RESUMEN

Human pegivirus type 1 (HPgV-1) infection has been associated with a beneficial effect on the prognosis of human immunodeficiency virus type 1 (HIV-1)-coinfected individuals. However, the mechanisms involved in this protection are not yet fully elucidated. To date, circulating HPgV-1 genotypes in HIV-1-infected individuals have not yet been identified in the extreme south of Brazil. The present study aimed to determine the genotypic circulation of HPgV-1 and the influence of HPgV-1 status and persistence time on the evolution of HIV-1 infection. A retrospective cohort of 110 coinfected individuals was analyzed. Samples were subjected to viral RNA extraction, cDNA synthesis, nested PCR, and genotyping. Genotypes 1 (2.8%), 2 (47.9% of subtype 2a and 42.3% of subtype 2b), and 3 (7%) were identified. In antiretroviral treatment-naïve subjects HPgV-1 subtype 2b was associated with lower HIV-1 viral load (VL) rates (p = 0.04) and higher CD4+ T-cell counts (p = 0.03) than was subtype 2a, and the positivity for HPgV-1 was associated with higher CD4+ T-cell counts (p = 0.02). However, there was no significant difference in HIV-1 VL between HPgV-1-positive and HPgV-1-negative subjects (p = 0.08). There was no significant association between the different groups in HPgV-1 persistence and median HIV-1 VL (p = 0.66) or CD4+ T-cell counts (p = 0.15). HPgV-1 subtype 2b is associated with better prognosis of HIV-1 infection. Although HPgV-1 infection is persistent, our data suggest that the time of infection does not influence HIV-1 VL or CD4+ T-cell counts in coinfected subjects.

Asunto(s)

Coinfección/virología , Virus GB-C/genética , Infecciones por VIH/virología , VIH-1/genética , Adulto , Brasil , Recuento de Linfocito CD4/métodos , Femenino , Genotipo , Humanos , Masculino , Proyectos Piloto , ARN Viral/genética , Estudios Retrospectivos , Carga Viral/genética

RESUMEN

OBJECTIVES: The aims of this study were (i) to determine the frequency of plasmid-mediated resistance to fluoroquinolones (FQs) in Escherichia coli isolated from patients with urinary tract infections (UTIs) of nosocomial and community origin and (ii) to determine the relationships between the presence of extended-spectrum ß-lactamases (ESBLs), mutations in the gyrA and parC genes, and resistance to FQs. METHODS: A total of 71 E. coli isolates, including 38 ESBL-producers and 33 non-ESBL-producers, were analysed. The aac(6')-Ib gene was amplified using PCR and was subsequently digested with the BtsCI restriction enzyme to identify aac(6')-Ib-cr, a variant associated with FQ resistance. Detection of qnr genes was performed by multiplex PCR. In isolates that tested positive for these genes, the gyrA and parC genes were sequenced and the modulation factor of an efflux pump inhibitor was determined on the minimum inhibitory concentration (MIC) of norfloxacin. RESULTS: The frequencies of qnrS, qnrB and qnrA were 4.2%, 2.8% and 0%, respectively. The frequency of aac(6')-Ib-cr was 40.8% and this variant was associated with double mutations in gyrA and parC as well as resistance to FQs and ESBL production. Modulation of efflux pump activity was more frequent in resistant isolates that had a wild-type parC gene. CONCLUSION: An interplay of resistance mechanisms increased the level of resistance to FQs, and the high frequency of putative plasmid-mediated quinolone resistance genes associated with ESBL-producing isolates reduced therapeutic options to treat UTIs in the affected population.

Asunto(s)

Girasa de ADN/genética , Topoisomerasa de ADN IV/genética , Farmacorresistencia Bacteriana Múltiple/genética , Proteínas de Escherichia coli/genética , Escherichia coli/genética , Infecciones Urinarias/microbiología , Antibacterianos/farmacología , Brasil , Escherichia coli/efectos de los fármacos , Escherichia coli/aislamiento & purificación , Infecciones por Escherichia coli/microbiología , Humanos , Pruebas de Sensibilidad Microbiana , Mutación , Reacción en Cadena de la Polimerasa

RESUMEN

The classification of human papillomavirus (HPV) intratypic lineages by complete genome sequencing is a determinant in understanding biological differences in association with this disease. In this work, we have characterised complete HPV genomes from southern Brazil. Fifteen cervicovaginal Pap smear negative samples previously categorised as HPV-positive were sequenced using ultradeep sequencing, and 18 complete genomes from 13 different HPV types were assembled. Phylogenetic and genetic distance analyses were performed to classify the HPV genomes into lineages and sublineages. This is the first report describing the distribution of HPV intratype lineages of high and low oncogenic risk in asymptomatic women from southern Brazil.

