Publicações

@conference{Sperhacke2015b,

title = {University and public health services joining forces in the fight against HIV epidemics in Caxias do Sul city, South of Brazil},

author = {Andréa Cristina Vanni AND Aline de Gregori Adami AND Machline Paim Paganella AND Grasiela Cemin Gabriel AND Rosa Dea Sperhacke},

url = {https://www.ucs.br/ips2/wp-content/uploads/2020/09/E-poster-Atlanta-1.pdf},

doi = {10.4172/2155-6113.C1.012},

isbn = {2155-6113},

year  = {2015},

date = {2015-11-30},

booktitle = {J AIDS Clin Res},

volume = {6},

number = {10},

pages = {83},

organization = {OMICS International},

abstract = {Caxias do Sul is located in Rio Grande do Sul State which belongs to the region with the highest HIV prevalence in Brazil. This scenario led the HIV/AIDS Research Laboratory (LPHA) of Caxias do Sul University to contribute to the local health secretariat and its department of infectious diseases in promoting HIV/AIDS prevention and testing campaigns. We evaluated three cooperative campaigns executed between 2012 and 2014. In 2012, we promoted the “AIDS Week” where information about HIV was broadcasted on local media, educational material and condoms were distributed along the city and 2000 undergraduates were oriented on HIV during college classes. In 2013 and 2014, actions were focused on city main square and we additionally made available HIV, syphilis and HBV/HCV rapid tests and counseling services. In 2013, the initiative brought 181 individuals and 164 rapid tests were performed, being 2 tests positive for syphilis and 3 for HCV. In 2014, 700 citizens received counseling and 200 tests were performed, being 19 tests positive for syphilis, 5 for HCV and 1 for HIV. We identified general lack of knowledge about HIV and STDs despite Brazilian government continuous eorts on prevention. LPHA’s support permitted approaching and orienting a higher number of individuals, besides expanding testing logistics, what resulted in more people seeking the test and orientation services during and afer these initiatives. These facts, summed to the increase of positive tests, highlight the relevance of these actions and their strengthening to promote changes on HIV dissemination pattern in this city.},

keywords = {},

pubstate = {published},

tppubtype = {conference}

}

@conference{daSperhacke2015,

title = {Ajuste do cut-off de um ensaio imunoenzimático anti-HIV em amostras de sangue em papel-filtro},

author = {Leonardo Rapone da Motta and Andréa Cristina Vanni and Aline De Gregori Adami and Sérgio Kakuta Kato and Rosa Dea Sperhacke},

year  = {2015},

date = {2015-11-18},

booktitle = {10° Congresso de HIV/AIDS e 3° Congresso de Hepatites Virais},

organization = {Departamento de DST, Aids e Hepatites Virais. Secretaria de Vigilância em Saúde. Ministério da Saúde.},

abstract = {INTRODUÇÃO: A utilização de amostras de sangue em papel-filtro é uma estratégia para a ampliação do acesso ao diagnóstico da infecção pelo HIV em regiões remotas. Atualmente no Brasil, um único conjunto diagnóstico de detecção de anticorpos anti-HIV-1/2 em amostras de sangue em papel-filtro apresenta registro válido e está comercialmente disponível. Durante a caracterização de um painel de amostras com resultado conhecido, identificou-se um elevado número de resultados falso-positivos, representando dificuldades na identificação de amostras não reagentes para HIV. Realizou-se o ajuste do valor do ponto de corte (cut-off) deste conjunto diagnóstico para adequá-lo ao perfil sorológico das amostras rotineiramente analisadas. 



MÉTODOS: O conjunto diagnóstico Umelisa HIV 1+2 Recombinant® (Centro de InmunoEnsayo, Havana, Cuba) emprega um cut-off fixo igual a 0,300. Através da Curva ROC (Receiver Operating Characteristic), que envolve o cálculo de especificidade e sensibilidade para diversos valores de cut-off, é possível determinar o cut-off em que o ensaio apresenta seu melhor desempenho para um dado conjunto de amostras. Avaliaram-se 249 amostras de sangue em papel-filtro, destas, 125 amostras reagentes para HIV de acordo com o algoritmo de referência, que incluía um ELISA e Western Blot. 



RESULTADOS: Ao utilizarmos o cut-off recomendado pelo fabricante foram identificadas 19 amostras com resultado falso-positivo, resultando em uma sensibilidade de 100% (IC 95%: 96,8-1,0) e uma especificidade de 84,7% (IC 95%: 81,4-84,7). Através da Curva ROC, determinou-se o valor do cut-off em que o ensaio apresentou melhor desempenho (0,375). Ao empregarmos o novo cut-off, o ensaio apresentou sensibilidade igual a 100% (IC 95%: 97,8-100) e especificidade igual a 100% (IC 95%: 97,8-100). Os resultados englobaram cinco diferentes lotes do conjunto diagnóstico e dois modelos diferentes de leitoras de placas (PR-521 e PR-621). 



CONCLUSÃO: O ajuste do cut-off permitiu a elevação da especificidade do conjunto diagnóstico, sem impactar na sua sensibilidade.},

keywords = {},

pubstate = {published},

tppubtype = {conference}

}

@conference{NISDIPLACESProtocol2015,

title = {Association between antiretroviral treatment and metabolic abnormalities (dyslipidemia and glucose abnormalities) in a cohort of hiv-infected Latin American children},

author = {Machline Paim Paganella and Rachel A. Cohen and D. Robert Harris and Ricardo de Souza Kuchenbecker and Rosa Dea Sperhacke and Sergio Kakuta Kato and Carmem Lúcia Oliveira da Silva and Rohan Hazra AND for the NISDI PLACES Protocol},

year  = {2015},

date = {2015-08-29},

booktitle = {XIX Congresso Brasileiro de Infectologia (Infecto2015).},

address = {Gramado, RS, Brasil},

organization = {Sociedade Brasileira de Infectologia},

abstract = {INTRODUCTION: Highly Active Antiretroviral Therapy (HAART) has demonstrated unquestionable value in reducing morbidity and mortality among HIV-infected children. Despite these benefits, studies have found an association between HAART and metabolic abnormalities, including dyslipidemia, and glucose abnormalities such as insulin resistance (IR) and type II diabetes, especially for regimens including protease inhibitors (PIs). Objective: To estimate the incidence of lipid and glucose abnormalities and assess their association with exposure to PI-containing and non-PI-containing antiretroviral (ARV) regimens compared to no ARVs among perinatally HIV-infected Latin American children.



METHODS: Data were analyzed for children from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) International Site Development Initiative (NISDI) PLACES (Pediatric Latin American Countries Epidemiologic Study) prospective cohort study. The incidence of dyslipidemia (total cholesterol>200mg/dL, HDL<35mg/dL, LDL≥130mg/dL, triglycerides>110md/dL for age<10 years and >150mg/dL for ≥10 years) and glucose abnormalities (IR: HOMA-IR>2.5 for Tanner Stage 1 or >4.0 for Tanner Stage >1; impaired glucose: fasting glucose 110 to <126mg/dL; diabetes: fasting glucose≥126mg/dL) was estimated. Proportional hazards regression was used to evaluate risk of abnormalities associated with ARV regimen, adjusted for covariates.



RESULTS: Among 500 children, 385 were eligible for the analysis; mean age was 6.6 years. Incident cholesterol abnormalities were reported in 18.1% of subjects (95% confidence interval [CI]: 14.1-22.8%); HDL and LDL cholesterol abnormalities were reported in 19.6% (15.1-24.7%) and 15.0% (11.3-19.5%), respectively, and triglyceride abnormalities in 44.2% (37.7-50.8%). Type of ARV regimen used was only associated with triglyceride abnormalities in multivariable analysis; subjects receiving a PI-containing regimen were nearly four times as likely to experience a triglyceride abnormality as those receiving no ARVs (adjusted hazard ratio=3.6, 95% CI: 1.3-10.5; p=0.0167). The cumulative incidence of IR was 3.8% (95% CI: 1.8-7.1); there were no incident cases of diabetes and only two incident cases of impaired fasting glucose.



CONCLUSIONS: Children receiving PI-containing regimens were at increased risk of developing triglyceride abnormalities. Continued monitoring of lipid levels in children receiving PI-containing regimens appears warranted.},

keywords = {},

pubstate = {published},

tppubtype = {conference}

}

@conference{Madi2015,

title = {Impacto da assistência pré-natal em gestantes vivendo com HIV/AIDS. Estudo caso-controle.},

author = {José Mauro Madi and Machline Paim Paganella and Sérgio Kakuta Kato and Rosa Dea Sperhacke and Andréa Cristina Vanni and Aline de Gregori Adami and Isnard Elman Litvin and Sílvia Mariani Costamilan},

year  = {2015},

date = {2015-08-29},

booktitle = {XIX Congresso Brasileiro de Infectologia (Infecto2015).},

address = {Gramado, RS, Brasil},

organization = {Sociedade Brasileira de Infectologia},

abstract = {INTRODUÇÃO: Estima-se que o número de gestantes com HIV no Brasil seja de aproximadamente 12 mil casos por ano. A assistência pré-natal é um dos pilares do cuidado na saúde materno-infantil e sua prática com qualidade está associada a melhores desfechos perinatais. A qualidade dessa assistência pode ser avaliada através do número de consultas realizadas e da idade gestacional de ingresso no serviço de saúde. Assim, torna-se fundamental vincular precocemente as gestantes HIV ao serviço pré-natal de alto risco. OBJETIVOS: Conhecer o perfil e avaliar o impacto da assistência pré-natal em gestantes de alto risco infectadas ou não pelo HIV.



MÉTODOS: Estudo caso-controle realizado com pacientes atendidas no período de Março/1998 a Dezembro/2014, no Serviço de Ginecologia e Obstetrícia do Hospital Geral de Caxias do Sul, serviço de referência regional para atendimento de gestantes de alto risco. As gestantes HIV positivas (casos) e as gestantes HIV negativas (grupo controle) foram pareadas por faixa etária e idade gestacional (1:5). Os critérios utilizados para a avaliação do pré-natal foram número de consultas, tipo de parto, principais intercorrências, peso do neonato e evolução fetal.



RESULTADOS: Dentre os 20.113 nascimentos ocorridos no período, foram identificadas 164 gestantes HIV positivo (0,8%). O grupo controle contou com 816 gestantes. Ambos os grupos apresentaram média de idade de 29 anos e 97,5% dos casos realizaram pré-natal, enquanto que no grupo controle, 96,9% realizaram (p=0,868). A taxa de cesáreas foi de 35,6% dentre as gestantes HIV positivo; no grupo controle, a taxa foi 23,3% (OR= 1,82 IC95% 1,27 – 2,61). Não houve diferença significativa entre os grupos quanto ao número de consultas realizadas (média de 7 consultas). As principais intercorrências identificadas foram infecção urinária (19,2%), anemia (7,7%), hipertensão arterial prévia (7,0%), parto prematuro (6,1%), diabete melito gestacional (5,5%), ameaça de aborto (3,6%) e aminiorrexe (2,4%). Não houve diferença estatística entre os grupos, exceto para a infecção urinária, que teve prevalência inferior no grupo de casos (OR= 0,50 IC95% 0,30 – 0,83). Observou-se equivalência entre os grupos quanto à ausência de complicações no parto (92%), peso médio do neonato de 2.984± 620g. Em ambos os grupos, mais de 80% dos neonatos apresentaram evolução normal. Conforme a Figura 1 observa-se que o grupo de casos está associado ao tamanho Adequado para Idade Gestacional (AIG) enquanto que o grupo controle ao tamanho Grande para a Idade Gestacional (GIG), o tamanho Pequeno para a Idade Gestacional (PIG) não se associou a nenhum grupo (p=0,028).



CONCLUSÃO: Apesar do estudo considerar apenas pacientes de alto risco com e sem HIV, a prevalência da assistência pré-natal foi próxima entre os grupos. Os dados demonstram a equivalência entre gestantes infectadas ou não pelo HIV quanto ao número de consultas realizadas, intercorrências identificadas durante a gestação e ausência de complicações no parto. A taxa de cesáreas no grupo de casos foi significativamente maior do que no grupo controle. Este estudo reforça a relevância do pré-natal na redução da morbimortalidade em gestantes de alto risco infectadas ou não pelo HIV. O monitoramento da assistência pré-natal pode se tornar uma ferramenta para o desenvolvimento de intervenções específicas.},

keywords = {},

pubstate = {published},

tppubtype = {conference}

}

@conference{Araújo2015,

title = {Aumento da prevalência de sífilis congênita: dados epidemiológicos da UTI neonatal do Hospital Geral de Caxias do Sul},

author = {Breno Fauth de Araújo AND Leonardo Rapone da Motta AND Luciana Boeira Amaral AND Sílvia Mariani Costamilan AND Sérgio Kakuta Kato AND Andréa Cristina Vanni AND Aline de Gregori Adami AND Rosa Dea Sperhacke},

year  = {2015},

date = {2015-08-27},

booktitle = {XIX Congresso Brasileiro de Infectologia (Infecto2015).},

address = {Gramado, RS, Brasil},

organization = {Sociedade Brasileira de Infectologia},

abstract = {INTRODUÇÃO: A sífilis congênita constitui um tradicional evento-sentinela para monitoramento da Atenção Primária em Saúde por se tratar de uma doença de fácil prevenção, cuja ocorrência sugere falhas no funcionamento da rede de atenção básica e/ou da sua integração com o sistema de saúde. O Hospital Geral de Caxias do Sul (HGCS), localizado na região nordeste do Rio Grande do Sul (RS), é referenciado para o atendimento ao parto em gestantes de alto risco de 49 municípios da 5ª Coordenadoria Regional da Saúde do RS. Desde o início das atividades, 7224 recém-nascidos (RN) foram atendidos na UTI Neonatal do HGCS, sendo 388 (5,4%) RN de mães com sífilis.



