Human immunodeficiency virus and other sexually transmitted diseases in Cuban women.

A cross-sectional study was performed in 60 Cuban women of child-bearing age who were seropositive for human immunodeficiency virus (HIV) and 60 controls. Human papillomavirus (HPV) was identified most frequently, with oncogenic HPV serotypes 16, 33 and 58 detected in HIV-positive patients, and serotypes 11, 33 and 51 in the controls (relative risk 4.41; 95% CI 2.21-8.29). Syphilis and hepatitis B and C viruses were detected exclusively in HIV-seropositive women (p<0.05). Sexually transmitted diseases (STDs) appeared to pose a substantial health problem, especially for HIV-positive women. Clinics should consider screening and treatment for STDs as part of their HIV prevention programmes.

Viral isolation from cases of epidemic neuropathy in Cuba.

OBJECTIVE: To investigate the possibility of a viral agent in the central nervous system of patients with epidemic neuropathy. DESIGN: Virus isolation attempts, in cell cultures and suckling mice, from cerebrospinal fluid (CSF) of neuropathy patients and controls undergoing lumbar puncture for unrelated reasons. Serologic studies in patients, contacts, and controls. SETTING: An epidemic of optic and peripheral neuropathy affected more than 50,000 people in Cuba in 1991 through 1993. Illness was associated with dietary limitations and increased physical demands accompanying the shortages of food and fuel experienced in Cuba since 1989. Most patients responded to parenteral vitamin therapy, and the epidemic began to subside when oral vitamin supplementation was begun for the entire Cuban population. RESULTS: Coxsackievirus A9 (five isolates) and a similar, less cytopathic virus (100 isolates) were recovered from 105 (84%) of 125 CSF specimens from neuropathy patients. The strains with light cytopathic effect were antigenically related to Coxsackieviruses A9 and B4 by cross-neutralization and immunoblotting assays. Virus persisted in CSF of some patients for 1 to 12 months. Cerebrospinal fluid from patients and both types of virus from cell culture produced illness, including complete posterior flaccid paralysis, in newborn mice, and virus was reisolated from the mice. Mouse tissues and sural nerve biopsy specimens from patients were stained by immunoperoxidase and colloidal gold techniques using hyperimmune rabbit antisera against the virus with light cytopathic effect. CONCLUSIONS: Coxsackievirus A9 or an antigenically related agent with a light cytopathic effect was present in CSF of 84% of 125 patients with epidemic neuropathy. The role of these agents, probably in combination with nutritional factors, in the pathophysiology of the disease requires further investigation.

[Meningoencephalitis caused by Herpesviridae family virus in Cuba. 1996-1998]. / Meningoencefalitis por virus de la familia Herpesviridae en Cuba. Período 1996-1998.

Herpesvirus isolation from cerebrospinal fluid (CSF) has proven not to be very useful because of its low sensitivity; that is the reason why PCR has considerably improved the diagnosis of several viral infections of the central nervous system. We studied, by means of PCR, 253 CSF received in our laboratory from 1996 to 1998, which had a suspected diagnosis of herpesviral-associated neurologic disease (encephalitits or meningoencephalitis). Of these, 182 were from HIV seropositive patients and the other 71 were from HIV seronegative. The percentage of all positive cases was 22.5% in AIDS patients and CMV was the virus most frequently detected (13.7%). We detected a percentage of 29.5 of positive cases in immunocompetent individuals, being HSV the virus most frequently found. Other herpesviruses (varicella-zoster virus, Epstein-Barr virus, human herpesvirus 6) were also detected in some cases in both groups. Finally, we obtained clinical data from all positive patients and established a relationship with PCR results.

[Herpesvirus detection in immunocompromised patients with meningoencephalitis by the polymerase chain reaction technic]. / Detección de herpesvirus en pacientes inmunocomprometidos con meningoencefalitis, mediante la técnica de reacción en cadena de la polimerasa.

The multiple polymerase chain reaction technique was used to detect in a single assay tube the presence of herpes simplex virus (HSV), Cytomegalovirus (CMV). Epstein Barr virus (EBV), varicella zoster virus (VZV), and/or human herpes virus-6 (HHV6). 50 cerebrospinal fluids from patients with AIDS and clinically suspected to have meningoencephalitis due to HSV were received and analyzed at the laboratories of Sexually Transmitted Diseases of the Virology Department of the "Pedro Kourí" Tropical Medicine Institute from 1993 to 1996. 4 of them were positive to HSV, 3 to CMV, 2 to VZV, and 1 to HHV6 for a positivity of 20%. The results of the PCR were correlated to the clinical findings presented by the patients at the time of the lumbar puncture. The introduction of this technique in the laboratory allows to have an easy, fast and useful tool for the diagnosis of meningoencephalitis due to herpesvirus.

