RESUMEN
Conditions related to the acquired immune deficiency syndrome (AIDS) are still a significant cause of morbidity and mortality among people living with HIV (PLHIV). Longer survival in this population were reported to increase the risk of developing noncommunicable chronic diseases (NCDs). This study aimed to estimate the survival and causes of death according to age group and sex among PLHIV monitored at two referral centers in the Northeastern Brazil. This is a prospective, retrospective cohort with death records from 2007 to 2018, based on a database that registers causes of death using the International Classification of Disease (ICD-10), which were subsequently coded following the Coding Causes of Death in HIV (CoDe). A total of 2,359 PLHIV participated in the study, with 63.2% being men, with a follow-up period of 13.9 years. Annual mortality rate was 1.46 deaths per 100 PLHIV (95% CI: 1.33 - 1.60) with a frequency of 20.9%. Risk of death for men increased by 49% when compared to women, and the risk of death in PLHIV increased by 51% among those aged 50 years and over at the time of diagnosis. It was observed that 73.5% accounted for AIDS-related deaths, 6.9% for non-AIDS defining cancer, 6.3% for external causes, and 3.2% for cardiovascular diseases. Among the youngest, 97.2% presented an AIDS-related cause of death. Highest frequency of deaths from neoplasms was among women and from external causes among men. There is a need for health services to implement strategies ensuring greater adherence to treatment, especially among men and young people. Moreover, screening for chronic diseases and cancer is essential, including the establishment of easily accessible multidisciplinary care centers that can identify and address habits such as illicit drug use and alcoholism, which are associated with violent deaths.
Asunto(s)
Causas de Muerte , Infecciones por VIH , Humanos , Masculino , Femenino , Brasil/epidemiología , Persona de Mediana Edad , Adulto , Infecciones por VIH/mortalidad , Estudios Retrospectivos , Adulto Joven , Adolescente , Estudios Prospectivos , Anciano , Factores de RiesgoRESUMEN
Acute megakaryoblastic leukemia (M7 AML) is a rare subtype of acute myeloid leukemia in adults, the incidence of which is higher in children aged 1 to 3 years, especially in patients with Down Syndrome; and in the age group between 60 and 70 years old, with an adverse prognosis. We report the case of a 28-year-old male patient, with a history of non-seminoma germ cell tumour of the testis, diagnosed with M7 AML. Nine months after performing an orchiectomy to remove the testicular tumour, the patient developed dyspnea, dry cough and asthenia, associated with the presence of erythematous-purple lesions on the skin, ascites and pleural effusion. The myelogram demonstrated medullary hypocellularity, with the presence of 53% of blastic, pleomorphic and bulky cells, with positivity for the markers CD34, CD31 and CD117 in immature cells in immunohistochemistry. Despite undergoing cycles of chemotherapy with cisplatin and a BEP regimen (Bleomycin, Etoposide and Cisplatin), the patient presented with chest tomography with the presence of pulmonary nodules and magnetic resonance imaging of the skull and neuraxial with infiltration of the bone marrow in the spine and cranial vault, resulting in with neurological impairment and died. In view of the case presented, we observed agreement with previous reports of the adverse prognosis of M7 AML in young adults and we questioned its relationship with germ cell tumour. (AU)
A leucemia megacarioblástica aguda (LMA M7) é um subtipo raro em adultos de leucemia mielóide aguda, cuja incidência é maior em crianças de 1 a 3 anos, especialmente em pacientes portadores de Síndrome de Down; e na faixa etária entre 60 e 70 anos, com um prognóstico adverso. Relatamos o caso de um paciente, do sexo masculino, 28 anos, com histórico de tumor germinativo não seminoma de testículo, diagnosticado com LMA M7. Nove meses após a realização de uma orquiectomia para a retirada do tumor testicular, o paciente apresentou quadro de dispneia, tosse seca e astenia, associado a presença de lesões eritemato-arroxeadas na pele, ascite e derrame pleural. O mielograma demonstrou hipocelularidade medular, com presença de 53% de células blásticas, pleomórficas e volumosas, com a positividade para os marcadores CD34, CD31 e CD117 em células imaturas na imunohistoquímica. Apesar da realização de ciclos de quimioterapia com cisplatina e esquema BEP (Bleomicina, Etoposídeo e Cisplatina), o paciente apresentou Tomografia de tórax com presença de nódulos pulmonares e ressonância magnética de crânio e neuroeixo com infiltração da medula óssea em coluna vertebral e calota craniana, intercorrendo com comprometimento neurológico e foi a óbito. Diante do caso apresentado observamos a concordância com relatos prévios do prognóstico adverso da LMA M7 em jovens adultos e indagamos a sua relação com o tumor de células germinativas. (AU)
