Sporotrichosis is a fungal disease usually restricted to the cutaneous and lymphatic systems. Visceral involvement is unusual. To date, only 21 cases of sporotrichosis meningitis have been reported, some of these associated with... more
Sporotrichosis is a fungal disease usually restricted to the cutaneous and lymphatic systems. Visceral involvement is unusual. To date, only 21 cases of sporotrichosis meningitis have been reported, some of these associated with immunosuppression. According to the reported cases, difficulty establishing the correct diagnosis is almost the rule which, undoubtedly, is associated with a worse prognosis. In this report, two HIV infected patients are described who developed meningitis due to Sporothrix schenckii associated with immune reconstitution inflammatory syndrome. This is the first report of sporotrichosis meningitis associated with immune reconstitution inflammatory syndrome in AIDS patients.
Research Interests: Neurology, Immunology, Medicine, British medical history, Brain, and 15 moreHumans, Male, Immunosuppression, Hiv Infection, Immune system, Adult, Meningitis, Antifungal Agents, Immune Reconstitution, Bacterial meningitis, Sporothrix, Acquired immunodeficiency syndrome, Psychology and Cognitive Sciences, immune reconstitution inflammatory syndrome, and Medical and Health Sciences
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Lopinavir/ritonavir approval for use in antiretroviral treatment 10 years ago was very important for the recognition of boosted protease inhibitor (PI)-based therapy as an attractive option for first-line therapy. Being coformulated with... more
Lopinavir/ritonavir approval for use in antiretroviral treatment 10 years ago was very important for the recognition of boosted protease inhibitor (PI)-based therapy as an attractive option for first-line therapy. Being coformulated with ritonavir and having less toxicity than former PIs it allowed for effective and durable virologic suppression with less impact on quality of life. It soon became the standard of care for salvage therapy in its class. Since then, however, its central role has been challenged by new PIs with a more favorable impact on lipid profile, better gastrointestinal tolerability or that are more active in the setting of multidrug resistance. This article summarizes the main clinical studies with lopinavir and discusses its particular characteristics as well as its possible current role in antiretroviral therapy.
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Research Interests: Medicine and Dolutegravir
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HIV-infected patients are at particular risk for invasive pneumococcal disease (IPD). We describe cases of IPD in people living with HIV/AIDS (PLWHA) and find associated risk factors for infection and death. Methods: A retrospective... more
HIV-infected patients are at particular risk for invasive pneumococcal disease (IPD). We describe cases of IPD in people living with HIV/AIDS (PLWHA) and find associated risk factors for infection and death. Methods: A retrospective case-control study, nested in a cohort, including PLWHA with and without IPD, conducted in Brazil, 2005–2020. Controls were of the same gender/age and seen at the same time/place as cases. Results: We identified 55 episodes of IPD (cases) in 45 patients and 108 controls. The incidence of IPD was 964/100,000 person-years. A total of 42 of 55 (76.4%) IPD episodes presented with pneumonia and 11 (20%) with bacteremia without a focus and 38/45 (84.4%) were hospitalized. Blood cultures were positive in 54/55 (98.2%). Liver cirrhosis and COPD were the only factors associated with IPD in PLWHA in univariate analysis, although no associated factors were found in multivariate analysis. Penicillin resistance was found in 4/45 (8.9%). Regarding antiretroviral thera...
