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Collaco JM, Abman SH, Austin ED, Avitabile CM, Bates A, Fineman JR, Freire GA, Handler SS, Ivy DD, Krishnan US, Mullen MP, Varghese NP, Yung D, Nies MK, Everett AD, Zimmerman KO, Simmons W, Chakraborty H, Yenokyan G, Newell‐Sturdivant A, Christensen E, Eyzaguirre LM, Hanley DF, Rosenzweig EB, Romer LH. Kids Mod PAH trial: A multicenter trial comparing mono- versus duo-therapy for initial treatment of pediatric pulmonary hypertension. Pulm Circ 2023; 13:e12305. [PMID: 37915400 PMCID: PMC10617301 DOI: 10.1002/pul2.12305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 09/20/2023] [Indexed: 11/03/2023] Open
Abstract
Pulmonary hypertension (PH) is a significant health problem that contributes to high morbidity and mortality in diverse cardiac, pulmonary, and systemic diseases in children. Evidence-based advances in PH care have been challenged by a paucity of quality endpoints for assessing clinical course and the lack of robust clinical trial data to guide pharmacologic therapies in children. While the landmark adult AMBITION trial demonstrated the benefit of up-front combination PH therapy with ambrisentan and tadalafil, it remains unknown whether upfront combination therapy leads to more rapid and sustained clinical benefits in children with various categories of PH. In this article, we describe the inception of the Kids Mod PAH Trial, a multicenter Phase III trial, to address whether upfront combination therapy (sildenafil and bosentan vs. sildenafil alone) improves PH outcomes in children, recognizing that marked differences between the etiology and therapeutic response between adults and children exist. The primary endpoint of this study is WHO functional class (FC) 12 months after initiation of study drug therapy. In addition to the primary outcome, secondary endpoints are being assessed, including a composite measure of time to clinical worsening, WHO FC at 24 months, echocardiographic assessment of PH and quantitative assessment of right ventricular function, 6-min walk distance, and NT-proBNP levels. Exploratory endpoints include selected biomarkers, actigraphy, and assessments of quality of life. This study is designed to pave the way for additional clinical trials by establishing a robust infrastructure through the development of a PPHNet Clinical Trials Network.
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Affiliation(s)
- Joseph M. Collaco
- Departments of Pediatrics, Neurology, Anesthesiology and Critical Care Medicine, and BiostatisticsJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Steven H. Abman
- Department of PediatricsChildren's Hospital ColoradoAuroraColoradoUSA
| | - Eric D. Austin
- Department of PediatricsVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Catherine M. Avitabile
- Department of Pediatrics, Children's Hospital of PhiladelphiaUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Angela Bates
- Departments of Pediatrics, Neurology, Anesthesiology and Critical Care Medicine, and BiostatisticsJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Jeffrey R. Fineman
- Department of PediatricsUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Grace A. Freire
- Department of PediatricsJohns Hopkins All Children's HospitalSt. PetersburgFloridaUSA
| | | | - Dunbar D. Ivy
- Department of PediatricsChildren's Hospital ColoradoAuroraColoradoUSA
| | - Usha S. Krishnan
- Department of Pediatrics, Vagelos College of Physicians and SurgeonsColumbia UniversityNew YorkNew YorkUSA
| | - Mary P. Mullen
- Department of PediatricsBoston Children's HospitalBostonMassachusettsUSA
| | - Nidhy P. Varghese
- Department of Pediatrics, Baylor College of MedicineTexas Children's HospitalHoustonTexasUSA
| | - Delphine Yung
- Department of PediatricsUniversity of Washington School of MedicineSeattleWashingtonUSA
| | - Melanie K. Nies
- Departments of Pediatrics, Neurology, Anesthesiology and Critical Care Medicine, and BiostatisticsJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Allen D. Everett
- Departments of Pediatrics, Neurology, Anesthesiology and Critical Care Medicine, and BiostatisticsJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Kanecia O. Zimmerman
- Departments of Biostatistics and Bioinformatics, Department of Pediatrics, Duke Clinical Research InstituteDuke UniversityDurhamNorth CarolinaUSA
| | - William Simmons
- Departments of Biostatistics and Bioinformatics, Department of Pediatrics, Duke Clinical Research InstituteDuke UniversityDurhamNorth CarolinaUSA
| | - Hrishikesh Chakraborty
- Departments of Biostatistics and Bioinformatics, Department of Pediatrics, Duke Clinical Research InstituteDuke UniversityDurhamNorth CarolinaUSA
| | - Gayane Yenokyan
- Departments of Pediatrics, Neurology, Anesthesiology and Critical Care Medicine, and BiostatisticsJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Allison Newell‐Sturdivant
- Departments of Pediatrics, Neurology, Anesthesiology and Critical Care Medicine, and BiostatisticsJohns Hopkins University School of MedicineBaltimoreMarylandUSA
- Department of Neurology, Johns Hopkins School of MedicineBIOS Clinical Trials Coordinating Center (CTCC)BaltimoreMarylandUSA
| | - Eric Christensen
- Departments of Pediatrics, Neurology, Anesthesiology and Critical Care Medicine, and BiostatisticsJohns Hopkins University School of MedicineBaltimoreMarylandUSA
- Department of Neurology, Johns Hopkins School of MedicineBIOS Clinical Trials Coordinating Center (CTCC)BaltimoreMarylandUSA
| | - Lindsay M. Eyzaguirre
- Departments of Pediatrics, Neurology, Anesthesiology and Critical Care Medicine, and BiostatisticsJohns Hopkins University School of MedicineBaltimoreMarylandUSA
- Department of Neurology, Johns Hopkins School of MedicineBIOS Clinical Trials Coordinating Center (CTCC)BaltimoreMarylandUSA
| | - Daniel F. Hanley
- Departments of Pediatrics, Neurology, Anesthesiology and Critical Care Medicine, and BiostatisticsJohns Hopkins University School of MedicineBaltimoreMarylandUSA
- Department of Neurology, Johns Hopkins School of MedicineBIOS Clinical Trials Coordinating Center (CTCC)BaltimoreMarylandUSA
| | - Erika B. Rosenzweig
- Department of Pediatrics, Vagelos College of Physicians and SurgeonsColumbia UniversityNew YorkNew YorkUSA
| | - Lewis H. Romer
- Departments of Pediatrics, Neurology, Anesthesiology and Critical Care Medicine, and BiostatisticsJohns Hopkins University School of MedicineBaltimoreMarylandUSA
