patients. The high proportion of nonadherence (28.4%) and the predictive factors related to this indicate that it is necessary to improve patients’ adherence to antiretroviral therapy.

No Brasil, a epidemia do HIV-1 adquiriu novas características ao longo do tempo, como o aumento da transmissão heterossexual e um declínio da razão homens:mulheres em casos de AIDS. Foi oferecida triagem para a infecção pelo HIV a todos os pacientes atendidos no Centro de Testagem e Aconselhamento da cidade de Paulista, Região Metropolitana de Recife, Pernambuco, Nordeste do Brasil, com o objetivo de determinar a incidência do HIV-1. Foi usado o enzimaimunoensaio de captura BED (BED-CEIA) para determinar a incidência do HIV-1, comparando-o com o método de índice de avidez AxSYM (Ax-AI). No período analisado, 2006-2009, 14.014 pessoas foram testadas, e apenas 18 gestantes foram diagnosticadas para a infecção por HIV, resultando em uma incidência de 0,15% ao ano (IC95%: 0,00-0,33), significativamente menor do que os homens (1,03; IC95%: 0,45-1,61) e mulheres não-grávidas (0,50; IC95%: 0,11-0,89). Apesar da baixa incidência de HIV-1 entre as mulheres grávidas, a alta taxa de infecção recente reforça cuidados no pré-natal para esta infecção, para evitar a transmissão vertical.

The HIV-1 epidemic in Brazil has displayed new characteristics over time, with an increase in heterosexual transmission and a decline in the male-to-female ratio in AIDS cases. HIV screening was offered to patients attending the Voluntary Counseling and Testing Center in Paulista, Greater Metropolitan Recife, Pernambuco State, in Northeast Brazil, to determine HIV-1 incidence. BED capture enzyme immunoassay (BED-CEIA) was used to measure HIV-1 incidence, comparing it to the AxSYM avidity index method (Ax-AI). From 2006 to 2009, 14,014 individuals were tested, and only 18 pregnant women were diagnosed with HIV infection, resulting in 0.15% annual incidence (95%CI: 0-0.33), significantly lower than in men (1.03; 95%CI: 0.45-1.61) and non-pregnant women (0.50; 95%CI: 0.11-0.89). Despite the low HIV-1 incidence in pregnant women, the high rate of recent infection detected during prenatal care emphasizes the need to increase measures to prevent vertical transmission.

En Brasil, epidemia del VIH-1 adquiere nuevas características con tiempo, como el aumento de la transmisión heterosexual y disminución de la razón hombres:mujeres en los casos de SIDA. La detección de infección por VIH se ofrece a todos los pacientes que acuden al Centro de Asesoramiento y Pruebas (CTA) en la ciudad de Paulista, área metropolitana de Recife, noreste - Brasil, con objetivo de determinar la incidencia del VIH-1. BED inmunoensayo enzimático de captura (BED-CEIA) se utilizó para determinar la incidencia de VIH-1, comparándolo con el método del índice de avidez AxSYM (AX AI). En el período de 2006-2009, 14.014 personas se pusieron a prueba, 18 mujeres embarazadas fueron diagnosticados con infección por VIH, com incidencia de 0.15% anual (IC95%: 0-0.33), inferior a los hombres (1.03; IC95%: 0.45-1.61) y las mujeres no embarazadas (0.50; IC95%: 0.11-0.89). A pesar de la baja incidencia de VIH-1 en las mujeres embarazadas, alta tasa de infección reciente aumenta en la atención prenatal para esta infección para prevenir la transmisión vertical.

No Brasil, a epidemia do HIV-1 adquiriu novas características ao longo do tempo, como o aumento da transmissão heterossexual e um declínio da razão homens:mulheres em casos de AIDS. Foi oferecida triagem para a infecção pelo HIV a todos os pacientes atendidos no Centro de Testagem e Aconselhamento da cidade de Paulista, Região Metropolitana de Recife, Pernambuco, Nordeste do Brasil, com o objetivo de determinar a incidência do HIV-1. Foi usado o enzimaimunoensaio de captura BED (BED-CEIA) para determinar a incidência do HIV-1, comparando-o com o método de índice de avidez AxSYM (Ax-AI). No período analisado, 2006-2009, 14.014 pessoas foram testadas, e apenas 18 gestantes foram diagnosticadas para a infecção por HIV, resultando em uma incidência de 0,15% ao ano (IC95%: 0,00-0,33), significativamente menor do que os homens (1,03; IC95%: 0,45-1,61) e mulheres não-grávidas (0,50; IC95%: 0,11-0,89). Apesar da baixa incidência de HIV-1 entre as mulheres grávidas, a alta taxa de infecção recente reforça cuidados no pré-natal para esta infecção, para evitar a transmissão vertical.

The HIV-1 epidemic in Brazil has displayed new characteristics over time, with an increase in heterosexual transmission and a decline in the male-to-female ratio in AIDS cases. HIV screening was offered to patients attending the Voluntary Counseling and Testing Center in Paulista, Greater Metropolitan Recife, Pernambuco State, in Northeast Brazil, to determine HIV-1 incidence. BED capture enzyme immunoassay (BED-CEIA) was used to measure HIV-1 incidence, comparing it to the AxSYM avidity index method (Ax-AI). From 2006 to 2009, 14,014 individuals were tested, and only 18 pregnant women were diagnosed with HIV infection, resulting in 0.15% annual incidence (95%CI: 0-0.33), significantly lower than in men (1.03; 95%CI: 0.45-1.61) and non-pregnant women (0.50; 95%CI: 0.11-0.89). Despite the low HIV-1 incidence in pregnant women, the high rate of recent infection detected during prenatal care emphasizes the need to increase measures to prevent vertical transmission.