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Background We evaluated in-hospital mortality and outcomes incidence after hospital discharge due to COVID-19 in a Brazilian multicenter cohort. Methods This prospective multicenter study (RECOVER-SUS, NCT04807699) included COVID-19... more
Background We evaluated in-hospital mortality and outcomes incidence after hospital discharge due to COVID-19 in a Brazilian multicenter cohort. Methods This prospective multicenter study (RECOVER-SUS, NCT04807699) included COVID-19 patients hospitalized in public tertiary hospitals in Brazil from June 2020 to March 2021. Clinical assessment and blood samples were performed at hospital admission, with post-hospital discharge remote visits. Hospitalized participants were followed-up until March 31, 2021. The outcomes were in-hospital mortality and incidence of rehospitalization or death after hospital discharge. Kaplan–Meier curves and Cox proportional-hazard models were performed. Findings 1589 participants [54.5% male, age=62 (IQR 50-70) years; BMI=28.4 (IQR,24.9–32.9) Kg/m² and 51.9% with diabetes] were included. A total of 429 individuals [27.0% (95%CI,24.8–29.2)] died during hospitalization (median time 14 (IQR,9–24) days). Older age [vs<40 years; age=60–69 years-aHR=1.89 (95%CI,1.08–3.32); age=70–79 years-aHR=2.52 (95%CI,1.42–4.45); age≥80-aHR=2.90 (95%CI 1.54–5.47)]; noninvasive or mechanical ventilation at admission [vs facial-mask or none; aHR=1.69 (95%CI 1.30–2.19)]; SAPS-III score≥57 [vs<57; aHR=1.47 (95%CI 1.13–1.92)] and SOFA score≥10 [vs <10; aHR=1.51 (95%CI 1.08–2.10)] were independently associated with in-hospital mortality. A total of 65 individuals [6.7% (95%CI 5.3–8.4)] had a rehospitalization or death [rate=323 (95%CI 250–417) per 1000 person-years] in a median time of 52 (range 1–280) days post-hospital discharge. Age ≥ 60 years [vs <60, aHR=2.13 (95%CI 1.15–3.94)] and SAPS-III ≥57 at admission [vs <57, aHR=2.37 (95%CI 1.22–4.59)] were independently associated with rehospitalization or death after hospital discharge. Interpretation High in-hospital mortality rates due to COVID-19 were observed and elderly people remained at high risk of rehospitalization and death after hospital discharge. Funding Fundação Carlos Chagas Filho de Amparo à Pesquisa do Estado do Rio de Janeiro (FAPERJ), Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) and Programa INOVA-FIOCRUZ.
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BACKGROUND Despite widespread availability of direct-acting antivirals including generic formulations, limited progress has been made in the global adoption of hepatitis C virus (HCV) treatment. Barriers to treatment scale-up include... more
BACKGROUND Despite widespread availability of direct-acting antivirals including generic formulations, limited progress has been made in the global adoption of hepatitis C virus (HCV) treatment. Barriers to treatment scale-up include availability and access to diagnostic and monitoring tests, health-care infrastructure, and requirement for frequent visits during treatment. METHODS ACTG A5360 was a phase 4, open-label, single-arm trial across 38 sites in Brazil, South Africa, Thailand, Uganda, and the USA. Key inclusion criteria were age of 18 years or older, evidence of active HCV infection (HCV RNA >1000 IU/mL) and HCV treatment-naive; patients with compensated cirrhosis and HIV/HCV co-infection were included but their enrolment was capped. All participants received a fixed dose combination of oral sofosbuvir (400 mg) and velpatasvir (100 mg) once daily for 12 weeks. The minimal monitoring (MINMON) approach consisted of four components: (1) there was no pre-treatment genotyping; (2) the entire treatment course (84 tablets) was dispensed at entry; (3) there were no scheduled visits or laboratory monitoring; and (4) there were two points of remote contact, at week 4 for adherence and week 22, to schedule outcome assessment at week 24 (-2 weeks to +4 weeks). Participants who missed the week 24 window could return for a visit to assess treatment response any time before week 72. Unplanned visits for any reason were permissible before the week 24 visit. The primary efficacy outcome was sustained virological response (SVR), defined as HCV RNA less than the lower limit of quantification measured at least 22 weeks post-treatment initiation; the primary safety outcome was serious adverse events. The primary efficacy analysis included all participants who initiated treatment, using a missing=failure approach. The primary safety analysis included all participants who initiated treatment and had at least one post-treatment assessment. This trial is registered at ClinicalTrials.gov, NCT03512210. FINDINGS Between Oct 22, 2018, and July 19, 2019, 400 participants were enrolled across all 38 sites; 399 initiated treatment. At the SVR assessment visit, 355 (89%) of 397 participants reported taking 100% of the trial medication during the 12-week treatment period; two patients did not have any follow-up visits after the entry visit and were excluded from the safety analyses. Overall, 379 of the 399 who initiated treatment had an SVR (95·0%, 95% CI 92·4-96·7). 14 (4%) of 397 participants reported serious adverse events between treatment initiation and week 28; none were treatment related or led to treatment discontinuation or death. 15 (4%) of 399 participants had unplanned visits; none were related to treatment. INTERPRETATION In this diverse global population of people with HCV, the MINMON approach with sofosbuvir-velpatasvir treatment was safe and achieved SVR comparable to standard monitoring observed in real-world data. Coupled with innovative case finding strategies, this strategy could be crucial to the global HCV elimination agenda. FUNDING US National Institutes of Health and Gilead Sciences.