RESUMEN
ABSTRACT Conditions related to the acquired immune deficiency syndrome (AIDS) are still a significant cause of morbidity and mortality among people living with HIV (PLHIV). Longer survival in this population were reported to increase the risk of developing noncommunicable chronic diseases (NCDs). This study aimed to estimate the survival and causes of death according to age group and sex among PLHIV monitored at two referral centers in the Northeastern Brazil. This is a prospective, retrospective cohort with death records from 2007 to 2018, based on a database that registers causes of death using the International Classification of Disease (ICD-10), which were subsequently coded following the Coding Causes of Death in HIV (CoDe). A total of 2,359 PLHIV participated in the study, with 63.2% being men, with a follow-up period of 13.9 years. Annual mortality rate was 1.46 deaths per 100 PLHIV (95% CI: 1.33 - 1.60) with a frequency of 20.9%. Risk of death for men increased by 49% when compared to women, and the risk of death in PLHIV increased by 51% among those aged 50 years and over at the time of diagnosis. It was observed that 73.5% accounted for AIDS-related deaths, 6.9% for non-AIDS defining cancer, 6.3% for external causes, and 3.2% for cardiovascular diseases. Among the youngest, 97.2% presented an AIDS-related cause of death. Highest frequency of deaths from neoplasms was among women and from external causes among men. There is a need for health services to implement strategies ensuring greater adherence to treatment, especially among men and young people. Moreover, screening for chronic diseases and cancer is essential, including the establishment of easily accessible multidisciplinary care centers that can identify and address habits such as illicit drug use and alcoholism, which are associated with violent deaths.
RESUMEN
The totiviridae family contains viruses with double-stranded RNA genomes of 4.6-7.0 kpb, which encode a capsid protein (CP) and RNA-dependent RNA polymerase (RdRp), and they are approximately 40 nm in diameter with icosahedral symmetry. Totiviruses were first isolated from mosquitoes collected in Shaanxi Province (China). Here, we report a new Aedes aegypti Totivirus (AaTV) identified in mosquitoes from the Amazon rainforest. Mosquitoes (Diptera: Culicidae) were collected from a forest reserve belonging to the Amazon forest in the city of Macapá, Amapá state, Northern Brazil. A viral sequence with a 5748 nucleotide length that was nearly identical to Aedes aegypti Totivirus (AaTV), here named Aedes aegypti Totivirus BR59AP, was detected. A detailed molecular analysis was performed and shows that AaTV-BR59AP is highly related to the AaTV strain from the Caribbean region. We emphasize the importance of the characterization of new viruses in mosquitoes to deepen our understanding of viral diversity in insects and their potential role in disease.
Asunto(s)
Aedes , Totiviridae , Totivirus , Virus , Animales , Totivirus/genética , Brasil , Totiviridae/genéticaRESUMEN
We evaluate the genetic characterization of 132 HIV-1 pol sequences from children and adolescents undergoing antiretroviral therapy in Northeast Brazil. Phylogenetic and recombination analyses were performed using the maximum likelihood method using SeaView version 4 and SIMPLOT software. Most individuals harbored HIV-1 B (84.8%) and BF recombinants (9.8%), although other non-B subtypes were detected: HIV-1 C (1.5%), HIV-1 F (2.4%), and BC recombinants (1.5%). Antiretroviral resistance was 47% (95% confidence interval [CI]: 38.7%-55.4%). Non-nucleoside reverse transcriptase inhibitors (NNRTIs) showed higher frequencies of primary mutations, with 40.9% (95% CI: 32.9%-49.4%), followed by nucleoside reverse transcriptase inhibitors (NRTI) and protease inhibitors (PIs) with 34.8% (95% CI: 27.3-43.3) and 6.1% (95% CI: 3.1%-11.5%), respectively. Among NRTIs, higher resistance levels were observed for abacavir, emtricitabine, and lamivudine; for NNRTI, nevirapine and efavirenz. The most common primary mutations found were M184V (29.5%), K103N (25%), M41L (9.8%), T215Y (8.3%), and G190A (8.3%). Our findings highlight the importance of surveillance of resistance mutations, which contributes to the continuous updating and implementation of preventive measures to decrease mother-to-child-transmission and transmitted drug resistance.