OBJETIVO: Descrever o perfil epidemiológico de parturientes e RN internados na UTI Neonatal do HGCS e suas mães no período entre 1998-2015. MÉTODOS: Os dados foram obtidos a partir de variáveis sociodemográficas, obstétricas e do RN provenientes do prontuário médico. Foi utilizada a definição de caso de sífilis congênita preconizada pelo Departamento de DST, Aids e Hepatites Virais desde janeiro de 2004.



RESULTADOS: Em relação às parturientes foi observado o predomínio na faixa etária de 20-34 anos (69,5%), baixa escolaridade (49% analfabetas ou com ensino fundamental incompleto) e residentes na cidade de Caxias do Sul (85,3%). O número médio de gestações anteriores foi de 3 (DP=2,5), sendo que 24,6% apresentaram aborto previamente. A maioria das parturientes realizou menos do que seis consultas durante o pré-natal (55%) e 15% não realizaram pré-natal. Foram identificadas 27 parturientes (7,0%) com co-infecção com HIV. Houve predominância do parto normal (66,8%) e sexo masculino (54,6%) para os RNs, sendo que 23,6% dos partos foram prematuros. Com relação ao índice de Apgar, a maioria apresentou boa vitalidade (Apgar ≥ 7) no 1° e 5° minuto, respectivamente, 82,9% e 95,0%. Em relação ao peso fetal, 10,5% dos RN eram pequenos para a idade gestacional (RNPIG). O tempo de internação médio foi de 12,9 dias (DP=9,1), sendo que 2,8% dos pacientes foram a óbito. Foi observado um aumento na ocorrência de casos de sífilis congênita entre os anos de 2011 (3,2%), 2012 (7,6%), 2013 (9,4%) e 2014 (10,6%) na UTI Neonatal do HGCS.



CONCLUSÃO: Os resultados obtidos neste estudo são indicativos de falhas na atenção às gestantes na rede de atenção básica. Apesar dos esforços recentes adotados para o combate à transmissão vertical da sífilis no Brasil, identificou-se a elevação do número de casos na região nordeste do RS.},

keywords = {},

pubstate = {published},

tppubtype = {conference}

}

@conference{Limberger2015,

title = {HIV/AIDS e infertilidade masculina: genotoxicidade espermática em usuários de terapia antirretroviral de alta potência},

author = {Viviane Raquel Buffon AND Lessandra Michelim AND João Antônio Pegas Henriques AND Fábio Firmbach Pasqualotto AND Renato Luís Rombaldi AND Eleonora Bedin Pasqualotto AND Rosa Dea Sperhacke AND André Luiz Mendes Juchem AND Cristiano Trindade AND Rafael Amoroso Santos AND Pamila Pricila Fredi Andres AND Renata da Silveira Limberger},

year  = {2015},

date = {2015-08-26},

booktitle = {XIX Congresso Brasileiro de Infectologia (Infecto2015).},

address = {Gramado, RS, Brasil},

organization = {Sociedade Brasileira de Infectologia},

abstract = {INTRODUÇÃO: A Síndrome da Imunodeficiência Adquirida (SIDA) é desencadeada pelo vírus da imunodeficiência humana (HIV). Apenas dois anos após a sua identificação, desenvolveram-se fármacos que reduziram a infectividade e replicação viral. Apesar de todos os benefícios proporcionados, um número crescente de co-morbidades relacionadas à terapia antirretroviral de alta potência (TARV) foram diagnosticadas. Entre elas, menor probabilidade de concepção indica que pode diminuir a competência reprodutiva.



OBJETIVOS: determinar, em homens adultos com HIV aderentes a TARV, a genotoxicidade espermática induzida por esses fármacos pelo Ensaio Cometa e o espermograma, comparando com pacientes com HIV naive de terapia antirretroviral 



MÉTODOS: Estudo caso-controle, qualitativo e quantitativo realizado no ambulatório de Infectologia da Prefeitura e na Universidade de Caxias do Sul. A análise foi realizada utilizando-se Nível de Significância 5%, Poder 80% e Desvio Padrão de 6,2 um com aumento esperado de 5um da cauda do cometa nos pacientes em uso de terapia antirretroviral de alta potência por meio do Software WinPepi versão 10.4, totalizando 52 pacientes, sendo 26 naive. Os critérios de exclusão: diagnóstico prévio de infertilidade, má adesão ao tratamento, idade inferior a 18 anos e doença oportunista com diagnóstico recente.



RESULTADOS: O índice de dano analisado de espermatozóides de 45 pacientes com e sem TARV variou de 1 a 364. Já a frequência de dano oscilou de 1% a 100%. Observou-se que quanto mais recente o diagnóstico de HIV, maior o índice de dano. No entanto, a frequência de dano foi semelhante entre os períodos analisados em anos. Quanto menor o CD4 e maior a carga viral, maior o índice e frequência de danos apesar de não haver diferença estatística. No entanto, houve um aumento dos danos quando CD4 maior de 500. Verificou-se um possível fator protetor entre tempo de uso de TARV e redução dos índices de danos. No esquema de TARV, o inibidor de protease relacionou-se a menor genotoxicidade. O uso de drogas e o etilismo conferiram maior dano genético quando comparado aos não dependentes químicos.



CONCLUSÕES: No estudo, pode-se inferir uma correlação benéfica entre a redução da carga viral pelo uso de TARV na genotoxicidade espermática de pacientes com retrovirose, reduzindo a infertilidade masculina nesse grupo de pacientes. A ampliação da amostra é necessária para concluir se a TARV é um fator genoprotetor a longo prazo para o DNA espermático.},

keywords = {},

pubstate = {published},

tppubtype = {conference}

}

@conference{Diaz2015b,

title = {Comportamento de alto risco entre parcerias sorodiscordantes identificadas nos centros de testagem e aconselhamento para HIV no sul do Brasil},

author = {Machline Paim Paganella AND Christopher D. Pilcher AND Cláudia A. Bisol AND Snigdha Vallabhaneni AND Leonardo R. Motta AND Sérgio K. Kato AND Rosa Dea Sperhacke AND Esper Kallás AND Frederick M. Hecht AND Ricardo S. Diaz},

url = {https://www.ucs.br/ips2/wp-content/uploads/2020/09/Resumo_DST_ANAIS15.pdf},

isbn = {0103-4065},

year  = {2015},

date = {2015-05-17},

booktitle = {Jornal Brasileiro de Doenças Sexualmente Transmissíveis},

volume = {27},

number = {Suplemento 1},

pages = {131},

organization = {Sociedade Brasileira de Doenças Sexualmente Transmissíveis},

abstract = {INTRODUÇÃO: As estratégias de prevenção da transmissão da infecção pelo vírus da imunodeficiência humana (HIV) em casais sorodiscordantes geralmente são voltadas para as pessoas HIV positivas, não havendo consenso sobre a abordagem das parcerias soronegativas. Objetivo: Identificar e quantificar a ocorrência de comportamentos de risco em pessoas HIV negativas com parceria HIV positiva fixa. 



MÉTODOS: Examinamos a frequência com que os participantes de um estudo transversal relataram ter parceria HIV positiva no formulário padrão do serviço e/ou no questionário do estudo. Avaliamos comportamentos de risco e novos diagnósticos de infecção pelo HIV em pacientes “potencialmente sorodiscordantes” em comparação com os outros pacientes na população em geral. O diagnóstico de HIV foi realizado seguindo o algoritmo de testagem padrão. O teste BED EIA HIV-1 (Calypte Biomedical, Portland, OR; ODn cutoff=0,8) foi utilizado para classificar pessoas recentemente infectadas pelo HIV.



RESULTADOS: Entre os 3.100 pacientes com nenhum teste reagente para HIV anterior, 490 (15,8%) relataram estar em um relacionamento fixo com uma pessoa HIV positiva. Esta proporção foi semelhante tanto para homens que fazem sexo com homens (HSH) como em heterossexuais. Menos da metade dos participantes reportou ter usado o preservativo durante o último ato sexual com o parceiro HIV positivo. Apenas um quarto dos homens heterossexuais e um terço dos HSH e mulheres reportaram o uso consistente de preservativos com seu parceiro no último ano. Os principais motivos para não usar preservativo com o parceiro fixo foram: “confia no parceiro” (31,7%), seguido de “não gosta” (15,1%) e “parceiro não aceita” (8,9%). Foram diagnosticadas novas infecções pelo HIV em 23% do grupo de pacientes potencialmente discordantes (versus 13% na população geral; p=0,01). Participantes com uso inconsistente de preservativos com parceiro fixo apresentaram uma chance 4 vezes maior de ter resultado positivo para HIV, quando comparados com aqueles que reportaram sempre usar preservativos com o parceiro fixo (OR=4,2; IC95% 2,3–7,5). Houve uma maior adesão à utilização de preservativos com parcerias casuais no último ato sexual, variando de 58,5% (homens heterossexuais) a 75% (HSH e mulheres).



CONCLUSÃO: Parcerias sorodiscordantes fixas, com elevado risco de transmissão do HIV, podem ser identificadas no momento da testagem e do aconselhamento. O acesso a essa população é fundamental para a implantação de estratégias de prevenção em localidades com alta incidência de HIV.},

keywords = {},

pubstate = {published},

tppubtype = {conference}

}

@conference{daWelte2012,

title = {DPP Supplemental Rapid Test Data Can Discriminate Recent from Longstanding HIV Infection},

author = {Christopher D. Pilcher AND Reshma Kassanjee AND Leonardo Rapone da Motta AND Shelley Facente AND Sheila Keating AND Elaine McKinney AND Frederick Hecht AND Rosa Dea Sperhacke AND Michael P. Busch AND Gary Murphy AND Javan Esfandiari AND Alex Welte},

url = {https://custom.cvent.com/ADE0EB81B3184D618E2FB8340F1EC28E/files/29f3717707a44f91859f65feb4cefec6.pdfhttps://www.ucs.br/ips2/wp-content/uploads/2020/10/HIVDiagnosticsConference2012_Page88.pdf},

year  = {2012},

date = {2012-12-12},

booktitle = {2012 HIV Diagnostics Conference},

pages = {88},

address = {Atlanta, GA, USA},

organization = {Centers for Disease Control and Prevention, Association of Public Health Laboratories and the National Minority AIDS Council.},

abstract = {OBJECTIVE: HIV-1/2 discriminatory rapid tests using dual path platform (DPP) technology have replaced Western blot and IFA as preferred supplemental testing in many laboratories in Brazil, and a derivative assay (Geenius) has been developed by Biorad that is now being introduced to ex-US markets and in clinical trials for US FDA clearance, beyond the claims DPP has for high sensitivity and specificity, this class of rapid tests is also unique in that it generates reproducible, quantitative results for antibody binding (i.e., band intensities) against multiple HIV antigens. We investigated the potential performance of the existing Chembio DPP HIV-1/2 Confirmatory Test as a test for recent HIV infection. 



METHODS: 234 specimens from antiretroviral-naïve subtype B or C HIV-infected individuals were collected in US, South Africa, and Brazil. Samples were selected from subjects in whom the date of seroconversion was known to within 45 days; duration of time from seroconversion to sample collection varied from 8 days to 7 years (mean 1.5 years). Intensity of gp36, gp41, p24, gp120 and gp160 bands was measured as light reflectance units, using the DPP reader at 20 minutes. Optimal band intensity value thresholds were selected using ROC analysis, based on their ability to correctly classify individual samples as being within 90, 120 or 180 days of seroconversion. To assess potential utility of band intensity thresholds for cross-sectional HIV incidence estimation, we further calculated window periods (or, mean durations of recent infection, MDRI) based on linear interpolation of the observed data. The “false-recent rate” was calculated as the proportion of samples classified as recent among those >365 days from seroconversion. MDRI and FRR were calculated for both single band intensity thresholds and for combination algorithms using data from multiple bands.



RESULTS: Individual staging analysis: Different single band intensity thresholds were selected as optimal for classifying infections as being < 90, < 2% with only very slight reduction in the MDRI.



CONCLUSIONS: In addition to confirming HIV-1 and HIV-2 status, DPP supplemental tests could also be used to routinely stage individual’s infections as being acute, recent or longstanding. The method we describe is novel and must be further evaluated, but our data suggest that the risk of misclassifying longstanding (>1 yr) infections as ‘recent’ using routine DPP data could be very low. The possibility of using routinely collected DPP data for surveillance of recent infection and incidence estimation are being further investigated.},

keywords = {},

pubstate = {published},

tppubtype = {conference}

}

@conference{Borges2012,

title = {Performance of a “Rapid Results” 4th Generation Immunoassay Algorithm},

author = {Christopher D. Pilcher AND Leonardo Rapone da Motta AND Rosa Dea Sperhacker AND Frederick Hecht AND Ricardo Sohbie Diaz AND Lisa Stanga AND Luiz Gustavo dos Anjos Borges},

url = {https://custom.cvent.com/ADE0EB81B3184D618E2FB8340F1EC28E/files/29f3717707a44f91859f65feb4cefec6.pdf

https://www.ucs.br/ips2/wp-content/uploads/2020/10/HIVDiagnosticsConference2012_Page13.pdf},

year  = {2012},

date = {2012-12-12},

booktitle = {2012 HIV Diagnostics Conference},

pages = {13},

address = {Atlanta, GA, USA},

organization = {Centers for Disease Control and Prevention, Association of Public Health Laboratories and the National Minority AIDS Council.},

abstract = {OBJECTIVE: Several automated analysers can deliver 4th generation HIV immunoassay (4GIA) results within a few hours of specimen draw. We report a prospective trial of rapid testing for acute and chronic HIV infection using an all rapid results algorithm.



