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ABSTRACTIn the past few decades, several emerging/re-emerging mosquito-borne flaviviruses have resulted in disease outbreaks of public health concern in the tropics and subtropics. Due to cross-reactivities of antibodies recognizing the envelope protein of different flaviviruses, serosurveillance remains a challenge. Previously we reported that anti-premembrane (prM) antibody can discriminate between three flavivirus infections by Western blot analysis. In this study, we aimed to develop a serological assay that can discriminate infection or exposure with flaviviruses from four serocomplexes, including dengue (DENV), Zika (ZIKV), West Nile (WNV) and yellow fever (YFV) viruses, and explore its application for serosurveillance in flavivirus-endemic countries. We employed Western blot analysis including antigens of six flaviviruses (DENV1, 2 and 4, WNV, ZIKV and YFV) from four serocomplexes. We tested serum samples from YF-17D vaccinees, and from DENV, ZIKV and WNV panels that had been confirmed by RT–PCR or by neutralization assays. The overall sensitivity/specificity of anti-prM antibodies for DENV, ZIKV, WNV, and YFV infections/exposure were 91.7%/96.4%, 91.7%/99.2%, 88.9%/98.3%, and 91.3%/92.5%, respectively. When testing 48 samples from Brazil, we identified multiple flavivirus infections/exposure including DENV and ZIKV, DENV and YFV, and DENV, ZIKV and YFV. When testing 50 samples from the Philippines, we detected DENV, ZIKV, and DENV and ZIKV infections with a ZIKV seroprevalence rate of 10%, which was consistent with reports of low-level circulation of ZIKV in Asia. Together, these findings suggest that anti-prM antibody is a flavivirus serocomplex-specific marker and can be employed to delineate four flavivirus infections/exposure in regions where multiple flaviviruses co-circulate.

Untreated HIV infection leads to severe immunodeficiency and can be associated with an accelerated aging process and a higher prevalence of frailty. Systemic changes are known to cause greater oral manifestations and decreased orofacial function. However, there is no investigation on Temporomandibular Disorders (TMD) in this population. This study aims to assess the prevalence of TMD in individuals living with HIV/AIDS. This cross-sectional study included HIV patients, with undetectable plasma viral load, under follow-up in the infectious disease's outpatient clinic at the Federal University of Bahia hospital. We recorded socio-demographic data, Fried's frailty criteria, Research Diagnostic Criteria for Temporomandibular Disorder, and Beck's Depression Inventory (BDI) through the application of structured questionnaires and extra-oral examination findings. Data analysis was conducted on SPSS-v18. The sample consisted of 198 patients. The prevalence of TMD was (33.8 %), most affecting females (46.6 %). Difficulty in opening the mouth and parafunctional habits were the main symptoms of the disease, as well as functional limitations. The mean of the BDI score was higher in TMD group than in those without TMD (11.01 ± 8.61 vs. 7.60 ± 7.52 valor de p = 0.004). Logistic regression showed an association between sex (OR=2.305, 95 % CI 1.243‒4.275) and depression (OR = 1.045, 95 % CI 1.005‒1.087) and TMD in HIV patients. The present study observed the prevalence of symptoms associated with TMD as difficulty opening the mouth, muscle fatigue, and joint noises in patients with chronic HIV and associated with depression. Highlights the importance of a broader view of the health of individuals living with HIV.

Summary: We report an autochthonous case of mild unifocal chronic pulmonary paracoccidioidomycosis in a 48-year-old previously healthy woman with no history of possible environmental exposures in endemic rural areas, supposedly resulting from reactivation of a latent pulmonary focus secondary to the use of methotrexate for the control of Chikungunya arthropathy. Laboratory investigation ruled out other immunosuppression. Her only symptoms were a dry cough and chest pain. Diagnosis confirmed by needle lung biopsy. There were no abnormalities on physical examination nor evidence of central nervous system involvement. MRI of the total abdomen showed no involvement of other organs. Computed chest tomography showed a favorable evolution under the use of itraconazole (200 mg/day). Different tomographic presentations findings are highlighted when performed before and after treatment. Conclusions: PCM should be considered even in a woman without a history of consistent environmental exposure and in a non-endemic geographic area.

Abstract Background Dengue virus (DENV) is the leading cause of arboviral diseases in humans worldwide. Currently Dengvaxia, the first dengue vaccine licensed in 20 countries, was recommended for DENV seropositive individuals aged 9–45 years. Studying dengue seroprevalence can improve our understanding of the epidemiology and transmission dynamics of DENV, and facilitate future intervention strategies and assessment of vaccine efficacy. Several DENV envelope protein-based serological tests including IgG and IgG-capture enzyme-linked immunosorbent assays (ELISAs) have been employed in seroprevalence studies. Previously DENV IgG-capture ELISA was reported to distinguish primary and secondary DENV infections during early convalescence, however, its performance over time and in seroprevalence study remains understudied. Methods In this study, we used well-documented neutralization test- or reverse-transcription-polymerase-chain reaction-confirmed serum/plasma samples including DENV-naïve, primary and secondary DENV, primary West Nile virus, primary Zika virus, and Zika with previous DENV infection panels to compare the performance of three ELISAs. Results The sensitivity of the InBios IgG ELISA was higher than that of InBios IgG-capture and SD IgG-capture ELISAs. The sensitivity of IgG-capture ELISAs was higher for secondary than primary DENV infection panel. Within the secondary DENV infection panel, the sensitivity of InBios IgG-capture ELISA decreased from 77.8% at 20 years (p

Introdução/Objetivo: A maioria dos casos pediátricos de COVID-19 é leve, porém casos graves podem ocorrer. No Brasil ocorreram mais de 300 óbitos em em crianças e adolescentes, no ano de 2022, destacando a necessidade da vacinação. Este ensaio clínico avaliou imunogenicidade e segurança da vacinação de crianças e adolescentes, de 3 a 17 anos, com a vacina inativada (Coronavac) contra o SARS-Cov2 com grupo controle que recebeu a vacina BNT162b2 (Pfizer). Métodos: Ensaio clínico de não inferioridade para avaliar imunogenicidade e segurança da vacina inativada (Coronavac/Butantan) em crianças de 3 a 17 anos, com braço randomizado, duplo-cego de comparação com imunizante BNT/Pfizer. Os participantes (5-17 anos) do braço randomizado foram divididos em dois grupos (2:1) e receberam vacina Coronavac/Butantan ou BNT162b2 (Pfizer). Todos receberam duas doses com intervalo de 28 dias. Foram coletadas amostras nos tempos: pré-vacinação, 28 dias, 3 meses, 6 meses e 12 meses após segunda dose. Para determinação quantitativa de anticorpos contra a porção Receptor Binding Domain - RBD da proteína Spike do SARS-CoV-2 foi empregado o ensaio de eletroquimioluminescência do tipo sanduíche-duplo denominado Anti-SARS-CoV-2 S da Abbott. Considerou positivo ≥50 AU/mL ou 7,1 BAU/mL. O tamanho da amostra considerou análise de não inferioridade, taxa de soroconversão, poder de estudo de 80%, erro alfa de 5% e perdas de 30% (160 indivíduos por grupo). Resultados: Foram incluídas 1.125 crianças de 3 a 17 anos, sendo 460 de 5 a 17 anos no braço randomizado (293 no grupo Coronavac e 167 no grupo Pfizer). Não houve eventos adversos moderados ou graves em nenhum grupo. A frequência geral de eventos adversos locais ou sistêmicos foi menor no grupo Coronavac em comparação à Pfizer. Os eventos sistêmicos foram mais comuns em crianças de 3-4 anos. A soroconversão foi 100% em todos os grupos, com títulos médios geométricos significativamente maiores após a vacinação. Coronavac foi não inferior a BNT/Pfizer para induzir soroconversão de anticorpos (anti-RBD IgG-S) mas a BNT/Pfizer induz títulos maiores de IgG-S comparado com Coronavac, na faixa etária de 5-17 anos. Conclusão: A Coronavac foi menos reatogênica e não inferior à BNT/Pfizer na indução de soroconversão de anticorpos anti-RBD IgG-S. Ambas as vacinas foram seguras, sem eventos adversos graves ou moderados. Estudo registrado no ClinicalTrials.gov NCT05225285.

