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Fortea et al.'s. (2024) recent data analysis elegantly calls attention to familial late-onset Alzheimer's disease (AD) with APOE4 homozygosity. The article by Grant (2024) reviews the factors associated with AD, particularly the APOE genotype and lifestyle, and the broad implications for prevention, both for individuals with the lifestyles associated with living in resource-rich countries and for those enduring environmental adversity in poverty settings, including high exposure to enteric pathogens and precarious access to healthcare. Grant discusses the issue of APOE genotype and its implications for the benefits of lifestyle modifications. This review highlights that bearing APOE4 could constitute an evolutionary benefit in coping with heavy enteric infections and malnutrition early in life in the critical formative first two years of brain development. However, the critical issue may be that this genotype could be a health concern under shifts in lifestyle and unhealthy diets during aging, leading to severe cognitive impairments and increased risk of AD. This commentary supports the discussions of Grant and the benefits of improving lifestyle for decreasing the risks for AD while providing further understanding and modelling of the early life benefits of APOE4 amidst adversity. This attention to the pathophysiology of AD should help further elucidate these critical, newly appreciated pathogenic pathways for developing approaches to the prevention and management in the context of the APOE genetic variations associated with AD.
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Doença de Alzheimer , Apolipoproteína E4 , Desnutrição , Plasticidade Neuronal , Humanos , Doença de Alzheimer/genética , Doença de Alzheimer/prevenção & controle , Apolipoproteína E4/genética , Plasticidade Neuronal/genética , Desnutrição/genética , Desnutrição/complicações , Homozigoto , Estilo de VidaRESUMO
Background: Adipose tissue (AT) around and within non-AT organs (i.e., ectopic adiposity) is emerging as a strong risk factor for type 2 diabetes (T2D). Not known is whether major ectopic adiposity depots, such as hepatic, skeletal muscle, and pericardial adiposity (PAT), are associated with T2D independent of visceral adiposity (VAT). More data are particularly needed among high-risk nonobese minority populations, as the race/ethnic gap in T2D risk is greatest among nonobese. Methods: Thus, we measured several ectopic adiposity depots by computed tomography in 718 (mean age = 64 years) African-Caribbean men on the Island of Tobago overall, and stratified by obesity (obese N = 187 and nonobese N = 532). Results: In age, lifestyle risk factors, health status, lipid-lowering medication intake, body mass index and all other adiposity-adjusted regression analyses, and hepatic and skeletal muscle adiposity were associated with T2D among nonobese men only (all P < 0.05), despite no association between VAT and PAT and T2D. Conclusions: Our results support the "ectopic fat syndrome" theory in the pathogenesis of T2D among nonobese African-Caribbean men. Longitudinal studies are needed to clarify the independent role of ectopic adiposity in T2D, and to identify possible biological mechanisms underlying this relationship, particularly in high-risk African ancestry and other nonwhite populations.
Assuntos
Adiposidade , Diabetes Mellitus Tipo 2/fisiopatologia , Gordura Intra-Abdominal/fisiopatologia , Fígado/fisiopatologia , Músculo Esquelético/fisiopatologia , Obesidade/fisiopatologia , Adiposidade/etnologia , Idoso , População Negra , Estudos de Casos e Controles , Estudos Transversais , Diabetes Mellitus Tipo 2/diagnóstico por imagem , Diabetes Mellitus Tipo 2/etnologia , Humanos , Gordura Intra-Abdominal/diagnóstico por imagem , Fígado/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Músculo Esquelético/diagnóstico por imagem , Obesidade/diagnóstico por imagem , Obesidade/etnologia , Prevalência , Medição de Risco , Fatores de Risco , Tomografia Computadorizada por Raios X , Trinidad e Tobago/epidemiologiaRESUMO
Heterodera glycines, the soybean cyst nematode, and Macrophomina phaseolina, causal agent of charcoal rot, are economically important soybean pathogens. The impact and effect of these pathogens on soybean yield in coinfested fields in the Midwest production region is not known. Both pathogens are soilborne, with spatially aggregated distribution and effects. Spatial regression analysis, therefore, is an appropriate method to account for the spatial dependency in either the dependent variable or regression error term from data produced in fields naturally infested with H. glycines and M. phaseolina. The objectives of this study were twofold: to evaluate the combined effect of H. glycines and M. phaseolina on soybean yield in naturally infested commercial fields with ordinary least squares and spatial regression models; and to evaluate, under environmentally controlled conditions, the combined effect of H. glycines and M. phaseolina through nematode reproduction and plant tissue fungal colonization. Six trials were conducted in fields naturally infested with H. glycines and M. phaseolina in Ohio. Systematic-grid sampling was used to determine the population densities of H. glycines and M. phaseolina, and soybean yield estimates. Though not used in any statistical analysis, M. phaseolina colony forming units from plant tissue, charcoal rot severity, and H. glycines type were also recorded and summarized. In two greenhouse experiments, treatments consisted of H. glycines alone, M. phaseolina alone, and coinfestation of soybean with both pathogens. Moran's I test indicated that the yield from five fields was spatially correlated (P < 0.05) and aggregated. In these fields, to account for spatial dependence, spatial regression models were fitted to the data. Spatial regression analyses revealed a significant interaction effect between H. glycines and M. phaseolina on soybean yield for fields with high initial population densities of both pathogens. In the greenhouse experiments, H. glycines reproduction was significantly (P < 0.05) reduced in the presence of M. phaseolina; however, soybean tissue fungal colonization was not affected by the presence of H. glycines. The direct mechanisms by which H. glycines and M. phaseolina interact were not demonstrated in this study. Future studies must be conducted in the field and greenhouse to better understand this interaction effect.
