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da Silva NCH, Sonon P, Medeiros FS, da Silva MC, Dos Santos Gomes FO, Peixoto CA, Crispim JCO, Paiva LA, Rygaard MCV, Menezes MLB, Welkovic S, Donadi EA, Lucena-Silva N. Contribution of HLA-G and FOXP3 genes and proteins in the severity of cervical intraepithelial neoplasia during HPV infection. Hum Immunol 2023:S0198-8859(23)00069-1. [PMID: 37149423 DOI: 10.1016/j.humimm.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 04/23/2023] [Accepted: 04/24/2023] [Indexed: 05/08/2023]
Abstract
Human Papillomavirus (HPV) persistence leads to the chronification of cervical inflammation, where HLA-G and Foxp3; immunomodulatory molecules, may contribute to the aggravation of the lesion and cancerization. Here, we evaluated the synergic effect of these two molecules in the worsening of the lesion in presence of HPV infection. Hundred and eighty (180) women cervical cells and biopsies were collected for (i) HLAG Sanger sequencing and gene expression, and (ii) HLA-G and Foxp3 molecule expressions by immunohistochemistry. 53 women were HPV+ against 127 women HPV-. HPV+ women were more at risk of having cytological changes (p ≤ 0.0123), histological changes (p < 0.0011), and cervical lesion (p = 0.0004). The HLA-G + 3142CC genotype predisposed women to infection (p = 0.0190), while HLA-G + 3142C and +3035 T alleles were associated with HLA-G5 transcript expression. Both sHLA-G (p = 0.030) and Foxp3 (p = 0.0002) proteins were higher in cervical lesion as well as in high-grade lesion. In addition, sHLA-G+ cells were positively correlated to Foxp3+ cells in presence of HPV infection and in cervical grade II/III injuries. In conclusion, HPV may use HLA-G and Foxp3 as a way of host immune escape contributing to the persistence of infection and inflammation, leading to the cervical lesion and the worsening of lesions.
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Affiliation(s)
- Neila Caroline Henrique da Silva
- Laboratório de Imunogenética, Departamento de Imunologia do Instituto Aggeu Magalhães-Fiocruz, Av. Moraes rego, s/n, Campus da UFPE, Cidade Universitária, 50740-465 Recife, PE, Brazil
| | - Paulin Sonon
- Laboratório de Imunogenética, Departamento de Imunologia do Instituto Aggeu Magalhães-Fiocruz, Av. Moraes rego, s/n, Campus da UFPE, Cidade Universitária, 50740-465 Recife, PE, Brazil
| | - Fernanda Silva Medeiros
- Laboratório de Imunogenética, Departamento de Imunologia do Instituto Aggeu Magalhães-Fiocruz, Av. Moraes rego, s/n, Campus da UFPE, Cidade Universitária, 50740-465 Recife, PE, Brazil; Instituto de Medicina Integral Professor Fernando Figueira, 50070-550 Recife, PE, Brazil.
| | - Mauro César da Silva
- Laboratório de Imunogenética, Departamento de Imunologia do Instituto Aggeu Magalhães-Fiocruz, Av. Moraes rego, s/n, Campus da UFPE, Cidade Universitária, 50740-465 Recife, PE, Brazil
| | - Fabiana Oliveira Dos Santos Gomes
- Laboratório de Ultraestrutura, Departamento de Entomologia do Instituto Aggeu Magalhães-Fiocruz, Av. Moraes rego, s/n, Campus da UFPE, Cidade Universitária, 50740-465 Recife, PE, Brazil.
| | - Christina Alves Peixoto
- Laboratório de Ultraestrutura, Departamento de Entomologia do Instituto Aggeu Magalhães-Fiocruz, Av. Moraes rego, s/n, Campus da UFPE, Cidade Universitária, 50740-465 Recife, PE, Brazil.
| | - Janaína C O Crispim
- Mestrado Acadêmico em Ciências Aplicada à Saúde da Mulher-UFRN, 59075-000 Natal, RN, Brazil
| | | | - Maria Carolina Valença Rygaard
- Instituto de Medicina Integral Professor Fernando Figueira, 50070-550 Recife, PE, Brazil; Centro Integrado de Saúde Amaury de Medeiros, CISAM-UPE, 52030-010 Recife, PE, Brazil.
| | | | - Stefan Welkovic
- Centro Integrado de Saúde Amaury de Medeiros, CISAM-UPE, 52030-010 Recife, PE, Brazil
| | - Eduardo Antônio Donadi
- Departamento de Imunologia, Universidade de Medicina de Ribeirão Preto, Av. Bandeirantes, 3900, HC, Vila Monte Alegre, 14049-900 Ribeirão Preto, SP, Brazil.
| | - Norma Lucena-Silva
- Laboratório de Imunogenética, Departamento de Imunologia do Instituto Aggeu Magalhães-Fiocruz, Av. Moraes rego, s/n, Campus da UFPE, Cidade Universitária, 50740-465 Recife, PE, Brazil; Instituto de Medicina Integral Professor Fernando Figueira, 50070-550 Recife, PE, Brazil.