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Sevransky JE, Rothman RE, Hager DN, Bernard GR, Brown SM, Buchman TG, Busse LW, Coopersmith CM, DeWilde C, Ely EW, Eyzaguirre LM, Fowler AA, Gaieski DF, Gong MN, Hall A, Hinson JS, Hooper MH, Kelen GD, Khan A, Levine MA, Lewis RJ, Lindsell CJ, Marlin JS, McGlothlin A, Moore BL, Nugent KL, Nwosu S, Polito CC, Rice TW, Ricketts EP, Rudolph CC, Sanfilippo F, Viele K, Martin GS, Wright DW. Effect of Vitamin C, Thiamine, and Hydrocortisone on Ventilator- and Vasopressor-Free Days in Patients With Sepsis: The VICTAS Randomized Clinical Trial. JAMA 2021; 325:742-750. [PMID: 33620405 PMCID: PMC7903252 DOI: 10.1001/jama.2020.24505] [Citation(s) in RCA: 144] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
IMPORTANCE Sepsis is a common syndrome with substantial morbidity and mortality. A combination of vitamin C, thiamine, and corticosteroids has been proposed as a potential treatment for patients with sepsis. OBJECTIVE To determine whether a combination of vitamin C, thiamine, and hydrocortisone every 6 hours increases ventilator- and vasopressor-free days compared with placebo in patients with sepsis. DESIGN, SETTING, AND PARTICIPANTS Multicenter, randomized, double-blind, adaptive-sample-size, placebo-controlled trial conducted in adult patients with sepsis-induced respiratory and/or cardiovascular dysfunction. Participants were enrolled in the emergency departments or intensive care units at 43 hospitals in the United States between August 2018 and July 2019. After enrollment of 501 participants, funding was withheld, leading to an administrative termination of the trial. All study-related follow-up was completed by January 2020. INTERVENTIONS Participants were randomized to receive intravenous vitamin C (1.5 g), thiamine (100 mg), and hydrocortisone (50 mg) every 6 hours (n = 252) or matching placebo (n = 249) for 96 hours or until discharge from the intensive care unit or death. Participants could be treated with open-label corticosteroids by the clinical team, with study hydrocortisone or matching placebo withheld if the total daily dose was greater or equal to the equivalent of 200 mg of hydrocortisone. MAIN OUTCOMES AND MEASURES The primary outcome was the number of consecutive ventilator- and vasopressor-free days in the first 30 days following the day of randomization. The key secondary outcome was 30-day mortality. RESULTS Among 501 participants randomized (median age, 62 [interquartile range {IQR}, 50-70] years; 46% female; 30% Black; median Acute Physiology and Chronic Health Evaluation II score, 27 [IQR, 20.8-33.0]; median Sequential Organ Failure Assessment score, 9 [IQR, 7-12]), all completed the trial. Open-label corticosteroids were prescribed to 33% and 32% of the intervention and control groups, respectively. Ventilator- and vasopressor-free days were a median of 25 days (IQR, 0-29 days) in the intervention group and 26 days (IQR, 0-28 days) in the placebo group, with a median difference of -1 day (95% CI, -4 to 2 days; P = .85). Thirty-day mortality was 22% in the intervention group and 24% in the placebo group. CONCLUSIONS AND RELEVANCE Among critically ill patients with sepsis, treatment with vitamin C, thiamine, and hydrocortisone, compared with placebo, did not significantly increase ventilator- and vasopressor-free days within 30 days. However, the trial was terminated early for administrative reasons and may have been underpowered to detect a clinically important difference. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03509350.
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Affiliation(s)
- Jonathan E. Sevransky
- Division of Pulmonary, Allergy, Critical Care, and Sleep, Emory University School of Medicine, Atlanta, Georgia
- Emory Critical Care Center, Emory Healthcare, Atlanta, Georgia
| | - Richard E. Rothman
- Department of Emergency Medicine, Johns Hopkins University, Baltimore, Maryland
| | - David N. Hager
- Division of Pulmonary Critical Care, Johns Hopkins University, Baltimore, Maryland
| | - Gordon R. Bernard
- Division of Pulmonary Critical Care, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Samuel M. Brown
- Division of Pulmonary Critical Care, Intermountain Medical Center and University of Utah, Salt Lake City
| | - Timothy G. Buchman
- Emory Critical Care Center, Emory Healthcare, Atlanta, Georgia
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Laurence W. Busse
- Division of Pulmonary, Allergy, Critical Care, and Sleep, Emory University School of Medicine, Atlanta, Georgia
- Emory Critical Care Center, Emory Healthcare, Atlanta, Georgia
| | - Craig M. Coopersmith
- Emory Critical Care Center, Emory Healthcare, Atlanta, Georgia
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia
| | - Christine DeWilde
- Division of Pulmonary Critical Care, Virginia Commonwealth University, Richmond
| | - E. Wesley Ely
- Division of Pulmonary Critical Care, Vanderbilt University Medical Center, Nashville, Tennessee
- Johns Hopkins Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Baltimore, Maryland
- Veteran’s Affairs Tennessee Valley Geriatric Research Education Clinical Center (GRECC), Nashville
| | | | - Alpha A. Fowler
- Division of Pulmonary Critical Care, Virginia Commonwealth University, Richmond
| | - David F. Gaieski
- Department of Emergency Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Michelle N. Gong
- Department of Critical Care, Montefiore Medical Center, Bronx, New York
| | - Alex Hall
- Department of Emergency Medicine, Emory University, Atlanta, Georgia
| | - Jeremiah S. Hinson
- Department of Emergency Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Michael H. Hooper
- Division of Pulmonary Critical Care, Sentara Healthcare, Norfolk, Virginia
| | - Gabor D. Kelen
- Department of Emergency Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Akram Khan
- Division of Pulmonary Critical Care, Oregon Health & Science University, Portland
| | - Mark A. Levine
- Molecular and Clinical Nutrition Section, National Institutes of Health, Bethesda, Maryland
| | - Roger J. Lewis
- Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, California
- Berry Consultants LLC, Austin, Texas
- Department of Emergency Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California
- Lundquist Institute for Biomedical Innovation, Torrance, California
| | - Chris J. Lindsell
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jessica S. Marlin
