Metabolic syndrome in people with HIV from Guatemala: analysis of components and risk factors.

BACKGROUND: People with HIV (PWH) in Latin America are at a greater risk of developing comorbidities due to the increasing burden of obesity and metabolic syndrome in the region. We explored the associations between social, cardiovascular and HIV-related risk factors with metabolic syndrome in PWH from Guatemala. METHODS: Cross-sectional study analyzing demographic, clinical and laboratory data from PWH. Metabolic syndrome diagnosis and components are defined by the harmonized Joint Scientific Statement criteria. Data were collected from July 2019 to March 2020 and analyzed using correlations and logistic regression. RESULTS: Median age was 39 years [IQR 31-48], 56.8% of participants were male and 31.5% (n = 266, 95% CI 0.28-0.34) had metabolic syndrome. Age (adjusted odds ratio (aOR): 1.03, 95% CI 1.02-1.05, p <0.001), urban dweller (aOR: 1.48, 95% CI 1.00-2.18, p = 0.049), low physical activity (aOR: 1.45, 95% CI 1.01-2.08, p = 0.046), hyperuricemia (aOR: 3.31, 95% CI 1.93-5.67, p <0.001), current CD4+ T cell count < 200 cells/mm3 (aOR: 1.96, 95% CI 1.19-3.23, p = 0.009), 6 months of efavirenz (aOR: 1.89, 95% CI 1.29-2.77, p = 0.001), and obesity (aOR: 37.0, 95% CI 7.70-178.2, p < 0.001) were independently associated with metabolic syndrome. CONCLUSIONS: Prevalence of metabolic syndrome in this study was high and driven mainly by social and cardiovascular risk factors such as age, urban dwelling, obesity, hyperuricemia and low physical activity. Efavirenz use and CD4 count were the only HIV-related factors associated with metabolic syndrome.

Factors associated with viremia in people living with HIV on antiretroviral therapy in Guatemala.

INTRODUCTION: Viral suppression prevents HIV transmission and disease progression, but socio-economic and clinical factors can hinder the goal of suppression. We evaluated factors associated with viral non suppression (VNS) and persistent viremia (PV) in people living with HIV (PLHIV) receiving antiretroviral therapy (ART) in Guatemala. METHODS: We conducted a cross sectional analysis using data from an ongoing cohort of PLHIV attending the largest HIV clinic in Guatemala. Univariable and multivariable analyses were conducted between PLHIV with viral suppression and detectable viremia. VNS was defined as most recent HIV RNA ≥ 200 copies/ml and PV as two consecutive HIV RNA ≥ 200 copies/ml. RESULTS: Of 664 participants, 13.3% had VNS and 7.1% had PV. In univariable analysis disaggregated by gender, low income, poor education, perceived difficulty attending healthcare, and alcohol use were associated with VNS in men while low CD4 at diagnosis, multiple prior ART regimens and treatment interruptions were significant in both genders. Multiple prior ART regimens (adjusted Odds Ratio (aOR) 2.82, [95% confidence interval (CI) 1.59, 4.99], p < 0.01), treatment interruptions (aOR 4.51, [95% CI 2.13, 9.58], p < 0.01), excessive alcohol consumption (aOR 2.56, [95% CI 1.18, 5.54], p < 0.05) perceived difficulty attending healthcare (aOR 2.07, [ 95% CI 1.25, 3.42], p < 0.01) and low CD4 at diagnosis (aOR 2.34, 95% [CI 1.30, 4.20], p < 0.01) were independently associated with VNS on multivariable regression. CONCLUSIONS: We conclude that socio-economic and clinical factors influence viral suppression in our cohort and vary between men and women. Gender specific approaches are necessary to achieve the 90% suppression goal.

Caracterización de factores asociados a la infección por el virus de la hepatitis C Guatemala 2017 / Characterization of factors associated with infection with the hepatitis C virus Guatemala 2017