[Western blot study of sera from patients with epidemic neuropathy]. / Estudio por western blot de sueros de pacientes con neuropatía epidémica.

The immune response of a group of patients with epidemical neuropathy and of controls was studied by the immunoblotting technique against proteins of the Coxsackie virus and the proteins of slow effect isolated in our laboratory. 13 sera of patients with epidemical neuropathy and 9 sera of controls were studied. Of the 13 sera studied, 8 (61.5%) recognized protein VPI and 2 sera (15.3%) protein VP0 of the strain 47.93. Of the 9 controls studied, 4 (44.4%) recognized protein VPI and 3 (33.3%) protein VP0 only. With the antigen prepared from the slow effect strain it was obtained a specific signal in 5 (38.5%) sera of patients and in 2 sera (22.5%) of controls. It should be stressed that in this last case the protein observed had a molecular weight of 41,300 D, and that its size was smaller than that of the preceding protein detected against the strain 47.93 was of 45,000 D.

[Follow-up serological study of herpes simplex and cytomegalovirus in Cuban patients infected with human immunodeficiency virus (HIV)]. / Estudio serológico evolutivo a herpes simple y citomegalovirus en pacientes cubanos infectados con el virus de la inmunodeficiencia humana (VIH).

The evolution serological response against the herpes simplex virus and citomegalovirus in HIV infected patients grouped into different stages of the disease was studied. Fluctuations in the TPG of antibodies were observed in these values in a cyclical way through time. There was a greater significant difference among the TPG of antibodies against HSV in the group of asymptomatic patients compared with AIDS patients and with those who died. There is a marked decrease in the TPG of antibodies against HSV and CMV approximately one year before the death of patients.

[Prevalence of antibodies against herpes simplex virus, Epstein-Barr virus and cytomegalovirus in a group of patients after hemodialysis]. / Prevalencia de anticuerpos contra virus herpes simple, virus Epstein-Barr y citomegalovirus en un grupo de pacientes con hemodiálisis realizada.

Infections from herpes virus play a key role in post-transplantation pathology, so it is indispensable to characterize the group of would-be renal transplant recipients. IgG antibody titers were detected by indirect immunofluorescence to Herpes simplex virus, Epstein Barr virus (EBV) and cytomegalovirus (CMV) in 100 patients treated with hemodialysis in the Nephrology Institute. The prevalence of antibodies to cytomegalovirus and to Herpes simplex and Epstein Barr viruses was 100% and 95% respectively. Average geometric titers (AGT) of antibodies to CMV were significantly higher. There was no correlation between AGT and sex, age, time of disease remission, number of blood transfusions and number of transplants.

[Cuban epidemic neuropathy. II. The antigenic characteristics of the viral isolates]. / Neuropatía epidémica cubana. Parte II. Algunas características antigénicas de los aislamientos virales.

With the aim of characterizing antigenically isolations producing mild cytopathogenic effect obtained from the cerebrospinal fluid of patients presenting with epidemic neuropathy, neutralization tests and western blot analysis were performed using hyperimmune sera of patients and hyperimmune sera of rabbits. It was confirmed that isolations with mild cutopathogenic effect studied have the same antigenic characteristics and that they are related to Coxsackie A9 and B4 viruses. Structural proteins were not detected in the strains with mild cytopathogenic effects, only antigens having a high molecular weight which were considered as precursor proteins for viral replication were confirmed.

[Virological diagnosis of an outbreak of fever and rashes caused by parvovirus B19, Cuba, 1995]. / Diagnóstico virológico de un brote de fiebre y rash producido por parvovirus B19, Cuba, 1995.

The results obtained in the study of an a outbreak of fever and rash occurred in Havana City in March, 1995, are reported. Dengue, measles, rubella, herpes simplex, and Epstein Barr were discarded as causal agents of the outbreak in the samples of 35 patients. Parvovirus B19 was identified as the causing agent of the outbreak by the detection of IgM antibodies and the polymerase chain reaction technique (PCR). The infection produced by this agent was confirmed in 14/18 samples (77.7%) by some of the techniques used. This study makes reference to the first outbreak of Parvovirus B19 that was proved in Cuba.

[Cuban epidemic neuropathy. IV. The antigenic relationship of the viral isolates to the structures of the central nervous system. A possible etiopathogenic mechanism?]. / Neuropatía epidémica cubana. Parte IV. Relación antigénica de los aislamientos virales con estructuras del sistema nervioso central. Posible mecanismo etiopatogénico?