Assuntos
Glycine max , Tylenchoidea , Animais , Ohio , Doenças das Plantas , Regressão EspacialRESUMO
OBJECTIVE: Decreased radiodensity of adipose tissue (AT) located in the visceral AT (VAT), subcutaneous AT (SAT), and intermuscular AT (IMAT) abdominal depots is associated with hyperglycemia, hyperinsulinemia, and insulin resistance independent of AT volumes. These associations were sought in African-ancestry men, who have higher risk for type 2 diabetes and have been underrepresented in previous studies. METHODS: This cross-sectional analysis included 505 nondiabetic men of African-Caribbean ancestry (median age: 61 years; median BMI: 26.8 kg/m2 ) from the Tobago Health Study. AT volumes and radiodensities were assessed using computed tomography, including abdominal (VAT and SAT) and thigh (IMAT) depots. Associations between AT radiodensities were assessed with fasting serum glucose and insulin and with insulin resistance (updated homeostatic model assessment of insulin resistance, HOMA2-IR). RESULTS: Higher radiodensity in any AT depot was associated with lower log-insulin and log-HOMA2-IR (ß range: -0.16 to -0.18 for each; all P < 0.0001). No AT radiodensity was associated with glucose. Thigh IMAT radiodensity associations were independent of, and similar in magnitude to, VAT radiodensities. Model fit statistics suggested that AT radiodensities were a better predictor for insulin and insulin resistance compared with AT volumes in individuals with overweight and obesity. CONCLUSIONS: AT radiodensities at multiple depots are significantly associated with insulin and insulin resistance in African-ancestry men.
Assuntos
Adiposidade/fisiologia , População Negra/etnologia , Gordura Intra-Abdominal/metabolismo , Obesidade/etnologia , Sobrepeso/etnologia , Gordura Subcutânea/metabolismo , Tecido Adiposo/fisiopatologia , Adulto , Idoso , Glicemia/metabolismo , Composição Corporal/fisiologia , Estudos Transversais , Glucose/metabolismo , Humanos , Insulina/sangue , Gordura Intra-Abdominal/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Obesidade/diagnóstico , Obesidade/metabolismo , Sobrepeso/diagnóstico , Sobrepeso/metabolismo , Gordura Subcutânea/diagnóstico por imagem , Coxa da Perna/diagnóstico por imagem , Índias Ocidentais/etnologiaRESUMO
BACKGROUND: Among women aged 50 to 59 years at baseline in the Women's Health Initiative (WHI) Estrogen-Alone (E-Alone) trial, randomization to conjugated equine estrogen-alone versus placebo was associated with lower risk of myocardial infarction and mortality, and, in an ancillary study, the WHI-CACS (WHI Coronary Artery Calcification Study) with lower CAC, measured by cardiac computed tomography ≈8.7 years after baseline randomization. We hypothesized that higher CAC would be related to post-trial coronary heart disease (CHD), cardiovascular disease (CVD), and total mortality, independent of baseline randomization or risk factors. METHODS AND RESULTS: WHI-CACS participants (n=1020) were followed ≈8 years from computed tomography scan in 2005 (mean age=64.4) through 2013 for incident CHD (myocardial infarction and fatal CHD, n=17), CVD (n=69), and total mortality (n=55). Incident CHD and CVD analyses excluded women with CVD before scan (n=89). Women with CAC=0 (n=54%) had very low age-adjusted rates/1000 person-years of CHD (0.91), CVD (5.56), and mortality (3.45). In comparison, rates were ≈2-fold higher for women with any CAC (>0). Associations were not modified by baseline randomization to conjugated equine estrogen-alone versus placebo. Adjusted for baseline randomization and risk factors, the hazard ratio (95% confidence interval) for CAC >100 (19%) was 4.06 (2.11, 7.80) for CVD and 2.70 (1.26, 5.79) for mortality. CONCLUSIONS: Among a subset of postmenopausal women aged 50 to 59 years at baseline in the WHI E-Alone Trial, CAC at mean age of 64 years was strongly related to incident CHD, CVD, and to total mortality over ≈8 years, independent of baseline randomization to conjugated equine estrogen-alone versus placebo or CVD risk factors. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT00000611.
