Submitted by Edisangela Bastos (edisangela@ufpa.br) on 2013-04-18T19:48:50Z No. of bitstreams: 2 license_rdf: 23898 bytes, checksum: e363e809996cf46ada20da1accfcd9c7 (MD5) Dissertacao_AlteracoesEndocrinasMetabolicas.pdf: 877457 bytes, checksum: f261ddbe8cf6348f3145ce53590258ad (MD5) / Approved for entry into archive by Ana Rosa Silva(arosa@ufpa.br) on 2013-04-19T16:44:13Z (GMT) No. of bitstreams: 2 license_rdf: 23898 bytes, checksum: e363e809996cf46ada20da1accfcd9c7 (MD5) Dissertacao_AlteracoesEndocrinasMetabolicas.pdf: 877457 bytes, checksum: f261ddbe8cf6348f3145ce53590258ad (MD5) / Made available in DSpace on 2013-04-19T16:44:13Z (GMT). No. of bitstreams: 2 license_rdf: 23898 bytes, checksum: e363e809996cf46ada20da1accfcd9c7 (MD5) Dissertacao_AlteracoesEndocrinasMetabolicas.pdf: 877457 bytes, checksum: f261ddbe8cf6348f3145ce53590258ad (MD5) Previous issue date: 2007 / A lipodistrofia do HIV e evento comum em pacientes em uso de terapia antiretroviral fortemente ativa (HAART). O presente estudo avalia as alterações metabolicas e endocrinas em pacientes que apresentam lipodistrofia. Foram avaliados 40 pacientes com lipodistrofia e classificados em lipoatrofia, lipohipertrofia (lipoacumulacao) e lipodistrofia mista e analisadas as alterações endocrinas e metabolicas. As variáveis estudadas foram: resistência insulínica pelo HOMA-IR (Homeostasis Model Assesment Insulin Resistance), teste oral de tolerancia a glicose, TSH, T4 livre, cortisol, DHEA, prolactina, testosterona em homens, FSH, LH e estradiol nas mulheres, colesterol total e fracoes (HDL e LDL), acido úrico, ureia, creatinina, AST e ALT, medidas antropométricas (peso, estatura, índice de massa corpórea, circunferência abdominal, quadril, relação cintura/quadril), densitometria óssea e avaliação de esteatose hepática por ultrassonografia abdominal. A lipo-hipertrofia isolada ocorreu em sua totalidade no sexo feminino (p <0,05). A média de idade foi semelhante nos três grupos, sem variação na distribuição por faixa etária. Dislipidemia ocorreu em todos os grupos após o inicio da terapia anti-retroviral (lipodistrofia mista, 100%, lipo-hipertrofia, 80% e lipoatrofia 70%). Variáveis antropométricas mostram elevação da cintura abdominal em mulheres com lipo-hipertrofia. (98,2 + 13,4) e menores em mulheres com lipoatrofia (76,8 + 6,1). Pacientes com lipoatrofia apresentam-se eutroficos (82,4%), e pacientes com lipo-hipertrofia apresentam sobrepeso ou obesidade (60%). Foi encontrada associação entre osteoporose e sexo masculino (p < 0,05) alta prevalência de dislipidemia (85%) e síndrome metabólica (37,5%) em todos os grupos estudados. A síndrome metabólica esteve associada com a lipo-hipertrofia. Não foram encontradas alterações significativas na tireoide, cortisol, relação cortisol/DHEA, testosterona, FSH, LH e prolactina. Conclusão: O sexo feminino apresenta forte associação com a lipo-hipertrofia isolada. A lipo-hipertrofia parece estar associado com a síndrome metabólica e resistência insulínica. Os homens tem maiores risco de desenvolvimento de osteopenia e osteoporose. Esteatose hepática, apesar de bastante comum não esta associado a um tipo particular de lipodistrofia. Alterações hormonais não são eventos comuns em pacientes com lipodistrofia do HIV. / Lipodystrophy is one of the complications of highly active antiretroviral therapies (HAART). This study evaluates the metabolic and endocrine changing in patients with lipodystrophy. Forty patients were evaluated and classified as lipoatrophy, lipohypertrophy and mixed syndrome. We analyzed insulin