- Vanderbilt Coordinating Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Brooks L. Moore
- Department of Emergency Medicine, Emory University, Atlanta, Georgia
| | | | - Samuel Nwosu
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Carmen C. Polito
- Division of Pulmonary, Allergy, Critical Care, and Sleep, Emory University School of Medicine, Atlanta, Georgia
- Emory Critical Care Center, Emory Healthcare, Atlanta, Georgia
| | - Todd W. Rice
- Division of Pulmonary Critical Care, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Erin P. Ricketts
- Department of Emergency Medicine, Johns Hopkins University, Baltimore, Maryland
| | | | - Fred Sanfilippo
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Kert Viele
- Berry Consultants LLC, Austin, Texas
- Department of Biostatistics, University of Kentucky, Lexington
| | - Greg S. Martin
- Division of Pulmonary, Allergy, Critical Care, and Sleep, Emory University School of Medicine, Atlanta, Georgia
- Emory Critical Care Center, Emory Healthcare, Atlanta, Georgia
| | - David W. Wright
- Department of Emergency Medicine, Emory University, Atlanta, Georgia
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3
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Jumare J, Ndembi N, El-Kamary SS, Magder L, Hungerford L, Burdo T, Eyzaguirre LM, Dakum P, Umlauf A, Cherner M, Abimiku A, Charurat M, Blattner WA, Royal W. Cognitive Function Among Antiretroviral Treatment-Naive Individuals Infected With Human Immunodeficiency Virus Type 1 Subtype G Versus CRF02_AG in Nigeria. Clin Infect Dis 2018; 66:1448-1453. [PMID: 29182762 PMCID: PMC5905588 DOI: 10.1093/cid/cix1019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 11/19/2017] [Indexed: 12/22/2022] Open
Abstract
Background Human immunodeficiency virus type 1 (HIV-1) subtype has been shown to be associated with disease progression. We compared cognitive function between individuals infected with HIV-1 subtype G and CRF02_AG in Nigeria. Methods For this cross-sectional study, samples were analyzed from 146 antiretroviral-naive participants. Genotypic analysis of plasma HIV RNA was performed by nested polymerase chain reaction of protease and reverse transcriptase genes, and sequences were aligned with curated HIV-1 subtype references. Cognitive status was determined using demographically adjusted T scores and global deficit score (GDS) obtained from a comprehensive neuropsychological test battery. Results A total of 76 (52.1%) participants were infected with CRF02_AG, 48 (32.8%) with subtype G, and 22 (15.1%) with other HIV-1 strains. In a multivariable linear regression adjusting for plasma HIV RNA, CD4 count, and depression score, mean global T score was lower among subtype G-infected compared with CRF02_AG-infected participants (mean difference, -3.0 [95% confidence interval {CI}, -5.2, to -.7]; P = .011). Also, T scores were significantly lower among subtype G- than CRF02_AG-infected participants for the speed of information processing, executive function, and verbal fluency ability domains. Adjusting for similar variables in a logistic regression, the odds of global cognitive impairment (GDS ≥0.5) were 2.2 times higher among subtype G compared with CRF02_AG-infected participants (odds ratio, 2.2 [95% CI, .9-5.4]; P = .078). Conclusions Cognitive performance was significantly worse among antiretroviral-naive individuals with HIV-1 subtype G vs CRF02_AG infection. Further studies are required to characterize the mechanistic basis for these differences.
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Affiliation(s)
| | | | | | | | | | - Tricia Burdo
- School of Medicine, Temple University, Philadelphia, Pennsylvania
| | | | - Patrick Dakum
- School of Medicine, University of Maryland, Baltimore
| | - Anya Umlauf
- School of Medicine, University of California, San Diego
| | | | | | - Man Charurat
- School of Medicine, University of Maryland, Baltimore
| | | | - Walter Royal
- School of Medicine, University of Maryland, Baltimore
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4
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Royal W, Cherner M, Burdo TH, Umlauf A, Letendre SL, Jumare J, Abimiku A, Alabi P, Alkali N, Bwala S, Okwuasaba K, Eyzaguirre LM, Akolo C, Guo M, Williams KC, Blattner WA. Associations between Cognition, Gender and Monocyte Activation among HIV Infected Individuals in Nigeria. PLoS One 2016; 11:e0147182. [PMID: 26829391 PMCID: PMC4734765 DOI: 10.1371/journal.pone.0147182] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 12/30/2015] [Indexed: 01/06/2023] Open
Abstract
The potential role of gender in the occurrence of HIV-related neurocognitive impairment (NCI) and associations with markers of HIV-related immune activity has not been previously examined. In this study 149 antiretroviral-naïve seropositive subjects in Nigeria (SP, 92 women and 57 men) and 58 seronegative (SN, 38 women and 20 men) were administered neuropsychological testing that assessed 7 ability domains. From the neuropsychological test scores was calculated a global deficit score (GDS), a measure of overall NCI. Percentages of circulating monocytes and plasma HIV RNA, soluble CD163 and soluble CD14 levels were also assessed. HIV SP women were found to be younger, more educated and had higher CD4+ T cell counts and borderline higher viral load measures than SP men. On the neuropsychological testing, SP women were more impaired in speed of information processing and verbal fluency and had a higher mean GDS than SN women. Compared to SP men, SP women were also more impaired in speed of information processing and verbal fluency as well as on tests of learning and memory. Numbers of circulating monocytes and plasma sCD14 and sCD163 levels were significantly higher for all SP versus all SN individuals and were also higher for SP women and for SP men versus their SN counterparts. Among SP women, soluble CD14 levels were slightly higher than for SP men, and SP women had higher viral load measurements and were more likely to have detectable virus than SP men. Higher sCD14 levels among SP women correlated with more severe global impairment, and higher viral load measurements correlated with higher monocyte numbers and sCD14 and sCD14 levels, associations that were not observed for SP men. These studies suggest that the risk of developing NCI differ for HIV infected women and men in Nigeria and, for women, may be linked to effects from higher plasma levels of HIV driving activation of circulating monocytes.
