Francisco Antunes

Santa Maria Goretti Hospital, Littoria, Latium, Italy

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Publications (143)574.99 Total impact

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    ABSTRACT: Pneumocystis pneumonia (PcP) is a major HIV-related illness caused by Pneumocystis jirovecii. Definitive diagnosis of PcP requires microscopic detection of P. jirovecii in pulmonary specimens. The objective of this study was to evaluate the usefulness of two serum markers in the diagnosis of PcP. Serum levels of (1-3)-beta-d-glucan (BG) and lactate dehydrogenase (LDH) were investigated in 100 HIV-positive adult patients and 50 healthy blood donors. PcP cases were confirmed using indirect immunofluorescence with monoclonal anti-Pneumocystis antibodies and nested-PCR to amplify the large subunit mitochondrial rRNA gene of P. jirovecii in pulmonary specimens. BG and LDH levels in serum were measured using quantitative microplate-based assays. BG and LDH positive sera were statistically associated with PcP cases (P ≤ 0.001). Sensitivity, specificity, positive/negative predictive values (PPV/NPV), and positive/negative likelihood ratios (PLR/NLR) were 91.3 %, 61.3 %, 85.1 %, 79.2 %, 2.359, and 0.142, respectively, for the BG kit assay, and 91.3 %, 35.5 %, 75.9 %, 64.7 %, 1.415 and 0.245, respectively, for the LDH test. Serologic markers levels combined with the clinical diagnostic criteria for PcP were evaluated for their usefulness in diagnosis of PcP. The most promising cutoff levels for diagnosis of PcP were determined to be 400 pg/ml of BG and 350 U/l of LDH, which combined with clinical data presented 92.8 % sensitivity, 83.9 % specificity, 92.8 % PPV, 83.9 % NPV, 5.764 PLR and 0.086 NLR (P < 0.001). This study confirmed that BG is a reliable indicator for detecting P. jirovecii infection. The combination between BG/LDH levels and clinical data is a promising alternative approach for PcP diagnosis.
    European Journal of Clinical Microbiology 02/2014; · 3.02 Impact Factor
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    ABSTRACT: Rare systemic studies concerning prevalence of intestinal parasites in children have been conducted in the second smallest country in Africa, the Democratic Republic of São Tomé and Príncipe. Fecal specimens from 348 children (214 in-hospital attending the Aires de Menezes Hospital and 134 from Agostinho Neto village) in São Tome Island were studied by parasitological and molecular methods. Of the 134 children from Agostinho Neto, 52.2% presented intestinal parasites. 32.1% and 20.2% of these children had monoparasitism and polyparasitism, respectively. Ascaris lumbricoides (27.6%), G. duodenalis (7.5%), T. trichiura (4.5%) and Entamoeba coli (10.5%) were the more frequent species identified in the children of this village. Giardia duodenalis (7.5%) and E. bieneusi (5.2%) were identified by PCR. Nested-PCR targeting G. duodenalis TPI identified Assemblage A (60%) and Assemblage B (40%). The E. bieneusi ITS-based sequence identified genotypes K (57.1%), KIN1 (28.6%) and KIN3 (14.3%). Among the 214 in-hospital children, 29.4% presented intestinal parasites. In 22.4% and 7.0% of the parasitized children, respectively, one or more species were concurrently detected. By microscopy, A. lumbricoides (10.3%) and Trichiuris trichiura (6.5%) were the most prevalent species among these children, and Cryptosporidium was detected by PCR in 8.9% of children. GP60 locus analysis identified 6.5% of C. hominis (subtypes IaA27R3 [35.7%], IaA23R3 [14.3%], IeA11G3T3 [28.6%] and IeA11G3T3R1 [21.4%]) and 2.3% of C. parvum (subtypes IIaA16G2R1 [20.0%], IIaA15G2R1 [20.0%], IIdA26G1 [40.0%] and IIdA21G1a [20.0%]). G. duodenalis and E. bieneusi were identified in 0.5% and 8.9% of the in-hospital children, respectively. G. duodenalis Assemblage B was characterized. The E. bieneusi genotypes K (52.6%), D (26.4%), A (10.5%) and KIN1 (10.5%) were identified. Although further studies are required to clarify the epidemiology of these infectious diseases in this endemic region the significance of the present results highlights that it is crucial to strength surveillance on intestinal pathogens.
