RESUMEN
OBJECTIVES: Monkeypox (Mpox) recent outbreak has changed in terms of predominant transmission route and typical presentation. Describing current epidemiological and clinical characteristics is crucial to identifying cases and halting transmission. METHODS: An observational study was conducted at a Peruvian tertiary-level hospital and included all individuals with Mpox virus infection between July 01 and September 03, 2022. RESULTS: Among 205 confirmed cases, 99% (202/205) were men, 94% (192/205) were men who have sex with men or bisexual, and 66% (136/205) were living with HIV. Regarding sexual behavior, 87% (179/205) had a sexual encounter 21 days before consultation, although only 8% (17/205) identified sexual contact with a Mpox confirmed case; 65% (133/205) had sexual intercourse with casual partners, 55% (112/205) reported a last sexual partner unknown, and 21.5% (44/205) continued having sexual intercourse with symptoms. Systemic symptoms were fever (162/205, 79%), malaise (123/205, 60%), headache (119/205, 58%), fatigue (105/205, 52%), and lymphadenopathy (111/205, 54%). The distribution of skin lesions was generalized (166/205, 81%), located in the anogenital area (160/205, 78%), polymorphic (174/205, 85%), and it was the first symptom identified in 46% (94/205) of cases. Overall, 10% (21/205) required hospitalization, of whom 85.7% (18/205) have HIV infection. Complications included bacterial superinfection (n = 18), proctitis (n = 6), balanitis (n = 4), and necrosis of skin lesions (n = 3). CONCLUSION: In 2022, Mpox mainly affects men who have sex with men and People living with HIV/AIDS. It presents with skin lesions localized to the anogenital area and can lead to severe complications requiring hospitalization.
Asunto(s)
Infecciones por VIH , Mpox , Minorías Sexuales y de Género , Masculino , Humanos , Femenino , Infecciones por VIH/complicaciones , Infecciones por VIH/epidemiología , Homosexualidad Masculina , Perú/epidemiología , Mpox/epidemiología , Monkeypox virus , HospitalesRESUMEN
OBJECTIVE: To assess the effectiveness and safety of hydroxychloroquine (HCQ) prophylaxis for the prevention of SARS-CoV-2 infection in healthcare workers (HCW) on duty during the COVID-19 pandemic. RESULTS: A total of 68 HCWs met the eligibility criteria were randomly allocated to receive HCQ (n = 36) or not (n = 32). There were no significant differences between groups in respects to age, gender, or medical history. Eight participants met the primary efficacy endpoint of SAR-CoV-2 infection during the study period; there was no difference in incidence of SARS-CoV-2 infections between both study arms (HCQ: 5 vs Control: 3, p = 0.538). The relative risk of SARS-CoV-2 infection in the HCQ arm was 1.69 compared to the control group (95%CI 0.41-7.11, p = 0.463); due to poor participant accrual, the resulting statistical power of the primary efficacy outcome was 11.54%. No serious adverse events occurred; however, two (2/36, 5.6%) participants no longer wished to participate in the study and withdrew consent due to recurring grade 1 and 2 adverse events. TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT04414241. (Registered on June 4, 2020).
