Association of Early Nasopharyngeal Immune Markers With COVID-19 Clinical Outcome: Predictive Value of CCL2/MCP-1.

Early recognition of severe forms of coronavirus disease 2019 (COVID-19) is essential for an opportune and effective intervention, reducing life-risking complications. An altered inflammatory immune response seems to be associated with COVID-19's pathogenesis and progression to severity. Here we demonstrate the utility of early nasopharyngeal swab samples for detection of the early expression of immune markers and the potential value of CCL2/MCP-1 in predicting disease outcome.

High frequency of antiviral drug resistance and non-b subtypes in HIV-1 patients failing antiviral therapy in Cuba.

INTRODUCTION: Emergence of HIV-1 drug resistance may limit the sustained benefits of antiretroviral therapy (ART) in settings with limited laboratory monitoring and drug options. The objective is to implement the surveillance of drug resistance and subtypes in HIV-1 patients failing ART in Cuba. METHODS: This study compiled clinical and genotypic drug resistance data 588 ART-experienced HIV-1 patients attending a clinical center in Havana in 2009-2013. Drug resistance testing was performed as part of routine clinical care. Drug resistance mutations and levels were determined using Rega version 8.0.2. RESULTS: Eighty-three percent received solely ART containing at least three drugs. Patients from 2009 to 2010 were longer treated (median: 4.9 vs 2.7 years) and exposed to more ART regimens (median: 4 vs 2 regimens) compared to patients from 2011-2013. Nucleoside reverse transcriptase inhibitor (NRTI), non-nucleoside RTI (NNRTI) and PI mutations were present in 83.5, 77.4 and 52.0%. Full-class resistance (FCR) to NRTI, NNRTI, PI and multidrug resistance (MDR) were detected in 25.0, 33.7, 11.4 and 6.3%. FCR to NRTI, NNRTI, PI and MDR were present in 12.8, 28.7, 0 and 0% after first-line failure (164 patients) and in 23.1, 34.6, 3.8 and 3.1% after second-line failure (130 patients). Subtype B (32.5%), BG recombinants (19.6%) and CRF19_cpx (16.2%) were the most prevalent genetic forms. Subtype distribution did not change significantly between 2009-2010 and 2011-2013, except for BG recombinants that increased from 12.2 to 21.3% (p=0.002). CONCLUSIONS: Our study found a high prevalence of drug resistance and supports the need for appropriate laboratory monitoring in clinical practice and access to drug options in case of virological failure.

Antiretroviral drug resistance in HIV-1 therapy-naive patients in Cuba.

In Cuba, antiretroviral therapy rollout started in 2001 and antiretroviral therapy coverage has reached almost 40% since then. The objectives of this study were therefore to analyze subtype distribution, and level and patterns of drug resistance in therapy-naive HIV-1 patients. Four hundred and one plasma samples were collected from HIV-1 therapy-naive patients in 2003 and in 2007-2011. HIV-1 drug resistance genotyping was performed in the pol gene and drug resistance was interpreted according to the WHO surveillance drug-resistance mutations list, version 2009. Potential impact on first-line therapy response was estimated using genotypic drug resistance interpretation systems HIVdb version 6.2.0 and Rega version 8.0.2. Phylogenetic analysis was performed using Neighbor-Joining. The majority of patients were male (84.5%), men who have sex with men (78.1%) and from Havana City (73.6%). Subtype B was the most prevalent subtype (39.3%), followed by CRF20-23-24_BG (19.5%), CRF19_cpx (18.0%) and CRF18_cpx (10.3%). Overall, 29 patients (7.2%) had evidence of drug resistance, with 4.0% (CI 1.6%-4.8%) in 2003 versus 12.5% (CI 7.2%-14.5%) in 2007-2011. A significant increase in drug resistance was observed in recently HIV-1 diagnosed patients, i.e. 14.8% (CI 8.0%-17.0%) in 2007-2011 versus 3.8% (CI 0.9%-4.7%) in 2003 (OR 3.9, CI 1.5-17.0, p=0.02). The majority of drug resistance was restricted to a single drug class (75.8%), with 55.2% patients displaying nucleoside reverse transcriptase inhibitor (NRTI), 10.3% non-NRTI (NNRTI) and 10.3% protease inhibitor (PI) resistance mutations. Respectively, 20.7% and 3.4% patients carried viruses containing drug resistance mutations against NRTI+NNRTI and NRTI+NNRTI+PI. The first cases of resistance towards other drug classes than NRTI were only detected from 2008 onwards. The most frequent resistance mutations were T215Y/rev (44.8%), M41L (31.0%), M184V (17.2%) and K103N (13.8%). The median genotypic susceptibility score for the commonly prescribed first-line therapies was 2.5. This analysis emphasizes the need to perform additional surveillance studies to accurately assess the level of transmitted drug resistance in Cuba, as the extent of drug resistance might jeopardize effectiveness of first-line regimens prescribed in Cuba and might necessitate the implementation of baseline drug resistance testing.

