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1.
Artigo em Inglês | MEDLINE | ID: mdl-32125378

RESUMO

BACKGROUND: Current knowledge on HIV-1 resistance to integrase inhibitors (INIs) is based mostly on subtype B strains. This contrasts with the increasing use of INIs in low- and middle-income countries, where non-B subtypes predominate. MATERIALS AND METHODS: HIV-1 drug resistance genotyping was performed in 30 HIV-1-infected individuals undergoing virological failure to raltegravir. Drug resistance mutations (DRMs) and HIV-1 subtype were characterized using Stanford HIVdb and phylogenetic analyses. RESULTS: Of the 30 integrase (IN) sequences, 14 were characterized as subtype F (47%), 8 as subtype B (27%), 7 as BF recombinants (23%) and 1 as a putative CRF05_DF (3%). In 25 cases (83%), protease and reverse transcriptase (PR-RT) sequences from the same individuals confirmed the presence of different BF recombinants. Stanford HIVdb genotyping was concordant with phylogenetic inference in 70% of IN and 60% of PR-RT sequences. INI DRMs differed between B and F IN subtypes, with Q148K/R/H, G140S and E138K/A being more prevalent in subtype B (63% versus 0%, P = 0.0021; 50% versus 0%, P = 0.0096; and 50% versus 0%, P = 0.0096, respectively). These differences were independent of the time on raltegravir therapy or viral load at the time of genotyping. INI DRMs in subtype F IN genomes predicted a lower level of resistance to raltegravir and no cross-resistance to second-generation INIs. CONCLUSIONS: Alternative resistance pathways to raltegravir develop in subtypes B and F IN genomes, with implications for clinical practice. Evaluating the role of HIV-1 subtype in development and persistence of mutations that confer resistance to INIs will be important to improve algorithms for resistance testing and optimize the use of INIs.

2.
Rev. argent. salud publica ; 10(38): 38-42, Abril 2019.
Artigo em Espanhol | LILACS, BINACIS, ARGMSAL | ID: biblio-996494

RESUMO

INTRODUCCIÓN: El diagnóstico oportuno de la infección por VIH es una estrategia clave en el control de la epidemia. El uso de las pruebas rápidas facilita el acceso al diagnóstico en el primer nivel de atención y en espacios por fuera del sistema de salud. MÉTODOS: Se describió el proceso de implementación del test rápido para VIH en la Ciudad Autónoma de Buenos Aires (CABA), analizando indicadores epidemiológicos para evaluar el impacto sanitario. RESULTADOS: Desde el inicio de esta estrategia en 2012 y hasta 2018, el test rápido se implementó en 36 centros de la ciudad, tanto en el sistema de salud como en organizaciones de la sociedad civil. En 2014 se inició una campaña de promoción con testeos mensuales en el espacio público de distintos barrios. El número de personas sometidas a la prueba se duplicó en los centros de testeo y aumentó progresivamente en los laboratorios de los hospitales públicos, con un descenso en la proporción de diagnósticos en estadios sintomáticos. CONCLUSIONES: La implementación de la prueba rápida para el diagnóstico de VIH en CABA muestra un modelo exitoso de oferta de prestación en los puntos de atención, que facilita el acceso al tamizaje y que puede extenderse para el diagnóstico y tratamiento de otras infecciones de transmisión sexual.


Assuntos
Humanos , Saúde Pública , HIV , Diagnóstico , Implementação de Plano de Saúde
3.
J Antimicrob Chemother ; 74(3): 722-730, 2019 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-30517632

