Browsing by Author "Morais, Joana"
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- Clinical and public health implications of HIV-genetic diversity and drug resistance mutations in Angola: a systematic reviewPublication . Sebastião, Cruz S.; Morais, Joana; Brito, MiguelHIV-1 genetic diversity and drug resistance mutations (DRMs) remain a public health concern mainly in low- and middle-income countries. In this review, we estimated the HIV-1 molecular evolution over the past 40 years (1980-2019) in Angola to help guide affordable strategies for HIV-1 epidemic surveillance. We searched for studies written in English or Portuguese on HIV-1 diversity and DRMs carried out in Angola and published between 1980 and 2019. This review yielded eight studies describing a total of 493 samples. No HIV-1 Group N, O, and P were identified, whereas a ll non-B subtypes f rom Group M were identified. About 66% of HIV-1 subtypes were pure subtype and 34% recombinant strains. The frequency of recombinant strains increases from 1980 to 2019 (23.6%-41.4%, p<0.001). The subtypes C, F1, CRF02_AG, and the recombinant U/H were the most frequent. One DRM in the PIs was found (I54 M), 22 in the nucleoside reverse transcriptase inhibitors (NRTIs), and 18 in the non-nucleoside reverse transcriptase inhibitors (NNRTIs). The major DRM in the NRTIs was the M184V, whereas the G190A, K103N, and Y181C were the major DRMs in the NNRTIs. Over the past 40 years, the frequency of the DRM M184V (50-64.3%, p=0.363), G190A (17.2-46.2%, p=0.021), and K103N (34.5-42.3%, p=0.551) increased, while the frequency of Y181C (17.2-7.7%, p=0.289) decreased. The current review shows an increase in HIV-1 genetic complexity and DRMs in Angola. Our findings suggest the need to include PIs or integrase strand transfer inhibitors in the first-line antiretroviral therapy regimens in Angola.
- Clinical features related to severity and mortality among COVID-19 patients in a pre-vaccine period in Luanda, AngolaPublication . Sebastião, Cruz S.; Cogle, Adis; Teixeira, Alice D’Alva; Cândido, Ana Micolo; Tchoni, Chissengo; Amorim, Maria João; Loureiro, N’gueza; Parimbelli, Paolo; Penha-Gonçalves, Carlos; Demengeot, Jocelyne; Sacomboio, Euclides; Mendes, Manuela; Arrais, Margarete; Morais, Joana; Vasconcelos, Jocelyne Neto de; Brito, MiguelBackground: Infection due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is associated with clinical features of diverse severity. Few studies investigated the severity and mortality predictors of coronavirus disease 2019 (COVID-19) in Africa. Herein, we investigated the clinical features of severity and mortality among COVID-19 patients in Luanda, Angola. Methods: This multicenter cohort study involved 101 COVID-19 patients, between December 2020 and April 2021, with clinical and laboratory data collected. Analysis was done using independent-sample t-tests and Chi-square tests. The results were deemed significant when p < 0.05. Results: The mean age of patients was 51 years (ranging from 18 to 80 years) and 60.4% were male. Fever (46%), cough (47%), gastrointestinal symptoms (26.7%), and asthenia (26.7%), were the most common symptoms. About 64.4% of the patients presented coexistent disorders, including hypertension (42%), diabetes (17%), and chronic renal diseases (6%). About 23% were non-severe, 77% were severe, and 10% died during hospitalization. Variations in the concentration of neutrophil, urea, creatinine, c-reactive protein, sodium, creatine kinase, and chloride were independently associated with severity and/or mortality (p < 0.05). Conclusion: Several factors contributed to the severity and mortality among COVID-19 patients in Angola. Further studies related to clinical features should be carried out to help clinical decision-making and follow-up of COVID-19 patients in Angola.
