THE INFLUENCE OF HIV-1 SUBTYPES C, CRF31_BC AND B ON DISEASE PROGRESSION AND INITIAL VIROLOGIC RESPONSE TO HAART IN A SOUTHERN BRAZILIAN COHORT

Background: Although most HIV-1 infections in Brazil are due to subtype B, Southern Brazil has a high prevalence of subtype C and recombinant forms, such as CRF31_BC. This study assessed the impact of viral diversity on clinical progression in a cohort of newly diagnosed HIV-positive patients. Methods: From July/2004 to December/2005, 135 HIV-infected patients were recruited. The partial pol region was subtyped by phylogeny. A generalized estimating equation (GEE) model was used to examine the relationship between viral subtype, CD4+ T cell count and viral load levels before antiretroviral therapy. Hazard ratio (Cox regression) was used to evaluate factors associated with viral suppression (viral load < 50 copies/mL at six months). Results: Main HIV-1 subtypes included B (29.4%), C (28.2%), and CRF31_BC (23.5%). Subtypes B and C showed a similar trend in CD4+ T cell decline. Comparison of non-B (C and CRF31_BC) and B subtypes revealed no significant difference in the proportion of patients with viral suppression at six months (week 24). Higher CD4+ T cell count and lower viral load were independently associated with viral suppression. Conclusion: No significant differences were found between subtypes; however, lower viral load and higher CD4+ T cell count before therapy were associated with better response.Introdução: Embora a maioria das infecções de HIV-1 no Brasil seja devido ao subtipo B, o Sul do Brasil apresenta uma alta prevalência do subtipo C e formas recombinantes, como CRF31_BC. Este estudo avaliou o impacto da diversidade viral na evolução clínica em uma coorte de pacientes HIV-positivos recém diagnosticados. Métodos: De julho/2004 a dezembro/2005, 135 pacientes anti-HIV reagentes foram recrutados. A região pol parcial foi subtipada por filogenia. Um modelo de equação de estimativa generalizada (GEE) foi utilizado para examinar a relação entre subtipo viral, contagem de células CD4 e níveis de carga viral pré-terapia antirretroviral. Hazard ratio (regressão de Cox) foi utilizada para avaliar os fatores associados à supressão viral (carga viral < 50 cópias/mL em seis meses). Resultados: Os principais subtipos de HIV-1 incluíram B (29,4%), C (28,2%) e CRF31_BC (23,5%). Os subtipos B e C apresentaram uma tendência semelhante no declínio de células CD4. Quando comparados os subtipos não B (C e CRF31_BC) e B, não houve diferença significativa na proporção de pacientes com supressão viral aos seis meses (24 semanas). CD4 mais alto e carga viral mais baixa demonstraram associação independente com supressão viral. Conclusão: Não houve diferença significativa entre os subtipos; entretanto, viremia mais baixa e CD4 mais alto pré-terapia mostraram associação com melhor resposta

Avaliação de dois métodos de diagnóstico precoce de gestação em ovelhas: ultra-sonografia transretal e detector de prenhez para pequenos ruminantes (DPPR-80®)

Ultrasonography was perfomed in 88 ewes from Núcleo de Pesquisas Zootécnicas Sudoeste - Instituto de Zootecnia, São Paulo state, from march to may , 2001. Animals were examined from 19º to 33º days of pregnancy by transrectal ultrasonography in alternate days examinations, and by pregnancy detector for small ruminants (DPPR-80Ò) from 25º to 45º day. Positive diagnostic by transretal ultrasonography was obtained after yolk sac visualization. The embryo heartbeat was observed after 25 day of pregnancy. The positive diagnostic was obtained by pregnancy detector when embrionic heart was 160 to 200 beats/minute. Births confirmed the examinations. Three abortions ocurred during the experiment and these females were excluded from the group. From 85 ewes examined, 64 lambed. The transrectal ultrasonography accuracy in 19º day of pregnancy was 35,29%, with higher rate (82,53%) in 31º day. The doppler accuracy in 25º day was 24,71% and 34,12.00% in 45º day. Embryo heartbeat was detected by transrectal ultrasonography after 21 days of pregnancy and the first placentoms were observed after 25 days of pregnancy. In conclusion, transrectal ultrasonography was better than doppler in early pregnancy diagnosis in sheep.No período de março a maio de 2001, foram realizados os exames ultra-sonográficos em 88 ovelhas do Núcleo de Pesquisas Zootécnicas Sudoeste - Instituto de Zootecnia. Os animais foram examinados entre o 19º e 33º dia de gestação pela ultra-sonografia transretal com exames executados em dias alternados, e do 25º ao 45º dia pelo detector de prenhez para pequenos ruminantes (DPPR-80Ò). O diagnóstico foi considerado positivo pela ultra-sonografia transretal por meio da visualização do saco gestacional e embrião. Após o 25º dia de gestação foi observado também o batimento cardíaco embrionário, cuja freqüência é de 160 a 200 batimentos por minuto. Esta observação foi dada como diagnóstico de gestação. Os nascimentos confirmaram os resultados dos exames. Dentre 88 fêmeas acasaladas, 3 abortaram durante o experimento e foram retiradas do grupo. Das 85 fêmeas restantes, 64 pariram. O diagnóstico de prenhez por meio da ultra-sonografia transretal apresentou 35,29% de acurácia no 19º dia de gestação, culminando em 82,35.00% no 31º dia de gestação. Pelo detector de prenhez, a acurácia foi de 24,71% no 25º dia de gestação e 34,12.00% no 45º dia. Foi possível visualizar os batimentos cardíacos do embrião pela ultra-sonografia transretal à partir do 21º dia de gestação e os primeiros placentomas foram observados ao redor do 25º dia de gestação. A ultra-sonografia transretal mostrou-se um método superior ao detector de prenhez para pequenos ruminantes, para diagnóstico precoce de gestação em ovelhas

