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1.
Clin Infect Dis ; 64(8): 1092-1097, 2017 04 15.
Artículo en Inglés | MEDLINE | ID: mdl-28329390

RESUMEN

Background: In Western countries emergence of human immunodeficiency virus (HIV) drug resistance has tremendously decreased, and transmission of drug resistance has merely stabilized in recent years. However, in many endemic settings with limited resources rates of emerging and transmitted drug resistance are not regularly assessed. Methods: We performed a survey including all HIV-infected individuals who received resistance testing in 2010-2015 in Aruba, a highly endemic HIV area in the Caribbean. Transmitted HIV drug resistance was determined using World Health Organization (WHO) criteria. Transmission dynamics were investigated using phylogenetic analyses. In a subset, baseline samples were re-analyzed using next generation sequencing (NGS). Results: Baseline resistance testing was performed in 104 newly diagnosed untreated individuals (54% of all newly diagnosed individuals in 2010-2015): 86% were men, 39% were foreign-born, and 22% had AIDS at diagnosis. And 33% (95% CI: 24-42%) was infected with a drug-resistant HIV variant. The prevalence of resistance to non-nucleoside reverse transcriptase inhibitors (NNRTIs) reached 45% (95% CI: 27-64%) in 2015, all based on the prevalence of mutation K103N. NGS did not demonstrate additional minority K103N-variants compared to routine resistance testing. K103N-harboring strains were introduced into the therapy-unexposed population via at least 6 independent transmissions epidemiologically linked to the surrounding countries. Virological failure of the WHO-recommended first-line NNRTI-based regimen was higher in the presence of K103N. Conclusions: The prevalence of resistant HIV in Aruba has increased to alarming levels, compromising the WHO-recommended first-line regimen. As adequate surveillance as advocated by the WHO is limited, the Caribbean region could face an unidentified rise of NNRTI-resistant HIV.


Asunto(s)
Fármacos Anti-VIH/farmacología , Farmacorresistencia Viral , Infecciones por VIH/epidemiología , Infecciones por VIH/virología , VIH/efectos de los fármacos , Adulto , Fármacos Anti-VIH/uso terapéutico , Región del Caribe/epidemiología , Femenino , VIH/aislamiento & purificación , Infecciones por VIH/transmisión , Humanos , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios
2.
Ned Tijdschr Geneeskd ; 134(21): 1046-8, 1990 May 26.
Artículo en Holandés | MEDLINE | ID: mdl-2366895

RESUMEN

A retrospective study was conducted in 60 patients with stab or gunshot wounds to assess whether selective management is also justified if personnel involved has not had a great deal of experience. With selective management the results of the physical examination determine whether a laparotomy will or will not be performed.


Asunto(s)
Traumatismos Abdominales/terapia , Heridas Penetrantes/terapia , Traumatismos Abdominales/epidemiología , Adolescente , Adulto , Niño , Humanos , Laparotomía , Persona de Mediana Edad , Antillas Holandesas/epidemiología , Complicaciones Posoperatorias/etiología , Heridas por Arma de Fuego/terapia , Heridas Penetrantes/epidemiología , Heridas Punzantes/terapia
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