Victor Hugo Melo

Maternal antiretroviral drugs during pregnancy and infant low birth weight and preterm birth

Objective:To determine the relationship between maternal antiretroviral regimens during pregnancy and adverse infant outcomes [low birth weight (LBW) and preterm birth]. The a priori hypothesis was that protease inhibitor (PI)-containing regimens are associated with an increased risk of LBW and preterm birth. Design:Prospective cohort study of HIV-1-infected women and their infants (NISDI Perinatal Study). Methods:Data were analysed from 681 women receiving at least one antiretroviral drug [in order of increasing complexity: one or two nucleoside reverse transcriptase inhibitors (1–2 NRTI), two NRTI plus one non-nucleoside reverse transcriptase inhibitor (NNRTI) (HAART/NNRTI), or two NRTI plus one PI (HAART/PI)] for at least 28 days during pregnancy, and who delivered live born, singleton infants with known birth weight and gestational age by 1 March 2005. Multivariable logistic regression modeling was used to assess the relationship of maternal ART with LBW and with preterm birth, adjusting for covariates. Results:The incidence of LBW and preterm birth, respectively, was 9.6% and 7.4% (1–2 NRTI), 7.4% and 5.8% (HAART/NNRTI), and 16.7% and 10.6% (HAART/PI). There was no statistically significant increased risk of LBW [adjusted odds ratio (AOR), 1.5; 95% confidence interval (95% CI), 0.7–3.2] or preterm birth (AOR, 1.1; 95% CI, 0.5–2.8) among women who received HAART/PI compared with women receiving 1–2 NRTI. Conclusions:Among a population of HIV-1-infected women in Latin America and the Caribbean, maternal receipt of PI-containing ART regimens during pregnancy was not associated with a statistically significant increase in risk of LBW or preterm birth.

Cervical intraepithelial neoplasia recurrence after conization in HIV-positive and HIV-negative women

To evaluate the recurrence rates of cervical intraepithelial neoplasia (CIN) in a cohort of HIV‐infected and noninfected women who underwent the loop electrosurgical excision procedure (LEEP).

Comparison of HPV genotyping by type-specific PCR and sequencing

Human papillomavirus (HPV) infection is the most common sexually transmitted disease worldwide and there is a strong link between certain high-risk viral types and cervical carcinogenesis. Although there are several typing methods, it is still unclear which test is the best. This study compared the effectiveness of type-specific PCR (TS-PCR) and sequencing, with a focus on their clinical application. A total of 260 cervical samples from HPV-positive patients were tested for types 6, 11, 16, 18, 31, 33 and 35 using TS-PCR and sequencing. The genotype was identified in 36% of cases by TS-PCR and in 75% by sequencing. Sequencing was four times more likely to identify the viral type in positive samples than TS-PCR (p = 0.00). Despite being more effective for virus genotyping, sequencing was unable to identify viral types in multiple infections. Combining both techniques resulted in highly sensitive detection (87% of cases), showing that they are complementary methods. HPV genotyping is an important step in HPV management, helping to identify patients with a higher risk of developing cervical cancer and contributing to the development of type-specific vaccines.

Anal HPV prevalence and associated factors among HIV-seropositive men under antiretroviral treatment in Brazil.

Background:The incidence of anal cancer has increased in developed countries. There is evidence that high-grade anal intraepithelial neoplasia and anal cancer are both linked to some human papillomavirus (HPV) infections. There are scarce data on anal cancer or male anal HPV infection in Brazil. Objective:The purpose of this study was to assess the prevalence of anal HPV infection and associated risk factors, stratified by oncogenic and nononcogenic types, in a sample of HIV-seropositive men in Brazil. Methods:Multicenter cross-sectional study of HIV-seropositive male patients attending public AIDS clinics in urban Brazil. Participants were interviewed for sociodemographic and behavioral characteristics. Anal HPV specimens were collected with a moistened Dacron swab inserted into the anal and stored in ThinPrep solution. HPV DNA-positive samples were typed by dot-blot hybridization. The prevalences of oncogenic and nononcogenic HPV types were calculated and multinomial logistic regression was used to assess independent predictors of HPV infection. Results:Among 445 men, 65.6% were positive for HPV DNA in the anal canal. Oncogenic types were detected in 40.7%. Logistic regression indicated that lifetime history of sexual intercourse only with men or with men and women; receptive anal intercourse in the last 12 months; and CD4+ lymphocyte count below 200 cells per cubic millimeter were independently associated with the detection of anal HPV infection. Conclusions:The high prevalence of anal HPV infection in this cross-sectional study underscores the need for studying and implementing screening programs of high-risk groups in Brazil.

