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ABSTRACT Objective: To update the recommendations to support decisions regarding the pharmacological treatment of patients hospitalized with COVID-19 in Brazil. Methods: Experts, including representatives of the Ministry of Health and methodologists, created this guideline. The method used for the rapid development of guidelines was based on the adoption and/or adaptation of existing international guidelines (GRADE ADOLOPMENT) and supported by the e-COVID-19 RecMap platform. The quality of the evidence and the preparation of the recommendations followed the GRADE method. Results: Twenty-one recommendations were generated, including strong recommendations for the use of corticosteroids in patients using supplemental oxygen and conditional recommendations for the use of tocilizumab and baricitinib for patients on supplemental oxygen or on noninvasive ventilation and anticoagulants to prevent thromboembolism. Due to suspension of use authorization, it was not possible to make recommendations regarding the use of casirivimab + imdevimab. Strong recommendations against the use of azithromycin in patients without suspected bacterial infection, hydroxychloroquine, convalescent plasma, colchicine, and lopinavir + ritonavir and conditional recommendations against the use of ivermectin and remdesivir were made. Conclusion: New recommendations for the treatment of hospitalized patients with COVID-19 were generated, such as those for tocilizumab and baricitinib. Corticosteroids and prophylaxis for thromboembolism are still recommended, the latter with conditional recommendation. Several drugs were considered ineffective and should not be used to provide the best treatment according to the principles of evidence-based medicine and to promote resource economy.

RESUMO Objetivo: Atualizar as recomendações para embasar as decisões para o tratamento farmacológico de pacientes hospitalizados com COVID-19 no Brasil. Métodos: A elaboração desta diretriz foi feita por especialistas, incluindo representantes do Ministério da Saúde e metodologistas. O método utilizado para o desenvolvimento rápido de diretrizes baseou-se na adoção e/ou adaptação de diretrizes internacionais existentes (GRADE ADOLOPMENT) e contou com o apoio da plataforma e-COVID-19 RecMap. A qualidade das evidências e a elaboração das recomendações seguiram o método GRADE. Resultados: Chegaram-se a 21 recomendações, incluindo recomendações fortes quanto ao uso de corticosteroides em pacientes em uso de oxigênio suplementar e recomendações condicionais para o uso de tocilizumabe e baricitinibe, em pacientes com oxigênio suplementar ou ventilação não invasiva, e de anticoagulantes, para prevenção de tromboembolismo. Devido à suspensão da autorização de uso, não foi possível fazer recomendações para o tratamento com casirivimabe + imdevimabe. Foram feitas recomendações fortes contra o uso de azitromicina em pacientes sem suspeita de infecção bacteriana, hidroxicloroquina, plasma convalescente, colchicina e lopinavir + ritonavir, além de recomendações condicionais contra o uso de ivermectina e rendesivir. Conclusão: Foram criadas novas recomendações para o tratamento de pacientes hospitalizados com COVID-19, como as recomendações de tocilizumabe e baricitinibe. Ainda são recomendados corticosteroides e profilaxia contra tromboembolismo, esta em caráter condicional. Vários medicamentos foram considerados ineficazes e não devem ser usados, no intuito de proporcionar o melhor tratamento segundo os princípios da medicina baseada em evidências e promover a economia de recursos.

https://doi.org/10.5935/2965-2774.20230136-en

Brazilian pulmonology guidelines on Delphi panel for post-coronavirus disease 2019
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Tanni, Suzana Erico

; Baldi, Bruno Guedes

; Godoy, Irma

; Bacha, Hélio Arthur

; Barbosa, Alexandre Naime

; Bernardo, Wanderley Marques

Revista da Associação Médica Brasileira

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2023, Volume 69 Nº 7 elocation e2023D697

Resumo: En | Texto: En | PDF: En

https://doi.org/10.1590/1806-9282.2023d697

Use of anticoagulants in patients with COVID-19: an update of a living systematic review and meta-analysis
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Batista, Diane R

; Floriano, Idevaldo

; Silvinato, Antonio

; Bacha, Hélio A

; Barbosa, Alexandre Naime

; Tanni, Suzana E

; Bernardo, Wanderley M

Jornal Brasileiro de Pneumologia

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2023, Volume 49 Nº 3 elocation e20230095