METHODS: AMPLIAR Protocol 010 was a cross sectional study of HIV diagnostic testing, with a longitudinal component to follow patients with discrepant results to confirm HIV seroconversion and HIV status. Between 2007 and 2010, clients requesting HIV tests at 4 voluntary testing centers in South Brazil were enrolled. Site laboratories each performed 4GIA screening with confirmation by 3GIA and IFA/WB. Blood samples were obtained for pooled RNA (bDNA, 1:20), confirmatory testing as needed and BED-CEIA analysis. Beginning in 2009, samples were immediately tested using the VIDAS Duo Ultra 4GIA, Determine HIV 1/2 Ab rapid test and DPP HIV-1/2 Confirmatory Immunoblot rapid test. We evaluated performance of a serial rapid results algorithm (rapid 4GIA reflexed to Ab rapid test +/- confirmatory assay if 4GIA result is positive); a parallel algorithm (rapid 4GIA and Ab rapid test performed simultaneously, reflexed to confirmatory assay if either is positive); and standard batched 4GIA and pooled RNA-based algorithms.



RESULTS: 3,617 subjects were studied; of those 521 were confirmed HIV+ (HIV prevalence: 14.4%). A subset of 1,829 (296 HIV+) subjects were tested with the all-rapid-results algorithm. With a pooled RNA/Ab algorithm as a reference standard we observed the following performance characteristics: 1. Algorithm: 4GIA-rapid (parallel,) Turnaround: 2.5 hours, Se of algorithm: 100.0 (98.8,100), Sp of initial screening test(s): 99.0 (98.4,99.4) 2. Algorithm: 4GIA-rapid (serial), Turnaround: 3.5 hours, Se of algorithm: 98.9 (97.1,99.6), Sp of initial screening test(s): 99.3 (98.8,99.6) 3. Algorithm: 4GIAstandard (serial), Turnaround: 1-3 weeks, Se of algorithm: 99.0 (97.8,99.6), Sp of initial screening test(s): 99.3 (98.9,99.5) 4. Algorithm: Rapid Ab only, Turnaround: 1.0 hour, Se of algorithm: 98.4 (97.0, 99.2), Se of initial screening test(s): 99.8 (99.6,99.9).



CONCLUSIONS: Rapid results from an automated 4G assay analyser provided similar sensitivity and specificity to batched 4G testing. We found furthermore that an algorithm with parallel rapid 4G/ rapid Ab screening as the first step in the algorithm significantly reduced the time to final result, when compared to an algorithm with sequential rapid 4G screening and rapid Ab testing as the first steps. Parallel rapid 4G/rapid Ab testing also increased sensitivity. The parallel rapid test approach may be preferred when turnaround time is critical.},

keywords = {},

pubstate = {published},

tppubtype = {conference}

}

@conference{Mahvi2012,

title = {Identifying the unique needs of HIV-positive pregnant women and HIV-positive new mothers in Brazil: a qualitative study},

author = {Judith Bass AND Claudia Alquati Bisol AND Rosa Dea Sperhacke AND Machline Paim Paganella AND Andrea Vazzano AND A. Mahvi},

url = {http://www.abstract-archive.org/Abstract/Share/11043},

year  = {2012},

date = {2012-07-22},

booktitle = {XIX International AIDS Conference (AIDS 2012)},

number = {WEPE396},

address = {Washington, DC, USA},

organization = {International AIDS Society},

abstract = {BACKGROUND: The perinatal period presents an important time to study mental health and psychosocial needs of HIV-infected women for whom medical aspects of HIV infection are under control. Pregnant women and new mothers with HIV are at risk for problems due to neurotropic properties of HIV, psychological stressors of stigma, and knowledge that they have a disease with no known cure. While most research investigates issues that researchers select as relevant, this qualitative study identifies problems from the point of view of the women themselves.



METHODS: Free Listing interviews, a method that asks respondents questions designed to elicit responses in the form of a list, were implemented. Respondents included HIV-infected (N=30 pregnant; N=25 new mothers) and uninfected women (N=20 pregnant; N=20 new mothers), recruited from maternity hospitals in Porto Alegre and Caxias do Sul, Brazil. Results were compared across respondent HIV-status. Interviewers were local students and nurses. 



RESULTS: Among pregnant women, both HIV-infected and uninfected women reported anxiety, depression and lack of support from family and friends. Unique to HIV-infected women were worries about HIV transmission, impact of ART on the fetus, and fears specifically about not being around to see the child grow up. Among new mothers, depression and anxiety, as well as the issues with social support, continued for both groups. HIV-infected new mothers also talked about challenges they face with not being able to breastfeed, including stigma and their feelings of self-worth as a mother. 



CONCLUSIONS: Women in the perinatal period experience a wide range of mental health and psychosocial issues. Assuring adequate HIV-treatment in this period does not reduce the burden of these challenges and adds new ones specific living with HIV. Learning directly from the women themselves can improve our ability to develop locally appropriate and sustainable programs to reduce these problems.},

keywords = {},

pubstate = {published},

tppubtype = {conference}

}

@conference{Bass2012,

title = {The recommendation not to breastfeed: HIV infected pregnant women and new mothers report emotional suffering},

author = {Claudia Alquati Bisol AND Rosa Dea Sperhacke AND Machline Paim Paganella AND Andrea Vazzano AND A. Mahvi AND Judith Bass},

url = {http://www.abstract-archive.org/Abstract/Share/11067},

year  = {2012},

date = {2012-07-22},

booktitle = {XIX International AIDS Conference (AIDS 2012)},

number = {WEPE397},

address = {Washington, DC, USA},

organization = {International AIDS Society},

abstract = {BACKGROUND: Public health campaigns usually promote breastfeeding through campaign slogans such as 'breast is best' and 'breastfeeding is natural'. Psychodynamic approaches on motherhood emphasize the importance of breastfeeding for early mother-child bonding. HIV-infected women, however, are told to substitute breastfeeding for baby formula in many countries, including Brazil. This study seeks to investigate the main psychological issues raised by HIV-infected pregnant women and new mothers with regards to the recommendation not to breastfeed. 



METHODS: Free Listing interviews, a method that asks respondents questions designed to elicit responses in the form of a list, were conducted with HIV-infected pregnant women (n=30) and new mothers (n=25), aged ≥18, recruited from two maternity hospitals in Porto Alegre and Caxias do Sul, Brazil. Thematic content analysis was carried out. 



RESULTS: The fear that not breastfeeding can disclose their serostatus is common to both pregnant women and new mothers. While pregnant women talk about the importance of breastfeeding for the baby's health, many new mothers state that their babies get sick more easily and suffer emotional consequences in terms of bonding, though some women did describe behaviors they did to actively bond with their babies. Pregnant women emphasize breastfeeding as a natural part of motherhood and the new mothers report their pain, guilt and sadness for not being able to meet this role. Both groups reported making up excuses to avoid other people's questions.



CONCLUSIONS: Health care providers should help HIV-infected women to face the challenges of not being allowed to breastfeed when that is the case. Attention should be paid to social constraints due to mainstream discourses that might reinforce feelings of inadequacy and guilt. Also, counseling and group support might alleviate the difficulties related to mother-child initial bonding.},

keywords = {},

pubstate = {published},

tppubtype = {conference}

}

@conference{HIVRapidTestEvaluationGroup2011,

title = {Assesment of a novel HIV rapid confirmatory assay: imunoblot rápido DPP® HIV 1/2},

author = {Leonardo Rapone da Motta AND Andréa Cristina Vanni AND Luiz Gustavo dos Anjos Borges AND Sérgio Kakuta Kato AND Rosa Dea Sperhacke AND Rosângela Maria M. Ribeiro AND Lilian Amaral Inocêncio AND HIV Rapid Test Evaluation Group},

url = {http://www.abstract-archive.org/Abstract/Share/9393},

year  = {2011},

date = {2011-07-17},

booktitle = {6th IAS Conference on HIV Pathogenesis, Treatment and Prevention},

number = {MOPE145},

address = {Rome, Italy},

abstract = {BACKGROUND: Imunoblot Rápido DPP® HIV ½ (Bio-Manguinhos, Brazil) is a single-use immunocromatographic rapid test for the detection of individual antibodies (gp36, gp160, gp120, gp41 and p24) in whole blood, serum or plasma. DPP® assays presents two different paths: one for the sample and other for conjugated. The test takes less than 30 minutes to perform, results are visually read and it can differentiate an HIV-1 or 2 infection. The objective of this study was to evaluate the performance of the Imunoblot Rápido DPP® HIV ½ in a multi-center study in Brazil.



METHODS: Following informed consent, whole blood was obtained from patients enrolled in five clinic centers from distinct regions of Brazil, and tested by the Imunoblot Rápido DPP® HIV ½ well as by a dual-immunoassay+WB algorithm that defined the reference standard for HIV infection. Obtained results were interpreted in accordance with the manufacturer´s instructions.



RESULTS: A total of 964 samples were obtained: 139 (14.4%) were positive and 825 negative for HIV-1 antibodies according to the reference algorithm. Imunoblot Rápido DPP® was easy to perform. On examination by two different readers, discrepancies in band pattern interpretation were present in 1.38% of analyses; affecting the final interpretation. Consensus results were used for performance calculations. From 139 positive samples, 134 were positive and 4 indeterminate (clinical sensitivity: 96.4% (95% CI: 93.4-98.1)) Among HIV negative samples, the DPP assay gave indeterminate results in 3/825 samples but also gave “confirmed positive” results in 3/825 negative samples (clinical specificity: 99.3% (95% CI: 98.8-99.6)).



CONCLUSION: The reliability of the test was similar with most of confirmatory HIV tests commercially available. These results support the use of the Imunoblot Rápido DPP® as part of Brazil's national HIV test algorithm, as a rapid confirmatory test, which might facilitate expansion of VCT services and improve the efficiency in HIV results return.},

keywords = {},

pubstate = {published},

tppubtype = {conference}

}

@conference{HIVRapidTestEvaluationGroup2011b,

title = {Evaluation of five simple rapid HIV assays for use with national HIV test algorithm in Brazil},

author = {Leonardo Rapone da Motta AND Andréa Cristina Vanni AND Luiz Gustavo dos Anjos Borges AND Sérgio Kakuta Kato AND Rosa Dea Sperhacke AND Rosângela Maria M. Ribeiro AND Lilian Amaral Inocêncio AND HIV Rapid Test Evaluation Group},

url = {http://www.abstract-archive.org/Abstract/Share/8091},

year  = {2011},

date = {2011-07-17},

booktitle = {6th IAS Conference on HIV Pathogenesis, Treatment and Prevention},

number = {MOPE132},

address = {Rome, Italy},

organization = {International AIDS Society},

abstract = {BACKGROUND: Since 2006, the Department of STD, AIDS and Viral Hepatitis (D DST AIDS/HV, Brazil Ministry of Health Surveillance Secretariat) has been using a test algorithm that relies only on rapid testing for the diagnosis of HIV infection in special situations (i.e. occupational exposure, pregnant women without prenatal care, etc.). Because Brazil has unique viral subtypes, test performance must be validated in Brazil. This multi-center study was conducted as part of a D DST AIDS/HV evaluation to assess diagnostic testing performance of five rapid tests-all available, but not yet approved for use in Brazil-against a panel of diverse Brazilian specimens.



METHODS: We evaluated the following tests: VIKIA® HIV 1/2 ; Rapid Check HIV 1 & 2, HIV-1/2 3.0 Strip Test Bioeasy, Labtest HIV, Teste Rápido HIV 1/2 - Bio-Manguinhos. After informed consent, whole blood was obtained from patients enrolled in five clinic centers from distinct regions of Brazil. Results of rapid test assays were analyzed using a reference standard that defined HIV infection using a dual-immunoassay (4th/3rd generation) + Western blot.



RESULTS: Among 972 samples, 143 (14.9%) were confirmed HIV antibody positive, while 829 were negative. For the five tests evaluated, clinical sensitivity ranged from 99.3 to 100% and clinical specificity was 100% for all tests. Three tests met all the performance requirements from D DST AIDS/HV (clinical sensitivity = 100%): VIKIA® HIV 1/2; Rapid Check HIV 1 & 2, HIV-1/2 3.0 Strip Test Bioeasy. All tests were easy to perform and scored well on an operational assay performance evaluation.



CONCLUSION: Of the tests evaluated, three showed performance equivalent to the reference tests on samples of whole blood and were approved for use according with the national test algorithm.},

keywords = {},

pubstate = {published},

tppubtype = {conference}

}

@conference{Sperhacke2011,

title = {Evaluation of four rapid tests to detect HIV recent seroconversion},

author = {Gustavo Endres Cuccarolo AND Andréa Cristina Vanni AND Leonardo Rapone da Motta AND Luiz Gustavo dos Anjos Borges AND Sérgio Kakuta Kato AND Rosa Dea Sperhacke},

url = {http://www.abstract-archive.org/Abstract/Share/8047},

year  = {2011},

date = {2011-07-17},

booktitle = {6th IAS Conference on HIV Pathogenesis, Treatment and Prevention},

number = {CDB069},

address = {Rome, Italy},

organization = {International AIDS Society},

abstract = {BACKGROUND: HIV incidence estimation represents a challenge to health authorities and carries a substantial cost. The use of rapid tests to identify recent seroconversion may be an alternative for studies of HIV incidence once they do not require complex laboratory infrastructure and are easily performed. This study assessed the feasibility of four rapid HIV tests which were modified in order to reduce its sensitivity (detuned), aiming the detection of recent seroconversion.



METHODS: As gold standard, BED-CEIA assay (Calypte HIV-1 BED Incidence EIA Capture) which allows distinguishing patients with recent infection (less than 154 days) from patients with HIV chronic infection was carried out. Initially, the following rapid tests were evaluated: VIKIA® HIV-1/2, Rapid Check HIV 1 & 2, Teste Rápido DPP® HIV-1/2 Bio-Manguinhos and HIV-1/2 3.0 Strip Test Bioeasy. Dilutions with high concordance between rapid tests and gold standard were chosen. Rapid Check and Bioeasy were excluded due to discrepant results during dilution standardization. 213 HIV positive samples by two serological tests were selected, being 91 recent and 122 chronic by BED-CEIA assay. The samples were tested with VIKIA® (dilution 1:1100) and Bio-Manguinhos (dilution 1:560) assays. 