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Medeiros FS, da Silva MC, da Silva NCH, Gomes TT, Gomes RG, Paiva LA, dos Santos Gomes FO, Peixoto CA, Rygaard MCV, Welkovic S, Menezes MLB, Donadi EA, Lucena-Silva N. The antigen processing-associated transporter gene polymorphism: Role on gene and protein expression in HPV-infected pre-cancerous cervical lesion. Front Cell Infect Microbiol 2022; 12:979800. [PMID: 36619767 PMCID: PMC9811671 DOI: 10.3389/fcimb.2022.979800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022] Open
Abstract
Human papillomavirus (HPV) is the major pathogen for cervical lesions. The evasion mechanism of the immune response and persistence of HPV infection can be influenced by polymorphisms (SNPs) in genes associated with transporter associated with antigen processing (TAP), which may change the peptide binding affinity or the TAP expression impacting the efficiency of peptide transport in the secretory pathway, and the presentation of peptides to cytotoxic T lymphocytes. This study aimed to evaluate the role of the TAP1 and TAP2 polymorphisms, TAP1, and TAP2 genes expressions, and protein levels in cervical cells presenting different degrees of pre-cancerous lesions in 296 immunocompetent women infected or not by HPV. TAP SNPs were genotyped by Sanger sequencing, and gene expression by real-time PCR. Aneuploidy was determined by DNA index using flow cytometry. TAP-1 and TAP-2 tissue expressions were evaluated by immunohistochemistry. The Asp697Gly SNP of TAP1 presented a risk for cellular aneuploidy (P=0.0244). HPV+ women had higher TAP-2 mRNA (P=0.0212) and protein (P<0.0001) levels. The TAP2D and TAP2E haplotypes were associated with the risk for aneuploidy and pre-cancerous lesions. In conclusion, nucleotide variability at the peptide binding region of peptide transporter genes, particularly of the TAP2 gene, may influence the HPV-peptide transportation from the cytosol to the endoplasmic reticulum, increasing the susceptibility to the development of high-grade cervical lesions.
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Affiliation(s)
- Fernanda Silva Medeiros
- Laboratory of Immunogenetics, Department of Immunology, Aggeu Magalhães Institute, Oswaldo Cruz Foundation, Recife, Brazil
| | - Mauro César da Silva
- Laboratory of Immunogenetics, Department of Immunology, Aggeu Magalhães Institute, Oswaldo Cruz Foundation, Recife, Brazil
| | | | - Thailany Thays Gomes
- Laboratory of Immunogenetics, Department of Immunology, Aggeu Magalhães Institute, Oswaldo Cruz Foundation, Recife, Brazil
| | - Renan Garcia Gomes
- Laboratory of Molecular Biology, Institute of Integral Medicine Professor Fernando Figueira (IMIP) Hospital, Pediatric Oncology Service, Recife, Brazil
| | | | | | - Christina Alves Peixoto
- Laboratory of Ultrastructure, Department of Entomology, Aggeu Magalhães Institute, Oswaldo Cruz Foundation, Recife, Brazil
| | - Maria Carolina Valença Rygaard
- Laboratory of Molecular Biology, Institute of Integral Medicine Professor Fernando Figueira (IMIP) Hospital, Pediatric Oncology Service, Recife, Brazil
| | - Stefan Welkovic
- Integrated Health Center Amaury de Medeiros (CISAM), University of Pernambuco, Recife, Brazil
| | | | - Eduardo Antônio Donadi
- Clinical Immunology Division, Department of Medicine, School of Medicine of Ribeirão Preto, University of São Paulo (USP), Ribeirão Preto, Brazil
| | - Norma Lucena-Silva
- Laboratory of Immunogenetics, Department of Immunology, Aggeu Magalhães Institute, Oswaldo Cruz Foundation, Recife, Brazil,Laboratory of Molecular Biology, Institute of Integral Medicine Professor Fernando Figueira (IMIP) Hospital, Pediatric Oncology Service, Recife, Brazil,*Correspondence: Norma Lucena-Silva, ;
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Medeiros FS, Dos Santos Gomes FO, Paiva LA, da Silva NCH, da Silva MC, Rygaard MCV, Peixoto CA, Welkovic S, Menezes MLB, Cokan A, Diniz GTN, Donadi EA, Lucena-Silva N. Hierarchical evaluation of histology and p16-labeling can improve the risk assessment on cervical intraepithelial neoplasia progression. Exp Mol Pathol 2021; 124:104734. [PMID: 34914974 DOI: 10.1016/j.yexmp.2021.104734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 12/02/2021] [Accepted: 12/08/2021] [Indexed: 01/10/2023]
Abstract