    PLoS ONE 01/2014; 9(5):e97708. · 3.53 Impact Factor
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    ABSTRACT: To analyze the direct medical costs of HIV/AIDS in Portugal from the perspective of the National Health Service. A retrospective analysis of medical records was conducted for 150 patients from five specialized centers in Portugal in 2008. Data on utilization of medical resources during 12 months and patients' characteristics were collected. A unit cost was applied to each care component using official sources and accounting data from National Health Service hospitals. The average cost of treatment was 14,277 €/patient/year. The main cost-driver was antiretroviral treatment (€ 9,598), followed by hospitalization costs (€ 1,323). Treatment costs increased with the severity of disease from € 11,901 (> 500 CD4 cells/µl) to € 23,351 (CD4 count ≤ 50 cells/ µl). Cost progression was mainly due to the increase in hospitalization costs, while antiretroviral treatment costs remained stable over disease stages. The high burden related to antiretroviral treatment is counterbalanced by relatively low hospitalization costs, which, however, increase with severity of disease. The relatively modest progression of total costs highlights that alternative public health strategies that do not affect transmission of disease may only have a limited impact on expenditure, since treatment costs are largely dominated by constant antiretroviral treatment costs.
    Revista de Saúde Pública 10/2013; 47(5):865-872. · 1.07 Impact Factor
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    ABSTRACT: Background. Cobicistat (COBI) is a pharmacoenhancer with no antiretroviral activity in vitro.Methods. An international, randomized, double-blind, double-dummy, active-controlled trial was conducted to evaluate the efficacy and safety of COBI versus ritonavir (RTV) as a pharmacoenhancer of atazanavir (ATV) in combination with emtricitabine (FTC)/ tenofovir disoproxil fumarate (TDF) in treatment-naïve patients. Primary endpoint was HIV-1 RNA<50 copies/mL at Week 48 by FDA snapshot algorithm; non-inferiority margin was 12%.Results. A total of 692 patients were randomized and received study drug (344 COBI vs 348 RTV group). At Week 48, virologic success was achieved in 85% (COBI) and 87% (RTV) (difference: -2.2%; 95% CI: -7.4 to 3.0); among patients with baseline HIV-1 RNA >100,000 copies/mL, rates were similar (86% vs 86%). Similar percentages of patients in both groups had serious adverse events (10% vs 7%) and adverse events leading to study drug discontinuation (7% vs 7%). Median increases in serum creatinine were 0.13 and 0.09&emsp14;mg/dL, respectively.Conclusions. COBI was non-inferior to RTV in combination with ATV plus FTC/TDF at Week 48. Both regimens achieved high rates of virologic success. Safety and tolerability profiles of the two regimens were comparable. Once-daily COBI is a safe and effective pharmacoenhancer of the protease inhibitor ATV.Clinical Trials Registration. NCT01108510.
    The Journal of Infectious Diseases 03/2013; · 5.85 Impact Factor
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    ABSTRACT: BACKGROUND: Acute kidney injury (AKI) is common in hospitalized human immunodeficiency virus (HIV)-infected patients and is associated with hospital mortality. We aimed to evaluate the impact of AKI on long-term mortality of hospitalized HIV-infected patients. METHODS: Retrospective analysis of a cohort of 433 hospitalized HIV-infected patients who were discharged alive from the hospital. AKI was defined according to 'Risk Injury Failure Loss of kidney function End-stage kidney disease' creatinine criteria, as an increase of baseline serum creatinine (SCr) X 1.5 or in patients with baseline SCr > 4 mg/dL if there was an acute rise in SCr of at least 0.5 mg/dL. Cumulative mortality curves were determined by the Kaplan-Meier method, and log-rank test was employed to analyze statistically significant differences between curves. Cox regression method was used to determine independent predictors of mortality. Risk factors were assessed with univariate analysis, and variables that were statistically significant (P < 0.05) in the univariate analysis were included in the multivariate analysis. RESULTS: Sixty-four patients (14.8%) had AKI. Median follow-up was 37 months. At follow-up 81 patients (18.7%) died. At 1, 2 and 5 years of follow-up, the cumulative probability of death of patients with AKI was 21.2, 25 and 31.3%, respectively, as compared with 10, 13.3 and 16.5% in patients without AKI (log-rank, P = 0.011). In multivariate analysis AKI was associated with increased mortality (adjusted HR 1.7, 95% CI 1.1-3; P = 0.049). CONCLUSIONS: AKI was independently associated with long-term mortality of hospitalized HIV-infected patients.