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Affiliation(s)
- Walter Royal
- Department of Neurology, University of Maryland, School of Medicine, Baltimore, Maryland, United States of America
- * E-mail:
| | - Mariana Cherner
- HIV Neurobehavioral Research Center, University of California San Diego, School of Medicine, San Diego, California, United States of America
| | - Tricia H. Burdo
- Department of Biology, Boston College, Chestnut Hill, Massachusetts, United States of America
| | - Anya Umlauf
- HIV Neurobehavioral Research Center, University of California San Diego, School of Medicine, San Diego, California, United States of America
| | - Scott L. Letendre
- Department of Biology, Boston College, Chestnut Hill, Massachusetts, United States of America
| | - Jibreel Jumare
- Institute for Human Virology, University of Maryland, School of Medicine, Baltimore, Maryland, United States of America
- Institute for Human Virology-Nigeria, Abuja, Nigeria
| | - Alash’le Abimiku
- Institute for Human Virology, University of Maryland, School of Medicine, Baltimore, Maryland, United States of America
- Institute for Human Virology-Nigeria, Abuja, Nigeria
| | - Peter Alabi
- University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Nura Alkali
- Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Nigeria
| | | | - Kanayo Okwuasaba
- Institute for Human Virology, University of Maryland, School of Medicine, Baltimore, Maryland, United States of America
- Institute for Human Virology-Nigeria, Abuja, Nigeria
| | | | - Christopher Akolo
- Institute for Human Virology, University of Maryland, School of Medicine, Baltimore, Maryland, United States of America
- Institute for Human Virology-Nigeria, Abuja, Nigeria
| | - Ming Guo
- Department of Neurology, University of Maryland, School of Medicine, Baltimore, Maryland, United States of America
| | - Kenneth C. Williams
- Department of Biology, Boston College, Chestnut Hill, Massachusetts, United States of America
| | - William A. Blattner
- Institute for Human Virology, University of Maryland, School of Medicine, Baltimore, Maryland, United States of America
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5
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Ramkissoon AP, Amarakoon II, Hamilton CLC, Pierre RB, Eyzaguirre LM, Carr JK, Blattner WA, Roye ME. Analysis of reverse transcriptase and protease genes of HIV for antiretroviral drug resistance in treatment-exposed Jamaican pediatrics. AIDS Res Hum Retroviruses 2015; 31:932-7. [PMID: 26122980 DOI: 10.1089/aid.2015.0122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This study reports on the drug resistance profiles for HIV-infected pediatrics in Jamaica who have been exposed to antiretroviral therapy (ART). The genetic diversity of HIV-1 found in these patients was also determined using phylogenetic analysis. The protease-reverse transcriptase (Pro-RT) region of the genome was amplified from 40 samples, sequenced, and analyzed for the identification of antiretroviral resistance-associated mutations (RAMs). All isolates belonged to subtype B and 39 possessed multiple RAMs in the reverse transcriptase genes that would compromise the efficacy of drugs being used to treat these patients. Four isolates possessed RAMs in the protease genes. The overall frequency of HIV drug resistance was 95%. The high frequency of drug resistance is supported by epidemiological data that revealed an equally high frequency of treatment failure (98%) among the study participants. The results of this study indicate the urgent need for greater access to drug resistance testing in Jamaica.
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Affiliation(s)
| | - Icolyn I. Amarakoon
- Biotechnology Centre, University of the West Indies, Mona, Kingston, Jamaica
| | | | - Russell B. Pierre
- Department of Child and Adolescent Health, University of the West Indies, Mona, Kingston, Jamaica
| | - Lindsay M. Eyzaguirre
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Jean K. Carr
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland
| | - William A. Blattner
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Marcia E. Roye
- Biotechnology Centre, University of the West Indies, Mona, Kingston, Jamaica
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Eyzaguirre LM, Charurat M, Redfield RR, Blattner WA, Carr JK, Sajadi MM. Elevated hypermutation levels in HIV-1 natural viral suppressors. Virology 2013; 443:306-12. [PMID: 23791226 DOI: 10.1016/j.virol.2013.05.019] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Revised: 04/05/2013] [Accepted: 05/10/2013] [Indexed: 12/28/2022]
Abstract
Mutations in the HIV-1 proviral genomes delay the progression of the disease. We compared the mutation status in full-length proviral genomes of 23 HIV-infected patients with undetectable viral loads in the absence of therapy named natural viral suppressors (NVS) or Elite Controllers with 23 HIV-infected controls (10 patients on HAART treatment and 13 untreated patients). Provirus DNA was extracted from PBMC for amplification and sequencing to determine the mutation status. Nine (39 %) of the 23 NVS patients had defective proviral genomes, compared to 4 of the treated controls (40%, p = 0.96) and only one of the untreated controls (8%, p = 0.059). Most of the defective genomes resulted from Gto-A hypermutation. Among patients with hypermutation, the rate ratio for mutation was significantly higher for the NVS compared to treated controls (p = 0.043). Our data suggests that inactivation of the virus through the APOBEC3G system may contribute to the NVS phenotype.
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Affiliation(s)
- Lindsay M Eyzaguirre
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, United States 725 West Lombard Street Baltimore, MD 21201, USA.
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Hamilton CLC, Eyzaguirre LM, Amarakoon II, Figueroa P, Duncan J, Carr JK, Roye ME. Analysis of protease and reverse transcriptase genes of HIV for antiretroviral drug resistance in Jamaican adults. AIDS Res Hum Retroviruses 2012; 28:923-7. [PMID: 22049946 DOI: 10.1089/aid.2011.0312] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This study reports on the drug resistance profiles for HIV-infected adults in Jamaica using genotypic methods. The genetic diversity of HIV-1 found in these patients was also determined using phylogenetic analysis. Epidemiological data were documented for each patient, blood was collected by venous puncture, and plasma was separated and stored. Viral RNA was extracted and analyzed for mutations in the viral genome by the amplification of the protease and reverse transcriptase (Pro-RT) regions using a nested PCR method. The rate of drug resistance among treatment-experienced individuals was 35%, while treatment-naive individuals showed a prevalence of 29%. The overall prevalence of drug resistance mutations in Jamaicans was consistent with the increased use of antiretroviral drugs in the region, with many of the mutations detected reducing susceptibility to the drugs commonly used to treat Jamaican patients. These results indicate the need for regular drug resistant surveillance to guide treatment strategies.