High frequency of antiviral drug resistance and non-B subtypes in HIV-1 patients failing antiviral therapy in Cuba.

BACKGROUND: Emergence of HIV-1 drug resistance may limit the sustained benefits of antiretroviral therapy (ART) in settings with limited laboratory monitoring and drug options. OBJECTIVES: Surveillance of drug resistance and subtypes in HIV-1 patients failing ART in Cuba. STUDY DESIGN: This study compiled data of ART-experienced HIV-1 patients attending a clinical center in Havana in 2003 and 2009-2011. The first period included results of a cross-sectional study, whereas in the second period genotyping was performed as part of routine care. Drug resistance mutations and levels were determined using HIVdb version 6.0.9. RESULTS: Seventy-six percent received solely ART containing at least 3 drugs, of which 79.1% ever receiving unboosted protease inhibitors (PI). Patients from 2009 to 2011 were longer treated and exposed to more ART regimens. Subtype B (39%) and CRF19_cpx (18%) were the most prevalent genetic forms. Subtype distribution did not change significantly between both periods, except for BG recombinants that increased from 6% to 14%. Nucleoside reverse transcriptase inhibitor (NRTI), non-nucleoside RTI (NNRTI) and PI mutations were present in 69.5%, 54.8% and 44.4%. Full-class resistance (FCR) to NRTI, NNRTI, PI and multidrug resistance (MDR) were detected in 31.8%, 37.9%, 18.5% and 15.4%. FCR to NRTI, NNRTI, PI and MDR were present in 9.8%, 14.1%, 0%, 0% after first-line failure and in 19.8%, 20.8%, 2.9% and 2.9% after second-line failure. CONCLUSIONS: Our study found a high prevalence of drug resistance and supports the need for appropriate laboratory monitoring in clinical practice and access to drug options in case of virological failure.

Segunda encuesta nacional de infecciones parasitarias intestinales en Cuba, 2009 / Second national survey of intestinal parasitic infections in Cuba, 2009

Introducción: en Cuba las parasitosis intestinales continúan siendo endémicas, con una mayor frecuencia en zonas rurales y montañosas. Después de haber transcurrido casi 25 años desde la última encuesta nacional, se hizo necesario hacer una nueva encuesta para conocer los índices de prevalencia de las parasitosis intestinales y comparar los resultados obtenidos entre ambos estudios. Tal conocimiento resultaría de gran valor para elaborar estrategias de salud y el diseño de programas de control de las infecciones parasitarias intestinales. Objetivo: determinar los índices actuales de prevalencia de las parasitosis intestinales, y comparar los resultados con los de la encuesta anterior luego de haber transcurrido 25 años. Métodos: se realizó un estudio descriptivo de corte trasversal durante los meses de mayo a agosto de 2009 en una muestra de la población cubana. A cada uno se le recogió una muestra de heces que fue analizada por el método de examen directo, la técnica de concentración de Willis y el examen de Kato-Katz; también se le llenó un cuestionario. Resultados: al comparar los resultados de las encuestas nacionales de infecciones parasitarias intestinales realizadas en 1984 y 2009, se encontró que en general disminuyeron las infecciones por parásitos, tanto los helmintos como los protozoos patógenos, aunque los infectados con comensales aumentaron su frecuencia en la de 2009. También se produjo una disminución de las frecuencias de infecciones por todas las especies de geohelmintos, Trichuris trichiura, Ascaris lumbricoides, ancylostomídeos, y Strongyloides stercoralis, así como por los protozoos patógenos Giardia lamblia y Entamoeba histolytica/E. dispar, y los comensales: Endolimax nana y Entamoeba coli en 2009. La única especie de parásito intestinal que aumentó su frecuencia con respecto a la encuesta de 1984 fue Enterobius vermicularis. En ambos estudios la frecuencia de infección con parásitos o comensales fue mayor en el grupo de 5 a 14 años (edad escolar). Conclusiones: al comparar los resultados de las encuestas nacionales de infecciones parasitarias intestinales realizadas en 1984 y 2009, se encontró que en general disminuyeron las frecuencias de infecciones con parásitos intestinales. El hallazgo en ambos estudios de una frecuencia mayor de infección con parásitos o comensales en el grupo de 5 a 14 años (edad escolar), respalda la recomendación de poner énfasis en los programas de control para las parasitosis intestinales en este grupo de edad.