OBJECTIVE High-grade cervical lesions (HSIL) are associated with the presence of high-risk HPV types, tissue expression of p16, and increased chance of malignant progression, requiring surgical intervention. To improve risk evaluation, we assessed the discriminatory power of the histological findings associated with p16 immunohistochemistry (IHC) staining to classify the low-grade cervical lesion (LSIL) and HSIL. METHODS We collected cervical biopsies from colposcopy-visible lesions and non-affected tissue (adjacent to the lesions) of 62 Brazilian women and labeled them with anti-p16 antibodies. In addition to the observational pattern and labeling to define the latent classes (affected vs. non-affected), a computational tool was used for semi-quantitative analysis of p16 expression. The intensity of staining of the nucleus or cytoplasm was captured using the Gimp 2.10 software. ROC curves were used to determine cutoff values for p16 expression in patients classified as LSIL and HSIL by latent class statistics for each labeling stratum. RESULTS p16 nuclear labeling showed the best sensitivity and specificity to discriminate LSIL with low p16 expression (62%) and HSIL with high p16 expression (37%). Many patients whose lesions had intermediate levels of p16 nuclear staining were subsequently stratified according to the expression of p16 in the cytoplasm, indicating that five of 21 LSIL were at risk of progression, and 13 of 41 HSIL at risk of regression. CONCLUSIONS We suggest a hierarchical analysis, with histology at the first level, followed by a labeling analysis in the nucleus and then in the cytoplasm to increase the accuracy of the HPV cervical lesion stratification.
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Affiliation(s)
- Fernanda Silva Medeiros
- Laboratory of Immunogenetics, Aggeu Magalhães Institute, Oswaldo Cruz Foundation, Recife, Brazil.
| | | | | | | | - Mauro César da Silva
- Laboratory of Immunogenetics, Aggeu Magalhães Institute, Oswaldo Cruz Foundation, Recife, Brazil
| | | | - Christina Alves Peixoto
- Laboratory of Ultrastructure, Aggeu Magalhães Institute, Oswaldo Cruz Foundation, Recife, Brazil.
| | - Stefan Welkovic
- Integrated Health Centre Amaury de Medeiros (CISAM), University of Pernambuco, Recife, Brazil
| | | | - Andrej Cokan
- Clinic for Gynecology and Perinatology, Department for Gynecologic and Breast Oncology, University Medical Centre Maribor, Slovenia.
| | - George Tadeu Nunes Diniz
- Laboratory Computational Methods, Aggeu Magalhães Institute, Oswaldo Cruz Foundation, Recife, Brazil.
| | - Eduardo Antônio Donadi
- Division of Clinical Immunology, Department of Medicine, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil.
| | - Norma Lucena-Silva
- Laboratory of Immunogenetics, Aggeu Magalhães Institute, Oswaldo Cruz Foundation, Recife, Brazil.
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Menezes MLB, Giraldo PC, Linhares IM, Boldrini NAT, Aragon MG. Comments on Ricardo F Savaris' Letter to the Editor regarding the publication in the JBSTM-Brazilian Protocol for Sexually Transmitted Infections, 2020: "Pelvic Inflammatory Disease". Rev Soc Bras Med Trop 2021; 54:e0457. [PMID: 34787269 PMCID: PMC8582959 DOI: 10.1590/0037-8682-0457-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 08/25/2021] [Indexed: 11/22/2022] Open
Affiliation(s)
| | - Paulo Cesar Giraldo
- Universidade Estadual de Campinas, Departamento de Tocoginecologia, Campinas, SP, Brasil
| | - Iara Moreno Linhares
- Universidade de São Paulo, Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, São Paulo, SP, Brasil
| | | | - Mayra Gonçalves Aragon
- Ministério da Saúde, Secretaria de Vigilância em Saúde, Brasília, DF, Brasil.,Universidade Federal do Espírito Santo, Programa de Pós-Graduação em Doenças Infecciosas, Vitória, ES, Brasil
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da Silva MC, Medeiros FS, da Silva NCH, Paiva LA, Gomes FODS, Costa E Silva M, Gomes TT, Peixoto CA, Rygaard MCV, Menezes MLB, Welkovic S, Donadi EA, Lucena-Silva N. Increased PD-1 Level in Severe Cervical Injury Is Associated With the Rare Programmed Cell Death 1 ( PDCD1) rs36084323 A Allele in a Dominant Model. Front Cell Infect Microbiol 2021; 11:587932. [PMID: 34290992 PMCID: PMC8288189 DOI: 10.3389/fcimb.2021.587932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 04/21/2021] [Indexed: 11/16/2022] Open
Abstract