Resumo: En Pt | Texto: En Pt | PDF: En | PDF: Pt

https://doi.org/10.36416/1806-3756/e20230095

Effectiveness of wearing masks during the COVID-19 outbreak in cohort and case-control studies: a systematic review and meta-analysis
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Floriano, Idevaldo

; Silvinato, Antônio

; Bacha, Hélio Arthur

; Barbosa, Alexandre Naime

; Tanni, Suzana

; Bernardo, Wanderley Marques

Jornal Brasileiro de Pneumologia

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2023, Volume 49 Nº 6 elocation e20230003

Resumo: En Pt | Texto: En Pt | PDF: En | PDF: Pt

ABSTRACT Objective: To evaluate the efficacy of wearing a mask to prevent COVID-19 infection. Methods: This was a systematic review and meta-analysis of cohort and case-control studies, considering the best level of evidence available. Electronic databases (MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Clinical Trials.gov) were searched to identify studies that evaluated the effectiveness of wearing masks compared with that of not wearing them during the COVID-19 pandemic. Risk of bias and quality of evidence were assessed using the Cochrane risk of bias tool and the Grading of Recommendations Assessment, Development, and Evaluation. Results: Of the 1,028 studies identified, 9 met the inclusion criteria (2 cohort studies and 7 case-control studies) and were included in the analysis. The meta-analysis using cohort studies alone showed statistically significant differences, wearing a cloth mask decreased by 21% [RD = −0.21 (95% CI, −0.34 to −0.07); I2 = 0%; p = 0,002] the risk of COVID-19 infection, but the quality of evidence was low. Regarding case-control studies, wearing a surgical mask reduced the chance of COVID-19 infection [OR = 0.51 (95% CI, 0.37-0.70); I2 = 47%; p = 0.0001], as did wearing an N95 respirator mask [OR = 0.31 (95% CI, 0.20-0.49); I2 = 0%; p = 0.00001], both with low quality of evidence. Conclusions: In this systematic review with meta-analysis, we showed the effectiveness of wearing masks in the prevention of SARS-CoV-2 infection regardless of the type of mask (disposable surgical mask, common masks, including cloth masks, or N95 respirators), although the studies evaluated presented with low quality of evidence and important biases.

RESUMO Objetivo: Avaliar a eficácia do uso de máscaras na prevenção da infecção por COVID-19. Métodos: Revisão sistemática e meta-análise de estudos de coorte e caso-controle, considerando o melhor nível de evidência disponível. Bancos de dados eletrônicos (MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials e ClinicalTrials.gov) foram pesquisados para identificar estudos que avaliassem a eficácia do uso de máscaras em comparação com ausência de seu uso durante a pandemia de COVID-19. O risco de viés e a qualidade da evidência foram avaliados usando a ferramenta Cochrane risk of bias e Grading of Recommendations Assessment, Development, and Evaluation. Resultados: Dos 1.028 estudos identificados, 9 preencheram os critérios de inclusão (2 estudos de coorte e 7 estudos de caso-controle) e foram incluídos na análise. A meta-análise usando apenas estudos de coorte mostrou diferenças estatisticamente significativas: o uso de máscara de tecido diminuiu 21% [(risk difference = −0,21 (IC 95%: −0,34 a −0,07); I2 = 0%; p = 0,002] o risco de infecção por COVID-19, mas a qualidade da evidência foi baixa. Em relação aos estudos caso-controle, o uso de máscara cirúrgica reduziu a chance de infecção por COVID-19 [OR = 0,51 (IC 95%: 0,37-0,70); I2 = 47%; p = 0,0001], assim como o uso de máscara respiratória N95 [OR = 0,31 (IC 95%: 0,20-0,49); I2 = 0%; p = 0,00001], ambos com baixa qualidade de evidência. Conclusões: Nesta revisão sistemática com meta-análise, demonstramos a eficácia do uso de máscaras na prevenção da infecção por SARS-CoV-2 independentemente do tipo de máscara (máscara cirúrgica descartável, máscaras comuns, incluindo máscaras de tecido, ou respiradores N95), embora os estudos avaliados apresentassem evidências de baixa qualidade e vieses importantes.

https://doi.org/10.36416/1806-3756/e20230003

The use of neutralizing monoclonal antibody in patients with COVID-19: a systematic review and meta-analysis
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Tanni, Suzana Erico