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ObjectivesWe aimed to evaluate the accuracy of serological biomarkers for non‐alcoholic fatty liver disease (NAFLD) and advanced fibrosis (METAVIR‐F3F4) in HIV mono‐infected individuals.MethodsIn all, 674 participants from the PROSPEC‐HIV... more
ObjectivesWe aimed to evaluate the accuracy of serological biomarkers for non‐alcoholic fatty liver disease (NAFLD) and advanced fibrosis (METAVIR‐F3F4) in HIV mono‐infected individuals.MethodsIn all, 674 participants from the PROSPEC‐HIV study (NCT02542020), who had blood sample tests and transient elastography (TE) performed on the same day, were eligible. Exclusion criteria were viral hepatitis co‐infection (n = 90), abusive alcohol intake (n = 61), missing data (n = 47) or unreliable TE (n = 39). NAFLD was defined by controlled attenuation parameter ≥ 248 dB/m and advanced fibrosis by liver stiffness measurement ≥ 8.7 kPa with M probe or ≥ 7.2 kPa with XL probe. Biomarkers for NAFLD [Steato‐ELSA, Fatty Liver Index (FLI), Hepatic Steatosis Index (HSI), NAFLD‐Liver Fat Score (NAFLD‐LFS)] and fibrosis [Fibrosis‐4 score (FIB‐4), Aspartate‐to‐Platelet Ratio Index (APRI) and NAFLD Fibrosis Score (NFS)] were calculated.ResultsA total of 437 patients [57% female, age = 44 (interquartile...
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Background Since the beginning of the COVID-19 pandemic, therapeutic options for treating COVID-19 have been investigated at different stages of clinical manifestations. Considering the particular impact of COVID-19 in the Americas, this... more
Background Since the beginning of the COVID-19 pandemic, therapeutic options for treating COVID-19 have been investigated at different stages of clinical manifestations. Considering the particular impact of COVID-19 in the Americas, this document aims to present recommendations for the pharmacological treatment of COVID-19 specific to this population. Method Fifteen experts, members of the Brazilian Society of Infectious Diseases (SBI) and the Pan-American Association of Infectious Diseases (API) make up the panel responsible for developing this guideline. Questions were formulated regarding prophylaxis and treatment of COVID-19 in outpatient and inpatient settings. The outcomes considered in decision-making were mortality, hospitalisation, need for mechanical ventilation, symptomatic COVID-19 episodes, and adverse events. In addition, a systematic review of randomised controlled trials was conducted. The quality of evidence assessment and guideline development process followed the ...
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Resistance Brazil Mutations a b s t r a c t Background: Development of drug-resistance mutations is the main cause of failure in antiretroviral therapy. In Brazil, there is scarce information on resistance pattern for patients failing... more
Resistance Brazil Mutations a b s t r a c t Background: Development of drug-resistance mutations is the main cause of failure in antiretroviral therapy. In Brazil, there is scarce information on resistance pattern for patients failing antiretroviral therapy. Objectives: To define the HIV mutational profile associated with drug resistance in Brazilian patients from 5 large cities, after first, second or further failures to antiretroviral therapy. Methods: We reviewed genotyping results of 1520 patients failing therapy in five Brazilian cities. Frequency of mutations, mean number of active drugs, viral susceptibility to each antiretrovirals drug, and regional differences were assessed. Results: Mean time of antiretrovirals use was 22.7 ± 41.1 months. Mean pre-genotyping viral load was 4.2 ± 0.8 log (2.1 ± 2.0 after switching antiretrovirals). Mean number of remaining active drugs was 9.4, 9.0, and 7.9 after 1st, 2nd, and 3rd failure, respectively. We detected regional variations in dr...