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Affiliation(s)
| | - Lindsay M. Eyzaguirre
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Icolyn I. Amarakoon
- Biotechnology Centre, University of the West Indies, Mona, Kingston, Jamaica
| | - Peter Figueroa
- Department Community Health and Psychiatry, University of the West Indies, Mona, Kingston, Jamaica
| | | | - Jean K. Carr
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Marcia E. Roye
- Biotechnology Centre, University of the West Indies, Mona, Kingston, Jamaica
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8
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Ng OT, Eyzaguirre LM, Carr JK, Chew KK, Lin L, Chua A, Leo YS, Redd AD, Quinn TC, Laeyendecker O. Identification of new CRF51_01B in Singapore using full genome analysis of three HIV type 1 isolates. AIDS Res Hum Retroviruses 2012; 28:527-30. [PMID: 21902588 DOI: 10.1089/aid.2011.0177] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
A recent HIV-1 molecular epidemiology survey in Singapore identified a novel CRF01_AE/B recombinant form, which accounted for 13 (11.9%) of 109 patient samples. Peripheral blood mononuclear cell DNA from three of these 13 patients was used to generate near full-length sequences to characterize the novel CRF01_AE/B recombinant form. The three isolates had a recombinant structure composed of CRF01_AE and subtype B, and shared identical breakpoints. As the three patients were not epidemiologically linked, this recombinant form has been designated CRF51_01B. Identification of the novel recombinant forms indicates ongoing active HIV-1 transmission in Singapore.
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Affiliation(s)
- Oon Tek Ng
- Johns Hopkins School of Medicine, Johns Hopkins Medical Institution, Baltimore, MD, USA.
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9
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Emerson CB, Eyzaguirre LM, Albrecht JS, Comer AC, Harris AD, Furuno JP. Healthcare-associated infection and hospital readmission. Infect Control Hosp Epidemiol 2012; 33:539-44. [PMID: 22561707 DOI: 10.1086/665725] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Hospital readmissions are a current target of initiatives to reduce healthcare costs. This study quantified the association between having a clinical culture positive for 1 of 3 prevalent hospital-associated organisms and time to hospital readmission. DESIGN Retrospective cohort study. PATIENTS AND SETTING Adults admitted to an academic, tertiary care referral center from January 1, 2001, through December 31, 2008. METHODS The primary exposure of interest was a clinical culture positive for methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), or Clostridium difficile obtained more than 48 hours after hospital admission during the index hospital stay. The primary outcome of interest was time to readmission to the index facility. Multivariable Cox proportional hazards models were used to model the adjusted association between positive clinical culture result and time to readmission and to calculate hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS Among 136,513 index admissions, the prevalence of hospital-associated positive clinical culture result for 1 of the 3 organisms of interest was 3%, and 35% of patients were readmitted to the index facility within 1 year after discharge. Patients with a positive clinical culture obtained more than 48 hours after hospital admission had an increased hazard of readmission (HR, 1.40; 95% CI, 1.33-1.46) after adjusting for age, sex, index admission length of stay, intensive care unit stay, Charlson comorbidity index, and year of hospital admission. CONCLUSIONS Patients with healthcare-associated infections may be at increased risk of hospital readmission. These findings may be used to impact health outcomes after discharge from the hospital and to encourage better infection prevention efforts.
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Affiliation(s)
- Carley B Emerson
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
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Abstract
This study seeks to analyze nearly full-length viral genomes for distinct genetic characteristics that are unique to local or regional strains and to identify regions that have high variability or are highly conserved. Nearly full length sequences of seven HIV-1 samples were obtained to ascertain the circulating subtype diversity in the HIV-1 epidemic in Jamaica as well as conduct detailed sequence analysis. The phylogenetic analysis of the seven sequences showed all the sequences clustering with HIV-1 pure B subtype references. The predicted amino acid sequenced in the V3 loop for the Jamaican samples showed that six samples contained the characteristic conserved tetrapeptide motif GPGR. One occurrence in isolate 09JM.PF09WX displayed a GQGP tetrameric motif similar to that found in a Korean B strain. All seven isolates (100%) were R5 viruses for preferential cofactor usage. These samples were collected from individuals who had tested positive for 1-5 years and were drug naive. The results suggested that the viruses were isolated from patients in the nonprogressive stage of disease. These are early stages in the assessment and the patient should be monitored to predict the progression of the disease and when HAART should begin.
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Affiliation(s)
- Marcia E Roye
- Biotechnology Centre, University of the West Indies, Mona, Kingston, Jamaica.
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Beyrer C, Patel Z, Stachowiak JA, Tishkova FK, Stibich MA, Eyzaguirre LM, Carr JK, Mogilnii V, Peryshkina A, Latypov A, Strathdee SA. Characterization of the emerging HIV type 1 and HCV epidemics among injecting drug users in Dushanbe, Tajikistan. AIDS Res Hum Retroviruses 2009; 25:853-60. [PMID: 19689193 DOI: 10.1089/aid.2008.0206] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This study aimed to determine HIV, HCV, and syphilis prevalence and correlates, and to characterize the molecular epidemiology of HIV-1 among injecting drug users (IDUs) in Dushanbe, Tajikistan. A cross-sectional study assessing risk factors for HIV and HCV through an interview administered survey was conducted. A total of 491 active adult IDUs were recruited from May to November 2004 in Dushanbe, Tajikistan. HIV-1 antibody status was determined with rapid testing and confirmed with ELISA. HCV antibody testing was conducted using a BIOELISA HCV kit. HIV-1 subtyping was done on a subset with full-length sequencing. Correlates of HIV and HCV infection were assessed using logistic regression. Overall prevalence of HIV was 12.1%, HCV was 61.3%, and syphilis was 15.7%. In a multivariate logistic regression model controlling for gender and ethnicity, daily injection of narcotics [odds ratio (OR) OR 3.22] and Tajik nationality (OR 7.06) were significantly associated with HIV status. Tajik nationality (OR 1.91), history of arrest (OR 2.37), living/working outside Tajikistan in the past 10 years (OR 2.43), and daily injection of narcotics (OR 3.26) were significantly associated with HCV infection whereas being female (OR 0.53) and always using a sterile needle (OR 0.47) were inversely associated with HCV infection. Among 20 HIV-1-positive IDU with specimens available for typing, 10 were subtype A, 9 were CRF02_AG, and one was an A-CRF02_AG recombinant. Epidemics of HIV-1, HCV, and drug use are underway in Dushanbe. The molecular epidemiology is distinctive, with West African variants accounting for roughly 50% of prevalent infections. Targeted prevention programs offering both needle exchange programs and opiate substitution therapies are urgently called for to prevent the further spread of HIV and HCV in Tajikistan.