Assuntos
Doença da Artéria Coronariana/epidemiologia , Terapia de Reposição de Estrogênios/métodos , Estrogênios Conjugados (USP)/administração & dosagem , Calcificação Vascular/epidemiologia , Saúde da Mulher , Distribuição de Qui-Quadrado , Angiografia por Tomografia Computadorizada , Angiografia Coronária/métodos , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/mortalidade , Terapia de Reposição de Estrogênios/efeitos adversos , Terapia de Reposição de Estrogênios/mortalidade , Estrogênios Conjugados (USP)/efeitos adversos , Feminino , Humanos , Incidência , Pessoa de Meia-Idade , Análise Multivariada , Pós-Menopausa , Modelos de Riscos Proporcionais , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Estados Unidos/epidemiologia , Calcificação Vascular/diagnóstico por imagem , Calcificação Vascular/mortalidadeRESUMO
BACKGROUND AND AIMS: There is strong evidence that fat accumulating in non-adipose sites, "ectopic fat", is associated with cardiovascular disease (CVD), including vascular calcification. Most previous studies of this association have assessed only a single ectopic fat depot. Therefore, our aim was to assess the association of total, regional, and ectopic fat with abdominal aorto-illiac calcification (AAC) and coronary artery calcification (CAC) in 798 African ancestry men. METHODS: Participants (mean age 62) were from the Tobago Bone Health Study cohort. Adiposity was assessed via clinical examination, dual x-ray absorptiometry, and computed tomography (CT). Ectopic fat depots included: abdominal visceral adipose tissue (VAT), liver attenuation, and calf intermuscular adipose tissue (IMAT). Vascular calcification was assessed by CT and quantified as present versus absent. Associations were tested using multiple logistic regression adjusted for traditional cardiovascular risk factors. Models of ectopic fat were additionally adjusted for total body fat and standing height. RESULTS: All adiposity measures, except VAT, were associated with AAC. Lower liver attenuation or greater calf IMAT was associated with 1.2-1.3-fold increased odds of AAC (p < 0.03 for both), though calf IMAT was a stronger predictor than liver attenuation (p < 0.001) when entered in a single model. No ectopic fat measure was associated with CAC. CONCLUSIONS: Greater adiposity in the skeletal muscle and liver, but not in the visceral compartment, was associated with increased odds of AAC in African ancestry men. These results highlight the potential importance of both quantity and location of adiposity accumulation throughout the body.
Assuntos
Adiposidade/etnologia , Aorta Abdominal , Doenças da Aorta/fisiopatologia , População Negra , Doença da Artéria Coronariana/fisiopatologia , Artéria Ilíaca , Gordura Intra-Abdominal/fisiopatologia , Fígado/fisiopatologia , Músculo Esquelético/fisiopatologia , Calcificação Vascular/fisiopatologia , Absorciometria de Fóton , Adulto , Idoso , Aorta Abdominal/diagnóstico por imagem , Doenças da Aorta/diagnóstico por imagem , Doenças da Aorta/etnologia , Aortografia/métodos , Distribuição de Qui-Quadrado , Angiografia por Tomografia Computadorizada , Angiografia Coronária/métodos , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/etnologia , Humanos , Artéria Ilíaca/diagnóstico por imagem , Gordura Intra-Abdominal/diagnóstico por imagem , Fígado/diagnóstico por imagem , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Músculo Esquelético/diagnóstico por imagem , Razão de Chances , Estudos Prospectivos , Fatores de Risco , Trinidad e Tobago/epidemiologia , Calcificação Vascular/diagnóstico por imagem , Calcificação Vascular/etnologiaRESUMO
OBJECTIVE: Sclerostin, a Wingless (Wnt) pathway antagonist, is an established regulator of bone mineralization in humans but its potential importance in the regulation of vascular calcification is less clear. Therefore, our objective was to assess the relationship of serum sclerostin levels with coronary and aortic artery calcification (CAC and AAC, respectively) in Afro-Caribbean men on the island of Tobago. METHODS: Serum sclerostin levels and computed tomography of CAC and AAC were measured in 191 men (age mean(SD): 62.9(8.0)years) recruited without regard to health status. Multivariable logistic regression models were used to assess the cross-sectional association of sclerostin with prevalent arterial calcification. RESULTS: Mean(SD) sclerostin was 45.2 pmol/L (15.6 pmol/L). After adjusting for risk factors including age, physical and lifestyle characteristics, comorbidities, lipoproteins and kidney function, 1 SD greater sclerostin level was associated with a 1.61-times (95%CI 1.02-2.53) greater odds of having CAC. Sclerostin was not associated with AAC in any model. CONCLUSIONS: This is the first study to show that, among Afro-Caribbean men, greater serum sclerostin concentrations were associated with prevalence and extent of CAC. Further studies are needed to better define the role of the Wnt signaling pathway in arterial calcification in humans.