RESULTS: VIKIA® and Bio-Manguinhos tests results presented a concordance of 75.6% (95% CI: 71.6 to 76.9; Kappa = 0.465) and 77.9% (95% CI: 73.2 - 80.5; Kappa = 0.525), respectively. VIKIA® assay misclassified 52 samples and Bio-Manguinhos 47 samples. 



CONCLUSIONS: The applicability of rapid tests in classifying recent and chronic infection has not been established and there is a lack of rapid tests designed to diagnose recent infection. Data showed the evaluated rapid tests are not recommended for detecting recent seroconversion, enlightening the need of developing standardized rapid tests which can be used as tools to estimate incidence of HIV infection.},

keywords = {},

pubstate = {published},

tppubtype = {conference}

}

@conference{Chies2011,

title = {High prevalence of CXCR4 using HIV-1 strains as predicted by genotypic tools among recently infected antiretroviral naïve individuals and among subtype C strains in Southern Brazil},

author = {Andréa Cristina Vanni AND Leonardo Rapone da Motta AND Rosa Dea Sperhacke AND Sérgio Kakuta Kato AND Ricardo Sohbie Diaz AND José Artur Bogo Chies},

url = {http://www.abstract-archive.org/Abstract/Share/9016},

year  = {2011},

date = {2011-07-17},

booktitle = {6th IAS Conference on HIV Pathogenesis, Treatment and Prevention},

number = {CDB119},

address = {Rome, Italy},

organization = {International AIDS Society},

abstract = {BACKGROUND: Specificity of HIV-1 coreceptor usage for CCR5 or CXCR4 is believed to be dictated mainly by the V3 loop's structure and charge. Understanding the tropism of circulating strains is critical for the therapeutic use of CCR5 antagonists, disease natural history comprehension and prediction of disease progression. This study analyzed the coreceptor tropism of HIV-1 subtypes B, C and BC recombinants of drug naïve individuals from Rio Grande do Sul through genotypic tools.



METHODS: Stored plasma specimens from 81 patients, enrolled on Project Ampliar, known to be infected with subtypes B (30), C (25) or BC (26) recombinants based on RT and PR sequences along the pol gene were selected. After nested PCR, the V3 region of env gene was sequenced and the tropism inferred using genotypic methods: Raymond's Rule, Geno2pheno coreceptor 5% and 10%, WebPSSMX4R5, SINSI(B), SINSI(C), R5/X4-Pred and NSI/SI-Pred. A sample was considered as CXCR4 tropic strain if any of genotypic tools classified as such, otherwise it was considered R5.



RESULTS: Forty-seven (58%) individuals were men, 15 (18.5%) were recent seroconverters and 78 (96.3%) reported sexual exposure. Subtypes found at env region were 36 B (44.4%) and 45 C (55.6%). The overall prevalence of R5 viruses was 71.6%. Considering the subtypes from both pol and env regions, CXCR4 usage was predicted in 28.6% of BC recombinants, 31% of B and 25% of C. CXCR4 tropic strains proportions among subtypes from env region, which determines the tropism, were 33.3% for B and 24.4% for C (no statistical differencep=0.263). X4 prevalence in recent seroconverters was 33.3%. There was no association between tropism and viral load.



CONCLUSION: Significant prevalence of CXCR4 tropic strains (28.4%) was found among drug naïve HIV-1 infected individuals from southern Brazil, including recent seroconverters and subtype C, which has been previously associated to infrequent transition from R5 to X4 strains.},

keywords = {},

pubstate = {published},

tppubtype = {conference}

}

@conference{Sperhacke2010,

title = {Evaluation of four rapid tests to detect HIV recent seroconversion},

author = {Gustavo Endres Cucarollo AND Andréa Cristina Vanni AND Leonardo Rapone da Motta AND Luiz Gustavo dos Anjos Borges AND Sérgio Kakuta Kato AND Rosa Dea Sperhacke},

year  = {2010},

date = {2010-10-17},

booktitle = {XXI National Meeting of Virology & V Mercosur Meeting of Virology},

volume = {15},

number = {Supplement 1},

pages = {264},

address = {Gramado, RS, Brasil},

organization = {Brazilian Society for Virology},

abstract = {INTRODUCTION: HIV incidence estimation represents a challenge to health authorities and carries a substantial cost. The use of rapid tests to identify recent seroconversion may be an alternative for studies of HIV incidence once they do not require complex laboratory infrastructure and are easily performed. This study, which belongs to AMPLIAR program, designed to study the biology of HIV, assessed the feasibility of four rapid HIV tests which were modified in order to reduce its sensitivity (detuned), aiming the detection of recent seroconversion. Objectives: To evaluate the feasibility of rapid tests to detect recent seroconversion and its consequent use in studies of HIV incidence.



METHODS: As gold standard, BED-CEIA assay (Calypte HIV-1 BED Incidence EIA Capture) which allows to distinguish patients with recent infection (less than 154 days) from patients with HIV chronic infection was carried out. Initially, the following rapid tests were evaluated: VIKIA® HIV-1/2, Rapid Check HIV 1 & 2, Teste Rápido DPP® HIV-1/2 Bio-Manguinhos and HIV-1/2 3.0 Strip Test Bioeasy. Dilutions with high concordance between rapid tests and gold standard were chosen. Rapid Check and Bioeasy were excluded due to discrepant results during dilution standardization. 213 HIV positive samples by two serological tests were selected, being 91 recent and 122 chronic by BED-CEIA assay. The samples were tested with VIKIA® (dilution 1:1100) and Bio-Manguinhos (dilution 1:560) assays 



RESULTS: VIKIA® and Bio-Manguinhos tests results presented a concordance of 75.6% (95% CI: 71.6 - 76.9; Kappa = 0.465) and 77.9% (95% CI: 73.2 - 80.5; Kappa = 0.525), respectively. VIKIA® assay misclassified 52 samples and Bio-Manguinhos 47 samples. Discussion: We observed a moderate agreement between the assessed tests and the gold standard. Rapid tests used in the study were developed to detect HIV infection, applied in screening studies. So its use to differentiate between recent and chronic infection has not been established. These results demonstrate the need for studies in the development of rapid tests capable of diagnosing recent HIV infection. Additionally, recent studies raise questions about the performance of BED-CEIA assay, which could also explain the disagreement between results. Nevertheless, this is the unique commercially available test for this purpose currently.



CONCLUSIONS: Data showed the evaluated rapid tests are not recommended for detecting recent seroconversion, enlightening the need of developing standardized rapid tests which can be used as tools to estimate incidence of HIV infection.},

keywords = {},

pubstate = {published},

tppubtype = {conference}

}

@conference{Pilcher2010,

title = {Association between heterosexual exposure and infection with B/C and C subtype HIV-1 in Southern Brazil},

author = {Oliver M. Bacon AND Ricardo da Silva de Souza AND Simon Frost AND Ricardo Sohbie Diaz AND Sattish Pillai AND Leonardo Rapone da Motta AND Rosa Dea Sperhacke AND Edwin D. Charlesbois AND Frederick Hecht AND Christopher D. Pilcher},

url = {http://www.abstract-archive.org/Abstract/Share/6780},

year  = {2010},

date = {2010-07-18},

booktitle = {XVIII International AIDS Conference (AIDS 2010)},

number = {WEPE0018},

address = {Vienna, Austria},

organization = {International AIDS Society},

abstract = {BACKGROUND: Subtype C is the predominant global strain of HIV-1, in many countries overtaking a preexisting epidemic strain. Reasons for this may include founder effect, segregation of subtypes within non-overlapping sociodemographic groups, or biological properties favoring heterosexual transmission of subtype C. It has been difficult to distinguish among these in previously studied settings. Projeto AMPLIAR is studying an explosive subtype C epidemic in the southern Brazilian state of Rio Grande do Sul.



METHODS: Socio-demographic and risk behavior data were collected prior to counseling from consenting VCT clients ≥ 16 years old at 4 testing sites. HIV status was determined by a reference standard including a 4th generation EIA, HIV NAAT, and follow-up serology (if initially positive). Population pol sequences were analyzed using multiple subtyping tools (Rega,RIP3.0,NCBI,STAR).



RESULTS: From 10/2004 through 11/2008 4584 clients were evaluated, with 731 (15.9%) HIV+. Of these, 333 were subtyped (35% C, 34% B/C recombinants, 24% B, and 7% F/F recombinants). The 113 B/C viruses showed 62 distinct patterns of recombination: 44 were unique forms, 5 were CRF31, and 64 fell into 17 novel groups. Subtyping and behavioral data were available on 221 participants. Odds of subtype C vs. B infection were much higher in heterosexuals, when compared to MSM (AOR 4.7 (1.6-13.8)), adjusting for sexual exposure, age, schooling, and race. Adjusted odds of infection with BC recombinants vs. B were also higher among heterosexuals than MSM (AOR 3.4 (1.07-11).



CONCLUSIONS: In a region with co-circulating subtypes, C-containing virus accounted for 69% of infections. The prevalence and diversity of BC recombinants suggests extensive mixing, yet both pure C and C-containing viruses are strongly and consistently associated with heterosexual exposure. This association is not explained by sociodemographic factors. These observations suggest a biological contribution to the transmission efficiency of C-containing virus, although a contributing founder effect cannot be ruled out.},

keywords = {},

pubstate = {published},

tppubtype = {conference}

}

@conference{deSouza2010,

title = {Persistent HIV transmission risk behaviors among HIV-serodiscordant couples in South Brazil},

author = {Machline Paim Paganella AND Leonardo Rapone da Motta AND Sérgio Kakuta Kato AND Rosa Dea Sperhacke AND Cristopher D. Pilcher AND Oliver M. Bacon AND Fredereick M. Hecht AND Ricardo da Silva de Souza},

url = {http://www.abstract-archive.org/Abstract/Share/6919},

year  = {2010},

date = {2010-07-18},

booktitle = {XVIII International AIDS Conference (AIDS 2010)},

number = {WEPE0375},

address = {Vienna, Austria},

organization = {International AIDS Society},

abstract = {BACKGROUND: The rate of HIV infection is increasing in the South region of Brazil, despite wide availability of free HIV care. We wished to assess HIV transmission risk behaviors in couples where one partner already knew he or she was HIV+ (HIV serodiscordant couples).



METHODS: The AMPLIAR project enrolls individuals with previously HIV - or unknown status at the time they seek routine HIV voluntary counseling in South Brazil. The study collects information concerning clinical and sociodemographic factors, HIV transmission risk behavior and sexual partnerships from all subjects. Testing for HIV infection includes staging of infections as 'recent' (< 6 months) using the BED capture EIA. 



RESULTS: Among 3591 HIV testers studied during 2006-2009, we identified 489 (14%) who were in HIV discordant steady partnerships and 3102 (86%) with only HIV-/unknown partnerships. The mean rate of sexual intercourse reported within HIV discordant couples (4.7 acts/2 weeks) was slightly greater than that reported by other participants (3.0 acts/ 2 wks; p=NS). HIV discordant couples reported low rates of condom use, with 34.6% reporting inconsistent and 33.5% reporting no condom use within the partnership. Main reasons for not using condoms in discordant couples included “trust in the partner” (36.0%), “don't like to use it” (20.1%) and “partner does not accept using it” (11.6%). Individuals in discordant couples who reported no or inconsistent condom use were significantly more likely to be newly HIV+ (OR 4.0 (95CI: 2.2, 7.1).



CONCLUSIONS: Despite the broad availability of HIV care and prevention services in Brazil, individuals in HIV-discordant partnerships continue to engage in frequent HIV transmission risk behaviors and to transmit HIV. Reasons for this are often related to interpersonal dynamics within couples. To combat HIV in South Brazil, increased efforts are needed that focus on HIV prevention in couples.},

keywords = {},

pubstate = {published},

tppubtype = {conference}

}

@conference{Mofenson2010,

title = {Viral load predicts WHO Stage 3 and 4 events in HIV-infected children on HAART, independent of CD4 T-lymphocyte value},

author = {George K. Siberry AND Ricardo Hugo S. Oliveira AND Margot Krauss AND Suzanne Essama-Bibi AND Cristina Hofer AND D. Robert Harris AND Adriana Tiraboschi AND Ricardo da Silva de Souza AND Heloisa Marques AND Regina Succi AND Thalita Abreu AND Marinella Della Negra AND Rohan Hazra AND Lynne M. Mofenson},

year  = {2010},

date = {2010-07-16},

booktitle = {2nd International Pediatric HIV Workshop},

address = {Vienna, Austria},

keywords = {},

pubstate = {published},

tppubtype = {conference}

}

@conference{deSouza2009,

title = {Evaluation of Cyto-Chex® reagent on the stability of T CD4+ and T CD8+ cell markers in whole blood samples},

author = {Bétani de Souza Velho AND Daiana Pellenz AND Luiz Gustavo dos Anjos Borges AND Andréa Cristina Vanni AND Sérgio Kakuta Kato AND Leonardo Rapone da Motta AND Rosa Dea Sperhacke AND Cristopher D. Pilcher AND Ricardo da Silva de Souza},

url = {http://www.abstract-archive.org/Abstract/Share/958},

year  = {2009},

date = {2009-07-19},

booktitle = {5th IAS Conference on HIV Pathogenesis, Treatment, and Prevention},

number = {MOPEB011},

address = {Cape Town, South Africa},

organization = {International AIDS Society},

abstract = {BACKGROUND: In Brazil and other moderately resourced settings flow cytometry can be made available in central laboratories to monitor immune status in HIV-infected patients. However, specimens must typically be analyzed within 24 hours after phlebotomy, which dramatically limits availability of this testing. We evaluated the Cyto-Chex® reagent, a stabilizer that preserves the white blood cells markers.