Antecedentes: Actualmente se estima que a nivel mundial cerca de 150 millones de personas están infectadas con virus de la hepatitis C (HCV) y se encuentran en riesgo de padecer cirrosis hepática y/o cáncer hepático. De estas, aproximadamente 350,000 mueren cada año por las causas antes mencionadas.(1) En Guatemala, los programas de prevención se han concentrado en el tamizaje y detección de la enfermedad en donantes de sangre, madres embarazadas, pacientes con alcoholismo crónico, usuarios de drogas, entre otros. Objetivo: Caracterizar y describir los principales factores asociados a la infección por el VHC. Materiales y Métodos: Es un estudio ambispectivo, descriptivo y analítico realizado en 138 pacientes con diagnóstico de infección por el HCV que asisten a la Clínica de Enfermedades Infecciosas de Hospital Roosevelt en el período 2007-2016. Se analizaron 29 variables agrupadas en cinco. categorías: características sociodemográficas, características de referencia, factores asociados a la infección por el HCV, características serológicas y virológicas del HCV y criterios para el cumplimiento de tratamiento. Cada una estás fue descrita en base a frecuencias, porcentajes y se calcularon intervalos de confianza al 95% para las variables relacionadas con los factores asociados a la infección por el HCV. También se estudiaron las relaciones entre los factores demográficos y los factores asociados con las pruebas estadísticas Xi cuadrado (a:0.10) y OR. Resultados: 138 pacientes fueron estudiados. 67 hombres y 71 mujeres, con edad promedio de 45 años. El perfil sociodemográfico más común en base a estos pacientes es una persona de 45 años de edad, residente de la ciudad capital, heterosexual, soltero(a), con una profesión u ocupación no relacionada a la salud y con un nivel de escolaridad de diversificado. Los factores asociados a la infección por el VHC que presentaron mayor porcentaje fueron; el antecedente de múltiples parejas sexuales (37%), transfusión de algún hemoderivado (30%) antecedente de alcoholismo (27%) y relaciones sexuales extramaritales sin protección. El 36% de los pacientes cumplió con criterios para inicio de tratamiento. Únicamente el 35% de los pacientes fue referido de otros hospitales nacionales o clínicas particulares. Conclusiones: La hepatitis C en pacientes diagnosticados y en seguimiento en Hospital Roosevelt, corresponden a donantes de sangre referidos, pacientes co-infectados con VIH o de Clínicas privadas u otros centros. Es importante generar programas de detección activa pues con los tratamientos actuales se puede curar a mas del 95% de los pacientes y evitar su progresión a cirrosis o cáncer de hígado...(AU)

Abstract: Currently it is estimated worldwide that about 150 million people are infected with Hepatitis C Virus (HCV) and are at risk for developing cirrhosis and/or liver cancer. From these, approximately 350,000 people die each year from the conditions described previously (1). In Guatemala, prevention programs have focused on screening persons who donate blood, pregnant women, patients with a history of chronic alcoholism, intravenous drug users, etc. Objective: Characterize and describe the main factors associated with HCV infection. Materials and Methods: This current study is ambispective, descriptive and analytic. It was conducted in 138 patients with a diagnosis of HCV infection attending the Infectious Diseases Clinic, Roosevelt Hospital in 2007-2016. A total of 29 variables were registered and grouped within 5 categories (social and demographic characteristics, characteristics of reference, factors associated with HCV infection, virological and serological characteristics and criteria satisfaction for the initiation of HCV infection treatment). Results: 138 patients were studied: 67 male and 71 female with an average age of 45 years. The most common sociodemographic profile in these patients was a person of 45 years of age, residing within the city, heterosexual, single, with a profession or occupation not related to health services, and with a high school education level. The factors associated with HCV infection with the highest percentage were; history of multiple sexual partners (37%), transfusion of some blood products (30%) alcoholism (27%) and unprotected extramarital sex. Thirty-six percent of the patients met criteria for initiating treatment. Only 35% of the patients were referred from other national hospitals or private clinics. Conclusions: Hepatitis C in patients diagnosed and seconded at Roosevelt Hospital correspond to referred blood donors, patients co-infected with HIV or from private clinics or other centers. It is important to generate active screening programs because with current treatments more than 95% can be cured and therefore prevent their progression to cirrhosis or liver cancer...(AU)

The MANGUA Project: A Population-Based HIV Cohort in Guatemala.

Introduction. The MANGUA cohort is an ongoing multicenter, observational study of people living with HIV/AIDS in Guatemala. The cohort is based on the MANGUA application which is an electronic database to capture essential data from the medical records of HIV patients in care. Methods. The cohort enrolls HIV-positive adults ≥16 years of age. A predefined set of sociodemographic, behavioral, clinical, and laboratory data are registered at entry to the cohort study. Results. As of October 1st, 2012, 21 697 patients had been included in the MANGUA cohort (median age: 33 years, 40.3% female). At enrollment 74.1% had signs of advanced HIV infection and only 56.3% had baseline CD4 cell counts. In the first 12 months after starting antiretroviral treatment 26.9% (n = 3938) of the patients were lost to the program. Conclusions. The implementation of a cohort of HIV-positive patients in care in Guatemala is feasible and has provided national HIV indicators to monitor and evaluate the HIV epidemic. The identified percentages of late presenters and high rates of LTFU will help the Ministry to target their current efforts in improving access to diagnosis and care.