Avaliação de dois métodos de diagnóstico precoce de gestação em ovelhas: ultra-sonografia transretal e detector de prenhez para pequenos ruminantes (DPPR-80®)

Ultrasonography was perfomed in 88 ewes from Núcleo de Pesquisas Zootécnicas Sudoeste - Instituto de Zootecnia, São Paulo state, from march to may , 2001. Animals were examined from 19º to 33º days of pregnancy by transrectal ultrasonography in alternate days examinations, and by pregnancy detector for small ruminants (DPPR-80Ò) from 25º to 45º day. Positive diagnostic by transretal ultrasonography was obtained after yolk sac visualization. The embryo heartbeat was observed after 25 day of pregnancy. The positive diagnostic was obtained by pregnancy detector when embrionic heart was 160 to 200 beats/minute. Births confirmed the examinations. Three abortions ocurred during the experiment and these females were excluded from the group. From 85 ewes examined, 64 lambed. The transrectal ultrasonography accuracy in 19º day of pregnancy was 35,29%, with higher rate (82,53%) in 31º day. The doppler accuracy in 25º day was 24,71% and 34,12.00% in 45º day. Embryo heartbeat was detected by transrectal ultrasonography after 21 days of pregnancy and the first placentoms were observed after 25 days of pregnancy. In conclusion, transrectal ultrasonography was better than doppler in early pregnancy diagnosis in sheep.No período de março a maio de 2001, foram realizados os exames ultra-sonográficos em 88 ovelhas do Núcleo de Pesquisas Zootécnicas Sudoeste - Instituto de Zootecnia. Os animais foram examinados entre o 19º e 33º dia de gestação pela ultra-sonografia transretal com exames executados em dias alternados, e do 25º ao 45º dia pelo detector de prenhez para pequenos ruminantes (DPPR-80Ò). O diagnóstico foi considerado positivo pela ultra-sonografia transretal por meio da visualização do saco gestacional e embrião. Após o 25º dia de gestação foi observado também o batimento cardíaco embrionário, cuja freqüência é de 160 a 200 batimentos por minuto. Esta observação foi dada como diagnóstico de gestação. Os nascimentos confirmaram os resultados dos exames. Dentre 88 fêmeas acasaladas, 3 abortaram durante o experimento e foram retiradas do grupo. Das 85 fêmeas restantes, 64 pariram. O diagnóstico de prenhez por meio da ultra-sonografia transretal apresentou 35,29% de acurácia no 19º dia de gestação, culminando em 82,35.00% no 31º dia de gestação. Pelo detector de prenhez, a acurácia foi de 24,71% no 25º dia de gestação e 34,12.00% no 45º dia. Foi possível visualizar os batimentos cardíacos do embrião pela ultra-sonografia transretal à partir do 21º dia de gestação e os primeiros placentomas foram observados ao redor do 25º dia de gestação. A ultra-sonografia transretal mostrou-se um método superior ao detector de prenhez para pequenos ruminantes, para diagnóstico precoce de gestação em ovelhas

Genomic-based surveillance reveals high ongoing transmission of multi-drug-resistant Mycobacterium tuberculosis in Southern Brazil

