Avian Reoviruses in Poultry Farms from Brazil.

Avian reovirus (ARV) is highly disseminated in commercial Brazilian poultry farms, causing arthritis/tenosynovitis, runting-stunting syndrome, and malabsorption syndrome in different meat- and egg-type birds (breeders, broilers, grillers, and layers). In Brazil, ARV infection was first described in broilers in the 1970s but was not considered an important poultry health problem for decades. A more concerning outcome of field infections has been observed in recent years, including condemnations at slaughterhouses because of the unsightly appearance of chicken body parts, mainly the legs. Analyses of the performance of poultry flocks have further evidenced economic losses to farms. Genetic and antigenic characterization of ARV field strains from Brazil demonstrated a high diversity of lineages circulating in the entire country, including four of the five main phylogenetic groups previously described (I, II, III, and V). It is still unclear if all of them are associated with different diseases affecting flocks' performance in Brazilian poultry. ARV infections have been controlled in Brazilian poultry farms by immunization of breeders and young chicks with classical commercial live vaccine strains (S1133, 1733, 2408, and 2177) used elsewhere in the Western Hemisphere. However, genetic and antigenic variations of the field isolates have prevented adequate protection against associated diseases, so killed autogenous vaccines are being produced from isolates obtained on specific farms. In conclusion, ARV field variants are continuously challenging poultry farming in Brazil. Epidemiological surveillance combined with molecular biological analyses from the field samples, as well as the development of vaccine strains directed toward the ARV circulating variants, are necessary to control this economically important poultry pathogen.

Reovirus aviares en granjas avícolas de Brasil. El reovirus aviar (ARV) está muy diseminado en las granjas avícolas comerciales brasileñas y causa artritis/tenosinovitis viral, síndrome de retraso de enanismo infeccioso y síndrome de malabsorción en diferentes tipos de aves de carne y huevos (reproductoras, pollos de engorde, parrillas y ponedoras). En Brasil, la infección por reovirus aviares se describió por primera vez en pollos de engorde en la década de 1970, pero no se consideró un problema importante de salud avícola durante décadas. En los últimos años se ha observado un resultado más preocupante de las infecciones de campo, incluidos los decomisos en las plantas de procesamiento debido a la apariencia antiestética de las partes del cuerpo de los pollos, principalmente las patas. Los análisis del desempeño de las parvadas avícolas han evidenciado pérdidas económicas adicionales para las granjas. La caracterización genética y antigénica de las cepas de campo de reovirus aviares de Brasil demostró una gran diversidad de linajes que circulan en todo el país, incluidos cuatro de los cinco grupos filogenéticos principales descritos anteriormente (I, II, III y V). Todavía no está claro si todos ellos están asociados con diferentes enfermedades que afectan el rendimiento de las parvadas en las aves de corral brasileñas. Las infecciones por reovirus aviares se han controlado en granjas avícolas brasileñas mediante la inmunización de reproductores y pollitos jóvenes con cepas vacunales vivas comerciales clásicas (S1133, 1733, 2408 y 2177) utilizadas en otras partes del hemisferio occidental. Sin embargo, las variaciones genéticas y antigénicas de los aislamientos de campo han impedido una protección adecuada contra enfermedades asociadas, por lo que se están produciendo vacunas autógenas inactivadas a partir de aislamientos obtenidos en granjas específicas. En conclusión, las variantes de campo de ARV son un desafío continuo para la avicultura en Brasil. La vigilancia epidemiológica combinada con análisis de biología molecular de las muestras de campo, así como el desarrollo de cepas de vacunas dirigidas a las variantes circulantes de los reovirus aviares, son necesarias para controlar este patógeno avícola económicamente importante.

Importance of support groups to the health and well-being of vulnerable children and young people living with HIV: a case study of the Kids Clubs program in Haiti.

BACKGROUND: Although access to antiretroviral therapy (ART) among children and young people living with HIV has increased in recent years, adherence to medication and viral suppression remain challenges. Evidence of benefits of support groups is growing and reflects a range of models and approaches. Since 2014, hospital-linked psychosocial support groups for children and young people living with HIV, known as Kids Clubs, have been established throughout Haiti. The program provides safe spaces for them to meet with peers, supports medication adherence, delivers health and life skills education, and facilitates linkages with clinic visits and social services. This study describes program enrollment and participant engagement, ART adherence and viral suppression among participants, and other outcomes attributed to the program by participants, caregivers, and program implementers. METHODS: Our mixed methods study included quantitative analysis of program monitoring data on rollout and attendance, and medication adherence and viral load results extracted from medical records. We collected qualitative data from club members, caregivers, and implementers about their experiences with the clubs and the impact of participation. RESULTS: From January 2014-December 2018, 1330 individuals aged 8-29 were enrolled in the program; over three-quarters participated for at least 12 months. In 2018, 1038 members attended at least one club meeting; more than half missed three or fewer monthly meetings. Three-quarters of ever-enrolled members reported consistent medication use at their most recent clinic visit; 64.2% (600/935) of those with a recent viral load test were virally suppressed. Level of club attendance was positively associated with ART adherence (p < 0.01) and viral suppression (p < 0.05). Club members, caregivers, and implementers noted the value of the clubs to participants' retention in care and medication adherence, health knowledge, and capacity to deal with peer pressure, stigma, shyness, and depression. CONCLUSIONS: The Kids Club program has been successful in scaling HIV support services to highly vulnerable children and young people through peer-based groups, and program participation has led to a range of benefits. Efforts to innovate, evaluate, and scale support strategies for vulnerable young populations must be accelerated in order to ensure that they survive, thrive, and reach their full potential.