- Dengue virus among HIV-infected pregnant women attending antenatal care in Luanda, Angola: an emerging public health concernPublication . Sebastião, Cruz S.; Neto, Zoraima; Jandondo, Domingos; Mirandela, Marinela; Morais, Joana; Brito, MiguelThe dissemination of the dengue virus (DENV) in endemic regions with HIV is a public health concern with greater importance when there is evidence of vertical transmission of DENV during pregnancy. Herein, we investigated DENV among HIV-infected pregnant women in Luanda, the capital city of Angola. This was part of a cross-sectional study carried out on 42 pregnant women newly diagnosed with HIV. A total of 36 plasma samples from the 42 HIV-positive pregnant women were screened for DENV using RT‐PCR and ELISA. None of the specimens tested positive for DENV by RT-PCR. Regarding seroprevalence, 94.4% of the samples were positive for IgG and 11.1% for IgM. Recent infection (IgG-/IgM+ or IgG+/IgM+) was detected in 11.1% of the samples and past infection (IgG+/IgM-) in 83.3%. The risk of recent infection was higher in pregnant women over 25 years of age [OR: 13.0 (95% CI: 1.14-148), p=0.039]. Our study showed laboratory evidence of a recent DENV infection among HIV-infected pregnant women attending antenatal care in Luanda. Our findings provide critical data regarding DENV infection among HIV-infected pregnant women in Luanda. Future studies involving a larger sample size of HIV-infected pregnant women are necessary to support ongoing public health programs to combat arboviruses in Angola.
- Distribution of CCR5-Delta32, CCR2-64I, and SDF1-3’A host genetic factors in HIV-infected and uninfected individuals in Luanda, AngolaPublication . Sebastião, Cruz S.; Pimentel, Victor; Jandondo, Domingos; Sebastião, Joana M. K.; Sacomboio, Euclides; Pingarilho, Marta; Brito, Miguel; Cassinela, Edson kuatelela; Vasconcelos, Jocelyne Neto de; Abecasis, Ana B.; Morais, JoanaBackground: The HIV/AIDS pandemic remains a public health concern. Studies on host genetic polymorphisms that confer resistance to HIV-1 infection or delay HIV disease progression are scarce in African countries. Herein, we investigate the proportion of the mutated phenotype of the AIDS-related polymorphisms CCR5-Delta32, CCR2-64I, and SDF1-3'A in HIV-infected and uninfected individuals in Luanda, the capital of Angola, a sub-Saharan African country. Methods: This was a cross-sectional study conducted with 284 individuals, of whom 159 were HIV-negative and 125 were HIV-positive. The CCR5-Delta32, CCR2-64I, and SDF1-3'A genotypes were detected by conventional PCR and visualised on a 2% agarose gel. A Chi-square test determined the frequency of each genetic variant and was deemed significant when p < 0.05. Results: The frequency of CCR5-Delta32, CCR2-64I, and SDF1-3 A was 0% (0/272), 60.2% (154/256), and 42.5% (114/268), respectively. CCR2-64I and SDF1-3 A polymorphisms were statistically related to HIV infection (p < 0.001). Statistically significant was observed between ABO blood groups (p = 0.006) and HIV-1 subtype (p = 0.015) with CCR2-64I. Also, the age group (p = 0.024) and RH blood group (p = 0.018) were statistically related to the distribution of SDF1-3 A polymorphism. Conclusions: We found no CCR5-Delta32 allele, while CCR2-64I and SDF1-3'A were found and presented a relationship with HIV infection, age, ABO/RH blood group, and HIV-1 subtypes. The observed associations of CCR2-64I and SDF1-3'A with HIV underscore the urgent need for further multidisciplinary research, with potential implications for targeted prevention and public health strategies. Therefore, studies investigating biological and non-biological factors related to susceptibility to HIV infection and AIDS progression or death should be conducted in Angola.