Assuntos
Proteínas Morfogenéticas Ósseas/sangue , Calcificação Vascular/sangue , Calcificação Vascular/etnologia , Doenças Vasculares/sangue , Doenças Vasculares/etnologia , Proteínas Adaptadoras de Transdução de Sinal , Idoso , Aorta/patologia , População Negra , Glicemia/análise , Região do Caribe , Marcadores Genéticos , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Fatores de Risco , Tomografia Computadorizada por Raios X , Trinidad e Tobago , Calcificação Vascular/fisiopatologia , Via de Sinalização WntRESUMO
SUMMARY: We tested for association between cortical and trabecular volumetric bone mineral density (vBMD) with abdominal aortic calcification (AAC) prevalence in 278 Afro-Caribbean men. AAC was present in 68.3 % of the men. Greater cortical, but not trabecular, vBMD was associated with significantly decreased odds of AAC independent of traditional risk factors. INTRODUCTION: The aim of this study is to assess the prevalence and correlates of AAC in a sample of 278 Afro-Caribbean men (mean age 56) and to test for a largely unexplored association between cortical and trabecular vBMD with AAC prevalence. METHODS: Men were recruited consecutively as part of an ongoing prospective cohort study of body composition in men aged 40+. For this analysis, AAC was assessed by computed tomography of the abdomen from L3 to S1. Aortic calcium was scored using the Agatston method, and prevalence was defined as a score ≥10 to rule out false positives. Men also had BMD assessed using peripheral quantitative computed tomography at 4 % (trabecular vBMD) and 33 % (cortical vBMD) of the radius and tibia. RESULTS: Abdominal aortic calcification was present in 68.3 % of the men. Significant independent predictors of AAC prevalence were increased age, increased BMI, hypertension, and current smoking. Age was the strongest predictor, with each SD (7.8 year) increase in age conferring 2.7 times increased odds of having AAC (P < 0.0001). A one SD greater cortical, but not trabecular, vBMD was associated with a significant decreased odds of AAC prevalence independent of other traditional risk factors (OR 0.65; 95 % CI 0.45-0.92). CONCLUSIONS: Cortical vBMD is inversely associated with AAC presence. This finding suggests that there may be shared physiology between cortical bone compartment remodeling and vascular calcification.
Assuntos
Doenças da Aorta/fisiopatologia , Densidade Óssea/fisiologia , Calcificação Vascular/fisiopatologia , Adulto , Idoso , Aorta Abdominal , Doenças da Aorta/etnologia , População Negra/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Fatores de Risco , Tomografia Computadorizada por Raios X/métodos , Trinidad e Tobago/epidemiologia , Calcificação Vascular/etnologiaRESUMO
This preliminary report sought to provide insight into the genetic diversity of human immunodeficiency virus drug resistance (HIVDR) in Jamaica. This was done by investigating the genetic diversity associated with drug resistance in pregnant women living with HIV attending antenatal clinics in Kingston, Jamaica. Blood samples were collected and viral RNA were extracted and analysed. The protease and reverse transcriptase (Pro-RT) genes were amplified using the nested polymerase chain reaction (PCR) method. Polymerase chain reaction amplicons were obtained for nine of 16 patients (56%), of which five (55%) were antiretroviral (ARV) drug naïve and four (45%) were treatment experienced. Three minor protease resistant-conferring mutations (A71AT, A71V, A71T) and five mutations conferring high to low-level resistance (K219EK, T69S, K103S, G190A and K103N) were detected in the RT region. More than 50% of the resistance mutations found were detected in ARV drug naïve individuals, implying that viruses are being transmitted with the ARV resistance. These preliminary results will inform the health practitioners of the level of drug resistance that is being transmitted as well as strengthen the need to initiate a national baseline survey on HIVDR in Jamaica.
