HIV-1 mother-to-child transmission in Brazil (1994-2016): a time series modeling

Abstract HIV-1 mother-to-child transmission (HIV-1 MTCT), is an important cause of children mortality worldwide. Brazil has been traditionally praised by its HIV/Aids program, which provides free-of-charge care for people living with HIV-1. Using public epidemiology and demographic databases, we aimed at modeling HIV-1 MTCT prevalence in Brazil through the years (1994-2016) and elaborate a statistical model for forecasting, contributing to HIV-1 epidemiologic surveillance and healthcare decision-making. We downloaded sets of live births and mothers' data alongside HIV-1 cases notification in children one year old or less. Through time series modeling, we estimated prevalence along the years in Brazil, and observed a remarkable decrease of HIV-1 MTCT between 1994 (10 cases per 100,000 live births) and 2016 (five cases per 100,000 live births), a reduction of 50%. Using our model, we elaborated a prognosis for each Brazilian state to help HIV-1 surveillance decision making, indicating which states are in theory in risk of experiencing a rise in HIV-1 MTCT prevalence. Ten states had good (37%), nine had mild (33%), and eight had poor prognostics (30%). Stratifying the prognostics by Brazilian region, we observed that the Northeast region had more states with poor prognosis, followed by North and Midwest, Southeast and South with one state of poor prognosis each. Brazil undoubtedly advanced in the fight against HIV-1 MTCT in the past two decades. We hope our model will help indicating where HIV-1 MTCT prevalence may rise in the future and support government decision makers regarding HIV-1 surveillance and prevention.

Lactotransferrin gene functional polymorphisms do not influence susceptibility to human immunodeficiency virus-1 mother-to-child transmission in different ethnic groups

Lactotransferrin, also known as lactoferrin, is an iron binding glycoprotein that displays antiviral activity against many different infectious agents, including human immunodeficiency virus (HIV)-1. Lactotransferrin is present in the breast milk and in the female genitourinary mucosa and it has been hypothesised as a possible candidate to prevent mother-to-child HIV-1 transmission. To verify if two functional polymorphisms, Thr29Ala and Arg47Lys, in the lactotransferrin encoding gene (LTF) could affect HIV-1 infection and vertical transmission, a preliminary association study was performed in 238 HIV-1 positive and 99 HIV-1 negative children from Brazil, Italy, Africa and India. No statistically significant association for the Thr29Ala and Arg47Lys LTF polymorphisms and HIV-1 susceptibility in the studied populations was found. Additionally LTF polymorphisms frequencies were compared between the four different ethnic groups.

Multicenter study on the immunogenicity and safety of two recombinant vaccines against hepatitis B

The immunogenicity and safety of a new recombinant hepatitis B vaccine from the Instituto Butantan (Butang®) were evaluated in a multicenter, double-blind, prospective equivalence study in three centers in Brazil. Engerix B® was the standard vaccine. A total of 3937 subjects were recruited and 2754 (70 percent) met all protocol criteria at the end of the study. All the subjects were considered healthy and denied having received hepatitis B vaccine before the study. Study subjects who adhered to the protocol were newborn infants (566), children 1 to 10 years old (484), adolescents from 11 to 19 years (740), adults from 20 to 30 years (568), and adults from 31 to 40 years (396). Vaccine was administered in three doses on the schedule 0, 1, and 6 months (newborn infants, adolescents, and adults) or 0, 1, and 7 months (children). Vaccine dose was intramuscular 10 æg (infants, children, and adolescents) or 20 æg (adults). Percent seroprotection (assumed when anti-HBs titers were > 10mIU/ml) and geometric mean titer (mIU/ml) were: newborn infants, 93.7 percent and 351.1 (Butang®) and 97.5 percent and 1530.6 (Engerix B®); children, 100 percent and 3600.0 (Butang®) and 97.7 percent and 2753.1 (Engerix B®); adolescents, 95.1 percent and 746.3 (Butang®) and 96 percent and 1284.3 (Engerix B®); adults 20-30 years old, 91.8 percent and 453.5 (Butang®) and 95.5 percent and 1369.0 (Engerix B®); and adults 31-40 years old, 79.8 percent and 122.7 (Butang®) and 92.4 percent and 686.2 (Engerix B®). There were no severe adverse events following either vaccine. The study concluded that Butang® was equivalent to Engerix B® in children, and less immunogenic but acceptable for use in newborn infants, adolescents, and young adults.

Genotipo MLB2 materno influencia a transmissao vertical em crianças brasileiras / MLB2 mothers' genotype influences HIV-1 vertical transmission in Brazilian children