Genotypic characterization and molecular evolution of avian reovirus in poultry flocks from Brazil.

Avian reovirus (ARV) is one of the main causes of infectious arthritis/tenosynovitis and malabsorption syndrome (MAS) in poultry. ARVs have been disseminated in Brazilian poultry flocks in the last years. This study aimed to genotype ARVs and to evaluate the molecular evolution of the more frequent ARV lineages detected in Brazilian poultry-producing farms. A total of 100 poultry flocks with clinical signs of tenosynovitis/MAS, from all Brazilian poultry-producing regions were positive for ARV by PCR. Seventeen bird tissues were submitted to cell culture and ARV RNA detection/genotyping by two PCRs. The phylogenetic classification was based on σC gene alignment using a dataset with other Brazilian and worldwide ARVs sequences. ARVs were specifically detected by both PCRs from the 17 cell cultures, and σC gene partial fragments were sequenced. All these sequences were aligned with a total of 451 ARV σC gene data available in GenBank. Phylogenetic analysis demonstrated five well-defined clusters that were classified into lineages I, II, III, IV, and V. Three lineages could be further divided into sub-lineages: I (I vaccine, Ia, Ib), II (IIa, IIb, IIc) and IV (IVa and IVb). Brazilian ARVs were from four lineages/sub-lineages: Ib (48.2%), IIb (22.2%), III (3.7%) and V (25.9%). The Bayesian analysis demonstrated that the most frequent sub-lineage Ib emerged in the world around 1968 and it was introduced into Brazil in 2010, with increasing spread soon after. In conclusion, four different ARV lineages are circulating in Brazilian poultry flocks, all associated with clinical diseases. RESEARCH HIGHLIGHTS One-hundred ARV-positive flocks were detected in all main poultry-producing regions from Brazil. A large dataset of 468 S1 sequences was constructed and divided ARVs into five lineages. Four lineages/sub-lineages (Ib, IIb, III and V) were detected in commercial poultry flocks from Brazil. Brazilian lineages shared a low identity with the commercial vaccine lineage (I vaccine). Sub-lineage Ib emerged around 1968 and was introduced into Brazil in 2010.

Temporal changes in ART initiation in adults with high CD4 counts in Latin America: a cohort study.

INTRODUCTION: In 2013, the World Health Organization (WHO) recommended initiating combination ART (cART) in all adults with HIV and CD4+ lymphocyte counts (CD4) <500 cells/mm3 . In 2015, this was updated to recommend cART initiation in all patients with HIV, regardless of CD4 count. Implementation of these guidelines in real-world settings has not been evaluated in Latin America. To assess changes in time to cART initiation during routine care, we estimated trends in time from enrolment in care to cART initiation in HIV-positive adults with high CD4 counts in the Caribbean, Central and South America network for HIV Epidemiology (CCASAnet) during 2003 to 2017. METHODS: All cART-naive individuals ≥18 years of age from 2003 to 2017 with CD4 ≥350 cells/mm3 and without AIDS at enrolment at five CCASAnet sites (Brazil, Chile, Honduras, Mexico and Peru) were included. Patients without information regarding AIDS-defining events were excluded. We estimated unadjusted median time from enrolment to cART initiation by calendar year using Kaplan-Meier methods and calculated adjusted hazard ratios (HR) and 95% confidence intervals (95% CI) for trends in cART initiation using Cox models and restricted cubic splines for continuous variables, accounting for age, sex, CD4 at enrolment, route of HIV transmission and clinic site. RESULTS: Of the 3171 patients included, 1,650 (52%) had CD4 ≥500 cells/mm3 at enrolment. Median time to cART initiation after 2013 was 6.21 weeks (interquartile range (IQR): 1.89, 23.21), and 4.71 weeks (IQR: 1.43, 9.57) after 2015. Among 763 (24%) patients who never initiated cART, 33 (4.3%) were reported as deceased, 481 (63%) were lost to follow-up, and 249 (33%) were administratively censored before initiation. Adjusted probability of cART initiation greatly increased in recent years, in particular after 2013 and 2015 (2013 vs. 2003: HR = 7.14; 95% CI: 5.84 to 8.73, and 2015 vs. 2003: HR = 12.60; 95% CI: 10.37 to 15.32). CONCLUSIONS: Time to cART initiation decreased substantially, roughly following changes in WHO guidelines in this real-world setting in Latin America. However, a very high proportion of patients never started cART, compromising retention in care and survival, as shown by their higher proportion of LTFU and death, which reinforce the notion that earlier treatment implementation strategies are needed.