RESUMO

OBJECTIVES: To assess the prevalence and patterns of pre-treatment HIV drug resistance (PDR) and HIV-1 subtype in infants from Argentina with exposure to different antiretroviral drugs (ARVs) for the prevention of mother-to-child transmission (PMTCT). PATIENTS AND METHODS: HIV-1 genotyping was performed in 115 infants (median age = 2.3 months) born between 2007 and 2014 to screen for drug resistance mutations (DRMs) before starting first-line ART. HIV-1 subtype was characterized by phylogenetic and recombination analysis. RESULTS: Overall, DRMs were found in 34 of 115 infants (PDR level 30% to any ARV, 3.5% to PIs, 12% to NRTIs and 22% to NNRTIs). Of the 115 infants, 22 (19.1%) were ARV-unexposed. Another 93 were ARV-exposed: 28 (24.3%) to short-course zidovudine monotherapy ARV prophylaxis; 25 (21.7%) to nevirapine-based ARV prophylaxis; 12 (10.4%) to perinatal infant zidovudine prophylaxis + maternal combination ART with NNRTIs; and 28 (24.3%) to perinatal infant zidovudine prophylaxis+maternal combination ART with PIs. Transmitted drug resistance among ARV-unexposed infants was 32% (5% to PIs, 9% to NRTIs and 18% to NNRTIs). ART-exposed infants showed multi-class ARV resistance. Importantly, vertical transmission of a triple-class-resistant virus was confirmed in one case. Patterns of DRMs predicted high-level resistance to NNRTIs in a similar and high proportion (>50%) of infants with at least one DRM independently of ARV exposure. BF recombinants were found in 74%, subtype B in 20%, subtype C in 3% and novel AG and AB recombinants in 3%. CONCLUSIONS: PDR in HIV-1-infected children from Argentina is among the highest reported, jeopardizing successful lifelong suppressive ART as well as the efficacy of current PMTCT regimens.

4.
Medicina (B Aires) ; 76(6): 349-354, 2016.
Artigo em Espanhol | MEDLINE | ID: mdl-27959842

RESUMO

The study aimed to determine the prevalence of antiretroviral resistance associated mutations in HIV-1 infected pregnant woman treated in Buenos Aires metropolitan area (period 2008-2014). A total of 136 women with viral load = 500 copies/ml were included: 77 (56.6%) were treatment-naïve and 59 (43.4%) were antiretroviral-experienced patients either with current (n: 24) or previous (n = 35) antiretroviral therapy. Genotypic baseline resistance was investigated in plasma of antiretroviral-naïve patients and antiretroviral-experienced patients. The resistance mutations were identified according to the lists of the World Health Organization and the International Antiviral Society, respectively. Frequencies of resistance associated mutations detected in 2008-2011 and 2012-2014 were compared. A total of 37 (27.2%) women presented at least one resistance associated mutation: 25/94 (26.5%) in 2008-2011 and 12/42 (28.5%) in 2012-2014 (p > 0.05). Among naïves, 15 (19.5%) had at least one mutation: 10/49 (20.4%) in the period 2008-2011 and 5/28 (17.8%) in 2012-2014 (p > 0.05). The resistance mutations detected in naïves were associated with non nucleoside reverse transcriptase inhibitors, being K103N the most common mutation in both periods. In antiretroviral experienced patients, 22/59 (37.3%) had at least one resistance mutation. This study demonstrates a high frequency of resistance associated mutations which remained stable in the period analyzed. These levels suggest an increased circulation of HIV-1 antiretroviral resistant strains in our setting compared to previous reports from Argentina.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Farmacorresistência Viral/efeitos dos fármacos , Infecções por HIV/tratamento farmacológico , HIV-1/efeitos dos fármacos , Complicações Infecciosas na Gravidez/tratamento farmacológico , Adolescente , Adulto , Fatores Etários , Terapia Antirretroviral de Alta Atividade/métodos , Argentina/epidemiologia , Farmacorresistência Viral/genética , Feminino , Genótipo , Idade Gestacional , Infecções por HIV/epidemiologia , Infecções por HIV/virologia , HIV-1/genética , Humanos , Mutação , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/virologia , Fatores de Tempo , Carga Viral , Adulto Jovem
5.
Medicina (B.Aires) ; 76(6): 349-354, dic. 2016. tab
Artigo em Espanhol | LILACS-Express | ID: biblio-841608