    BMC Nephrology 02/2013; 14(1):32. · 1.64 Impact Factor
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    ABSTRACT: Pneumocystis pneumonia (PcP) is a major cause of mortality and morbidity in immunocompromised patients. There are limited alternative therapeutic choices to trimethoprim-sulfamethoxazole (TMP-SMX) which is the standard first line therapy/prophylaxis for PcP. The efficacy of low doses of caspofungin and caspofungin in association with TMP-SMX standard-prophylactic dose was evaluated in an experimental model of Pneumocystis. Susceptibility of Pneumocystis spp. to low doses of caspofungin and caspofungin/TMP-SMX was evaluated in Balb/c immunosuppressed mice, infected intranasally with P. murina. Caspofungin was administered once daily at 0.1 mg/kg, 0.05 mg/kg, and 0.001 mg/kg and TMP-SMX was administered by oral gavage (12.25 mg/62.5 mg/day), for 21 days. Efficacy was calculated based on the reduction in organism burden determined through quantitative fluorescent-based real-time PCR (qPCR). Serum β-1,3-D-glucan was measured as an additional marker of infection. The present data showed that caspofungin demonstrated anti-Pneumomocystis effect. However, the doses administrated were too low to achieve Pneumocystis eradication, which suggests that echinocandin treatment should not be administrated as mono-therapy. After 21 days of treatment, P. murina was not detected in the lungs of mice with either TMP-SMX or caspofungin/TMP-SMX. The results showed that, even at the lowest concentrations tested, the efficacy of caspofungin in association with TMP-SMX was higher than the efficacy of either drug used alone. The administration of caspofungin/TMP-SMX was at least 1.4 times more effective against P. murina infection than TMP-SMX used alone. The most promising result was achieved with the combination of caspofungin 0.05 mg/kg/day with TMP-SMX 12.5 mg-62.5 mg/day, which reduced the parasite burden to undetectable levels immediately at the 14(th) day of treatment, showing a highly marked anti-Pneumomocystis effect. These data suggest that the administration of low doses of caspofungin in combination with low doses of TMP-SMX may provide an improved treatment protocol for Pneumocystis infection clearance.
    PLoS ONE 01/2013; 8(8):e70619. · 3.53 Impact Factor
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    ABSTRACT: Toxoplasmosis is an important zoonosis worldwide. Here we determined the presence of Toxoplasma gondii antibodies in sera and T. gondii DNA in feces of 215 domestic cats from veterinary clinics in the Lisbon area; 44 (20.5%) had anti-T. gondii IgG antibodies by the modified agglutination test (cut-off 1:40) and DNA was detected in 16 (35.6%) of 45 cat feces tested. Risk factor analysis indicated increase of seroprevalence with age of the cats. Sera and tissues of 381 pigs from a slaughter house were also tested for T. gondii infection; 27 (7.1%) of the 381 pigs were seropositive. T. gondii DNA was demonstrated in diaphragms and/or brains of seven (35.0%) of 20 anti-T. gondii seropositive pigs tested by the B1 nested-PCR. Results indicate very high prevalence of T. gondii DNA in the feces (oocysts) of definitive hosts and relatively low, but still worrying, seroprevalence of T. gondii antibodies in pigs destined for human consumption.
    Veterinary Parasitology 01/2013; · 2.38 Impact Factor
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    ABSTRACT: INTRODUCTION: Three major public health problems, tuberculosis, malaria and HIV/AIDS, are widespread in Angola, often as co-infections in the same individual. In 2009, it was assumed that 44,151 new cases of TB occurred in Angola. Interestingly, interventions such as treatment/prevention of malaria appear to reduce mortality in HIV-infected and possibly TB co-infected patients. However, despite the seriousness of the situation, current data on TB and co-infection rates are scarce. This study aimed to characterize all TB cases seen at the Hospital Sanatório de Luanda, and to determine the co-infection rate with HIV and/or malaria. METHODOLOGY: This retrospective study collected demographic, diagnostic and clinical data from all patients admitted during 2007. RESULTS: A total of 4,666 patients were admitted, of whom 1,906 (40.8%) were diagnosed with TB. Overall, 1,111 patients (58.3%) were male and most patients (n=1302, 68.3%) were adults (≥14 years). The rate of HIV co-infection was 37.4% (n=712). Malaria was diagnosed during admission and hospital stay in 714 patients (37.5%), with Plasmodium falciparum the predominant species. Overall mortality was 15.2% (n=290). CONCLUSIONS: Because Luanda does not have the infrastructure to perform culture-based diagnosis of TB, confirmation of TB is problematic. The HIV-co-infection rate is high, with 37.4% of patients requiring integrated approaches to address this problem. With more than 1/3 of the TB patients co-infected with malaria, even during the hospital stay, the prevention of malaria in TB patients appears to be an effective way to reduce overall mortality.