Caracterización clínico-epidemiológico de pacientes perinatalmente expuestos al VIH en el Hospital Nacional Mario Catarino Rivas / Clinical-epidemiological characterization of perinatally exposed HIV patients. Mario Catarino Rivas National Hospital

Antecedentes: En los países con escasos recursos, la infección por VIH infantil tiene dimensiones alarmantes. Más del 90% de los niños que viven con VIH en los países en desarrollo se infectaron por transmisión de madre a hijo durante el embarazo, parto o lactancia. Con el fin de reducir el número de niños infectados por el VIH, se ha enfatizado en los programas de prevención de la transmisión vertical, encontrándose una reducción de la transmisión del virus, actualmente menos del 1% en niños de bajo riesgo. Objetivo: Caracterizar clínica y epidemiológicamente a los pacientes perinatalmente expuestos al VIH atendidos en el Hospital Nacional Mario Catarino Rivas enero 2018 - junio del 2019. Pacientes y Métodos: Estudio cuantitativo, observacional, descriptivo; se realizó la revisión de 42 expedientes clínicos, se aplicó un cuestionario de 23 preguntas abiertas y cerradas, evaluando variables clínicas y epidemiológicas. Resultados: el 85% de las madres conocían el diagnostico de ser VIH positivo, 66% diagnosticadas previo al embarazo, 80% en tratamiento con ARV, 26% con carga viral no detectable, 78% finalizo su embarazo vía cesárea, 53% fueron categorizados como alto riesgo, 85% recibió terapia ARV por 4 semanas, incidencia de VIH fue de 4.7%, 2 de los 42 pacientes,19% están perdidos en seguimiento, 88% recibió profilaxis con TMP-SMX.Conclusiones: El diagnóstico precoz de VIH en la infancia mediante la realización de pruebas vi * Médico Residente tercer año de Pediatría, UNAH-VS. ** Médico Pediatra, Servicio de Atención Integral, HNMCR. *** Médico Pediatra, Servicio de Atención Integral, HNMCR. Dirigir correspondencia a: damavibau_723@hotmail.com Recibido: 20 de Diciembre 2019 Aprovado:15 de marzo 2020 favorece al inicio temprano de tratamiento antirretroviral con un pronóstico de vida más favorable...(AU)

Metabolic and Cardiovascular Comorbidities Among Clinically Stable HIV Patients on Long-Term ARV Therapy in Five Ambulatory Clinics in Lima-Callao, Peru.

BACKGROUND: There is scarcity of data about the prevalence of non-AIDS defining comorbidities among stable HIV-infected patients in Peru. OBJECTIVE: We aimed to describe the most frequent cardiometabolic comorbidities found among ambulatory adults on ARV in Peru. METHODS: A review of records for patients attending regular visits at 5 clinics in Lima-Callao in January-February 2016 is presented. Patients were adults on ARV for >6 months, with no recent AIDS-defining condition. RESULTS: Three hundred and five medical charts were reviewed. Most patients were male (73.1%, n=223) with a mean age of 46.0 years. Mean time from HIV diagnosis was 9.41 yrs. and mean duration of ARV was 7.78 yrs. Most patients were on an NNRTI-based first line regimen (76.4%, n=233), and 12.1% (n=37) were on rescue regimens. Median CD4 count was 614.2 cells/µL and the proportion of patients with viral load <40 c/mL was 90.8% (n=277). Most frequent metabolic diagnoses were dyslipidemia (51.5%, n=157), obesity (11.1%, n=34), and diabetes mellitus (7.2%, n=22). Hypertension was diagnosed in 8.9% (n=27). Other diagnoses of cardiovascular disease were documented in 3.3% (n=10). Pharmacologic treatment was prescribed in 91.3% of patients with diabetes or hypertension, but in only 29.3% of patients with dyslipidemia. CONCLUSION: A high proportion of metabolic comorbidities was found, with dyslipidemia being the most frequent, followed by obesity and diabetes. In contrast, cardiovascular disease was documented less frequently. Medical treatment was started for only a third of dyslipidemia patients. HIV care policies need to consider proper management of chronic comorbidities to optimize long-term outcomes.

Dinâmica temporal, subtipos e caracteristicas epidemiológicas da infecção pelo hiv-1, Brasil Central / Dinamic temporal, subtypes and epidemiological characteristics of hiv1 infection, Central Brazil

O objetivo deste estudo foi identificar os principais subtipos de HIV-1 circulantes no Mato Grosso do Sul (MS), Brasil Central. Métodos: Trata-se de um estudo transversal de séries temporais com dados de laboratório e relato de doença, analisados por período de diagnóstico e variáveis sociodemográficas e clínicas. Resultados: Subtipo B HIV-1 predominou quando os períodos foram analisados (85,4% vs 85,3%). Além disso, foi detectado um aumento na frequência do subtipo C do HIV-1, mas nenhuma diferença significativa foi observada entre os dois períodos. Após análise univariada, a faixa etária entre 25 e 45 anos (p = 0,004) e o gênero masculino (p = 0,04) mostraram-se associados ao subtipo B HIV-1. Os achados relacionados à resistência do HIV-1 à ARV mostraram que 30,6% dos pacientes diagnosticados com AIDS entre 1985 e 2012, submetidos a testes de genotipagem (212), eram resistentes a mais de três classes de ARVs (MDR). Conclusões: Estudos sobre a diversidade genética, bem como o perfil de mutações de resistência no HIV-1, são ferramentas importantes para a reconstrução histórica de epidemias regionais, vigilância epidemiológica local e diretrizes de tratamento.

The objective of this study was to identify the major subtypes of HIV-1 circulating in Mato Grosso do Sul (MS), Central Brazil. Methods:This is a cross-sectional study of time series with data from laboratory and disease report, analyzed by period of diagnosis and sociodemographic and clinical variables. Results: Subtype B HIV-1 predominated when periods were analyzed (85.4% vs 85.3%). In addition, an increase in the frequency of HIV-1 subtype C was detected, but no significant difference was seen between the two periods. After univariate analysis, the age range between 25 and 45 years (p = 0.004) and the masculine gender (p = 0.04) were found to be associated with subtype B HIV-1. The findings related to the resistance of HIV-1 to ARV showed that 30.6% of the investigated patients diagnosed AIDS between 1985 and 2012 who underwent genotyping tests (212) were resistant to more than three ARV classes (MDR). Conclusions: Studies on the genetic diversity, as well as the profile of resistance mutations in HIV-1, are important tools for both the historical reconstruction of regional epidemics and local epidemiological surveillance and treatment guidelines.