RESUMO

Se determinó la frecuencia de mutaciones asociadas a resistencia de HIV-1 a antirretrovirales en embarazadas del área metropolitana de Buenos Aires, 2008-2014. Se incluyeron 136 mujeres con carga viral ≥ 500 copias/ml: 77 (56.6%) eran naïve; las otras 59 (43.4%) eran expuestas, ya sea con tratamiento en curso (n: 24) o previo (n: 35). Se realizó análisis de resistencia genotípica basal en plasma de pacientes naïve y con experiencia de tratamiento antirretroviral. Las mutaciones se identificaron según las listas de la Organización Mundial de la Salud y la International Antiviral Society, respectivamente. Se comparó la frecuencia de mutaciones detectadas en los subperíodos 2008-2011 vs. 2012-2014. Un total de 37 (27.2%) mujeres presentaron ≥ 1 mutación asociada a resistencia: 25/94 (26.5%) en 2008-2011 y 12/42 (28.5%) en 2012-2014 (p > 0.05). Entre las naïve, 15 (19.5%) tenían ≥ 1 mutación: 10/49 (20.4%) en el subperíodo 2008-2011 y 5/28 (17.8%) en 2012-2014 (p > 0.05). Las mutaciones encontradas en pacientes naïve estuvieron asociadas a inhibidores no nucleosídicos de la transcriptasa reversa, y, como en estudios anteriores, K103N fue la más frecuente a lo largo de todo el período. Entre las pacientes expuestas, 22/59 (37.3%) presentaron ≥ 1 mutación asociada a resistencia. Este estudio demuestra una alta frecuencia de mutaciones asociadas a resistencia que se mantuvo estable a lo largo del período. Los niveles detectados sugieren una mayor circulación en nuestro medio de cepas de HIV-1 resistentes a antirretrovirales con respecto a los niveles previamente observados en Argentina.


The study aimed to determine the prevalence of antiretroviral resistance associated mutations in HIV-1 infected pregnant woman treated in Buenos Aires metropolitan area (period 2008-2014). A total of 136 women with viral load ≥ 500 copies/ml were included: 77 (56.6%) were treatment-naïve and 59 (43.4%) were antiretroviral-experienced patients either with current (n: 24) or previous (n = 35) antiretroviral therapy. Genotypic baseline resistance was investigated in plasma of antiretroviral-naïve patients and antiretroviral-experienced patients. The resistance mutations were identified according to the lists of the World Health Organization and the International Antiviral Society, respectively. Frequencies of resistance associated mutations detected in 2008-2011 and 2012-2014 were compared. A total of 37 (27.2%) women presented at least one resistance associated mutation: 25/94 (26.5%) in 2008-2011 and 12/42 (28.5%) in 2012-2014 (p > 0.05). Among naïves, 15 (19.5%) had at least one mutation: 10/49 (20.4%) in the period 2008-2011 and 5/28 (17.8%) in 2012-2014 (p > 0.05). The resistance mutations detected in naïves were associated with non nucleoside reverse transcriptase inhibitors, being K103N the most common mutation in both periods. In antiretroviral experienced patients, 22/59 (37.3%) had at least one resistance mutation. This study demonstrates a high frequency of resistance associated mutations which remained stable in the period analyzed. These levels suggest an increased circulation of HIV-1 antiretroviral resistant strains in our setting compared to previous reports from Argentina.