    The Journal of Infection in Developing Countries 01/2013; 7(3):269-272. · 1.00 Impact Factor
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    ABSTRACT: OBJECTIVES:: To characterize the nature and dynamics of the neutralizing antibody (NAb) response and escape in chronically HIV-2 infected patients. METHODS:: Twenty-eight chronically infected adults were studied over a period of 1-4 years. The neutralizing activity of plasma immunoglobulin G (IgG) antibodies against autologous and heterologous primary isolates was analyzed using a standard assay in TZM-bl cells. Coreceptor usage was determined in ghost cells. The sequence and predicted three-dimensional structure of the C2V3C3 Env region were determined for all isolates. RESULTS:: Only 50% of the patients consistently produced IgG NAbs to autologous and contemporaneous virus isolates. In contrast, 96% of the patients produced IgG antibodies that neutralized at least two isolates of a panel of six heterologous R5 isolates. Breadth and potency of the neutralizing antibodies were positively associated with the number of CD4 T cells and with the titer and avidity of C2V3C3-specific binding IgG antibodies. X4 isolates were obtained only from late stage disease patients and were fully resistant to neutralization. The V3 loop of X4 viruses was longer, had a higher net charge, and differed markedly in secondary structure compared to R5 viruses. CONCLUSION:: Most HIV-2 patients infected with R5 isolates produce C2V3C3-specific neutralizing antibodies whose potency and breadth decreases as the disease progresses. Resistance to antibody neutralization occurs in late stage disease and is usually associated with X4 viral tropism and major changes in V3 sequence and conformation. Our studies support a model of HIV-2 pathogenesis in which the neutralizing antibodies play a central role and have clear implications for the vaccine field.
    AIDS (London, England) 11/2012; 26(18):2275-2284. · 4.91 Impact Factor
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    ABSTRACT: Pneumocystis has been identified in various mammalian species, including domestic, wild and zoo animals. This study's main objectives were: (1) to estimate the prevalence of the Pneumocystis carinii f. sp. suis infection in slaughtered pigs in Portugal, (2) assess the prevalence differences within distinct age groups of animals, (3) determine the possible associations between pulmonary lesions and the infection, and (4) genetically characterize the P. carinii f. sp. suis isolates recovered from infected animals using PCR with DNA sequencing. An epidemiological cross-sectional study was conducted using 215 pig lung tissue samples which demonstrated a global prevalence of 7% (14 positive samples). This value was later validated by statistical analysis as being representative of the national population prevalence. Regarding the assessment of relations between the different variables investigated during the study (age, gender, geographical region, type of farming, weight and pulmonary lesion) and the P. carinii f. sp. suis infection, no significant statistical differences were found, and apparently, no predisposing factors could be defined. Nevertheless, infection by Pneumocystis in pigs is ubiquitous and it can be detected in healthy animals. Thus, the colonization of P. carinii f. sp. suis among healthy individuals suggests that asymptomatic carriers can be an effective reservoir for susceptible animals and participate in the transmission of infection. The present data confirmed that porcine Pneumocystis is genetically distinct from Pneumocystis DNA detected in other mammalian hosts.
    Medical mycology: official publication of the International Society for Human and Animal Mycology 08/2012; · 2.13 Impact Factor
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    ABSTRACT: Specific single-nucleotide polymorphisms (SNPs) are recognized as important DNA sequence variations influencing the pathogenesis of Pneumocystis jirovecii and the clinical outcome of Pneumocystis pneumonia, which is a major worldwide cause of illness among immunocompromised patients. Genotyping platforms for pooled DNA samples are promising methodologies for genetic characterization of infectious organisms. We have developed a new typing strategy for P. jirovecii, which consisted of DNA pools prepared according to clinical data (HIV diagnosis, microscopic and molecular detection of P. jirovecii, parasite burden, clinical diagnosis and follow-up of infection) from individual samples using quantitative real-time PCR followed by multiplex-PCR/single base extension (MPCR/SBE). The frequencies of multiple P. jirovecii SNPs (DHFR312, mt85, SOD215 and SOD110) encoded at three distinct loci, the dihydrofolate reductase (DHFR), the mitochondrial large-subunit rRNA (mtLSU rRNA) and the superoxide dismutase (SOD) loci, were estimated in seven DNA pooled samples, representing a total of 100 individual samples. The studied SNPs were confirmed to be associated with distinct clinical parameters of infection such as parasite burden and follow-up. The MPCR/SBE-DNA pooling methodology, described in the present study, was demonstrated to be a useful high-throughput procedure for large-scale P. jirovecii SNPs screening and a powerful tool for evaluation of clinically relevant SNPs potentially related to parasite burden, clinical diagnosis and follow-up of P. jirovecii infection. In further studies, the candidate SNPs mt85, SOD215 and SOD110 may be used as molecular markers in association with MPCR/SBE-DNA pooling to generate useful information for understanding the patterns and causes of Pneumocystis pneumonia.
