[Prevalence of resistance to antiretroviral drugs in Spain]. / Prevalencia de resistencia a fármacos antirretrovirales en España.

INTRODUCTION: The development of resistance to antiretroviral therapy (ART) reduces the effectiveness of these drugs in HIV-infected children. METHODS: We performed a cross-sectional study in 86 vertically HIV-infected children, divided into four groups according to prior treatment: group 1: nucleoside reverse transcriptase inhibitor (NRTI), group 2: NRTI and non-nucleoside reverse transcriptase inhibitor (NNRTI), group 3: NRTI and protease inhibitor (PI), group 4: NRTI, NNRTI and PI. RESULTS: In group 1 (11 children), the median treatment duration was 35 months (26 to 108). Nucleoside-associated mutations (NAMs) were found in 10 of these patients and the Q151M multiresistance mutation was found in two. The three children in group 2 were treated for 9, 32 and 42 months with NRTI and NNRTI. One child showed three NAMs and another showed Q151M. Two children had the K103N mutation. Group 3 (36 children) received treatment with NRTI and PI for 48.0 +/- 27.6 and 23.0 +/- 14.6 months, respectively. NAMs were observed in 94 % of the patients in this group, and one child showed the Q151M mutation. In group 4 (36 children) total treatment duration was 70.0 +/- 36.1 months (13.0 +/- 12.1 months with NNRTI, and 39.0 +/- 14.3 months with PI). NAMs were observed in all patients in this group, and Q151M was found in three children. K103N and Y181C were detected in 24 (67%) and 10 (28%) of the children respectively, while 32 (90%) showed primary mutations to PI. CONCLUSIONS: A high prevalence of resistance mutations to NRTI and early appearance of resistance to NNRTI were observed in treated children.

Prevalencia de resistencia a fármacos antirretrovirales en España / Prevalence of resistance to antiretroviral drugs in Spain

Introducción La aparición de resistencias a los antirretrovirales (ARV) compromete la eficacia del tratamiento antirretroviral (TAR) en los niños infectados por el virus de la inmunodeficiencia humana (VIH). Métodos Se realizó un estudio transversal en 86 niños divididos en 4 grupos según su historia de TAR previo: 1. inhibidores de la retrotranscriptasa análogos de nucleósido (NRTI); 2. NRTI e inhibidores de la retrotranscriptasa no análogos de nucleósido (NNRTI); 3. NRTI e inhibidores de la proteasa (IP); 4. NRTI, NNRTI e IP. Resultados En el grupo 1 (11 niños) la mediana de TAR fue de 35 meses (26-108). En 10 pacientes se detectaron mutaciones asociadas a los análogos de timidina (NAM) y en 2 pacientes se halló el complejo de multirresistencia Q151M. Los 3 niños del grupo 2, recibieron 9, 32 y 42 meses respectivamente de TAR con NNRTI. En un paciente de este grupo se aislaron 3 NAM y en otro el complejo Q151M. 2 pacientes tenían la mutación K103N. En el grupo 3 (36 niños) la media de duración de tratamiento con NRTI e IP era de 48,0 ± 27,6 y 23,0 ± 14,6 meses, respectivamente. El 94 % de los pacientes de este grupo, tenían NAM y un paciente tenía el complejo Q151M. En el grupo 4 (36 niños) el tiempo previo de TAR era de 70,0 ± 36,1 meses (NNRTI: 13,0 ± 12,1 meses; IP: 39,0 ± 14,3 meses). Todos los pacientes tenían NAM y 3 pacientes tenían el complejo Q151M. Las mutaciones K103N y Y181C se hallaron en 24 (67 %) y 10 (28 %) de los pacientes, respectivamente. Un total de 32 pacientes (90 %) tenían alguna mutación primaria a IP. Conclusiones La aparición de resistencias a los ARV es frecuente en niños, siendo de rápida aparición con los NNRTI