The high-risk oncogenic human papillomavirus (HPV) has developed mechanisms for evasion of the immune system, favoring the persistence of the infection. The chronic inflammation further contributes to the progression of tissue injury to cervical cancer. The programmed cell death protein (PD-1) after contacting with its ligands (PD-L1 and PD-L2) exerts an inhibitory effect on the cellular immune response, maintaining the balance between activation, tolerance, and immune cell-dependent lesion. We evaluated 295 patients exhibiting or not HPV infection, stratified according to the location (injured and adjacent non-injured areas) and severity of the lesion (benign, pre-malignant lesions). Additionally, we investigated the role of the promoter region PDCD1 -606G>A polymorphism (rs36084323) on the studied variables. PD-1 and PDCD1 expression were evaluated by immunohistochemistry and qPCR, respectively, and the PDCD1 polymorphism was evaluated by nucleotide sequencing. Irrespective of the severity of the lesion, PD-1 levels were increased compared to adjacent uninjured areas. Additionally, in cervical intraepithelial neoplasia (CIN) I, the presence of HPV was associated with increased (P = 0.0649), whereas in CIN III was associated with decreased (P = 0.0148) PD-1 levels, compared to the uninjured area in absence of HPV infection. The PDCD1 -606A allele was rare in our population (8.7%) and was not associated with the risk for development of HPV infection, cytological and histological features, and aneuploidy. In contrast, irrespective of the severity of the lesion, patients exhibiting the mutant PDCD1 -606A allele at single or double doses exhibited increased protein and gene expression when compared to the PDCD1 -606GG wild type genotype. Besides, the presence of HPV was associated with the decrease in PDCD1 expression and PD-1 levels in carriers of the -606 A allele presenting severe lesions, suggesting that other mediators induced during the HPV infection progression may play an additional role. This study showed that increased PD-1 levels are influenced by the -606G>A nucleotide variation, particularly in low-grade lesions, in which the A allele favors increased PDCD1 expression, contributing to HPV immune system evasion, and in the high-grade lesion, by decreasing tissue PD-1 levels.
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Affiliation(s)
- Mauro César da Silva
- Laboratory of Immunogenetics, Department of Immunology, Aggeu Magalhães Institute, Oswaldo Cruz Foundation, Recife, Brazil
| | - Fernanda Silva Medeiros
- Laboratory of Immunogenetics, Department of Immunology, Aggeu Magalhães Institute, Oswaldo Cruz Foundation, Recife, Brazil
| | | | | | | | - Matheus Costa E Silva
- Clinical Immunology Division, Department of Medicine, School of Medicine of Ribeirão Preto, University of São Paulo (USP), Ribeirão Preto, Brazil
| | - Thailany Thays Gomes
- Laboratory of Immunogenetics, Department of Immunology, Aggeu Magalhães Institute, Oswaldo Cruz Foundation, Recife, Brazil
| | - Christina Alves Peixoto
- Laboratory of Immunogenetics, Department of Immunology, Aggeu Magalhães Institute, Oswaldo Cruz Foundation, Recife, Brazil
| | | | | | - Stefan Welkovic
- Integrated Health Center Amaury de Medeiros (CISAM), University of Pernambuco, Recife, Brazil
| | - Eduardo Antônio Donadi
- Clinical Immunology Division, Department of Medicine, School of Medicine of Ribeirão Preto, University of São Paulo (USP), Ribeirão Preto, Brazil
| | - Norma Lucena-Silva
- Laboratory of Immunogenetics, Department of Immunology, Aggeu Magalhães Institute, Oswaldo Cruz Foundation, Recife, Brazil.,Laboratory of Molecular Biology, IMIP Hospital, Pediatric Oncology Service, Recife, Brazil
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Menezes MLB, Giraldo PC, Linhares IM, Boldrini NAT, Aragon MG. Brazilian Protocol for Sexually Transmitted infections, 2020: pelvic inflammatory disease. Rev Soc Bras Med Trop 2021; 54:e2020602. [PMID: 34008722 PMCID: PMC8210479 DOI: 10.1590/0037-8682-602-2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 03/10/2021] [Indexed: 11/25/2022] Open
Abstract
Pelvic Inflammatory Disease is a topic included in the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections, published by the Brazilian Ministry of Health in 2020. Pelvic inflammatory disease is an upper female genital tract acute infection due to canalicular spread of endogenous cervicovaginal microorganisms and especially the sexually transmitted microorganisms. Standing out among the etiological agents involved are Chlamydia trachomatis and Neisseria gonorrhoeae. The main sequelae are chronic pelvic pain, infertility, and ectopic pregnancy. Clinical diagnosis is the most important practical approach. Antibiotic treatment must start immediately after the clinical suspicion. Guidelines for health service managers and health professionals on diagnostic tests, treatment, follow-up, counseling, notification, handling sexual partners and special populations are described. Given the increased availability of the molecular biology techniques in Brazil, C. trachomatis and N. gonorrhoeae screening are recommended as a disease prevention strategy. Pelvic inflammatory disease is one of the most significant sexually transmitted infections, and in most cases, it is a main consequence of cervicitis.