Funding Information: Funding: This study was funded, in part, by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brasil (Grant No. 001) and supported by Fundação de Amparo à Pesquisa do Estado do Rio Grande do Sul (Grant No. 17/1265–8 INCT-TB). JP is supported by Fundação para a Ciência e Tecnologia through Estímulo Individual ao Emprego Científico (CEECIND/00394/2017). Funding Information: The authors wish to thank TGen, C-Path and ReSeqTB for supporting WGS, and the Brazilian Network of Tuberculosis Research for enabling this partnership. The authors would also like to thank the Mycobacteria Laboratory at LACEN-RS/CEVS/SES-RS for performing and providing information on drug susceptibility testing. Funding: This study was funded, in part, by the Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior - Brasil (Grant No. 001) and supported by Funda??o de Amparo ? Pesquisa do Estado do Rio Grande do Sul (Grant No. 17/1265?8 INCT-TB). JP is supported by Funda??o para a Ci?ncia e Tecnologia through Est?mulo Individual ao Emprego Cient?fico (CEECIND/00394/2017). Competing interests: None declared. Ethical approval: This project was approved by the Research Ethics Committee of the Funda??o Estadual de Produ??o e Pesquisa em Sa?de (Protocol No. 1.587.621 CAAE: 18269313.0.0000.5320). Data availability: M. tuberculosis genome data were deposited in the NCBI BioProject database (IDs: PRJNA535343, PRJNA639713 and PRJNA692642). Individual accession numbers for genomes analysed in this study are given in the online supplementary material. Publisher Copyright: © 2021 Elsevier LtdGenomic-based surveillance on the occurrence of drug resistance and its transmission dynamics has emerged as a powerful tool for the control of tuberculosis (TB). A whole-genome sequencing approach, phenotypic testing and clinical-epidemiological investigation were used to undertake a retrospective population-based study on drug-resistant (DR)-TB in Rio Grande do Sul, the largest state in Southern Brazil. The analysis included 305 resistant Mycobacterium tuberculosis strains sampled statewide from 2011 to 2014, and covered 75.7% of all DR-TB cases identified in this period. Lineage 4 was found to be predominant (99.3%), with high sublineage-level diversity composed mainly of 4.3.4.2 [Latin American and Mediterranean (LAM)/RD174], 4.3.3 (LAM/RD115) and 4.1.2.1 (Haarlem/RD182) sublineages. Genomic diversity was also reflected in resistance of the variants to first-line drugs. A large number of distinct resistance-conferring mutations, including variants that have not been reported previously in any other setting worldwide, and 22 isoniazid-monoresistant strains with mutations described as disputed in the rpoB gene but causing rifampicin resistance generally missed by automated phenotypic tests as BACTEC MGIT. Using a cut-off of five single nucleotide polymorphisms, the estimated recent transmission rate was 55.1%, with 168 strains grouped into 28 genomic clusters. The most worrying fact concerns multi-drug-resistant (MDR) strains, of which 73.4% were clustered. Different resistance profiles and acquisition of novel mutations intraclusters revealed important amplification of resistance in the region. This study described the diversity of M. tuberculosis strains, the basis of drug resistance, and ongoing transmission dynamics across the largest state in Southern Brazil, stressing the urgent need for MDR-TB transmission control state-wide.publishersversionpublishe

THE INFLUENCE OF HIV-1 SUBTYPES C, CRF31_BC AND B ON DISEASE PROGRESSION AND INITIAL VIROLOGIC RESPONSE TO HAART IN A SOUTHERN BRAZILIAN COHORT

Background: Although most HIV-1 infections in Brazil are due to subtype B, Southern Brazil has a high prevalence of subtype C and recombinant forms, such as CRF31_BC. This study assessed the impact of viral diversity on clinical progression in a cohort of newly diagnosed HIV-positive patients. Methods: From July/2004 to December/2005, 135 HIV-infected patients were recruited. The partial pol region was subtyped by phylogeny. A generalized estimating equation (GEE) model was used to examine the relationship between viral subtype, CD4+ T cell count and viral load levels before antiretroviral therapy. Hazard ratio (Cox regression) was used to evaluate factors associated with viral suppression (viral load < 50 copies/mL at six months). Results: Main HIV-1 subtypes included B (29.4%), C (28.2%), and CRF31_BC (23.5%). Subtypes B and C showed a similar trend in CD4+ T cell decline. Comparison of non-B (C and CRF31_BC) and B subtypes revealed no significant difference in the proportion of patients with viral suppression at six months (week 24). Higher CD4+ T cell count and lower viral load were independently associated with viral suppression. Conclusion: No significant differences were found between subtypes; however, lower viral load and higher CD4+ T cell count before therapy were associated with better response

Avaliação de dois métodos de diagnóstico precoce de gestação em ovelhas: ultra-sonografia transretal e detector de prenhez para pequenos ruminantes (DPPR-80®)