8.
J Int AIDS Soc ; 17(4 Suppl 3): 19704, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25397452

RESUMO

INTRODUCTION: Surveillance of primary resistance to antiretroviral drugs is particularly important in pregnant population, in which infection by drug-resistant HIV has not only implications for maternal treatment, but could also jeopardize the efficacy of neonatal prophylaxis. We aim to describe the prevalence of resistance associated mutations (RAMs) in pregnant women with intrapartum HIV diagnosis in a public hospital of Buenos Aires, Argentina. MATERIALS AND METHODS: Prospective pilot study (period from 2008 to October 2013). Plasma samples were tested for viral load by Versant HIV-1 RNA 3.0 (bDNA) and sequenced using HIV-1 TRUGENE™Genotyping Kit (Siemens). The prevalence of RAMs was analyzed according to World Health Organization (WHO) criteria. RESULTS: Of 231 HIV-infected pregnant women assisted, 6% (n=14) had intrapartum diagnosis of HIV infection. 12 patients (85.7%) had previous pregnancies, 10 (71.4%) had inadequate prenatal care and 3 (23.1%) seroconverted during pregnancy. Maternal characteristics (expressed medians and ranges) were: age 25.5 (16-35) years; gestational age at birth: 39 (30-42) weeks; CD4 count: 500 (132-925) cells/µL; viral load: 9418 (1800-55299) copies/mL. No one had hepatitis B virus (HBV) or hepatitis C virus (HCV) coinfection; four (33.3%) had syphilis. Eight patients (57.1%) had vaginal delivery and six emergency C-section (42.9%). In six cases (46.2%), membrane rupture was spontaneous; four patients (28.6%) failed to receive intrapartum zidovudine (ZDV) infusion. In 12 patients a genotypic resistance test was performed: two (16.7%) had WHO RAMs corresponding to K103N mutation in both cases, conferring high-level resistance to nevirapine (NVP) and efavirenz. Two newborns (14.3%) were preterm. All received neonatal prophylaxis: ZDV in 1 case and combined prophylaxis (ZDV/3TC/NVP) in the remaining 13 (92.9%). All newborns were formula-fed. Two (14.3%) had congenital syphilis, one of whom died. One newborn was HIV-infected (positive proviral DNA at 24 hours of life, wild-type HIV). CONCLUSIONS: This pilot study suggests that levels of transmitted resistance in this high-risk population of pregnant women could be moderate to high. We preliminarily observed high-level resistance to NVP: if this finding is confirmed with a larger sample, it could potentially jeopardize the utility of this drug in the combined neonatal prophylaxis recommended in the absence of maternal antiretroviral therapy.

9.
J Int AIDS Soc ; 16: 18519, 2013 Oct 03.
Artigo em Inglês | MEDLINE | ID: mdl-24093951

RESUMO

OBJECTIVE: Our objective was to estimate primary resistance in an urban setting in a developing country characterized by high antiretroviral (ARV) coverage over the diagnosed population and also by an important proportion of undiagnosed individuals, in order to determine whether any change in primary resistance occurred in the past five years. DESIGN: We carried out a multi-site resistance surveillance study according to WHO HIV resistance guidelines, using a weighted sampling technique based on annual HIV case reports per site. METHODS: Blood samples were collected from 197 drug-naive HIV-1-infected individuals diagnosed between March 2010 and August 2011 at 20 HIV voluntary counselling and testing centres in Buenos Aires. Clinical records of enrolled patients at the time of diagnosis were compiled. Viral load and CD4 counts were performed on all samples. The pol gene was sequenced and the resistance profile determined. Phylogenetic analysis was performed by neighbour-joining (NJ) trees and bootscanning analysis. RESULTS: We found that 12 (7.9%) of the 152 successfully sequenced samples harboured primary resistance mutations, of which K103N and G190A were the most prevalent. Non-nucleoside reverse transcriptase inhibitors (NNRTI) resistance mutations were largely the most prevalent (5.9%), accounting for 75% of all primary resistance and exhibiting a significant increase (p=0.0072) in prevalence during the past 10 years as compared to our previous study performed in 1997-2000 and in 2003-2005. Nucleoside reverse transcriptase inhibitor (NRTI) and protease inhibitor primary resistance were low and similar to the one previously reported. CONCLUSIONS: Levels of primary NNRTI resistance in Buenos Aires appear to be increasing in the context of a sustained ARV coverage and a high proportion of undiagnosed HIV-positive individuals.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Farmacorresistência Viral , Infecções por HIV/epidemiologia , Infecções por HIV/virologia , HIV-1/efeitos dos fármacos , Adulto , Fármacos Anti-HIV/farmacologia , Argentina/epidemiologia , Feminino , Genótipo , Infecções por HIV/tratamento farmacológico , HIV-1/isolamento & purificação , Humanos , Incidência , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Análise de Sequência de DNA , População Urbana , Adulto Jovem , Produtos do Gene pol do Vírus da Imunodeficiência Humana/genética
10.
Rev. argent. salud publica ; 1(4): 14-19, sept. 2010. tab
Artigo em Espanhol | LILACS | ID: lil-597388