    Clinical Microbiology and Infection 03/2012; 18(6):E177-84. · 4.58 Impact Factor
  • Maria Luísa Lobo, Lihua Xiao, Francisco Antunes, Olga Matos
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    ABSTRACT: Despite recent advances in the understanding and diagnosis of emerging microsporidian pathogens, more research is necessary to elucidate their complex epidemiology. In fact, studies that reflect true human-infecting microsporidian prevalence are still inadequate. The present 10-year study was undertaken to examine the occurrence of Microsporidia in 1989 stools, 69 urine and 200 pulmonary specimens from HIV-positive and HIV-negative patients using PCR and DNA sequencing. In stools, 12.0% were Microsporidia-positive. Prevalences of 13.9% and 8.5% were observed for HIV+ and HIV- samples, respectively. The percentage of children that were Microsporidia-positive (18.8%) was significantly higher than that of adults (10.2%). In stools, Enterocytozoon bieneusi (6.3%) and Vittaforma-like parasites (6.8%) were identified. Based on the internal transcribed spacer (ITS) region of E. bieneusi, Type IV (37.5%), Peru 6 (29.2%), D (12.5%), A (8.3%), C (6.3%) and PtEb II (6.3%) genotypes were identified. Microsporidia were detected in 1.5% and 1.0% of urine and pulmonary specimens, respectively. Encephalitozoonintestinalis was detected in urine. In pulmonary specimens, Encephalitozoon cuniculi and Vittaforma-like parasites were identified. An immunosuppressive condition and youth (children) appear to be risk factors for microsporidian infection. Microsporidia seems to have an important impact on public health in Portugal, highlighting the need to implement routine diagnosis.
    International journal for parasitology 02/2012; 42(2):197-205. · 3.39 Impact Factor
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    ABSTRACT: The baseline susceptibility of primary HIV-2 to maraviroc (MVC) and other entry inhibitors is currently unknown. The susceptibility of 19 HIV-2 isolates obtained from asymptomatic and AIDS patients and seven HIV-1 clinical isolates to the fusion inhibitors enfuvirtide (ENF) and T-1249, and to the coreceptor antagonists AMD3100, TAK-779 and MVC, was measured using a TZM-bl cell-based assay. The 50% inhibitory concentration (IC(50)), 90% inhibitory concentration (IC(90)) and dose-response curve slopes were determined for each drug. ENF and T-1249 were significantly less active on HIV-2 than on HIV-1 (211- and 2-fold, respectively). AMD3100 and TAK-779 inhibited HIV-2 and HIV-1 CXCR4 tropic (X4) and CCR5 tropic (R5) variants with similar IC(50) and IC(90) values. MVC, however, inhibited the replication of R5 HIV-2 variants with significantly higher IC(90) values (42.7 versus 9.7 nM; P<0.0001) and lower slope values (0.7 versus 1.3; P<0.0001) than HIV-1. HIV-2 R5 variants derived from AIDS patients were significantly less sensitive to MVC than variants from asymptomatic patients, this being inversely correlated with the absolute number of CD4(+) T-cells. T-1249 is a potent inhibitor of HIV-2 replication indicating that new fusion inhibitors might be useful to treat HIV-2 infection. Coreceptor antagonists TAK-779 and AMD3100 are also potent inhibitors of HIV-2 replication. The reduced sensitivity of R5 variants to MVC, especially in severely immunodeficient patients, indicates that the treatment of HIV-2-infected patients with MVC might require higher dosages than those used in HIV-1 patients, and should be adjusted to the disease stage.