Asunto(s)
Fármacos Anti-VIH/uso terapéutico , Farmacorresistencia Viral/genética , Infecciones por VIH/tratamiento farmacológico , VIH-1/genética , Adolescente , Brasil/epidemiología , Niño , Preescolar , Farmacorresistencia Viral/efectos de los fármacos , Genotipo , Infecciones por VIH/epidemiología , Infecciones por VIH/virología , VIH-1/clasificación , VIH-1/efectos de los fármacos , VIH-1/aislamiento & purificación , Humanos , Mutación , FilogeniaRESUMEN
The efficacy of direct-acting antivirals (DAAs) in the treatment of chronic hepatitis C (CHC) in liver transplant recipients is poorly understood, and several factors, including immunosuppression, drug interactions, elevated viraemia, and intolerance to ribavirin (RBV), can reduce cure rates. We conducted a real-life study on liver transplant recipients with CHC treated with a combination of sofosbuvir (SOF) and daclatasvir (DCV) or simeprevir (SIM), with or without RBV, followed-up for 12 to 24 weeks. The treatment effectiveness was assessed by determining the sustained virological response (SVR) rates at 12 or 24 weeks after the treatment cessation. Eighty-four patients were evaluated, with a mean age of 63.4 ± 7.4 years, HCV genotype 1 being the most prevalent (63.1%). Nineteen patients (22.7%) had mild fibrosis (METAVIR < F2) and 41 (48.8%) significant fibrosis (METAVIR ≥ F2). The average time between liver transplantation and the start of treatment was 4 years (2.1-6.6 years). The SOF + DCV regimen was used in 58 patients (69%). RBV in combination with DAAs was used in seven patients (8.3%). SVR was achieved in 82 patients (97.6%), and few relevant adverse events could be attributed to DAA therapy, including a patient who stopped treatment due to a headache. There was a significant reduction in ALT, AST, GGT and FA levels, or the APRI index after 4 weeks of treatment, which remained until 12/24 weeks post-treatment. DAA treatment of CHC in liver-transplanted patients achieved a high SVR rate and resulted in the normalization of serum levels of liver enzymes.
Asunto(s)
Antivirales/uso terapéutico , Hepacivirus/efectos de los fármacos , Hepatitis C Crónica/tratamiento farmacológico , Trasplante de Hígado/efectos adversos , Ribavirina/uso terapéutico , Anciano , Antivirales/efectos adversos , Brasil , ADN Viral/genética , Quimioterapia Combinada , Femenino , Genotipo , Hepacivirus/genética , Humanos , Cirrosis Hepática/cirugía , Masculino , Persona de Mediana Edad , Ribavirina/efectos adversos , Receptores de Trasplantes , Resultado del TratamientoRESUMEN
Information on human immunodeficiency virus (HIV) molecular epidemiology is required to verify HIV/AIDS (acquired immune deficiency syndrome) epidemic dynamics in different regions, as well as provide support for response to antiretroviral therapy, transmission of resistance mutations, disease progression, and viral spread. The aim of this study was to conduct a systematic review and meta-analysis of the frequency of HIV-1 subtypes in Northeast Brazil. Seventy-six articles that refer to HIV-1 and its subtypes in the Northeast Brazil and published between 1 January 1999 and 31 August 2019 were identified. We included 27 articles for the qualitative synthesis, thus analyzing results from 4466 patients and 4298 genomic sequences. The results showed that subtypes B, F, and C and recombinant BF were responsible for 76% (IC95%: 71-80), 8% (IC95%: 5-11), 2% (IC95%: 2-3), and 7% (IC95%: 4-12) infections, respectively. The highest proportion of subtype B infections (82.2%) was observed in Piauí, while the subtype F had a high frequency in Pernambuco (23.4%). Bahia presented 11.6% of the proportion of recombinant BF. In addition, several recombinants such as AG, BC, BCF, and BD have been identified in the region. This is the first systematic review and meta-analysis on the HIV-1 subtype distribution in Northeast Brazil and has shown a high circulating viral diversity. Although subtype B is predominant in Brazil, a large frequency of non-B subtypes has also been found, which may have consequences for response to antiretroviral therapy, disease progression, and transmission. Thus, HIV molecular epidemiological data are essential for epidemic prevention and control strategies.