RESUMO

INTRODUCCIÓN: la pasta base de cocaína (PBC) es una forma fumable de cocaína de creciente utilización entre los jóvenes. OBJETIVO: describir el patrón de consumo de drogas, las seroprevalencias de VIH, hepatitis B (VHB), hepatitis C (VHC), sífilis y otrosproblemas de salud en usuarios de PBC en un centro asistencial de Argentina. MÉTODO: se incluyeron voluntarios mayores de 18 años, asistidos en el Centro Nacional de Reeducación Social (CENARESO)en el período 2006-2007, que consumieron PBC en los 6 meses anteriores a la entrevista y que nunca utilizaron drogas inyectables. Se aplicó un cuestionario estructurado, se tomó una muestra de sangre para serología de VIH, VHB, VHC y sífilis, y se analizó una sub-muestra de radiografías de tórax. RESULTADOS: más de la mitad de los 146 voluntarios manifestó haber fumado PBC varias veces por semana. Los participantes eran también consumidores frecuentes de cocaína en polvo (64%), cannabis (80,8%) y tranquilizantes (44,5%). Los principales problemas de salud auto-percibidos como consecuencia del consumo de PBC fueron las lesiones orales y la pérdida de peso. El 4,3% de los voluntarios resultó VIH-positivo. Las prevalencias de infección por sífilis, VHB y VHC fueron 2,7%, 5,5%, y 5,5%, respectivamente. El 16% estaba coinfectado con uno o más de los agentes estudiados. DISCUSIÓN: la prevalencia de infecciones, unida a otros problemas de salud de los usuarios de PBC, indica la necesidad de nuevas investigaciones a fin de diseñar intervenciones preventivas y terapéuticas apropiadas


INTRODUCTION: cocaine paste is a smokable form of cocaine increasingly used among young people. OBJECTIVE:to describe patterns of drugs, seroprevalences of HIV, hepatitis B (HBV), hepatitis C (HCV), syphilis and other health problems among coca paste users assisted at a drug treatment center in Argentina. METHOD: volunteers, eighteen-year-old and olderassisted at the National Center for Social Re-education (CENARESO)during 2006-2007, who had consumed coca paste over the past 6 months previous to the interview and had never injected drugs, were selected. A structured questionnaire wasused and blood was drawn to test HIV, HBV, HCV and syphilis. A sub-sample of thorax X-rays was analyzed. RESULTS: morethan half of the 146 volunteers had smoked coca paste severaltimes a week. The use of other drugs was frequently associated: sniffed cocaine 64%, cannabis 80,8%, and tranquilizers 44,5. Oral lesions and lost of weight were referred as health problems stemming from coca paste use. Out of the 146 volunteers, 4.3%resulted HIV-positive. Prevalences of infection for syphilis, HBV, and HCV were 2,7%, 5,5% and 5,5%, respectively. 16% wasco-infected with one or more infectious agents. DISCUSSION: the prevalence of infections detected, along with other clinical problems found among this coca paste users, show the need for further research, in order to design proper preventive and therapeutic interventions


Assuntos
Humanos , Cocaína , Transtornos Relacionados ao Uso de Cocaína , Demografia , Epidemiologia Descritiva , Capacitação de Recursos Humanos em Saúde , Hepacivirus , Vírus da Hepatite B , Infecções por HIV/prevenção & controle , Recursos para a Pesquisa , Sífilis/prevenção & controle , Ensaio de Imunoadsorção Enzimática
11.
Actual. SIDA ; 18(67): 18-24, mar. 2010. tab
Artigo em Espanhol | BINACIS | ID: bin-125607

