HIV treatment cascade in regions of Peru with the highest HIV prevalence.

OBJECTIVES: To describe the HIV treatment cascade and care continuum in regions of highest HIV prevalence in Peru. METHODS: An observational longitudinal study was carried out in 14 tertiary hospitals in Peru. These are the main hospitals that administer antiretroviral treatment (ART) in the regions that represent approximately 95% of reports of HIV/AIDS cases in Peru in 2013. We included individuals older than 18 years newly diagnosed with HIV from 1 January 2011 to 31 December 2012. Medical records were reviewed until 2015. RESULTS: A total of 2119 people living with HIV (PLHIV) were identified in the selected health facilities (mean age = 35.26 years, 78% male). 97.25% [1845/1897; 95% confidence interval (CI): 96.4-97.9%] of the patients attended the consultation at least once during the follow-up, but only 64.84% (885/1365; 95% CI: 62.2-67.4%) attended within a month after the diagnosis. After starting ART, 74.63% (95% CI: 71.9-77.2%) of PLHIV remained in healthcare. Regardless of the time after diagnosis, 88.40% (1837/2078; 95% CI: 86.9-89.7%) of PLHIV started ART during the observation time. However, 78.68% (95% CI: 76.8-80.4%) did so during the first post-treatment year and only 28.88% (95% CI: 27.9-31.9%) after 1 month. After starting treatment, it was observed that 51.60% (95% CI: 49.2-54%) of PLHIV reached viral suppression during the follow-up period. CONCLUSIONS: Further analysis and improvements in the definition of indicators are required to achieve conclusive results; however, these data will give us a general understanding of the progress of Peruvian health policies in achieving the goal established by the WHO.

Diffuse Multibacillary Leprosy of Lucio and Latapí with Lucio's Phenomenon, Peru.

Diffuse multibacillary leprosy of Lucio and Latapí is mainly reported in Mexico and Central America. We report a case in a 65-year-old man in Peru. He also had Lucio's phenomenon, characterized by vascular thrombosis and invasion of blood vessel walls by leprosy bacilli, causing extensive skin ulcers.

Mayaro virus infection, Amazon Basin region, Peru, 2010-2013.

During 2010-2013, we recruited 16 persons with confirmed Mayaro virus infection in the Peruvian Amazon to prospectively follow clinical symptoms and serologic response over a 12-month period. Mayaro virus infection caused long-term arthralgia in more than half, similar to reports of other arthritogenic alphaviruses.

Feasibility of Training Community Health Workers to Use Smartphone-Attached Microscopy for Point-of-Care Visualization of Soil-Transmitted Helminths in the Peruvian Amazon.

The prevalence of soil-transmitted helminths (STH) is high in communities within the Peruvian Amazon despite repeated mass-drug administration, demanding alternative strategies of control. Smartphone-attached microscopy (SAM) permits visualization of STH from a small portable microscope through a smartphone screen, potentially providing an inexpensive and rapid method of STH visualization in communities where diagnostic laboratories with microscopes are inaccessible. In this study, a total of 45 community health workers who work within the health systems of Loreto, Peru, attended a 1-day training session with lectures and practicums on STH and SAM. Participants received a pre- and post-intervention questionnaire. Post-intervention, participants were significantly more confident using SAM and identifying parasite images, symptoms, transmission, and treatment (P ≤ 0.0045). Post-intervention, participants correctly labeled a median of five of seven SAM apparatus components and five of eight steps of Kato-Katz technique, were less likely to choose taking medicine to prevent parasite infection (P = 0.0075), and were more likely to select Kato-Katz technique as a type of diagnostic test (P < 0.0001). Most participants felt ready to use SAM in their communities and stated that it could help rural communities far from health centers or laboratories (24%); provide faster identification, results, diagnosis (19%); permit at-home or on-the-spot visualization (14%); and save money (14%). Results show that community health workers show a high level of willingness and competency to learn about both STH and SAM and may be a yet-unexplored practical method of augmenting STH visualization, bringing healthcare to communities in Loreto with poor access to diagnostic laboratories and clinics.

