Norma Rubini

Testing Genotypic and Phenotypic Resistance in Human Immunodeficiency Virus Type 1 Isolates of Clade B and Other Clades from Children Failing Antiretroviral Therapy

ABSTRACT The emergence of resistance to antiretroviral drugs is a major obstacle to the successful treatment of human immunodeficiency virus type 1 (HIV-1)-infected patients. In this work, we correlate clinical and virological trends such as viral load (VL) and CD4 counts to genotypic and phenotypic antiretroviral (ARV) resistance profiles of HIV-1 isolates from the B and non-B subtypes found in vertically infected children failing ARV therapy. Plasma samples were collected from 52 vertically HIV-1-infected children failing different ARV therapies. Samples underwent HIV-1 pol sequencing and phenotyping and were clustered into subtypes by phylogenetic analysis. Clinical data from each patient were analyzed together with the resistance (genotypic and phenotypic) data obtained. Thirty-five samples were from subtype B, 10 samples were non-B (subtypes A, C, and F), and 7 were mosaic samples. There was no significant difference concerning treatment data between B and non-B clades. Prevalence of known drug resistance mutations revealed slightly significant differences among B and non-B subtypes: L10I, 21 and 64%, K20R, 13 and 43%, M36I, 34 and 100%, L63P, 76 and 36%, A71V/T, 24 and 0%, and V77I, 32 and 0%, respectively, in the protease (0.0001 ≤ P ≤ 0.0886), and D67N, 38 and 8%, K70R, 33 and 0%, R211K, 49 and 85%, and K219Q/E, 31 and 0%, respectively, in the reverse transcriptase (0.0256 ≤ P ≤ 0.0704). Significant differences were found only in secondary resistance mutations and did not reflect significant phenotypic variation between clade B and non-B.

Pregnancy in HIV vertically infected adolescents and young women: a new generation of HIV-exposed infants.

Background:Vertically infected individuals are reaching childbearing age and the new generation of HIV-exposed infants is coming to pediatric care. Methods:Chart review of pregnancies among HIV vertically infected adolescents and young women. Results:Fifteen pregnancies were reviewed. Girls had HIV diagnosis at median age 10.1 years (range 1.3–20). They started sexual life at median age 15 years (range 13–19); median age at pregnancy was 16.9 years (range 14–21.5); 36.4% had presented an AIDS-defining clinical event; have been followed for median 8.5 years (range 2.9–15.8) and had used median two antiretroviral regimens (range 0–7). Fourteen (93.3%) received antiretroviral drugs during pregnancy; median CD4 cell count during pregnancy was 394 (range 117–651) cells/μl and median viral load was 4800 copies/ml (range 50–100 000); 54% had undetectable viral load near delivery. All patients delivered by elective c-section. Median birth weight was 2650 g (range 2085–3595), median length was 47.3 cm (range 42–51) and median gestational age 38 weeks (range 37–39). All newborn received zidovudine for 6 weeks of life and none was breastfed. Fourteen (93%) infants were considered HIV-uninfected; one was lost to follow-up. Conclusions:This group of adolescents seems to have sexual behavior similar to that of HIV-uninfected. Since this is an experimented antiretroviral population, new drugs may be necessary for adequate viral suppression to avoid HIV mother-to-child transmission. Follow-up of this third generation of HIV-exposed infants needs to be addressed within HIV adolescent care.

Total serum IgE levels and profile sensitization to dust mites in patients with asthma

Background Atopic asthma occurs in a significant percentage of patients in different age groups and the main sensitizing allergens are dust mites. The aim of this study was to assess the levels of total serum IgE, specific IgE to Dermatophagoides pteronyssinus (Dp) and Blomia tropicalis (Bt) in patients with asthma as well as the influence of gender, age and severity of disease in the total serum IgE levels and in the sensitization to mites.

Profile and prognosis of adolescents and adults with primary immunodeficiencies in the public health service in Brazil

Results 33 patients were analyzed: 55% female, 70% Caucasian, 27% Black, and 3% Asian, with ages between 12 and 64 years (mean = 36.7, SD = 11) and length of follow-up between 1 and 17 years (mean = 8.84, SD = 11.29). The profile and frequency of PIDs was as follows: Predominantly antibody deficiencies (55%), Combined immunodeficiencies less profound than generally severe combined immunodeficiency (18%) Combined immunodeficiencies associated with features or syndromic (15%), Complement deficiencies (9%), and Autoinflammatory disorders (3%). The average time between onset of symptoms and diagnosis of PID ranged between 1 and 28 years (mean = 10.83, SD = 7.07). Compliance with treatment was good in 76% of patients, partial in 12% and 12% of treatment dropout. Survival between the onset of clinical manifestations and the end of the study ranged between 1 and 47 years (mean = 21.52, SD =13.79). Throughout the study period, one patient, with Wiskott-Aldrich syndrome and partial adherence to treatment, died due to septicemia and there were two deaths from cardiovascular disease.