Results which allow to state the existence of antigenic relationships between viruses isolated from the cerebrospinal fluid of patients presenting with epidemic neuropathy and structures of the human central nervous system are reported. These evidences were obtained by 2 different and independent ways: 1) by the double diffusion method in agarose, immunoblot analysis, and immunohistochemical analysis it was confirmed that antibodies induced by isolated viruses react with antigens of the central and peripheral nervous system, 2) serum obtained by the immunization of a rabbit with human brain extract neutralizes the same viruses as those neutralized by hyperimmune sera obtained by isolations. The possible role of viruses as mediators of an autoimmune process in the pathogenesis of the disease is discussed.

[The physicochemical characterization of the agents isolated during the outbreak of epidemic neuropathy in Cuba. I]. / Caracterización físico-química de los agentes aislados durante el brote de neuropatía epidémica en Cuba. Parte I.

This paper reports on the physical and chemical characteristics of agents isolated from serum samples of patients presenting with epidemic neuropathy. The behaviour of isolated enteroviruses was as described for such viruses. Mild cytopathogenic effects-producing agents behaved in a variable form regarding sensitivity to chloroform; on the other hand they were neither sensitive to phosphonoacetic acid (PAA) nor to guanidine hydrochloride (GHC1) and grew in cells previously treated with bromodeoxyuridine (BDUR). These results suggest the presence of agents resembling enteroviruses and enveloped viruses. Further studies for the characterization of such agents need to be performed.

[The factors affecting the growth of the agent, producing a mild cytopathic effect, isolated in patients with epidemic neuropathy]. / Factores que influyen en el crecimiento del agente productor del efecto citopático ligero aislado en pacientes con neuropatía epidémica.

Certain factors influencing upon the growth of the agent producer of mild cytopathogenic effect and isolated from the cerebrospinal fluid of patients presenting with epidemic neuropathy are described in this paper. It was demonstrated that a concentration of NaHCO3 was essential for the occurrence of the cytopathogenic effect. Determined concentrations of MnCl2 allowed for the visualization of the cytopathogenic effect and increased viral yields.

[Standardization of the plaque method for viruses isolated in patients with epidemic neuropathy]. / Normalización del método de placas para los virus aislados en pacientes con neuropatía epidémica.

This paper reports on the necessary conditions for plaque development in mild cutopathogenic effect-producing agents which were isolated from samples of the cerebrospinal fluid of patients presenting with epidemic neuropathy.

[Eradication of measles in Cuba]. / La eliminación del sarampión en Cuba.

The vaccine against measles came into use in Cuba in 1971. During the seventies, a new early strategy for measles control was established, and it was followed by further efforts in the early eighties. Despite improvements to the control program, disease outbreaks continued to occur. In 1986, after examining the experience acquired through the control initiatives that were already in place, a new measles vaccination strategy was adopted. In time, the new vaccination strategy against measles came to have three main components: first, a single vaccination "catching-up" campaign targeting children 1 to 14 years of age. Second, efforts were made to achieve and maintain high vaccine coverage through mandatory vaccination services for 12-month-old children ("maintenance vaccination"). Finally, periodic "follow-up" campaigns were carried out for children 2 to 6 years of age. Steps were taken, for the purpose of monitoring the progress made so far toward eliminating measles, to strengthen disease surveillance systems, including the screening of suspected cases. The "catching-up" and "follow-up" campaigns both achieved greater than 98% coverage within targeted age groups. The routine vaccination program has also maintained high coverage. The high population immunity against measles that has been attained through these vaccination strategies has resulted in a rapid decrease in the incidence of the disease. From 1989 to 1992, less than 20 laboratory-confirmed cases were reported annually. In Cuba, the last case confirmed through serologic screening was reported in July 1993. Cuba's strategy for measles elimination has interrupted disease transmission and kept the causal virus from circulating on the island. Cuba's experience with measles elimination suggests that if an appropriate vaccination strategy is applied, measles can be globally eradicated.

[The physicochemical characterization of the strains isolated during the outbreak of epidemic neuropathy in Cuba. II]. / Caracterización físico-química de los agentes aislados durante el brote de neuropatía epidémica en Cuba. Parte II.

The presence of 2 agents such as a Cox A9 strain and another mild cytopathogenic effect-producing strain, both isolated from patients presenting with epidemic neuropathy is reported in this paper. A mild cutopathogenic effect which was propagated in successive dilutions was developed in the dilution 10(-4) by means of the neutralization test of a Coxsackie A9 virus with its homologous hyperimmune serum. A gradient in saccharose was performed in a mild cytopathogenic effect-producing strain and a typical cytopathogenic effect of an Enterovirus developed from one of the fractions passed in tissular cultures in the presence phosphonoacetic acid (PAA). The possible pathogenic role of these viruses are discussed.

