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1.
S. Afr. med. j ; 112(2): 81-85, 2022.
Article in English | AIM (Africa) | ID: biblio-1358373

ABSTRACT

We describe a case of prolonged SARS-CoV-2 RNA shedding in an HIV-negative 21-year-old man recovering from abdominal and thoracic trauma. Nasopharyngeal (NP) swabs collected at 12 time points over a 95-day span all tested positive for SARS-CoV-2 by reverse transcription polymerase chain reaction (RT-PCR). Genotyping revealed canonical beta-variant E484K and N501Y mutations at earlier time points. Human rhinovirus, coronavirus NL63 and respiratory syncytial virus B were detected at different time points by RT-PCR. Full blood analysis at time point 9 (day 82) showed leukopenia with lymphocytosis. The patient's NP swab tested negative for SARS-CoV-2 by RT-PCR 101 days after the first positive test. The prolonged duration of SARS-CoV-2 RNA shedding in the context of trauma presented here is unique and has important implications for COVID-19 diagnosis, management and policy guidelines


Subject(s)
Humans , Male , Adult , Pneumothorax , COVID-19 Nucleic Acid Testing , SARS-CoV-2 , COVID-19
2.
S Afr Med J ; 112(2): 13499, 2022 02 01.
Article in English | MEDLINE | ID: mdl-35139987

ABSTRACT

We describe a case of prolonged SARS-CoV-2 RNA shedding in an HIV-negative 21-year-old man recovering from abdominal and thoracic trauma. Nasopharyngeal (NP) swabs collected at 12 time points over a 95-day span all tested positive for SARS-CoV-2 by reverse transcription polymerase chain reaction (RT-PCR). Genotyping revealed canonical beta-variant E484K and N501Y mutations at earlier time points. Human rhinovirus, coronavirus NL63 and respiratory syncytial virus B were detected at different time points by RT-PCR. Full blood analysis at time point 9 (day 82) showed leukopenia with lymphocytosis. The patient's NP swab tested negative for SARS-CoV-2 by RT-PCR 101 days after the first positive test. The prolonged duration of SARS-CoV-2 RNA shedding in the context of trauma presented here is unique and has important implications for COVID-19 diagnosis, management and policy guidelines.


Subject(s)
COVID-19 Nucleic Acid Testing , COVID-19/diagnosis , Pneumothorax/physiopathology , SARS-CoV-2/isolation & purification , Genotype , Humans , Male , RNA, Viral/isolation & purification , SARS-CoV-2/genetics , Time Factors , Virus Shedding , Young Adult
4.
S Afr Med J ; 111(3): 255-259, 2021 Mar 02.
Article in English | MEDLINE | ID: mdl-33944748

ABSTRACT

BACKGROUND: Large cohorts of HIV-1 perinatally infected children with long-term follow-up in developing countries are limited. OBJECTIVES: To explore rates and predictors of virological failure in a paediatric cohort. METHODS: A 10-year retrospective study was conducted from January 2004 to December 2013 to determine the incidence of and factors associated with virological failure among 1 659 HIV perinatally infected children in a public sector setting in South Africa (SA). Children aged <17 years who initiated first-line antiretroviral therapy between 1 January 2004 and 31 December 2013 and had at least 5 years of HIV viral load measurements were eligible. RESULTS: The 1 659 children contributed 7 075 person-years of follow-up (PYFU). In the initial cohort of 2 024 children, 51.0% were male and 62.0% were aged <5 years. The incidence of virological failure was 18.7 per 100 PYFU. Virological failure was associated with male gender, death of the mother, concurrent tuberculosis treatment and World Health Organization stage IV disease. Of the 320 HIV isolates successfully amplified, 249 (77.8%) had drug resistance mutations. CONCLUSIONS: We observed high rates of virological failure and emergence of HIV drug resistance mutations. Despite gains made by SA in the treatment of HIV, such results challenge the country's ability to meet global targets of 90% viral suppression by 2020.


Subject(s)
Drug Resistance, Viral , HIV Infections/drug therapy , HIV Infections/transmission , HIV-1 , Infectious Disease Transmission, Vertical/statistics & numerical data , Adolescent , Child , Child, Preschool , Female , Humans , Incidence , Infant , Infant, Newborn , Male , Retrospective Studies , Risk Factors , South Africa , Viral Load
5.
S Afr Med J ; 109(7): 511-515, 2019 Jun 28.
Article in English | MEDLINE | ID: mdl-31266578

ABSTRACT

BACKGROUND: Advances in HIV management have improved treatment outcomes in the HIV-infected population. However, these advances have not been without multifaceted challenges. In sub-Saharan Africa, their impact is reflected in the increased emergence of HIV drug resistance mutations. With the rise in exposure of children to protease inhibitors (PIs), the possibility of increasing PI resistance remains a concern. OBJECTIVES: To describe a group of antiretroviral-experienced children with PI drug resistance mutations after failure on first- or second-line regimens in a public sector setting in South Africa. METHODS: This was a retrospective cohort study of 22 children perinatally infected with HIV who had HIV genotyping conducted between January 2011 and December 2017. RESULTS: Of the 236 children who had HIV genotyping conducted, 22 (9.3%) had evidence of HIV PI resistance mutations. Twenty-one of the 22 children (95.5%) had major mutations in the protease region of the HIV genome. Of these children, 66.7% (14/21) had loss of response to both boosted lopinavir and atazanavir, with boosted darunavir remaining susceptible in only 12 (57.1%). The most frequent major PI mutations were V82A (76.2%), M46I/M46L (76.2%), I54V (62.0%) and L76V (33.3%). CONCLUSIONS: We observed a high rate of PI resistance mutations, with a resulting loss of PIs that could be used in construction of third-line regimens. To build on improvements from the introduction of antiretroviral therapy, increased efforts are needed by both health professionals and caregivers to improve adherence measures in children perinatally infected with HIV.


Subject(s)
Drug Resistance, Viral/genetics , HIV Infections/drug therapy , HIV Infections/virology , HIV Protease Inhibitors/administration & dosage , Mutation , Adolescent , Child , Child, Preschool , Cohort Studies , Female , Genotype , HIV/drug effects , HIV/genetics , HIV Protease Inhibitors/pharmacology , Humans , Infant , Infant, Newborn , Male , Retrospective Studies
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