METHODS: The samples were obtained from three clinical centers located in south Brazil, during June-July/2008, with separate aliquots stored in EDTA and Cyto-Chex BCT at room temperature (12°C-27°C) until the moment of analysis. CD4+ and CD8+ T cell counts were performed on EDTA specimens within 24 hours; Cyto-Chex® BCT (CCBCT) samples were analyzed over different time periods (3 to 5, 7, 9-11 days post collection). Assays were performed using BD Facs Count equipment.



RESULTS: Of forty-eight samples collected into CCBCT, forty-six (95.8%) gave valid CD4/CD8 results. Both CD4 and CD8 on fresh specimens were highly correlated whether in CCBCT or EDTA (CD4 r2=.965; CD8 r2=.958, p< .001); Fresh blood CD4 counts were similar but fresh blood CD8 counts were significantly lower on CCBCT specimens than on EDTA (mean difference: -34.81 CD8 cells/mm3; p< .001). We detected no change in CD4 or CD8 counts over time.



CONCLUSIONS: The Cyto-Chex® reagent appears to maintain integrity of white blood cell antigens for CD4 and CD8 enumeration for up to 11 days, providing additional time for sample shipment and processing to a flow cytometry laboratory. This could be an important tool in resource-poor settings where refrigeration and other ancillary laboratory equipment may not be available at collection sites.},

keywords = {},

pubstate = {published},

tppubtype = {conference}

}

@conference{Siberry2009,

title = {HIV viral load predicts World Health Organization (WHO) stage 3 and 4 events among children in Latin American independent of CD4 level},

author = {Ricardo Hugo Oliveira AND Margot Krauss AND Suzanne Essama-Bibi AND Cristina Hofer AND Robert Harris AND Adriana Tiraboschi AND Ricardo da Silva de Souza AND Heloisa Marques AND Regina Succi AND Thalita Abreu AND Rohan Hazra AND George Siberry},

year  = {2009},

date = {2009-07-17},

booktitle = {1st International Workshop on HIV Pediatrics},

address = {Cape Town, South Africa},

keywords = {},

pubstate = {published},

tppubtype = {conference}

}

@conference{Souza2008b,

title = {Assesment of recent HIV-1 infection by Western blot in dried blood spots},

author = {Leonardo Rapone da Motta AND Sérgio Kakuta Kato AND Rosa Dea Sperhacke AND Luiz Gustavo Anjos Borges AND Cristopher D. Pilcher AND Ricardo da Silva de Souza},

url = {http://www.abstract-archive.org/Abstract/Share/66729},

year  = {2008},

date = {2008-08-03},

booktitle = {XVII International AIDS Conference (AIDS 2008)},

address = {Mexico City, Mexico},

organization = {International AIDS Society},

abstract = {BACKGROUND: Project AMPLIAR is a research consortium developed in part to evaluate testing methods to detect recent infections in south Brazil applicable to resource-limited settings. Recent reports have suggested that antibody specificity patterns (i.e. bands on LIA or WB) can be useful for both confirmation of infection and for simultaneous staging of infections as recent or longer-term infections. We wished to investigate whether Western blot (WB) could be used for this dual purpose using dried blood spots (DBS).



METHODS: In a cross-sectional diagnostic performance evaluation from September 2006 to August 2007, we screened DBS from 101 consecutive HIV+ samples collected by Projeto AMPLIAR using both WB (DAVIH Blot HIV-1 DBS) and BED-CEIA (Calypte HIV-1 BED Incidence Capture EIA) assays. We assessed a variety of WB band patterns identified in the literature as having the ability to distintuish recent (<~154 days) from long-term infection, using a BED normalized OD (ODn)<0.8 as the reference standard for recent HIV infection.



RESULTS: BED-CEIA classified 14 of 101 positive individuals (13,5%, 95% CI, 7,0-20,7) as recently infected. A WB algorithm requiring the absence of gp120, p24, p55 and p34 was able to identify recent HIV infections with the highest accuracy (77.2%), with a sensitivity of 57,1% (95% CI, 28,8-85,5) and specificity of 80,5% (95% CI, 72,0-88,9). Previously suggested algorithms based on raw band count or intensity scores were markedly less sensitive. Absence of the p31 (p34) band, suggested in the literature as being ‘characteristic’ of recent infection, was found in only 2 of 14 patients with recent infection (sensitivity=14%).



CONCLUSIONS: WB can be used to confirm HIV infection on DBS in situations with limited laboratory infrastructure where samples can be mailed to a centralized laboratory. However, our preliminary results suggest that WB patterns alone may have limited utility in discerning recent from long term infections in these settings.},

keywords = {},

pubstate = {published},

tppubtype = {conference}

}

@conference{Shor-Posner2008,

title = {HIV/AIDS knowledge and health-related behaviors: a hearing vs. deaf or a boy vs. girl issue?},

author = {Claudia Alquati Bisol AND T.M. Sperb AND T.H. Brewer AND Sérgio Kakuta Kato AND Gail Shor-Posner},

url = {http://www.abstract-archive.org/Abstract/Share/68284},

year  = {2008},

date = {2008-08-03},

booktitle = {XVII International AIDS Conference (AIDS 2008)},

number = {WEAD0204},

address = {Mexico City, Mexico},

organization = {International AIDS Society},

abstract = {BACKGROUND: Literature regarding deaf youths usually reports insufficient knowledge and understanding of HIV/AIDS, and that they are at greater risk of HIV infection compared to hearing youths.



METHODS: This study was conducted in the South of Brazil with 42 deaf and 50 hearing students, 40 of which were boys and 52 were girls. Volunteers answered a self-administered computer-assisted questionnaire with simultaneous video translation to Brazilian Sign Language and a branched decision-tree structure. Data were analyzed using SPSS.



RESULTS: Deaf participants had lower levels of HIV/AIDS knowledge and of school education. However, relevant differences in health-related attitudes and behaviors were not found except for the high rate of sexual abuse among the deaf youths (31%, p=<.001). Testing for gender effects revealed that it might be an important variable to consider. Gender differences were found in being sexually active (boys= 62.5%, girls=38.5%, p=.035), discussing sexual issues (girls talk more frequently with their mothers than boys do [Mann-Whitney U=664,00; p=.002]), visiting gynecologists/urologists (boys=17.5% , girls 61.5%, p<.001), and drug use (boys=20%, girls=3.8%, p=.018). No significant differences were found for either hearing vs. deaf or boys vs. girls in terms of sexual debut and sexual partnership.



CONCLUSIONS: Findings consistent with the literature regarding the deaf are the lower levels of HIV/AIDS knowledge and of school education and the high rates of reported sexual abuse. These results demonstrate a need to improve school based instruction, tailor health education to their communication needs and improve protection against sexual violence. Gender effects indicate that, even within the deaf community, youths are a heterogeneous group affected by several social determinants that must be considered when promoting health-related attitudes and behaviors for preventing HIV/AIDS.},

keywords = {},

pubstate = {published},

tppubtype = {conference}

}

@conference{Pilcher2008,

title = {Lower prevalence of primary antiretroviral resistance among clade C infected individuals as compared to clade B in South Brazil’s emerging clade C HIV-1 epidemic},

author = {Ricardo Sohbie Diaz AND Ricardo da Silva de Souza AND Maria Cecília Sucupira AND Elizabeth Cavalieri AND Karin M. Ribeiro AND Ludia Mondini AND Kimberly Page-Shafer AND Luiz Gustavo dos Anjos Borges AND Machline Paim Paganella AND Cristopher D. Pilcher},

url = {http://www.abstract-archive.org/Abstract/Share/68042},

year  = {2008},

date = {2008-08-03},

booktitle = {XVII International AIDS Conference (AIDS 2008)},

number = {TUAA0205},

address = {Mexico City, Mexico},

organization = {International AIDS Society},

abstract = {BACKGROUND: A growing epidemic by clade C viruses is occurring in the south of Brazil. We sought to characterize the prevalence of primary HIV-1 resistance among newly diagnosed, ARV-naive HIV infected individuals in the epicenter of this south Brazilian clade C epidemic.



METHODS: We studied 109 consecutive HIV positive samples collected from October 2006 to August 2007 at 4 anonymous HIV testing sites in Rio Grande do Sul, Brazil. HIV-1 pol regions were DNA sequenced, and infections were classified as recent or established infections according to the BED CEIA incidence assay (OD cutoff < 0.80). 



RESULTS: 15 out of 109 (13.7%) HIV+ individuals were classified as recently infected and 94 as established infections. 13.3% of those with recent infection and 7.2% of established infections presented ARV resistance to at least one antiretroviral class. According to pol sequences, 61.5% of individuals were infected by clade C viruses, 28.4% were infected by clade B, and 10.1% by non-B non-C strains, and proportions of recent infection were similar between clades. The prevalence of primary drug resistance was 9% among clade C infected vs. 22.6% among clade B infected, vs. 27% among non-B non-C infected individuals. The odds of resistance were significantly higher among HIV positives with subtype B and non-B non-C (p=0.03). 43% of patients with resistance mutations showed resistance to NRTI, 25% had TAMs, 25% had other NAMs, and 6.2% showed resistance to PIs. 



CONCLUSIONS: In south Brazil, where clade C infections have overgrown clade B infections, clade C viruses show a lower prevalence of primary ARV resistance. These observations may be explained in part by more recent introduction of clade C to south Brazil; by less diagnosis or ARV use in populations affected by clade C (heterosexuals); and/or by biologic factors.},

keywords = {},

pubstate = {published},

tppubtype = {conference}

}

@conference{Read2008,

title = {Lower respiratory tract infections and hospitalizations among HIV-exposed, uninfected infants born in Latin America. The NICHD International Site Development Initiative (NISDI) perinatal protocol},

author = {Marisa Mussi-Pinhata AND Fabrizio Motta AND Laura Freimanis-Hance AND Ricardo da Silva de Souza AND Edgardo Szyld AND Regina Succi AND Celia Christie AND Maria J. Rolon AND Mariana Ceriotto AND Jennifer S. Read},

year  = {2008},

date = {2008-05-02},

booktitle = {2008 Annual Meeting of the American Pediatric Society & Society for Pediatric Research},

number = {634467.7},

address = {Honolulu, Hawaii, USA},

organization = {American Pediatric Society & Society for Pediatric Research},

abstract = {BACKGROUND: We have previously described a high frequency of lower respiratory tract infections (LRTIs) among HIV-exposed but uninfected infants. Objective: To describe the frequency and characteristics of LRTIs, and to evaluate factors associated with occurrence of and hospitalizations for LRTI.



DESIGN/METHODS: We analyzed a cohort of HIV-exposed but uninfected, singleton, term infants with birth weight > 2500 grams who were prospectively followed from birth to 6 months and whose HIV-infected mothers had been enrolled during pregnancy at NISDI sites in Argentina and Brazil. Infants with underlying congenital, cardiovascular, and pulmonary conditions were excluded. Definitive or presumptive diagnoses of LRTIs were recorded based on information obtained at birth, 6-12 weeks, and at 6 months of age. Occurrence and reasons for hospitalization were recorded. Correlates for LRTI and hospitalization events were evaluated in univariate analysis.



RESULTS: A total of 547 infants met inclusion criteria for this analysis. Overall, 103 (18.8%) experienced 116 episodes of LRTI (incidence of 0.85 LRTIs/100 child-weeks of observation [95%CI: 0.69-1.01]). Most episodes (81%) were bronchiolitis. Fifty-one (9.3%) infants were hospitalized at least once with a LRTI, of whom 13 (25.4%) had severe signs and symptoms. Of 22 infants with pneumonia, 14 (63.6%) were hospitalized. Of 83 infants with bronchiolitis, 38 (45.8%) were hospitalized. Maternal CD4 decline during gestation [OR = 1.6 (95%CI 1.01 – 2.5)], infant CD4 decline from birth [OR = 2.0 (95%CI 1.02 – 4.0)], and infant anemia after birth [OR= 3.6 (95%CI 2.2 – 5.8)] were associated with the occurrence of LRTI in the postneonatal period. Household crowding [OR = 2.9 (95%CI 1.3 – 6.5)] and length for age below the 5th percentile [OR = 5.4 (95%CI 1.1 – 26.2)] were associated with hospitalization.



CONCLUSIONS: LRTIs and hospitalization are relatively common among HIV-exposed, uninfected infants. Maternal and infant immunological conditions and infant anemia were associated with acquiring LRTIs. Similar to the general population, household crowding and length for age appear to be risk factors for hospitalization among HIV-exposed, uninfected infants with LRTI.},

keywords = {},

pubstate = {published},

tppubtype = {conference}

}

@conference{Pilcher2008b,

title = {A Foothold for Subtype C in the Americas: Associations with C and Non-C HIV Infection in South Brazil},

author = {Oliver Bacon AND Ricardo da Silva de Souza AND Kimberly Page-Shafer AND Ricardo Sohbie Diaz AND Vânia Fátima Tusset De Bastiani AND Gisele Maria Inchauspe Preussler AND Maria Letícia Ikeda AND Nêmora Barcellos AND Wayne Steward AND Cristopher D. Pilcher},

url = {https://www.ucs.br/ips2/wp-content/uploads/2020/09/CROI-2008-A-Foothold-for-Subtype-C-in-the-Americas.pdf},

year  = {2008},

date = {2008-02-03},

booktitle = {15th Conference on Retroviruses and Opportunistic Infections.},

number = {#508},

address = {Boston, MA, USA},

organization = {International Antiviral Society USA},

abstract = {BACKGROUND:

• HIV epidemic in Brazil is has stabilized, with nationwide seroprevalence <1%.

