EDCTP Alumni Network

Fostering excellence and collaboration in the next generation of researchers

Call Career Development Fellowship (CDF)
Programme EDCTP2
Start Date 2021-12-01
End Date 2024-11-30
Project Code TMA2020CDF-3217
Status Active


Diagnosis of PCP using nasopharyngeal aspirates and venous blood samples in HIV-infected infants with severe pneumonia: an EMPIRICAL ancillary study

Host Organisation

Institution Country

Current Organisation

Eduardo Mondlane University

Current Job Title


Students Supervised

Type Name Title University Start Date End Date


Role Committee/board Start Date End Date


Institution Degree Year
Catholic University of Mozambique, Mozambique Licentiate

Areas Of Specialisation

Human Immuno-deficiency Virus (HIV)



J Infect Dev Ctries

Introduction: The novel coronavirus, severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), etiological agent of coronavirus disease 2019 (COVID-19) was first reported in China in December 2019 and spread worldwide. As of March 6th, 2021, there have been 116,670,105 million confirmed cases globally including 2,592,085 deaths. COVID-19 cases have been reported in 219 countries and territories, creating global panic. Mozambique has witnessed the evolution of COVID-19 epidemic associated with the weakness of health system, mostly in terms of laboratory diagnosis capacity, concerns on compliance to effective public health measures including physical distancing, use of masks in crowded indoor areas, hand hygiene, isolation and quarantine of people. Methodology: The data included in this study were collected from published articles regarding COVID-19 imported cases and severity in Africa, especially in Mozambique. Additionally, official documents of COVID-19 epidemiology from Minister of Health and National Institute of Health of Mozambique from 22nd of March 2020 to 1st of August 2020 were included. Results: The SARS-CoV-2 strains imported mainly from South Africa and European countries might have been playing an important role on COVID-19 epidemic evolution in Mozambique. Conclusions: These circulating strains in the country, might be similar enough to the strains found in other countries, yet the genomic characterization is needed particularly during the phase of borders reopening through understanding the source of infections and guiding the implementation of containment and mitigation measures in the country.

Jacobs, T. G., Mumbiro, V., Chitsamatanga, M., Namuziya, N., Passanduca, A., Domínguez-Rodríguez, S., Tagarro, A., Nathoo, K. J., Nduna, B., Ballesteros, A., Madrid, L., Mujuru, H. A., Chabala, C., Buck, W. C., Rojo, P., Burger, D. M., Moraleda, C., Colbers, A., & EMPIRICAL Clinical Trial Group , Journal of acquired immune deficiency syndromes (1999), 10.1097/QAI.0000000000003168. Advance online publication. https://doi.org/10.1097/QAI.0000000000003168
Journal of acquired immune deficiency syndromes

Background: While super-boosted lopinavir/ritonavir (LPV/r; ratio 4:4 instead of 4:1) is recommended for infants living with HIV and receiving concomitant rifampicin, in clinical practice many different LPV/r dosing strategies are applied due to poor availability of paediatric separate ritonavir formulations needed to super-boost. We evaluated LPV pharmacokinetics in infants with HIV receiving LPV/r dosed according to local guidelines in various sub-Saharan African countries with or without rifampicin-based tuberculosis (TB)-treatment.

Methods: This was a 2-arm pharmacokinetic sub-study nested within the EMPIRICAL trial (#NCT03915366). Infants aged 1-12 months recruited into the main study were administered LPV/r according to local guidelines and drug availability either with or without rifampicin-based TB-treatment; during rifampicin co-treatment they received double-dosed (ratio 8:2) or semi-superboosted LPV/r (adding a ritonavir 100mg crushed tablet to the evening LPV/r dose). Six blood samples were taken over 12 hours after intake of LPV/r.

Results: In total, 14/16 included infants had evaluable pharmacokinetic curves; 9/14 had rifampicin co-treatment (5 received double-dosed and 4 semi-superboosted LPV/r). The median (IQR) age was 6.4 months (5.4-9.8), weight 6.0kg (5.2-6.8) and 10/14 were male. Of those receiving rifampicin, 6/9 (67%) infants had LPV C trough <1.0mg/L compared to 1/5 (20%) in the control arm. LPV apparent oral clearance was 3.3-fold higher for infants receiving rifampicin.

Conclusion: Double-dosed or semi-superboosted LPV/r for infants aged 1-12 months receiving rifampicin resulted in substantial proportions of subtherapeutic LPV levels. There is an urgent need for data on alternative antiretroviral regimens in infants with HIV/TB co-infection, including twice-daily dolutegravir.

SAGE Open Med Case Rep

While there is ample evidence that antiretroviral therapy (ART) can improve cognitive outcomes in older children living with HIV, encephalopathy in infants has historically been considered an advanced disease presentation with less likelihood of neurodevelopmental recovery on treatment. More recent studies suggest that timely ART can halt encephalopathic disease progression and even lead to symptom resolution. Here we present a case of an HIV-positive infant diagnosed with encephalopathy who experienced impressive and rapid improvement with a multi-disciplinary care approach that included physical and occupational therapy and ART.


Alfeu Passanduca
Name Country Institution
Jahit Sacarlal Mozambique Eduardo Mondlane University
Chris Buck United States University of California LA
Franflyn Egbe United Kingdom Lincoln University
Alfeu Passanduca Mozambique Eduardo Mondlane University
The primary objective is 1. To attempt to diagnose PCP infection in HIV-infected infants with severe pneumonia on empirical PCP treatment with nasopharyngeal aspirates using immunofluorescence and real-time PCR, and with venous blood using BG and KL-6 assays; Secondary objectives are: 1. To correlate confirmed PCP infection with clinical and radiological manifestations, specifically with hypoxemia; 3. To evaluate the efficacy of cotrimoxazole preventive therapy by assessing pre-admission adherence in patients with study-confirmed PCP infection. This will include patients who were on cotrimoxazole as HIV-exposed infants who only had HIV infection confirmed at the time of hospitalization and children are already known to be HIV-infected at the time of admission.
Maputo Central Hospital, Beira Central Hospital, Nampula Central Hospital, Xai-Xai Provincial Hospital, José Macamo General Hospital, Mavalane General Hospital, Matola District Hospital and Manhiça District Hospital.
Study Design:
This is a cross-sectional diagnostic study embedded within EMPIRICAL trial, which is a prospective randomized controlled clinical trial.
HIV-infected infants from 1 month to 12 months of age with severe pneumonia
Start Date:
End Date:

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