Honduras HIV cohort: HLA class I and CCR5-Δ32 profiles and their associations with HIV disease outcome.

IMPORTANCE: We identify both canonical and novel human leukocyte antigen (HLA)-HIV associations, providing a first step toward improved understanding of HIV immune control among the understudied Honduras Mestizo population. Our results are relevant to understanding the protective or detrimental effects of HLA subtypes in Latin America because their unique HLA diversity poses challenges for designing vaccines against HIV and interpreting results from such vaccine trials. Likewise, the description of the HLA profile in an understudied population that shows a unique HLA immunogenetic background is not only relevant for HIV immunology but also relevant in population genetics, molecular anthropology, susceptibility to other infections, autoimmune diseases, and allograft transplantation.

Transversalización de la ética en intervenciones comunitarias y atención integral en salud para personas viviendo con VIH / Ethics mainstreaming in community interventions and integral health care to people living with HIV

En este artículo se presenta una reflexión sobre la vinculación de las intervenciones comunitarias y la atención integral en salud, para personas infectadas por el virus de la inmunodeficiencia humana (VIH), desde una perspectiva ética. Se parte de revisar los conceptos sobre moral, ética y bioética, además del escenario de las intervenciones comunitarias como estrategia final en la mejora de la salud de una comunidad. La atención integral en salud se valora con acciones de vigilancia, tales como: promoción de salud, prevención de enfermedades, vigilar y controlar el daño, así como brindar una atención dirigida a la recuperación y rehabilitación de la salud de las personas, con pertinencia cultural y enfoques de género, con un componente ético que asegure el adecuado funcionamiento de las intervenciones comunitarias y la atención integral en salud (AU).

This article offers a reflection, from an ethical point of view, on the linking of the community interventions and the comprehensive health care for people living with HIV. It begins reviewing the concepts of moral, ethics and bioethics, and also the surroundings of the community interventions as a final strategy in improving the community health. The comprehensive health care is assessed through surveillance actions as health promotion, disease prevention, monitoring and damage control; it also includes providing care aimed to people´s health recovery and rehabilitation, with cultural pertinence and gender approach and an ethic component, ensuring the adequate functioning of the community interventions and the comprehensive health care (AU).

HIV Drug Resistance Surveillance in Honduras after a Decade of Widespread Antiretroviral Therapy.

INTRODUCTION: We assessed HIV drug resistance (DR) in individuals failing ART (acquired DR, ADR) and in ART-naïve individuals (pre-ART DR, PDR) in Honduras, after 10 years of widespread availability of ART. METHODS: 365 HIV-infected, ART-naïve, and 381 ART-experienced Honduran individuals were enrolled in 5 reference centres in Tegucigalpa, San Pedro Sula, La Ceiba, and Choluteca between April 2013 and April 2015. Plasma HIV protease-RT sequences were obtained. HIVDR was assessed using the WHO HIVDR mutation list and the Stanford algorithm. Recently infected (RI) individuals were identified using a multi-assay algorithm. RESULTS: PDR to any ARV drug was 11.5% (95% CI 8.4-15.2%). NNRTI PDR prevalence (8.2%) was higher than NRTI (2.2%) and PI (1.9%, p<0.0001). No significant trends in time were observed when comparing 2013 and 2014, when using a moving average approach along the study period or when comparing individuals with >500 vs. <350 CD4+ T cells/µL. PDR in recently infected individuals was 13.6%, showing no significant difference with PDR in individuals with longstanding infection (10.7%). The most prevalent PDR mutations were M46IL (1.4%), T215 revertants (0.5%), and K103NS (5.5%). The overall ADR prevalence in individuals with <48 months on ART was 87.8% and for the ≥48 months on ART group 81.3%. ADR to three drug families increased in individuals with longer time on ART (p = 0.0343). M184V and K103N were the most frequent ADR mutations. PDR mutation frequency correlated with ADR mutation frequency for PI and NNRTI (p<0.01), but not for NRTI. Clusters of viruses were observed suggesting transmission of HIVDR both from ART-experienced to ART-naïve individuals and between ART-naïve individuals. CONCLUSIONS: The global PDR prevalence in Honduras remains at the intermediate level, after 10 years of widespread availability of ART. Evidence of ADR influencing the presence of PDR was observed by phylogenetic analyses and ADR/PDR mutation frequency correlations.