CTC-derived AR-V7 detection as a prognostic and predictive biomarker in advanced prostate cancer.

INTRODUCTION: Prostate cancer is a highly heterogeneous disease, with remarkably different prognosis across all stages. Increased circulating tumor cell (CTC) count (≥ 5) using the CellSearch assay has been identified as one of the markers that can be used to predict survival, with added value beyond currently available prognostic factors. Recently, androgen receptor splice variant 7 (AR-V7) detection has been associated with worse outcomes for patients with castration-resistant prostate cancer (CRPC) treated with novel androgen receptor-signaling (ARS) inhibitors such as abiraterone and enzalutamide but not taxane chemotherapies. Areas covered: In this manuscript, the authors review the available biomarkers in CRPC and discuss emerging data on the value of CTC-derived AR-V7 status to assess prognosis and its potential role to guide treatment selection for patients with advanced prostate cancer. Expert commentary: Current evidence supports AR-V7 status as a prognostic biomarker and also as a potential predictive biomarker for patients with mCRPC. The authors expect that the incorporation of AR-V7 status and other biomarkers (e.g. AR mutations) in the sequential assessment of patients with advanced prostate cancer will lead to a more rational use of available and future therapies, with significant improvements in outcomes for our patients.

A novel capillary nano-immunoassay for assessing androgen receptor splice variant 7 in plasma. Correlation with CD133 antigen expression in circulating tumor cells. A pilot study in prostate cancer patients.

PURPOSE: Androgen receptor (AR) splice variant 7 (AR-V7) has been related with both a higher risk of prostate cancer (PC) progression and differential responsiveness to hormonal agents versus chemotherapy. The objective of this study was to investigate the feasibility of a novel capillary nano-immunoassay in assessing AR-V7 in plasma from PC patients. METHODS: Patients with either localized or advanced PC were included in the study. Assessment of AR-V7 in plasma was performed through a capillary nano-immunoassay platform. Correlation with clinical data, stem cell biomarkers (such as CD133+), AR amplification and PTEN status was identified. RESULTS: The study included 72 PC patients. AR-V7 signal was detected in 21 (29%) patients: 17 (81%) had a Gleason score ≥7, 15 (71%) castration-resistant prostate cancer (CRPC), 18 (86%) metastatic disease and PSA (median) high than AR-V7 negative (p < 0.05). CD133 was expressed in 69 (96%) patients. The median CD133+ expression in circulating tumor cells CTCs was higher among the 21 AR-V7 positive cases versus AR-V7 negative (7 vs. 3). Androgen Receptor and PTEN fluorescence in situ hybridization (FISH) on CD133+ captured cells were performed: 37 cases showed ≥four CD133+ CTCs, of which 81% showed an increased AR copy number. This percentage was similar in both AR-V7-positive and AR-V7-negative patients. A total of 68% of the cases showed deletion of PTEN: 70% were ARV-7 positive vs. 67%, which were AR-V7 negative. CONCLUSIONS: Assessing the presence of AR-V7 in plasma from PC patients is feasible by a novel capillary nano-immunoassay. AR-V7 was observed in 29% of the tumors and is more frequent in aggressive tumors.

Galeterone for the treatment of advanced prostate cancer: the evidence to date.

Major advances have been achieved recently in the treatment of metastatic castration-resistant prostate cancer, resulting in significant improvements in quality of life and survival with the use of several new agents, including the next-generation androgen receptor (AR)-targeted drugs abiraterone and enzalutamide. However, virtually all patients will eventually progress on these therapies and most will ultimately die of treatment-refractory metastatic disease. Recently, several mechanisms of resistance to AR-directed therapies have been uncovered, including the AR splice variant 7 (AR-V7), which is a ligand-independent constitutionally-active form of the AR that has been associated with poor outcomes to abiraterone and enzalutamide. Galeterone, a potent anti-androgen with three modes of action (CYP17 lyase inhibition, AR antagonism, and AR degradation), is a novel agent under clinical development that could potentially target both full-length AR and aberrant AR, including AR-V7. In this manuscript, we will first discuss the biological mechanisms of action of galeterone and then review the safety and efficacy data from Phase I and II clinical studies of galeterone in patients with metastatic castration-resistant prostate cancer. A Phase III study of galeterone (compared against enzalutamide) in AR-V7-positive patients is currently underway, and represents the first pivotal trial using a biomarker-selection design in this disease.