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Affiliation(s)
| | - Paulo Cesar Giraldo
- Universidade Estadual de Campinas, Departamento de Tocoginecologia, Campinas, SP, Brasil
| | - Iara Moreno Linhares
- Universidade de São Paulo, Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, São Paulo, SP, Brasil
| | | | - Mayra Gonçalves Aragon
- Ministério da Saúde, Secretaria de Vigilância em Saúde, Brasilia, DF, Brasil.,Universidade Federal do Espírito Santo, Programa de Pós-Graduação em Doenças Infecciosas, Vitória, ES, Brasil
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Domingues CSB, Duarte G, Passos MRL, Sztajnbok DCDN, Menezes MLB. Brazilian Protocol for Sexually Transmitted Infections, 2020: congenital syphilis and child exposed to syphilis. Rev Soc Bras Med Trop 2021; 54:e2020597. [PMID: 34008719 PMCID: PMC8210493 DOI: 10.1590/0037-8682-597-2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 03/10/2021] [Indexed: 11/22/2022] Open
Abstract
The topics of congenital syphilis and children exposed to syphilis compose the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections, published by the Brazilian Ministry of Health in 2020. Such document was elaborated based on scientific evidence and validated in discussions with specialists. This article provides guidelines for syphilis in pregnant women and congenital syphilis clinical management, emphasizing the vertical transmission of Treponema pallidum prevention. Epidemiological and clinical aspects of these infections are presented and recommendations for managers in the programmatic and operational management of syphilis. The article also includes guidelines for health professionals in screening, diagnosing, and treating people with sexually transmitted infections and their sex partners, in addition to strategies for surveillance actions, prevention, and control of the disease. Most congenital syphilis cases arise from test failures in prenatal care or inadequate or no treatment of maternal syphilis.
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Affiliation(s)
- Carmen Silvia Bruniera Domingues
- Secretaria de Estado da Saúde de São Paulo, Centro de Referência e Treinamento de Doenças Sexualmente Transmissíveis e Aids, São Paulo, SP, Brazil
| | - Geraldo Duarte
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, SP, Brazil
| | - Mauro Romero Leal Passos
- Universidade Federal Fluminense, Departamento de Microbiologia e Parasitologia, Niterói, RJ, Brazil
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Menezes MLB, Araújo MAL, Santos ASDD, Gir E, Bermúdez XPD. Brazilian Protocol for Sexually Transmitted Infections 2020: sexual violence. Rev Soc Bras Med Trop 2021; 54:e2020600. [PMID: 34008721 PMCID: PMC8210477 DOI: 10.1590/0037-8682-600-2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 03/10/2021] [Indexed: 11/21/2022] Open
Abstract
This article addresses sexual violence, as part of the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections, published by the Brazilian Ministry of Health. Guidance is provided in programmatic and operational management, focusing on the service network for people in situation of sexual violence, recommendations to health staff about pregnancy and viral and non-viral sexually transmitted infections prophylactic measures, in addition to surveillance action strategies. Sexual violence is an encompassing issue that includes wider areas than the health field. It involves conceptual and programmatic challenges for health staff, at the forefront of care for affected people and also to the implementation of prevention strategies addressed to the whole society. Sexual violence is one of the principal forms of human rights violation, affecting the right to life, health, and bodily integrity.
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Affiliation(s)
| | - Maria Alix Leite Araújo
- Universidade de Fortaleza - UNIFOR, Programa de Pós-Graduação em Saúde Coletiva, Fortaleza, CE, Brasil
| | | | - Elucir Gir
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Ribeirão Preto, SP, Brasil
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Domingues CSB, Duarte G, Passos MRL, Sztajnbok DCDN, Menezes MLB. [Brazilian Protocol for Sexually Transmitted Infections 2020: congenital syphilis and child exposed to syphilis]. ACTA ACUST UNITED AC 2021; 30:e2020597. [PMID: 33729402 DOI: 10.1590/s1679-4974202100005.esp1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 10/03/2020] [Indexed: 11/22/2022]
Abstract
The topics of congenital syphilis and children exposed to syphilis are part of the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections, published by the Brazilian Ministry of Health in 2020. The Protocol and Guidelines have been developed based on scientific evidence and validated in discussions with specialists. This article provides guidelines for clinical management of both syphilis in pregnant women and also congenital syphilis, emphasizing prevention of vertical transmission of Treponema pallidum. Epidemiological and clinical aspects of these infections are presented, as well as recommendations for health service managers regarding the programmatic and operational management of syphilis. The article also includes guidelines for health professionals on screening, diagnosing and treating people with sexually transmitted infections and their sex partners, in addition to strategies for syphilis surveillance, prevention and control actions.