O presente estudo analisa os polimorfismos geneticos no primeiro exon MBL2, em um coorte de 21 pares de maes e filhos infectados por HIV-1 e um coorte de 11 pares constituidos por maes infectadas por HIV-1 e filhos nao infectados, na cidade de Recife(PE), localizada no nordeste do Brasil, com objetivo de avaliar se o genotipo MBL2, de maes infectadas por HIV-1 poderia estar relacionado com transmissibilidade do virus para seus conceptos. Todas criancas nasceram de maes infectadas por HIV-1 que nao haviam recebido nenhum tratamento antiretroviral durante a gravidez e não foram submetidas a parto cesareano para prevenir transmissão. Maes que transmitiram HIV-1 a seus conceptos (MT) tinham frequencia mais alta (14 porcento) de genotipo 00 no MBL2(tipico de maus produtores de MBL) se comparado com frequencia de 0 porcento observada entre maes infectadas que transmitiram o virus para seus filhos (MNT). Esta diferença foi estatisticamente significante. A presença do genotipo 0 e 00 no alelo MBL2 em MT se associou com transmissao viral. O genotipo AA de MBL (associado com produçao normal de MBL) teve frequencia de 82 porcento em MNT, significantemente mais alta que a frequencia de 52 porcento de MT. A presença do alelo A em 91 porcento das MNT conferiu menor risco de transmissao vertical no coorte estudado. Nossos resultados sugerem que a transmissao vertical de HIV-1 depende somente do genotipo MBL2 da crianca e da mae, nas quais os niveis da proteina MBL poderiam desempenhar um importante papel na transmissao do virus

Serological and virological markers for hepatitis band c infection in children and teenagers under cancer treatment

Crianças adolescêntes com câncer têm fatores de risco adicionais para adquirir e remover as infecções por HBV e HCV, no períododo tratamento do câncer, o qual pode estar relacionados a procedimentos clínicos invasivos e o estado de imunossupressão relacionado com tratamento quimioterápico, respectivamente. Nosso objetivos foram investigar a situação de crianças e adolescêntes sob tratamento oncológico pediátrico, na Unidade da Oncoclínica Pediátrica do Hospital Universitário Oswaldo Cruz (HUOC-UPE) em Recife, Brasil, relacionada à prevalência dos marcadores de HBV e HCV. A frequência de paciente submetidos a imunoprofilaxia, em nosso estudo, foi somente de 25,2por cento e 3,0por cento que não mostravam soro converão. O total de AntiHBc foi positivo em 19, 7por cento e foi infecção dupla HBV/HCV em 5,1por cento do corte. A investigação sorológica mostrou 24,4 por cento de pacientes positivos para HbsAge e 7,3por centp positivo para AntiHCV. Pode-se concluir que as medidas de biosegurança, vacinação, controle dos componentes de hemoderivados e estratégias para diminuir o tempo de hospitalização (tratamento ambulatórial), são medidas extremamente importantes para serem estabelecidas nos serviços de oncologia, no sentido de evitar essas situações deletérias em pacientes que obtenham sucesso nos seus tratamentos das doenças de base

Neurological aspects of the dengue infection in Brazilian patients during the DENV3 epidemicas

The dengues ia an acute febrile illness of benign course in the classical or dengue fever (DF) clinical form, however it could develop the dengue hemoohagic fever (DHF)and dengue shock syndrome, which are the most severe clinical forms. Neurological manifestations associated with dengue are known since the beginning of the past century. With the reemergence of dengue after the World War II more emphasis has been given to the DHF ignoring the neurological complications. Nevertheless, an elevated number of cases of FD associated with encephalopaties and encephalitis has been reported worldwide. During the dengue epidemics in two Brazilian states Ceará (1994) and Pernambuco (1997) dengue cases with neurological complications were reported. The lack of knowledge about this clinical form of the disease hampers an efficiente control strategy and treatment management. a iming highlight the clinical and laboratorial aspects involved in the dengue with neurological symptoms we reported 31 cases of dengue with neurological manifestations during the epidemics of DENV 3 in Recife, Brazil. The following neurological manifestations were observed: Guillain-Barré Syndrome, encephalitis, myelitis, ADEM, facial paralysis of the VII nerve, convulsion and encephalopaties. Clinical, epidemiological and laboratorial aspects are discussed

Prevalência de hepatite B em parturientes e perfil sorológico perinatal / Prevalence of hepatitis B in parturients and perinatal serologic profile

OBJETIVOS: avaliar a prevalência do antígeno de superfície do vírus B da hepatite (HBsAg) em parturientes internadas no Instituto Materno-Infantil de Pernambuco (IMIP), Recife-PE, e o perfil sorológico das positivas. MÉTODOS: este é estudo de secçäo de corte transversal prospectivo no qual foram utilizados os sistemas VIDAS e VIDAS HBs, respectivamente, para detecçäo e confirmaçäo do HBsAg. As participantes foram selecionadas de forma aleatória. Nas pacientes HBsAg+, os outros marcadores sorológicos foram testados com o sistema automatizado AxSYM. Os recém-nascidos de mäes HBsAg+ foram vacinados ao nascer com a vacina Engerix B. RESULTADOS: de um total de 1584, encontramos 9 (0,6 por cento) gestantes HBsAg positivas. Nenhuma delas apresentava anti-HBc IgM, sendo assim casos prevalentes. Em 1/9 (11,1 por cento) das gestantes havia presença do HBeAg isolado e em 4/9 (44,4 por cento), deste antígeno e seu anticorpo correspondente, revelando os diferentes graus de risco de transmissäo vertical da infecçäo. Com a exceçäo de dois recém-nascidos de um parto gemelar (um de baixo peso), todos apresentaram soroconversäo para o anti-HBs com três doses da vacina. Os gemelares prematuros só mostraram soroconversäo após a quarta dose da vacina. CONCLUSÖES: a prevalência da hepatite B em parturientes no IMIP é relativamente baixa e todas as pacientes detectadas entäo tinham a forma crônica da infecçäo