Introduction: the intestinal parasitic infections are still endemic in Cuba, with a higher frequency in rural and mountain regions. Twenty five years after the last national survey, it deemed necessary to carry out a new national survey in order to know the prevalence of intestinal parasitic infections and to compare the obtained results between both studies. That knowledge would be valuable to work out strategies of health and to design a control program for intestinal parasitic infections in Cuba. Objective: to determine the current prevalence of intestinal parasitic infections in Cuba and to compare these results with those obtained from the previous survey after a 25 year-period. Methods: a cross sectional study was conducted from May to August of 2009 in a sample of Cuban population. A stool sample was collected from each individual, which was analyzed by direct examination, Willis' brine flotation method and the Kato-Katz thick smear technique. Additionally, a questionnaire was administered. Results: the comparison between 1984 and 2009 surveys showed a general decrease of frequencies of intestinal parasitic infections caused by both helminths and pathogenic protozoa; however, the percentage of infections with commensal protozoa increased in 2009. In this last survey, there was observed decline of frequencies of infections with soil transmitted species, Trichuris trichiura, Ascaris lumbricoides, hookworm, and Strongyloides stercoralis and the pathogenic protozoa: Giardia lamblia, Entamoeba histolytica/E. dispar, and the commensals: Endolimax nana and Entamoeba coli. The intestinal parasite Enterobius vermicularis was the only parasitic species that increased the frequency of infections with respect to the 1984 survey. The frequencies of parasitic and commensal infections in both studies were higher in the 5-14 y age group (school age). Conclusions: the comparison between the intestinal parasitic infections surveys of 1984 and 2009 showed a reduction in the frequencies of intestinal parasitic infections in the last survey. The finding in both studies of a higher frequency of pathogenic parasitic infections and commensal infections in the 5-14 y age group (school age) supports the recommendation of making emphasis on the control programs for intestinal parasitic infections in this age group.

[Second national survey of intestinal parasitic infections in Cuba, 2009]. / Segunda encuesta nacional de infecciones parasitarias intestinales en Cuba, 2009.

INTRODUCTION: the intestinal parasitic infections are still endemic in Cuba, with a higher frequency in rural and mountain regions. Twenty five years after the last national survey, it deemed necessary to carry out a new national survey in order to know the prevalence of intestinal parasitic infections and to compare the obtained results between both studies. That knowledge would be valuable to work out strategies of health and to design a control program for intestinal parasitic infections in Cuba. OBJECTIVE: to determine the current prevalence of intestinal parasitic infections in Cuba and to compare these results with those obtained from the previous survey after a 25 year-period. METHODS: a cross sectional study was conducted from May to August of 2009 in a sample of Cuban population. A stool sample was collected from each individual, which was analyzed by direct examination, Willis' brine flotation method and the Kato-Katz thick smear technique. Additionally, a questionnaire was administered. RESULTS: the comparison between 1984 and 2009 surveys showed a general decrease of frequencies of intestinal parasitic infections caused by both helminths and pathogenic protozoa; however, the percentage of infections with commensal protozoa increased in 2009. In this last survey, there was observed decline of frequencies of infections with soil transmitted species, Trichuris trichiura, Ascaris lumbricoides, hookworm, and Strongyloides stercoralis and the pathogenic protozoa: Giardiau lamblia, Entamoeba histolytica/E. dispar, and the commensals: Endolimax nana and Entamoeba coli. The intestinal parasite Enterobius vermicularis was the only parasitic species that increased the frequency of infections with respect to the 1984 survey. The frequencies of parasitic and commensal infections in both studies were higher in the 5-14 y age group (school age). CONCLUSIONS: the comparison between the intestinal parasitic infections surveys of 1984 and 2009 showed a reduction in the frequencies of intestinal parasitic infections in the last survey. The finding in both studies of a higher frequency of pathogenic parasitic infections and commensal infections in the 5-14 y age group (school age) supports the recommendation of making emphasis on the control programs for intestinal parasitic infections in this age group.