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Affiliation(s)
- Chris Beyrer
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, Maryland 21205
| | - Zeenat Patel
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, Maryland 21205
| | - Julie A. Stachowiak
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, Maryland 21205
| | - Farida K. Tishkova
- Tajik Scientific and Research Institute of Prevention Medicine, Federal Virology Laboratory, Dushanbe, Tajikistan
| | - Mark A. Stibich
- AIDS infoshare Russia, Dorozhny Proezd, dom 9/10, Moscow 113545, Russia
| | | | - Jean K. Carr
- Henry M. Jackson Foundation, 1401 Rockville Pike, Rockville, Maryland 20852
| | - Vladimir Mogilnii
- AIDS infoshare Russia, Dorozhny Proezd, dom 9/10, Moscow 113545, Russia
| | - Alena Peryshkina
- AIDS infoshare Russia, Dorozhny Proezd, dom 9/10, Moscow 113545, Russia
| | - Alisher Latypov
- Tajik Scientific and Research Institute of Prevention Medicine, Federal Virology Laboratory, Dushanbe, Tajikistan
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Nadai Y, Eyzaguirre LM, Sill A, Cleghorn F, Nolte C, Charurat M, Collado-Chastel S, Jack N, Bartholomew C, Pape JW, Figueroa P, Blattner WA, Carr JK. HIV-1 epidemic in the Caribbean is dominated by subtype B. PLoS One 2009; 4:e4814. [PMID: 19279683 PMCID: PMC2652827 DOI: 10.1371/journal.pone.0004814] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2008] [Accepted: 02/04/2009] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The molecular epidemiology of HIV-1 in the Caribbean has been described using partial genome sequencing; subtype B is the most common subtype in multiple countries. To expand our knowledge of this, nearly full genome amplification, sequencing and analysis was conducted. METHODOLOGY/PRINCIPAL FINDINGS Virion RNA from sera collected in Haiti, Dominican Republic, Jamaica and Trinidad and Tobago were reverse transcribed, PCR amplified, sequenced and phylogenetically analyzed. Nearly full genomes were completed for 15 strains; partial pol was done for 67 strains. All but one of the 67 strains analyzed in pol were subtype B; the exception was a unique recombinant of subtypes B and C collected in the Dominican Republic. Of the nearly full genomes of 14 strains that were subtype B in pol, all were subtype B from one end of the genome to the other and not inter-subtype recombinants. Surprisingly, the Caribbean subtype B strains clustered significantly with each other and separate from subtype B from other parts of the pandemic. CONCLUSIONS The more complete analysis of HIV-1 from 4 Caribbean countries confirms previous research using partial genome analysis that the predominant subtype in circulation was subtype B. The Caribbean strains are phylogenetically distinct from other subtype B strains although the biological meaning of this finding is unclear.
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Affiliation(s)
- Yuka Nadai
- Institute of Human Virology, School of Medicine, University of Maryland, Baltimore, Maryland, United States of America
| | - Lindsay M. Eyzaguirre
- Institute of Human Virology, School of Medicine, University of Maryland, Baltimore, Maryland, United States of America
| | - Anne Sill
- Institute of Human Virology, School of Medicine, University of Maryland, Baltimore, Maryland, United States of America
| | - Farley Cleghorn
- Institute of Human Virology, School of Medicine, University of Maryland, Baltimore, Maryland, United States of America
| | - Claudine Nolte
- GHESKIO, Port-au-Prince, Haiti and Weill Medical College of Cornell University, New York, New York, United States of America
| | - Manhattan Charurat
- Institute of Human Virology, School of Medicine, University of Maryland, Baltimore, Maryland, United States of America
| | | | - Noreen Jack
- Medical Research Foundation, Port of Spain, Trinidad and Tobago
| | | | - Jean W. Pape
- GHESKIO, Port-au-Prince, Haiti and Weill Medical College of Cornell University, New York, New York, United States of America
| | | | - William A. Blattner
- Institute of Human Virology, School of Medicine, University of Maryland, Baltimore, Maryland, United States of America
| | - Jean K. Carr
- Institute of Human Virology, School of Medicine, University of Maryland, Baltimore, Maryland, United States of America
- * E-mail:
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13
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Nadai Y, Eyzaguirre LM, Constantine NT, Sill AM, Cleghorn F, Blattner WA, Carr JK. Protocol for nearly full-length sequencing of HIV-1 RNA from plasma. PLoS One 2008; 3:e1420. [PMID: 18183300 PMCID: PMC2170516 DOI: 10.1371/journal.pone.0001420] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2007] [Accepted: 12/07/2007] [Indexed: 11/18/2022] Open
Abstract
Nearly full-length genome sequencing of HIV-1 using peripheral blood mononuclear cells (PBMC) DNA as a template for PCR is now a relatively routine laboratory procedure. However, this has not been the case when using virion RNA as the template and this has made full genome analysis of circulating viruses difficult. Therefore, a well-developed procedure for sequencing of full-length HIV-1 RNA directly from plasma was needed. Plasma from U.S. donors representing a range of viral loads (VL) was used to develop the assay. RNA was extracted from plasma and reverse-transcribed. Two or three overlapping regions were PCR amplified to cover the entire viral genome and sequenced for verification. The success of the procedure was sensitive to VL but was routinely successful for VL greater than 105 and the rate declined in proportion to the VL. While the two-amplicon strategy had an advantage of increasing the possibility of amplifying a single species of HIV-1, the three-amplicon strategy was more successful in amplifying samples with low viral loads. This protocol provides a useful tool for molecular analysis to understand the HIV epidemic and pathogenesis, as well as diagnosis, therapy and future vaccine strategies.
