Drug resistance-associated mutations in antiretroviral treatment-experienced patients in kuwait

Objectives: To investigate the prevalence of nonpolymorphic resistance-associated mutations [RAM] in HIV-1 patients on first-line antiretroviral therapy in Kuwait

Subjects and Methods: Total RNA was isolated from plasma samples of 42 patients who received a first-line nonnucleoside reverse transcriptase inhibitor [NNRTI]-based regimen. HIV-1 protease and reverse transcriptase genetic regions were then amplified by nested reverse transcription-polymerase chain reaction and directly sequenced. The HIV-1 subtype was identified using the Bayesian phylogenetic method, and RAM were identified using the Stanford University genotypic resistance interpretation algorithm

Results: The HIV-1 viral load at sampling ranged from < 20 to 8.25 × 10[4] copies/ml. CRF01_AE, C, and B were the most predominant HIV-1 subtypes. Nonpolymorphic mutations associated with resistance to antiretroviral drugs were detected in 11 [26.2%] of the 42 patients; 5 [11.9%] patients had mutations associated with a high-level resistance to nucleoside reverse transcriptase inhibitors [NRTI], 4 [9.5%] patients had mutations associated with resistance to NNRTI, 1 [2.4%] patient had mutations associated with resistance to both NRTI and NNRTI, and 1 [2.4%] patient had mutations potentially associated with low-level resistance to both protease inhibitors and NNRTI. All patients with RAM had a detectable plasma HIV-1 RNA level

Conclusion: Our results indicate the development of RAM during an NNRTI-based regimen and highlight the importance of considering other regimens to avoid treatment failure

Human washington university polyomavirus in patients with respiratory tract infection in Kuwait

Objective: To determine Washington University [WU] polyomavirus strains circulating among hospitalized patients with respiratory tract infections [RTI] in Kuwait

Materials and Methods: Samples from 459 hospitalized children and adult RTI patients were screened for respiratory viruses by polymerase chain reaction from April 2013 to April 2016. The VP2 gene from WU virus (WUV)-positive samples was se-quenced and subjected to phylogenetic analysis

Results: Of the 459 hospitalized RTI patients, 18 [3.9%] patients were positive for WUV infection. WUV infection was common among children aged <11 years (9 patients, 50%]. Among the 18 WUV-infected hospitalized patients, viral co-infection was detected in 9 patients [50%]. The most common viruses associated with mixed infection were respiratory syncytial virus and human rhinovirus [2 patients, 11.1 % each]. Of the 18 WUV-infected patients, 4 were sequenced and subjected to phylogenetic analysis. The circulating strains belong to type la and Illb

Conclusions:This study enabled us to detect WUV among hospitalized RTI patients. Co-infection with other respiratory viruses was notable. Two circulating WUV genotypes [la and Illb] were identified among hospitalized RTI patients in Kuwait

Evaluation of the xTAG gastrointestinal pathogen panel assay for the detection of enteric pathogens in Kuwait

Objective: To evaluate the utility of the Luminex xTAG gastrointestinal pathogen panel [GPP] assay in the detection of enteric pathogens from diarrheal stool samples in Kuwait

Materials and Methods: The Luminex xTAG GPP assay was used according to the manufacturer's instructions to evaluate single diarrheal stool samples from 109 hospitalized patients at Mubarak Al-Kabeer Hospital, Kuwait, from March 2014 to June 2015. The assay procedure involved nucleic acid extraction from stool samples, amplification of the target by reverse transcriptase polymerase chain reaction, hybridization of the amplified target by probe, detection of the target by the Luminex instrument and computerized data analysis. Conventional microbiological assays were used as the gold standard for comparison

Results: From the 109 diarrheal stool samples, 20 [18.4%] pathogens were detected by the xTAG GPP assay compared to 10 [9.2%] pathogens using conventional assays. Both methods detected 3 Salmonella spp., 3 Clostridium difficile, 2 rotavirus and 2 norovirus. In addition, the xTAG GPP assay detected 1 Shigella sp., 6 Campylobacter spp., 1 Cryptosporidium sp. and 2 Giardia lamblia which were missed by conventional assays