    Antiviral therapy 01/2012; 17(3):565-70. · 3.07 Impact Factor
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    ABSTRACT: Purpose of the study: This study intends to characterize a Portuguese patient population with chronic HCV and HIV coinfection, followed at our Research Unit, underline the importance of early treatment and incorporate the importance of DDA for retreatment of HCV infection. Methods: Retrospective, observational analysis of medical records of 348 HCV/HIV coinfected patients from 2001 to 2011. Demographic, epidemiological, clinical and laboratory data and virologic response were collected. Summary of results: Review of 348 HCV/HIV coinfected patients, 121 of those (34.7%) under treatment, predominantly male (77.0%) and Caucasians (94.8%) with a median age of 44 yrs old (min 25; max 77 yrs). Intravenous drug use was the main route of HCV infection, in 71.3% of patients, and 8.3% were related with MSM. Frequent morbidities were alcohol abuse (46.8%), illicit drug use (70.1%), methadone (25.6%) and mental disturbances (12.3%) of patients. Regarding HIV infection, six were HIV-2 and 342 HIV-1; 36.1% were stage A and 29.6% were stage C (CDC Atlanta), 94.8% on antiretroviral treatment and only 21.9% of them with more than 350 TCD4 cell count. Genotype 1 was the most prevalent (58.1%-117 genotype 1a, 26 genotype 1b); 1.6% were genotype 2, 22.8% genotype 3 and 17.5% genotype 4. Previous to treatment initiation, HCV ARN was above 600.000 IU/mL in 56.9% patients. Fibrosis was evaluated by fibroelastography in 41.1% and hepatic biopsy in 26.3% of patients; in those, 44.0% had a score above F2 (METAVIR) and ALT was elevated 2 times the limit in 38.0%, with an average value of 94 UI/L. IL 28B testing was performed in only 35 patients at the time, with 45.7% CC and 17.1% CT genotype. Treatment was started in 34.8% of patients, with 1.7 treatments per individual, and regimen was based on peguilated interferon with ribavirin in 93.6% of cases (72.1% with peginterferon alfa 2a). The SVR rate was 51.2%, with 28.9% non responders, 3 relapsers and 9 treatment interruptions due to major toxicities. Conclusions: Our data presents a low HCV treatment initiation, illustrated by 65.2% patients who did not begin any treatment. The majority completed treatment and the SVR rate was similar to literature. Individualized approach is essential to determine the optimal time to initiate HCV treatment, to assess patient adherence and adverse events management, in order to optimize treatment and reserve DDA drugs to experienced patients with worse predictive factors.
    Journal of the International AIDS Society 01/2012; 15(6):18428. · 3.94 Impact Factor
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    ABSTRACT: Acute confusion and memory loss associated with asymmetrical mesiotemporal hyperintensity on T2-weighted MRI are characteristic of herpes encephalitis. The authors report the case of a patient with these symptoms and MRI presentation who had neurosyphilis. Recently clinical and imaging patterns usually associated with herpes simplex encephalitis have been seen in patients with neurosyphilis. Because syphilis is "The Great Pretender" not only clinically but also in imaging and because its numbers are rising, it must be sought as a differential diagnosis.
    Case reports in infectious diseases. 01/2012; 2012:154863.
  • D Pires, A Zagalo, F Antunes
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    ABSTRACT: Purpose of the study: About a third of HIV-infected patients in Europe present for care late in their disease. In 2010 a consensus was reached for a definition of late presentation, providing a new tool for research and acting. With regard to HIV2 infection this population has never been characterized. Methods: Retrospective analysis of the clinical records of all the HIV2-infected patients who meet the inclusion criteria (those defined by the European Late Presenter Consensus working group: Late presentation of HIV infection: a consensus definition 1) admitted to our ward between January 2006 and December 2011. The patients were characterized according to epidemiological, clinical and immunologic status and outcome. Summary of results: During the period analyzed, 15 HIV2 patients were late presenters. The mean age of the patients was 48 years old (although 53% were older than 50 years); 8 (53%) were men; 11 (73%) were of African origin. Heterosexual transmission was reported in three of the patients, in the remainder the transmission mode was not available. The mean TCD4 cell was 188 (range 27-339), with 8 (53%) with a CD4 count below 200 cells. Twelve (80%) of the patients fulfilled AIDS criteria. There were 3 deaths, corresponding to a mortality rate of 20%. The cause of death was disseminated tuberculosis in two cases and non-Hodgkin's lymphoma in the third case. Conclusions: Most late presenters with HIV2 infection are of African origin, there is an even distribution between genders, their mean age is around 50 years old, more than half had a CD4 cell count below 200 and there was a 20% mortality rate. These patients pose challenges at various levels: their mortality rate is much higher than in the general HIV-infected population and they are diagnosed very late, leading to a disproportionate increase in risk of transmission, morbidity and mortality.