• AIDS incidence overall declined 40% between 2000 and 2006.

• But recently, the Southern states of Rio Grande do Sul, Paraná, and Santa Catarina surpassed São Paulo and Rio de Janeiro as the regions most affected by the epidemic. – In 2006, AIDS incidence was 17 cases/100,000 in the South, vs. 11.5 in the Southeast (São Paulo and Rio de Janeiro), and 10.1 nationally.

• HIV subtype C is now the dominant circulating HIV strain in the south, whereas HIV subtype B still predominates elsewhere in Brazil (Figure 1).

• It is unknown whether the co-circulation of subtypes C and B is due to differences in risk behavior, social or sexual mixing, or viral-host interactions such as tissue tropism.



OBJECTIVE: To better understand the epidemiology of infection and the differential spread of HIV subtypes in Southern Brazil, especially the rapid expansion of HIV subtype C infection. We examine prevalent HIV infection, recently acquired HIV, and HIV subtypes in associations with sociodemographic and risk behavior data in a large population of persons attending HIV counseling and testing (VCT) centers in Rio Grande do Sul. 



METHODS

• Projeto AMPLIAR studies the epidemiology of HIV transmission in South Brazil.

• Population: HIV testing clients >16 years old from 4 VCT centers covering 65% of the testing population in Rio Grande do Sul.

• Data collection: Pre-test sociodemographic and risk behavior data from consenting VCT clients using a modified version of the national risk assessment questionnaire.

• Laboratory tests: HIV status determined by a reference standard including a 4th generation EIA with confirmatory Ab testing, HIV NAAT if 4th gen negative (Roche Amplicor 1.5 Ultra pooled 1:20), and follow-up serology (if initially positive). Recent infections assessed using the BED CEIA assay (Calypte; ODn cutoff=0.8). Subtyping by population sequencing of pol (ViroSeq; Abbott) and phylogenetic analysis.

• Statistical analyses: Assessed associations between sociodemographic and behavioral variables and the principal outcomes (HIV infection [prevalent and recent] and HIV subtype) in bivariate analyses using chi-square and Fisher’s exact tests, and in multivariate logistic regression (STATA version 9).



SUMMARY OF RESULTS POPULATION:

• 1210 AMPLIAR participants, enrolled between October 2006 and August 2007.

• 46% were female; 50% aged 24 to 40 years; 45% were married. Few reported sex work (7.3%) or injection drug use (0.5%).

HIV infection: 

• HIV seroprevalence was 12.4% (Table 1). 

• HIV infection positively associated with being nonwhite, <8 years of education, age, ever married, and being MSM (Table 1); and negatively associated with sex work.

• Variables independently associated with HIV included: sexual partner choice (MSM vs.non-MSM; AOR 3.4, 95% CI 1.89–6.2), <8 years of education (AOR 1.6, 95% CI, 1.13–2.35), and sex work, which was protective (AOR 0.07, 95% CI 0.01–0.49) (Table 3). 

Recent/acute HIV infection:

• 29 participants (2.4%) classified as recently or acutely infected (Table 2).

• Recent/acute HIV infection associated with being MSM, and <8 years of education (Tables 2 and 3).

HIV subtype:

• 110 (72%) of 152 HIV-infected participants were subtyped: 62% were C, 29% B, and 9% other (F and recombinants) (Figure 2).

• Subtype C infection was associated with age >40 and being a heterosexual male vs. MSM (Table 4).



CONCLUSIONS:

• There is an association between subtype C and being heterosexual (vs. MSM) in Southern Brazil.

• No evidence of heterosexual and MSM populations being socially and sexually isolated.

• Thus, findings suggest that subtype C may be more efficiently transmitted female-to-male, perhaps by preferential shedding in vaginal mucosa (John-Stewart 2005). Alternatively, there may be sexual mixing patterns not captured by behavioral measures.

• More specific behavioral data (e.g., at partner and network level), linked to subtyping, is required to understand better the relationship between HIV subtype, partner choice, and type of intercourse.

• Analysis of recent infection data suggest that MSM and persons with less formal education continue to be at risk and in need of increased prevention efforts.

• Very low rate of HIV infection among sex workers, despite a median of 51/2000 partners over 12 months (data not shown), may indicate that this group has more effectively adopted prevention strategies, and warrants future study. Limitations

• Results obtained from persons seeking HIV testing at VCTs and, as such, are not generalizable to the overall population.

• Underreporting of risk behaviors may result in conservative estimates of excess risk associated with HIV infection.

• Small sample size of this interim analysis limits our ability to identify associations with subtype C vs. non-C HIV infection.

• Some populations at risk of HIV infection may not present for testing at the VCT sites that participated in this study (e.g., sex workers, IDU). Low numbers of IDU are particularly concerning as IDU is a well-recognized risk factor for HIV infection and a prevalent behavior in Rio Grande do Sul.},

keywords = {},

pubstate = {published},

tppubtype = {conference}

}

@conference{Inocêncio2007,

title = {Evaluation of two fourth-generation screening assays for the detection of HIV-1/2 in dried blood spots},

author = {Ricardo da Silva de Souza AND Luiz Gustavo dos Anjos Borges AND Leonardo Rapone da Motta AND Denise de Souza AND Lilian Amaral Inocêncio},

url = {http://www.abstract-archive.org/Abstract/Share/60651},

year  = {2007},

date = {2007-07-22},

booktitle = {4th IAS Conference on HIV Pathogenesis, Treatment and Prevention},

number = {CDB052},

address = {Sydney, Australia},

organization = {International AIDS Society},

abstract = {OBJECTIVES: There is an urgent need for simple and highly sensitive HIV screening assays suitable to resource-limited settings. Dried blood spot (DBS) is a reliable method for the collection, transport and storage of samples while fourth-generation EIAs (FGEIA) detect HIV Ab and p24 Ag simultaneously offering greater sensitivity and a shorter window of detection. Combined these systems can improve HIV testing access and performance. We aimed to evaluate two commercially available FGEIAs using a modified protocol for DBS specimens stored for short and long periods.



METHODS: Two reference HIV panels were obtained from blood donors and HIV patients in southern Brazil. Fifty microliters whole blood–EDTA specimens were transferred to filter paper (S&S 903) and dried and stored at room temperature in zip-lock bags with desiccant for a period of 6 to 15 weeks (short-term=ST) and 17 to 34 weeks (long-term=LT). DBS was screened for the presence of HIV 1/2 by Genscreen Plus HIV Ag/Ab (Biorad) and Murex HIV Ag/Ab Combination (Abbot). DBS was eluted empirically using the same protocol for both assays and tested according to the manufacturer´s instruction. Performance characteristics were calculated using the reference panel. Results: For ST (HIV- (n=43); HIV+ (n=62)) Genscreen resulted in a sensitivity (Se) 100% (95%CI 92.7-100%); specificity (Sp) 88.3% (95%CI 74.1-99.5%). ST Murex, (HIV- (n=44); HIV+ (n=49)): Se 100% (95%CI 90.9-100%); Sp 88.6% (95%CI 74.6-95.7%). For LT (HIV- (n=192); HIV+ (n=92), Genscreen maintained its performance. LT Murex, (HIV- (n=42); HIV+ (n=39); had optimal Se but poor Sp (11.9% (95%CI 4.4-26.4%).



CONCLUSIONS: FGEIA kits can be modified for use with DBS stored for up to 15 weeks, are easy to perform and use equipment found in most laboratories. Definition of elution protocols needs to be tailored to each FGEIA kit to avoid problems with low specificity.},

keywords = {},

pubstate = {published},

tppubtype = {conference}

}

@conference{daMotta2007,

title = {Stability of HIV-1/2 antibodies in dried blood spots stored for up to 13 months under various environmental conditions in Brazil},

author = {Ricardo da Silva de Souza AND Luiz Gustavo dos Anjos Borges AND Lilian Amaral Inocêncio AND Denise de Souza AND Leonardo Rapone da Motta},

url = {http://www.abstract-archive.org/Abstract/Share/60618},

year  = {2007},

date = {2007-07-22},

booktitle = {4th IAS Conference on HIV Pathogenesis, Treatment and Prevention.},

number = {CDB051},

address = {Sydney, Australia},

organization = {International AIDS Society},

abstract = {OBJECTIVES: Dried blood spot (DBS) is an affordable and reliable method for the collection, transport and storage of samples for serologic and molecular assays. HIV antibody concentrations in DBS are stable for up to 6 weeks, however, it declines steadly thereafter. Our objective was to evaluate the stability of HIV antibodies in DBS stored for short and long periods under room temperature and controlled conditions.



METHODS: Four sets of DBS cards originated from a panel (n=10) of HIV positive (n=5) and negative (n=5) specimens from reference whole blood–EDTA were transferred to filter paper (S&S 903) and dried. Cards were placed in zip-lock bags with desiccant and panels were stored in different environments: room temperature (RT), 4°C, -20°C or -70°C. DBS panels were screened at baseline, 6, 11, 17, 21, 42 and 53 weeks by Q-Preven HIV 1/2 (Q-preven, Brazil), a validated DBS assay. Humidity and temperature were recorded daily and optical density (OD) ratios were obtained.



RESULTS: With storage under 4°C, -20°C and -70°C (humidity <50%) all HIV positive and negative samples remained concordant with stable OD ratios. One low-titer (1/5) HIV-positive at 4°C presented a 50% decrease in OD ratio over time, remaining positive. For RT, mean temperature was 22.2°C (range 27.2 - 12.1). Humidity remained >50% during most of the 53 weeks (mean 59.5%; range 72% - 45%). During the initial 6 weeks, all specimens maintained their serological status. Decrease of OD ratios was seen at 6 weeks with high-titer positives losing reactivity at 11 weeks. Negatives did not change status. 



CONCLUSIONS: DBS can be stored effectively for 53 weeks (13.2 months) at 4°C, -20°C and -70°C and for 6 weeks at room temperature with humidity >50%, simulating field conditions. DBS use for the detection of HIV antibody is a convenient tool for HIV surveillance in remote areas of Brazil.},

keywords = {},

pubstate = {published},

tppubtype = {conference}

}

@conference{Pilcher2007,

title = {Utilization of HIV RNA tests for infant diagnosis in Brazil, 2000-2006},

author = {Ricardo da Silva de Souza AND Denise de Souza AND Lilian Amaral Inocêncio AND Kimberly Page-Shafer AND Hilary Spindler AND Machline Paim Paganella AND Cristopher D. Pilcher},

url = {http://www.abstract-archive.org/Abstract/Share/60686},

year  = {2007},

date = {2007-07-22},

booktitle = {4th IAS Conference on HIV Pathogenesis, Treatment and Prevention.},

number = {TUPEB023},

address = {Sydney, Australia},

organization = {International AIDS Society},

abstract = {OBJECTIVES: Early HIV diagnosis in children allows administration of OI prophylaxis and/or ART to decrease morbidity and mortality, but requires use of viral molecular tests early in life. To understand patterns of access and current standards of HIV RNA test usage in Brazil, we conducted a retrospective analysis using the national SISCEL database.



METHODS: The Brazilian STD/AIDS Program developed SISCEL in 1999, a laboratory database which integrates public health laboratories supporting Brazil’s universal ART program. HIV RNA testing records were examined for all children with at least one HIV RNA test before 24 months of age and born between January 2000 and June 2006. 



RESULTS: 22,053 HIV exposed children attending 557 clinics were identified. A total of 37,162 HIV RNA tests were performed in 70 public laboratories of the SISCEL network. 88.7% of children had a test before 12 months of age. Although two tests are recommended for early diagnosis, 8,334 (41.8%) children born before 2006 had only one RNA test performed. Mean age at first test was 5.4 months (166 days); and age at first test varied significantly by region. Of the 11,607 (52%) children that had a second RNA test performed, median time between first and second test was 131 days (range:1 –1462 days). Median time from specimen collection to results was 15 days. Agreement between first and second test results was 96.2% for RT-PCR, 89.9% for b-DNA, and 83.9% for NASBA. 



CONCLUSIONS: In Brazil, where RNA testing is widely available in support of ART, early HIV diagnosis in exposed children using HIV RNA quantitative assays remains challenging. Strategies to encourage earlier and more frequent testing of infants are therefore necessary, especially in underdeveloped areas of Brazil where the system of care is less established.},

keywords = {},

pubstate = {published},

tppubtype = {conference}

}

@conference{NISDIPediatricProtocolStudyGroup2006,

title = {HAART in children and adolescents in Latin America: relationship between viral load and clinical characteristics from the National Institute of Child Health and Human Development International Site Development Initiative (NISDI) pediatric study},

author = {Ricardo Hugo Oliveira AND Julianne Byrne AND Ricardo da Silva Souza AND Adriana A. Tiraboschi Bárbaro AND Heloisa Helena de Souza Marques AND Regina Succi AND Leslie K. Serchuck AND NISDI Pediatric Protocol Study Group},

url = {http://www.abstract-archive.org/Abstract/Share/53179},

year  = {2006},

date = {2006-08-13},

booktitle = {XVI International AIDS Conference (AIDS 2006)},

number = {THPE0129},

address = {Toronto, Canada},

organization = {International AIDS Society},

abstract = {BACKGROUND: A goal of combination antiretroviral (ARV) therapy is to control viral replication to levels below detection, with the intent of decreasing clinical disease progression. Achieving such levels may be less common in children than adults, in part because of the high viral load (VL) in children. We compared 12-month clinical outcome of children on HAART in NISDI by VL (< vs >400 copies/mL= DETECT vs UNDETECT).



METHODS: NISDI is a prospective observational study of HIV-exposed and infected children enrolled at 14 sites in Mexico, Argentina and Brazil. We evaluated the relationship between VL and clinical outcome (defined as any Stage 3/4 event from 2005 Interim WHO Pediatric Clinical Staging of HIV/AIDS) in 345 children aged <1-19 years receiving HAART at enrollment and with follow-up for 12 months. 