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Affiliation(s)
- Carmen Silvia Bruniera Domingues
- Secretaria de Estado da Saúde de São Paulo, Centro de Referência e Treinamento de Doenças Sexualmente Transmissíveis e Aids, São Paulo, SP, Brasil
| | - Geraldo Duarte
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, SP, Brasil
| | - Mauro Romero Leal Passos
- Universidade Federal Fluminense, Departamento de Microbiologia e Parasitologia, Niterói, RJ, Brasil
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Menezes MLB, Araújo MAL, Santos ASDD, Gir E, Bermúdez XPD. [Brazilian Protocol for Sexually Transmitted Infections 2020: sexual violence]. ACTA ACUST UNITED AC 2021; 30:e2020600. [PMID: 33729404 DOI: 10.1590/s1679-4974202100018.esp1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 10/19/2020] [Indexed: 11/22/2022]
Abstract
This article addresses sexual violence, a topic that makes up the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections, published by the Ministry of Health of Brazil. Guidance is given to managers in programmatic and operational management with a focus on the service network for people in situations of sexual violence, recommendations to health professionals about prophylactic measures of pregnancy and viral and non-viral sexually transmitted infections, in addition to strategies for surveillance actions. Sexual violence is a broad problem that goes beyond the health field and involves conceptual and programmatic challenges for both health professionals, who are at the forefront of care for affected people, and for society, in terms of possible forms of prevention.
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Affiliation(s)
| | | | | | - Elucir Gir
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Ribeirão Preto, SP, Brasil
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Menezes MLB, Giraldo PC, Linhares IM, Boldrini NAT, Aragón MG. [Brazilian Protocol for Sexually Transmitted Infections 2020: pelvic inflammatory disease]. ACTA ACUST UNITED AC 2021; 30:e2020602. [PMID: 33729405 DOI: 10.1590/s1679-4974202100011.esp1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 09/16/2020] [Indexed: 11/22/2022]
Abstract
Pelvic Inflammatory Disease is a topic included in the Clinical Protocol and Therapeutic Guidelines for Comprehensive Care for People with Sexually Transmitted Infections, published by the Brazilian Ministry of Health in 2020. Pelvic inflammatory disease is an acute infection of the upper female genital tract due to canalicular spread of endogenous cervicovaginal microorganisms, in particular sexually transmitted organisms. Standing out among the etiological agents involved are Chlamydia trachomatis and Neisseria gonorrhoeae. The most important sequels are chronic pelvic pain, infertility and ectopic pregnancy. Clinical diagnosis is the most important practical approach. Antibiotic treatment should start immediately upon clinical suspicion. The article contains guidance for health service managers and health professionals on diagnostic tests, treatment, follow-up, counseling, notification, handling of sexual partnerships and special populations. In view of increased availability of the molecular biology technique in Brazil, C. trachomatis and N. gonorrhoeae screening is recommended as a disease prevention strategy.
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Affiliation(s)
| | - Paulo Cesar Giraldo
- Universidade Estadual de Campinas, Departamento de Tocoginecologia, Campinas, SP, Brasil
| | - Iara Moreno Linhares
- Universidade de São Paulo, Departamento de Obstetrícia e Ginecologia, São Paulo, SP, Brasil
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Medeiros FS, Martins AES, Gomes RG, de Oliveira SAV, Welkovic S, Maruza M, Menezes MLB, Ximenes RADA, Diniz GTN, Donadi EA, Lucena-Silva N. Variation sites at the HLA-G 3' untranslated region confer differential susceptibility to HIV/HPV co-infection and aneuploidy in cervical cell. PLoS One 2018; 13:e0204679. [PMID: 30278059 PMCID: PMC6168131 DOI: 10.1371/journal.pone.0204679] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 09/12/2018] [Indexed: 01/17/2023] Open
Abstract
Post-transcriptional regulatory elements associated with transcript degradation or transcript instability have been described at the 3' untranslated region (3'UTR) of the HLA-G gene. Considering that HPV infection and aneuploidy, which causes gene instability, are associated with cervical cell malignancy, as well as the fact that HIV infection and HLA-G may modulate the immune response, the present study aimed to compare the frequencies of HLA-G 3'UTR polymorphic sites (14-base pair insertion/deletion, +3142C/G, and +3187A/G) between 226 HIV+ women co-infected (n = 82) or not with HPV (n = 144) and 138 healthy women. We also evaluated the relationship between those HLA-G 3'UTR variants and aneuploidy in cervical cells. HPV types and HLA-G polymorphisms were determined by PCR and sequencing of cervical samples DNA. Aneuploidy in cervical cell was measured by flow cytometry. The HLA-G 3'UTR 14-bp ins/del was not associated with either HIV nor HIV/HPV co-infection. The +3142G allele (p = 0.049) and +3142GG genotype (p = 0.047) were overrepresented in all HIV-infected women. On the other hand, the +3187G allele (p = 0.028) and the +3187GG genotype (p = 0.026) predominated among healthy women. The +3142G (p = 0.023) and +3187A (p = 0.003) alleles were associated with predisposition to HIV infection, irrespective of the presence or not of HIV/HPV co-infection. The diplotype formed by the combination of the +3142CX (CC or CG) and +3187AA genotype conferred the highest risk for aneuploidy in cervical cell induced by HPV. The HLA-G 3'UTR +3142 and +3187 variants conferred distinct susceptibility to HIV infection and aneuploidy.