RESUMEN
The HIV-1 epidemic in Brazil has been growing in northeast and north regions, particularly an increase in AIDS cases among the younger male population has been observed. This study aims to characterize the HIV-1 genetic diversity and to evaluate its antiretroviral resistance profile among individuals presenting virological failure in the state of Maranhão-Brazil. HIV-1 pol gene sequences from 633 patients on antiretroviral therapy were obtained from the Department of Surveillance, Prevention and Control of Sexually Transmitted Infections, HIV/AIDS and Viral Hepatitis of the Brazilian Ministry of Health. Phylogenetic and recombination analyses were performed to characterize viral genetic diversity. The presence of antiretroviral resistance mutations was assessed using the HIV Drug Resistance Database online platform of Stanford University. A predominance of subtype B (84.5%) was observed, followed by recombinant BF (9.5%), where more than half of the sequences were dispersed in 3 clusters. Antiretroviral resistance was detected in 74.1% of the sequences, and it was significantly higher for nucleoside analogue reverse-transcriptase inhibitors (NRTIs) than for non-nucleoside analogue reverse-transcriptase inhibitors (NNRTIs) and protease inhibitors (PIs). Inference of putative transmissions clusters identified 11 clusters with 22 query sequences (22/633, 3.5%). Thus, we conclude that continuous monitoring of the molecular epidemiology of HIV-1 is essential for prevention strategies, epidemic control, and treatment adequacy.
Asunto(s)
Fármacos Anti-VIH/uso terapéutico , Farmacorresistencia Viral/genética , Variación Genética , VIH-1/genética , VIH-1/fisiología , Brasil/epidemiología , Humanos , Productos del Gen pol del Virus de la Inmunodeficiencia Humana/genéticaRESUMEN
Abstract Background: People living with HIV are at increased risk of cardiovascular disease and carotid thickness, due to the inflammation caused by the virus, the antiretroviral therapy, and other risk factors. However, few studies have observed the occurrence of cardiovascular diseases and carotid thickness in HIV-positive population at low cardiovascular risk and with undetectable viral load. Objectives: To evaluate the association between levels of inflammatory markers and carotid thickness in people living with HIV, under antiretroviral therapy and at low cardiovascular risk. Methods: To determine low cardiovascular risk in both groups (HIV infected and non-infected individuals), the Framingham Risk Score was used. Inflammatory markers (IFN-γ, TNF-α, IL-1β, IL-6, sVCAM-1, and sICAM-1) were assessed using flow cytometry. Carotid thickness (mm) was measured using Doppler ultrasound. Level of significance was p < 0.05. Results: In People living with HIV, age and smoking status were associated with carotid thickness alterations. In the non-HIV group, age, higher total cholesterol, and LDL levels were associated with increased carotid thickness. Using the multivariate analysis, a significant association between TNF-α and IL- 1( levels, and a higher chance of atherosclerosis development in HIV group were observed. Conclusions: Both groups have a similar risk for developing cardiovascular disease, therefore our study demonstrates that HIV-positive individuals with undetectable viral load in antiretroviral therapy without protease inhibitors and with low cardiovascular risk do not present differences in carotid thickness in relation to uninfected individuals.
