Banca de DEFESA: MARIANA ARAÚJO PEREIRA

Uma banca de DEFESA de DOUTORADO foi cadastrada pelo programa.
STUDENT : MARIANA ARAÚJO PEREIRA
DATE: 18/11/2022
TIME: 15:00
LOCAL: IGM Sala Virtual 5
TITLE:

Determinants of the relationship between anemia and unfavorable clinical outcomes in people living with with HIV.

KEY WORDS:

tuberculosis; hiv; anemia; systemic inflammation; outcome;

PAGES: 235
BIG AREA: Ciências da Saúde
AREA: Medicina
SUMMARY:

ABSTRACT
INTRODUCTION: People living with HIV (PLHIV) often have anemia as a complication. Anemia in HIV patients may be associated with an exacerbation of the inflammatory profile, with an increase in blood cytokines and more accelerated disease progression. However, little has been reported on the impact of anemia severity on unfavorable clinical outcomes during treatment of these patients with antiretroviral drugs, such as incident tuberculosis (TB), immunoreconstitution inflammatory syndrome (IRIS) and death. OBJECTIVE: To characterize the inflammatory profile of anemic patients with HIV, as well as to identify the associations between the presence of anemia and its severity with the unfavorable treatment outcomes of these patients. METHODS: This thesis brings together a set of six manuscripts that aim to characterize and associate anemia with the clinical outcomes of PLHIV. Altogether, data from 1617 PLHIV were evaluated. Anemia and its severity were defined according to World Health Organization criteria. For each manuscript, a different PLHIV cohort was used, and in each of them the plasma levels of inflammatory markers were analyzed, as well as clinical, socioeconomic and laboratory data. Descriptive statistical methods and a set of multidimensional techniques were applied, including network analyses, integrative analyses, logistic regressions and calculation of the degree of inflammatory perturbation (DIP). RESULTS: In the first study, we concluded that anemic PLHIV are more likely to develop incident TB after starting antiretroviral treatment (ART) compared to non-anemic individuals. In the second, it was found that severe anemia increases the risk of IRIS, mainly from TB, during ART. In the third study, it was observed that anemia is associated with a greater dissemination of TB in PLHIV. In the three aforementioned studies, moderate/severe anemia are risk factors for death. The fourth study demonstrated that low hemoglobin levels were associated with higher DIP in HIV-TB patients. Next, we observed that HIV-TB patients with persistent anemia have a higher risk of dying than non-anemic patients during anti-TB treatment (ATT). This last result was reinforced by the sixth study, where moderate/severe anemia pre-ATT was a risk factor for death. CONCLUSIONS: Together, the manuscripts of this thesis add important information regarding the importance of anemia in the context of HIV-TB co-infection. By identifying moderate and severe anemia as a risk factor for incident TB, IRIS, disseminated TB, inflammatory disturbance, and death, we demonstrate that anemic PLHIV should be carefully monitored and, if possible, anemia should be carefully evaluated as a hallmarker of possible opportunistic infection and worse prognosis. In this context, this information is useful in directing new approaches to optimize clinical management and improve the quality and life expectancy of PLHIV.

COMMITTEE MEMBERS:
Externo à Instituição - TIMOTHY R. STERLING
Presidente - ***.442.755-** - BRUNO DE BEZERRIL ANDRADE - UFBA
Externo ao Programa - 287953 - CARLOS ROBERTO BRITES ALVES - nullInterna - ***.753.118-** - ISADORA CRISTINA DE SIQUEIRA - UFBA
Externo à Instituição - MARCELO CORDEIRO DOS SANTOS