resistance for HOMA-IR (Homeostasis Model Assesment Insulin Resistance), fasten glucose and OGTT, urea, creatinine, TSH, Free T4, cortisol, DHEA, ratio cortisol/DHEA, prolactin, testosterone (in male), FSH, LH and estradiol (in female), total cholesterol, LDL-c, HDL-c, uric acid. Anthropometrics measures (Weight, height, body mass index, waist, hip and skin folds thickness), ultrasonographic exams for evaluate hepatic steatosis and measure of bone density. The isolated lipohipertrophy occurred only in female (p<0,05). The mean of age was similar in the groups, without changing in the distribution by age group. Dyslipidemia occurred in all groups after HAART (lipodystrophy mixed, 100%, lipohypertrophy, 80% and lipoatrophy, 70%). Antropometric data showed waist increased in the female with lipohypertrophy (98+ 13,4) and decreased in female with lipoatrophy (76,8 + 6,1). Patients with lipoatrophy have been eutrophic (82,4%) and patients with lipohypertrophy have overweight or obesity (60%). Male was associated with osteoporosis (p < 0,05). We found elevated prevalence of the dyslipidemia (85%) and metabolic syndrome (37,5%) in all groups. The metabolic syndrome was associated with lipohypertrophy. No significant changes were found in the thyroid, cortisol, cortisol/DHEA ratio, testosterone, FSH, LH and prolactina. Conclusions: Female is associated with isolated lipohypertrophy, metabolic syndrome and insulin resistance. Male is related with Osteopenia and osteoporosis. Hepatic steatosis were common, but is not influenced for a type of lipodystrophy. Hormonal changing were unusual events in lipodystrophy.

Submitted by Cleide Dantas (cleidedantas@ufpa.br) on 2014-02-07T12:24:35Z No. of bitstreams: 2 license_rdf: 23898 bytes, checksum: e363e809996cf46ada20da1accfcd9c7 (MD5) Tese_EstudoEpidemiologicoAgentes.pdf: 1947171 bytes, checksum: 6e5b26f28d72747b8ddf43e483e52232 (MD5) / Approved for entry into archive by Ana Rosa Silva(arosa@ufpa.br) on 2014-02-11T15:40:47Z (GMT) No. of bitstreams: 2 license_rdf: 23898 bytes, checksum: e363e809996cf46ada20da1accfcd9c7 (MD5) Tese_EstudoEpidemiologicoAgentes.pdf: 1947171 bytes, checksum: 6e5b26f28d72747b8ddf43e483e52232 (MD5) / Made available in DSpace on 2014-02-11T15:40:47Z (GMT). No. of bitstreams: 2 license_rdf: 23898 bytes, checksum: e363e809996cf46ada20da1accfcd9c7 (MD5) Tese_EstudoEpidemiologicoAgentes.pdf: 1947171 bytes, checksum: 6e5b26f28d72747b8ddf43e483e52232 (MD5) Previous issue date: 2010 / A prevalência da infecção por agentes virais como o HIV-1, HTLV1/2, VHB e CMV, ainda é pouco conhecida na população de adolescentes grávidas na região norte do Brasil. Este trabalho teve como um dos objetivos descrever esta prevalência das infecções HIV-1, HTLV1/2, VHB e CMV em adolescentes grávidas atendidas em um centro de referência do estado do Pará. Foram coletadas amostras de sangue de 324 gestantes procedentes de vários municípios do estado no período de novembro de 2009 a fevereiro de 2010. As amostras foram submetidas a um ensaio imunoenzimático do tipo ELISA, para a detecção de anticorpos anti-HIV, anti HTLV-1/2, anti-VHB e anti-CMV IgM/IgG. A análise sorológica revelou uma amostra soropositiva para o HIV-1, duas amostras positivas para HTLV1/2, enquanto a maioria das amostras apresentaram anticorpos anti-CMV IgG, embora a ocorrência da infecção aguda tenha sido baixa (2,2%). A prevalência da infecção para VHB em adolescentes gestantes foi de 0,62%, porém numero expressivo (83,3%) de adolescentes estão suscetíveis a infecção pelo VHB, o que sugere que não foram