Introdução/Objetivo: O Projeto Curumim é um estudo de não inferioridade, sobre eficácia, imunogenicidade e segurança da vacina inativada (Coronavac) contra SARS-CoV-2, em crianças e adolescentes de 3 a 17 anos, comparado a vacina BNT162b2 (Pfizer), com um braço randomizado e um braço aberto (sem cegamento, administrando Coronavac). O braço aberto surgiu da demanda de pais que, desconfortáveis em vacinar as crianças com a Pfizer, optaram pela Coronavac, plataforma vacinal com vírus inativado, mais conhecida. O objetivo deste trabalho é divulgar a hesitação vacinal que ocorreu entre familiares de uma coorte de crianças e adolescentes, com a vacina contra COVID-19. Métodos: Os participantes (5-17 anos) do braço randomizado foram divididos em dois grupos (2:1) e receberam vacina Coronavac/Butantan ou BNT162b2 (Pfizer). Os participantes do braço aberto receberam apenas a Coronavac. Foram aplicadas 2 doses dos imunizantes, com intervalo de 28 dias. Este estudo está registrado no ClinicalTrials.gov NCT05225285. Resultados: Foram incluídos 1125 participantes de 3 a 17 anos. Destes, 460 maiores de 5 anos de idade, elegíveis para a randomização, entretanto, 119 (25%) optaram pelo braço aberto, para receber a vacina Coronavac, por uma recusa dos familiares a vacina BNT162B2 (Pfizer). Hesitação vacinal é o atraso ou recusa em aceitar as vacinas recomendadas, quando elas estão disponíveis nos serviços de saúde. O Programa Nacional de Imunização (PNI) do Brasil é um modelo exitoso por fornecer ampla quantidade de vacinas forma gratuita a população, mas desde 2016 vem enfrentando quedas nas suas coberturas. A divulgação de notícias falsas sobre as vacinas contra COVID-19 causou uma desconfiança na população, especialmente referente às novas plataformas de imunização, como as vacinas de RNAm. Esse fenômeno causou uma quebra da confiança da população, causando inclusive queda nas taxas de vacinação de outras doenças imunopreviníveis. A cobertura vacinal contra COVID-19 em crianças no Brasil ainda é baixa e movimentos contrários a falsas notícias sobre vacinas são necessários, para melhor adesão à vacinação. Conclusão: Nesta coorte, houve uma recusa em receber a vacina da Pfizer em 25% das famílias dos participantes maiores de 5 anos de idade. É de extrema importância conhecer o fenômeno de hesitação vacinal, para que sociedades médicas, pesquisadores e gestores se mobilizem em busca de maiores coberturas vacinais contra COVID-19 e outras doenças imunopreviníveis.

Introdução/Objetivo: O objetivo deste estudo foi investigar os fatores associados às mudanças da terapia antirretroviral (TARV) inicial dos indivíduos acompanhados no serviço de referência estadual em Salvador, Bahia. Métodos: Estudo longitudinal, incluindo todas as PVHIV, maiores de 18 anos, matriculadas no Centro Estadual Especializado em Diagnóstico, Assistência e Pesquisa (CEDAP) em 2017 e em uso de TARV. Foram analisadas mudanças ocorridas até 31/12/2022. Os dados foram extraídos dos prontuários e de sistemas nacionais (SISCEL e SICLOM). Foram coletados variáveis epidemiológicas, clínicas, tratamento, motivo da troca, adesão suficiente (superior a 80% das retiradas de ARV na farmácia), sucesso virológico na troca (carga viral inferior a 50 cópias/mL) e óbito. Este estudo foi aprovado pelo Comitê de Ética em Pesquisa da Sesab. Resultados: Foram incluídos 493 indivíduos em TARV. A idade média foi 36,8±10,8 anos e variou de 18 a 73 anos. Prevaleceu o sexo masculino (64,1%), autodeclarados negros e pardos (84,6%), com até 8 anos de estudo (48,2%), residentes em Salvador (78,7%). O tempo médio de seguimento foi 154 semanas. A TARV inicial mais frequente foi a combinação de lamivudina (3TC) + tenofovir (TDF) + Dolutegravir (DTG) (60,4%), seguido de 3TC+TDF associado ao Efavirenz (25,0%) ou Atazanavir/ritonavir (4,9%). Ocorreram 173 trocas de esquema inicial, com tempo médio 50 semanas entre o início da TARV e a troca. As mudanças foram menos frequentes na TARV inicial baseada em DTG (15,9%) do que naquela sem DTG (65,1%), com risco 2,4 vezes maior de necessitar mudança na TARV (p < 0,01; IC 2,0 – 2,9). A ocorrência de reações adversas foi o principal motivo para as mudanças (41,0%), respondendo por 23,9% para esquemas baseados em DTG versus 76,1% para outros ARV (p > 0,05). A reação adversa ao DTG ocorreu em 15,2%, com ocorrência de alteração no padrão de sono, peso e tontura. O EFV foi associado a 29,9% de reações como alucinação, alteração no padrão de sono, ansiedade e depressão. Houve associação negativa entre a ocorrência de trocas e insucesso virológico (p < 0,01; IC 1,6-3,9). Foram observados 39 óbitos na amostra e, em 16 casos (41,0%), houve mudança de tratamento. Conclusão: O principal determinante das mudanças de TARV inicial foi a ocorrência de RAM. A maioria dos pacientes mudou a TARV inicial uma única vez. A TARV inicial baseada em DTG reduz a necessidade de mudanças no tratamento e favorece a manutenção do sucesso virológico.

Introdução/Objetivo: A Coorte ECOAH (Estudo de Coorte Ambispectiva em pacientes HIV acompanhados em um centro de referência na Bahia–Brasil, 2001–2030) visa entender a epidemia por HIV na Bahia. Objetivamos descrever a mortalidade das pessoas vivendo com HIV/AIDS (PVHIV) em 20 anos de acompanhamento no CEDAP (Centro Estadual Especializado em Diagnóstico, Assistência e Pesquisa). Métodos: Estudo longitudinal, incluindo todas as PVHIV, maiores de 18 anos, matriculadas no CEDAP, entre 2002 a 2021. Os dados foram obtidos a partir dos registros individuais, com busca ativa de óbito das PVHIV, no Sistema de Informação de Mortalidade com declarações de óbito disponíveis até 31/06/2022. As causas de morte foram agrupadas em 13 categorias baseadas na 10ª edição da Classificação Estatística Internacional de Doenças e Problemas Relacionados com a Saúde. Estudo aprovado pelo Comitê de Ética em Pesquisa da Sesab, com apoio do CNPq (Conselho Nacional de Desenvolvimento Científico e Tecnológico). Resultados: Ocorreram 21.689 matriculas no CEDAP no período. Do total, 61,0% (n = 13.240) relacionavam-se ao HIV/AIDS em maiores de 18 anos e destas, 48,0% (n = 10.508) foram acompanhadas no centro. A taxa de mortalidade geral foi 19,3% (n = 2026), o tempo médio de seguimento 6,1 anos (±3,9) e a média de idade ao morrer 42,9 (±12,6) anos. Em 5,5% dos casos, os óbitos ocorreram no mesmo ano de matrícula. Prevaleceu o sexo masculino (62,4%), solteiros (57,7%), autodeclarados negros e pardos (79,1%), com até 8 anos de estudo (40,7%), residentes em Salvador (70,7%). O óbito foi mais frequente em hospitais (76,2%) e 5,5% dos casos ocorreram no mesmo ano de matrícula, podendo refletir o acesso tardio ao tratamento e/ou cuidados clínicos. A causa básica associada ao HIV/Aids ocorreu em 63,2%, seguida das causas externas (8,8%), neoplasias (5,3%) e doenças cardiovasculares (5,1%). A tuberculose foi a coinfecção mais frequentemente relatada como causa imediata ou associada ao óbito (8,4%). Considerando os óbitos ocorridos a partir de 2020 (n = 310), cerca de 15% foram associados à infecção pelo coronavírus (COVID-19), reflexo do impacto da coinfecção por COVID nas PVHIV. Conclusão: Os resultados relativos à mortalidade das PVHA acompanhadas no centro de referência da Bahia demonstram que as principais causas de morte nessa população ainda são aquelas diretamente relacionadas ao HIV/Aids, a despeito de dados recentes demonstrando uma redução das mortes associadas ao HIV/Aids.

Introdução: O tempo de sobrevida de pacientes após o diagnóstico de aids têm sofrido alterações, com aumento significativo da expectativa de vida. Existem poucos dados epidemiológicos e estudos de evolução clínica no estado da Bahia. Nosso objetivo foi avaliar os fatores associados à sobrevida das pessoas vivendo com HIV (PVHIV) em 20 anos de acompanhamento no centro de referência estadual, Salvador, Bahia. Método: Trata-se de um estudo de coorte ambispectiva, incluído PVHIV, maiores de 18 anos, matriculadas no CEDAP entre 2002-2020, Salvador (Bahia), randomizados após mapeamento dos motivos de matrícula no centro. Durante a consulta clínica de rotina, as PVHIV foram convidadas para participar da coorte com assinatura do Termo de Consentimento Livre e Esclarecido no período de 2018 a 2022. Utilizou-se o cálculo amostral simples, com nível de confiança de 95% e erro amostral de 5%. Os dados foram analisados com o programa SPSS (versão 20.0), através de estatística descritiva e inferencial. Para análise de sobrevida foram utilizadas curva de Kaplan Meier e teste long-rank. Este estudo foi aprovado pelo Comitê de Ética em Pesquisa da Sesab e foi realizado com apoio do CNPq. Resultados: A amostra randomizada foi composta por 155 PVHIV matriculados no período de 2002 a 2020. A média de idade foi 36,2 anos (±10,5), com predomínio do sexo masculino (60,0%), solteiros (44,4%), autodeclarados negros e pardos (91,1%) e residentes em Salvador (95,6%). O tempo médio de seguimento foi de 9,2 (±7,0) anos. Na ocasião da matrícula, 68,4% estavam sintomáticos, 34,2% tiveram diagnóstico de Aids e 13,5% diagnóstico de tuberculose (TB); a média da contagem de linfócitos T CD4 pré-TARVc foi de 220,6 cél/mm3 (±193,4) e 45,8% apresentaram CV superior a 100.000 cp/mL no momento pré-tratamento. Ao longo do seguimento, a incidência de TB foi de 21,9% (2,4 casos de TB/100 pessoas-ano. Os indivíduos avaliados usaram, em média, 4 esquemas ARV; 21,9% já falharam o tratamento (2,4 falhas/100 pessoas-ano) e 38,1% já abandonaram TARV (4,1 abandonos/100 pessoas-ano). A taxa de mortalidade foi de 25,8% (2,8 óbitos/100 pessoas-ano). A sobrevida foi menor em indivíduos com CV pré tarv > 100.000 cp/mL (p < 0,05) e história de abandono do tratamento (p