Asunto(s)
COVID-19 , Hidroxicloroquina , Humanos , Hidroxicloroquina/efectos adversos , Pandemias/prevención & control , COVID-19/prevención & control , Tratamiento Farmacológico de COVID-19 , SARS-CoV-2 , Personal de SaludRESUMEN
Introduction: In patients with HIV in antiretroviral treatment (ART) and virological failure to the first-line regimen, establishing a therapeutic regimen after having identified the M184V mutation, which confers ART resistance, represents a dilemma. Objective: To compare the virological response of the therapeutic regimens prescribed to patients with HIV who presented the M184V mutation in two national hospitals in Lima, Peru, during the years 2008 to 2019, and to determine the risk factors associated with poor virological response. Methods: A retrospective cohort study was developed based on the information of the HIV program participants with the M184V mutation. Results: A total of 175 participants were eligible for the study. The male sex predominated (75.4%), the current median age was 41 years [interquartile range (IQR) 35.84-47.47], and the time on ART was 89 months (IQR 57.7-124.53). The median initial viral load (VL) was 4.5 log10 copies/mL (IQR 3.97-5.09) and the time between genotyping and the change of therapy was 2 months (IQR 0-3.56). The most used antiretroviral regimen was protease inhibitor plus two nucleoside reverse transcriptase inhibitors (55.4%). With the protease inhibitor plus integrase inhibitor (PI + INI) ART, 69% less risk of poor virological response was obtained [p = .019 (confidence interval 95% 0.117-0.825)]. Conclusions: In patients with HIV and the M184V mutation, the PI + INI ART has shown a greater decrease in control VL and, thus, a good virological response. The risk factors associated with a poor virological response were the delay between genotyping and change of therapy, high levels of initial VL, and poor adherence among the participants.
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Fármacos Anti-VIH , Infecciones por VIH , Fármacos Anti-VIH/farmacología , Fármacos Anti-VIH/uso terapéutico , Preescolar , Farmacorresistencia Viral/genética , Infecciones por VIH/tratamiento farmacológico , Hospitales , Humanos , Masculino , Mutación , Perú , Estudios Retrospectivos , Carga ViralAsunto(s)
Sustitución de Aminoácidos , Fármacos Anti-VIH/uso terapéutico , Farmacorresistencia Viral/genética , Infecciones por VIH/tratamiento farmacológico , VIH-1/efectos de los fármacos , Mutación Missense , Mutación Puntual , Adulto , Sustitución de Medicamentos , Quimioterapia Combinada , Femenino , Infecciones por VIH/epidemiología , VIH-1/genética , Hospitales Públicos/estadística & datos numéricos , Hospitales Urbanos/estadística & datos numéricos , Humanos , Masculino , Perú/epidemiología , Insuficiencia del TratamientoRESUMEN
Non-Hodgkin Lymphoma (NHL) is a neoplasm associated with a group of malignancies called AIDs-Defining Malignancies (ADMs) in Human-Immunodeficiency Virus (HIV) -patients. Similar to the case of NHL in Latin America, particularly in Peru, the amount of research done on others ADMs is limited, especially in the case of Kaposi's Sarcoma (KS). Prior investigations have talked about the great potential risk that represents this illness in latin american population, but topics as prognosis factors are yet to be well defined. In this letter, we address the importance of investigation in this area and include previously reported data that may enlighten the current national standpoint.
Asunto(s)
Censos , Grupos de Población , Brasil , Recolección de Datos , Demografía , Países en Desarrollo , Humanos , Dinámica Poblacional , Población UrbanaAsunto(s)
Humanos , Censos , Grupos de Población , Población Urbana , Brasil , Dinámica Poblacional , Demografía , Recolección de Datos , Países en DesarrolloRESUMEN
OBJECTIVE: The objective of this study is to identify human leukocyte antigen (HLA) class I and killer-cell immunoglobulin-like receptor (KIR) genotypes associated with different risks for HIV acquisition and HIV disease progression. DESIGN: A cross-sectional study of a cohort of 468 high-risk individuals (246 HIV-positive and 222 HIV-negative) from outpatient clinics in Lima (Perú). METHODS: The cohort was high-resolution HLA and KIR-typed and analysed for potential differences in single-allele frequencies and allele combinations between HIV-positive and HIV-negative individuals and for associations with HIV viral load and CD4 cell counts in infected individuals. RESULTS: HLA class I alleles associated with a lack of viral control had a significantly higher population frequency than relatively protective alleles (Pâ=â0.0093), in line with a rare allele advantage. HLA-A02â:â01 and HLA-C04â:â01 were both associated with high viral loads (Pâ=â0.0313 and 0.0001, respectively) and low CD4 cell counts (Pâ=â0.0008 and 0.0087, respectively). Importantly, the association between HLA-C04â:â01 and poor viral control was not due to its linkage disequilibrium with other HLA alleles. Rather, the coexpression of its putative KIR ligand KIR2DS4f was critically linked to elevated viral loads. CONCLUSION: These results highlight the impact of population allele frequency on viral control and identify a novel association between HLA-C04â:â01 in combination with KIR2DS4f and uncontrolled HIV infection. Our data further support the importance of the interplay of markers of the adaptive and innate immune system in viral control.