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No dinâmico cenário do tratamento da infecção pelo HIV, precisamos sempre rediscutir e repensar nossas estratégias à luz das novas evidências científicas e das diferentes situações epidemiológicas. Assim, o estímulo expresso nos... more
No dinâmico cenário do tratamento da infecção pelo HIV, precisamos sempre rediscutir e repensar nossas estratégias à luz das novas evidências científicas e das diferentes situações epidemiológicas. Assim, o estímulo expresso nos diferentes protocolos e diretrizes – incluindo os Protocolos Clínicos e Diretrizes Terapêuticas (PCDT) do Ministério da Saúde do Brasil – quanto ao tratamento precoce e universal de todos os pacientes que vivem com HIV tem levado a uma exposição cada vez maior desses pacientes aos esquemas de primeira linha, o que traz grandes desafios às unidades de saúde em relação ao acolhimento, à retenção no cuidado e ao estímulo à adesão. Considerando-se a reduzida barreira genética do esquema proposto para tratamento inicial em áreas de recursos limitados, composto geralmente por efavirenz (EFV) associado ao tenofovir (TDF) + lamivudina (3TC), e o aumento progressivo nas taxas de resistência transmitida com impacto principalmente na classe dos inibidores de transcript...
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The role of liver stiffness measurement (LSM) after sustained virological response (SVR) in HCV patients treated by direct-acting antivirals (DAAs) remains unclear. We aimed to evaluate LSM regression value after SVR and to identify risk... more
The role of liver stiffness measurement (LSM) after sustained virological response (SVR) in HCV patients treated by direct-acting antivirals (DAAs) remains unclear. We aimed to evaluate LSM regression value after SVR and to identify risk factors associated with liver related complications (LRC) or death. This retrospective study analyzed patients with LSM ≥ 10 kPa with LSM by transient elastography pre-DAAs and post-SVR. Patients with previous hepatic decompensation were excluded. Medical records were reviewed to identify primary outcomes. Kaplan–Meier curves and time-to-event Cox proportional-hazard models were performed. 456 patients [65% female, 62 years (IQR 57–68)] were included. During a follow-up of 2.3 years (IQR 1.6–2.7), 28 patients developed 37 outcomes [rate = 29.0 (95% CI 20.0–42.0) per 1000 person-years]. The cumulative incidence of outcomes was significantly lower in patients who regressed LSM ≥ 20% [3.4% (95% CI 1.8–7.0) vs. 9.0% (5.5–14.5), p = 0.028]. In a multivar...
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Introdução Ao lado das doenças neoplásicas e das alterações hepáticas, metabólicas e cardiovasculares, a doença renal atualmente é, sem dúvida, uma das principais preocupações relacionadas ao cuidado dos pacientes que vivem com HIV. Além... more
Introdução Ao lado das doenças neoplásicas e das alterações hepáticas, metabólicas e cardiovasculares, a doença renal atualmente é, sem dúvida, uma das principais preocupações relacionadas ao cuidado dos pacientes que vivem com HIV. Além do impacto gerado diretamente pelas alterações da função renal na saúde dos pacientes e da perda da qualidade de vida associada à doença renal terminal, em que há necessidade de tratamento dialítico até a disponibilidade de transplante renal, esses pacientes apresentam um risco aumentado de progressão para condições definidoras e óbito.1,2 Também pode ser necessário reajustar as doses de medicamentos e restringir o uso de outros, o que leva a dificuldades logísticas para a terapia antirretroviral (TARV) e as demais comorbidades. Assim, é importante que os clínicos envolvidos no atendimento a pacientes com infecção pelo HIV estejam atentos e sejam capazes de identificar a lesão renal em seu estágio inicial e abordá-la corretamente por suas múltiplas ...