Evaluación de resistencia genotípica del VIH-1 en pacientes con fallo virológico de Guatemala / Evaluation of genotypic resistance of HIV-1 in patients with virologic failure Guatemala

La resistencia a la terapia antirretroviral (TARV) es un factor determinante para el fallo virológico en pacientes con VIH. El objetivo de este estudio fue identificar los patrones genotípicos de resistencia en pacientes con fallo virológico. Fueron incluidos pacientes de las diferentes unidades de atención integral de VIH en Guatemala, de quienes se sospechaba resistencia y que necesitaban cambios en la TARV por fallo virológico, se requirió haber evaluado la adherencia y una carga viral ≥1,000 copias/ml. La información clínica y demográfica fue recolectada a través de la forma de solicitud. El análisis de resistencia se realizó a través de la metodología TRUGENE® HIV-1. La muestra se restringió a 25 pacientes por motivos de accesibilidad. El 68% de las muestras analizadas presentaron resistencia; por familia de ARV la resistencia fue de 88.2% para ITINN, 70.5% para ITIAN y 17.6% para IP. Se identificaron 79 mutaciones entre el grupo de estudio, el 46.8% de fueron asociadas a ITINN, 76.6% a ITIAN y 26.6% a IP. Para ITIAN las mutaciones más frecuentes fueron la M184V 43%, M184I 14% y K219E 10%; el 23.8% fueron mutaciones TAMs. Para ITINN fueron la V179D 16%, K103N 14%, G190A 14% y Y181C 14%. Para los IP la mutación más frecuente fue la M36I con 29%. La resistencia identificada en este grupo, fue menor a lo reportado en otros países latinoamericanos; sin embargo es similar a lo reportado por OMS en países con bajo o medio ingreso económico.

ARV drug resistance is one of the leading causes of virologic failure among HIV patients on HAART. Theobjective of this study was to determine genotypic resistance profiles among HIV patients on virologic failure. Patients from one HIV clinic in Guatemala on whom ARV drug resistance was suspected and needed a change in their ARV regimen due to virologic failure were included. In order to perform the genotype, the patient had to demonstrate good adherence to therapy and a confirmed viral load ≥1,000 copies/ml. Demographics andclinical data were collected through the resistance-testing questionnaire. The TRUGENE® HIV-1 methodology was used for resistance analysis. The patient sample was restricted to 25 patients due to accessibility, 68% presented resistance to at least one ARV drug. By ARV class, 88.2% presented resistance to NNRTIs, 70.5% to NRTIs and 17.6% to IPs. We found 79 mutations among the samples analyzed. Of the mutations found, 46.8% were associated with NNRTI resistance, 76.6% to NRTI resistance and the remainder 26.6% to PI resistance. The most frequent NRTI associated mutations were M184V 43%, M184I 14% and K219E 10%; 23.8% were TAM. The NNRTI associated mutations were V179D 16%, K103N 14%, G190A 14% and Y181C 14%. For the PI the most frequent mutation was M36I with 29%. The resistance found in this study was lower to that reported in other Latin American studies, however, it is similar to what is reported by WHO in low and middle income countries.

The occurrence of orthoreovirus, rotavirus and chicken anemia virus in chickens of the poultry industry in Minas Gerais, Brazil / Ocorrência de orthoreovirus, rotavirus e vírus da anemia das galinhas em frangos de corte da indústria avícola de Minas Gerais

Fifty-four fecal samples taken from broiler chickens from 1 to 45 days of age, and of pullets from 10 to 13 weeks of age, original from eight different poultry regions in the state of Minas Gerais, Brazil, were collected from March 2008 to January 2010 for avian Orthoreovirus (ARV) and avian Rotavirus (AvRV) analyses. For the assay of ARV, RNA was immediately extracted (Trizolâ) and transcribed into cDNA for assaying in a nested-PCR with ARV-specific primers. For AvRV, polyacrylamide gel electrophoresis (PAGE) was performed with RNA extracts obtained by phenol-chloroform extraction. CAV was additionally investigated through a nested-PCR of thymus and spleen. Results found 5.55% positive for ARV and 9.25% for AvRV. Also, CAV and ARV genomes were detected in co-infection, in a highly prostrated and claudicating chicken flock. No ARV or AvRV infections were detected in pullets. Material of a clinically affected flock was inoculated into SPF embryos, resulting in embryonic hemorrhage, whitish foci in the chorio-allantoic membrane and death. Sequencing of ARV amplicons and isolate cDNA grouped local strains with the ARV S1133 strain, historically used in live vaccines, suggesting the continued circulation of this vaccine virus strain in intensive poultry regions. Detection rates for ARV and AvRV, as well as the presence of CAV, were additionally indicative of failing biosecurity strategies for the intensive poultry regions examined.

Avaliou-se a ocorrência de Orthoreovirus (ARV) e Rotavirus (AvRV) aviários na avicultura industrial de Minas Gerais. Foram colhidas cinquenta e quatro amostras de fezes de frangos de corte entre um e 45 dias e de frangas de postura de 10 a 13 semanas de idade. Para análise de ARV, o RNA foi imediatamente extraído (Trizol), transcrito em cDNA e avaliado em uma PCR com oligonucleotídeos iniciadores específicos para ARV. Para a investigação de AvRV, os extratos de RNA foram obtidos por fenol-clorofórmio e submetidos à eletroforese em gel de poliacrilamida. Todas as amostras foram também avaliadas para o DNA do vírus da anemia das galinhas (CAV) em uma nested-PCR específica. Em frangos de corte, a positividade encontrada para ARV foi de 5,55% e para AvRV de 9,25%. CAV foi detectado em coinfecção em um plantel com refugagem, claudicação e prostração. Nenhuma amostra de poedeiras foi positiva para ARV ou AvRV. Material de plantel com sinais clínicos foi purificado e inoculado em ovos SPF embrionados, sendo obtidas lesões hemorrágicas e focos brancos na membrana cório-alantóide. O sequenciamento dos produtos de PCR e de embrião agrupou os isolados de ARV com a estirpe S1133, historicamente usada como vacina viva. Os resultados sugerem a continuada circulação da infecção por estirpes assemelhadas a ARV S1133 nas regiões de avicultura industrial. Os índices de detecção de ARV, AvRV e CAV indicam que a intensificação nas regiões produtoras tem resultado em falhas de biosseguridade.