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Affiliation(s)
- Yuka Nadai
- Department of Epidemiology, Institute of Human Virology, University of Maryland, Baltimore, Maryland, United States of America
| | - Lindsay M. Eyzaguirre
- Department of Epidemiology, Institute of Human Virology, University of Maryland, Baltimore, Maryland, United States of America
| | - Niel T. Constantine
- Department of Epidemiology, Institute of Human Virology, University of Maryland, Baltimore, Maryland, United States of America
| | - Anne M. Sill
- Department of Epidemiology, Institute of Human Virology, University of Maryland, Baltimore, Maryland, United States of America
| | | | - William A. Blattner
- Department of Epidemiology, Institute of Human Virology, University of Maryland, Baltimore, Maryland, United States of America
| | - Jean K. Carr
- Department of Epidemiology, Institute of Human Virology, University of Maryland, Baltimore, Maryland, United States of America
- * To whom correspondence should be addressed. E-mail:
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Eyzaguirre LM, Erasilova IB, Nadai Y, Saad MD, Kovtunenko NG, Gomatos PJ, Zeman VV, Botros BA, Sanchez JL, Birx DL, Earhart KC, Carr JK. Genetic characterization of HIV-1 strains circulating in Kazakhstan. J Acquir Immune Defic Syndr 2007; 46:19-23. [PMID: 17514018 DOI: 10.1097/qai.0b013e318073c620] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
To determine the HIV-1 genetic diversity in Kazakhstan, 85 blood samples from HIV-seropositive donors were collected between 2001 and 2003. The study population consisted of 91.8% injecting drug users (IDUs); the remainder was infected sexually or iatrogenically. A genomic region that included part of the polymerase gene was sequenced for all 85 samples, and from these, 6 samples were randomly selected for nearly full genome sequencing. Subtype A was the most common genetic form (94.1%), followed by CRF02_AG (4.7%) and subtype C (1.2%). All subtype A sequences clustered closely with samples from countries of the former Soviet Union (FSU). From these sequences, 47 (58.8%) presented the secondary protease inhibitor mutation V77I that has been linked to a genetic lineage in the FSU epidemic. In addition, most had the other 2 mutations that characterize the "V77I haplotype." All 6 nearly full-length sequences were subtype A and clustered with other FSU strains. The CRF02_AG strains from this population clustered with strains from Uzbekistan, reflecting the spread of the CRF02_AG epidemic in Central Asia. The HIV epidemic in Kazakhstan is predominantly in IDUs and is indigenous to the geographic region, and most of the strains are genetically similar to those circulating in the FSU and other parts of Central Asia.
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Affiliation(s)
- Lindsay M Eyzaguirre
- US Military HIV Research Program, Walter Reed Army Institute of Research, and the Henry M. Jackson Foundation for the Advancement of Military Medicine, Rockville, MD, USA
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15
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Pando MA, Eyzaguirre LM, Carrion G, Montano SM, Sanchez JL, Carr JK, Avila MM. High genetic variability of HIV-1 in female sex workers from Argentina. Retrovirology 2007; 4:58. [PMID: 17697319 PMCID: PMC1971708 DOI: 10.1186/1742-4690-4-58] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2007] [Accepted: 08/13/2007] [Indexed: 11/17/2022] Open
Abstract
Background A cross-sectional study on 625 Female Sex Workers (FSWs) was conducted between 2000 and 2002 in 6 cities in Argentina. This study describes the genetic diversity and the resistance profile of the HIV-infected subjects. Results Seventeen samples from HIV positive FSWs were genotyped by env HMA, showing the presence of 9 subtype F, 6 subtype B and 2 subtype C. Sequence analysis of the protease/RT region on 16 of these showed that 10 were BF recombinants, three were subtype B, two were subtype C, and one sample presented a dual infection with subtype B and a BF recombinant. Full-length genomes of five of the protease/RT BF recombinants were also sequenced, showing that three of them were CRF12_BF. One FSW had a dual HIV-1 infection with subtype B and a BF recombinant. The B sections of the BF recombinant clustered closely with the pure B sequence isolated from the same patient. Major resistance mutations to antiretroviral drugs were found in 3 of 16 (18.8%) strains. Conclusion The genetic diversity of HIV strains among FSWs in Argentina was extensive; about three-quarters of the samples were infected with diverse BF recombinants, near twenty percent had primary ART resistance and one sample presented a dual infection. Heterosexual transmission of genetically diverse, drug resistant strains among FSWs and their clients represents an important and underestimated threat, in Argentina.