; Batista, Diane Rezende

; Bacha, Hélio Arthur

; Barbosa, Alexandre Naime

; Bernardo, Wanderley Marques

Revista da Associação Médica Brasileira

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Jun 2022, Volume 68 Nº 6 Páginas 723 - 735

Resumo: En | Texto: En | PDF: En

https://doi.org/10.1590/1806-9282.2022d686

Antibiotics in the prophylaxis of COVID or in the treatment of mild COVID
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Barbosa, Alexandre Naime

; Silvinato, Antonio

; Bacha, Hélio

; Floriano, Idevaldo

; Tanni, Suzana

; Bernardo, Wanderley

Revista da Associação Médica Brasileira

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Mai 2022, Volume 68 Nº 5 Páginas 553 - 556

Resumo: En | Texto: En | PDF: En

https://doi.org/10.1590/1806-9282.2022d685

Use of disease-modifying drugs (tocilizumab, tofacitinib, and baricitinib—a biological or synthetic target specific) in patients hospitalized with COVID-19
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Barbosa, Alexandre Naime

; Silvinato, Antonio

; Bacha, Hélio

; Floriano, Idevaldo

; Tanni, Suzana

; Bernardo, Wanderley

Revista da Associação Médica Brasileira

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Jan 2022, Volume 68 Nº 1 Páginas 3 - 8

Resumo: En | Texto: En | PDF: En

https://doi.org/10.1590/1806-9282.2022d681

Use of remdesivir in patients with COVID-19: a systematic review and meta-analysis
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Tanni, Suzana E

; Silvinato, Antonio

; Floriano, Idevaldo

; Bacha, Hélio A

; Barbosa, Alexandre Naime

; Bernardo, Wanderley M

Jornal Brasileiro de Pneumologia

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2022, Volume 48 Nº 1 elocation e20210393

Resumo: Pt En | Texto: Pt En | PDF: Pt | PDF: En

RESUMO Objetivo: Estudos na literatura sobre o uso de remdesivir no tratamento de pacientes com COVID-19 têm apresentado resultados divergentes. O objetivo deste estudo foi responder a perguntas a respeito do uso de remdesivir no tratamento de pacientes hospitalizados com COVID-19 moderada a grave. Métodos: Trata-se de uma revisão sistemática e meta-análise de ensaios clínicos controlados randomizados (ECR) de fase 3 e estudos observacionais de coorte recuperados de diversos bancos de dados, comparando pacientes hospitalizados com COVID-19 moderada a grave recebendo remdesivir a controles. Resultados: Foram recuperados 207 estudos, dos quais 9 preencheram os critérios de elegibilidade e foram incluídos no estudo. A meta-análise somente dos ECR não mostrou diferenças estatisticamente significativas entre os grupos remdesivir e controle quanto à mortalidade ou ao uso de ventilação mecânica/oxigenação por membrana extracorpórea, e a qualidade das evidências foi moderada e baixa, respectivamente. O uso de remdesivir aumentou a taxa de recuperação em 6% (IC95%: 3-9; p = 0,004) e a taxa de melhora clínica em 7% (IC95%: 1-14; p = 0,02). Além disso, não foram observadas diferenças significativas entre os grupos remdesivir e controle quanto à mortalidade quando a meta-análise concentrou-se apenas nos estudos observacionais de coorte [diferença de risco = −0,01 (IC95%: −0,02 a 0,01); p = 0,32; qualidade das evidências: moderada], e o risco de eventos adversos foi de 4% (IC95%: −0,08 a 0,01; p = 0,09). Conclusões: O uso de remdesivir no tratamento de pacientes com COVID-19 moderada a grave não teve impacto significativo em desfechos clinicamente importantes.