A 19-year-old male patient was admitted to the Evandro Chagas National Institute of Infectious Diseases, Fiocruz, on 10 March 2020 complaining of an 8-month history of progressive weight loss; multiple cervical, axillary, and inguinal... more
A 19-year-old male patient was admitted to the Evandro Chagas National Institute of Infectious Diseases, Fiocruz, on 10 March 2020 complaining of an 8-month history of progressive weight loss; multiple cervical, axillary, and inguinal lymph node enlargements; abdominal distension; and disseminated cutaneous lesions (Fig 1). A histopathological examination of the left inguinal lymph node revealed chronic granulomatous lymphadenitis with the presence of multiple budding fungal structures typical of
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To the Editor Nonspecific myelodysplastic features (MDF) due to hematopoietic effects of the human immunodeficiency virus (HIV) were frequent before the antiretroviral therapy (ART) era. Pronounced hypocellularity, plasmacytosis, and... more
To the Editor Nonspecific myelodysplastic features (MDF) due to hematopoietic effects of the human immunodeficiency virus (HIV) were frequent before the antiretroviral therapy (ART) era. Pronounced hypocellularity, plasmacytosis, and eosinophilia were observed and are referred to as HIVmyelopathy [1,2]. TheseMDF alterations generally resolve with the institution of ART. They should be separated from myelodysplastic syndrome (MDS), a heterogeneous groupofmyeloid clonal diseases. Myelodysplastic syndromes can have a primary cause, also called de novo MDS, or secondary (sMDS), both with the risk of progression to acutemyeloid leukemia (AML). Some case reports and small case series of MDS in well-controlled HIV patients were described [3-6]. Herein, a new case of a long-stand well-controlled HIV infected patient with MDS is reported. The MDS status evolved with clonal karyotype associated with trisomy 8 and ASXL1mutation. A 61-year-old black woman was diagnosed with HIV in 2002, and ART—Zidovudine, Lamivudine (3TC), and Efavirenz—was initiated. She remained on this treatment for 16 years with long-term suppressed viral load, and CD4 cell counts >600 cells/mm3. In January 2018, she presented with progressive anemia and mental depression and the scheme was switched to Tenofovir, 3TC, and Dolutegravir. In September 2018, she developed severe anemia and thrombocytopenia (hemoglobin [Hb] 4.3 g/dL, leucocyte 8.7 × 109/L, neutrophils 2.2 × 109/L, and platelets 45 × 109/L, reticulocyte 0.13%, and serum ferritin 1225 μg/L) with red blood cell transfusion dependency. The polymerase chain reaction for Parvovirus B19 was negative on the blood sample. Bone marrow (BM) aspiration and biopsy were performed. The morphology disclosed a BM hypercellular with multilineage dysplasia (80%) and blast cells (5%). The histology was characterized by erythroid reduction and granulocytic hyperplasia with increased precursor cells and abnormal localization of immature precursors (ALIP). No acid-fast or fungal microorganisms were observed. The G-banding of BM cells identified the karyotype: 47,XX,+8[5]/46,XX[9] (Figure 1A), and the fluorescence in situ hybridization (FISH) analysis confirmed the trisomy 8 (Figure 1B). ASXL1 andDNMT3A somatic mutations were tested by Sanger sequencing [7,8]. DNMT3A was wild type, and ASXL1mutation in exon
In Brazil, hepatitis C treatment has been evolving significantly with the licensing of direct-acting antivirals (DAAs). However, viral determinants (amino acid substitutions in hepatitis C virus (HCV) genome and infective genotype)... more
In Brazil, hepatitis C treatment has been evolving significantly with the licensing of direct-acting antivirals (DAAs). However, viral determinants (amino acid substitutions in hepatitis C virus (HCV) genome and infective genotype) associated with host factors (hepatic condition and prior HCV therapy) might limit the achievement of sustained virologic response (SVR). Here, we described two case reports in which the occurrence of HCV NS5A mutations A30K (subtype 3a) and Y93N (subtype 1a) might have influenced daclatasvir (DCV)/sofosbuvir (SOF) combined therapy non-response. Despite high response rates for DAA combined therapies in Brazil, these case reports stated the importance of an investigation about how to manage a DAA treatment failure since a combination of factors, especially the occurrence of resistance substitutions, could impact a rescue therapy with new available antivirals in clinical routine.
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BACKGROUND AND AIMS Treatment for hepatitis C has evolved significantly with the licensing of direct-acting antiviral drugs (DAAs). However, one of the limiting factors of the effectiveness of antiviral therapy with protease inhibitors... more
BACKGROUND AND AIMS Treatment for hepatitis C has evolved significantly with the licensing of direct-acting antiviral drugs (DAAs). However, one of the limiting factors of the effectiveness of antiviral therapy with protease inhibitors (PIs) is the emergence of resistance caused by point mutations. The aim of this study was to determine the prevalence of resistance-associated substitutions (RASs) in HCV NS3 gene in patients infected with genotype 1 before therapy with simeprevir. METHODS A total of 73 serum samples from 15 treatment-experienced patients with boceprevir/telaprevir and 58 DAA-naïve patients were collected before therapy with DAAs simeprevir, daclatasvir and/or sofosbuvir. Presence of baseline resistance-associated substitutions (RAS) in the serine protease domain of HCV NS3 was analyzed by nucleotide sequencing followed by amino acid deduction. RESULTS Overall RAS prevalence in this study was 13.7% (10/73). RAS prevalence for HCV subtype 1b was 17.4% (4/23) while for HCV subtype 1a was 12% (6/50). Primary mutations V36M/L and R155K were observed only in HCV subtype 1a, whereas T54S and Q80K were identified only in HCV subtype 1b. RAS V36M, which is related to reduction of susceptibility to second-generation PIs, was the most frequent in the study (6.9%; 5/73). CONCLUSIONS Our results indicated that Brazilian isolates of HCV present a distinct pattern of RAS depending on the infecting viral subtype. In contrast to data from other countries, RAS Q80K prevalence in Brazil is low in HCV subtype 1a. This study improves the knowledge of genetic barrier for resistance to PIs involving RASs in chronically infected patients and its possible impact on an unsuccessful treatment outcome, information that might be crucial to upcoming decisions of incorporation of new DAAs in Brazilian guidelines of antiviral therapy against HCV infection.