- Factors influencing HIV drug resistance among pregnant women in Luanda, Angola: findings from a cross-sectional studyPublication . Sebastião, Cruz S.; Morais, Joana; Brito, MiguelThe increase in HIV infection and drug-resistant strains is an important public health concern, especially in resource-limited settings. However, the identification of factors related to the propagation of infectious diseases represents a crucial target offering an opportunity to reduce health care costs as well as deepening the focus on preventing infection in high-risk groups. In this study, we investigate the factors related to drug resistance among HIV-infected pregnant women in Luanda, the capital city of Angola. This was a part of a cross-sectional study conducted with 42 HIV-positive pregnant women. A blood sample was collected, and HIV-1 genotyping was carried out using an in-house method. Multivariate analyses were performed to determine the interaction between sociodemographic characteristics and drug resistance. HIV drug resistance was detected in 44.1% of the studied population. High probabilities of drug resistance were observed for HIV-infected pregnant women living in rural areas (AOR: 2.73; 95% CI: 0.50–14.9) with high educational level (AOR: 6.27; 95% CI: 0.77–51.2) and comorbidities (AOR: 5.47; 95% CI: 0.28–106) and infected with an HIV-1 non-B subtype other than subtype C (AOR: 1.60; 95% CI: 0.25–10.3). The present study reports high HIV drug resistance. Furthermore, older-age, rural areas, high educational levels, unemployed status, having comorbidities, and HIV-1 subtypes were factors related to drug resistance. These factors impact drug susceptibility and need to be urgently addressed in order to promote health education campaigns able to prevent the spread of drug-resistant HIV strains in Angola.
- Genetic diversity and drug resistance of HIV-1 among infected pregnant women newly diagnosed in Luanda, AngolaPublication . Sebastião, Cruz S.; Neto, Zoraima; Jesus, Carlos S. de; Mirandela, Marinela; Jandondo, Domingos; Couto-Fernandez, José C.; Tanuri, Amilcar; Morais, Joana; Brito, MiguelMonitoring genetic diversity and drug resistance mutations (DRMs) is critical for understanding HIV epidemiology. Here, we report HIV-1 genetic diversity and DRMs in blood samples from 42 HIV-positive pregnant women naive to antiretroviral therapy (ART), in Luanda. The samples were subjected to nested-PCR, followed by sequencing of the HIV-1 pol gene, targeting the protease and reverse transcriptase fragments. HIV-1 diversity was analyzed using the REGA HIV-1 subtyping tool and DRMs were identified using the Calibrated Population Resistance tool. A total of 34 sequences were obtained. The data revealed wide HIV-1 subtypes heterogeneity, with subtype C (38%, 13/34) the most frequent, followed by the subtypes F1 (18%, 6/34), A1 (9%, 3/34), G (9%, 3/34), D (6%, 2/34) and H (3%, 1/34). In addition, recombinants strains were detected, with CRF02_AG (6%, 2/34) the most frequent, followed by CRF37_cpx, F1/C, A1/G, and H/G, all with 3% (1/34). A total of 6/34 (18%) of the sequences presented DRMs. The non-nucleoside reverse transcriptase inhibitors presented 15% (5/34) of resistance. Moreover, 1/34 (3%) sequence presented resistance against both non-nucleoside reverse transcriptase inhibitors and nucleoside reverse transcriptase inhibitors, simultaneously. Despite the small sample size, our results suggest the need to update currently used ART regimens. Surveillance of HIV-1 subtypes and DRMs are necessary to understand HIV epidemiology and to guide modification of ART guidelines in Angola.
- HIV, hepatitis B virus, hepatitis C virus, and syphilis among pregnant women attending antenatal care in Luanda, Angola: seroprevalence and risk factorsPublication . Sebastião, Cruz S.; Neto, Zoraima; Jandondo, Domingos; Mirandela, Marinela; Morais, Joana; Brito, MiguelInfectious diseases during pregnancy remain a public health concern, especially in a resource-limited setting. The study aimed to determine the seroprevalence and determinants of HIV and co-infection with hepatitis B virus (HBV), hepatitis C virus (HCV), and syphilis among pregnant women attending antenatal care in Luanda, the capital city of Angola. A cross-sectional study was conducted with 1612 pregnant women screened for HIV during antenatal care. HIV-reactive were also screened for HBV, HCV, and syphilis using immunoassay kits. A logistic regression model, adjusted odds ratios (AOR) and their 95% confidence interval (CI) were calculated with a level of significance set at 5%. The overall seroprevalence of HIV was 2.6%. About 13% of HIV-positive pregnant women were coinfected. From which, 7.5% were reactive to HBV and 5% to syphilis. There was no reactivity to HCV. Pregnant women younger aged than 25 years were significantly protected from HIV-infection (AOR, 0.43 [95% CI, 0.20-0.91], P = .026). The co-infection was 1.3 times (AOR, 0.04-41.0) in younger aged than 25 years, 7.0 times (AOR, 0.50-99.2) to residents in urbanized areas, and 1.4 times (AOR, 0.10-20.9) in pregnant women with a high educational level. In conclusion, infectious diseases are a public health burden among pregnant women in Luanda. However, include an integrated antenatal screening mainly in urbanized areas is crucial to reduce the spread of infectious diseases in different communities of Angola.