RESULTS: At enrollment, 36.9% had UNDETECT and 63.1% had DETECT VL. After 12 months of follow-up, 43 of 345 (12.5%) children had Stage 3/4 events. Among 168 children with DETECT VL both at enrollment and at 12 months (median 16,280 copies/ml), 13.1% experienced either a Stage 3/4 event, compared to 8.4% (9/107) with UNDETECT VL at both time points (p=0.32). There were no differences in frequency of Stage 3/4 events according to gender or age at HIV diagnosis. Almost half of all events occurred in subjects with normal age-adjusted CD4 cells. More children with UNDETECT VL had CD4 > 25% compared to those with DETECT VL (p<0.01). No deaths occurred during follow-up.



CONCLUSIONS: In this preliminary analysis, ARV-experienced children maintained on HAART with persistently DETECT VL had a similar proportion of disease progression compared to those with UNDETECT VL. These data suggest that ARV-treated children, particularly those with limited therapeutic options, may not require immediate ARV change when they have DETECT VL.},

keywords = {},

pubstate = {published},

tppubtype = {conference}

}

@conference{deSouza2006b,

title = {High-risk sexual behavior among undergraduate college students in southern Brazil},

author = {Carla Tessari de Souza AND Alice Maggi AND Mariana Bisol AND Tânia Wagner AND Ricardo da Silva de Souza},

url = {http://www.abstract-archive.org/Abstract/Share/51278},

year  = {2006},

date = {2006-08-13},

booktitle = {XVI International AIDS Conference (AIDS 2006)},

number = {WEPE0712},

address = {Toronto, Canada},

organization = {International AIDS Society},

abstract = {BACKGROUND: High-risk sexual behaviors continue to be one of the major factors contributing to the HIV epidemic. Disclosure of HIV serostatus can expand awareness of risk to partners, increase opportunities for risk reduction, enable couples to make informed reproductive health choices and improve access to care and treatment programs. Our objective was to investigate the knowledge, attitudes and beliefs of college students regarding HIV disclosure and sexual risk behavior in order to develop appropriate strategies to encourage healthier and safer sex practices.



METHODS: 645 undergraduate students were invited to participate in a cross-sectional anonymous survey at Universidade de Caxias do Sul, Caxias do Sul, Brazil from November to December, 2004. A questionnaire comprised of single and multiple choice questions was administered after proper introduction and formal consent to collect information on demographic data, knowledge of HIV transmission, sexual behavior in real and hypothetical situations, prevention and testing behavior. Privacy was assured to respondents.



RESULTS: 635 students participated. 235 (37%) indicated that they would disclose HIV status to their sexual partner, if they were HIV positive but, 257 (40.5%) would not disclose their HIV status and 143 (22.5%) were not sure. Among the 235 that would inform their partner, 72.2% were women and 68.9% were single. Of the 257 that would not disclose their status, 143 (55,6%) reported that they would not use condoms in casual relationships.



CONCLUSIONS: A large proportion of undergraduate students reported that they would not disclose their HIV status nor use condoms in casual relationships. The high potential for spread of HIV among this population emphasizes the failure of current prevention programs in reaching young adults and the need for expanding HIV prevention strategies to include specific programs for youths at all educational levels.},

keywords = {},

pubstate = {published},

tppubtype = {conference}

}

@conference{Ryder2006,

title = {Rapid and efficient acute HIV detection by 4th generation Ag/Ab ELISA},

author = {Ricardo da Silva de Souza AND Cristopher D. Pilcher AND Susan Fiscus AND Ada Cachafeiro AND Melissa Kerkau AND Luciene Scherer AND Rosa Dea Sperhacke AND Márcia Silva AND Simone Castro AND Luiz Fernando de Macedo Brígido AND Robert W. Ryder},

url = {http://www.abstract-archive.org/Abstract/Share/55301},

year  = {2006},

date = {2006-08-13},

booktitle = {XVI International AIDS Conference (AIDS 2006)},

number = {TUAB0201},

address = {Toronto, Ontario, Canada},

organization = {International AIDS Society},

abstract = {OBJECTIVES: HIV NAAT with specimen pooling can identify Ab-negative acute HIV infections (AHI), but is technologically complex and loses efficiency at high prevalences. Fourth-generation EIAs (FGEIA) detecting HIV Ab and p24 Ag simultaneously have not been directly compared to HIV NAAT for AHI detection.



METHODS: 933 consenting patients requesting HIV testing at a public HIV clinic in southern Brazil were screened with FGEIA (Genscreen Plus HIV Ag-Ab -Biorad) and NAAT (pooled 1:12). Confirmatory testing used parallel Axsym HIV1/2 gO MEIA (Abbott), IFA (Bio-manguinhos), Determine RT (Abbott) and WB (Genelabs). FGEA+ but Ab- or WB indeterminate specimens with available serum were confirmed by NAAT. HIV infection was defined by positivity on FGEIA and one or more confirmatory test; AHI was defined by one or more negative antibody test.



RESULTS: HIV was detected in 183 of 933 specimens (HIV prevalence: 19.6%). Five cases of Ab- negative infection (AHI prevalence: 0.5%) were all detected by FGEIA (Sensitivity (Se) 100.0 (95CI; 97.4,100.0)). FGEIA had no false positives (specificity (Sp) 100.0 (95CI; 99.3,100.0)). Pooled NAAT detected no additional cases.

 #	FGEIA OD	MEIA	IF	Determine	WB	   HIV NAAT	Subtype 

1	Pos (3.136)	Pos	     Neg	     Pos	        Pos  	Pos     	   CB 

2	Pos (2.897)	Neg	     Neg	     Pos	        ND	        QNS	         QNS

3	Pos (0.442)	Neg	     Neg	     Pos	        ND	        Pos	         QNS 

4	Pos (0.950)	Pos	     Pos	     Pos	       Indet	        Pos      	    B 

5	Pos (1.2)	        Pos	     Pos	    Neg	        Neg	       QNS	         QNS 

[FGEIA and confirmatory results for cases of AHI]



CONCLUSIONS: In a clinic setting with high HIV prevalence and mixed subtypes in Southern Brazil, HIV antibody tests failed to detect 1 to 3% of confirmed HIV infections. Pooled NAAT offered no advantage over 4th generation EIA screening for detection of AHI. Simpler FGEIA screening detects AHI with sufficient accuracy to make acute HIV based prevention strategies feasible in resource limited settings.},

keywords = {},

pubstate = {published},

tppubtype = {conference}

}

@conference{Castro2005,

title = {Evaluation of ‘Q-PREVEN’ an HIV-1/2 Assay Developed Specifically for the Detection of Antibodies on Dried Blood Spots},

author = {Ricardo da Silva de Souza AND Luiz Gustavo dos Anjos Borges AND Leonardo Rapone da Motta AND Andréa Cauduro de Castro},

url = {http://www.abstract-archive.org/Abstract/Share/49089},

year  = {2005},

date = {2005-07-24},

booktitle = {3rd IAS Conference on HIV Pathogenesis and Treatment (IAS 2005)},

number = {MoPe15.2C25},

address = {Rio de Janeiro, RJ, Brasil},

organization = {International AIDS Society},

abstract = {INTRODUCTION: Simple sampling methods that can be applied under difficult field conditions are needed to expand access to diagnosis and treatment. Q-Preven HIV 1+2 (Symbiosis Diangnóstica, Brazil), is an enzimeimmunoassay (ELISA) developed for the detection of antibodies against all strains of HIV specifically in whole blood collected and dried on filter paper (DBS). Our objective was to determine the sensitivity, specificity and predictive values of Q-Preven. We also evaluated the stability of HIV antibody detection on DBS stored at ambient temperature for a period of 35 days. 



METHODS: 309 sera and DBS samples were collected in parallel from blood donors and patients attending a reference hospital in southern Brazil from December to January, 2005. Samples were tested according to the manufacturer´s instruction. DBS was screened for the presence of antibodies to HIV by Q-Preven, and sera by ELISA (Cobas Core, Abbott Axsym HIV-1/2 gO) and HIV RNA reference tests (Bayer bDNA, v3.0). The performance characteristics of Q-Preven were calculated using the reference protocol as the gold standard. Samples with discordant results from the reference were retested in triplicate.



RESULTS: Two hundred and one samples were HIV negative (65%), and 108 were HIV positive (35%) resulting in the following performance data in the first run: sensitivity 100% (95%CI 97.9-100%); specificity 99.5% (95%CI 98.4-99.5%); PPV 99,1%( 95%CI 97%-99%%); NPV 100% (95%CI 98,9-100%). It is noteworthy that the initial discordant sample (false-positive) was retested resulting in triplicate concordant results. Analyses of stability with high titer positive samples demonstrated no decrease over time in the mean OD ratios after 35 days of room temperature storage.



CONCLUSIONS: Q-Preven demonstrated high performance characteristics. The requirement of less blood volume, easy storage and transportation make the assay ideal for use in areas where specimens have to be sent to a centralized testing facility, especially in resource limited settings.},

keywords = {},

pubstate = {published},

tppubtype = {conference}

}

@conference{deSouza2005,

title = {Integrating HIV counseling and testing to routine medical care may increase testing rates among undergraduate students},

author = {Carla Tessari de Souza AND Mariana Bisol AND Alice Maggi AND Tânia Wagner AND Ricardo da Silva de Souza},

url = {http://www.abstract-archive.org/Abstract/Share/48314},

year  = {2005},

date = {2005-07-24},

booktitle = {3rd IAS Conference on HIV Pathogenesis and Treatment (IAS 2005)},

number = {TuPe15.4P08},

address = {Rio de Janeiro, RJ, Brasil},

organization = {International AIDS Society},

abstract = {INTRODUCTION: Many HIV-infected persons do not get tested until late in their infection. The development of new testing strategies creates new prospects for expanding testing to identify and treat HIV-infected persons earlier, avoiding new infections and reducing care costs. Our objective was to evaluate HIV testing behaviors and motives to facilitate optimization of testing practices.



METHODS: Cross-sectional anonymous survey of 645 undergraduate students in Caxias do Sul, Brazil from November to December, 2004. A questionnaire comprised of single and multiple choice questions was administered after proper introduction and formal consent to collect information on demographic data, HIV transmission risks prevention and testing behaviors. Privacy was assured to respondents.



RESULTS: Mean age of the 635 eligible participants was 25 years (range 17-56), 68.7% were female, and 73.1% were single. Of the 635 participants, 295(46,5%) reported testing and knowledge of their HIV status. Of the 295 that reported testing, 137 (46.4%) pointed reasons for testing: physician request 36 (26,3%), blood donation 26(19%), curiosity 25 (18,2%), risk of exposure 16(11.7%), partner request 11 (8%), employer request 11(8%) and others 12(8.8%). Although reasons for testing vary, the reasons most frequently mentioned were related to referral by a health care provider (53,3%) Overall, 48,5% of men and 58,2% of women that informed reasons for testing were tested primarily because the test was offered or recommended by a health-care professional.



CONCLUSIONS: Most of college students sought testing as consequence of third party request instead of their willingness to do the test. This observation suggests that a better engagement of health care providers on the awareness of the importance of HIV testing may facilitate optimization of testing practices and have a positive impact on testing rates. We speculate that incorporating HIV testing to routine medical care may contribute to reduce the emotional distress associated to HIV testing.},

keywords = {},

pubstate = {published},

tppubtype = {conference}

}

@conference{Read2005b,

title = {Safety of Receipt of Antiretroviral Drugs during Pregnancy among HIV-1-Infected Women in Latin America and the Caribbean: The NICHD International Site Development Initiative (NISDI) Perinatal Study},

author = {Mariana Ceriotto AND René Gonin AND Geraldo Duarte AND Robert Harris AND Aguiar R AND Eduardo Warley AND José Mauro Madi AND Zala C AND Jennifer S. Read},

url = {http://www.abstract-archive.org/Abstract/Share/48403},

year  = {2005},

date = {2005-07-24},

booktitle = {3rd IAS Conference on HIV Pathogenesis and Treatment (IAS 2005)},

number = {TuPe11.8C01},

address = {Rio de Janeiro, RJ, Brasil},

organization = {International AIDS Society},

abstract = {INTRODUCTION: Our objectives were to assess the association between ARVs during pregnancy and adverse events through 6-12 weeks postpartum among HIV-1-infected women in Latin America and the Caribbean. 



METHODS: We analyzed data from a prospective cohort study of HIV-1-infected women and their infants in Argentina, the Bahamas, Brazil and Mexico (NISDI Perinatal Study). This analysis included ARV-naïve women with HIV-1 infection diagnosed during the index pregnancy followed for at least 6-12 weeks after delivery. Maternal clinical (rash, nausea and/or vomiting, headache) and laboratory (elevated SGPT and SGOT, anemia, leucopenia, thrombocytopenia) adverse events at hospital discharge and at 6-12 weeks postpartum were analyzed.



RESULTS: Of 743 women enrolled as of October 2004, 289 met the inclusion criteria. Most (91%) had mild clinical disease (CDC Category A) at enrollment. Receipt of ARVs during pregnancy was categorized according to the most complex regimen received: Group1: ZDV alone or 2 NRTIs [43 (15%)]; Group2: 2 NRTIs + 1 NNRTI [132 (46%)]; Group3: 2 NRTIs + 1 PI [105 (36%)]; or none/other [9 (3%)]. Significant findings at hospital discharge and at 6-12 weeks postpartum included the following. At hospital discharge, anemia was most common in Group1 (57%) vs. Group2 or Group3 (p = 0.002), while leucopenia was least common in Group3 (5.0%) vs. Group1 or Group2 (p = 0.013). At 6-12 weeks postpartum, rash was most common in Group2 (4.8%) vs. Group1 or Group3 (p = 0.034), while headache was least common in Group1 (4.7%) vs. Group2 or Group3 (p = 0.028); elevated SGPT (18.6%) (p = 0.015) and SGOT (16.3%) (p = 0.014) values were most common in Group1 vs. Group2 and Group3.