No período de março a maio de 2001, foram realizados os exames ultra-sonográficos em 88 ovelhas do Núcleo de Pesquisas Zootécnicas Sudoeste - Instituto de Zootecnia. Os animais foram examinados entre o 19º e 33º dia de gestação pela ultra-sonografia transretal com exames executados em dias alternados, e do 25º ao 45º dia pelo detector de prenhez para pequenos ruminantes (DPPR-80Ò). O diagnóstico foi considerado positivo pela ultra-sonografia transretal por meio da visualização do saco gestacional e embrião. Após o 25º dia de gestação foi observado também o batimento cardíaco embrionário, cuja freqüência é de 160 a 200 batimentos por minuto. Esta observação foi dada como diagnóstico de gestação. Os nascimentos confirmaram os resultados dos exames. Dentre 88 fêmeas acasaladas, 3 abortaram durante o experimento e foram retiradas do grupo. Das 85 fêmeas restantes, 64 pariram. O diagnóstico de prenhez por meio da ultra-sonografia transretal apresentou 35,29% de acurácia no 19º dia de gestação, culminando em 82,35.00% no 31º dia de gestação. Pelo detector de prenhez, a acurácia foi de 24,71% no 25º dia de gestação e 34,12.00% no 45º dia. Foi possível visualizar os batimentos cardíacos do embrião pela ultra-sonografia transretal à partir do 21º dia de gestação e os primeiros placentomas foram observados ao redor do 25º dia de gestação. A ultra-sonografia transretal mostrou-se um método superior ao detector de prenhez para pequenos ruminantes, para diagnóstico precoce de gestação em ovelhas

Nontuberculous mycobacterial lung disease in a high tuberculosis incidence setting in Brazil

ABSTRACT Objective: The incidence of lung disease caused by nontuberculous mycobacteria (NTM) has been increasing worldwide. In Brazil, there are few studies about nontuberculous mycobacterial lung disease (NTMLD), and its prevalence is yet to be known. Our objective was to determine the specific etiology of the disease in the state of Rio Grande do Sul, Brazil, as well as the frequency and diversity of NTM species in our sample of patients. Methods: This is a retrospective analysis of the medical records of patients diagnosed with NTMLD treated in a referral center located in the city of Porto Alegre, Brazil, between 2003 and 2013. Results: Our sample comprised 100 patients. The most prevalent NTM species were Mycobacterium avium complex (MAC), in 35% of the cases; M. kansasii, in 17%; and M. abscessus, in 12%. A total of 85 patients had received previous treatment for tuberculosis. Associated conditions included structural abnormalities in the lungs, such as bronchiectasis, in 23% of the cases; COPD, in 17%; and immunosuppressive conditions, such as AIDS, in 24%. Conclusions: MAC and M. kansasii were the most prevalent species involved in NTMLD in the state, similarly to what occurs in other regions of Brazil. Data on regional epidemiology of NTMLD, its specific etiology, and associated conditions are essential to establish appropriate treatment, since each species requires specific regimens. Most patients with NTMLD had received previous tuberculosis treatment, which might lead to development of resistance and late diagnosis

Genomic-based surveillance reveals high ongoing transmission of multi-drug-resistant Mycobacterium tuberculosis in Southern Brazil

Genomic-based surveillance on the occurrence of drug resistance and its transmission dynamics has emerged as a powerful tool for the control of tuberculosis (TB). A whole-genome sequencing approach, phenotypic testing and clinical-epidemiological investigation were used to undertake a retrospective population-based study on drug-resistant (DR)-TB in Rio Grande do Sul, the largest state in Southern Brazil. The analysis included 305 resistant Mycobacterium tuberculosis strains sampled statewide from 2011 to 2014, and covered 75.7% of all DR-TB cases identified in this period. Lineage 4 was found to be predominant (99.3%), with high sublineage-level diversity composed mainly of 4.3.4.2 [Latin American and Mediterranean (LAM)/RD174], 4.3.3 (LAM/RD115) and 4.1.2.1 (Haarlem/RD182) sublineages. Genomic diversity was also reflected in resistance of the variants to first-line drugs. A large number of distinct resistance-conferring mutations, including variants that have not been reported previously in any other setting worldwide, and 22 isoniazid-monoresistant strains with mutations described as disputed in the rpoB gene but causing rifampicin resistance generally missed by automated phenotypic tests as BACTEC MGIT. Using a cut-off of five single nucleotide polymorphisms, the estimated recent transmission rate was 55.1%, with 168 strains grouped into 28 genomic clusters. The most worrying fact concerns multi-drug-resistant (MDR) strains, of which 73.4% were clustered. Different resistance profiles and acquisition of novel mutations intraclusters revealed important amplification of resistance in the region. This study described the diversity of M. tuberculosis strains, the basis of drug resistance, and ongoing transmission dynamics across the largest state in Southern Brazil, stressing the urgent need for MDR-TB transmission control state-wide.This study was funded, in part, by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brasil (Grant No. 001) and supported by Fundação de Amparo à Pesquisa do Estado do Rio Grande do Sul (Grant No. 17/1265–8 INCT-TB). JP is supported by Fundação para a Ciência e Tecnologia through Estímulo Individual ao Emprego Científico (CEECIND/00394/2017).info:eu-repo/semantics/publishedVersio