Resumo Fundamento: As pessoas que vivem com HIV têm um risco aumentado de doença cardiovascular e espessamento da carótida, devido à inflamação causada pelo vírus, à terapia antirretroviral e a outros fatores de risco. No entanto, poucos estudos observaram a ocorrência de doenças cardiovasculares e espessamento carotídeo na população soropositiva com baixo risco cardiovascular e carga viral indetectável. Objetivos: Avaliar a associação entre níveis de marcadores inflamatórios e espessura da carótida em pessoas vivendo com HIV, sob terapia antirretroviral e com baixo risco cardiovascular. Métodos: Para determinar o baixo risco cardiovascular em ambos os grupos (indivíduos infectados e não-infectados pelo HIV), foi utilizado o Escore de Risco de Framingham. Os marcadores inflamatórios (IFN-γ, TNF-α, IL-1β, IL-6, sVCAM-1 e sICAM-1) foram avaliados por citometria de fluxo. A espessura da carótida (mm) foi mensurada por meio de ultrassom com Doppler. O nível de significância foi de p < 0,05. Resultados: Em pessoas vivendo com HIV, a idade e o tabagismo foram associados a alterações da espessura da carótida. No grupo não-HIV, idade e níveis mais altos de colesterol total e LDL foram associados ao aumento da espessura da carótida. Utilizando a análise multivariada, observou-se associação significativa entre os níveis de TNF-α e IL-1β e maior chance de desenvolvimento de aterosclerose no grupo com HIV. Conclusão: Ambos os grupos têm risco semelhante de desenvolver doença cardiovascular, portanto, nosso estudo demonstra que indivíduos HIV-positivos com carga viral indetectável em terapia antirretroviral sem inibidores de protease e com baixo risco cardiovascular não apresentam diferenças na espessura da carótida em relação aos indivíduos não-infectados.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Biomarcadores/sangre , Enfermedades Cardiovasculares/sangre , Infecciones por VIH/sangre , Grosor Intima-Media Carotídeo , Inflamación/sangre , Infecciones por VIH/complicaciones , Infecciones por VIH/tratamiento farmacológico , Estudios Transversales , Carga Viral , Terapia Antirretroviral Altamente Activa , Antirretrovirales/administración & dosificaciónRESUMEN
BACKGROUND: People living with HIV are at increased risk of cardiovascular disease and carotid thickness, due to the inflammation caused by the virus, the antiretroviral therapy, and other risk factors. However, few studies have observed the occurrence of cardiovascular diseases and carotid thickness in HIV-positive population at low cardiovascular risk and with undetectable viral load. OBJECTIVES: To evaluate the association between levels of inflammatory markers and carotid thickness in people living with HIV, under antiretroviral therapy and at low cardiovascular risk. METHODS: To determine low cardiovascular risk in both groups (HIV infected and non-infected individuals), the Framingham Risk Score was used. Inflammatory markers (IFN-γ, TNF-α, IL-1ß, IL-6, sVCAM-1, and sICAM-1) were assessed using flow cytometry. Carotid thickness (mm) was measured using Doppler ultrasound. Level of significance was p < 0.05. RESULTS: In People living with HIV, age and smoking status were associated with carotid thickness alterations. In the non-HIV group, age, higher total cholesterol, and LDL levels were associated with increased carotid thickness. Using the multivariate analysis, a significant association between TNF-α and IL- 1( levels, and a higher chance of atherosclerosis development in HIV group were observed. CONCLUSIONS: Both groups have a similar risk for developing cardiovascular disease, therefore our study demonstrates that HIV-positive individuals with undetectable viral load in antiretroviral therapy without protease inhibitors and with low cardiovascular risk do not present differences in carotid thickness in relation to uninfected individuals.
Asunto(s)
Biomarcadores/sangre , Enfermedades Cardiovasculares/sangre , Grosor Intima-Media Carotídeo , Infecciones por VIH/sangre , Inflamación/sangre , Adulto , Antirretrovirales/administración & dosificación , Terapia Antirretroviral Altamente Activa , Estudios Transversales , Femenino , Infecciones por VIH/complicaciones , Infecciones por VIH/tratamiento farmacológico , Humanos , Masculino , Persona de Mediana Edad , Carga ViralRESUMEN
ABSTRACT BACKGROUND: Nonadherence to antiretroviral therapy (ART) may lead to viral replication and development of antiretroviral resistance. OBJECTIVE: To identify the factors associated with nonadherence to ART among people living with the human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) (PLWHA). DESIGN AND SETTING: Cross-sectional study in a tertiary-level hospital in northeastern Brazil. METHODS: Intake of less than 90% of the antiretroviral drugs prescribed in the last week prior to the interview was defined as nonadherence. Intake was evaluated using a questionnaire. Descriptive and multivariate analyses were conducted on the study population, with estimation of the respective odds ratios and 95% confidence intervals. RESULTS: The prevalence of nonadherence was 28.4%. Significant associations were found regarding the following variables: age less than 35 years, smoking, sedentary lifestyle, lack of medication and lack of knowledge regarding the patient's HIV status, on the part of the patient's partner or family. CONCLUSIONS: Encouragement of adherence to antiretroviral therapy is one of the fundamental pillars of treatment for HIV-infected patients. The high proportion of nonadherence (28.4%) and the predictive factors related to this indicate that it is necessary to improve patients' adherence to antiretroviral therapy.
Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Adulto , Adulto Joven , Infecciones por VIH/tratamiento farmacológico , Fármacos Anti-VIH/uso terapéutico , Terapia Antirretroviral Altamente Activa/estadística & datos numéricos , Cumplimiento de la Medicación/estadística & datos numéricos , Cumplimiento y Adherencia al Tratamiento/estadística & datos numéricos , Brasil/epidemiología , Actitud Frente a la Salud , Infecciones por VIH/epidemiología , Demografía/estadística & datos numéricos , Prevalencia , Estudios Transversales , Encuestas y Cuestionarios , Terapia Antirretroviral Altamente Activa/psicología , Cumplimiento de la Medicación/psicología , Cumplimiento y Adherencia al Tratamiento/psicologíaRESUMEN
BACKGROUND: Nonadherence to antiretroviral therapy (ART) may lead to viral replication and development of antiretroviral resistance. OBJECTIVE: To identify the factors associated with nonadherence to ART among people living with the human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) (PLWHA). DESIGN AND SETTING: Cross-sectional study in a tertiary-level hospital in northeastern Brazil. METHODS: Intake of less than 90% of the antiretroviral drugs prescribed in the last week prior to the interview was defined as nonadherence. Intake was evaluated using a questionnaire. Descriptive and multivariate analyses were conducted on the study population, with estimation of the respective odds ratios and 95% confidence intervals. RESULTS: The prevalence of nonadherence was 28.4%. Significant associations were found regarding the following variables: age less than 35 years, smoking, sedentary lifestyle, lack of medication and lack of knowledge regarding the patient's HIV status, on the part of the patient's partner or family. CONCLUSIONS: Encouragement of adherence to antiretroviral therapy is one of the fundamental pillars of treatment for HIV-infected patients. The high proportion of nonadherence (28.4%) and the predictive factors related to this indicate that it is necessary to improve patients' adherence to antiretroviral therapy.
Asunto(s)
Fármacos Anti-VIH/uso terapéutico , Terapia Antirretroviral Altamente Activa/estadística & datos numéricos , Infecciones por VIH/tratamiento farmacológico , Cumplimiento de la Medicación/estadística & datos numéricos , Cumplimiento y Adherencia al Tratamiento/estadística & datos numéricos , Adolescente , Adulto , Terapia Antirretroviral Altamente Activa/psicología , Actitud Frente a la Salud , Brasil/epidemiología , Estudios Transversales , Demografía/estadística & datos numéricos , Femenino , Infecciones por VIH/epidemiología , Humanos , Masculino , Cumplimiento de la Medicación/psicología , Prevalencia , Encuestas y Cuestionarios , Cumplimiento y Adherencia al Tratamiento/psicología , Adulto JovenRESUMEN
PURPOSE: Diverse human immunodeficiency virus 1 (HIV-1) subtypes and circulating recombinant forms are found in Brazil. The majority of HIV-1 molecular epidemiological studies in Brazil have been conducted in the southern and south-eastern regions of the country, although several recent studies in the north-eastern region have addressed this issue. The objective of this study was to molecularly characterize HIV-1 circulating in Pernambuco, north-eastern Brazil. METHODOLOGY: A total of 64 samples were collected from 2002 to 2003, and another 103 were collected from 2007 to 2009. The protease and partial reverse transcriptase regions of the HIV-1 polymerase-encoding (pol) gene were sequenced, and subtyping, recombination and phylogenetic analyses were performed.Results/Key findings. Subtype B (60.9â%) was found to be predominant, followed by HIV-1 F (31.4â%). Several BF recombinants (4.2â%), and BC and AG recombinants were also identified. The intra-subtype genetic diversity was estimated to be 0.065 (sd±0.004) for HIV-1 B and 0.055 (sd±0.004) for HIV-1 F, reflecting a greater accumulation of mutations in subtype B (P<0.01). More codons were found to be under positive selective pressure in samples collected from 2007 to 2009, from individuals with a T-cell count≥200 cells mm-3 and from women. Coalescence data indicated that the subtype F population has been continuously expanding. CONCLUSIONS: HIV-1 shows high genetic diversity in the state of Pernambuco. Thus, additional molecular evaluations of circulating strains will provide a better understanding of the epidemic and may lead to more effective preventive strategies.