Perfil das gestantes infectadas pelo HIV atendidas em pré-natal de alto risco de referência de Belo Horizonte

OBJECTIVES: identify HIV infected pregnant women in a referral center and investigate characteristics related to infection and parity. METHODS: a cross-sectional study comprising all HIV infected women treated at the High Risk Prenatal Care in the Hospital das Clinicas da Universidade Federal de Minas Gerais, in 2004. Demographic data, HIV epidemiology infection and obstetrical history were collected. For statistical analysis SPSS 12.0 was used. RESULTS: eighty five women median aged 29.1 and 90 pregnancies were followed-up. In 55 pregnancies (61.1%) women had prior information of the infection. Sixty four (71.1%) informed they lived together. Probably they all acquired HIV in heterosexual relations. Fifty four (60%) were diagnosed during one of the pregnancies. The global pregnancies median was 3.5, and 1.71 following diagnosis. Patients with prior diagnosis had a higher pregnancy median as compared to those who were diagnosed during their pregnancies (p = 0.002). Eighty six pregnant women made use of anti-retroviral medication, 56.7% through therapeutic indication. No vertical transmission cases were determined. CONCLUSIONS: new pregnancies in HIV infected women are not rare notwithstanding contraceptive resources offered. Therefore, further investigations are necessary to identify what difficulties not previously approached they have during routine medical assistance.

Associação entre a contagem de linfócitos T CD4+ e a gravidade da neoplasia intra-epitelial cervical diagnosticada pela histopatologia em mulheres infectadas pelo HIV

OBJETIVO: avaliar a associacao entre a contagem de linfocitos T CD4+ e a gravidade da neoplasia intra-epitelial cervical em pacientes HIV positivas. METODOS: estudo transversal no qual foram incluidas 87 pacientes infectadas pelo HIV, confirmado por testes sorologicos previos. Todas eram portadoras do HPV cervical, diagnosticado por meio da reacao em cadeia da polimerase. Foram realizados anamnese, exame fisico e colposcopia de todas em pacientes. A biopsia do colo uterino foi realizada quando indicada pelo exame colposcopico. Os resultados histopatologicos foram classificados com neoplasia intra-epitelial de baixo grau (NIC I) ou de alto grau (NIC II e II). A associacao entre a contagem de linfocitos T CD4+ e a gravidade da lesao foi verificada por meio da comparacao de medias utilizando a analise da variância (ANOVA). RESULTADOS: entre as 60 pacientes biopsiadas foram encontrados 24 casos (40,0%) com NIC I, oito (13,3%) NIC II, tres (5%) NIC III, 14 (23,3%) pacientes somente com cervicite cronica e 11 (18,3%) apresentando efeito citopatico produzido pelo HPV, mas sem perda da polaridade celular. Isso equivale a 35 mulheres com lesao intra-epitelial de baixo grau (NIC I + HPV) (58,3%) e 11 (18,3%) com lesao intra-epitelial de alto grau (NIC II + NIC III). A associacao entre a media da contagem de linfocitos T CD4+ e a gravidade da lesao intra-epitelial cervical nao foi significativa (p=0,901). CONCLUSOES: nao houve associacao entre a contagem de linfocitos T CD4+ e a gravidade da lesao intra-epitelial do colo uterino, diagnosticada pelo exame histopatologico.