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Affiliation(s)
- María A Pando
- Centro Nacional de Referencia para el SIDA (CNRS), Departamento de Microbiología, Parasitología e Inmunología, Facultad de Medicina, Universidad de Buenos Aires, Paraguay 2155, Piso 11, C1121ABG, Buenos Aires, Argentina
- Department of Epidemiology, Institute of Human Virology, University of Maryland Biotechnology Institute, 725 West Lombard Street, Baltimore, MD 21201, USA
| | - Lindsay M Eyzaguirre
- Department of Epidemiology, Institute of Human Virology, University of Maryland Biotechnology Institute, 725 West Lombard Street, Baltimore, MD 21201, USA
| | - Gladys Carrion
- US Naval Medical Research Center Detachment (NMRCD). Unit 3800, APO-AA 34031-3800, Lima, Peru
| | - Silvia M Montano
- US Naval Medical Research Center Detachment (NMRCD). Unit 3800, APO-AA 34031-3800, Lima, Peru
| | - José L Sanchez
- Department of Defense Global Emerging Infections Surveillance and Response System (DoD-GEIS), Walter Reed Army Institute of Research, 2900 Linden Lane, Suite 100, Silver Spring, MD, 20910, USA
| | - Jean K Carr
- Department of Epidemiology, Institute of Human Virology, University of Maryland Biotechnology Institute, 725 West Lombard Street, Baltimore, MD 21201, USA
| | - María M Avila
- Centro Nacional de Referencia para el SIDA (CNRS), Departamento de Microbiología, Parasitología e Inmunología, Facultad de Medicina, Universidad de Buenos Aires, Paraguay 2155, Piso 11, C1121ABG, Buenos Aires, Argentina
- CONICET, Argentina
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Eyzaguirre LM, Brouwer KC, Nadai Y, Patterson TL, Ramos R, Cruz MF, Orozovich P, Strathdee S, Carr JK. First Molecular surveillance report of HIV in injecting drug users and female sex workers in Mexico. Retrovirology 2006. [PMCID: PMC1716903 DOI: 10.1186/1742-4690-3-s1-p79] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Pando MA, Eyzaguirre LM, Segura M, Bautista CT, Marone R, Ceballos A, Montano SM, Sánchez JL, Weissenbacher M, Ávila MM, Carr JK. First report of an HIV-1 triple recombinant of subtypes B, C and F in Buenos Aires, Argentina. Retrovirology 2006; 3:59. [PMID: 16959032 PMCID: PMC1570496 DOI: 10.1186/1742-4690-3-59] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2006] [Accepted: 09/07/2006] [Indexed: 11/22/2022] Open
Abstract
We describe the genetic diversity of currently transmitted strains of HIV-1 in men who have sex with men (MSM) in Buenos Aires, Argentina between 2000 and 2004. Nearly full-length sequence analysis of 10 samples showed that 6 were subtype B, 3 were BF recombinant and 1 was a triple recombinant of subtypes B, C and F. The 3 BF recombinants were 3 different unique recombinant forms. Full genome analysis of one strain that was subtype F when sequenced in pol was found to be a triple recombinant. Gag and pol were predominantly subtype F, while gp120 was subtype B; there were regions of subtype C interspersed throughout. The young man infected with this strain reported multiple sexual partners and sero-converted between May and November of 2004. This study reported for the first time the full genome analysis of a triple recombinant between subtypes B, C and F, that combines in one virus the three most common subtypes in South America.
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Affiliation(s)
- María A Pando
- Centro Nacional de Referencia para el SIDA, Departamento de Microbiología, Parasitología e Inmunología, Facultad de Medicina, Universidad de Buenos Aires, Paraguay 2155, Piso 11, C1121ABG, Buenos Aires, Argentina
- Department of Epidemiology, Institute of Human Virology, University of Maryland Biotechnology Institute, 725 W. Lombard street, Baltimore, MD 21201, USA
| | - Lindsay M Eyzaguirre
- Department of Epidemiology, Institute of Human Virology, University of Maryland Biotechnology Institute, 725 W. Lombard street, Baltimore, MD 21201, USA
| | - Marcela Segura
- Centro Nacional de Referencia para el SIDA, Departamento de Microbiología, Parasitología e Inmunología, Facultad de Medicina, Universidad de Buenos Aires, Paraguay 2155, Piso 11, C1121ABG, Buenos Aires, Argentina
| | - Christian T Bautista
- US Military HIV Research Program at the Walter Reed Army Institute of Research and the Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., 1 Taft Court, Suite 250, Rockville, MD 20850, USA
| | - Rubén Marone
- Nexo Asociación Civil, Callao Av. 339, Piso 5, C1022AAD, Buenos Aires, Argentina
| | - Ana Ceballos
- Centro Nacional de Referencia para el SIDA, Departamento de Microbiología, Parasitología e Inmunología, Facultad de Medicina, Universidad de Buenos Aires, Paraguay 2155, Piso 11, C1121ABG, Buenos Aires, Argentina
| | - Silvia M Montano
- US Naval Medical Research Center Detachment (NMRCD). Unit 3800, APO-AA 34031-3800 Lima, Peru
| | - José L Sánchez
- Department of Defense Global Emerging Infections Surveillance and Response System (DoD-GEIS), Walter Reed Army Institute of Research, 503 Robert Grant Avenue, Room 1A30, Silver Spring, MD 20910, USA
| | - Mercedes Weissenbacher
- Centro Nacional de Referencia para el SIDA, Departamento de Microbiología, Parasitología e Inmunología, Facultad de Medicina, Universidad de Buenos Aires, Paraguay 2155, Piso 11, C1121ABG, Buenos Aires, Argentina
| | - María M Ávila
- Centro Nacional de Referencia para el SIDA, Departamento de Microbiología, Parasitología e Inmunología, Facultad de Medicina, Universidad de Buenos Aires, Paraguay 2155, Piso 11, C1121ABG, Buenos Aires, Argentina
| | - Jean K Carr
- Department of Epidemiology, Institute of Human Virology, University of Maryland Biotechnology Institute, 725 W. Lombard street, Baltimore, MD 21201, USA
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Viñoles J, Serra M, Russi JC, Ruchansky D, Sosa-Estani S, Montano SM, Carrion G, Eyzaguirre LM, Carr JK, Olson JG, Bautista CT, Sanchez JL, Weissenbacher M. Seroincidence and phylogeny of human immunodeficiency virus infections in a cohort of commercial sex workers in Montevideo, Uruguay. Am J Trop Med Hyg 2005; 72:495-500. [PMID: 15827294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
A cohort study involving 60 human immunodeficiency virus (HIV)-negative male transvestite commercial sex workers (CSWs) was conducted in Montevideo, Uruguay in 1999-2001. Serum samples were tested for HIV by an enzyme-linked immunosorbent assay screening with immunoblot confirmation. Six participants seroconverted for an incidence-density rate of 6.03 (95% confidence interval = 2.21-13.12) per 100 person-years. Inconsistent condom use during client sex (adjusted hazard ratio [AHR] = 6.7), during oral sex (AHR = 5.6), and at the last sexual encounter (AHR = 7.8), and use of marihuana (AHR = 5.4) were marginally associated with HIV seroconversion. Five samples were genotyped in the protease and reverse transcriptase regions; three were subtypes B and two were BF recombinants. Full genome analysis of four samples confirmed all three subtype B samples and one of the two BF recombinants. Male transvestite CSWs sustained a high rate of HIV infection. Larger prospective studies are required to better define subtypes and associated sexual and drug-related risk factors.
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Affiliation(s)
- Jose Viñoles
- HIV/AIDS National Control Program, and Department of Laboratories of Public Health, Ministry of Health, Montevideo, Uruguay
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