Introdução/Objetivo: A hepatite A é uma doença infectocontagiosa causada pelo vírus da hepatite A (HAV), que é transmitido mormente via fecal-oral, incluindo sexo oral-anal. Entre usuários de profilaxia pré-exposição ao HIV (PrEP HIV) no Brasil, dos quais 83% são gays e HSH, recomenda-se avaliar a susceptibilidade ao HAV por sorologia para fins de prevenção. Este estudo teve por objetivo avaliar a prevalência de anticorpos Anti-HAV IgG/total entre gays e HSH em uso de PrEP HIV e caracterizar suas práticas sexuais. Métodos: Estudo transversal, realizado entre agosto/2021 e junho/2023, envolvendo gays e HSH ≥ 18 anos, usuários de PrEP HIV, atendidos no principal Serviço de Atendimento Especializado (SAE) do Rio Grande do Norte. Através de um instrumento de coleta padronizado, coletaram-se dados do prontuário sobre aspectos socioeconômicos, práticas sexuais e o resultado da sorologia Anti-HAV IgG/total. O tamanho amostral foi calculado em 185 participantes, com base em prevalência prévia de 62,3% de Anti-HAV IgG/total entre HSH, limite de confiança de ± 7%, erro tipo-α = 5% e erro tipo-β = 20%. Os resultados foram apresentados em proporções e seus intervalos de confiança de 95%. O estudo foi aprovado no comitê de ética sob CAAE n° 31650520.0.2005.5292. Resultados: Participaram do estudo 287 usuários (49,5% daqueles atualmente atendidos no SAE). A mediana de idade foi de 31 anos [IQ = 27-36). Declararam-se negros em 53,7% [43,9-62,7%] e brancos em 45,3% [39,7-50,9%]. Em sua maioria, eram solteiros (82,6% [78,4-86,8%]), residentes em Natal (76,7% [71,8-81,5%]) e homens cis (98,6% [97,2-100%]), tinham > 11 anos de estudo (87,8% [84,0-91,6%]) e renda ≤ 3 salários mínimos (59,9% [54,0-65,5%]). Na inclusão do estudo 64,5% [54,0-75,3%] já usavam PrEP HIV há, pelo menos, 6 meses. Em 62,4% [56,4-68,4%] dos participantes, os anticorpos Anti-HAV IgG/total foram reagentes. Sexo anal desprotegido foi relatado por 83,9% [79,0-88,0%] dos usuários. Em algum momento da vida, frequentar sauna foi relatado por 39,0% [33,1-45,3%], usar sex toys com parcerias em 22,3% [17,4-27,9%] e praticar fisting em 19,9% [15,3-25,1%] dos usuários. Práticas de fingering e sexo oral-anal em algum momento da vida foram relatados por 59,9% [54,0-65,2%] e 92,7% [89,2-95,5%], respectivamente. Conclusão: A prevalência de imunidade contra o HAV entre a população de gays e HSH em uso de PrEP HIV está abaixo dos níveis estimados (> 70%) necessários para impedir transmissão viral sustentada e futuros surtos.

Introduction: COVID-19 can trigger different clinical presentations in distinct population groups, some of which are considered at higher risk of SARS-CoV-2 infection. Little is known about the susceptibility of certain populations to the infection. Objectives: We aimed to determine the prevalence of COVID-19 among People Living With HIV/AIDS (PLWH) attending a tertiary public hospital in Salvador, Brazil, patients with active pulmonary tuberculosis and Hospital's Healthcare Workers (HCW), and to compare their SARS-CoV-2 antibody levels. Methods: In this observational study we included 2294 participants from June 9, 2020 to August 10, 2021. IgG SARS-CoV-2 antibodies from all participants (275 PLWH, 42 with active tuberculosis and 1977 healthcare workers) were measured. Prevalence of COVID-19 and antibodies indexes were compared across groups. Results: We detected a higher prevalence of COVID-19 in patients with active tuberculosis (42.9%) than in PLWH (22.5%) or HCW (11.7%). Previously vaccinated participants with a COVID-19 history had median higher IgG antibody indexes (8.2; IQR: 5.5‒10) than those vaccinated who did not have COVID-19 until the time of this study (4.1; IQR: 1.6‒6.2, p < 0.001). Conclusion: Prevalence of previous SARS-CoV-2 infection was higher among tuberculosis patients than that found in HCW and PLWH, but antibodies levels were similar across groups.

Background: Excessive weight gain is a current concern among People Living with HIV (PLHIV) starting ART. Objectives: To evaluate the weight gain after 48-weeks of ART in naive patients, according with baseline CD4 count. Methods: PLHIV starting 3TC + TDF + DTG with at least 48-weeks of follow up in two AIDS referral centers were stratified by baseline CD4 count (lower or higher than 200 cells/mm3). Data on CD4 count, HIV viral load, weight/Body Mass Index (BMI), lipids and glucose levels were collected at baseline, 24 and 48 weeks of treatment. For analysis purpose, patients were categorized according to their BMI progression. Results: A total of 270 patients were included in the study. Mean CD4 count were 78.3 ± 61.7 and 536.7 ± 273 cells/mm3 for low and high CD4 count groups, respectively (p < 0.001). Baseline BMI was significantly lower in low CD4 group (21.7 vs. 23.6 Kg/m2, p < 0.001). Patients in low CD4 group gained more weight than those in high CD4 group (11.2 ± 8.5 kg vs. 2.2 ± 4.2 Kg, p = 0.004). Overall weight gain was higher in women, regardless group (13.1 ± 7.9 Kg vs. 1.4 ± 3.6 Kg for women and men, respectively, p < 0.001). The proportion of overweight/obesity significantly increased in low CD4 group. Viral suppression rate was high for both groups. At week 48 the overall proportion of overweight/obesity was like that reported for the Brazilian population. Conclusions: Weight gain in the present study indicates a “return to health” phenomenon. Excessive weight gain was more frequent in women.

The number of people living with HIV / AIDS in the world has increased and, in Salvador, Brazil, the mortality rate is above the state and national rates. This study sought to describe the characteristics of HIV patients who died in a referral hospital. This is a retrospective cohort study between 2012 and 2017 conducted at the, Federal University of Bahia´s Hospital, involving patients who died during hospitalization. There were 62 deaths among the 461 hospitalized patients with a predominance of males, blacks, and residents of Salvador. Mean age was 41.4 years. Most patients had at least one associated infection and 13% had a malignant neoplasm. The main reported cause of death was septic shock / HIV-associated infections. About 6.4% had an undetectable viral load and in-hospital survival was longer in this group. The lowest in-hospital survival was seen in patients presenting with pneumonia. Although the HIV / AIDS mortality rate at this center reflects the complexity of the country's epidemiological scenario poor adherence and therapeutic failure play a key role in the risk of death.

Objective: To retrospectively investigate the cause of recurring tuberculosis (rcTB) among participants with pulmonary TB recruited from a prospective population-based study conducted between July 2012 and December 2015. Methods: Mycobacterium tuberculosis complex isolates obtained from rcTB cases were characterized by standard mycobacterial genotyping tools, whole-genome sequencing, and phylogenetic analysis carried out to assess strain relatedness. Results: The majority (58.3%, 21/36) of study participants with rcTB episodes had TB recurrence within 12 months post treatment. TB strains with isoniazid (INH) resistance were found in 19.4% (7/36) of participants at the primary episode, of which 29% (2/7) were also rifampicin-resistant. On TB recurrence, an INH-resistant strain was found in a larger proportion of participants, 27.8% (10/36), of which 40% (4/10) were MDR-TB strains. rcTB was attributed to relapse (same strain) in 75.0% (27/36) of participants and 25.0% (9/36) to re-infection. Conclusion: Our findings indicate that previous unresolved infectiondue to inadequate treatment, may be the major cause of rcTB.

Background: Brazil is the third country most affected by Coronavirus Disease 2019 (COVID-19) in the world. Health care workers (HCWs) are at higher risk of infection. Despite the increasing numbers of studies on the topic, There are gaps in the knowledge of characteristics and risk factors for infection of HCWS. This information is important to design preventive strategies and to mitigate the disease impact. The objective of this study was to estimate the incidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, to identify factors associated, and to describe symptoms reported by healthcare workers at a tertiary hospital in Salvador, Brazil. Methods: All HCWs were evaluated in a cross-sectional study conducted between May and September 2020, using self-administered questionnaires, and screening all participants for SARS-COV-2 IgG and IgM antibodies by rapid tests. Reactive IgG samples were retested by ELISA and IgM-positive test had a saliva sample retest by RT-PCR. Univariate associations were estimated by a non-adjusted incidence proportion ratio. Variables associated with COVID-19 incidence at p < 0.20 were selected for inclusion in a binary logistic regression model. Results: A total of 2083 HCWs were included, mean age 41±10 years, 71.8% women, and 77.8% non-white. Of these, 271 (13.0%) and 25 (1.2%) HCWs tested positive for IgG and IgM SARS-CoV-2 antibodies, respectively, and three had a positive RT-PCR. Ancillary work [Odds Ratio (OR): 4.96], elementary education (OR: 2.91), high school education (OR: 2.89), and catholic religion (OR: 2.16) were associated with an increased likelihood of a positive IgG antibodies against SARS-CoV-2. Anosmia [Incidence Proportion Ratio (IPR): 7.41] and ageusia (IPR:8.51) were the most frequent associated symptoms. Conclusion: HCWs with low mean family income, lower level of schooling, ancillary workor being black had a significantly higher likelihood of testing positive for SARS-CoV-2 antibodies. Social vulnerability was an important risk factor for COVID-19 infection.