imunizadas. A maioria (63,4%) das adolescentes continuaram estudando mesmo sabendo da gravidez e 34,6% buscaram o pré-natal tardiamente possibilitando um numero mínimo de quatro consultas de pre natal O resultado reforça a hipótese que estas adolescentes grávidas possuem uma prevalência de infecções desses tipos virais, semelhante a taxas nacionais das gestantes de modo geral. A prevalência dos subtipos virais (HTLV-2 e HIV-1 subtipo B) obtidas através da caracterização molecular das amostras soropositivas das gestantes foi concordante com a prevalência dos subtipos da região norte. / The prevalence of infection by viral agents such as HIV-1, HTLV1/2, VHB and CMV is not so much known in pregnant teenage population from the North region of Brazil. One of the objectives of this study was to describe the prevalence of infections HIV-1, HTLV1/2, VHB and CMV in pregnant adolescents, attended in a Reference Center in the State of Pará. To achieve the objectives, it was collected blood samples from 324 pregnant adolescents, who came from several cities of the State, from November of 2009 to February of 2010. The samples were submitted to an immuno-enzymatic test (ELISA), in order to detect antibodies Anti- HIV, Anti- HTL V1/2, Anti- VHB and Anti- CMV IgM/ IgG. The serological analysis revealed one serum positive sample for HIV-1, two positives samples for HTLV1/2, while the majority of samples showed antibodies Anti-CMV-IgG, although the occurrence of high infection was low (2.2%). The prevalence of infection for VHB in pregnant adolescents was 0.62%, however a great number (83.3%) of adolescents are susceptible to the infection by VHB, what means they probably were not immunized. The majority of adolescents (63.4%) continued their studies, even though they know about their pregnancy and 34.6% started prenatal later, so they only had a minimum number of four consultations of prenatal. The result reinforces the hypothesis that pregnant adolescents have prevalence for those viral type infections, what is similar to the national pregnant women rates. The prevalence of viral subtypes (HTLV-2 and HIV-1 subtype B) obtained by the molecular characterization of serum positive samples from pregnant adolescents agreed with the prevalence of subtypes from the North region.

Les traitements antirétroviraux combinés limitent la morbidité et la mortalité liées au SIDA après l'infection par le VIH, mais une hyperactivation du système immunitaire persiste, notamment au niveau des cellules myéloïdes, en corrélation avec une morbidité et une mortalité métabolique et cardio-vasculaire plus précoces que celles de la population générale. Il existe deux types de VIH ; l'infection par le VIH-2, prévalente en Afrique de l'Ouest et dans des communautés émigrées de cette région, conduit moins rapidement et moins fréquemment au SIDA que l'infection par le VIH-1, pour des raisons de relation hôte-virus encore à élucider. Lors de l'infection aigüe par le VIH-1, un pic sérique d'interféron (IFN) de type I et d'autres cytokines est observé, puis régulé négativement. Il est accompagné d'une forte réponse des gènes stimulés par l'IFN, qui persiste lors du passage à l'infection chronique, avec hyperactivation du système immunitaire. Les IFN de type I sont produits par toutes les cellules, mais en particulier par les cellules dendritiques plasmacytoïdes (pDC). Les IFN de type III (lambda) sont liés à la résolution de l'infection par le VHC, mais leur production en réponse au VIH reste à explorer. Durant mon doctorat, j'ai montré pour la première