Asunto(s)

Humanos , Femenino , Adulto , Papillomaviridae , Papillomaviridae/genética , Frotis Vaginal , ADN Viral , Enfermedades del Cuello del Útero/virología , Genoma Viral , Infecciones por Papillomavirus/virología , Factores de Riesgo

RESUMEN

The classification of human papillomavirus (HPV) intratypic lineages by complete genome sequencing is a determinant in understanding biological differences in association with this disease. In this work, we have characterised complete HPV genomes from southern Brazil. Fifteen cervicovaginal Pap smear negative samples previously categorised as HPV-positive were sequenced using ultradeep sequencing, and 18 complete genomes from 13 different HPV types were assembled. Phylogenetic and genetic distance analyses were performed to classify the HPV genomes into lineages and sublineages. This is the first report describing the distribution of HPV intratype lineages of high and low oncogenic risk in asymptomatic women from southern Brazil.

Asunto(s)

Genoma Viral , Papillomaviridae/genética , Infecciones por Papillomavirus/virología , Enfermedades del Cuello del Útero/virología , Adulto , Brasil , ADN Viral , Femenino , Humanos , Papillomaviridae/aislamiento & purificación , Filogenia , Factores de Riesgo , Frotis Vaginal

RESUMEN

BACKGROUND Increasing evidence suggests that human papillomavirus (HPV) intratype variants (specific lineages and sublineages) are associated with pathogenesis and progression from HPV infection to persistence and the development of cervical cancer. OBJECTIVES This study aimed to verify the prevalence of HPV infection and distribution of HPV types and HPV16 variants in southern Brazil in women with normal cytology or intraepithelial lesions. METHODS HPV typing was determined by L1 gene sequencing. To identify HPV16 variants, the LCR and E6 regions were sequenced, and characteristic single nucleotide variants were identified. FINDINGS A total of 445 samples were studied, with 355 from cervical scrapes and 90 from cervical biopsies. HPV was detected in 24% and 91% of these samples, respectively. The most prevalent HPV types observed were 16 (cervical, 24%; biopsies, 57%) and 58 (cervical, 12%; biopsies, 12%). Seventy-five percent of the HPV16-positive samples were classified into lineages, with 88% defined as lineage A, 10% as lineage D, and 2% as lineage B. MAIN CONCLUSIONS This study identified a high frequency of European and North American HPV16 lineages, consistent with the genetic background of the human population in southern Brazil.

Asunto(s)

Humanos , Femenino , Adulto , Variación Genética/genética , ADN Viral/genética , Neoplasias del Cuello Uterino/virología , Infecciones por Papillomavirus/virología , Papillomavirus Humano 16/genética , Factores Socioeconómicos , Brasil , Displasia del Cuello del Útero , Reacción en Cadena de la Polimerasa , Estudios Transversales

RESUMEN

BACKGROUND: Increasing evidence suggests that human papillomavirus (HPV) intratype variants (specific lineages and sublineages) are associated with pathogenesis and progression from HPV infection to persistence and the development of cervical cancer. OBJECTIVES: This study aimed to verify the prevalence of HPV infection and distribution of HPV types and HPV16 variants in southern Brazil in women with normal cytology or intraepithelial lesions. METHODS: HPV typing was determined by L1 gene sequencing. To identify HPV16 variants, the LCR and E6 regions were sequenced, and characteristic single nucleotide variants were identified. FINDINGS: A total of 445 samples were studied, with 355 from cervical scrapes and 90 from cervical biopsies. HPV was detected in 24% and 91% of these samples, respectively. The most prevalent HPV types observed were 16 (cervical, 24%; biopsies, 57%) and 58 (cervical, 12%; biopsies, 12%). Seventy-five percent of the HPV16-positive samples were classified into lineages, with 88% defined as lineage A, 10% as lineage D, and 2% as lineage B. MAIN CONCLUSIONS: This study identified a high frequency of European and North American HPV16 lineages, consistent with the genetic background of the human population in southern Brazil.