Background: There is scarce information on the human immune response to the SARS-CoV-2 infection, and on the exacerbated inflammatory reaction observed in severe COVID-19 cases. Objective: To review the available evidence on the role of interferons type I and type III to SARS-CoV-2 infection. Methods: We reviewed the available published evidence on the role of immune response to SARS-CoV-2 infection as well as recent publications on characteristics and outcomes of COVID-19, and their relationship with interferons type I and type III. Results: The available data indicates that immune response plays an important role in controlling SARS-CoV-2 infection and the immune dysregulation can significantly modify the clinical outcomes of affected patients. In addition, the evidence suggests that IFN type I and III can play an important role in controlling viremia and modulating the immune response in COVID-19. Conclusions: Due to their central role in immune response against SARS-CoV-2 infection, IFN type I and III could be considered for treatment of COVID-19.

Background: Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is the cause of Coronavirus Disease 2019 (COVID-19). Although Real Time Reverse Transcription Polymerase Chain Reaction (qRT-PCR) of respiratory specimens is the gold standard test for detection of SARS-CoV-2 infection, collecting nasopharyngeal swabs causes discomfort to patients and may represent considerable risk for healthcare workers. The use of saliva as a diagnostic sample has several advantages. Objectives: The aim of this study was to validate the use of saliva as a biological sample for diagnosis of COVID-19. Methods: This study was conducted at Infectious Diseases Research Laboratory (LAPI), in Salvador, Brazil. Participants presenting with signs/symptoms suggesting SARS-CoV-2 infection underwent a nasopharyngeal swab (NPS) and/or oropharyngeal swab (OPS), and saliva collection. Saliva samples were diluted in PBS, followed by RNA isolation and RT-Real Time PCR for SARS-CoV-2. Results of conventional vs saliva samples testing were compared. Statistical analyses were performed using Statistical Package for the Social Sciences software (SPSS) version 18.0. Results: One hundred fifty-five participants were recruited and samples pairs of NPS/OPS and saliva were collected. The sensitivity and specificity of RT-PCR using saliva samples were 94.4% (95% CI 86.4–97.8) and 97.62% (95% CI 91.7–99.3), respectively. There was an overall high agreement (96.1%) between the two tests. Conclusions: Use of self-collected saliva samples is an easy, convenient, and low-cost alternative to conventional NP swab-based molecular tests. These results may allow a broader use of molecular tests for management of COVID19 pandemic, especially in resources-limited settings.

Background: The heterogeneity in detection rates of Human immunodeficiency virus, (HIV), Human T lymphotropic virus (HTLV) and Hepatitis B and C infections among pregnant women and the continuous exposure to risk factors limits the adoption of preventive and control actions. Objective: To evaluate the HIV, HTLV, Hepatitis B and C seroprevalence rates, and associated risk factors in parturient women in Salvador, Brazil. Methods: This was a cross-sectional study in 2099 parturient women attended in two public maternity hospitals in Salvador, Brazil. One blood sample was drawn for serological screening and socio-demographic, obstetric and clinical data were collected. Results: HIV seroprevalence rate was 1.5% (of which 0.6% were new cases); seroprevalence rates for HTLV, HBV, and HCV were 0.4%, 0.4%, and 0.1%, respectively. Univariate analysis showed a significant association between socio-demographic and behavioral factors with retroviral infections, while viral hepatitis was mainly associated with parenteral exposure. In a multivariate analysis, multiple sexual partners (OR 3.3; 95% CI: 1.1–9.2), history of sexual/domestic violence (OR 2.8; 95% CI: 1.1–6.9), syphilis co-infection (OR 2.6; 95% CI: 1.0–6.9), use of alcohol or drugs (OR 2.5; 95% CI: 1.2–5.5), and low schooling level (OR 2.3; 95% CI: 1.1–4.9) were independent risk factors for HIV infection. History of stillbirth and low birth weight infants was significantly associated with HTLV positive status, showing a negative impact on gestation. Conclusions: The seroprevalence rates for HIV, HCV, HBV, and HTLV were similar to that found in previous studies in other Brazilian regions. The high individual, socioeconomic, and social vulnerability detected in seropositive parturient women indicates the need to improve coverage and effectiveveness of STDs control with prevention, detection and monitoring strategies, focusing in pregnant women exposed to high biopsychosocial risk.

A eficácia não inferior a longo prazo do regime de 2 medicamentos foi demonstrada em estudos de 144 semanas em virgens de tratamento e pacientes experimentados com um bom perfil de segurança e uma alta barreira à resistência. Avaliamos a eficácia e segurança da mudança para combinação de dose fixa DTG/3TC em adultos com HIV-1 em uso de qualquer regime antirretroviral (CAR) atual. SALSA é um estudo randomizado, controlado e aberto. Os participantes com RNA de HIV-1 6 meses em um esquema de 3/4DR sem falha virológica anterior ou mutações associadas à resistência a inibidor da transcriptase reversa de nucleosídeo (NRTI) ou DTG foram randomizados 1:1 (estratificado pela classe de terceiro agente da linha de base ) para mudar para DTG/3TC ou continuar CAR por 52 semanas. O desfecho primário foi a proporção de participantes com RNA de HIV-1 plasmático ≥50 c/mL na semana 48 (população exposta por intenção de tratamento ; falha virológica instantânea). Estimativas e intervalos de confiança foram baseados em análise estratificada usando o teste Cochran-Mantel-Haenszel ajustados para a terceira classe de agente da linha de base. No geral, 493 participantes foram randomizados (59% brancos; 39% mulheres; 39% com idade ≥50 anos; 50%/40%/10% com não NRTI/inibidor da integrase/inibidor da protease no início do estudo). DTG/3TC não foi inferior ao CAR contínuo na semana 48 usando análise de falha virológica instantânea (DTG / 3TC, 1/246 [0,4%]; CAR, 3/247 [1,2%]; diferença de tratamento ajustada [IC de 95%], -0,8% [-2,4%, 0,8%]); os resultados foram consistentes com a análise de resposta virológica instantânea (DTG/3TC, 232/246 [94,3%]; CAR, 229/247 [92,7%]; diferença de tratamento ajustada [IC de 95%], 1,6% [-2,8%, 5,9% ]). Nenhuma retirada virológica confirmada ou resistência observada ocorreu em nenhum dos grupos. Os resultados gerais de segurança foram comparáveis entre os grupos DTG/3TC e CAR quanto à frequência de quaisquer eventos adversos (AEs; 73% vs 70%), AEs que levam à retirada (2% vs 1%) e AEs graves (3% vs 6% ), respectivamente. Conclusão: No SALSA, a mudança para DTG/3TC foi não inferior à continuação da CAR na manutenção da supressão virológica na semana 48, com um perfil de segurança consistente com as bulas de DTG e 3TC. Ao longo de 48 semanas, o esquema com 2DR (DTG/3TC) oferece uma opção de troca com menos drogas antirretrovirais em comparação com 3/4DRs tradicionais, sem aumento do risco de falha virológica ou resistência.

Introdução/Objetivo: A hepatite E é uma doença negligenciada no Brasil. O HEV pode ser transmitido pela via fecal-oral, sanguínea e zoonótica a partir principalmente de suínos, e pode ocasionar doença crônica em pacientes imunocomprometidos. O objetivo deste estudo é determinar a soroprevalência e a prevalência de infecção do HEV em Salvador-BA em diferentes populações: (1) candidatos à doação de sangue, (2) pacientes imunocomprometidos e (3) criadores de suínos. Métodos: O desenho do estudo é de corte transversal. Os candidatos à doação de sangue foram recrutados na Fundação HEMOBA, os pacientes imunocomprometidos (pacientes transplantados, pacientes com doença inflamatória intestinal e pacientes com infecção pelo HIV) no Complexo Hospitalar Universitário Professor Edgar Santos (HUPES) e no Hospital São Rafael (HSR) e os criadores de suínos registrados na Agência Estadual de Defesa Agropecuária da Bahia (ADAB). Os dados foram coletados através de entrevistas e revisão do prontuário médico, e uma amostra de sangue foi coletada para a pesquisa dos anticorpos anti-HEV IgG e IgM (Wantai), dosagem das transaminases séricas AST e ALT (Wiener lab) e detecção do HEV RNA. Nos casos com viremia confirmada, o HEV RNA será sequenciado para análise filogenética dos isolados virais humanos e dos suínos. Resultados: Dados preliminares foram analisados dos 279 candidatos a doação de sangue e 35 transplantados de medula óssea (TMO) recrutados até o momento. A maioria dos candidatos a doação de sangue e pacientes TMO foram do sexo masculino (53% e 66%, respectivamente), sendo que a idade média dos candidatos a doação (32,6 anos) foi inferior a dos pacientes TMO (41,9 anos), enquanto o nível de escolaridade foi mais alto (ensino médio completo/superior incompleto ou completo, 93% e 53%, respectivamente). A taxa de inaptidão para doação de sangue foi de 19%, sendo que neste grupo houve um predomínio de pessoas do sexo feminino. Do total de participantes a soroprevalência estimada para o anti-HEV IgG 12,3% (10/81) nos candidatos a doação de sangue e 3% (1/30) nos pacientes TMO. Nenhuma amostra testada foi soropositiva para anti-HEV IgM. Conclusão: Apesar dos dados ainda serem preliminares, alguns participantes já foram expostos ao HEV. Na perspectiva de uma Saúde Única, este estudo pretende contribuir sobre o conhecimento da saúde humana, da saúde animal, do ambiente e apontar para a adoção de políticas públicas efetivas para prevenção e controle da hepatite E.