    Journal of the International AIDS Society 01/2012; 15(6):18299. · 3.94 Impact Factor
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    ABSTRACT: Portugal is the European country with the highest frequency of HIV-2 infection, which is mainly concentrated in West Africa. The cumulative number of notified HIV-2 infections in Portugal was 1813 by the end of December 2008. To better characterize the dynamics of HIV-2 infection in the country and to obtain data that may be of use in the prevention of the spread of HIV-2, we evaluated a large pooled sample of patients. Five Portuguese hospitals provided data on HIV-2-infected patients from 1984 to the end of 2007. Data concerning demographic characteristics and clinical variables were extracted. Patients were stratified according to date of diagnosis in approximately 5-year categories. The sample included 442 patients, accounting for 37% of all HIV-2 infections notified in Portugal during that period. HIV-2-infected patients showed clearly different characteristics according to the period of diagnosis. Until 2000, the majority of HIV-2-infected patients were Portuguese-born males living in the north of the country. From 2000 to 2007, most of the patients diagnosed with HIV-2 infection had a West African origin, were predominantly female and were living in the capital, Lisbon. The average age at diagnosis and loss to follow-up significantly increased over time. HIV-2 infection has been documented in Portugal since the early 1980s and its epidemiology appears to reflect changes in population movement. These include the movements of soldiers and repatriates from African territories during the independence wars and, later, migration and mobility from high-endemicity areas. The findings of this study stress the importance of promoting migrant-sensitive health care.
    HIV Medicine 12/2011; 13(4):219-25. · 3.16 Impact Factor
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    ABSTRACT: Our aim was to characterize for the first time the genetic diversity of HIV in Cape Verde Islands as well as the drug resistance profiles in treated and untreated patients. Blood specimens were collected from 41 HIV-1 and 14 HIV-2 patients living in Santiago Island. Half of the patients were on antiretroviral treatment (ART). Pol and env gene sequences were obtained using in-house methods. Phylogenetic analysis was used for viral subtyping and the Stanford Algorithm was used for resistance genotyping. For HIV-1, the amplification of pol and env was possible in 27 patients (66%). HIV-1 patients were infected with subtypes G (13, 48%), B (2, 7%), F1 (2, 7%), and CRF02_AG (2, 7%), and complex recombinant forms including a new C/G variant (n=8, 30%). Drug resistance mutations were detected in the PR and RT of three (10%) treated patients. M41L and K103N transmitted drug resistance mutations were found in 2 of 17 (12%) untreated patients. All 14 HIV-2 isolates belonged to group A. The origin of 12 strains was impossible to determine whereas two strains were closely related to the historic ROD strain. In conclusion, in Cape Verde there is a long-standing HIV-2 epidemic rooted in ROD-like strains and a more recent epidemic of unknown origin. The HIV-1 epidemic is caused by multiple subtypes and complex recombinant forms. Drug resistance HIV-1 strains are present at moderate levels in both treated and untreated patients. Close surveillance in these two populations is crucial to prevent further transmission of drug-resistant strains.
    AIDS research and human retroviruses 09/2011; 28(5):510-22. · 2.18 Impact Factor
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    ABSTRACT: Hepatitis delta virus (HDV) infection results in the most aggressive form of chronic viral hepatitis. There is scarce information about the prevalence, epidemiology, virological profile and natural history of hepatitis delta in HIV patients. From 16,597 HIV patients enrolled in EuroSIDA, 1319 (7.9%) have ever reported serum hepatitis B virus (HBV) surface antigen (HBsAg)-positive. At last follow-up, 1084 (6.5%) patients were HBsAg-positive. The HDV substudy was carried out in 422 individuals for whom stored sera were available at the time they were HBsAg-positive. Anti-HDV immunoglobulin G was assessed using a commercial enzyme immunoassay (EIA) and serum HDV-RNA was quantified using a real-time PCR method. A total of 61 of 422 HBsAg-positive carriers were anti-HDV-positive (prevalence: 14.5%). Hepatitis delta predominated in intravenous drug users and for this reason in south and/or east Europe. Serum HDV-RNA was detectable in 87% of tested anti-HDV-positive patients, with a median titer of 1.76×10(7) copies/ml. Overall, delta hepatitis patients showed lower serum HBV-DNA than the rest of HBsAg-positive carriers, although the inhibitory effect of HDV on HBV replication was not recognized in HBV genotype D patients. Whereas HDV was not associated with progression to AIDS, it significantly influenced the risk of death. The prevalence of anti-HDV in chronic HBsAg-positive/HIV carriers in EuroSIDA is 14.5%. Most of these patients exhibit detectable HDV viraemia. Viral interference between HBV and HDV is manifested in all but HBV genotype D carriers in whom overt coreplication of both viruses occurs which might result in enhanced liver damage. Overall, delta hepatitis increases the risk of liver-related deaths and overall mortality in HIV patients.