Asunto(s)

Variación Genética/genética , Papillomavirus Humano 16/genética , Infecciones por Papillomavirus/virología , Displasia del Cuello del Útero/virología , Neoplasias del Cuello Uterino/virología , Adulto , Brasil , Estudios Transversales , ADN Viral/genética , Femenino , Humanos , Reacción en Cadena de la Polimerasa , Factores Socioeconómicos

RESUMEN

PROBLEM: Herpes simplex virus 1 (HSV-1) commonly causes orolabial infection, but can also infect the genital mucosa. In contrast, HSV-2 is usually genital. Genital herpes can transmit the virus vertically to the fetus during pregnancy. We sought to estimate the prevalence of HSV-1/2 on the maternal and fetal sides of the placenta. METHOD OF STUDY: Placental tissues were collected from pregnant women seen at the Rio Grande University Hospital. HSV-1 and HSV-2 were detected by nested PCR. RESULTS: The prevalence of HSV-1 and HSV-2 was, respectively, 28% and 12.6% (maternal side) and 29.9% and 8.3% (fetal side). All HSV-positive women were asymptomatic. Sexual behavior, vaginal delivery, and presence of HSVs on one side of the placenta were risk factors associated with HSV infection. CONCLUSION: The occurrence of HSVs in placental tissue was high, especially for HSV-1. Novel strategies need to be implemented for the management of asymptomatic women who might transmit HSV to their newborns.

Asunto(s)

Herpes Genital/virología , Herpes Simple/virología , Herpesvirus Humano 1 , Herpesvirus Humano 2 , Placenta/virología , Complicaciones Infecciosas del Embarazo/virología , Adolescente , Adulto , Coinfección/virología , Femenino , Feto , Humanos , Embarazo , Factores de Riesgo , Adulto Joven

RESUMEN

OBJECTIVE: To determine the prevalence of human pegivirus (HPgV) and factors associated with vertical transmission among pregnant women infected with HIV. METHOD: A retrospective cross-sectional study was conducted among pregnant women treated at an HIV reference service in Rio Grande, Brazil, between January 1, 2010, and January 1, 2015. The polymerase chain reaction was used to diagnose HPgV infection among the women and their neonates. Clinical, obstetric, and neonatal data were obtained from medical records. RESULTS: Infection with HPgV was detected among 16 (25%) of 63 women and 5 (8%) of 63 newborns, corresponding to a vertical transmission rate of 31%. Multivariate analysis demonstrated that the absence of prenatal care was the only risk factor for vertical transmission of HPgV (prevalence ratio 19.61, 95% confidence interval 1.29-297.48; P=0.032). CONCLUSION: Prenatal care could protect against vertical transmission of HPgV among women infected with HIV; however, studies among HIV-negative individuals are still required to verify this correlation.

Asunto(s)

Infecciones por Flaviviridae/epidemiología , Infecciones por Flaviviridae/transmisión , Virus GB-C/aislamiento & purificación , Infecciones por VIH/epidemiología , Transmisión Vertical de Enfermedad Infecciosa/estadística & datos numéricos , Complicaciones Infecciosas del Embarazo/epidemiología , Adulto , Brasil/epidemiología , Estudios Transversales , Femenino , Infecciones por Flaviviridae/complicaciones , Infecciones por Flaviviridae/virología , Infecciones por VIH/complicaciones , Humanos , Recién Nacido , Embarazo , Complicaciones Infecciosas del Embarazo/virología , Prevalencia , Estudios Retrospectivos , Factores de Riesgo , Adulto Joven

