RESUMO
Background: Transmitted drug resistance (TDR) occurs in patients with HIV infection who are not exposed to antiretroviral drugs but who are infected with a virus with mutations associated with resistance. Aim: To determine the prevalence of TDR and characterize HIV reverse transcriptase and protease mutation patterns. Material and Methods: HIV infected antiretroviral treatment-naive patients treated in three centers between 2014 and 2018 were studied. A genotyping study was carried out. The HIVdb Program (Stanford University) and the World Health Organization (WHO) TDR surveillance mutation list were used to register resistance-associated mutations. Results: We enrolled 220 patients aged a median of 29 (interquartile range (IQR) 24-34) years, 99% men. Median CD4 count was 365 cells/μL (IQR 250-499 cells/μL) and median viral load was 39.150 copies/mL (IQR 9,270 −120,000). The overall prevalence of RTD was 10.45% (95% CI 6.7-15.2, N = 23/220). The higher frequency of TDR was against non-nucleoside reverse transcriptase inhibitors, reaching 9.0% (95% CI 5.6-13.6), followed by nucleoside reverse transcriptase inhibitors reaching 1.8% (95% CI 0.49-4.5) and protease inhibitors reaching 0.45% (95% CI 0.01-2.5). The mutations in reverse transcriptase were M41L, L210W, D67N, K70E, M184V, K103N (6.36%, 95% CI 3.5-10.4), G190A, E138A, K101E, and I84V in protease. Conclusions: These results should prompt a change in recommendations for starting antiretoviral therapy, especially in first-line regimens that include non-nucleoside reverse transcriptase inhibitors.
Assuntos
Idoso , Feminino , Humanos , Masculino , Infecções por HIV , HIV-1 , Fármacos Anti-HIV , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Chile/epidemiologia , Prevalência , HIV-1/genética , Fármacos Anti-HIV/uso terapêutico , Fármacos Anti-HIV/farmacologia , Farmacorresistência Viral/genética , Genótipo , MutaçãoRESUMO
The prevalence of food allergy (FA) is about 2-8 percent, with clinical manifestations ranging from localized symptoms, to severe anaphylactic reactions. FA is generally caused by milk, eggs, soybeans, tree nuts, peanuts, wheat, fish and crustacean; being peanut one of the main foods involved in Western countries. Although in other parts of the world peanut allergy (PA) is not a problem, probably due to timing of introduction into the diet, form and preparation, genetics, and the hygiene hypothesis. Unfortunately, in Chile there are no epidemiological data about FA or PA. A number of food allergens have been identified, which has improved patient diagnosis and treatment assessment. Regarding peanut, 9 allergens have been identified, Ara h 1 to Ara h 9 (Arachis hypogaea). The diagnosis of IgE-mediated PA is based on a consistent history and evidence of peanut-specific IgE sensitization, carried out by skin-prick testing or in vitro determination. PA treatment consists of peanuts avoidance, which often becomes difficult due to inadvertent consumption. Today promising treatments are under development, including oral induction tolerance or sublingual immunotherapy. These treatments offer the possibility of at least raising the threshold of the amount of peanut that would be necessary to cause a life-threatening allergic reaction.
Assuntos
Humanos , Masculino , Feminino , Hipersensibilidade a Amendoim/diagnóstico , Hipersensibilidade a Amendoim/fisiopatologia , Hipersensibilidade a Amendoim/terapia , Antígenos de PlantasRESUMO
En Chile, la infección por hantavirus Andes (ANDV) tiene una expresión clínica variable, reconociéndose diversos grados de severidad. El presente estudio se realizó con el objeto de analizar la posible asociación entre la constitución genética de pacientes chilenos para el sistema HLA y la expresión clínica de la infección por ANDV. Se analizaron los alelos HLA A, B, DRB1 y DQB1, en dos grupos de pacientes con infección por ANDV: 41 pacientes con evolución clínica leve (sin insuficiencia respiratoria severa y sin requerimientos de ventilación mecánica) y 46 pacientes con evolución clínica grave (con insuficiencia respiratoria grave y/o shock). La determinación molecular del sistema HLA se realizó mediante SSP-PCR. El alelo HLA DRB1 * 15, se encontró en una frecuencia significativamente más alta en los pacientes leves (p = 0,007). Por lo tanto, el alelo DRB 1*15 se asociaría al curso clínico leve de la enfermedad. El alelo HLA-B*08, se encontró en una frecuencia mayor en los pacientes graves, la diferencia alcanzó una significación estadística marginal (p = 0,06). Así, el alelo HLA-B*08, podría estar asociado al curso clínico grave de síndrome cardiopulmonar ocasionado por hantavirus Andes.
Andes hantavirus (ANDV) infection in Chile has a variable clinical expression, and infected individuals may present with different grades of disease severity. This study aimed to determine if clinical expression of ANDV infection in Chilean patients is associated with the HLA system. HLA alíeles A, B, DRB1 and DQB1, were studied in two groups of patients with confirmed ANDV infection: 41 patients with a mild disease course (without respiratory failure and cardiovascular shock) and 46 patients with a severe disease course (with respiratory failure and shock). Molecular typing of HLA system was performed by SSP-PCR. The HLA-DRB 1*15 alíele, was significantly more common in the group of patients with mild disease (p = 0,007) and thus for possibly associated with a protective effect against ANDV infection. Conversely, HLA-B*08 was more common in patients with severe disease (p = 0,06). Although the association was marginally significant, alíele HLA-B*08 may be linked to an increased susceptibility to the severe clinical course of HCPS by ANDV.