ABSTRACT Objective: Studies in the literature regarding the use of remdesivir to treat COVID-19 patients have shown conflicting results. This study sought to answer questions related to the use of remdesivir for the treatment of patients hospitalized with moderate to severe COVID-19. Methods: This was a systematic review and meta-analysis including phase 3 randomized clinical trials (RCTs) and observational cohort studies selected from various databases, comparing patients hospitalized with moderate to severe COVID-19 receiving remdesivir and controls. Results: A total of 207 studies were retrieved, 9 of which met the eligibility criteria and were included in the study. The meta-analysis using RCTs alone showed no statistically significant differences regarding mortality or use of mechanical ventilation/extracorporeal membrane oxygenation between remdesivir and control groups, and the quality of evidence was moderate and low, respectively. The use of remdesivir increased the recovery rate by 6% (95% CI, 3-9); p = 0.004) and the clinical improvement rate by 7% (95% CI, 1-14); p = 0.02). Additionally, no significant differences in mortality were found between remdesivir and control groups when the meta-analysis used observational cohort studies alone (risk difference = −0.01 (95% CI, −0.02 to 0.01; p = 0.32), the quality of evidence being moderate, and the risk of adverse events was 4% ([95% CI, −0.08 to 0.01]; p = 0.09). Conclusions: The use of remdesivir for the treatment of patients with moderate to severe COVID-19 had no significant impact on clinically important outcomes.

https://doi.org/10.36416/1806-3756/e20210393

Brazilian guidelines for the treatment of outpatients with suspected or confirmed COVID-19. A joint guideline of the Brazilian Association of Emergency Medicine (ABRAMEDE), Brazilian Medical Association (AMB), Brazilian Society of Angiology and Vascular Surgery (SBACV), Brazilian Society of Geriatrics and Gerontology (SBGG), Brazilian Society of Infectious Diseases (SBI), Brazilian Society of Family and Community Medicine (SBFMC), and Brazilian Thoracic Society (SBPT)
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Falavigna, Maicon

; Belli, Karlyse Claudino

; Barbosa, Alexandre Naime

; Zavascki, Alexandre Prehn

; Nastri, Ana Catharina de Seixas Santos

; Santana, Christiane Machado

; Stein, Cinara

; Gräf, Débora Dalmas

; Cadegiani, Flavio Adsuara

; Guimarães, Hélio Penna

; Monteiro, José Tadeu

; Ferreira, Juliana Carvalho

; de Azevedo, Luciano Cesar Pontes

; Magri, Marcelo Mihailenko Chaves

; Sobreira, Marcone Lima

; Dias, Maria Beatriz Gandra de Souza

; de Oliveira, Maura Salaroli

; Corradi, Mirian de Freitas Dal Ben

; Rosa, Regis

; Heinzelmann, Ricardo Souza

; da Silva, Rosemeri Maurici

; Belfort Junior, Rubens

; Cimerman, Sergio

; Colpani, Verônica

; Veiga, Viviane Cordeiro

; de Carvalho, Carlos Roberto Ribeiro

Brazilian Journal of Infectious Diseases

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2022, Volume 26 Nº 2 elocation 102347

Resumo: En | Texto: En | PDF: En

ABSTRACT Background Several therapies have been used or proposed for the treatment of COVID-19, although their effectiveness and safety have not been properly evaluated. The purpose of this document is to provide recommendations to support decisions about the drug treatment of outpatients with COVID-19 in Brazil. Methods A panel consisting of experts from different clinical fields, representatives of the Brazilian Ministry of Health, and methodologists (37 members in total) was responsible for preparing these guidelines. A rapid guideline development method was used, based on the adoption and/or adaptation of recommendations from existing international guidelines combined with additional structured searches for primary studies and new recommendations whenever necessary (GRADE-ADOLOPMENT). The rating of quality of evidence and the drafting of recommendations followed the GRADE method. Results Ten technologies were evaluated, and 10 recommendations were prepared. Recommendations were made against the use of anticoagulants, azithromycin, budesonide, colchicine, corticosteroids, hydroxychloroquine/chloroquine alone or combined with azithromycin, ivermectin, nitazoxanide, and convalescent plasma. It was not possible to make a recommendation regarding the use of monoclonal antibodies in outpatients, as their benefit is uncertain and their cost is high, with limitations of availability and implementation. Conclusion To date, few therapies have demonstrated effectiveness in the treatment of outpatients with COVID-19. Recommendations are restricted to what should not be used, in order to provide the best treatment according to the principles of evidence-based medicine and to promote resource savings by aboiding ineffective treatments.

https://doi.org/10.1016/j.bjid.2022.102347

10.

Human monkeypox preparedness in Latin America – Are we ready for the next viral zoonotic disease outbreak after COVID-19?
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Cimerman, Sergio

; Chebabo, Alberto

; Cunha, Clovis Arns da

; Barbosa, Alexandre Naime

; Rodríguez-Morales, Alfonso J.