RESUMEN

Previous studies have demonstrated that coinfection with HPgV is a protective factor for human immunodeficiency virus (HIV)-infected patients, leading to slower disease progression, and longer survival after established disease. The present study sought to estimate the prevalence of HPgV infection and associated risk factors in patients harboring C or non-C HIV-1 subtypes followed-up at HU-FURG, southern Brazil. Samples from 347 HIV-1-infected subjects were subjected to plasma RNA extraction, cDNA synthesis, HPgV RNA detection, and HIV-1 genotyping. The overall prevalence of HPgV RNA was 34%. Individuals aged 18-30 years had higher chances of infection compared with those 50 years or older (95%CI 1.18-52.36, P = 0.03). The number of sexual partner between one and three was a risk factor for HPgV infection (95%CI 1.54-10.23; P < 0.01), as well as the time since diagnosis of HIV-1 ≥ 11 years (95%CI 1.01-2.89; P = 0.04). Patients infected with HIV non-C subtypes had six times more chance of being HPgV-infected when compared to subtype C-infected subjects (95%CI 2.28-14.78; P < 0.01). This was the first study conducted in southern Brazil to find the circulation of HPgV. HIV/HPgV coinfection was associated with a longer survival among HIV+ patients. Of novelty, individuals infected by HIV non-C subtypes were more susceptible to HPgV infection. However, additional studies are needed to correlate the HIV-1 subtypes with HPgV infection and to clarify cellular and molecular pathways through which such associations are ruled. J. Med. Virol 88:2106-2114, 2016. © 2016 Wiley Periodicals, Inc.

Asunto(s)

Coinfección/virología , Infecciones por Flaviviridae/complicaciones , Infecciones por Flaviviridae/epidemiología , Virus GB-C/aislamiento & purificación , Infecciones por VIH/complicaciones , Adolescente , Adulto , Brasil/epidemiología , Coinfección/epidemiología , Estudios Transversales , Femenino , Infecciones por Flaviviridae/virología , Virus GB-C/fisiología , Genotipo , Infecciones por VIH/virología , VIH-1/genética , Humanos , Masculino , Persona de Mediana Edad , Filogenia , Prevalencia , ARN Viral/sangre , ARN Viral/genética , Parejas Sexuales , Adulto Joven

RESUMEN

Determinar a prevalência e os genótipos do HPV em mulheres atendidas em um Hospital Universitário no Sul do Brasil. Metodologia: Foram coletadas amostras de secreções cérvico-vaginal de 200 mulheres. O HPV foi detectado pela Reação em Cadeia da Polimerase aninhada e os genótipos por sequenciamento. As variáveis foram analisadas pelo Teste Exato de Fisher e pelo Chi-quadrado de Pearson com o nível de significância < 5%. A força de associação foi calculada pela razão de prevalência e os seus intervalos de confiança a 95%. A análise Multivariada foi calculada pela Regressão Logística Binária para as variáveis com P <0,20. Resultados:O DNA do HPV foi detectado em 55 mulheres (27,5%). A prevalência do HPV foi associada a baixa renda(P =0,01), o início sexual precoce (P <0,001), a gestação (P = 0, 002), a infecção pelo HIV–1 (P = 0,001) e a coilocitose no exame citopatológico (P =0,006). Houve associação entre o status sorológico para o HIV–1 e os genótipos HPV–33 (P =0,001) e HPV–68 (P <0,001). Na análise multivariada, a prevalência do HPV foi associada ao início sexual precoce (P =0,001), a infecção pelo HIV–1 (P =0,01),a gestação (P =0,02) e a coilocitose no citopatológico (P =0,01). Sobre os genótipos, 90,4% eram de alto risco oncogênico (18 HPV–18, 14 HPV–16, quatro HPV–53, três HPV–31, dois HPV–58, dois HPV–59,dois HPV–68, um HPV–33 e um HPV–52) e 9,6% de baixo risco (dois HPV–11, dois HPV–16 e um HPV–70). Conclusões: Esse estudo teve a prevalência do HPV semelhante à prevalência descrita para esta região. Os genótipos do HPV de alto risco foram os mais prevalentes, sendo o HPV–18 o principal tipo viral encontrado...

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Study design: cross-sectional. Objective: To determine the HPV prevalence and genotypes in women treated at University Hospital in southern Brazil. Methodology: Cervical cells samples from 200 women were collected. HPV was detected by nested polymerase chain reaction and genotypes were determined by sequencing. Variables were analyzed by the Fisher Exact Test and Chi-squared test of Pearson (X²)with a significance level of ≤ 5%. The strength of association was calculated by the prevalence ratio, with their confidence intervals at 95%. Multivariate analysis was calculated by Binary Logistic Regression for variables with P <0.20 Results: HPV DNA was detected in 55 women (27.5%). HPV prevalence was associate with income (P =0.01), early initiation of sexual life (P <0.001), pregnant (P = 0. 002), HIV-1 infection (P = 0. 001) and koilocytosis presence in cytological test (P =0.006). Were found an association between serological status for HIV-1 and the genotypes HPV–33 (P =0.001) and HPV–68 (P <0.001).Multivariate analysis showed that HPV prevalence was associated with patients who had early initiation of sexual life (P =0.001), was infected by HIV–1 (P = 0.01), was pregnant (P = 0.02), and women with koilocytosis in cytological test (P =0.01). Genotypes were 90.4% higher-risk oncogenic (18 HPV–18, 14HPV–16, four HPV–53, three HPV–31, two HPV–58, two HPV–59, two HPV–68, one HPV–33 and one HPV–52) and 9.6% low-risk (two HPV–11, two HPV–16 and one HPV–70). Conclusions: This study had the HPV prevalence similar to prevalence described in this region. The high-risk HPV genotypes were the most prevalent, being HPV–18 the main viral type found...