fois qu'in vitro, le VIH-1 et le VIH-2 stimulent la production d'IFN-lambda par les PBMC de donneurs sains de façon comparable. Chez des donneurs sains, les pDC produisent ces IFN de façon intrinsèque, mais pas les autres DC myéloïdes. Les pDC ont également un rôle dans la réponse immunitaire adaptative contre le VIH. L’équipe a en effet montré qu’elles peuvent effectuer la présentation croisée d’antigènes de cellules mortes infectées par le VIH, comme le font les autres DC. Elles peuvent ainsi activer des réponses T cytotoxiques spécifiques qui vont éliminer les cellules infectées. J’ai étudié ce mécanisme et montré que l’activation spécifique des lymphocytes T par les pDC est potentialisée par une pré-activation non-spécifique. En effet, les pDC s’activent en présence du virus et sécrètent des cytokines qui pré-activent une production intracellulaire d'IFN-gamma par les lymphocytes T CD8. Ces lymphocytes ne relarguent l'IFN-gamma qu'après reconnaissance spécifique par leur récepteur T d'un complexe peptide-CMH. Les résultats de cette thèse pourraient donner une place aux IFN-lambda ou à leur inhibition dans l'arsenal thérapeutique contre le VIH, ainsi qu'à l'activation des pDC pour conduire à une meilleure détection et élimination des réservoirs viraux par présentation croisée. / Combined antiretroviral treatments limit AIDS-related morbidity and mortality after HIV infection. But hyperactivation of the immune system persists, notably within the myeloid cell compartment, in correlation with metabolic and cardiovascular morbidity, which occurs earlier than in the general population. Two types of HIV have been described: HIV-2 infection, prevalent in West Africa and in emigrated communities originating from this area, leads less frequently and less rapidly to AIDS compared to HIV-1 infection, because of host-virus, which still need to be characterized. During acute HIV-1 infection, in the plasma, peak levels of type I Interferon (IFN) and other cytokines are observed, then they are down-modulated. A strong IFN stimulated gene (ISG) response is also observed. During chronic infection, the ISG response persists, with hyperactivation of the immune system. Type I IFN are produced by all cell types, but more specifically by plasmacytoid Dendritic Cells (pDC). Certain type III IFN (lambda) gene variants correlate with clearance of HCV infection, but IFN-lambda production in response to HIV remained to be studied. During my PhD, I showed for the first time that, in vitro, HIV-1 and HIV-2 induce IFN-lambda production by healthy donors PBMC at comparable levels. Plasmacytoid DC from healthy donors produce these IFN intrinsically, but not conventional DC. Plasmacytoid DC also have a role in the induction of adaptive immune responses against HIV. Our team demonstrated that they can crosspresent antigens from HIV infected apoptotic cells, like other DC. They can therefore activate specific cytotoxic T cell responses which eliminate infected cells. I studied this mechanism and showed that the activation of specific T cell by pDC is potentiated by non-specific pre-activation. Indeed, pDC become activated in the presence of virus and secrete cytokines which pre-activate intracellular IFN-gamma production by CD8 T cells. IFN-gamma is then secreted only after cognate MHC-peptide-T cell receptor interaction. The results of this thesis potentially give a role to IFN-lambda or their blockade in HIV treatment, and to the activation of pDC to induce better detection and elimination of HIV reservoirs through crosspresentation.