Prevalência do papilomavírus humano e seus genótipos em mulheres portadoras e não-portadoras do vírus da imunodeficiência humana

Purpose: to estimate the prevalence of HPV and its genotypes in HIV-infected and non-infected women, using the Polymerase Chain Reaction (PCR) technique. Methods: a sectional study with 79 enrolled women: a study group, with 41 HIV-infected women, and a control group, with 38 non-infected women attended at a Basic Health Unit. All were submitted to a serologic test for the detection of HIV and spontaneously looked for gynecological attendance at those units, for the first time. They answered a standard questionnaire and were submitted to a gynecological examination with a cervical swab and specimen for the detection of DNA-HPV and its genotypes. Statistical analysis was performed using Kruskal-Wallis, χ 2 or Fisher’s exact tests. Statistical significance was considered at p<0.05. Results: the demographic characteristics, obstetric and

Behavior Surveillance: Prevalence and Factors Associated with High-Risk Sexual Behavior Among HIV-Infected Men in Brazil in the Post-HAART Era

A cross-sectional analysis was conducted to describe unsafe sexual practices among HIV-infected men under care in two Brazilian urban areas. Data were collected by face-to-face interviews. Twenty-five percent practiced unprotected sex in the previous year, 16% were abstinent, 33% had sex with men only, 45% with women only, 48% had male/female stable partners, 84% were on HAART and 48% had AIDS. Illicit drug use, number of female partners, having stable partners, and STD diagnosis were associated with unsafe sex. Interventions to reduce risk taking behavior among HIV-positive men under care in these settings are urgent, especially among heterosexual stable couples

Prevalence and Risk Factors Associated With Anal Intraepithelial Neoplasia Among HIV-Positive Men in Brazil

Objective This study aimed to assess the prevalence of, and associated factors with, anal intraepithelial neoplasia (AIN) among HIV-positive men evaluated at public health services in Brazil. Materials and Methods This is a multicenter cross-sectional study of HIV-positive male patients attending 6 public AIDS referral clinics in urban Brazil. Participants were interviewed for sociodemographic and behavioral characteristics. Anal swab specimens were collected for anal cytology and HPV DNA testing using L1 polymerase chain reaction. Univariate and multivariate analyses were performed to evaluate risk factors associated with the presence of low-grade squamous intraepithelial lesion (LSIL) and/or high-grade squamous intraepithelial lesion (HSIL). Results Anal swabs were collected from 343 participants. Prevalence of LSIL/HSIL was 24.8%. The majority (60.1%) reported sexual intercourse with both men and women in their lifetime. At least 36.7% had 1 or more oncogenic HPV types. Four variables were independently associated with the presence of LSIL/HSIL in multivariate analysis: history of sex with both men and women (odds ratio [OR] = 4.8) or men only (OR = 6.2) compared with those having sex with women only; current cigarette smoking (OR = 2.2); current CD4+ level between 200 and 500 cells/mm3 (OR = 2.9) or below 200 cells/mm3 (OR = 3.8) compared with CD4+ level above 500 cells/mm3; and presence of oncogenic anal HPV infection (OR = 9.6). Conclusions We found a high prevalence of AIN among HIV-positive men in Brazil. This population may serve as an important bridge population to women with implications for anogenital HPV infection in both men and women. Our findings confirm the need to assess screening programs for AIN among high-risk groups, similar to those used to prevent cervical cancer.

Prevalence and risk factors for cervical intraepithelial neoplasia among HIV-infected women.

OBJECTIVES To evaluate the prevalence and the risk factors for cervical intraepithelial neoplasia (CIN) among HIV-infected women. METHODS Cross-sectional study of 494 HIV-infected women in Brazil, between 1998 and 2008. Gynecologic exam was performed, and samples were collected for cervical cytology and for HPV DNA detection. Cervical biopsy was carried out when indicated. HPV infection, CD4 T-lymphocyte count and HIV viral load were compared with cervical histopathology. Univariate and multivariate statistical analyses were performed to evaluate the statistical association of several risk factors. RESULTS CIN prevalence detected by histopathology was 23.4% (6% of CIN2/3 and 17.4% cases of CIN1). Multivariate analysis confirmed an independent association of CIN with CD4 T-lymphocyte count below 200 cells/mm³ (OR 5.0, 95% CI 2.5-10.1), with a positive detection of HPV DNA (OR 2.0, 95% CI 1.2-3.5), and with age < 34 years old (OR 1.5, 95% CI 1.0-2.4). HIV viral load and antiretroviral use were not independent risk factors for CIN. CONCLUSIONS Severity of immunosuppression, presence of HPV infection and younger age are strong predictors of CIN among HIV-infected women.