Asunto(s)

Humanos , Femenino , Biología Molecular , Infecciones por Papillomavirus , Papillomaviridae , Reacción en Cadena de la Polimerasa , Salud de la Mujer , Técnicas de Genotipaje

RESUMEN

In the absence of intervention, the rate of vertical transmission of HIV can range from 15-45%. With the inclusion of antiretroviral drugs during pregnancy and the choice of delivery route this amounts to less than 2%. However ARV use during pregnancy has generated several questions regarding the adverse effects of the gestational and neonatal outcome. This study aims to analyze the risk factors for vertical transmission of HIV-1 seropositive pregnant women living in Rio Grande and the influence of the use of ARVs in pregnancy outcome. Among the 262 pregnant women studied the rate of vertical transmission of HIV was found to be 3.8%. Regarding the VT, there was a lower risk of transmission when antiretroviral drugs were used and prenatal care was conducted at the referral service. However, the use of ART did not influence the outcome of pregnancy. However, initiation of prenatal care after the first trimester had an influence on low birth weight, as well as performance of less than six visits increased the risk of prematurity. Therefore, the risk factors analyzed in this study appear to be related to the realization of inadequate pre-natal and maternal behavior.

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Na ausência de intervenção, as taxas de transmissão vertical do HIV podem variar de 15-45%. Com a inserção dos antirretrovirais durante a gestação e a escolha da via de parto estas taxas chegam a menos de 2%. No entanto o uso de ARV na gestação tem gerado várias duvidas quanto aos efeitos adversos causados ao desfecho gestacional e ao neonato. Este estudo objetiva analisar os fatores de risco da transmissão vertical do HIV-1 em gestantes soropositivas atendidas na cidade do Rio Grande e a influência do uso do ARV no desfecho gestacional. Entre as 262 gestantes estudadas a taxa de transmissão vertical do HIV encontrada foi de 3,8%. Em relação à TV, foi observado menor risco de transmissão quando esta havia feito uso de antirretrovirais e o pré-natal era realizado no serviço de referência. Entretanto, o uso de ARV não influenciou negativamente o desfecho gestacional. No entanto, o inicio do pré-natal após o primeiro trimestre teve influencia sobre o baixo peso ao nascer, assim como a realização de menos de seis consultas aumentou o risco de prematuridade. Portanto, os fatores de risco analisados neste estudo parecem estar relacionados à realização não adequada do pré-natal e ao comportamento materno.

Asunto(s)

Adulto , Femenino , Humanos , Recién Nacido , Embarazo , Adulto Joven , Fármacos Anti-VIH/uso terapéutico , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/transmisión , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Resultado del Embarazo , Complicaciones Infecciosas del Embarazo/tratamiento farmacológico , Puntaje de Apgar , Escolaridad , VIH-1 , Recién Nacido de Bajo Peso , Recien Nacido Prematuro , Paridad , Factores de Riesgo

RESUMEN

In the absence of intervention, the rate of vertical transmission of HIV can range from 15-45%. With the inclusion of antiretroviral drugs during pregnancy and the choice of delivery route this amounts to less than 2%. However ARV use during pregnancy has generated several questions regarding the adverse effects of the gestational and neonatal outcome. This study aims to analyze the risk factors for vertical transmission of HIV-1 seropositive pregnant women living in Rio Grande and the influence of the use of ARVs in pregnancy outcome. Among the 262 pregnant women studied the rate of vertical transmission of HIV was found to be 3.8%. Regarding the VT, there was a lower risk of transmission when antiretroviral drugs were used and prenatal care was conducted at the referral service. However, the use of ART did not influence the outcome of pregnancy. However, initiation of prenatal care after the first trimester had an influence on low birth weight, as well as performance of less than six visits increased the risk of prematurity. Therefore, the risk factors analyzed in this study appear to be related to the realization of inadequate pre-natal and maternal behavior.