The occurrence of Orthoreovirus, Rotavirus and chicken anemia virus in chickens of the poultry industry in Minas Gerais, Brazil / Ocorrência de Orthoreovirus, Rotavirus e vírus da anemia das galinhas em frangos de corte da indústria avícola de Minas Gerais

Fifty-four fecal samples taken from broiler chickens from 1 to 45 days of age, and of pullets from 10 to 13 weeks of age, original from eight different poultry regions in the state of Minas Gerais, Brazil, were collected from March 2008 to January 2010 for avian Orthoreovirus (ARV) and avian Rotavirus (AvRV) analyses. For the assay of ARV, RNA was immediately extracted (Trizolâ) and transcribed into cDNA for assaying in a nested-PCR with ARV-specific primers. For AvRV, polyacrylamide gel electrophoresis (PAGE) was performed with RNA extracts obtained by phenol-chloroform extraction. CAV was additionally investigated through a nested-PCR of thymus and spleen. Results found 5.55% positive for ARV and 9.25% for AvRV. Also, CAV and ARV genomes were detected in co-infection, in a highly prostrated and claudicating chicken flock. No ARV or AvRV infections were detected in pullets. Material of a clinically affected flock was inoculated into SPF embryos, resulting in embryonic hemorrhage, whitish foci in the chorio-allantoic membrane and death. Sequencing of ARV amplicons and isolate cDNA grouped local strains with the ARV S1133 strain, historically used in live vaccines, suggesting the continued circulation of this vaccine virus strain in intensive poultry regions. Detection rates for ARV and AvRV, as well as the presence of CAV, were additionally indicative of failing biosecurity strategies for the intensive poultry regions examined.(AU)

Avaliou-se a ocorrência de Orthoreovirus (ARV) e Rotavirus (AvRV) aviários na avicultura industrial de Minas Gerais. Foram colhidas cinquenta e quatro amostras de fezes de frangos de corte entre um e 45 dias e de frangas de postura de 10 a 13 semanas de idade. Para análise de ARV, o RNA foi imediatamente extraído (Trizol), transcrito em cDNA e avaliado em uma PCR com oligonucleotídeos iniciadores específicos para ARV. Para a investigação de AvRV, os extratos de RNA foram obtidos por fenol-clorofórmio e submetidos à eletroforese em gel de poliacrilamida. Todas as amostras foram também avaliadas para o DNA do vírus da anemia das galinhas (CAV) em uma nested-PCR específica. Em frangos de corte, a positividade encontrada para ARV foi de 5,55% e para AvRV de 9,25%. CAV foi detectado em coinfecção em um plantel com refugagem, claudicação e prostração. Nenhuma amostra de poedeiras foi positiva para ARV ou AvRV. Material de plantel com sinais clínicos foi purificado e inoculado em ovos SPF embrionados, sendo obtidas lesões hemorrágicas e focos brancos na membrana cório-alantóide. O sequenciamento dos produtos de PCR e de embrião agrupou os isolados de ARV com a estirpe S1133, historicamente usada como vacina viva. Os resultados sugerem a continuada circulação da infecção por estirpes assemelhadas a ARV S1133 nas regiões de avicultura industrial. Os índices de detecção de ARV, AvRV e CAV indicam que a intensificação nas regiões produtoras tem resultado em falhas de biosseguridade.(AU)

Respuesta de la terapia antirretroviral en niños con infección por VIH-1. Corte Transversal / Response of antiretroviral therapy in children with HIV-1 infection. Cross-cutting

En el 2003 se inició el Tratamiento Antirretrov iral de Gran Act ividad (TARGA) por parte de la Secretaria de Salud de nuestro país. El seguimiento de estos pacientes se hac ía clí nicamente y con exámenes de laboratorio como hemograma y quím ica Sanginea, del conteo de CD4 se inicio en el 2005 al igual que la carga viral (CV), esta ultima de modo muy irregular. Neuroestudio, inicia en el 2009 con la disponibilidad permanebte de exámenes de CD4 y CV. Nuestro objetivo fueron identificar las respuestas terapeutica de los niños(a) con infección del VIH-1 tratado en el Centro de atención integral del Hospital Nacional del Dr. Mario Catarino Rivas entre el 2009 y el 2011; realizando un análisis descriptivo de la situación clínica, inmunológica y virológica de los niños(as) en tratamiento antirretroviral. utilizamos la Clasificación de CDC para la valoración clínica e inmunológica. Consideramos no detectable la CV que es menor de 50 copias/mi a los 6 meses de iniciado el tratatamiento antirretroviral por el método aplificación por RT-PCR (Abbott Real Time m2000rt). Se analizaron 338 expedientes, encontrando una eficacia terapéutica total del 80.2%. El esquema terapeutico de segunda línea sin falla terapéutica. La causa mas frecuente de falla fue la mala adherencia en un 73.9% y por resistenci a en un 10.1%. En conclusión la adherenci a es un factor importante para mantener la eficac ia terapéutica, aunque en nuestr o estudio no resultó estadísticamente significativo...(AU)

Initial antiretroviral therapy in a 20-year observational cohort of patients followed at a reference center in the city of São Paulo, Brazil / Terapia antiretroviral inicial (ARV) em uma coorte observacional de 20 anos de pacientes em seguimento em um centro de referência na cidade de São Paulo, Brasil