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Zika virus (ZIKV) is a member of the Flaviviridae family, along with other agents of clinical significance such as dengue (DENV) and hepatitis C (HCV) viruses. Since ZIKV causes neurological disorders during fetal development and in... more
Zika virus (ZIKV) is a member of the Flaviviridae family, along with other agents of clinical significance such as dengue (DENV) and hepatitis C (HCV) viruses. Since ZIKV causes neurological disorders during fetal development and in adulthood, antiviral drugs are necessary. Sofosbuvir is clinically approved for use against HCV and targets the protein that is most conserved among the members of the Flaviviridae family, the viral RNA polymerase. Indeed, we found that sofosbuvir inhibits ZIKV RNA polymerase, targeting conserved amino acid residues. Sofosbuvir inhibited ZIKV replication in different cellular systems, such as hepatoma (Huh-7) cells, neuroblastoma (SH-Sy5y) cells, neural stem cells (NSC) and brain organoids. In addition to the direct inhibition of the viral RNA polymerase, we observed that sofosbuvir also induced an increase in A-to-G mutations in the viral genome. Together, our data highlight a potential secondary use of sofosbuvir, an anti-HCV drug, against ZIKV.
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Development of drug-resistance mutations is the main cause of failure in antiretroviral therapy. In Brazil, there is scarce information on resistance pattern for patients failing antiretroviral therapy. To define the HIV mutational... more
Development of drug-resistance mutations is the main cause of failure in antiretroviral therapy. In Brazil, there is scarce information on resistance pattern for patients failing antiretroviral therapy. To define the HIV mutational profile associated with drug resistance in Brazilian patients from 5 large cities, after first, second or further failures to antiretroviral therapy. We reviewed genotyping results of 1520 patients failing therapy in five Brazilian cities. Frequency of mutations, mean number of active drugs, viral susceptibility to each antiretrovirals drug, and regional differences were assessed. Mean time of antiretrovirals use was 22.7±41.1 months. Mean pre-genotyping viral load was 4.2±0.8log (2.1±2.0 after switching antiretrovirals). Mean number of remaining active drugs was 9.4, 9.0, and 7.9 after 1st, 2nd, and 3rd failure, respectively. We detected regional variations in drug susceptibility: while BA and RS showed the highest (∼40%) resistance level to ATV/r, FPV/r...
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HIV-infected individuals have a higher risk of serious illnesses following infection by infection with influenza. Although anti-influenza vaccination is recommended, immunosuppression may limit their response to active immunization. We... more
HIV-infected individuals have a higher risk of serious illnesses following infection by infection with influenza. Although anti-influenza vaccination is recommended, immunosuppression may limit their response to active immunization. We followed-up a cohort of HIV-infected individuals vaccinated against influenza to assess the immunogenicity and sustainability of the immune response to vaccination. Individuals were vaccinated 2011 with inactivated triple influenza vaccine (TIV), and they had received in 2010 the monovalent anti-A(H1N1)pdm09 vaccine. The sustainability of the immune response to A(H1N1)pdm09 at 12 months after monovalent vaccination fell, both in individuals given two single or two double doses. For these individuals, A(H1N1)pdm09 component from TIV acted as a booster, raising around 40% the number of seroprotected individuals. Almost 70% of the HIV-infected individuals were already seroprotected to A/H3N2 at baseline. Again, TIV boosted over 90% the seroprotection to ...