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Affiliation(s)
- Fernanda Silva Medeiros
- Department of Immunology, Laboratory of Immunogenetics, Aggeu Magalhães Institute, Oswaldo Cruz Foundation, Recife, Brazil
| | - Albert Eduardo Silva Martins
- Department of Immunology, Laboratory of Immunogenetics, Aggeu Magalhães Institute, Oswaldo Cruz Foundation, Recife, Brazil
| | - Renan Garcia Gomes
- Department of Immunology, Laboratory of Immunogenetics, Aggeu Magalhães Institute, Oswaldo Cruz Foundation, Recife, Brazil
| | | | - Stefan Welkovic
- Integrated Health Centre Amaury de Medeiros (CISAM), University of Pernambuco, Recife, Brazil
| | - Magda Maruza
- Hospital Correia Picanço, Health Secretariat of Pernambuco, Recife, Brazil
| | - Maria Luiza Bezerra Menezes
- Maternal and Child Department of the Faculty of Medical Sciences—University of Pernambuco (UPE), Recife, Brazil
| | | | - George Tadeu Nunes Diniz
- Department of Public Health, Laboratory Computational Methods, Aggeu Magalhães Institute, Recife, Brazil
| | - Eduardo Antônio Donadi
- Department of Medicine, School of Medicine of Ribeirão Preto, University of São Paulo (USP), Ribeirão Preto, Brazil
| | - Norma Lucena-Silva
- Department of Immunology, Laboratory of Immunogenetics, Aggeu Magalhães Institute, Oswaldo Cruz Foundation, Recife, Brazil
- Pediatric Oncology Service, IMIP Hospital, Recife, Brazil
- * E-mail:
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Martins AES, Lucena-Silva N, Garcia RG, Welkovic S, Barboza A, Menezes MLB, Maruza M, Tenório T, Ximenes RAA. Prevalence of human papillomavirus infection, distribution of viral types and risk factors in cervical samples from human immunodeficiency virus-positive women attending three human immunodeficiency virus-acquired immune deficiency syndrome reference centres in northeastern Brazil. Mem Inst Oswaldo Cruz 2014; 109:738-47. [PMID: 25317701 PMCID: PMC4238765 DOI: 10.1590/0074-0276140070] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 06/20/2014] [Indexed: 01/27/2023] Open
Abstract
Human immunodeficiency virus (HIV)-positive patients have a greater prevalence of coinfection with human papillomavirus (HPV) is of high oncogenic risk. Indeed, the presence of the virus favours intraepithelial squamous cell lesion progression and may induce cancer. The aim of this study was to evaluate the prevalence of HPV infection, distribution of HPV types and risk factors among HIV-positive patients. Cervical samples from 450 HIV-positive patients were analysed with regard to oncotic cytology, colposcopy and HPV presence and type by means of polymerase chain reaction and sequencing. The results were analysed by comparing demographic data and data relating to HPV and HIV infection. The prevalence of HPV was 47.5%. Among the HPV-positive samples, 59% included viral types of high oncogenic risk. Multivariate analysis showed an association between HPV infection and the presence of cytological alterations (p = 0.003), age greater than or equal to 35 years (p = 0.002), number of partners greater than three (p = 0.002), CD4⁺ lymphocyte count < 200/mm³ (p = 0.041) and alcohol abuse (p = 0.004). Although high-risk HPV was present in the majority of the lesions studied, the low frequency of HPV 16 (3.3%), low occurrence of cervical lesions and preserved immunological state in most of the HIV-positive patients were factors that may explain the low occurrence of precancerous cervical lesions in this population.
