RESUMO
The subtypes of the human immunodeficiency virus - type 1 (HIV-1) strains from 54 HIV-1 - infected persons including 44 strains which were typed previously by heteroduplex mobility assay (HMA) were determined by DNA sequencing and phylogenetic analysis. Of 54 HIV- infected persons, 92.5% were infected with HIV-1 subtype B and 7.5% with other HIV-1 subtypes including subtypes D (3.7%), A (1.9%) and J (1.9%). In the phylogenetic analysis, the subtype A virus found in the sample clustered with subtype A reference strains and a circulating recombinant form (CRF) reference strain which originates in Central Africa and is circulating in Cuba indicating a close relationship between these viruses. There was 86% concordance between HMA and DNA sequencing in assigning subtype B viruses. For the non-B subtype viruses, there was less concordance between the two methods (67%). The results confirm the predominance of HIV-1 subtype B strains and the high genetic diversity of HIV-1 strains in circulation in Jamaica. The efficacies and some limitations of the HMA as a method of HIV-1 subtyping also were noted. It is important that the HIV/AIDS epidemic in Jamaica be monitored meticulously for possible expansions in non-B subtypes and the emergence of inter-subtype recombinant forms. We recommend that the more expensive DNA sequencing and phylogenetic analysis, including HIV-1 genotyping for antiretroviral drug resistance testing, be used as an adjunct to the more cost-effective HMA to track the HIV/AIDS epidemic in Jamaica.
Assuntos
DNA Viral/química , Variação Genética , Infecções por HIV/virologia , HIV-1/genética , HIV-1/classificação , Análise Heteroduplex , Humanos , Jamaica , Filogenia , Reprodutibilidade dos Testes , Análise de Sequência de DNA , Produtos do Gene env do Vírus da Imunodeficiência Humana/genética , Produtos do Gene gag do Vírus da Imunodeficiência Humana/genéticaRESUMO
PURPOSE: The emergency treatment of seizures is an important practical issue, in particular the therapy of status epilepticus. Antiepileptic drugs for this condition should be easy to use, show rapid action, have a long-lasting antiepileptic effect, and have minimal cardiopulmonary and other side-effects. Unfortunately, none of the presently available medications such as phenytoin and barbiturates seems to have all of these four properties. Intravenous valproate became available some years ago and first experiences show promising safety data and efficacy results. METHODS: We report a series of 102 adult patients who received standardized high dosage intravenous valproate in various emergency situations, including status epilepticus. The therapeutic goal was persistent seizure control, defined as successful interruption of clinical seizure activity within less than 15 min, followed by seizure freedom during intravenous therapy for at least 12h. All side effects were documented. RESULTS: In 83/97 patients (85.6%) the therapeutic goal was achieved. Serious side effects were not documented in any patient. In particular there was no evidence of sedation, cardiorespiratory disturbances and hypotension as often seen in barbiturates and phenytoin. Mild side effects occurred in seven cases (6.9%). CONCLUSIONS: The intravenous application of VPA seems to be an easy-to-use, safe and efficient formulation as an alternative to phenytoin in all seizure emergency situations including status epilepticus. Further controlled comparison studies have to be performed in the future.
Assuntos
Anticonvulsivantes/administração & dosagem , Convulsões/tratamento farmacológico , Estado Epiléptico/tratamento farmacológico , Ácido Valproico/administração & dosagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Benzodiazepinas/administração & dosagem , Feminino , Humanos , Injeções Intravenosas/métodos , Masculino , Pessoa de Meia-Idade , Fenitoína/administração & dosagem , Estudos Prospectivos , Tempo de Reação/efeitos dos fármacos , Estudos Retrospectivos , Fatores de Tempo , Resultado do TratamentoRESUMO
The subtypes of 141 isolates of human immunodeficiency virus type-1 (HIV-1) from Jamaica were determined by a combination of env and gag heteroduplex mobility analysis (HMA) genotyping. The majority of HIV-1 isolates were subtype B (131/141, 93.0%); one (0.8%) isolate each of subtypes C, D and E was found and 7 (4.9%) were indeterminate. These results and the failure of the sets of primers used to amplify some of the HIV-1 isolates provide strong evidence of genetic diversity of the HIV/AIDS epidemic in Jamaica. Surveillance of the circulating HIV-1 genetic subtypes is a pre-requisite for developing regional vaccine strategies and understanding the transmission patterns of the virus. This is the first study of its kind in Jamaica and the findings complement data from other Caribbean countries. This work supports the view of colleagues from the French and Spanish-speaking Caribbean that an epidemiological network supported by regional laboratories will help track this epidemic accurately with positive outcomes for the public.
Assuntos
Genes env , Genes gag , Infecções por HIV/epidemiologia , HIV-1/classificação , DNA Viral/análise , Países em Desenvolvimento , Feminino , Infecções por HIV/diagnóstico , HIV-1/genética , Humanos , Incidência , Jamaica/epidemiologia , Masculino , Reação em Cadeia da Polimerase/métodos , Medição de Risco , Estudos de Amostragem , Sensibilidade e EspecificidadeRESUMO
The subtypes of 141 isolates of human immunodeficiency virus type-1 (HIV-1) from Jamaica were determined by a combination of env and gag heteroduplex mobility analysis (HMA) genotyping. The majority of HIV-1 isolates were subtype B (131/141, 93.0); one (0.8) isolate each of subtypes C, D and E was found and 7 (4.9) were indeterminate. These results and the failure of the sets of primers used to amplify some of the HIV-1 isolates provide strong evidence of genetic diversity of the HIV/AIDS epidemic in Jamaica. Surveillance of the circulating HIV-1 genetic subtypes is a pre-requisite for developing regional vaccine strategies and understanding the transmission patterns of the virus. This is the first study of its kind in Jamaica and the findings complement data from other Caribbean countries. This work supports the view of colleagues from the French and Spanish-speaking Caribbean that an epidemiological network supported by regional laboratories will help track this epidemic accurately with positive outcomes for the public.
Los subtipos de 141 aislados del virus tipo 1 de la inmunodeficiencia humno (VIH-1) en Jamaica, fueron determinados combinando la genotipificación por análisis de heterodúplex (HMA) en los genes env y gag. La mayor parte de los aislados HIV-1 fueron del subtipo B (131/141, 93.0%), se halló uno (0.8%) aislado para cada uno de los subtipos C, D y E, en tanto que 7 (4.9%) fueron indeterminados. Estos resultados y el fallo de los conjuntos de primers usados para amplificar algunos de los aislados de VIH-1, ofrecen fuerte evidencia de la diversidad epidémica del VIH/SIDA en Jamaica. La vigilancia de los subtipos genéticos de VIH-1 en circulación, constituye un pre-requisito, tanto para desarrollar estrategias de vacunas a nivel regional, como para entender los patrones de transmisión del virus. Este es el primer estudio de este tipo en Jamaica, y nuestros hallazgos complementan los datos obtenidos en otros países del Caribe. Coincidimos con nuestros colegas del Caribe francófono e hispano-parlante en cuanto a que una red epidemiológica apoyada por los laboratorios regionales, nos ayudaría a continuar rastreando esta epidemia con exactitud, y con resultados positivos para el público.