CONCLUSIONS: Significant associations between maternal ARV regimens during pregnancy and clinical/laboratory abnormalities were observed. Further analyses are underway to more completely characterize toxicities according to ARV regimen.},

keywords = {},

pubstate = {published},

tppubtype = {conference}

}

@conference{Wagner2005,

title = {Willingness to Participate in HIV Vaccine Trials Among College Students in Southern Brazil},

author = {Ricardo da Silva de Souza AND Carla Tessari de Souza AND Aline Maggi AND Mariana Bisol AND Tânia Wagner},

url = {http://www.abstract-archive.org/Abstract/Share/49240},

year  = {2005},

date = {2005-07-24},

booktitle = {3rd IAS Conference on HIV Pathogenesis and Treatment (IAS 2005)},

number = {WePe13.13P10},

address = {Rio de Janeiro, RJ, Brasil},

organization = {International AIDS Society},

abstract = {INTRODUCTION: Efficacy trials of candidate HIV-1 vaccines require study populations at high risk of infection who adhere to complex protocols with frequent HIV testing and who are willing to participate. We investigated the willingness to participate in HIV vaccine trials and its association with HIV testing experience among college students in southern Brazil. 



METHODS: Cross-sectional anonymous survey of 645 college students in Caxias do Sul, Brazil from November and December, 2004. A questionnaire comprised of single and multiple choice questions with hypothetical and real life situations related to sexual behavior, HIV testing experience and willingness to participate in vaccine trials was administered after proper introduction and formal consent. Privacy was assured to respondents.



RESULTS: Mean age of 637 eligible participants was 25 years (range 17-56), 68,7% were female, 73,1% were single and 295 (46,3%) reported having an HIV test. Of 637 participants, 259 (40.7%) indicated that they would definitely be willing to participate in a vaccine trial, 201 (31.6%) reported that they would participate depending on additional information and 178 (27.9%) that they would not participate. Of the ones that definitely would participate, 30% reported having an HIV test. In univariate analysis, there was no association between HIV testing and willingness to participate in a vaccine trial. 



CONCLUSIONS: Our survey on willingness to participate in future HIV vaccine trials in this population indicated that 40.7% to 72.3% of the participants would be part of a trial, considering respondents that needed additional information to participate. This finding suggests that college students may be an alternative cohort, suitable for future HIV prevention trials. Addressing barriers and concerns by providing information through appropriate agencies may lead to successful HIV vaccine trials with college students in southern Brazil.},

keywords = {},

pubstate = {published},

tppubtype = {conference}

}

@conference{Gonin2005,

title = {A prospective cohort study of HIV-1-infected pregnant women and their infants in Latin America and the Caribbean: The NICHD International Site Development Initiative (NISDI) Perinatal Study},

author = {Jennifer S. Read AND Pedro Cahn AND Marcelo H. Losso AND Jorge Pinto AND Esau Custodio Joao AND Geraldo Duarte AND Chang D AND Edmundo Cardoso AND Edgardo Szyld AND James Korelitz AND Regina Succi AND Ricardo da Silva de Souza AND Mariana Ceriotto AND Laura Freimanis-Hance AND René Gonin},

year  = {2005},

date = {2005-02-22},

booktitle = {12th Conference on Retroviruses and Opportunistic Infections (CROI)},

address = {Boston, Massachusets, Estados Unidos da América},

organization = {International Antiviral Society USA},

keywords = {},

pubstate = {published},

tppubtype = {conference}

}

@conference{Read2005bb,

title = {Infectious disease morbidity among HIV-1-uninfected infants born to HIV-1-infected mothers in Latin America and the Caribbean: The NICHD International Site Development Initiative (NISDI) Perinatal Study.},

author = {Marisa Mussi-Pinhata AND James Korelitz AND Jorge Pinto AND Cruz L AND Marcelo H. Losso AND Laura Freimanis-Hance AND Regina Succi AND Marzo S AND Chang D AND Edmundo Cardoso AND Ricardo da Silva de Souza AND René Gonin AND Mariana Ceriotto AND Jennifer S. Read},

year  = {2005},

date = {2005-02-22},

booktitle = {12th Conference on Retroviruses and Opportunistic Infections (CROI)},

address = {Boston, Massachusets, Estados Unidos da América},

organization = {International Antiviral Society USA},

keywords = {},

pubstate = {published},

tppubtype = {conference}

}

@conference{Korelitz2005,

title = {Mode of delivery and postpartum morbidity among HIV-1-infected women in Latin America and the Caribbean: The NICHD International Site Development Initiative (NISDI) Perinatal Study},

author = {Geraldo Duarte AND Jennifer S. Read J AND René Gonin AND Marcelo H. Losso AND Claudia Mayoral AND Chang D AND Edmundo Cardoso AND Regina Succi AND Laura Freimanis-Hance AND Ricardo da Silva de Souza AND Mariana Ceriotto AND James Korelitz},

year  = {2005},

date = {2005-02-22},

booktitle = {12th Conference on Retroviruses and Opportunistic Infections (CROI)},

address = {Boston, Massachusets, Estados Unidos da América},

organization = {International Antiviral Society USA},

keywords = {},

pubstate = {published},

tppubtype = {conference}

}

@conference{Read2005a,

title = {Receipt of PI-containing HAART during pregnancy and adverse pregancy outcomes (low birth weight, preterm birth) among HIV-1-infected women in Latin America and the Caribbean: The NICHD International Site Development Initiative (NISDI) Perinatal Study},

author = {Edgardo Szyld AND René Gonin AND Eduardo Warley AND Pedro Cahn AND Guilherme Amaral Calvet AND Geraldo Duarte AND Victor Hugo Melo AND James Korelitz AND Edmundo Cardoso AND Adriana Duran AND Laura Freimanis-Hance AND Regina Succi AND Ricardo da Silva de Souza AND Chang D AND Jennifer S. Read},

year  = {2005},

date = {2005-02-22},

booktitle = {12th Conference on Retroviruses and Opportunistic Infections},

address = {Boston, Massachusets, Estados Unidos da América},

organization = {International Antiviral Society USA},

keywords = {},

pubstate = {published},

tppubtype = {conference}

}

@conference{Bertelli2004,

title = {Improved performance after implementation of a quality assurance program in a multisite perinatal HIV research initiative in Southern Brazil},

author = {Carla Tessari de Souza AND Ricardo da Silva de Souza AND Leonardo Rapone da Motta AND Melissa Cláudia Bisi AND Melissa Cavagnoli AND Ana Luiza Aver dos Anjos AND Paola Barbieri Pasquali AND Marcelo Bertelli},

url = {http://www.abstract-archive.org/Abstract/Share/41192},

year  = {2004},

date = {2004-07-11},

booktitle = {XV International AIDS Conference (AIDS 2004)},

number = {E12789},

address = {Bangkok, Tailândia},

organization = {International AIDS Society},

abstract = {ISSUES: Quality assurance is an important part of a research protocol. Poor quality can compromise research results and lead to unrealistic findings. Objectives are to describe the preparation and implementation of a Quality Assurance Program (QAP) in a multicenter research initiative and to evaluate site performance.



DESCRIPTION: University of Caxias do Sul (UCS) is participating in an international Perinatal HIV research initiative coordinating a consortium of four sites in two different cities, 83 miles apart, where most staff never participated in a long term observational study. Sites were invited to present a list of problems and suggestion for the QAP. Site evaluation was based on monthly site performance report (MSPR) provided by the sponsor. MSPR is based on the data received from sites and processed by the US based data center. Acceptable site performance parameter is data retrieval (DR) < 5%. DR is calculated on mistakes: e.g.; missing data, date problems and inconsistencies. We compared overall consortium MSPR results from the three previous months (P1) of implementation with the three subsequent months of implementation (P2).



LESSONS LEARNED: QAP preparation took 20 days. Forms, flowcharts, roles and procedures were developed based on the experience of administrative and sites staff. Implementation is ongoing and reflects a learning period of 7 months. Common mistakes prior to QAP implementation were related to completion of forms and inconsistencies with patient past history. QAP implementation resulted in a significant reduction in DR (P1: 15.56%; P2: 3.24%; (p<0.05) and its success was due to the adaptation of specific site organizational structure and staff involvement.



RECOMMENDATION: QAP is important to assure quality data and should be introduced to the research team before protocol implementation. Also it's important to enforce the message that QAP is not made to police performance but develop research skills and appropriate organizational infrastructure. Continuous monitoring will be conducted to assure QAP compliance.},

keywords = {},

pubstate = {published},

tppubtype = {conference}

}

@conference{Mitchell2004,

title = {Low acceptability of real time HIV counseling and testing among prision inmates in South Brazil},

author = {Leonardo Rapone da Motta AND Ricardo da Silva de Souza AND Carla Tessari de Souza AND Melissa Cavagnoli AND Melissa Cláudia Bisi AND Paola Barbieri Pasquali AND Marcelo Bertelli AND Ana Luiza dos Anjos Aver AND Charles D. Mitchell},

url = {http://www.abstract-archive.org/Abstract/Share/41151},

year  = {2004},

date = {2004-07-11},

booktitle = {XV International AIDS Conference (AIDS 2004)},

number = {MoPeC3507},

address = {Bangkok, Tailândia},

organization = {International AIDS Society},

abstract = {BACKGROUND: Inmate populations include a large number of individuals at risk of human immunodeficiency virus (HIV) infection due to injection drug use, unsafe sex, body piercing and tattooing. Special strategies to identify and prevent HIV infection in these settings are needed. Objective: To assess acceptability of a real time HIV voluntary counseling and testing strategy (RT-VCT) and to describe sociodemographic and behavioral characteristics of inmates of a regional prison in South Brazil. We also estimated HIV seroprevalence among participants.



METHODS: We conducted a cross-sectional survey (n=439) at Presídio Industrial de Caxias do Sul in the period of 24 - 27 of February, 2003. Inmates were group counseled and offered RT-VCT (HIV rapid test performed in front of the patient while responding a questionnaire and results given at the same visit). Data on demographics, knowledge of HIV, risk factors for acquisition and their opinion on RT-VCT process was obtained. Testing was conducted preserving confidentiality. After consent, inmates' whole blood was screened for HIV antibodies by InstantScreen Ultra-Rapid HIV-1/2 (GAIFAR GmbH, Germany).



RESULTS: Of 439 male inmates, 125 participated (28,5%); (95% CI: 24,3 – 32,9). 102 (81.6%) were white. 68 (54.8%) were single and 54 (43.5%) reported inconsistent use of condoms. The mean age was 28,3 years (SD: 7,5). Mean (median) time of incarceration was 20 (13) months. Mean time for individual counseling and testing: entire group: 28 min, (negatives: 15 min; positives: 39 min). The prevalence of HIV infection was 4,0% (95% CI: 1,3 – 9,1).



CONCLUSION: Prison environment present a special challenge for the implementation of HIV RT-VCT. Correctional institutions need to offer adequate space and trained personnel to increase RT-VCT participation. Voluntary HIV testing in prison should be encouraged, and inmates should receive appropriate counseling and information to allow realistic assessment of risk and care. We speculate low participation due to stigma in this environment.},

keywords = {},

pubstate = {published},

tppubtype = {conference}

}

@conference{Repke2002,

title = {Evaluation of 'InstantScreen', an ultra-rapid HIV1/2 assay based upon novel technologies for the detection of the HIV antibodies},

author = {Ricardo da Silva de Souza AND Leonardo Rapone da Motta AND Vicent Wong AND Orlando Goméz-Marin AND Charles D. Mitchell AND Heinrich Repke},

url = {http://www.abstract-archive.org/Abstract/Share/36341},

year  = {2002},

date = {2002-07-07},

booktitle = {XIV International AIDS Conference (AIDS 2002)},

number = {TuPeC4890},

address = {Barcelona, Espanha},

organization = {International AIDS Society},

abstract = {BACKGROUND: InstantScreen Rapid HIV-1/2 assay (GAIFAR, Germany), uses novel technologies for antibody detection (OCA-particles) and antibody-capture (epitope-combi-antigens) and detects antibodies against all strains of HIV in 30 seconds irrespective of whether blood, serum or plasma is being used. No specialized equipment, ancillary supplies or storage conditions are required. Internal control and a positive result are read visually as blue dots.



OBJECTIVE: To evaluate InstantScreen under routine conditions in Caxias do Sul, Brazil. Methods: 781 sera samples collected from blood donors, patients with acquired immunodeficiency syndrome (AIDS), pregnant women and children (<12 months of age) attending local health centres. Tests were conducted between April 1, and December 20, 2001. Informed consent and basic demographic information was obtained. Serum was screened for the presence of antibodies to HIV by InstantScreen as well as ELISA reference tests (Genscreen HIV-1/2 Version 2, Sanofi Pasteur; ICE HIV-1.0.2, Murex Diagnostics; and Abbott Axsym HIV-1/HIV-2).



RESULTS: 780 samples were tested resulting in the following performance data: sensitivity (95% CL) 160/160 = 100% (98-100%); specificity (95% CL) 620/620 = 100% (99-100%). It is noteworthy that a six months old baby born to an HIV-positive mother was tested negative by InstantScreen while two ELISAs and a Western Blot gave a positive result. Six months later, both the reference tests and InstantScreen confirmed the truly sero-negative status of the child.



CONCLUSION: InstantScreen was simple to perform and easy to interpret. The reliability of the test exceeds that of most laboratory assays. The test membranes can be removed, providing the option for permanent documentation. Accordingly, the test is suitable for use in virtually any setting.},

keywords = {},

pubstate = {published},

tppubtype = {conference}

}