Asunto(s)
Infecciones por VIH/epidemiología , Proteasa del VIH/genética , VIH-1/genética , Productos del Gen pol del Virus de la Inmunodeficiencia Humana/genética , Adulto , Secuencia de Bases , Brasil/epidemiología , Femenino , Variación Genética/genética , Infecciones por VIH/virología , Humanos , Masculino , Epidemiología Molecular , Filogenia , ARN Viral/genética , Análisis de Secuencia de ARNRESUMEN
[This corrects the article DOI: 10.1371/journal.pone.0155854.].
RESUMEN
BACKGROUND: HIV-1 diversity causes important differences in the virus' biological properties and their interactions with hosts, such as cell tropism, responses to antiretroviral therapy, drug-resistance, and disease progression. OBJECTIVES: We evaluated the interrelationship of phylogenetic inference with epidemiological and laboratory data for HIV-1 isolates circulating in Pernambuco, Northeast Region-Brazil. STUDY DESIGN: A total of 168 HIV-1 pol sequences were analysed, 64 were obtained from 2002-2003, and 104, from 2007-2009. Socio-demographic, clinical, and behavioural data were obtained from medical records. Laboratory testing enabled the determination of recent HIV-1 infections and co-infections with HBV, HCV, HTLV, or syphilis. Surveillance drug-resistance mutation analysis and antiretroviral susceptibility profiling were performed using HIV Drug-Resistance Database. RESULTS: HIV-1 non-B was associated with female, lower education, lower viral loads, and higher T cell counts mean. Frequencies of co-infection HIV-HBV, HIV-HCV, and HIV-syphilis were 27.8% (95% CI: 19.8-37.7), 1.04% (95% CI: 0.05-5.00) and 14.7% (95% CI: 8.6-23.0), respectively. Drug-resistant mutations rate was 2.98% (95% CI: 1.10-6.47). HIV-HBV subtype B co-infection was associated with men who have sex with men (MSM), higher education, higher viral loads and males. HIV-syphilis subtype non-B co-infection was associated with MSM status, lower T cell counts and males. CONCLUSIONS: Data showed the importance of molecular characterisations of the HIV-1 epidemic and its relation with epidemiological and clinical characteristics of the population, as well as its association with other infectious diseases, so they can effort to improve preventive measures for health services and more information about the progress and effects of the epidemic in Northeastern-Brazil.
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Coinfección/epidemiología , Infecciones por VIH/epidemiología , VIH-1/clasificación , VIH-1/genética , Productos del Gen pol del Virus de la Inmunodeficiencia Humana/genética , Adulto , Fármacos Anti-VIH/farmacología , Fármacos Anti-VIH/uso terapéutico , Brasil/epidemiología , Coinfección/virología , Farmacorresistencia Viral , Femenino , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/virología , VIH-1/efectos de los fármacos , VIH-1/aislamiento & purificación , Hepatitis B/epidemiología , Hepatitis C/epidemiología , Humanos , Masculino , Mutación , Filogenia , Sífilis/epidemiología , Carga ViralRESUMEN
The HIV-1 epidemic in Brazil has displayed new characteristics over time, with an increase in heterosexual transmission and a decline in the male-to-female ratio in AIDS cases. HIV screening was offered to patients attending the Voluntary Counseling and Testing Center in Paulista, Greater Metropolitan Recife, Pernambuco State, in Northeast Brazil, to determine HIV-1 incidence. BED capture enzyme immunoassay (BED-CEIA) was used to measure HIV-1 incidence, comparing it to the AxSYM avidity index method (Ax-AI). From 2006 to 2009, 14,014 individuals were tested, and only 18 pregnant women were diagnosed with HIV infection, resulting in 0.15% annual incidence (95%CI: 0-0.33), significantly lower than in men (1.03; 95%CI: 0.45-1.61) and non-pregnant women (0.50; 95%CI: 0.11-0.89). Despite the low HIV-1 incidence in pregnant women, the high rate of recent infection detected during prenatal care emphasizes the need to increase measures to prevent vertical transmission.