Safety of specific subcutaneous immunotherapy in patients with allergic rhinitis

Methods We conducted a retrospective, longitudinal study evaluating patients with AR, over the age of three, who were using SCIT with extracts of D pteronyssinus (Dp) and/or B tropicalis (Bt) (FDA Allergenic). Data were collected through interviews and medical records. The classification of the severity of adverse reactions met the criteria established by the Allergen Immunotherapy: a Practice Parameter Third Update (2011).

Correlation between asthma control and quality of life in patients with moderate and severe asthma

Background The evaluation of the degree of disease control and quality of life of patients with asthma is a challenge for general practitioners and medical specialists. The aim of this study was to assess the degree of disease control and quality of life in patients with moderate and severe asthma in clinical follow-up of Allergy and Immunology clinic as well as comparatively evaluate two instruments for assessing asthma control, versus quality of life evaluation.

Comparative evaluation of the accuracy of skin tests and measurement of mite-specific IgE in patients with allergic rhinitis.

Background The diagnostic investigation of sensitization to dust mites is performed through measurement of specific IgE and cutaneous immediate hypersensitivity tests. The general aim of this study was to comparatively evaluate the diagnostic accuracy of immediate hypersensitivity skin tests and specific IgE for Dermatophagoides pteronyssinus (Dp) and Blomia tropicalis in patients with allergic rhinitis.

Levels of total serum IgE and specific IgE sensitization profile in patients with atopic dermatitis.

Background Atopic dermatitis is a multifactorial disease associated with elevated production of IgE and sensitization to multiple food and inhalant allergens.The aim of this study was to assess the levels of total serum IgE (IgE) and specific IgE (sp IgE ) for Dermatophagoides pteronyssinus (Dp), Blomia tropicalis (Bt), egg white, casein, alpha-lactalbumin and beta-lactoglobulin in patients with atopic dermatitis (AD); and the influence of gender, age and severity of disease in these parameters.

235 Frequency of Patients With Clinical Manifestations of Allergic Rhinitis without Evidence of Systemic Atopy and Specific ige Sensitization.

Background The diagnosis of allergic rhinitis (AR) is based on clinical manifestations and supported by a positive result for skin prick test (SPT) or serum specific immunoglobulin E (sIgE) antibodies to aeroallergens. Our objective was to investigate the frequency of patients with clinical manifestations of AR without evidence of specific IgE sensitization. Methods We evaluated patients with clinical manifestations suggestive of AR, other causes of rhinitis excluded, aged >5 years and who had total serum IgE and SPT or sIgE to aeroallergens measured. Skin tests were performed with extracts of Dermatophagoides pteronyssinus, Dermatophagoides farinae, Blomia tropicalis and Aspergillus fumigatus (FDA Allergenic) and total serum IgE and sIgE, for the same allergens, by ImmunoCAP (Phadia). Patients were subdivided into groups according to the results profile, and comparatively analyzed for association with asthma, severity of rhinitis and age. Results We evaluated 116 patients (64% female) aged between 5 and 79 years, including 34 children (29%) and 63 (54%) with bronchial asthma. The observed profiles and frequencies were: high IgE levels and positivity in the SPT or sIgE –55%; normal IgE levels and SPT or sIgE positivity –9%; high IgE levels and SPT and sIgE negativity –3 %; normal IgE levels and negativity in the SPT and sIgE –23%. Among patients with normal levels of total serum IgE and no evidence of specific IgE sensitization, 14% had asthma, while in the remainder the prevalence of asthma was 34% (P = 0.0009). There was no statistical significance in the influence of the rhinitis severity and age in the absence of markers of atopy and allergen sensitization. Conclusions We observed a significant number of patients with clinical manifestations of AR, without evidence of systemic atopy and specific IgE sensitization, indicating the importance of careful research of local allergic rhinitis, as well as other causes of chronic rhinitis. Local allergic rhinitis appears to be less frequent in patients with rhinitis and asthma. The observation of 13% of patients with elevated levels of total IgE without specific sensitization implies the possibility of sensitization to aeroallergens which were not investigated, such as occupational allergens.