Perfil de resistencia del VIH-1 a anti-retrovirales en pacientes con fallo virològico: Hospital Roosevelt-Guatemala 2008-2012 / Patterns of HIV-1 resistance to antiretroviral drugs in patients with virologic failure: Roosevelt Hospital, Guatemala 2008-2012

Objective: To assess the secondary resistance patterns of HIV-1to Anti-Retroviral Agents drugs (ART) in patients with virological failure in the main HIV care center in Guatemala. Methods: Using the Stanford HIV Database,HIV pol sequences were analyzed to obtain resistance patterns in patients with first-failure to ART or multiple-failures (2 or more regimens failed), from 2008 to 2012. Proportions and odds ratio (OR) with 95% confidence intervals (95%CI) were calculated. Results: 83% (43) in the first-failure and 75% (30) in multiple-failures had resistance. The highest frequency (70%)of resistance was found in the non-nucleoside-inhibitors ART family. 44% (42) showed resistance to two ART families and 4% (4) to the three families. First-failure patients had higher risk of nucleoside-inhibitor resistance (OR:3.0, 95%CI 1.29-6.98) and multidrug resistance (OR:4.94, 95%CI 1.98-12.32). Most frequent mutations were: M184V, K103N and K65R (71, 50 and 22%, respectively). 70% of patients with first-failure were resistant to at least one of the drugs used as second ART in Guatemala (ABC, ddI or AZT). Conclusions: The high level of HIV-1 resistance to ART observed, suggest the need to amend the current second line regimen treatments in Guatemala and the importance of viral genotyping in all patients with first-failure to ART.

Objetivo: Evaluar el perfil de resistencia secundaria del VIH-1 a anti-retrovirales (ARV) en pacientes con fallo virológico en la clínica de atención integral más grande de Guatemala. Métodos: Uso de Stanford HIV Database para análisis de secuencias pol para perfiles de resistencia de VIH en pacientes con fallo virológico al primer esquema ARV o fallo múltiple (dos o más esquemas ARV fallidos), entre los años 2008 y 2012. Determinación de proporciones y análisis de riesgo. Resultados: Evidencia de resistencia de 83% (n: 43) en primer fallo y 75% (n: 30) en fallo múltiple. La mayor frecuencia de resistencia se presentó en los inhibidores-no-nucleosídicos (70%). Cuarenta y cuatro por ciento (n: 42) evidenció resistencia a dos familias de ARV y 4% (n: 4) a las tres familias. Pacientes con primer fallo tuvieron más riesgo de resistencia a inhibidores-nucleosídicos (OR: 3,0; IC 95% 1,29-6,98) y más riesgo de multi-resistencia (OR: 4,94; IC 95% 1,98-12,32). Mutaciones más frecuentes fueron: M184V, K103N y K65R (71, 50 y 22%, respectivamente). Setenta por ciento de los pacientes con primer fallo presentaron resistencia a al menos uno de los medicamentos utilizado como segunda línea en Guatemala (ABC/ddI/AZT). Conclusiones: El alto nivel de resistencia del VIH-1 a los ARV observada, sugiere la necesidad de modificar el actual esquema terapéutico de rescate en Guatemala y la importancia de realizar genotipificación viral en todos los pacientes con fallo al primer esquema.

[Patterns of HIV-1 resistance to antiretroviral drugs in patients with virologic failure: Roosevelt Hospital, Guatemala 2008-2012]. / Perfil de resistencia del VIH-1 a anti-retrovirales en pacientes con fallo virològico: Hospital Roosevelt-Guatemala 2008-2012.

OBJECTIVE: To assess the secondary resistance patterns of HIV-1to Anti-Retroviral Agents drugs (ART) in patients with virological failure in the main HIV care center in Guatemala. METHODS: Using the Stanford HIV Database,HIV pol sequences were analyzed to obtain resistance patterns in patients with first-failure to ART or multiple-failures (2 or more regimens failed), from 2008 to 2012. Proportions and odds ratio (OR) with 95% confidence intervals (95%CI) were calculated. RESULTS: 83% (43) in the first-failure and 75% (30) in multiple-failures had resistance. The highest frequency (70%)of resistance was found in the non-nucleoside-inhibitors ART family. 44% (42) showed resistance to two ART families and 4% (4) to the three families. First-failure patients had higher risk of nucleoside-inhibitor resistance (OR:3.0, 95%CI 1.29-6.98) and multidrug resistance (OR:4.94, 95%CI 1.98-12.32). Most frequent mutations were: M184V, K103N and K65R (71, 50 and 22%, respectively). 70% of patients with first-failure were resistant to at least one of the drugs used as second ART in Guatemala (ABC, ddI or AZT). CONCLUSIONS: The high level of HIV-1 resistance to ART observed, suggest the need to amend the current second line regimen treatments in Guatemala and the importance of viral genotyping in all patients with first-failure to ART.