[Assessment of the humoral immunity induced by Sputnik V COVID-19 vaccine (Gam-COVID-Vac) in healthcare workers]. / Evaluación de la respuesta de los anticuerpos IGG específicos contra SARS-CoV-2 en el personal de salud con el esquema completo de la vacuna Sputnik V (Gam-COVID-Vac).

Background: Vaccination for COVID-19 in healthcare workers (HCW) is essential to protect one of the populations most exposed to this disease. However, data on the humoral response rate to the vaccine and the factors associated with it in this population are limited. Therefore, we aimed to evaluate the antibody response against SARS-CoV-2 in HCWs with complete Sputnik V vaccine scheme and factors associated with an increased antibody response. Material and methods: Prospective study to evaluate the anti-SARS-CoV-2 humoral response in HCWs vaccinated with two doses of the Sputnik V vaccine (April-July 2021). The assessment of anti-Spike IgG antibodies in plasma was performed using the COVIDAR IgG enzyme-linked immunosorbent assay. A logistic regression was performed to identify independent factors associated with a positive IgG serology test and an elevated antibody response. Results: A total of 630 HCWs were enrolled. Median age (IQR): 47 years (35-56). Female sex: 462 (73.33%). Previous COVID-19: 158 (25%). The median interval time between vaccine doses was 3 (3-4) weeks. Positive serology was observed in 607 (96.35%) HCWs. In the multivariate analysis, a history of systemic reactogenicity was identified as an independent variable associated with a positive serology; and history of systemic reactogenicity, COVID-19, interval between doses ≥ 4 weeks and time to serology < 14 weeks were associated with an elevated antibody response. Conclusions: This study provides data on the humoral response to the Sputnik V vaccine in a real-life setting. These initial data can contribute to the development of future immunization strategies in HCWs.

Resistance to HIV integrase strand transfer inhibitors in Argentina: first interim survey / Resistencia a inhibidores de la integrasa en Argentina: primera encuesta interina

OBJECTIVES: No data on resistance to HIV integrase strand transfer inhibitors (InSTIs) in Argentina are available as access to these drugs and to integrase genotypic resistance test is limited. We aimed to evaluate the clinical profile of patients who underwent an integrase genotypic resistance test, prevalence of InSTI resistance mutations and predicted efficacy of raltegravir, elvitegravir and dolutegravir in our country. PATIENTS AND METHODS: Retrospective multicentric pilot survey from January 2011 to November 2017 of InSTI-failing patients assisted at two private and one public healthcare institutions located in Buenos Aires city, Argentina. RESULTS: Sixty seven patients were included. Patients had a median of 5 (4-7) prior treatments. All patients had InSTI-containing regimens (median exposure of 22.5 months); 94% were under raltegravir therapy and 71.9% had InSTI-resistance mutations. Predominant major mutations were N155H (35.1%), Q148H/R (15.8%) and G140A/S (14%). Considering Stanford HIVdb program, extremely low and identical activity of raltegravir and elvitegravir was described while dolutegravir remained either partially or fully active in 97.7% of patients. CONCLUSIONS: Integrase resistance test was prescribed almost exclusively in heavily pretrated raltegravir-exposed patients. The three main mutational pathways were described, with a predominance of N155H. Despite almost null susceptibility and extensive cross resistance was shown among raltegravir and elvitegravir, dolutegravir remains active in the majority of patients

OBJETIVOS: No hay datos disponibles sobre resistencia a inhibidores de la integrasa (INIs) en Argentina, ya que el acceso a estas drogas y al estudio de resistencia genotípica es limitado. Nuestro objetivo fue evaluar el perfil clínico de los pacientes a los que se les indicó un estudio de resistencia genotípico de integrasa, la prevalencia de mutaciones de resistencia INIs y la predicción de eficacia para raltegravir, elvitegravir y dolutegravir en nuestro país. PACIENTES Y MÉTODOS: Encuesta piloto retrospectiva multicéntrica, enero de 2011 a noviembre de 2017, de pacientes con fallo virológico a INIs asistidos en dos instituciones de salud privadas y una pública en Buenos Aires, Argentina. RESULTADOS: Se incluyeron 67 pacientes, con una mediana de 5 (4-7) tratamientos previos. Todos tenían regímenes con INIs (exposición media de 22,5 meses); el 94% estaba recibiendo raltegravir y el 71,9% tenía mutaciones de resistencia a INIs. Las mutaciones primarias predominantes fueron N155H (35,1%), Q148H/R (15,8%) y G140A/S (14%). Considerando el programa de HIVdb de la Universidad de Stanford, se describió una actividad extremadamente baja e idéntica para raltegravir y elvitegravir, mientras que dolutegravir se mantuvo parcial o totalmente activo en el 97,7% de los pacientes. CONCLUSIONES: La prueba de resistencia a la integrasa se indicó casi exclusivamente en pacientes experimentados en tratamiento antirretroviral y expuestos a raltegravir. Se describieron las vías mutacionales principales, con predominio de N155H. Pese a la susceptibilidad casi nula y extensa resistencias cruzada entre raltegravir y elvitegravir, dolutegravir permaneció activo en la mayoría de los pacientes