- HIV-1 diversity and pre-treatment drug resistance in the era of integrase inhibitor among newly diagnosed ART-naïve adult patients in Luanda, AngolaPublication . Sebastião, Cruz S.; Abecasis, Ana B.; Jandondo, Domingos; Sebastião, Joana M.; Vigário, João; Comandante, Felícia; Pingarilho, Marta; Pocongo, Bárbara; Cassinela, Edson; Gonçalves, Fátima; Gomes, Perpétua; Giovanetti, Marta; Francisco, Ngiambudulu M.; Sacomboio, Euclides; Brito, Miguel; Neto de Vasconcelos, Jocelyne; Morais, Joana; Pimentel, VictorThe surveillance of drug resistance in the HIV-1 naïve population remains critical to optimizing the effectiveness of antiretroviral therapy (ART), mainly in the era of integrase strand transfer inhibitor (INSTI) regimens. Currently, there is no data regarding resistance to INSTI in Angola since Dolutegravir-DTG was included in the first-line ART regimen. Herein, we investigated the HIV-1 genetic diversity and pretreatment drug resistance (PDR) profile against nucleoside/tide reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs), protease inhibitors (PIs), and INSTIs, using a next-generation sequencing (NGS) approach with MinION, established to track and survey DRMs in Angola. This was a cross-sectional study comprising 48 newly HIV-diagnosed patients from Luanda, Angola, screened between March 2022 and May 2023. PR, RT, and IN fragments were sequenced for drug resistance and molecular transmission cluster analysis. A total of 45 out of the 48 plasma samples were successfully sequenced. Of these, 10/45 (22.2%) presented PDR to PIs/NRTIs/NNRTIs. Major mutations for NRTIs (2.2%), NNRTIs (20%), PIs (2.2%), and accessory mutations against INSTIs (13.3%) were detected. No major mutations against INSTIs were detected. M41L (2%) and I85V (2%) mutations were detected for NRTI and PI, respectively. K103N (7%), Y181C (7%), and K101E (7%) mutations were frequently observed in NNRTI. The L74M (9%) accessory mutation was frequently observed in the INSTI class. HIV-1 pure subtypes C (33%), F1 (17%), G (15%), A1 (10%), H (6%), and D (4%), CRF01_AG (4%) were observed, while about 10% were recombinant strains. About 31% of detected HIV-1C sequences were in clusters, suggesting small-scale local transmission chains. No major mutations against integrase inhibitors were detected, supporting the continued use of INSTI in the country. Further studies assessing the HIV-1 epidemiology in the era of INSTI-based ART regimens are needed in Angola.