RESUMO
Candida biofilms are microbial communities, embedded in a polymeric matrix, growing attached to a surface, and are highly recalcitrant to antimicrobial therapy. These biofilms exhibit enhanced resistance against most antifungal agents except echinocandins and lipid formulations of amphotericin B. In this study, biofilm formation by different Candida species, particularly Candida albicans, C. tropicalis, and C. parapsilosis, was evaluated, and the effect of caspofungin (CAS) was assessed using a clinically relevant in vitro model system. CAS displayed in vitro activity against C. albicans and C. tropicalis cells within biofilms. Biofilm formation was evaluated after 48 h of antifungal drug exposure, and the effects of CAS on preformed Candida species biofilms were visualized using scanning electron microscopy (SEM). Several species-specific differences in the cellular morphologies associated with biofilms were observed. Our results confirmed the presence of paradoxical growth (PG) in C. albicans and C. tropicalis biofilms in the presence of high CAS concentrations. These findings were also confirmed by SEM analysis and were associated with the metabolic activity obtained by biofilm susceptibility testing. Importantly, these results suggest that the presence of atypical, enlarged, conical cells could be associated with PG and with tolerant cells in Candida species biofilm populations. The clinical implications of these findings are still unknown.
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Antifúngicos/farmacologia , Biofilmes/efeitos dos fármacos , Biofilmes/crescimento & desenvolvimento , Candida/efeitos dos fármacos , Candida/crescimento & desenvolvimento , Equinocandinas/farmacologia , Candida/ultraestrutura , Caspofungina , Humanos , Lipopeptídeos , Microscopia Eletrônica de VarreduraRESUMO
HIV prevalence is increasing among high-risk populations in the Mexican-U.S. border cities of Tijuana and Ciudad Juarez. In 2005, the molecular epidemiology of HIV-1 was studied among injecting drug users (IDU) and female sex workers (FSW) in these cities, which are corridors for over two-thirds of the migrant flow between Mexico and the United States. Eleven samples (eight IDU and three FSW) were successfully amplified, sequenced, and analyzed. The results revealed that all 11 samples were subtype B. There was no phylogenetic clustering or separation of the strains between IDU and FSW or between Tijuana and Ciudad Juarez nor was the Mexican strain phylogenetically distinct from other subtype B strains. Two of three drug naive FSWs had low-level HIV-1 resistance mutations. This community-based study demonstrated that HIV-positive IDUs and FSWs in Ciudad Juarez and Tijuana were predominantly infected with subtype B. Further prevalence studies on HIV-1 resistance mutations among FSWs in these border cities are warranted.
Assuntos
Infecções por HIV/genética , HIV-1/genética , DNA Polimerase Dirigida por RNA/genética , Trabalho Sexual , Estudos Transversais , Feminino , Infecções por HIV/epidemiologia , HIV-1/classificação , Humanos , México/epidemiologia , Dados de Sequência Molecular , Prevalência , DNA Polimerase Dirigida por RNA/classificação , Abuso de Substâncias por Via Intravenosa/virologia , Estados Unidos/epidemiologiaRESUMO
OBJECTIVE: Assessment of HIV prevalence and associated risk behaviours among female commercial sex workers (FCSW) across major cities in South America. METHODS: Seroepidemiological, cross sectional studies of 13 600 FCSW were conducted in nine countries of South America during the years 1999-2002. Participants were recruited in brothels, massage parlours, hotels, and streets where anonymous questionnaires and blood samples were collected. HIV infection was determined by enzyme linked immunosorbent assay (ELISA) screening and western blot confirmatory tests. RESULTS: The overall HIV seroprevalence was 1.2% (range 0.0%-4.5%). The highest HIV seroprevalences were reported in Argentina (4.5%) and Paraguay (2.6%); no HIV infected FCSW were detected in Venezuela and Chile. Consistent predictors of HIV seropositivity were: (1) a previous history of sexually transmitted infections (STI, AORs = 3.8-8.3), and (2) 10 years or more in commercial sex work (AORs = 2.2-24.8). In addition, multiple (> or =3) sexual contacts (AOR = 5.0), sex with foreigners (AOR = 6.9), use of illegal drugs (AOR = 3.2), and marijuana use (AOR = 8.2) were associated with HIV seropositivity in Southern Cone countries. CONCLUSIONS: Consistently low HIV seroprevalences were detected among FCSW in South America, particularly in the Andean region. Predictors of HIV infection across the continent were STI and length of commercial sex work; however, use of illegal drugs, especially marijuana, and sexual contacts with foreigners were also found to be associated risk factors in the Southern Cone region. Interventions for the control of HIV and other STI need to be region and country specific; drug use appears to have an ever increasing role in the spread of HIV among heterosexually active populations.