Brazilian Journal of Infectious Diseases

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2022, Volume 26 Nº 3 elocation 102372

Resumo: En | Texto: En | PDF: En

https://doi.org/10.1016/j.bjid.2022.1023721413-8670

11.

Vertical transmission of maternal COVID-19 antibodies after CoronaVac vaccine: A case report
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Menegali, Bruno Thizon

; Schuelter-Trevisol, Fabiana

; Barbosa, Alexandre Naime

; Izidoro, Talita Menegali

; Feurschuette, Otto Henrique May

; Marcon, Chaiana Esmeraldino Mendes

; Trevisol, Daisson José

Revista da Sociedade Brasileira de Medicina Tropical

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2021, Volume 54 elocation e0385-2021

Resumo: En | Texto: En | PDF: En

Abstract The use of coronavirus disease 2019 RNA vaccines in pregnant women led to reports on the first cases of newborns with antibodies to sudden acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a phenomenon that was unknown when using immunizations with inactivated viruses. Thus, this study aimed to report a case of passive anti-SARS-CoV-2 immunity in a newborn through immunoprophylaxis of a pregnant woman who received the CoronaVac® vaccine in the third trimester of pregnancy. Twenty-four hours after delivery, samples were collected from the newborn and screened by enzyme immunoassays, which revealed antibodies to SARS-CoV-2.

https://doi.org/10.1590/0037-8682-0385-2021 90 downloads

12.

Risk factors for leptospirosis and brucellosis in people living with human immunodeficiency virus who attended a referral hospital in southeastern Brazil
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Brito, Flavio Gonçalves

; Menozzi, Benedito Donizete

; Mantovan, Karine Bott

; Barbosa, Alexandre Naime

; Victória, Cassiano

; Langoni, Helio

; Silva, Rodrigo Costa da

Revista da Sociedade Brasileira de Medicina Tropical

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2021, Volume 54 elocation e0076-2021

Resumo: En | Texto: En | PDF: En

Abstract INTRODUCTION: Leptospirosis and brucellosis cause immunosuppression that worsens the clinical condition of people living with HIV/AIDS (PLWHA). We investigated the serological profile and risk factors of PLWHA. METHODS: Serum samples (n=238) were researched for Brucella spp. antibodies using Rose Bengal and tube agglutination tests and Leptospira spp. antibodies using the microscopic agglutination test. RESULTS: All samples were negative for Brucella spp. For leptospirosis, four samples (1.69%) were positive, and Andamana was the prevalent serovar. CONCLUSIONS: Low or no detection of these zoonoses does not reduce their importance in PLWHA. Vigilant, educational, and preventive measures should be adopted.

https://doi.org/10.1590/0037-8682-0076-2021 91 downloads

13.

Honey bee envenoming in Santa Catarina, Brazil, 2007 through 2017: an observational, retrospective cohort study
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Oliveira, Suzana Kniphoff de

; Trevisol, Daisson José

; Parma, Gabriel Cremona

; Ferreira Júnior, Rui Seabra

; Barbosa, Alexandre Naime

; Barraviera, Benedito

; Schuelter-Trevisol, Fabiana

Revista da Sociedade Brasileira de Medicina Tropical

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2019, Volume 52 elocation e20180418

Resumo: En | Texto: En | PDF: En

Abstract INTRODUCTION: We evaluated the epidemiological and clinical profile of reported cases of bee sting incidents in Santa Catarina, Brazil. METHODS: This retrospective cohort study included all reported cases of bee sting incidents among the population of Santa Catarina from 2007 to 2017. RESULTS: In total, 8,912 cases were reported, corresponding to an overall rate of 12.3/100,000 population. The mean age was 29,8 years with 60.2% men. The lethality rate was 0.2%. CONCLUSIONS: Santa Catarina has a high incidence rate of bee stings, which is higher than the national average. The data presented in this study may be underestimated.

https://doi.org/10.1590/0037-8682-0418-2018 742 downloads

14.