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Progresión de la Enfermedad , Predisposición Genética a la Enfermedad , Infecciones por VIH/genética , Infecciones por VIH/patología , Antígenos HLA-C/genética , Receptores KIR/genética , Recuento de Linfocito CD4 , Estudios Transversales , Frecuencia de los Genes , Infecciones por VIH/inmunología , Infecciones por VIH/virología , Humanos , Perú , Carga ViralRESUMEN
Hepatitis C virus (HCV) infection occurs among human immunodeficiency virus (HIV)-infected men who have sex with men (MSM) because of shared routes of transmission. To assess the association between HCV and HIV infection among MSM in Peru, we conducted a matched case-control study (162 HIV-positive cases and 324 HIV-negative controls) among participants of an HIV sentinel surveillance survey in six urban cities. The HCV infection was initially screened using anti-HCV ELISA and immunoblot assay, and thereafter confirmed by the HCV RNA qualitative assay. Among cases, no confirmed HCV infection was found while among controls, only two confirmed HCV infections were reported (0.62%). This matched case-control reports a very low probability of association between HCV and HIV co-infection and suggests a very low prevalence of HCV infection among MSM in Peru.
Asunto(s)
Infecciones por VIH/epidemiología , Hepatitis C/epidemiología , Homosexualidad Masculina , Conducta Sexual , Adolescente , Adulto , Infecciones por VIH/complicaciones , Hepatitis C/complicaciones , Anticuerpos contra la Hepatitis C/sangre , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , ARN Viral/sangreRESUMEN
BACKGROUND: In the Andean Region, HIV and sexually transmitted infections (STI) are most prevalent among men who have sex with men (MSM), but incidence estimates and associated factors have never been prospectively assessed. METHODS: A cohort of 1,056 high-risk HIV-negative MSM in Lima, Peru, were recruited during 1998-2000 (the ALASKA Cohort), and a nested case-control analysis was conducted between seroconverters and nonseroconverters, matched 1:3 by age and duration of follow-up for comparison of risk behaviors, acute retroviral symptoms, circumcision, and STI. RESULTS: During average follow-up of 335 days, 34 men seroconverted, providing a HIV incidence estimate of 3.5 per 100 person-years [95% confidence interval (CI): 2.3 to 4.7]. High syphilis (8.4 per 100 person-years, 95% CI: 6.7 to 10.1) and herpes simplex virus type 2 (HSV-2) infection (10.4 per 100 person-years, 95% CI: 8.6 to 11.9) incidence estimates were obtained. HIV seroconverters were more likely than men who remained seronegative to report fever >or=3 days (46% vs. 7%), to seek medical care (62% vs. 27%), and to have >or=1 casual partner (86.2% vs. 74.1%) since their last visit. HIV seroconverters also were more likely to have acquired syphilis or HSV-2 infection (31% vs. 8% among initially HSV-2-seronegative men) although they were less likely to be circumcised (4.2% vs. 20.6%, a nonsignificant difference). In multivariate analysis, incident syphilis or HSV-2 infection (odds ratio [OR]: 5.9, 95% CI: 1.5 to 22.7) and sex with any casual partner (OR: 4.8, 95% CI: 0.9 to 26.2) were associated with HIV seroconversion. CONCLUSIONS: STI that may cause anogenital ulcers are important risk factors for HIV acquisition among high-risk MSM in Lima, a population with a very high HIV incidence estimate. Synergistic interventions focusing in preventing both HIV and HSV-2, like male circumcision, are warranted to be assessed, especially in MSM populations with low levels of circumcision and high incidence estimates of ulcerative STI.