- Learner-low dose aspirin preterm trial (Angola) – Low dose aspirin in pregnant women with sickle cell disease when started in the first versus second trimester: a clinical control study in AngolaPublication . Brito, Miguel; Ginete, Catarina; Gomes, Tatiana; Pitangueira, Helena; Mendes, Manuela; Furtado, Ana; Alves, Ligia; Simão, Fernanda; Gonçalves, Mauer; Morais, JoanaSickle Cell Disease (SCD) is marked by episodes of acute vaso-occlusive crises, severe anemia, acute chest syndrome, multi-organ damage and stroke, among others. Pregnancy in these patients is associated with an increased risk of adverse outcomes, such as intrauterine growth restriction, perinatal and maternal mortality, low birth weight, eclampsia, pre-eclampsia, and stroke. Therefore, increasing the surveillance during pregnancy and searching prophylactic solutions for early prevention of pregnancy complications in women with SCD in African countries, where the burden of SCD is disproportionally higher, is an urgent need. Aspirin is already widely prescribed for the prevention of cardiovascular complications, and at a low daily dose, is used during pregnancy to prevent preeclampsia, intrauterine growth restriction, and other maternal-and-fetal disorders. In pregnant women with SCD, low dose aspirin is considered safe and is recommended for those who are at severe risk of pre-eclampsia. LEARNER (ClinicalTrials.gov ID, NCT06417411), is a prospective, opened label study to evaluate the effects of daily low dose aspirin in pregnant women with SCD when initiated at the first trimester versus the second trimester of the gestational period (where it is frequently started). We hypothesize that a low dose of aspirin (100 mg/daily) initiated early in pregnancy (weeks 6-13) can be more beneficial, than when it is started in the second trimester (weeks 14-27), reducing the incidence of fetal and maternal complications. This study intends to quantify the reduction in preterm delivery, perinatal death/miscarriage, and the risk of other maternal complications including pre-eclampsia, hypertensive disorders, number of vaso-occlusive crises, need for blood transfusion, urinary tract infections, respiratory tract infections, acute chest syndrome, retained placenta, placental abruption, and vaginal bleeding, when initiating low dose aspirin in the earliest stage of the gestation period. A total of 450 pregnant women, with confirmed diagnosis of SCD, will be enrolled in this study. Enrollment is taking place at maternity and infant hospitals in Luanda, Angola. Patients who consent to participate in the study will be assigned to one of two groups based on their gestational age, confirmed through ultrasound. Participants will then start daily use of 100 mg aspirin; dosing will be suspended at time of delivery, week 36, or earlier, if deemed necessary by the clinical team. Participants will be followed from the consenting visit to 6 weeks post-partum. Recruitment started in April 2024, after regulatory approval (local EC approval nº52/CEMS/2023, and national IRB approval 99/ARMED/MINSA/2024), and to date, 15 participants have been consented and 10 are in the treatment period. The biggest challenge to date is recruiting participants in the first trimester as most pregnant women that visit the hospital, in Angola, are already at the end of the second or in the third trimester. Our strategy to increase the study's visibility and facilitate patient recruitment will be advertisements in social media and patient support groups and to reach out to local health centers around Luanda. Additionally, this study aims to build capacity in Angola for the conduction of future clinical trials, involving local research sites and hospitals, capacitating Angolan institutions and professionals in clinical trial conduction and data capture abilities, promoting national and international collaborations, and creating population awareness for clinical research studies. The study team is comprised of the scientific team, local clinical team, an electronic data capture specialty team, a site management organization (SMO), and a Contract Research Organization (CRO). This is the first of its kind in Angola, which will revolutionize research in the country and help with our understanding of many diseases by diversifying the studied population pool for SCD and all other research that will be conducted in the country following the model established by this study.
- New challenges for the future: abstract proceedings of 4th International Congress on Environmental Health 2019 (ICEH)Publication . Almeida-Silva, Marina; Belo, Maria; Morais, Irene; Morais, Joana; Natividade, Liliana; Pena, Pedro; Pimenta, Márcia; Simão, MarianaThe Environmental Health area of the Teaching and Research Unit in Clinical Laboratory, Public Health and Environment of the Lisbon School of Health Technology, in conjunction with the National Environmental Health Association, the Departments of Environmental Health of the Coimbra Health School and the School of Health of Polytechnic Institute of Porto Porto hold the International Congress on Environmental Health “New” Challenges for the Future (ICEH 2019). The event runs concurrently with the 40th anniversary of the National Health Service with a tribute to Environmental Health Technicians who in 2019 complete 40 years of the profession at the National Health Service. ICEH 2019 takes place in the Lisbon School of Health Technology, between the 25th and 27th September of 2019 in the School auditorium. ICEH 2019 presents the most recent scientific and technological developments in the field of environmental health, emphasizing in individual disciplines, namely Air Quality, Biomarkers of Exposure/Effects, Climate Change & Sustainability, Emergency Preparedness, Environmental & Occupational Toxicology, Environmental Risk Assessment, Food Safety, Health Impact Assessment, Health Tracking & Informatics, Healthy Homes, Occupational Safety & Health, Public Health & Epidemiology, Waste Management, Water Quality and Zoonoses. The meeting aims to bring together researchers from a number of different countries and continents, involved in these issues. Therefore, the Organizing Committee is pleased to announce an exciting innovative congress, with scientific presentations covering a wide range of topics.