INTRODUÇÃO: A produção e o acesso gratuito e universal aos antiretrovirais (ARV) foram responsáveis pela grande queda na morbi-mortalidade por HIV/Aids no Brasil. OBJETIVO: descrever o tratamento com ARV no Centro de Referência e Treinamento DST/AIDS São Paulo. MÉTODO: Análise longitudinal das características do primeiro tratamento com antirretrovirais de uma coorte retrospectiva de pacientes com 13 anos e mais, matriculados no Centro de Referência, 1985-2005, descrito através de tabelas de frequência e gráficos. RESULTADOS: Foram descritos 4191 pacientes. A maior concentração de iniciação foi no período 1999-2003; 82,7 por cento dos pacientes eram virgens de tratamento. A monoterapia prevaleceu até 1995, o pico da terapia dupla foi 1996-1998, e o período de 1999 a 2005 se caracterizou pela prescrição de terapia tripla. Na terapia tripla, esquemas com inibidores de protease corresponderam a 1.462 (34,9 por cento) de todas as prescrições iniciais. A combinação AZT, 3TC e EFV foi o esquema mais frequentemente prescrito (47,4 por cento) em 2005. CONCLUSÕES: Esse estudo descritivo possibilita o desenvolvimento de análises mais profundas sobre os fatores envolvidos no tratamento de pacientes com HIV/AIDS.

INTRODUCTION: Production and free universal access to ART for patients with HIV/Aids were responsible for a major fall in morbidity-mortality in Brazil. OBJECTIVE: To describe antiretroviral treatment at the São Paulo STD/Aids Training and Reference Center. METHODS: Cross-sectional analysis of the characteristics of the first treatment with antiretroviral drugs of a retrospective cohort of patients 13 years and over, enrolled at the Reference Center, 1985-2005, described by frequency tables and graphs. RESULTS: 4,191 patients were described. The most frequent initiation period was 1999-2003; 82.7% of patients were treatment naïve. Monotherapy prevailed until 1995, the peak of double therapy was 1996-98, and 1999-2005 was characterized by triple therapy. Regarding triple therapy, regimens with protease inhibitors accounted for 1,462 (34.9%) of all first prescriptions. The combination AZT, 3TC and EFV was the most frequently prescribed regimen (47.4%) in 2005.CONCLUSIONS: This descriptive study may enable more in depth analyses on the factors involved in the treatment patients with HIV/AIDS.

Efectos adversos y uso de antirretrovirales en el centro de atención integral VIH-Sida pediátrico del Hospital Nacional Dr. Mario Catarino Rivas / Adverse effects and use of antiretrovirals at the comprehensive pediatric HIV-AIDS center at the Dr. Mario Catarino Rivas National Hospital

En la tercera dé cada de la infecci ón por VIH, las nuevas terapias antirretrovirales han transformado la enfermedad de mortal a crónica. La realidad actual es reconocer que el prin- cipal y único enemigo del VIH es la preven- ción. Los ni ños infectados por VIH tambi én se han beneficiado de los avances en los conocimientos de la propia infecci ón, t écni cas diagnó sticas y de los tratamientos anti - rretrovirales del momento, igual que los adultos. Desde 1996, los niños infectados por el virus de la inmunodeficiencia humana reci ben tratamientos antirretrovirales denomina dos de gran actividad (TARGA). Se realiz ó un estudio Retrospectivo, anal ítico, longitudinal de dichos efectos en los pacientes atendidos en el Cen tro de Atenci ón integral (CA Í) del Hospital Nacional Dr. Mario Catarino Rivas de San Pedro Sula, en el periodo comprendido desde Enero del añ o 2000, hasta Noviembre del 2010, con una poblaci ón de 406 pacientes los cuales recibieron TARGA en nuestro hospital...(AU)

Antiretroviral drugs for treating pregnant women and preventing HIV infection in infants: recommendations for a public health approach 2010 version

For the first time, the elimination of mother-to-child transmission of HIV (MTCT) is now considered a realistic public health goal and an important part of the campaign to achieve the millennium development goals. The 2010 revised PMTCT recommendations are based on two key approaches; lifelong ART for HIV-infected women in need of treatment for their own health, which is also safe and effective in reducing MTCT. And ARV prophylaxis to prevent MTCT during pregnancy, delivery and breastfeeding for HIV-infected women not in need of treatment.

Reflexões de pessoas vivendo com HIV/Aids acerca do acompanhamento em uma unidade de atenção primária à saúde