RESUMO

Dado que en Argentina el ensayo de HIV RNA cualitativo (QL) ha sido discontinuado, el objetivo del presente trabajo fue evaluar el ensayo de RNA cuantitativo (CV) COBAS AMPLICOR Monitor HIV-1 para su posible incorporación en el diagnóstico pediátrico de infección por HIV en niños expuestos perinatalmente y estimar la concordancia con QL. Fueron incluidas 214 muestras (134 pacientes), 174 muestras de 113 pacientes negativos y 40 correspondientes a 21 pacientes positivos con diagnóstico definitivo. Todas las muestras fueron estudiadas para CV usando el procedimiento estándar (ST, rango 400-750.000 copias/ml) y aquellas por debajo del rango lineal se procesaron por el método ultrasensible (US, rango 50-100.000 copias/ml). El ensayo de CV fue comparado con el de QL en un subgrupo de 93 muestras (78 negativas y 15 positivas). Las 174 muestras pertenecientes a niños HIV negativos tuvieron CV indetectables y entre las 40 muestras pertenecientes a niños HIV positivos, 37 evidenciaron CV detectables (2-5,88 log 10). En 4/37 muestras se detectaron CV entre 165-575 copias/ml, que en muestras posteriores evidenciaron altos valores de CV. El 83,7 % de las muestras resultaron con CV> a 4 log 10. La sensibilidad de la CV según grupo etario fue de 77,7 % < 15 días, 93,3 % entre 15-45 días y la especificidad general del 100 %. La concordancia global entre QL y CV fue del 97,8 %, siendo el ensayo de CV más sensible. Nuestros resultados sugieren la inclusión del ensayo COBAS AMPLICOR en el algoritmo diagnóstico, no presentando resultados falsos positivos.(AU)


Since in Argentina qualitative dHIV RNA (QL) test, has been discontinued, the objective of this study was to evaluate the quantitative RNA (VL) COBAS AMPLICOR monitor HIV-1, for its possible inclusion in the paediatric diagnosis of HIV infection and to evaluate the concordance between both assays. In this study 214 samples corresponding to 134 patients were included, 174 and 40 specimens from 113 HIV-negative and 21 HIV-positive patients respectively. All samples were studied for VL using the standard procedure (ST, range 400-750.000 copies/mal), and those below the linear range were further tested by the ultrasensitive method (US, range 50-100.000 copies/ml) QL and VL assays were compared among a subgroup of 93 samples (78 negative and 15 positive). All 174 samples from HIV negative children had undetectable VL. 37/40 samples from HIV-positive had detectable VL (2-5,88 log 10) 4/37 specimens had VL between 165-575 copies/ml, later samples from the corresponding patients showed high VL. 83,7 % of the samples had VL> 4 log 10. The sensitivities found were 77,7 % and 93,3 % among infants < 15 days and between 15-45 days of aged respectively. The general specificity of the COBAS AMPLICOR was 100 %. The concordance between QL and VL eas 97,8 %, showing the later one better sensitivity. Our results support the inclusion of COBAS AMPLICOR in the diagnosis algorithm, not showing false positive results.(AU)


Assuntos
Humanos , Criança , Técnicas e Procedimentos Diagnósticos , HIV/imunologia , Ácidos Nucleicos , Diagnóstico Precoce , RNA , Carga Viral/estatística & dados numéricos , Avaliação de Processos e Resultados (Cuidados de Saúde)/métodos , Terapia Antirretroviral de Alta Atividade/22074 , Técnicas de Amplificação de Ácido Nucleico/métodos
12.
Actual. SIDA ; 18(67): 18-24, mar. 2010. tab
Artigo em Espanhol | LILACS | ID: lil-566745

RESUMO

Dado que en Argentina el ensayo de HIV RNA cualitativo (QL) ha sido discontinuado, el objetivo del presente trabajo fue evaluar el ensayo de RNA cuantitativo (CV) COBAS AMPLICOR Monitor HIV-1 para su posible incorporación en el diagnóstico pediátrico de infección por HIV en niños expuestos perinatalmente y estimar la concordancia con QL. Fueron incluidas 214 muestras (134 pacientes), 174 muestras de 113 pacientes negativos y 40 correspondientes a 21 pacientes positivos con diagnóstico definitivo. Todas las muestras fueron estudiadas para CV usando el procedimiento estándar (ST, rango 400-750.000 copias/ml) y aquellas por debajo del rango lineal se procesaron por el método ultrasensible (US, rango 50-100.000 copias/ml). El ensayo de CV fue comparado con el de QL en un subgrupo de 93 muestras (78 negativas y 15 positivas). Las 174 muestras pertenecientes a niños HIV negativos tuvieron CV indetectables y entre las 40 muestras pertenecientes a niños HIV positivos, 37 evidenciaron CV detectables (2-5,88 log 10). En 4/37 muestras se detectaron CV entre 165-575 copias/ml, que en muestras posteriores evidenciaron altos valores de CV. El 83,7 % de las muestras resultaron con CV> a 4 log 10. La sensibilidad de la CV según grupo etario fue de 77,7 % < 15 días, 93,3 % entre 15-45 días y la especificidad general del 100 %. La concordancia global entre QL y CV fue del 97,8 %, siendo el ensayo de CV más sensible. Nuestros resultados sugieren la inclusión del ensayo COBAS AMPLICOR en el algoritmo diagnóstico, no presentando resultados falsos positivos.