Antiretroviral Therapy Containing Raltegravir to Prevent Mother-to-Child Transmission of HIV in Infected Pregnant Women.

We conducted a retrospective study in a general hospital in Buenos Aires, Argentina (2009-2015) aimed at evaluating outcomes in HIV-infected pregnant women (HIPW), who were prescribed raltegravir (RAL)-containing antiretroviral therapy (ART). A total of 239 HIPW were enrolled in our study; among them 31 received RAL (12.9%) at different clinical stages: i) intensification (INS): addition of RAL to current ART because of detectable antepartum viral load, 13 (41.9%); ii) late presenter (LP): standard ART + RAL as fourth drug, 15 (48.4%); iii) treatment of resistant-HIV: 3 (9.7%). Median gestational age at RAL initiation was 34 weeks and median exposure was 30 days. In INS-group, median viral load (VL) decrease was 1.48 log10. In LP-group, median VL decline was 2.15 log10. No clinical adverse events or maternal intolerance attributable to RAL were observed. Elective cesarean section was done in 51.7%; mild elevation of transaminases was observed in 35% of neonates. No vertical transmission was documented.

Rilpivirine resistance associated mutations in HIV-1 infected pregnant women / Mutaciones asociadas a resistencia a rilpivirina en embarazadas infectadas por VIH-1

No disponible

Score de sensibilidad genotípico de tratamientos antirretrovirales en embarazadas naïve infectadas por VIH-1 / Genotypic sensitivity score of antiretroviral therapies in naïve HIV-1 infected pregnant women

Introducción: el score de sensibilidad genotípica (GSS) es una herramienta para predecir el resultado virológico del TARV. El objetivo de este estudio es comparar el GSS de tres tratamientos an-tirretrovirales (TARVs) en una población de embarazadas infectadas por VIH (EIV) naïve en Buenos Aires, Argentina. Materiales y Métodos: se analizaron las pruebas de resistencia de 47 EIV naïve en la ciudad de Buenos Aires (período 2008-2011), utilizan-do el algoritmo de la Universidad de Stanford-HIVdb program (pre-valencia de resistencia primaria del 21,2 %). La eficacia predicha de cada fármaco se computó como 1,00-0,75-0,50-0,25 y 0,00 para las cinco categorías HIVdb: desde susceptible a resistencia de alto nivel. El GSS se obtuvo con la suma de las puntuaciones de los fármacos individuales incluidos (GSS = 3, significa tres medicamentos total-mente activos). Tres TARVs se compararon: zidovudina+lamivudina más nevirapina (ART1), nelfinavir (ART2) o lopinavir/ritonavir (ART3). Resultados: se obtuvo un GSS de 3 en el 80,9 % con ART1 y el 91,5 % con ART2 y ART3. No hubo diferencia estadísticamente significati-va en la posibilidad de lograr un GSS de 3 entre los TARVs evaluados. Conclusiones: no hubo diferencia estadística en la probabilidad de proporcionar un régimen comple-tamente activo con un inhibidor de la proteasa o nevirapina. En nuestra opinión, un TARV con una alta barrera genética sería preferible en el contex-to de la alta prevalencia de resistencia primaria ob-servada