Asunto(s)
Infecciones por VIH/epidemiología , Infecciones por VIH/transmisión , Adulto , Brasil/epidemiología , Femenino , Infecciones por VIH/prevención & control , Humanos , Incidencia , Transmisión Vertical de Enfermedad Infecciosa/estadística & datos numéricos , Masculino , Embarazo , Complicaciones Infecciosas del Embarazo/epidemiología , Atención Prenatal , PrevalenciaRESUMEN
The aims of this study were to compare the automated AxSYM avidity assay index with the BED capture enzyme immunoassay test and to calculate the HIV-1 incidence using the BED capture enzyme immunoassay and AxSYM avidity assay index algorithms within a population seeking the Voluntary Counselling and Testing Centres in two municipalities in the Metropolitan Region of Recife, Northeast of Brazil. An analysis was conducted in 365 samples that tested positive for HIV infection from frozen serum collected during the period 2006-2009. There was a similar proportion of males and females; most patients were heterosexual (86%) with a median age of 29 years. Of the 365 samples, 102 (28%) and 66 (18.1%) were identified as recent infections by BED capture enzyme immunoassay and AxSYM avidity assay index, respectively. The HIV-1 total incidence in the BED capture enzyme immunoassay and AxSYM avidity assay index algorithms were: 0.79 (95% CI: 0.60-0.98) and 0.34 (95% CI: -0.04 to 0.72), respectively. Incidence was higher among men. There was good agreement between the tests, with a kappa of 0.654 and a specificity of 95.8%. AxSYM avidity assay index may be helpful in improving the quality of the estimates of recent HIV infection and incidence, particularly when used in a combined algorithm with BED capture enzyme immunoassay.
Asunto(s)
Anticuerpos Anti-VIH/sangre , Infecciones por VIH/diagnóstico , Infecciones por VIH/epidemiología , Adulto , Afinidad de Anticuerpos , Brasil/epidemiología , Consejo , Femenino , Humanos , Técnicas para Inmunoenzimas , Incidencia , Masculino , Persona de Mediana Edad , Sensibilidad y EspecificidadRESUMEN
Determining the prevalence and type of antiretroviral (ARV) resistance among ARV-naïve individuals is important to assess the potential responses of these individuals to first-line regimens. The prevalence of primary resistance and the occurrence of recent infections among individuals with human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) were identified among recently diagnosed patients at five sexually transmitted disease/AIDS testing and counselling centres in the metropolitan region of Recife (RMR), Pernambuco, Brazil, between 2007-2009. One-hundred and eight samples were analysed using the Calypte® BED assay. Males predominated (56%), as did patients aged 31-50 years. Twenty-three percent presented evidence of a recent HIV infection. The median CD4+ T lymphocyte count was 408 cells/mm³ and the median viral load was 3.683 copies/mL. The prevalence of primary resistance was 4.6% (confidence interval 95% = 1-8.2%) based on criteria that excluded common polymorphisms in accordance with the surveillance drug resistance mutation criteria. The prevalence of resistance to non-nucleoside reverse transcriptase, nucleoside/nucleotide reverse transcriptase and protease inhibitors were 3.8%, 1.5% and 0.8%, respectively. Fifty-seven percent of strains were from clade B, 37.7% were clade F and 3.1% were clade C; there were no statistically significant differences with respect to resistance between clades. Recent infection tended to be more common in men (p = 0.06) and in municipalities in the south of the RMR (Jaboatão dos Guararapes and Cabo de Santo Agostinho) (p = 0.046). The high prevalence of recent infection and the high prevalence of non-B strains in this poor Brazilian region merit further attention.