Introduction The development of resistance to antiretroviral therapy (ART) reduces the effectiveness of these drugs in HIV-infected children. Methods We performed a cross-sectional study in 86 vertically HIV-infected children, divided into four groups according to prior treatment: group 1: nucleoside reverse transcriptase inhibitor (NRTI), group 2: NRTI and non-nucleoside reverse transcriptase inhibitor (NNRTI), group 3: NRTI and protease inhibitor (PI), group 4: NRTI, NNRTI and PI. Results In group 1 (11 children), the median treatment duration was 35 months (26 to 108). Nucleoside-associated mutations (NAMs) were found in 10 of these patients and the Q151M multiresistance mutation was found in two. The three children in group 2 were treated for 9, 32 and 42 months with NRTI and NNRTI. One child showed three NAMs and another showed Q151M. Two children had the K103N mutation. Group 3 (36 children) received treatment with NRTI and PI for 48.0 ± 27.6 and 23.0 ± 14.6 months, respectively. NAMs were observed in 94 % of the patients in this group, and one child showed the Q151M mutation. In group 4 (36 children) total treatment duration was 70.0 ± 36.1 months (13.0 ± 12.1 months with NNRTI, and 39.0 ± 14.3 months with PI). NAMs were observed in all patients in this group, and Q151M was found in three children. K103N and Y181C were detected in 24 (67 %) and 10 (28 %) of the children respectively, while 32 (90 %) showed primary mutations to PI. Conclusions A high prevalence of resistance mutations to NRTI and early appearance of resistance to NNRTI were observed in treated children

[False negative diagnosis of HIV-1]. / Falso negativo en el diagnóstico de VIH-1.

We report a case of a false negative diagnosis of HIV-1 infection in an African girl. Two HIV-1 DNA polymerase chain reaction (PCR) tests were negative at the second and fourth months of life. Because anti-HIV antibodies persisted when the patient was 18 months old, the HIV-1 RNA PCR test was performed with a positive result, confirming HIV-1 non-B subtype, recombinant A-G. The prevalence of non-B HIV-1 subtypes are increasing in Spain, which could be related to the phenomenon of immigration. Approximately one-third of HIV-infected foreigners have non-B subtypes and the percentage increases to 70 % of the African population in Spain. In non-B HIV-1 subtypes, false negative results and inconsistencies between viral load and CD4 count are more frequent. These subtypes also show a higher rate of resistance to protease inhibitors, which can have therapeutic implications.

Falso negativo en el diagnóstico de VIH-1 / False negative diagnosis of HIV-1

Se presenta un caso de falso negativo en el diagnóstico de infección por virus de la inmunodeficiencia humana tipo 1 (VIH-1) en una niña de origen africano. Las pruebas de reacción en cadena de la polimerasa (PCR) de ADN proviral realizadas a los 2 y 4 meses de vida fueron negativas. A los 18 meses, por persistencia de los anticuerpos anti-VIH-1, se realizó una PCR de ARN que resultó positiva, confirmándose la infección por VIH-1, subtipo no B, forma recombinante A-G. La prevalencia de los subtipos no B está en aumento en nuestro medio en relación con el fenómeno de la inmigración, ya que un tercio de los extranjeros infectados lo están por subtipos no B y asciende al 70 % de los pacientes africanos. En estos subtipos son más frecuentes los resultados falsos negativos y las discrepancias entre la carga viral y el recuento de linfocitos CD4. Los subtipos no B muestran una mayor tasa de resistencias a los inhibidores de la proteasa, lo que puede tener implicaciones terapéutica

We report a case of a false negative diagnosis of HIV-1 infection in an African girl. Two HIV-1 DNA polymerase chain reaction (PCR) tests were negative at the second and fourth months of life. Because anti-HIV antibodies persisted when the patient was 18 months old, the HIV-1 RNA PCR test was performed with a positive result, confirming HIV-1 non-B subtype, recombinant A-G. The prevalence of non-B HIV-1 subtypes are increasing in Spain, which could be related to the phenomenon of immigration. Approximately one-third of HIV-infected foreigners have non-B subtypes and the percentage increases to 70 % of the African population in Spain. In non-B HIV-1 subtypes, false negative results and inconsistencies between viral load and CD4 count are more frequent. These subtypes also show a higher rate of resistance to protease inhibitors, which can have therapeutic implications

[Dengue infection in children and adolescents in Panama]. / Dengue pediátrico en Panamá.