Apesar dos inúmeros avanços em relação ao HIV/Aids, ainda são necessários mais esforços para que o cuidado aos usuários se dê de maneira mais efetiva nos serviços de saúde. Devido às novas características da epidemia houve a necessidade de ampliar e diversificar as ações de prevenção e assistência nos serviços de atenção básica. O objetivo deste artigo é relatar as observações a respeito do pensam os moradores portadores de HIV/Aids da comunidade em estudo sobre sua condição de saúde e o seu acompanhamento nos serviços de saúde. A pesquisa qualitativa foi desenvolvida na vila Dique, área de ocupação irregular localizada em Porto Alegre/RS, que conta com o trabalho da equipe multidisciplinar de uma unidade de atenção primária à saúde. Após aprovação no Comitê de Ética em Pesquisa, obteve-se uma lista com os nomes dos usuários com CIDS correspondentes à evidência laboratorial para o vírus HIV registrados até dia 31 de dezembro de 2008. A partir disto foram sorteadas 16 pessoas maiores de 18 anos, duas de cada micro-área de vigilância do território, para entrevistas. A análise de conteúdo produziu cinco grandes categorias analíticas: uso de terapia anti-retroviral (TARV); vinculo com seviços de saúde; coordenação cuidado; acesso aos serviços de saúde; e conhecimento das pessoas sobre HIV/Aids e seu tratamento. A não adesão ao tratamento se apresenta como uma das maiores dificuldades para o controle da epidemia. O vínculo estabelecido entre usuário e profissional de referência é fator determinante para o acompanhamento. Muitos usuários demonstraram preferência por consultarem na unidade de saúde local, porém, o acesso aparece como um dos fatores que afasta os usuários dos serviços da APS, que acabam por buscar nível hospitalar. Podemos concluir que o acompanhamento na APS facilita a desão ao tratamento na medida em que as pessoas são atendidas por profissionais com quem já mantêm algum vínculo .

Anticorpos contra vírus em galinhas de terreiro do Estado do Rio Grande do Sul, Brasil / Antibodies against avian viruses in backyard poultry from the Rio Grande do Sul State, Brazil

No Brasil, a população de aves conhecida como galinhas de terreiro encontra-se fora do sistema de biosseguridade aplicada às criações comerciais. Para investigar a presença de anticorpos contra alguns vírus específicos nesta população, foram coletadas amostras de sangue de 867 aves não-vacinadas em 60 propriedades de 22 municípios do Estado do Rio Grande do Sul, Brasil. O soro foi testado para a presença de anticorpos contra o vírus da bronquite infecciosa das galinhas (IBV), reovírus aviário (ARV) e o vírus da doença infecciosa da bolsa (IBDV) pela técnica de soroneutralização. Anticorpos contra IBV foram detectados em 65 por cento (564/867) das amostras, contra ARV em 21,6 por cento (187/867) e contra IBDV em 80,2 por cento (695/867) das aves. Todas as propriedades avaliadas apresentavam uma ave positiva para anticorpos contra IBV e IBDV e 88,3 por cento delas eram positivas para ARV. Os resultados demonstram que esses vírus estão presentes em galinhas de terreiro nas criações avícolas não-industriais da região central do Estado. Os resultados indicam a necessidade de um programa de vigilância permanente nessa população e ainda indicam a necessidade de avaliar o impacto destas infecções nos próprios plantéis e o risco associado à transmissão destas às criações comerciais.

The backyard poultry are not included in the biosecurity system applied in commercial flocks in Brazil. To investigate the presence of antibodies to specific viral pathogens in this population, blood samples were collected from 867 non-vaccinated birds, from 60 flocks in 22 counties of the Rio Grande do Sul State, Brazil. The samples were tested to detect antibodies against infectious bronchitis virus (IBV), avian reovirus (ARV) and infectious bursal disease virus (IBDV), through the virus neutralization test. Antibodies to IBV were detected in 65 percent (564/867), against ARV in 21.6 percent (187/867), and against IBDV in 80.2 percent (695/867) of the samples. All the flocks had chickens positive to IBV and IBDV antibodies, and 88.3 percent of them harbored antibodies to ARV. The results show the presence of these viruses in backyard poultry from the central region of the State. It also indicates the need for additional studies aimed to evaluate the real importance of these infections for this type of flocks.

Clinical and biochemical evaluation of HIV-related lipodystrophy in an ambulatory population from the Hospital Universitário Cassiano Antonio de Morais, Vitória, ES, Brazil

We designed a retrospective cohort study to identify factors associated with HIV-1 related lipodystrophy at a tertiary HIV-care center in Vitória, ES, Brazil. Inclusion criteria were documented HIV diagnosis, anti-retroviral therapy and age above 17 years. Highly active antiretroviral therapy (HAART) was initially the exposure variable, but a second analysis was also performed, as a nested case-control, based on the presence or absence of lipodystrophy. Use of protease inhibitors (PI) was associated with an increase in serum triglycerides (243.7 ± 189 mg/dL vs. 172.7 ± 131 mg/dL, p = 0.015), but not of total cholesterol (TC) or HDL fraction levels. Non-nucleoside reverse transcriptase inhibitors (NNRTI) were associated with an increase in serum TC (180.6 ± 46.8 mg/dL versus 162.4 ± 41.4 mg/dL; p= 0.018) and an increase in HDL cholesterol (47.3 ± 13.8 mg/dL versus 23.3 ± 24.3 mg/dL; p < 0.001), with no significant effect on triglyceride levels. Lipodystrophy was diagnosed in 59.3 percent of the patients, but exposure to PI versus NNRTI did not affect the frequency of this disorder (43.4 percent versus 37.2 percent; p = 0.68). Serum TC, but not HDL cholesterol or triglyceride levels, was higher among the lipodystrophy cases (183.8 ±47.5 mg/dL versus 162.1 ±35.7; p=0.006). Among the controls (patients without lipodystrophy), HDL cholesterol (45.3 ±14.4 mg/dL vs. 27.1 ±26.3; p=0.001)and triglyceride levels (178.3 ±146.3 mg/dL vs. 126.3 ±126.9; p=0.013) also increased, but not TC. In conclusion, lipodystrophy was highly prevalent in our series. Lipid disorders were also frequent and apparently were related to lipodystrophy, except for triglyceride levels.