Asunto(s)

Fármacos Anti-VIH/uso terapéutico , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/transmisión , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Complicaciones Infecciosas del Embarazo/tratamiento farmacológico , Resultado del Embarazo , Adulto , Puntaje de Apgar , Escolaridad , Femenino , VIH-1 , Humanos , Recién Nacido de Bajo Peso , Recién Nacido , Recien Nacido Prematuro , Paridad , Embarazo , Factores de Riesgo , Adulto Joven

RESUMEN

The aim of this study was to establish normal ranges of blood flow velocities and indices in the fetal ductus venosus (DV) during the second half of normal pregnancy. A Doppler study of 60 healthy pregnant women without fetal pathologies was performed during the second half of pregnancy. The peak systolic velocity (PSV), peak diastolic velocity (PDV), maximum velocity during atrial contraction (VAC), peak systolic velocity/maximum velocity during atrial contraction (S/A ratio), pulsatility index for the vein (PIV), preload index (PLI) and velocity index for the vein (VIV) were calculated from the DV at 4-week intervals. A significant increase in PSV, PDV and VAC was observed from the 20-23(6/7) to the 28-31(6/7) weeks, with stabilization of values until the end of the pregnancy. On the other hand, the study showed a significant decrease for the S/A ratio, PIV, PLI and VIV from the 20-23(6/7) to the 28-31(6/7) weeks and remaining stable from then until term.

Asunto(s)

Estudios Longitudinales , Placenta/irrigación sanguínea , Venas Umbilicales/irrigación sanguínea , Vena Cava Inferior/embriología , Adolescente , Adulto , Velocidad del Flujo Sanguíneo , Femenino , Edad Gestacional , Humanos , Embarazo , Estudios Prospectivos , Estándares de Referencia , Programas Informáticos , Adulto Joven

RESUMEN

OBJECTIVE: Studies carried out to assess the effects of antiretroviral drugs (ARV) in HIV-1 infected pregnant women have demonstrated carbohydrate intolerance. Some reports also refer to the effect of disturbances in the expression of the insulin-like growth factor (IGF) system on pancreas beta-cell function in humans and IGF-2/ApaI polymorphisms have been associated with obesity and features of the metabolic syndromes. In the present study, we tested the association between IGF-2/ApaI genotype and hyperglycemia in HIV-1 infected pregnant women receiving ARV. DESIGN: We studied IGF-2/ApaI polymorphism in 87 healthy pregnant women, 43 HIV-1 infected pregnant women taking ARV with hyperglycemia during pregnancy, and 43 HIV-1-negative pregnant women with gestational diabetes. Blood samples were obtained for DNA extraction, PCR and genotyping. Data were analyzed statistically by the Kolmogorov-Smirnov normality, ANOVA and chi-square tests. RESULTS: There were no significant differences in genotype frequency among the three groups analyzed. Considering the HIV-1-infected pregnant women, there were no significant differences in genotype frequency between the zidovudine group and the triple antiretroviral treatment group. There were no significant differences in allele frequencies among the groups evaluated. Non-white pregnant women tended to present the GG genotypes compared to white pregnant women. CONCLUSION: These results contribute to a better understanding of metabolic glycemic disorders in HIV-1-infected pregnant women using ARV, showing that IGF-2/ApaI polymorphisms are not responsible as a single causative factor of glycemic alterations. These data indicate that other variables should be studied in order to explain these glycemic abnormalities.

Asunto(s)

Fármacos Anti-VIH/uso terapéutico , Desoxirribonucleasas de Localización Especificada Tipo II/genética , Infecciones por VIH/sangre , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/genética , VIH-1/metabolismo , Factor II del Crecimiento Similar a la Insulina/genética , Polimorfismo Genético , Área Bajo la Curva , Estudios de Casos y Controles , Femenino , Genotipo , Homocigoto , Humanos , Embarazo , Complicaciones Infecciosas del Embarazo/tratamiento farmacológico , Complicaciones Infecciosas del Embarazo/genética , Factores de Tiempo