Conclusions: In this study, xTAG GPP detected twice as many pathogens as the conventional assays. We recommend the introduction of this assay in routine diagnostic laboratories for a rapid and better diagnosis and treatment of diarrheal disease

Phylogenetic analysis of human metapneumovirus detected in hospitalized patients in Kuwait during the years 2009–2011

Human metapneumovirus [hMPV] is an important cause of both upper and lower respiratory tract infections [RTIs] in all age groups. Children, elderly, and immunocompromised individuals are the most affected groups. HMPV infection accounts for 5% of hospitalized patients with respiratory tract infections in Kuwait. It is mostly detected among infants and elderly age groups, and both hMPV genotypes A and B circulate in Kuwait. In this study, the genetic diversity of detected hMPV was evaluated, and a phylogenetic analysis based on partial nucleotide and amino acid sequences of the G gene was performed for hMPV detected among hospitalized patients with RTIs. Our results showed that 62% of hMPV sequences belonged to the A genotype and 38% to the B genotype. A2b and B2 subtypes were detected and circulated during the study period, whereas A1 and B1 subtypes were not detected. Based on nucleotide sequences of the G gene, most of hMPV strains [57%] were clustered with Indian strains, followed by Greek strains [24%] and Canadian strains [14%]. One strain [5%] clustered within the B genotype but had different branches than B1 and B2 branches. Our data showed the co-circulation of hMPV genotypes A2b and B2 in Kuwait with genetic diversity suggestive of evolution through negative selection

First description of gastroenteritis viruses in Lebanese children: a pilot study

Human enteric viruses are important causes of acute gastroenteritis in infants and children. The role of rotaviruses, adenoviruses, human caliciviruses and astroviruses in the development of severe acute gastroenteritis requiring hospitalization of infants and young children in North Lebanon was investigated. Stool specimens collected between April and May 2010 from 79 Lebanese infants and children hospitalized for severe acute gastroenteritis, were screened for enteric viruses by immunoassays and internally controlled multiplex PCR assay. Out of 79 stool samples, 38 [48%] were positive for rotavirus, and 5 [6%] were positive for norovirus genogroup II. Enteric adenoviruses, sapoviruses and human astroviruses were not detected. Children with severe rotavirus gastroenteritis were younger than those with severe norovirus gastroenteritis. These results highlight the importance of rotavirus and norovirus as causes of severe gastroenteritis in Lebanese children, and the need to incorporate routine screening tests for norovirus infection in clinical settings

Hepatitis C virus infection in a population with high incidence of type 2 diabetes: Impact on diabetes complications

A growing number of reports suggest a connection between hepatitis C virus [HCV] infection and type 2 diabetes [T2D]. However, the association of HCV infection with diabetes-related complications has not yet been clarified. The aim of this study was to determine the prevalence of HCV infection in T2D-patients in Kuwait which has a high incidence of type 2 diabetes, and to investigate the association between HCV viremia and diabetes-related complications. A total of 438 patients with T2D [325 Kuwaitis and 113 Egyptians], and 440 control subjects, were enrolled for this study. HCV infection was assessed by testing for serum HCV-specific antibodies, and by detection of HCV RNA. HCV viral load and hemoglobin A1c [HbA1c] levels were assessed in patients with and without diabetes complications. Thirty one [7%] out of 438 T2D-patients had evidence of HCV infection compared to 4 [1%] out of 440 control adults [p < 0.0001]. The prevalence of HCV infection in Kuwaiti and Egyptian T2D-patients was 3% and 18%, respectively. Most of the HCV sequences detected in T2D patients and control subjects were of genotype 4. The HbA1c levels in T2D-patients with HCV viremia were significantly higher than those in HCV-negative patients. HCV viremia, female sex, age, family history of diabetes were found to be independent risk factors for diabetes complications. The results suggest that T2D-patients in Kuwait have higher prevalence of HCV infection than controls, and that HCV viremia is associated with diabetes-related complications