A phase I clinical trial of a multi-epitope polypeptide TAB9 combined with Montanide ISA 720 adjuvant in non-HIV-1 infected human volunteers.

A phase I clinical trial was performed to examine the safety and immunogenicity of a multi-epitope polypeptide comprising the central 15 amino acids of the V3 loop from six HIV-1 isolates. This protein called TAB9 was emulsified in Montanide ISA720 (Seppic, Paris) and administered intramuscularly at doses of 0, 0.2 and 1 mg to 24 healthy, HIV-1 seronegative adult males. Three immunisations were given at months 0, 1 and 6 in a randomised, double blind, placebo controlled clinical trial. The placebo was generally well tolerated. However, severe local reactions were observed in TAB9 vaccinated subjects after the second and third inoculations. Seven out of eight volunteers from the lower dose group showed moderate or severe local inflammation, while four out of eight subjects from the higher dose group developed granulomas and sterile abscesses. In general, the reactogenicity depended on the number of inoculations given and the dose of TAB9. Both doses were immunogenic, all immunised volunteers seroconverted and antibodies were broadly reactive against the V3 peptides included in the protein. All vaccine's sera reacted against gp120 in Western blot and 50% of them also neutralised at least one out of five laboratory isolates tested. No differences between doses were found. Anti TAB9 lymphoproliferative responses were observed, being more intense in the high dose group. Due to the strong local reactions that were found in this study, a change in the formulation will be required for further trials with this vaccine candidate in humans.

Meningoencefalitis por virus de la familia Herpesviridae en Cuba. Período 1996-1998. / [Meningoencephalitis caused by Herpesviridae family virus in Cuba. 1996-1998]

Herpesvirus isolation from cerebrospinal fluid (CSF) has proven not to be very useful because of its low sensitivity; that is the reason why PCR has considerably improved the diagnosis of several viral infections of the central nervous system. We studied, by means of PCR, 253 CSF received in our laboratory from 1996 to 1998, which had a suspected diagnosis of herpesviral-associated neurologic disease (encephalitits or meningoencephalitis). Of these, 182 were from HIV seropositive patients and the other 71 were from HIV seronegative. The percentage of all positive cases was 22.5

in AIDS patients and CMV was the virus most frequently detected (13.7

). We detected a percentage of 29.5 of positive cases in immunocompetent individuals, being HSV the virus most frequently found. Other herpesviruses (varicella-zoster virus, Epstein-Barr virus, human herpesvirus 6) were also detected in some cases in both groups. Finally, we obtained clinical data from all positive patients and established a relationship with PCR results.

Meningoencefalitis por virus de la familia Herpesviridae en Cuba. Período 1996-1998 / Meningoencephalitis caused by Herpesviridae family virus in Cuba. 1996-1998

Herpesvirus isolation from cerebrospinal fluid (CSF) has proven not to be very useful because of its low sensitivity; that is the reason why PCR has considerably improved the diagnosis of several viral infections of the central nervous system. We studied, by means of PCR, 253 CSF received in our laboratory from 1996 to 1998, which had a suspected diagnosis of herpesviral-associated neurologic disease (encephalitits or meningoencephalitis). Of these, 182 were from HIV seropositive patients and the other 71 were from HIV seronegative. The percentage of all positive cases was 22.5 in AIDS patients and CMV was the virus most frequently detected (13.7). We detected a percentage of 29.5 of positive cases in immunocompetent individuals, being HSV the virus most frequently found. Other herpesviruses (varicella-zoster virus, Epstein-Barr virus, human herpesvirus 6) were also detected in some cases in both groups. Finally, we obtained clinical data from all positive patients and established a relationship with PCR results.(AU)

Meningoencefalitis por virus de la familia Herpesviridae en Cuba. Período 1996-1998 / Meningoencephalitis caused by Herpesviridae family virus in Cuba. 1996-1998

Herpesvirus isolation from cerebrospinal fluid (CSF) has proven not to be very useful because of its low sensitivity; that is the reason why PCR has considerably improved the diagnosis of several viral infections of the central nervous system. We studied, by means of PCR, 253 CSF received in our laboratory from 1996 to 1998, which had a suspected diagnosis of herpesviral-associated neurologic disease (encephalitits or meningoencephalitis). Of these, 182 were from HIV seropositive patients and the other 71 were from HIV seronegative. The percentage of all positive cases was 22.5 in AIDS patients and CMV was the virus most frequently detected (13.7). We detected a percentage of 29.5 of positive cases in immunocompetent individuals, being HSV the virus most frequently found. Other herpesviruses (varicella-zoster virus, Epstein-Barr virus, human herpesvirus 6) were also detected in some cases in both groups. Finally, we obtained clinical data from all positive patients and established a relationship with PCR results.