Introdução: Os principais desafios enfrentados pelos serviços de saúde para o enfrentamento das infecções sexualmente transmissíveis, estão relacionados a oferecer garantia de acesso aos direitos de cidadania, melhor qualidade de vida, acesso ao tratamento e aconselhamento. No que concerne a região norte, em especial a metrópole Belém, o processo de urbanização deflagrou contradições de diversas ordens conforme a cidade cresceu. Os locais mais afastados foram ocupados pelas populações de menor renda, o que refletiu diretamente em situações de vulnerabilidade social que estão atreladas a um maior risco de desenvolvimento de agravos a saúde, dentre esses as infecções sexualmente transmissíveis. Objetivo: avaliar fatores de risco de exposição as infecções sexualmente transmissíveis em populações atendidas em diversas unidades de saúde de cidade de Belém (Pará). Método: no período de setembro de 2020 até agosto de 2021 foram entrevistados 822 pacientes, atendidos em unidades municipais de saúde de Belém, usando um questionário epidemiológico contendo as seguintes informações: idade, renda, cor, escolaridade, exposição a infecções sexualmente transmissíveis. Resultados: Dos pacientes acompanhados nos diversos serviços de saúde no presente estudo, 580 (70,5 %) eram do sexo feminino e 242 (29,4 %) do sexo masculino, 548 (66,6 %) vivem com até um salário mínimo, 353 (42,9 %) tem mais de 1 filho, 464 (56,4 %) não trabalham. Quanto a escolaridade, 549 (66,7 %) possuem mais de 8 anos de estudos, em relação a exposição a IST 86 (10,4%) referiram já ter apresentado alguma IST, destes 81(9,8%) referiram já ter tratado ou estar tratando sífilis (9,8%). Conclusão: Os resultados demonstram que dentro de uma mesma região metropolitana existe um misto de características que estão intimamente relacionadas as diversas vulnerabilidades, que quando avaliadas unicamente é possível denotar perfis populacionais e grau de exposição a riscos à saúde diferentes, sendo necessário a reorganização da assistência à saúde e descentralização destes serviços para áreas periféricas, bem como a realização de testagem em massa, para se verificar a real incidência das infecções e, assim estabelecer estratégias de assistência à saúde focais com o objetivo de reduzir os altos índices destas infecções.

Background: Effective antiretroviral therapy (ART) has increased life expectancy for HIV patients to levels close to that observed for general population. Comorbidities are also increasing, due to ageing of such population. Erectile dysfunction (ED) has been a frequent finding in men living with HIV. Objectives: The goals of the present study were to define the prevalence of ED and associated factors in HIV-infected men, in a referral center of Salvador city, Brazil. Methods: HIV-infected men ≥18 years of age, receiving care at the AIDS Clinics of Complexo Hospitalar Professor Edgard Santos (C-HUPES), Universidade Federal da Bahia were consecutively included in the study until the estimated sample size (N = 134) was reached. Patients filled a structured questionnaire on clinical-epidemiological characteristics, as well as the International Index on Erectile Function to assess ED. Results: Most (55%) were black and single (79%), mean age 44.8 years. ED was detected in 29 (21.6%) patients; 86% of ED cases were classified as severe. The only factors associated with ED were low income (p = 0.02) and unemployment (p = 0.01). No association was found between ED and frequency of comorbidities, age, or ART used by patients. Conclusion: In a referral center in Salvador city, socio-economic problems were the main factors associated with ED. Psychological impact of poor social conditions should be routinely assessed in patients with ED to implement preventive measures for ED. Keywords: Erectile dysfunction, AIDS, Bahia, Risk factors

A previously healthy 20-year-old female presented with extensive retiform purpura located at the face, upper and lower limbs, one week after an episode of acute tonsillitis. Despite the exuberance of the cutaneous findings and progression to skin necrosis she had no accompanying symptoms. Laboratory investigation revealed a heterozygous protein C mutation (exon 9, c.1332G> C, p.Trp444Cys), accounting for a partial deficiency of this anticoagulant protein. The patient was started on broad spectrum antibiotics, anticoagulation and systemic corticosteroids, with no lesional progression and complete resolution of cutaneous ulceration within 6 months. This is a singular case of purpura fulminans, since two different causative factors precipitated the events. The previous tonsillitis reported by the patient is significant, because the serum concentration of protein S may also decrease after an infectious event - post-infectious purpura fulminans. This case illustrates that purpura fulminans due to autoantibodies against protein S, although rare, should be considered, especially in the absence of a severe acute infection. It also illustrates how in a given patient different independent factors can act simultaneously, triggering potentially devastating clinical scenarios.

Background: Over-the-counter use of ivermectin amongst other drugs as SARS-CoV-2 treatment has been increasingly common, despite the lack of evidence on its clinical efficacy. Objective: To evaluate the effect of ivermectin use on production of antibodies against SARS-CoV-2 in health care workers (HCW) diagnosed with COVID-19 and of Th1/Th2 cytokines by stimulated peripheral blood mononuclear cells of the same cohort (PBMCs). Methods: This cross-sectional study evaluated seroconversion and neutralizing antibodies production in HCW at Complexo Hospitalar Universitário Professor Edgard Santos (Salvador, Brazil), diagnosed with COVID-19 from May to July, 2020, as well as in vitro production of antibody against SARS-CoV-2 and Th1/Th2 cytokines. Analyses were performed between December 2020 and February 2021. Participants were stratified according to the use of ivermectin (≤ 1 dose vs. multiple doses) for treatment of COVID-19. Results: 45 HCW were included (62% women). Mean age was 39 years, and disease severity was similar across groups. Neutralizing antibodies were detected less frequently in multiple doses (70%) vs. ≤ 1 dose (97%) groups, p = 0.02). PBMCs of patients in multiple doses group also were less likely to produce antibodies against SARS-CoV-2 following in vitro stimulation with purified spike protein in comparison with patients in ≤ 1 dose group (p

Infection by human T-cell lymphotropic virus type 1 (HTLV-1) occurs in lymphocytes, which travel throughout the body, thus affecting several target organs and causing varied clinical outcomes, particularly in populations that are underserved and do not have access to healthcare. However, the mechanism of pathogenesis is not yet fully understood. The TAX and HTLV-1 basic leucine zipper factor (HBZ) proteins maintain viral persistence and affect pathogenesis through cell proliferation and immune and inflammatory responses that accompany each clinical manifestation. TAX expression leads to inhibition of transcription error control, OX40 overexpression, and cell proliferation in adult T-cell leukemia (ATL). OX40 levels are elevated in the central nervous system (CNS), and the expression of TAX in the CNS causes neuronal damage and loss of immune reactivity among patients with HTLV-1-associated myelopathy (HAM). HBZ reduces viral replication and suppresses the immune response. Its cell compartmentalization has been associated with the pathogenesis of HAM (cytoplasmic localization) and ATL (nuclear localization). TAX and HBZ seem to act antagonistically in immune responses, affecting the pathogenesis of HTLV-1 infection. The progression from HTLV-1 infection to disease is a consequence of HTLV-1 replication in CD4+ T and CD8+ T lymphocytes and the imbalance between proinflammatory and anti-inflammatory cytokines. The compartmentalization of HBZ suggests that this protein may be an additional tool for assessing immune and inflammatory responses, in addition to those already recognized as potential biomarkers associated with progression from infection to disease (including human leukocyte antigen (HLA), killer immunoglobulin-like receptors (KIR), interleukin (IL)-6, IL-10, IL-28, Fas, Fas ligand, interferon (IFN)-γ, tumor necrosis factor (TNF)-α, and mannose-binding lectin).

Erythema multiforme (EM), Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis (TEN) have been reported as possible adverse effects of some classes of first-line antiretroviral drugs (ART) for HIV treatment. Herein we report an unusual presentation of TEN lesions associated with ART in an HIV-infected patient. The patient presented disseminated cutaneous eruption and oral lesions from the lips to the oropharynx region, causing odynophagia and dysphagia. In the tongue, circular, atypical erythematous lesions appeared, increasing in diameter over seven days and coalescing since then to complete remission. TEN treatment included efavirenz interruption, use of methylprednisolone, prophylactic antibiotic, and daily laser therapy with low-intensity red light. The circular oral lesions have not been described yet. Reporting our findings and clinical management may help diagnosing other similar cases and guide the clinical conduct. Analgesia and acceleration of oral ulcer repair with red laser therapy are recommended. Keywords: Toxic epidermal necrolysis, Stevens–Johnson syndrome, Antiretroviral therapy, HIV.