Asunto(s)
Infecciones por VIH/epidemiología , Herpes Genital/epidemiología , Sífilis/epidemiología , Adolescente , Adulto , Circuncisión Masculina , Comorbilidad , Homosexualidad Masculina , Humanos , Incidencia , Masculino , Perú/epidemiología , Factores de Riesgo , Adulto JovenRESUMEN
OBJECTIVE: To assess and estimate trends in HIV, sexually transmitted infections (STIs), and sexual behavior among men who have sex with men (MSM) in Lima, Peru. DESIGN: Second-generation HIV sentinel surveillance surveys conducted in 1996, 1998, 2000, and 2002. METHODS: Adult men reporting sex with at least 1 man during the previous year were eligible to participate. Sexual behavior and serum HIV-1 and syphilis antibodies were assessed. HIV seroincidence was estimated by a sensitive/less-sensitive enzyme immunoassay strategy. Rectal and pharyngeal swabs for Neisseria gonorrhoeae culture and a first-void urine sample for urethral leukocytes for presumptive diagnosis of urethritis were obtained. Herpes simplex virus 2 (HSV-2) antibodies were measured in 2002. RESULTS: Although HIV prevalence increased from 18.5% to 22.3% from 1996 through 2002, bacterial prevalence declined significantly for syphilis (16.0% to 12.4%), early syphilis (8.6% to 3.4%), and rectal gonorrhea (5.1% to 0.2%). High HIV seroincidence was estimated, with the lowest (4.8%) incidence in 1998. In 2002, HSV-2 seroprevalence was 51.0%. After adjustment for age, education, and self-reported sexual identity, our data suggest that a yearly increase by 6% in the prevalence of HIV occurred among MSM in Lima, with a corresponding decline in syphilis (by 9%), early syphilis (by 18%), and rectal gonorrhea (by 64%). Condom use during last sexual intercourse increased by 26% each year with the most recent male steady partner and, among non-sex workers, by 11% with the most recent casual partner. CONCLUSIONS: HIV continued to spread among MSM in Lima even when a decline in bacterial STIs and increase in condom use were estimated to occur. Intensification of medical and behavior prevention interventions is warranted for MSM in Peru.
Asunto(s)
Infecciones por VIH/transmisión , Homosexualidad Masculina , Adolescente , Adulto , Condones/estadística & datos numéricos , Infecciones por VIH/epidemiología , Infecciones por VIH/prevención & control , VIH-1 , Humanos , Masculino , Perú/epidemiología , Conducta Sexual , Enfermedades de Transmisión Sexual/epidemiología , Sexo Inseguro/prevención & controlRESUMEN
BACKGROUND: We evaluated associations between human immunodeficiency virus (HIV) infection, herpes simplex virus type 2 (HSV-2) infection, and syphilis among men who have sex with men (MSM) in Peru. METHODS: A surveillance survey of 3280 MSM was conducted; sexual behavior was assessed with a structured computer-assisted self-interview, and serum antibody testing was performed for HIV, HSV-2, and Treponema pallidum. RESULTS: HIV, HSV-2, and syphilis seroprevalences of 13.9%, 46.3%, and 13.4% were detected, respectively. HSV-2 seroprevalence was twice as high in HIV-infected subjects (80.5%) than it was in HIV-uninfected subjects (40.8%) (P < .01), and HSV-2 seropositivity (adjusted odds ratio [AOR], 5.66) was found to be strongly associated with HIV infection. In addition, homosexual self-definition (AOR, 3.12), exchange of sex for money (AOR, 1.61), unprotected sex (no condom) (AOR, 2.81), history of sex work (AOR, 1.89), oral receptive sex (AOR, 1.43), and cocaine use before/during sex (AOR, 2.53) within the preceding 6 months, as well as such sexually transmitted infections (STIs) and STI syndromes as proctitis (AOR, 2.80), genital ulcer disease (GUD) (AOR, 2.06), prior syphilis (AOR, 2.64), genital warts (AOR, 1.70), and self-reported STIs within the preceding 6 months (AOR, 1.61), were also found to be significant predictors of HIV infection. CONCLUSIONS: We found a strong association between HSV-2 seropositivity and HIV infection. Intervention measures against GUD due to HSV-2 infection and syphilis, such as routine testing, early detection, HSV-2 suppressive treatment, and condom distribution, need to be enhanced as part of STI prevention strategies at a national level to effectively reduce HIV infection among MSM in Peru.