Assuntos
Infecções por HIV/epidemiologia , Soroprevalência de HIV , HIV-1 , Trabalho Sexual/estatística & dados numéricos , Adulto , Western Blotting , Ensaio de Imunoadsorção Enzimática , Métodos Epidemiológicos , Feminino , Humanos , Fatores de Risco , América do Sul/epidemiologiaRESUMO
INTRODUÇÃO: A reabilitação neurológica e a contribuição da fisioterapia mudaram consideravelmente nas últimas décadas, uma vez que o desenvolvimento científico e tecnológico permitiu uma maior compreensão dos mecanismos de reorganização cerebral e dos mecanismos envolvidos no controle e desempenho motores, em suas dificuldades e adaptações. OBJETIVO: Este artigo apresenta uma perspectiva histórica da segunda metade do século passado. DISCUSSÃO: Pesquisas científicas atuais e a subseqüente reavaliação do efeito funcional dos problemas que aparecem pela lesão do neurônio motor superior estão levando à mudança de foco das intervenções clínicas, com ênfase na otimização motora através de exercícios de tarefas orientadas, de ganho de força e de treino de desempenho físico. Achados em modelos animais e humanos sugerem que, para que a reabilitação seja eficiente em otimizar a reorganização neural e a recuperação funcional, uma ênfase maior deve ser colocada em tarefas úteis que sejam desafios interessantes com um treino que promove o aprendizado. As questões da intensidade do treino de tarefas e da extensão do estresse cardiovascular durante a atividade física também são discutidos. Embora exista muito que se aprender em achados de pesquisa clínica, a prática clínica da reabilitação continua ser altamente variada, dependendo largamente do método preferido pelo terapeuta individual, e com predomínio dos métodos terapêuticos desenvolvidos meio século atrás. Fisioterapeutas necessitam assumir a responsabilidade do uso de técnicas baseadas em evidências, ou pelo menos usar métodos de intervenção e medidas objetivas de resultados que sejam cientificamente aceitáveis.
Assuntos
Medicina Baseada em Evidências , Atividade Motora , Modalidades de Fisioterapia , Reabilitação , Reabilitação/métodosRESUMO
We examined the genetic makeup of 221 HIV-1 strains from Chilean persons living with HIV/AIDS by HMA and DNA sequencing of the env gene: 143 cases were infected by sexual contact with an already-infected partner, 76 were infected by mother-to-child transmission, and 2 were transfusion related. We found env HIV-1 subtype B in 202 cases (91.4%) and subtype F in 19 cases (8.6%). Subtype B strains were found throughout the country whereas subtype F viruses were predominantly found in cases from the metropolitan/central to the northern regions of Chile (p < 0.01). Chilean F subtypes clustered in two different groups: viruses from the central region clustered with F subtypes from Argentina, Uruguay, and Brazil, and viruses from the northern region, which independently segregated from other South American and European F strains. All of the 59 men having sex with men (MSM) were infected with B subtype strains whereas 7 (9.2%) and 12 (15.8%), respectively, of heterosexually infected females and children were infected with F subtype strains (p < 0.01). It appears that F subtype strains have been introduced into Chile by separate heterosexual transmission events from other nearby countries in the Southern Cone whereas B subtype strains have continued to persist predominantly among MSM.