Background: The 36-Item Short Form Health Survey questionnaire (SF-36) is a widely used instrument for evaluating health-related quality-of-life (HRQoL). The psychometric validation of the SF-36 version 2.0 (SF-36v2) in HIV-infected patients had not yet conducted in Brazil. Aim: To test data quality, reliability and validity of the SF-36v2 as a measure of HRQoL among Brazilian individuals living with HIV. Methods: A cross-sectional study included 393 HIV-infected patients in whom HRQoL was assessed by using the SF-36v2 questionnaire. Demographic characteristics, socioeconomic status and clinical data were also collected. The SF-36 version 1 translated into Brazilian-Portuguese was adapted and introduced version 2 improvements according to the instrument developers. SPSS version 21 was used for data analyses. Confirmatory factor analysis (CFA) and structural equation modelling were performed using AMOS SPSS version 18. T-test for independent samples was used to compare differences between mean levels of HRQoL components in different groups. Linear multiple regression techniques were used to analyze the relationship between Physical Component Summary (PCS), Mental Component Summary (MCS) and independent variables. Results: We performed the CFA and tested the hypothetical measurement model. We included five parameters to improve the adherence of data to the model. All indicators met the requirement suggested by specialized literature (χ2 (gl): 980.7 (527); CFI: 0.949; GFI: 0.873; TLI: 0.943; RMSEA: 0.047; 90% IC: 0.042-0.051). Multiple regression analyses revealed that depression (p = 0.001), family income (p = 0.007), sex (p = 0.001) and age (p

The Zika virus outbreak in Latin America resulted in congenital malformations, called congenital Zika syndrome (CZS). For unknown reasons, CZS incidence was highest in northeastern Brazil; one potential explanation is that dengue virus (DENV)–mediated immune enhancement may promote CZS development. In contrast, our analyses of historical DENV genomic data refuted the hypothesis that unique genome signatures for northeastern Brazil explain the uneven dispersion of CZS cases. To confirm our findings, we performed serotype-specific DENV neutralization tests in a case–control framework in northeastern Brazil among 29 Zika virus–seropositive mothers of neonates with CZS and 108 Zika virus–seropositive control mothers. Neutralization titers did not differ significantly between groups. In contrast, DENV seroprevalence and median number of neutralized serotypes were significantly lower among the mothers of neonates with CZS. Supported by model analyses, our results suggest that multitypic DENV infection may protect from, rather than enhance, development of CZS.

Background: Several tools have been developed to evaluate HIV health-related quality of life (HRQoL) during and after antiretroviral therapy (ART). Few longitudinal studies evaluated the effect of ART on the quality of life of HIV patients. Objective: To evaluate changes in HRQoL in HIV-infected individuals one year after initiating ART. Methods: A prospective study was conducted from May 2016 to July 2018. Data on clinical and sociodemographic characteristics of 91 HIV-infected patients were collected prior to initiation of ART and one year thereafter. Demographic and clinical data were collected and the questionnaires 36-item Short Form Health Survey (SF-36) and HIV/AIDS-targeted quality of life (HAT-QoL) were administered in both periods. Asymptomatic individuals, aged ≥18 years, were included in the study. Patients who discontinued treatment were excluded. The association between predictors of physical and mental HRQoL was analyzed by multiple linear regression analysis. Results: Patients were predominantly male (78.0%), mean age 35.3 ± 10.7 years, with no stable relationship (80.2%), and no comorbidities (73.6%). Most of the SF-36 domains improved after one year, particularly Physical Function (p = 0.0001), General Health (p = 0.0001), Social Functioning (p = 0.0001), Mental Health (p = 0.001), and Mental Component Summary (p = 0.004). HAT-QoL domains improved in the Overall Function (p = 0.0001), Life Satisfaction (p = 0.0001), Provider Trust (p = 0.001), and Sexual Function (p = 0.0001) domains. Sex (p = 0.032), age (p = 0.001), income (p = 0.007), and stable relationship (p = 0.004) were good predictors of the Physical Component Summary. Sex (p = 0.002) and stable relationship (p = 0.038) were good predictors of the Mental Component Summary. SF-36 and HAT-QoL scales presented strong correlations, except for Medication Concerns (0.15–0.37), HIV Mastery (0.18–0.38), Disclosure Worries (−0.15 to 0.07), and Provider Trust (−0.07 to 0.15). Conclusions: ART improved HRQoL after one year of use. The HAT-QoL and SF-36 correlated well and are good tools to evaluate HRQoL in HIV-infected patients on ART. Keywords: Health-related quality of life, Antiretroviral Therapy, HIV, Patient Reported Outcome Measures

Highly active antiretroviral therapy (HAART) has significantly improved survival of people living with HIV/Aids (PLWHA). However, poor treatment adherence to HAART and other problems, still cause therapy failure and contribute to increased morbidity and mortality of PLWHA. In this retrospective cohort study (2013–2015), we sought to evaluate the factors associated with mortality of PLWHA failing HAART in 2013, who were receiving care at a reference center for sexually transmitted diseases (STD) and HIV/AIDS. A total of 165 individuals over 18 years of age who were failing antiretroviral therapy were evaluated. In two-year follow-up, 19 (11.5%) deaths were documented. There were a significant association between mortality and report of illicit drug use (53%, p

ABSTRACT Background: Mother-to-child-transmission (MTCT) is the main route of HIV-1 infection in children. Genetic studies suggest HLA-B alleles play an important role on HIV-1 transmission, progression, and control of HIV-1 infection. Objective: To evaluate which polymorphisms of HLA-B are involved in HIV-1 MTCT. Methods: Two independent reviewers performed a systematic review on search engines PubMed, Europe PMC, Cochrane, Scientific Electronic Library Online (SciELO), and Literatura Latino-americana e do Caribe em Ciências da Saúde (Lilacs), using the following key terms: "HIV infection", "HIV newborn", "HLA polymorphisms", "HLA-B", and "Mother to child transmission". All studies focusing on evaluation of HIV-1 MTCT, HIV infection evolution, and molecular analyses of HLA-B in children were selected. Results: Nine studies fulfilled the inclusion criteria. Sixteen HLA-B alleles groups were associated with HIV-1 infection; seven of them (43.8%) were related to slow disease progression or reduced risk of MTCT, while six (37.5%) alleles groups were linked to a faster progression of HIV infection in children and to increased risk of MTCT. The available evidence suggest that HLA-B*57 group allele is associated with slow disease progression, while HLA-B*35 group allele is associated to increased risk of MTCT and rapid disease progression in infected children. The role of HLA-B*18, B*58 and B*44 are still controversial because they were associated to both, protection against MTCT, and to higher HIV replicative capacity, in different studies. Conclusion: HLA-B*57 group allele can be protective against MTCT while HLA-B*35 groups alleles are consistently associated with HIV-1 MTCT.

Background: Class I human leukocyte antigens, especially the molecules encoded at the B locus (HLA-B), are associated with AIDS progression risk. Different groups of HLA-B alleles have been associated to a protective effect or increasing susceptibility to HIV infection and are expressed from the earliest stages of gestation. Objective: The aim of this study was to evaluate which variants of HLA-B are associated with the risk of HIV vertical transmission in infected pregnant women and in their offspring, in a referral center in Salvador Bahia. Methods: We performed HLA-B genotyping in 52 HIV-infected mothers and their children exposed to HIV-1 during pregnancy (N = 65) in Salvador, Brazil. We compared the HLA-B alleles frequency in mothers, uninfected and infected children, according to the use of antiretroviral prophylaxis. Results: Absence of antiretroviral antenatal and postnatal prophylaxis was significantly associated with vertical transmission of HIV-1 (p =

Background: Mother-to-child-transmission (MTCT) is the main route of HIV-1 infection in children. Genetic studies suggest HLA-B alleles play an important role on HIV-1 transmission, progression, and control of HIV-1 infection. Objective: To evaluate which polymorphisms of HLA-B are involved in HIV-1 MTCT. Methods: Two independent reviewers performed a systematic review on search engines PubMed, Europe PMC, Cochrane, Scientific Electronic Library Online (SciELO), and Literatura Latino-americana e do Caribe em Ciências da Saúde (Lilacs), using the following key terms: “HIV infection”, “HIV newborn”, “HLA polymorphisms”, “HLA-B”, and “Mother to child transmission”. All studies focusing on evaluation of HIV-1 MTCT, HIV infection evolution, and molecular analyses of HLA-B in children were selected. Results: Nine studies fulfilled the inclusion criteria. Sixteen HLA-B alleles groups were associated with HIV-1 infection; seven of them (43.8%) were related to slow disease progression or reduced risk of MTCT, while six (37.5%) alleles groups were linked to a faster progression of HIV infection in children and to increased risk of MTCT. The available evidence suggest that HLA-B*57 group allele is associated with slow disease progression, while HLA-B*35 group allele is associated to increased risk of MTCT and rapid disease progression in infected children. The role of HLA-B*18, B*58 and B*44 are still controversial because they were associated to both, protection against MTCT, and to higher HIV replicative capacity, in different studies. Conclusion: HLA-B*57 group allele can be protective against MTCT while HLA-B*35 groups alleles are consistently associated with HIV-1 MTCT. Keywords: “Mother to child transmission”, “HIV”, “HLA-B”