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Affiliation(s)
- Albert Eduardo Silva Martins
- Laboratório de Imunogenética, Centro de Pesquisas Aggeu
Magalhães-Fiocruz, Recife PE, Brasil
- Laboratório de Biologia Molecular, Departamento de Oncologia
Pediátrica, Hospital de Ensino, Instituto de Medicina Integral Professor Fernando
Figueira, Recife, PE, Brasil
| | - Norma Lucena-Silva
- Laboratório de Imunogenética, Centro de Pesquisas Aggeu
Magalhães-Fiocruz, Recife PE, Brasil
- Laboratório de Biologia Molecular, Departamento de Oncologia
Pediátrica, Hospital de Ensino, Instituto de Medicina Integral Professor Fernando
Figueira, Recife, PE, Brasil
| | - Renan Gomes Garcia
- Laboratório de Imunogenética, Centro de Pesquisas Aggeu
Magalhães-Fiocruz, Recife PE, Brasil
| | - Stefan Welkovic
- Centro Integrado de Saúde Amaury de MedeirosFaculdade de Ciências
Médicas, Universidade de Pernambuco Recife, PE, Brasil
| | - Aureliana Barboza
- Departamento Materno-Infantil, Faculdade de Ciências Médicas,
Universidade de Pernambuco, Recife, PE, Brasil
| | - Maria Luiza Bezerra Menezes
- Departamento Materno-Infantil, Faculdade de Ciências Médicas,
Universidade de Pernambuco, Recife, PE, Brasil
| | - Magda Maruza
- Hospital Correia Picanço, Secretaria de Saúde de Pernambuco, Recife,
PE, Brasil
| | - Terezinha Tenório
- Departamento Materno-Infantil, Universidade Federal de Pernambuco,
Recife, PE, Brasil
| | - Ricardo AA Ximenes
- Departamento de Medicina Tropical, Universidade Federal de Pernambuco,
Recife, PE, Brasil
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Martins AES, Lucena-Silva N, Garcia RG, Welkovic S, Barbosa A, Menezes MLB, Tenório T, Maruza M, Ximenes RAA. Prognostic evaluation of DNA index in HIV-HPV co-infected women cervical samples attending in reference centers for HIV-AIDS in Recife. PLoS One 2014; 9:e104801. [PMID: 25144309 PMCID: PMC4140713 DOI: 10.1371/journal.pone.0104801] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 07/14/2014] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Persistence of cervical infection caused by human papillomavirus (HPV) types with high oncogenic risk may lead to cervical intraepithelial neoplasia (CIN). The aim of the present study was to evaluate whether, in HIV-positive women, the presence of aneuploidy in cervical cell samples is associated with presence and evolution of CIN. METHODS The present study had two stages. In the first stage, comprising a cross-sectional study, the association between the presence of aneuploidy seen via flow cytometry and sociodemographic characteristics, habits and characteristics relating to HPV and HIV infection was analyzed. In the second stage, comprising a cohort study, it was investigated whether aneuploidy was predictive of CIN evolution. RESULTS No association was observed between the presence of aneuploidy and HPV infection, or between its presence and alterations seen in oncotic cytological analysis. On the other hand, aneuploidy was associated with the presence of CIN (p = 0.030) in histological analysis and with nonuse of antiretroviral therapy (p = 0.001). Most of the HIV-positive women (234/272) presented normal CD4+ T lymphocyte counts (greater than 350 cells/mm3) and showed a greater aneuploidy regression rate (77.5%) than a progression rate (23.9%) over a follow-up of up to two years. CONCLUSION Although there was an association between the presence of cervical tissue lesions and the DNA index, the latter was not predictive of progression of the cervical lesion. This suggests that progression of the cervical lesion to cancer in HIV-positive women may also be changed through improvement of the immunological state enabled by using antiretroviral therapy.
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Affiliation(s)
- Albert Eduardo Silva Martins
- Laboratório de imunogenética, Centro de pesquisas Aggeu Magalhães, Fundação Oswaldo Cruz, Recife, Brasil
- Laboratório de biologia molecular, Departamento de oncologia pediátrica, Hospital IMIP, Recife, Brasil
- * E-mail:
| | - Norma Lucena-Silva
- Laboratório de imunogenética, Centro de pesquisas Aggeu Magalhães, Fundação Oswaldo Cruz, Recife, Brasil
- Laboratório de biologia molecular, Departamento de oncologia pediátrica, Hospital IMIP, Recife, Brasil
| | - Renan Gomes Garcia
- Laboratório de imunogenética, Centro de pesquisas Aggeu Magalhães, Fundação Oswaldo Cruz, Recife, Brasil
| | - Stefan Welkovic
- Departamento Materno-Infantil e Centro Integrado de Saúde Amaury de Medeiro (CISAM-UPE), Universidade de Pernambuco, Recife, Brasil
| | - Aureliana Barbosa
- Departamento Materno-Infantil e Centro Integrado de Saúde Amaury de Medeiro (CISAM-UPE), Universidade de Pernambuco, Recife, Brasil
| | - Maria Luiza Bezerra Menezes
- Departamento Materno-Infantil e Centro Integrado de Saúde Amaury de Medeiro (CISAM-UPE), Universidade de Pernambuco, Recife, Brasil
| | - Terezinha Tenório
- Departamento Materno-Infantil, Universidade Federal de Pernambuco, Recife, Brasil
| | - Magda Maruza
- Hospital Correia Picanço, Secretaria de Saúde de Pernambuco, Recife, Brasil
| | - Ricardo A. A. Ximenes
- Departamento de Medicina Tropical, Universidade Federal de Pernambuco (UFPE), Recife, Brasil
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