Development of a Novel Protocol Based on Blood Clot to Improve the Sensitivity of qPCR Detection of Toxoplasma gondii in Peripheral Blood Specimens.

Quantitative polymerase chain reaction (qPCR) for Toxoplasma gondii multicopy genes has emerged as a promising strategy for sensitive detection of parasite DNA. qPCR can be performed from blood samples, which are minimally invasive to collect. However, there is no consensus about what type of blood specimen yields the best sensitivity. The development of a novel protocol for qPCR detection of T. gondii using blood clot, involving an appropriate DNA extraction method and the use of an internal amplification control to monitor the reaction is presented in the current study. Assays directed to the B1 and REP529 genes were performed in spiked specimens of whole blood, guanidine-ethylenediaminetetraacetic acid blood, and clot. The clot-based qPCR was shown to be more sensitive when compared with other types of specimens, detecting five and 0.05 T. gondii genomes, using B1 and REP529 targets, respectively. Finally, a comparative analysis with samples from HIV patients with clinical suspicion of toxoplasmosis was performed, demonstrating the detection of four positive suspected cases with clots compared with only one using guanidine-ethylenediaminetetraacetic acid blood. The high analytical sensitivity and the cost-effective advantages offered by clot supports this methodology as a good laboratory tool to monitor parasite burden.

Long-Term Arthralgia after Mayaro Virus Infection Correlates with Sustained Pro-inflammatory Cytokine Response.

Mayaro virus (MAYV), an alphavirus similar to chikungunya virus (CHIKV), causes an acute debilitating disease which results in the development of long-term arthralgia in more than 50% of infected individuals. Currently, the immune response and its role in the development of MAYV-induced persistent arthralgia remain unknown. In this study, we evaluated the immune response of individuals with confirmed MAYV infection in a one-year longitudinal study carried out in Loreto, Peru. We report that MAYV infection elicits robust immune responses that result in the development of a strong neutralizing antibody response and the secretion of pro-inflammatory immune mediators. The composition of these inflammatory mediators, in some cases, differed to those previously observed for CHIKV. Key mediators such as IL-13, IL-7 and VEGF were strongly induced following MAYV infection and were significantly increased in subjects that eventually developed persistent arthralgia. Although a strong neutralizing antibody response was observed in all subjects, it was not sufficient to prevent the long-term outcomes of MAYV infection. This study provides initial immunologic insight that may eventually contribute to prognostic tools and therapeutic treatments against this emerging pathogen.

Variabilidad climática y transmisión de malaria en Loreto, Perú: 1995-2007 / Climate variability and malaria transmission in Loreto, Peru: 1995-2007

Objetivos. Explorar la asociación entre las variables climáticas con la transmisión de malaria en Loreto, en un periodo de 13 años. Materiales y métodos. Estudio ecológico realizado con los datos mensuales promedio de temperatura (ºC), humedad relativa (por ciento), pluviosidad (mm) y nivel de río Amazonas (metros) con los casos de malaria confirmados por gota gruesa registrados por la Dirección Regional de Salud Loreto, se usó modelos de regresión lineal simple y múltiple. Resultados. Encontramos correlación negativa significativa entre temperatura y casos de malaria para cinco años: 1997, 1999, 2003, 2005 y 2006; nivel de río para cuatro: 1997, 1998, 2003 y 2005 y humedad para tres años: 1996, 2005, 2006. No se encontró asociación para ningún año con pluviosidad. Los modelos de regresión múltiple fueron significativos en tres años (1999, 2003 y 2006) con valores de r2 entre 0,870 y 0,937. Conclusiones. Algunas variables climáticas pueden estar asociadas con la transmisión de malaria pero la importancia de cada una de ellas puede variar año a año. Los años de presentación de El Niño o posteriores, son los años de mayor correlación. Cuando la temperatura promedio es menor es probable que los ciclos esporogónicos y gonotróficos del vector se vean favorecidos, es en ese momento que el potencial de transmisión de la población vectorial se hace máxima, lo cual favorece la transmisión de malaria.