The fast evolution of pathogenic viruses has allowed for the development of phylodynamic approaches that extract information about the epidemiological characteristics of viral genomes. Thanks to advances in whole genome sequencing, they can be applied to slowly evolving bacterial pathogens like Mycobacterium tuberculosis. In this study, we investigate and compare the epidemiological dynamics underlying two M. tuberculosis outbreaks using phylodynamic methods. Specifically, we (i) test if the outbreak data sets contain enough genetic variation to estimate short-term evolutionary rates and (ii) reconstruct epidemiological parameters such as the effective reproduction number.The first outbreak occurred in the Swiss city of Bern (1987–2012) and was caused by a drug-susceptible strain belonging to the phylogenetic M. tuberculosis Lineage 4. The second outbreak was caused by a multidrug-resistant (MDR) strain of Lineage 2, imported from the Wat Tham Krabok (WTK) refugee camp in Thailand into California.There is little temporal signal in the Bern data set and moderate temporal signal in the WTK data set. Thanks to its high sampling proportion (90%) the Bern outbreak allows robust estimation of epidemiological parameters despite the poor temporal signal. Conversely, there is much uncertainty in the epidemiological estimates concerning the sparsely sampled (9%) WTK outbreak. Our results suggest that both outbreaks peaked around 1990, although they were only recognized as outbreaks in 1993 (Bern) and 2004 (WTK). Furthermore, individuals were infected for a significantly longer period (around 9 years) in the WTK outbreak than in the Bern outbreak (4–5 years).Our work highlights both the limitations and opportunities of phylodynamic analysis of outbreaks involving slowly evolving pathogens: (i) estimation of the evolutionary rate is difficult on outbreak time scales and (ii) a high sampling proportion allows quantification of the age of the outbreak based on the sampling times, and thus allows for robust estimation of epidemiological parameters. Keywords: Phylodynamic analysis, Tuberculosis outbreak, Epidemic dynamics, Transmission dynamics

In the pandemic, rapid and accurate detection of SARS-CoV-2 is crucial in controlling the outbreak. Recent studies have shown a high detection rate using saliva/oral fluids as specimens for laboratory detection of the virus. We intended to evaluate the test performance of the Xpert Xpress SARS-CoV-2 cartridge assay in comparison to a conventional qRT-PCR testing, using saliva as biological specimen. Forty saliva samples from symptomatic participants were collected. Conventional qRT-PCR was performed for amplification of E and RdRp genes and the Xpert Xpress SARS-CoV-2 assay amplified E and N2 genes. In the conventional assay, the median cycle threshold value of the E gene was 34.9, and of the RdRp gene was 38.3. In the Xpert Xpress assay, the median cycle threshold value of the E gene was 29.7, and of the N2 gene was 31.6. These results can allow a broaden use of molecular tests for management of COVID-19 pandemic, especially in resources-limited settings.

Introdução: A dermo-hipodermite aguda bacteriana (DHAB) é uma infeção aguda da derme e hipoderme que mais frequentemente atinge os membros inferiores. Apesar de a diabetes mellitus (DM) ser frequentemente apontada como um fator de risco para o seu desenvolvimento, estudos recentes têm questionado tal relação. O objetivo do presente estudo foi comparar as características da DHAB em doentes com e sem diabetes mellitus. Material e Métodos: Estudo prospetivo dos doentes hospitalizados no Serviço de Dermatologia do Centro Hospitalar e Universitário de Coimbra com o diagnóstico de DHAB entre Janeiro e Junho de 2018. Foram avaliados os seguintes parâmetros: 1) dados demográficos / biométricos – género, idade; índice de massa corporal (IMC); 2) aspetos clínico-evolutivos – localização, tempo de evolução dos sintomas até ao diagnóstico, história de episódio prévio de DHBA; diagnóstico prévio de DM; 3) alterações laboratoriais – leucocitose, proteína-C reativa (PCR), pesquisa de microrganismo (sangue, pus de abcesso, exsudato de ferida, conteúdo de bolha); 3) terapêutica – duração da antibioterapia, necessidade de terapêutica de segunda linha, duração do internamento; 4) complicações locais (abcesso, necrose) ou sistémicas (bacteriémia, exantema medicamentoso, descompensação de doença subjacente e morte). Os dados foram analisados com o software SPSS, procurando sobretudo a influência da DM nos distintos parâmetros avaliados. A significância estatística foi definida para p< 0,05. Resultados: Foram incluídos 102 doentes, 55 do género feminino (53,9%) e 47 do masculino (46,1%), com idade média de 68,6 ± 13,9 anos. O membro inferior foi o local mais atingido (73,5%), seguido do membro superior (20,6%) e face (5,9%), tendo a DHBA uma média de 3,1 ± 2,5 dias de evolução dos sintomas à data da hospitalização. Vinte e quatro doentes tinham o diagnóstico de DM (23,5%), seis dos quais insulinotratados (25%). Não foi encontrada diferença estatisticamente significativa entre o grupo de diabéticos e não diabéticos para o género, idade, localização da infeção, tempo de evolução dos sintomas até à hospitalização, nem no valor dos leucócitos circulantes ou da PCR. A pesquisa de microrganismo (sangue, pus de abcesso, exsudato de ferida, conteúdo de bolha) foi positiva em 2/8 diabéticos (25%) e em 15/39 não diabéticos (38,5%) (p=0,138), tendo sido o mesmo o tipo de microrganismo isolado. A antibioterapia inicial – cefoxitina em associação a clindamicina em 64,7% - foi substituída num doente não diabético e em 10 doentes diabéticos (p=0,451) e a duração total do tratamento antibiótico e do internamento entre os grupos foi semelhante. Complicações locais ocorreram em 3 diabéticos (12,5%) e em 15 não diabéticos (19,2%), e complicações sistémicas em 4 diabéticos (16,7%) e em 12 não diabéticos (15,4%), p=0,553 e p=1,000, respetivamente. Conclusão: O presente estudo demonstra que a DM em doentes hospitalizados com diagnóstico de DHAB não se associa a prior prognóstico nomeadamente necessidade de antibioterapia de segunda linha, internamento mais prolongados ou complicações locais ou sistémicas.

Serologic testing remains crucial for Zika virus diagnosis. We found that urea wash in a Zika virus nonstructural protein 1 IgG ELISA distinguishes secondary dengue virus infection from Zika virus infection with previous dengue (sensitivity 87.5%, specificity 93.8%). This test will aid serodiagnosis, serosurveillance, and monitoring of Zika complications in dengue-endemic regions.

We conducted an external quality assessment of Zika virus molecular diagnostic tests in Brazil using a new Zika virus standard. Of 15 laboratories, 73% showed limited sensitivity and specificity. Viral load estimates varied significantly. Continuous quality assurance is required for adequate estimates of Zika virus–associated disease and determination of patient care.

Abacavir can cause a multi-systemic hypersensitivity reaction (HSR) in 5–8% of the patients, which is related to HLA-B*57-01 allele. In Brazil, the HLA-B*57-01 screening test became available only in March 2018, several years after abacavir was in use. In this retrospective study we reviewed medical charts of all patients receiving an abacavir-containing regimen to evaluate the frequency of HSR in patients followed at a referral center in Salvador, Brazil. A total of 192 patients who received abacavir were identified, most male (67.1%), black or racially mixed (77.8%), and having diagnosis of a previous AIDS defining conditions (83.7%). Only one patient developed HSR (incidence: 0.52%). The main reasons for abacavir-containing antiretroviral therapy discontinuation were virological failure (28%), adverse effects to other components of the regimen (25%), and simplification of therapy (16%). The low incidence of HSR to abacavir does not support the use of HLA-B*57-01 screening test, in Salvador, Brazil. Keywords: Hypersensitivity, Antiretroviral, HIV, Abacavir

We describe a case of a 20-month-old girl with probable congenital Zika virus infection and normal neurodevelopment, despite microcephaly and abnormal neuroimaging. This case raises questions about early prognostic markers and draws attention to the need for investigation in suspected Zika cases, even if the child’s early neurodevelopment is normal.