En Brasil, epidemia del VIH-1 adquiere nuevas características con tiempo, como el aumento de la transmisión heterosexual y disminución de la razón hombres:mujeres en los casos de SIDA. La detección de infección por VIH se ofrece a todos los pacientes que acuden al Centro de Asesoramiento y Pruebas (CTA) en la ciudad de Paulista, área metropolitana de Recife, noreste - Brasil, con objetivo de determinar la incidencia del VIH-1. BED inmunoensayo enzimático de captura (BED-CEIA) se utilizó para determinar la incidencia de VIH-1, comparándolo con el método del índice de avidez AxSYM (AX AI). En el período de 2006-2009, 14.014 personas se pusieron a prueba, 18 mujeres embarazadas fueron diagnosticados con infección por VIH, com incidencia de 0.15% anual (IC95%: 0-0.33), inferior a los hombres (1.03; IC95%: 0.45-1.61) y las mujeres no embarazadas (0.50; IC95%: 0.11-0.89). A pesar de la baja incidencia de VIH-1 en las mujeres embarazadas, alta tasa de infección reciente aumenta en la atención prenatal para esta infección para prevenir la transmisión vertical.

The aims of this study were to compare the automated AxSYM avidity assay index with the BED capture enzyme immunoassay test and to calculate the HIV-1 incidence using the BED capture enzyme immunoassay and AxSYM avidity assay index algorithms within a population seeking the Voluntary Counselling and Testing Centres in two municipalities in the Metropolitan Region of Recife, Northeast of Brazil. An analysis was conducted in 365 samples that tested positive for HIV infection from frozen serum collected during the period 2006-2009. There was a similar proportion of males and females; most patients were heterosexual (86%) with a median age of 29 years. Of the 365 samples, 102 (28%) and 66 (18.1%) were identified as recent infections by BED capture enzyme immunoassay and AxSYM avidity assay index, respectively. The HIV-1 total incidence in the BED capture enzyme immunoassay and AxSYM avidity assay index algorithms were: 0.79 (95% CI: 0.60-0.98) and 0.34 (95% CI: -0.04 to 0.72), respectively. Incidence was higher among men. There was good agreement between the tests, with a kappa of 0.654 and a specificity of 95.8%. AxSYM avidity assay index may be helpful in improving the quality of the estimates of recent HIV infection and incidence, particularly when used in a combined algorithm with BED capture enzyme immunoassay.

Determining the prevalence and type of antiretroviral (ARV) resistance among ARV-naïve individuals is important to assess the potential responses of these individuals to first-line regimens. The prevalence of primary resistance and the occurrence of recent infections among individuals with human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) were identified among recently diagnosed patients at five sexually transmitted disease/AIDS testing and counselling centres in the metropolitan region of Recife (RMR), Pernambuco, Brazil, between 2007-2009. One-hundred and eight samples were analysed using the Calypte® BED assay. Males predominated (56%), as did patients aged 31-50 years. Twenty-three percent presented evidence of a recent HIV infection. The median CD4+ T lymphocyte count was 408 cells/mm³ and the median viral load was 3.683 copies/mL. The prevalence of primary resistance was 4.6% (confidence interval 95% = 1-8.2%) based on criteria that excluded common polymorphisms in accordance with the surveillance drug resistance mutation criteria. The prevalence of resistance to non-nucleoside reverse transcriptase, nucleoside/nucleotide reverse transcriptase and protease inhibitors were 3.8%, 1.5% and 0.8%, respectively. Fifty-seven percent of strains were from clade B, 37.7% were clade F and 3.1% were clade C; there were no statistically significant differences with respect to resistance between clades. Recent infection tended to be more common in men (p = 0.06) and in municipalities in the south of the RMR (Jaboatão dos Guararapes and Cabo de Santo Agostinho) (p = 0.046). The high prevalence of recent infection and the high prevalence of non-B strains in this poor Brazilian region merit further attention.

The BED capture enzyme immunoassay test makes it possible to determine whether individuals were recently infected with HIV. OBJECTIVE: In this study, the overall HIV and recent infections prevalences were determined at five Voluntary Counseling and Testing (VCT) centers, in the Metropolitan Region of Recife, Northeastern of Brazil. MATERIAL AND METHODS: A cross-sectional study was conducted among users of five VCTs in the metropolitan region of Recife between July 2007 and April 2009. Out of the individuals who tested positive for HIV, 169 were analyzed to assess the prevalence of recent infection by means of the BED-CEIA (BED-Calypte®). RESULTS: Out of 46,696 individuals tested 916 (1.96%) turned out positive for HIV infection The highest prevalence was in Recife (3.9%). The prevalence was higher among males (3.93%), and men who have sex with men (MSM) (12.4%). The frequency of recent infections among the 169 subjects evaluated was 23.7%. Recent infections were more common among individuals under 25 years of age. There was slight predominance of men and higher frequency of heterosexuals in both groups, but still a significant portion of MSM (33%). Subtype B predominated, followed by a high proportion of subtype F. CONCLUSIONS: Recent infection occurs mainly among young individuals and heterosexuals, despite a significant proportion of recent infection among MSM. These results suggest that preventive actions aimed at the MSM community remains a challenge and efforts focusing this group should continue to be a priority.