Assuntos
Infecções por HIV/epidemiologia , Infecções por HIV/virologia , HIV-1/genética , Epidemiologia Molecular , Adulto , Transfusão de Sangue , Criança , Chile/epidemiologia , Feminino , Infecções por HIV/transmissão , HIV-1/classificação , Humanos , Transmissão Vertical de Doenças Infecciosas , Masculino , Filogenia , Comportamento SexualRESUMO
OBJECTIVES: Sex among men constitutes an important route of transmission for HIV type 1 (HIV-1) in Latin America. Seeking better understanding of risk behaviours in this region, we determined the seroprevalence, potential risk factors, and geographic distribution of HIV-1 among groups of men who have sex with men (MSM). METHODS: Seroepidemiological, cross sectional studies of 13,847 MSM were conducted in seven countries of South America during the years 1999-2002. Volunteers were recruited in city venues and streets where anonymous questionnaires and blood samples were obtained. HIV-1 infection was determined by enzyme linked immunosorbent assay (ELISA) screening and western blot (WB) confirmatory tests. RESULTS: HIV-1 seroprevalence varied widely (overall 12.3%, range 11.0%-20.6%). The highest HIV-1 seroprevalence was noted in Bolivia (20.6%) and the lowest in Peru (11.0%). Predictors of HIV-1 infection varied among countries; however, a history of previous sexually transmitted disease (STD) was associated with a consistent increased risk (ORs=1.9-2.9, AORs=1.8-2.7). Multiple weekly sexual contacts was found to represent a secondary risk factor in Ecuador, Peru, and Argentina (ORs=1.6-2.9, AORs=1.6-3.1), whereas use of drugs such as cocaine was found to increase risk in Bolivia, Uruguay, and Paraguay (ORs=2.5-6.5, AORs=2.6-6.1). CONCLUSION: The results of this study illustrate an elevated HIV-1 seroprevalence among MSM participants from Andean countries. A previous STD history and multiple partners predicted HIV-1 infection in the seven countries of South America. In Southern Cone countries, HIV-1 infection was also associated with use of illegal drugs such as cocaine.
Assuntos
Infecções por HIV/epidemiologia , Soroprevalência de HIV , HIV-1 , Homossexualidade Masculina/estatística & dados numéricos , Adolescente , Adulto , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Fatores de Risco , Parceiros Sexuais , América do Sul/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Sexo sem Proteção/estatística & dados numéricos , Saúde da População UrbanaRESUMO
HIV subtypes B, F, and BF recombinants have been previously reported in South America. This report describes the presence of HIV-1 subtype C infection in the countries of Argentina, Uruguay, and Paraguay dating back to at least 1999. Surveillance for uncommon non-B/non-F subtype viruses circulating in South America has been conducted in samples obtained from nine countries. Peripheral blood mononuclear cells (PBMC), dried filter paper (FP), and fresh blood (FB) samples were collected from HIV-positive patients from Ecuador, Colombia, Venezuela, Peru, Chile, Bolivia, Argentina, Uruguay, and Paraguay. From a total of 2962 HIV seropositive samples examined during a 9-year period (1995-2003), only 11 (0.4%) were found to be infected with non-B/non-F HIV variants. Eight of these 11 strains were determined to be subtype C by heteroduplex mobility assay (HMA). Five of these 8 strains were further characterized by sequencing and phylogenetic analysis of the protease (Pro) and reverse transcriptase (RT) region of the genome and two were sequenced full length. One of the strains was found to be a unique BC recombinant. The spread of a third subtype of HIV, subtype C, should raise the question of its potential future role in the HIV epidemic in this region.
Assuntos
Infecções por HIV/epidemiologia , Infecções por HIV/virologia , HIV-1/classificação , HIV-1/genética , Adulto , Argentina/epidemiologia , Feminino , Protease de HIV/genética , Transcriptase Reversa do HIV/genética , Análise Heteroduplex , Humanos , Masculino , Pessoa de Meia-Idade , Dados de Sequência Molecular , Paraguai/epidemiologia , Filogenia , Análise de Sequência de DNA , Uruguai/epidemiologiaRESUMO
With the objective of monitoring the distribution of HIV-1 subtypes and circulating recombinant forms (CRFs)in South America, population-based surveillance studies were performed in seven countries. Peripheral blood mononuclear cell, filter paper, fresh blood, and cocultivation samples were collected from HIV-positive patients from Colombia, Ecuador, Peru, Bolivia, Chile, Argentina, and Uruguay, during a 7-year period(1995-2001). DNA was prepared and HIV envelope subtypes were determined by heteroduplex mobility as-say and DNA sequencing from 1289 HIV-positive samples. While subtypes B and F were the most commonly observed subtypes, two CRF02_AG strains were detected, in Ecuador. This is the first report of the existence of this CRF in South America.