BACKGROUND: Dengue is a serious emerging infectious disease and constitutes a major international health concern. MATERIAL AND METHODS: All reports of confirmed dengue infection in patients aged less than 18 years old between 2000 and 2005 were included. A confirmed diagnosis was established by culture of the virus within the first 3 days of symptom onset or by serologic assays 5-30 days after symptom onset. Clinical and epidemiological features were analyzed. RESULTS: A total of 457 patients were included (57.6 % female). The median age was 13 years (IQR 5 6). A greater number of cases were detected in urban areas and during the rainy season (May-November). Two epidemics were reported in 2001 (33.9 %) and the first eight months of 2005 (23.1 %). The most prevalent symptoms were fever (95.2 %), severe headache (74.2 %), chills (65.9 %), rash (63.5 %), myalgias (51.9 %) and retro-orbital pain (51.6 %). No significant differences were found between male and female patients. Significant differences in clinical features were found when the patients were divided into 3 groups; < 5 years old, 6-10 years old and > 10 years old. Fifty-three percent of the patients had had previous contact with a dengue-infected individual. There were 7 patients with dengue hemorrhagic fever, 4 of whom died. CONCLUSIONS: Dengue virus infection is still a major health problem in Panama. To achieve effective control of dengue, further epidemiological studies, such as our own, are needed to design appropriate preventive measures.

Dengue pediátrico en Panamá / Dengue infection in children and adolescents in Panama

Antecedentes El dengue es una enfermedad infecciosa emergente, considerada actualmente como un problema de salud pública mundial. Material y métodos Se incluyeron en el estudio todos los casos positivos de dengue confirmados de pacientes menores de 18 años, durante los años 2000-2005. En las muestras recibidas en los primeros 3 días de la enfermedad se aisló el virus mediante cultivo y en las recibidas entre los días 5-30 por serología. Se analizaron las características clínicas y epidemiológicas de los pacientes. Resultados Se incluyeron 457 pacientes (57,6 % niñas). La mediana de edad fue de 13 años (rango interquartílico 5 6). Se detectó un predominio de la infección en las zonas urbanas y en los meses de mayo-noviembre. Se registraron 2 epidemias en los años 2001 (33,9 %) y primeros 8 meses de 2005 (23,1 %). Las manifestaciones clínicas más frecuentes fueron: fiebre (95,2 %); cefalea (74,2 %); escalofríos (65,9 %); exantema (63,5 %); mialgias (51,9 %), y dolor retroorbitario (51,6 %). No se observaron diferencias significativas según el sexo pero sí al dividir a los pacientes en grupos de edad; menores de 5 años, 6-10 años y mayores de 10 años. En el 53,0 % de los pacientes se registró el antecedente de contacto con otro sujeto infectado en los 15 días previos. Se diagnosticaron 7 casos de dengue hemorrágico de los cuales cuatro murieron. Conclusiones En Panamá el dengue continúa siendo un importante problema de salud pública. Para conseguir un control efectivo de la infección es preciso realizar estudios epidemiológicos, que como el nuestro, contribuyan a diseñar estrategias preventivas adecuadas

Background Dengue is a serious emerging infectious disease and constitutes a major international health concern. Material and methods All reports of confirmed dengue infection in patients aged less than 18 years old between 2000 and 2005 were included. A confirmed diagnosis was established by culture of the virus within the first 3 days of symptom onset or by serologic assays 5-30 days after symptom onset. Clinical and epidemiological features were analyzed. Results A total of 457 patients were included (57.6 % female). The median age was 13 years (IQR 5 6). A greater number of cases were detected in urban areas and during the rainy season (May-November). Two epidemics were reported in 2001 (33.9 %) and the first eight months of 2005 (23.1 %). The most prevalent symptoms were fever (95.2 %), severe headache (74.2 %), chills (65.9 %), rash (63.5 %), myalgias (51.9 %) and retro-orbital pain (51.6 %). No significant differences were found between male and female patients. Significant differences in clinical features were found when the patients were divided into 3 groups; 10 years old. Fifty-three percent of the patients had had previous contact with a dengue-infected individual. There were 7 patients with dengue hemorrhagic fever, 4 of whom died. Conclusions Dengue virus infection is still a major health problem in Panama. To achieve effective control of dengue, further epidemiological studies, such as our own, are needed to design appropriate preventive measures