Objectives. To explore the relationship between climatic variables with the transmission of malaria in Loreto, in a period of 13 years. Material and methods. Ecological study was conducted with data from the monthly average temperature (º C), relative humidity (per cent), precipitation (mm) and the level of the Amazon River (meters), with cases of malaria confirmed by thick smear recorded by the Dirección Regional de Salud de Loreto. In addition, it was used simple linear regression and multiple linear regression models to determine relationship between these variables and malaria transmission. Results. We found significant negative correlation between temperature and cases of malaria for five years: 1997, 1999, 2003, 2005 and 2006; river level for four years: 1997, 1998, 2003 and 2005; and humidity for three years: 1996, 2005, 2006. No association was found for any years with rainfall. The multiple regression models were significant in three years (1999, 2003 and 2006) with R2 values between 0.870 and 0.937. Conclusions. Some climate variables may be associated with the transmission of malaria, but the importance of each one may vary from year to year. The years of El Niño or later years are the best correlation. When the average temperature is low, it's probably that the sporozoite cycle vector and gametocyte cycle vector are advantaged. It is at this time that the potential for transmission of the vector population is high, which favors the transmission of malaria.

Intervención de control de un brote de malaria en Nuevo Pevas, Loreto / Intervention control an outbreak of malaria in Nuevo Pevas, Loreto

Introducción: Nuevo Pevas, centro poblado con diez años de creación situado en el distrito de Pevas, Loreto, presentó en febrero del 2000 un brote epidémico de malaria. Objetivo: describir las características del brote de malaria en la localidad de Nuevo Pevas y el desarrollo de las acciones dirigidas a su control. Material y Métodos: reportado y verificado el brote, un equipo de intervención desarrolló actividades integrales de control de brote. Resultados: sobre 2 000 habitantes, se muestreó al 98.7% de la población, leyendo 1 974 láminas. Se detectó y trató 231 casos de malaria, 185 por P. falciparum y 46 por P. vivax. Diez casos de malaria grave/complicada ameritaron hospitalización entre los que no se registraron fallecidos. La tasa de incidencia del periodo de intervención fue de 115.5 por 1 000 habitantes. Se reportaron tres fallecimientos poco antes de que el equipo inicie sus actividades a plenitud. Durante la intervención no hubo defunciones. Discusión: la intervención fue rápida, integral y efectiva. Se trabajaron las dos acciones que doctrinariamente tiene el Programa de control de malaria, la búsqueda activa de casos y el tratamiento y acciones de control vectorial. Conclusiones: es probable que de no haber actuado con prontitud la morbi-mortalidad hubiera sido mayor. Se trata de una población migrante, con poco tiempo en el área, sin historia de residencia en zona endémica, por lo tanto ninguna inmunidad relativa contra malaria.

Introduction: In February 2000 an outbreak of malaria ocurred in Nuevo Pevas, a town with ten years of establishment situated in the district of Pevas, Loreto. Objective: To describe the characteristics of the outbreak of malaria in the village of Nuevo Pevas and the actions developped for its control. Methods: Once the outbreak was reported and verified an intervention team carried out comprehensive control of the outbreak. Results: Over 2 000 habitants we performed 1 974 blood smears (98.7% of population), detecting and treating 231 cases of malaria, 185 by P.falciparum and 46 by P. vivax. Ten cases of severe malaria merit hospitalization but none of them died. The incidence rate of the intervention period was 115.5 per 1 000. Three deaths were reported shortly before the team starts full activities. During the intervention there were no deaths. Discussion: the intervention was prompt, thorough and effective. The two actions the team worked were doctrinaire for Malaria control program, such as active case finding and treatment and vector control activities. Conclusions: it is likely that of not having acted promptly morbidity and mortality were higher. This is a migrant population, with little time in the area, with no history of residence in an endemic area, therefore no immunity against malaria on.