Assuntos
Infecções por HIV/epidemiologia , HIV-1/classificação , Recombinação Genética , Adulto , DNA Viral/sangue , Equador/epidemiologia , Feminino , Infecções por HIV/virologia , HIV-1/genética , Análise Heteroduplex , Humanos , Masculino , Dados de Sequência Molecular , Vigilância da População , Análise de Sequência de DNA , América do Sul/epidemiologiaRESUMO
The molecular epidemiology of HIV-1 in Argentina is more complex than was previously appreciated. One circulating recombinant form, CRF12_BF, and many related BF recombinant forms predominate in the capital city, Buenos Aires. This study of HIV-1 subtypes acquired perinatally between 1984 and 2000 has permitted, for the first time, a reconstruction of the history of BF recombination in Argentina. Sequencing of a partial genome region from the beginning of vpu to the beginning of env(gp120), which spans a breakpoint common in most contemporary Argentine BF recombinants, enabled samples to be rapidly screened. Among 23 children born between 1984 and 2000, 15 including 1 child born in 1986, harbored a BF recombinant. Thirteen of the 15 recombinants shared a common breakpoint at the 5' end of env(gp120). Full genome sequencing of two viruses, from 1986 and 1987, respectively, revealed them to be genetically related but not identical to CRF12_BF. Both contained more subtype B sequence than did CRF12_BF. BF recombinants related to CRF12_BF have been in circulation in Buenos Aires since 1986 and continue to predominate in perinatal transmissions.
Assuntos
Infecções por HIV/transmissão , HIV-1/genética , Transmissão Vertical de Doenças Infecciosas , Adolescente , Argentina/epidemiologia , Criança , Pré-Escolar , Proteína gp120 do Envelope de HIV/genética , Infecções por HIV/epidemiologia , Protease de HIV/genética , Transcriptase Reversa do HIV/genética , HIV-1/classificação , Proteínas do Vírus da Imunodeficiência Humana , Humanos , Lactente , Filogenia , RNA/genética , RNA Viral/genética , Análise de Sequência , Proteínas Virais Reguladoras e Acessórias/genéticaRESUMO
OBJECTIVE: To describe the genetic diversity of HIV-1 in South America by full genome sequencing and analysis. METHODS: Purified peripheral blood mononuclear cell DNA from HIV-infected individuals in Argentina, Uruguay and Bolivia was used to amplify full HIV-1 genomes. These were sequenced using the ABI 3100 automated sequencer and phylogenetically analysed. RESULTS: Twenty-one HIV-1 strains from three South American countries, 17 of which were pre-screened by envelope heteroduplex mobility assay (HMA), were studied. Ten out of 10 HMA subtype F and four out of seven HMA subtype B strains were actually BF recombinants upon full genome analysis. Two BF recombinants from Argentina and two from Uruguay had the same structure, representing a new circulating recombinant form termed CRF12_BF(ARMA159). Twelve other BF recombinants had structures related to CRF12 but with additional segments of subtype B; each was unique. BF recombinants were temporally and geographically widespread, found as early as 1986-1987 in vertically infected Argentinian children and in Argentina, Uruguay, and Bolivia.
Assuntos
Infecções por HIV/epidemiologia , HIV-1/classificação , HIV-1/genética , Recombinação Genética , Adulto , Feminino , Infecções por HIV/virologia , Análise Heteroduplex , Humanos , Masculino , Pessoa de Meia-Idade , Epidemiologia Molecular , Dados de Sequência Molecular , Filogenia , Análise de Sequência de DNA , América do Sul/epidemiologiaRESUMO
HIV-1 transmission worldwide is predominantly associated with heterosexual activity, and non-clade B viruses account for the most spread. The HIV-1 epidemic in Trinidad/Tobago and the Caribbean shares many features with such heterosexual epidemics, including a prominent role for coincident sexually transmitted diseases. This study evaluates the molecular epidemiology of HIV-1 in Trinidad/Tobago during a period when abrupt transition from homosexual to heterosexual transmission occurred in the absence of injecting drug use, concomitant with a rapid rise in HIV-1 prevalence in the heterosexual population. Of 31 viral isolates studied during 1987-1995, all cluster with subtype B reference strains. In the analysis of full env genes from 22 early seroconverters, the Trinidad isolates constitute a significant subcluster within the B subtype. The Trinidad V3 consensus sequence differs by a single amino acid from the prototype B V3 consensus and demonstrates stability over the decade of this study. In the majority of isolates, the V3 loop of env contains a signature threonine deletion that marks the lineage of the Trinidad HIV-1 clade B epidemic from pre-1984. No phenotypic features, including syncitium induction, neutralization profiles, and chemokine receptor usage, distinguish this virus population from other subtype B viruses. Thus, although the subtype B HIV-1 viruses being transmitted in Trinidad are genetically distinguishable from other subtype B viruses, this is probably the result of a strong founder effect in a geographically circumscribed population rather than genetic selection for heterosexual transmission. These results demonstrate that canonical clade B HIV-1 can generate a typical heterosexual epidemic.