The introduction of highly active antiretroviral therapy marked a major gain in efficacy of HIV/AIDS treatment and a reduction in morbidity and mortality of the infected patients. However, high levels of adherence are required to obtain virologic suppression. In Brazil, the policy of free and universal access to antiretroviral therapy has been in place since 1996, although there are reports of poor adherence. Objective: To define the clinical, demographic and psychological characteristics, and quality of life of patients with HIV/AIDS who present poor adherence to highly active antiretroviral therapy. Methods: This was a cross-sectional study. To be included in the study patients had to be 18 through 65 years old, diagnosed with HIV/AIDS, having the two previous viral loads above 500 copies, a surrogate for poor adherence to antiretrovirals. The following instruments were applied to all eligible patients: the sociodemographic questionnaire “Adherence Follow-up Questionnaire”, the Beck Depression Inventory (BDI-II), the Beck Anxiety Inventory (BAI), and the 36-Item Short Form Survey. Results: 47 patients were evaluated, 70.2% were female, mean age of 41.9 years (±10.5), 46.8% were single, 51.1% self-reported adherence ≥95%, 46.8% mentioned depression as the main reason for not taking the medication, 59.5% presented symptoms of moderate to severe depression, and 44.7% presented symptoms of moderate to severe anxiety. Finally, regarding health-related quality of life these patients obtained low scores in all dimensions, physical component summary of 43.96 (±9.64) and mental component summary of 33.19 (±13.35). Conclusion: The psychological component is considered to be fundamental in the management of HIV/AIDS patients. Psychoeducation should be conducted at the initial evaluation to reduce negative beliefs regarding antiretroviral therapy Assessment of anxiety and depression symptoms should be done throughout therapy as both psycological conditions are associated with patient adherence, success of treatment, and ultimately with patients’ quality of life. Keywords: Highly active antiretroviral therapy, HIV/AIDS, Adherence, Nonadherence, Anxiety, Depression, Quality of life

Antiretroviral therapy for HIV has led to increased survival of HIV-infected patients. However, tuberculosis remains the leading opportunistic infection and cause of death among people living with HIV/AIDS. Tuberculosis has been shown to be a good predictor of virological failure in this group. This study aimed to evaluate the incidence of tuberculosis and its consequences among individuals diagnosed with virological failure of HIV. This was a retrospective cohort study involving people living with HIV/AIDS being followed-up in an AIDS reference center in Salvador, Bahia, Brazil. Individuals older than 18 years with HIV infection on antiretroviral therapy for at least six months, diagnosed with virological failure (HIV-RNA greater than or equal to 1000 copies/mL), from January to December 2013 were included. Tuberculosis was diagnosed according to the criteria of the Brazilian Society of Pneumology. Fourteen out of 165 (8.5%) patients developed tuberculosis within two years of follow-up (incidence density = 4.1 patient-years). Death was directly related to tuberculosis in 6/14 (42.9%). A high incidence and tuberculosis-related mortality was observed among patients with virological failure. Diagnosis of and prophylaxis for tuberculosis in high-incidence countries such as Brazil is critical to decrease morbidity and mortality in people living with HIV/AIDS. Keywords: Tuberculosis, Virological failure, HIV infection

Background: Geographical distribution of HIV variants is an important way to understand the circulation and spread of such viral strains. Objectives: To evaluate the spatial distribution of HIV-1 variants in patients failing antiretroviral therapy, in Salvador, Brazil. Methods: We performed a cross-sectional evaluation of HIV resistance test reports of patients who underwent genotyping tests in a referral center in Salvador, Brazil, for the years 2008–2014. The laboratory database contains around 2500 resistance reports of patients failing antiretroviral therapy. Genotypic tests were performed by sequencing of HIV-1 POL region (TrueGene, Siemens). We assessed HIV-1 resistance mutations and subtype, as well as residential address, age, and gender of patients. Results: We evaluated 1300 reports, 772 (59.4%) of them from male patients. As expected, subtype B predominated (79%) followed by subtypes F1 (6.7%) and BF (6.5%). The most frequent mutations in HIV-1 reverse transcriptase were 184V (79.1%), 41L (33.5%), 67N (30.4%), 103N (42.4%), and 108I (11.1%). Most frequent mutations in HIV-1 protease were 63P (52.4%), 36I (47.9%), 15 V (33.0%), 62 V (28.1%) and 13 V (25.8%). Some mutations (41L, 215Y, 210W) were significantly more frequent among men. We detected a significantly higher accumulation of 103N mutation in specific areas of Salvador. We identified a more restricted circulation pattern for subtype FB (more frequent in some regions), and F1 (almost absent in a specific region). Conclusion: Our results suggest that specific subtypes/resistance mutations present a distinct frequency rate in specific areas of Salvador, probably due to a restricted circulation pattern. This trend to clustering was observed in regions covered by AIDS referral centers, suggesting that pattern of care for such patients can interfere in virological outcomes. Keywords: HIV-1, Resistance mutations, Brazil, Geolocalization

Objective: To evaluate the virological outcomes in children and adolescents infected with HIV-1 in Salvador, Bahia according to genotyping results. Methods: We retrospectively evaluated the rates of virological suppression of children and adolescents submitted to HIV-1 genotyping test from January/2008 to December/2012. The participants were followed in the two referral centers for pediatric AIDS care, in Salvador, Brazil. Resistance mutations, drug sensitivity profiles, and viral subtypes were analyzed using the Stanford HIV-1 Drug Resistance Database. Adherence was estimated by drugs withdrawal at pharmacies of the two sites. Results: 101 subjects were included: 35 (34.6%) were drug-naïve, and the remaining 66 were failing ART. In drug-naïve group, 3 (8.6%), presented with NNRTIs resistance mutations, along with polymorphic mutations to PIs in most (82.8%) of them. Among the failing therapy group, we detected a high frequency (89.4%) of resistance mutations to PIs, NRTI (84.8%), and NNRTI (59.1%). Virological suppression after introduction/modification of genotyping-guided ART was achieved only for patients (53.1%) with drug withdrawal over 95%. Main detected HIV-1 subtypes were B (67.3%), F (7.9), C (1.9%), and recombinant forms (22.9%). Conclusions: Despite the use of genotyping tests in guidance of a more effective antiretroviral regimen, poor adherence to ART seems to be the main determinant of low virological suppression rate for children and adolescents, in Salvador, Brazil. Keywords: Children, Virological suppression, Genotyping, Adherence

Detection of antibodies is widely used for the diagnosis of infections with arthropod-borne flaviviruses including dengue (DENV) and Zika virus (ZIKV). Due to the emergence of ZIKV in areas endemic for DENV, massive co-circulation is observed and methods to specifically diagnose these infections and differentiate them from each other are mandatory. However, serological assays for flaviviruses in general, and for DENV and ZIKV in particular, are compromised by the high degree of similarities in their proteins which can lead to cross-reacting antibodies and false-positive test results. Cross-reacting flavivirus antibodies mainly target the highly conserved fusion loop (FL) domain in the viral envelope (E-) protein, and we and others have shown previously that recombinant E-proteins bearing FL-mutations strongly reduce cross-reactivity. Here we investigate whether such mutant E-proteins can be used to specifically detect antibodies against DENV and ZIKV in an ELISA-format. IgM antibodies against DENV and ZIKV virus were detected with 100% and 94.2% specificity and 90.7% and 87.5% sensitivity, respectively. For IgG the mutant E-proteins showed cross-reactivity, which was overcome by pre-incubation of the sera with the heterologous antigen. This resulted in specificities of 97.1% and 97.9% and in sensitivities of 100% and 100% for the DENV and ZIKV antigens, respectively. Our results suggest that E-proteins bearing mutations in the FL-domain have a high potential for the development of serological DENV and ZIKV tests with high specificity.Emerging Microbes & Infections (2017) 6, e99; doi:10.1038/emi.2017.87; published online 8 November 2017

Background: Infections caused by Chlamydia trachomatis and Neisseria gonorrhoeae are the most common bacterial sexually transmitted infections throughout the world. These sexually transmitted infections are a growing problem in people living with HIV/AIDS. However, the presence of these agents in extra genital sites, remains poorly studied in our country. The objective of this study was to estimate the prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae anal and genital infection in people living with HIV/AIDS followed in a reference center in Salvador, Brazil. Methods: Cross-sectional study, from June 2013 to June 2015. Proven HIV-infected people attending this reference center were invited. Clinical and epidemiological data were obtained through interview with standardized form. Chlamydia trachomatis and Neisseria gonorrhoeae screening was performed using qPCR (COBAS 4800® Roche). Results: The frequency of positive cases of Chlamydia trachomatis and Neisseria gonorrhoeae was 12.3% in total, 9.2% cases amongst women and 17.1% amongst men. We found 14.0% of positive cases in anus and 3.1% in genital region in men, while 5.6% and 3.6%, in women, respectively. Among men, anal infection was associated with age 50 copies/mL (p = 0.020), and no antiretroviral use (p = 0.008). Anal infection in women was associated with age

Intravesical botulinum toxin A (BoNTA) injection has been widely used for the treatment of detrusor overactivity in patients with neurogenic bladder due to spinal cord injury who do not respond to conventional treatment. There is no consensus about antibiotic prophylaxis for this procedure. We conducted a retrospective analysis of medical records of adult patients with spinal cord injury who underwent detrusor BoNTA injection between January of 2007 and December of 2013 in a rehabilitation hospital. Occurrence of symptomatic urinary tract infection (UTI) was assessed in 3 groups in accordance with their use of antibiotics (prophylactic dosage, 3 days, more than 3 days) for the treatment of asymptomatic bacteriuria. All patients were performing self or assisted clean intermittent bladder catheterization and underwent a rigid cystoscopy, under general or regional anesthesia with sedation, and the drug used was Botox®. A total of 616 procedures were performed during the study period. There were 11 identified cases of UTI (1.8%) with a trend to a higher rate in the group that used antibiotics for longer time. This report shows that a single dose of antibiotics before the detrusor BoNTA injection is enough to prevent UTI. Randomized clinical trial should be conducted for definitive conclusions. Keywords: Botulinum toxin, type A, Urinary tract infections, Bacteriuria, Antibiotic prophylaxis