Background: The genotypic sensitivity score (GSS) is a tool to predict virological treatment outcome. The objective of this study is to compare the GSS of three antiretroviral treatment (ART) strategies in a population of naive pregnant women (NPW) in Buenos Aires city, Argentina. Methods: Resistance tests from 47 NPW were analyzed in the context of a sentinel resistance surveillance study in Buenos Aires city (period 2008-2011), considering the genotype interpretation system of the Stanford HIVdb program (prevalence of primary drug resistance of 21.2%). The predicted efficacy of each drug was scored either as 1.00-0.75-0.50-0.25 and 0.00 for the five HIVdb categories: from susceptible to high-level resistance. GSS was obtained with the sum of the scores for the individual drugs included in a regimen (GSS of 3 means three fully active drugs). GSS of three ARTs were compared: zidovudine+lamivudine plus either nevirapine (ART1), nelfinavir (ART2) or lopinavir/ritonavir (ART3). Results: A GSS of 3 was achieved in 80.9% with ART1 and 91.5% with both ART2 and ART3. There was no statistical difference in the possibility of achieving a GSS of 3 between the three ARTs evaluated. Conclusions: There was no statistical difference in the probability of providing a fully active regimen with either a protease inhibitor or nevirapine. In our opinion, an ART with a high genetic barrier backbone may be preferred in the context of the high prevalence of primary resistance observed

Reactivación de la enfermedad de Chagas en el sistema nervioso central de pacientes infectados por el virus de la inmunodeficiencia humana / Central nervous system reactivation of Chagas' disease in HIV-infected patients

La reactivación de la enfermedad de Chagas (ECH) en pacientes infectados por el virus de la inmunodeficiencia humana (VIH) puede causar lesiones cerebrales ocupantes. Considerando que el diseño de un algoritmo para el diagnóstico precoz podría reducir la mortalidad, deben considerarse diversos escenarios: 1) ¿Cuándo debe indicarse el examen parasitológico (EP) del frotis de sangre periférica y líquido cefalorraquídeo (LCR)? 2) ¿debe realizarse aún en aquellos pacientes con serología negativa para Trypanosoma cruzi?, 3) ¿en qué casos el tratamiento para la encefalitis por T. gondii puede interrumpirse?

Reactivation of Chagas disease (CHD) in patients infected with Human Immunodeficiency Virus (HIV) can cause brain mass lesions. As the design of an algorithm for early diagnosis could reduce mortality, different secenarios should be considered:1) when the parasitologic examination (PE) of peripheral blood smears and cerebrospinal fluid(CSF) should be indicated? 2) should it de performed even in patients with negative serology for Trypanosoma cruzi? 3) in which cases the treatment for T. gondii encephalitis can be discontinued?

Reactivación de la enfermedad de Chagas en el sistema nervioso central de pacientes infectados por el virus de la inmunodeficiencia humana / Central nervous system reactivation of Chagas disease in HIV-infected patients

La reactivación de la enfermedad de Chagas (ECH) en pacientes infectados por el virus de la inmunodeficiencia humana (VIH) puede causar lesiones cerebrales ocupantes. Considerando que el diseño de un algoritmo para el diagnóstico precoz podría reducir la mortalidad, deben considerarse diversos escenarios: 1) ¿Cuándo debe indicarse el examen parasitológico (EP) del frotis de sangre periférica y líquido cefalorraquídeo (LCR)? 2) ¿debe realizarse aún en aquellos pacientes con serología negativa para Trypanosoma cruzi?, 3) ¿en qué casos el tratamiento para la encefalitis por T. gondii puede interrumpirse?(AU)

Reactivation of Chagas disease (CHD) in patients infected with Human Immunodeficiency Virus (HIV) can cause brain mass lesions. As the design of an algorithm for early diagnosis could reduce mortality, different secenarios should be considered:1) when the parasitologic examination (PE) of peripheral blood smears and cerebrospinal fluid(CSF) should be indicated? 2) should it de performed even in patients with negative serology for Trypanosoma cruzi? 3) in which cases the treatment for T. gondii encephalitis can be discontinued?(AU)

Brucellosis complicating chronic non-infectious disorders: diagnostic and therapeutic dilemmas.

There is little information in the literature on the clinical progress of brucellosis in patients affected by other non-infectious diseases; however, the infection can often trigger an exacerbation of existing underlying conditions in certain target organs. In this report we present four cases of brucellosis complicating previous diseases, and the difficulties in relation to their diagnosis and treatment. The study involved four patients with the following disorders: polycythaemia vera, pulmonary fibrosis, cirrhosis of the liver and arthritis of the knee. Brucellosis was diagnosed by classical serological and bacteriological methods. The strains involved could be isolated only in three of the four patients: two strains were Brucella abortus biovar 1 and one was Brucella suis biovar 1. Two patients relapsed 10 and 7 months after admission, another presented chronic brucellosis and received various therapy schemes, and one died. Since the best selection of antibiotics and the optimal duration of therapy remain unknown for patients having brucellosis complicated by previous pathologies, these remain at the discretion of the attending physician. Management of our patients was controversial in terms of the selection of antibiotics, duration of treatment and decision regarding surgery.