    AIDS (London, England) 08/2011; 25(16):1987-92. · 4.91 Impact Factor
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    ABSTRACT: Acute kidney injury (AKI) in hospitalized human immunodeficiency virus (HIV)-infected patients in the highly active antiretroviral therapy (HAART) era has not been extensively addressed. The aim of the present study was to analyze the incidence, etiology, risk factors and the impact of AKI on in-hospital mortality in this population. A total of 489 HIV-infected patients hospitalized in the Department of Infectious Diseases of the Hospital de Santa Maria (Lisbon, Portugal) between January 2005 and December 2007 were retrospectively studied. AKI was defined by 'Risk Injury Failure Loss of kidney function End-stage kidney disease'(RIFLE) criteria based on serum creatinine. Comparisons between patients with and without AKI were performed using the Student's t-test or the χ2 test. Logistic regression method was used to determine predictors of AKI and in-hospital mortality. A two-tailed P-value <0.05 was considered significant. Eighty-eight patients (18%) had AKI within the hospitalization period. The most common etiologies of AKI were sepsis (59%), nephrotoxic drug administration (37.5%), volume depletion (21.6%) and radiocontrast use (20.5%). Preexisting hypertension [adjusted odds ratio (OR) 2.4, 95% confidence interval (CI) 1.04-5.6, P = 0.04], acquired immunodeficiency syndrome (adjusted OR 2.7, 95% CI 1.2-6, P = 0.02), sepsis (adjusted OR 23, 95% CI 11-45.3, P < 0.001) and nephrotoxic drug administration (adjusted OR 2.8, 95% CI 1.4-5.8, P = 0.004) were risk factors of AKI. Patients with AKI had higher in-hospital mortality than patients without AKI (27.3 versus 8%, P < 0.001). In multivariate analysis, AKI was a risk factor of in-hospital mortality (adjusted OR 2.7, 95% CI 1.3-5.6, P = 0.008). AKI occurred in 18% of hospitalized HIV-infected patients and it was independently associated with increased in-hospital mortality.
    Nephrology Dialysis Transplantation 05/2011; 26(12):3888-94. · 3.37 Impact Factor

Publication Stats

3k Citations
574.99 Total Impact Points

Institutions

  • 2009–2014
    • Santa Maria Goretti Hospital
      Littoria, Latium, Italy
  • 2004–2014
    • University of Lisbon
      • Faculty of Medicine
      Lisboa, Lisbon, Portugal
    • University of Milan
      Milano, Lombardy, Italy
  • 2010–2013
    • Centro Hospitalar Lisboa Norte
      Lisboa, Lisbon, Portugal
    • Hospital Carlos III - Madrid
      Madrid, Madrid, Spain
  • 2000–2013
    • New University of Lisbon
      • Faculty of Medical Sciences
      Lisboa, Lisbon, Portugal
  • 1987–2013
    • Hospital de Santa Maria
      Lisboa, Lisbon, Portugal
  • 2011
    • Instituto Português de Oncologia
      Oporto, Porto, Portugal
    • Hospital Egas Moniz
      Lisboa, Lisbon, Portugal
  • 1998–2009
    • Institute of Hygiene and Tropical Medicine
      Lisboa, Lisbon, Portugal
  • 2001–2008
    • University College London
      • Department of Primary Care and Population Health (PCPH)
      London, ENG, United Kingdom
    • Technical University of Lisbon
      • Faculdade de Medicina Veterinária
      Lisbon, Lisbon, Portugal
  • 1998–2007
    • Copenhagen University Hospital Hvidovre
      • Department of Infectious Diseases
      Hvidovre, Capital Region, Denmark
  • 2006
    • Centers for Disease Control and Prevention
      • Division of Parasitic Diseases and Malaria
      Atlanta, Michigan, United States
  • 2005
    • Centre Hospitalier Universitaire Saint-Pierre
      Bruxelles, Brussels Capital Region, Belgium
  • 1999
    • Goethe-Universität Frankfurt am Main
      Frankfurt, Hesse, Germany
  • 1997
    • Rigshospitalet
      • Department of Infectious Diseases
      Copenhagen, Capital Region, Denmark
  • 1996
    • Istituto Superiore di Sanità
      • Laboratory of Virology
      Roma, Latium, Italy