Since in Argentina qualitative dHIV RNA (QL) test, has been discontinued, the objective of this study was to evaluate the quantitative RNA (VL) COBAS AMPLICOR monitor HIV-1, for its possible inclusion in the paediatric diagnosis of HIV infection and to evaluate the concordance between both assays. In this study 214 samples corresponding to 134 patients were included, 174 and 40 specimens from 113 HIV-negative and 21 HIV-positive patients respectively. All samples were studied for VL using the standard procedure (ST, range 400-750.000 copies/mal), and those below the linear range were further tested by the ultrasensitive method (US, range 50-100.000 copies/ml) QL and VL assays were compared among a subgroup of 93 samples (78 negative and 15 positive). All 174 samples from HIV negative children had undetectable VL. 37/40 samples from HIV-positive had detectable VL (2-5,88 log 10) 4/37 specimens had VL between 165-575 copies/ml, later samples from the corresponding patients showed high VL. 83,7 % of the samples had VL> 4 log 10. The sensitivities found were 77,7 % and 93,3 % among infants < 15 days and between 15-45 days of aged respectively. The general specificity of the COBAS AMPLICOR was 100 %. The concordance between QL and VL eas 97,8 %, showing the later one better sensitivity. Our results support the inclusion of COBAS AMPLICOR in the diagnosis algorithm, not showing false positive results.


Assuntos
Humanos , Criança , Carga Viral/estatística & dados numéricos , Técnicas e Procedimentos Diagnósticos , Diagnóstico Precoce , Avaliação de Processos e Resultados (Cuidados de Saúde)/métodos , HIV , Ácidos Nucleicos , RNA , Técnicas de Amplificação de Ácido Nucleico/métodos , Terapia Antirretroviral de Alta Atividade
15.
J Acquir Immune Defic Syndr ; 42(4): 506-10, 2006 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-16773027

RESUMO

Here we present a survey including 52 drug-naive recently HIV-1-infected subjects from Buenos Aires City and province (79%) and 3 other regions in Argentina (21%). Recent infections were established from previous negative serology (32/52), indeterminate Western blot (12/52), or acute retroviral syndrome after high-risk HIV exposure (8/52) within 9 months before genotyping (median time, 4.2 months). Genotyping was performed from plasma by sequencing both protease and reverse transcriptase. Phylogenetic analysis combined with bootscanning resulted in 21 subtype B sequences and 31 B/F recombinants (RecBF). On protease, minor resistance-related mutations were found in both subtype B and RecBF with low frequencies. The substitution L89M, recently suggested as a resistance-related mutation in some subtype F viruses, was observed in 1 RecBF. On reverse transcriptase, major resistance-related mutations were found in 4 of 52 (7.7%) patients from different health centers: M41L (subtype B) and K103N+/-P225H (1 RecBF and 2 subtype B). The greater than 5% resistance threshold found indicates a need for sentinel resistance surveillances calling for an update in the current resistance testing guidelines in Argentina.


Assuntos
Infecções por HIV/tratamento farmacológico , Mutação , Inibidores da Transcriptase Reversa/uso terapêutico , Argentina , Sequência de Bases , Primers do DNA , Feminino , HIV-1 , Humanos , Masculino , Filogenia , Polimorfismo Genético , Recombinação Genética , Reação em Cadeia da Polimerase Via Transcriptase Reversa
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