Submitted by Alexandre Sousa (alexandre.sousa@incqs.fiocruz.br) on 2014-08-01T13:26:04Z No. of bitstreams: 1 Dissertação Claudia.pdf: 3475820 bytes, checksum: 6332703f9ff4576a262fa833bd645549 (MD5) / Made available in DSpace on 2014-08-01T13:26:04Z (GMT). No. of bitstreams: 1 Dissertação Claudia.pdf: 3475820 bytes, checksum: 6332703f9ff4576a262fa833bd645549 (MD5) Previous issue date: 2014 / Fundação Oswaldo Cruz. Bio-Manguinhos / A AIDS é um problema mundial de Saúde Pública. Com a necessidade de ampliar o acesso ao diagnóstico laboratorial da infecção causada pelo HIV, foi incentivado pelo Ministério da Saúde o desenvolvimento de testes de elevada sensibilidade e especificidade, além de baixo custo para uso em rotina, visando a detecção de anticorpos para o HIV no sangue humano. Esses testes sorológicos são instrumentos para auxiliar no diagnóstico clínico, na proteção do suprimento de sangue e no monitoramento da infecção pelo HIV. Bio-Manguinhos, Unidade Técnica da Fiocruz, voltada para o desenvolvimento e produção de imunobiológicos, biofármacos e reativos para diagnóstico, tem estimulado o estabelecimento de plataformas tecnológicas que permitam o desenvolvimento e a incorporação de novos produtos e processos para a Saúde Pública. Na presente avaliação, amostras de plasma de indivíduos soropositivos e negativos para a infecção pelo HIV e de doadores de sangue, além de um painel comercial de título misto para anticorpos contra o HIV, foram utilizadas na validação de reagentes e insumos disponíveis no mercado nacional em comparação aos importados, em uso, atualmente, na produção do tampão de corrida do Teste Rápido para Diagnóstico de HIV-1/2, de Bio-Manguinhos. O desempenho do tampão de corrida que compõe esse kit, formulado com insumos importados, frente ao tampão preparado com produtos encontrados no mercado nacional foi o mesmo, com relação à intensidade da linha teste e ao tempo da visualização da linha controle, a partir da adição da amostra e do referido tampão de corrida. No presente estudo foi verificado que não houve diferença estatística entre os reagentes analisados em um nível de significância de α=0,05. Além disso, todos os ensaios apresentaram percentuais de sensibilidade e especificidade de 100%, sugerindo que os reagentes nacionais podem ser utilizados em substituição aos importados, sem prejuízo no desempenho da reação imunológica inerente ao processo. Neste estudo não foram verificadas diferenças significativas no custo dos sete reagentes nacionais (Cloreto de sódio; Soro de Galinha; Sulfato de estreptomicina; Tween 20; EDTA Dissódico; Fosfato de Sódio Dibásico e EDTA Tetrassódico) avaliados frente aos importados. Sendo assim, de forma preliminar, podemos dizer que os reagentes nacionais apresentam o mesmo desempenho em relação aos importados, minimizando desta forma, os entraves burocráticos, permitindo maior agilidade no ato da compra e contribuindo para reduzir o período de espera da chegada do produto para o prosseguimento do processo produtivo do kit Teste Rápido por Bio-Manguinhos. / AIDS is a global problem of Public Health. With the need to expand access to the laboratory diagnosis of HIV infection it was encouraged by the Ministry of Health the development of tests of high sensitivity, specitivity and low cost for routine, in order to detect antibodies to HIV in human blood. These serological tests are important tools in clinical diagnosis, have in protecting the blood supply and in monitoring of HIV/AIDS. Bio-Manguinhos, a Technical Unit of Fiocruz on development and manufacturing of immunobiological, biopharmaceutical and reagents for diagnosis, have encouraged the establishment of technological platforms for the development and incorporation of new products and processes for Public Health. In the present study clinical samples from seropositive and nonreactive individuals for the HIV/AIDS infection and blood donors samples together with a mixed titer commercial panel were used in the validation of reagents and supplies obtained in internal market compared to those imported products currently used in the production of the running buffer of Rapid Test for Diagnosis of HIV – 1 / 2 Bio-Manguinhos. The performance of the running buffer of the kit, formulated with imported reagents in comparison with products found in the internal market was the same with respect to the intensity of the test line and to the time line view of control, from the moment of sample and the running buffer addition. In the study it was found that within a range of 95% there was no statistical difference between the reagents tested in α=0,05 significance level. Moreover, all the tests presented sensitivity and specificity percentages of 100% suggesting that the reagents obtained in the internal market may be used to replace imported ones without impairing performance of the immune response inherent to the process. In this study no significant differences in the cost of the seven reagents tested were observed (national or imported ones). Thus, in a preliminary way one can say that national reagents have the same performance in relation to those imported, thus minimizing the bureaucratic obstacles, allowing greater flexibility in the purchase and contributing to reduce the period for the arrival of the product the communication of the productive process Test Kit Rapid Bio-Manguinhos.