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Infecciones por VIH/complicaciones , Herpes Genital/complicaciones , Homosexualidad Masculina , Sífilis/complicaciones , Adolescente , Adulto , Anciano , Anticuerpos Antibacterianos/sangre , Anticuerpos Antivirales/sangre , Trastornos Relacionados con Cocaína/complicaciones , Condiloma Acuminado/complicaciones , Herpes Genital/epidemiología , Herpes Genital/virología , Herpesvirus Humano 2 , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Perú , Proctitis/complicaciones , Estudios Seroepidemiológicos , Trabajo Sexual/estadística & datos numéricos , Conducta Sexual/estadística & datos numéricos , Estadística como Asunto , Sífilis/epidemiología , Treponema pallidum , Sexo Inseguro/estadística & datos numéricosRESUMEN
Conflicting data on the role of total virus- and protein-specific cytotoxic-T-lymphocyte (CTL) responses in the control of human immunodeficiency virus (HIV) disease progression exist. We present data generated from a Peruvian cohort of untreated, clade B-infected subjects, demonstrating that the proportion of Gag-specific, and in particular p24-reactive, CTL responses among the total virus-specific CTL activity is associated with individuals' CD4 counts and viral loads. Analyses in a second cohort in the United States confirm these findings and point towards a dominant role of Gag-specific immunity in effective control of HIV infection, providing important guidance for HIV vaccine development.
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Proteína p24 del Núcleo del VIH/inmunología , Infecciones por VIH/inmunología , VIH/inmunología , Linfocitos T Citotóxicos/inmunología , Recuento de Linfocito CD4 , Femenino , Infecciones por VIH/virología , Humanos , Masculino , Carga ViralRESUMEN
En el presente manual, se resume en forma clara y concisa información de las entidades más frecuentes como causa de diarrea aguda, su planteamiento y enfoque diagnóstico el manejo de los casos y de sus complicaciones
Asunto(s)
Diarrea Infantil , Monitoreo Epidemiológico , Vipoma , PerúRESUMEN
El presente documento describe las presentaciones clínicas que comprometen el sistema nervioso central de diferentes niveles, que causan sobreposición en los cuadros clínicos, pudiendo tener enfermedades con la aparición aguda de disfunción neurológica como síndrome neurológico agudo.
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Enfermedades del Sistema Nervioso , Salud Mental , Síndrome Neurológico de Alta PresiónRESUMEN
En el presente manual, se resume en forma clara y concisa información de las entidades más frecuentes como causa de diarrea aguda, su planteamiento y enfoque diagnóstico el manejo de los casos y de sus complicaciones(AU)
Asunto(s)
Diarrea Infantil , Vipoma , Monitoreo Epidemiológico , PerúRESUMEN
El presente documento describe las presentaciones clínicas que comprometen el sistema nervioso central de diferentes niveles, que causan sobreposición en los cuadros clínicos, pudiendo tener enfermedades con la aparición aguda de disfunción neurológica como síndrome neurológico agudo(AU)