A clinical trial protocol to treat massive Africanized honeybee (Apis mellifera) attack with a new apilic antivenom
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Barbosa, Alexandre Naime

; Boyer, Leslie

; Chippaux, Jean-Philippe

; Medolago, Natalia Bronzatto

; Caramori, Carlos Antonio

; Paixão, Ariane Gomes

; Poli, João Paulo Vasconcelos

; Mendes, Mônica Bannwart

; Santos, Lucilene Delazari dos

; Ferreira Jr, Rui Seabra

; Barraviera, Benedito

Journal of Venomous Animals and Toxins including Tropical Diseases

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2017, Volume 23 elocation 14

Resumo: En | Texto: En | PDF: En

Abstract Background Envenomation caused by multiple stings from Africanized honeybees Apis mellifera constitutes a public health problem in the Americas. In 2015, the Brazilian Ministry of Health reported 13,597 accidents (incidence of seven cases per 100,000 inhabitants) with 39 deaths (lethality of 0.25%). The toxins present in the venom, which include melittin and phospholipase A2, cause lesions in diverse organs and systems that may be fatal. As there has been no specific treatment to date, management has been symptomatic and supportive only. Methods In order to evaluate the safety and neutralizing capacity of a new apilic antivenom, as well as to confirm its lowest effective dose, a clinical protocol was developed to be applied in a multicenter, non-randomized and open phase I/II clinical trial. Twenty participants with more than five stings, aged more than 18 years, of both sexes, who have not previously received the heterologous serum against bee stings, will be included for 24 months. The proposed dose was based on the antivenom neutralizing capacity and the number of stings. Treatment will be administered only in a hospital environment and the participants will be evaluated for a period up to 30 days after discharge for clinical and laboratory follow-up. Results This protocol, approved by the Brazilian regulatory agencies for ethics (National Commission for Ethics on Research – CONEP) and sanitation (National Health Surveillance Agency – ANVISA), is a guideline constituted by specific, adjuvant, symptomatic and complementary treatments, in addition to basic orientations for conducting a clinical trial involving heterologous sera. Conclusions This is the first clinical trial protocol designed specifically to evaluate the preliminary efficacy and safety of a new antivenom against stings from the Africanized honeybee Apis mellifera. The results will support future studies to confirm a new treatment for massive bee attack that has a large impact on public health in the Americas.

https://doi.org/10.1186/s40409-017-0106-y 773 downloads

15.

The absence of the human platelet antigen polymorphism effect on fibrosis progression in human immunodeficiency virus-1/hepatitis C virus coinfected patients
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Picelli, Natália

; Tanikawa, Aline Aki

; Grotto, Rejane Maria Tommasini

; Silva, Giovanni Faria

; Barbosa, Alexandre Naime

; Ferrasi, Adriana Camargo

; Silveira, Liciana Vaz de Arruda

; Pardini, Maria Inês de Moura Campos

Revista da Sociedade Brasileira de Medicina Tropical

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Ago 2015, Volume 48 Nº 4 Páginas 406 - 409

Resumo: En | Texto: En | PDF: En

AbstractINTRODUCTION:Hepatic fibrosis progression in patients with chronic hepatitis C virus infections has been associated with viral and host factors, including genetic polymorphisms. Human platelet antigen polymorphisms are associated with the rapid development of fibrosis in HCV-monoinfected patients. This study aimed to determine whether such an association exists in human immunodeficiency virus-1/hepatitis C virus-coinfected patients.METHODS:Genomic deoxyribonucleic acid from 36 human immunodeficiency virus-1/hepatitis C virus-coinfected patients was genotyped to determine the presence of human platelet antigens-1, -3, or -5 polymorphisms. Fibrosis progression was evaluated using the Metavir scoring system, and the patients were assigned to two groups, namely, G1 that comprised patients with F1, portal fibrosis without septa, or F2, few septa (n = 23) and G2 that comprised patients with F3, numerous septa, or F4, cirrhosis (n = 13). Fisher's exact test was utilized to determine possible associations between the human platelet antigen polymorphisms and fibrosis progression.RESULTS:There were no deviations from the Hardy-Weinberg equilibrium in the human platelet antigen systems evaluated. Statistically significant differences were not observed between G1 and G2 with respect to the distributions of the allelic and genotypic frequencies of the human platelet antigen systems.CONCLUSION:The greater stimulation of hepatic stellate cells by the human immunodeficiency virus and, consequently, the increased expression of transforming growth factor beta can offset the effect of human platelet antigen polymorphism on the progression of fibrosis in patients coinfected with the human immunodeficiency virus-1 and the hepatitis C virus.

https://doi.org/10.1590/0037-8682-0152-2015 1279 downloads

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