Association of IL1B -511C/-31T haplotype and Helicobacter pylori vacA genotypes with gastric ulcer and chronic gastritis

<p>Abstract</p> <p>Background</p> <p>The association between proinflammatory cytokine gene polymorphisms and gastric diseases related to <it>Helicobacter pylori </it>varies by population and geographic area.</p> <p>Our objective was to determine if the <it>IL-1B </it>-<it>511 T>C </it>and -<it>31 C>T </it>polymorphisms and <it>H. pylori vacA </it>genotypes are associated with risk of chronic gastritis and gastric ulcer in a Mexican population.</p> <p>Methods</p> <p>We conducted endoscopic studies in 128 patients with symptoms of dyspepsia. We took two biopsies from the body, antrum, or ulcer edge from each patient, and classified our histopathological findings according to the Sydney System. <it>H. pylori </it>infection and <it>vacA </it>genotyping were accomplished via PCR from total DNA of the gastric biopsies. We confirmed the presence of anti-<it>H. pylori </it>serum IgG and IgM in 102 control subjects. In both case subjects and control subjects, the <it>IL-1B </it>-<it>511 T>C </it>polymorphism was genotyped by PCR-RFLPs and the <it>IL-1B -31 C>T </it>polymorphism was genotyped by pyrosequencing.</p> <p>Results</p> <p>Sixty-two point seven (62.7%) of the 102 control subjects were <it>H. pylori-</it>seropositive. Among the case subjects, 100 were diagnosed with chronic gastritis and 28 with gastric ulcer. We found that 77% of the patients with chronic gastritis and 85.7% of the patients with gastric ulcer were <it>H. pylori-</it>positive. The predominant <it>H. pylori </it>genotype was <it>vacA s1m1 </it>(58.4%) and the most frequent subtype was <it>vacA s1</it>. The -<it>511 TC</it>, (rs16944 -511 T>C) genotype and the -<it>511C </it>allele were associated with chronic gastritis (OR = 3.1, 95% CI = 1.4-6.8 and OR = 3.0, 95% CI = 1.4-6.0, respectively). The subjects carrying -<it>31T </it>(rs1143627 -31 C>T) were found to be at a higher risk of having chronic gastritis (OR = 2.8, 95% CI = 1.3-5.8). The <it>IL-1B </it>-<it>511C/-31T </it>haplotype was associated with chronic gastritis (OR = 2.1, 95% CI = 1.2-3.8) but not with gastric ulcer.</p> <p>Conclusions</p> <p>The <it>H. pylori vacA </it>genotypes identified herein were similar to those reported for other regions of Mexico. The <it>vacA s1m1 </it>genotype was not associated with gastric ulcer. In the southern Mexican population, the <it>IL-1B -511C </it>and -<it>31T </it>alleles and the -<it>511C/-31T </it>and -<it>511T/-31T </it>haplotypes are associated with increased risk of chronic gastritis and gastric ulcer.</p

Determining a cost effective intervention response to HIV/AIDS in Peru

BACKGROUND: The HIV epidemic in Peru is still regarded as concentrated -- sentinel surveillance data shows greatest rates of infection in men who have sex with men, while much lower rates are found in female sex workers and still lower in the general population. Without an appropriate set of preventive interventions, continuing infections could present a challenge to the sustainability of the present programme of universal access to treatment. Determining how specific prevention and care strategies would impact on the health of Peruvians should be key in reshaping the national response. METHODS: HIV/AIDS prevalence levels for risk groups with sufficient sentinel survey data were estimated. Unit costs were calculated for a series of interventions against HIV/AIDS which were subsequently inputted into a model to assess their ability to reduce infection transmission rates. Interventions included: mass media, voluntary counselling and testing; peer counselling for female sex workers; peer counselling for men who have sex with men; peer education of youth in-school; condom provision; STI treatment; prevention of mother to child transmission; and highly active antiretroviral therapy. Impact was assessed by the ability to reduce rates of transmission and quantified in terms of cost per DALY averted. RESULTS: Results of the analysis show that in Peru, the highest levels of HIV prevalence are found in men who have sex with men. Cost effectiveness varied greatly between interventions ranging from peer education of female commercial sex workers at $US 55 up to$US 5,928 (per DALY averted) for prevention of mother to child transmission. CONCLUSION: The results of this work add evidence-based clarity as to which interventions warrant greatest consideration when planning an intervention response to HIV in Peru. Cost effectiveness analysis provides a necessary element of transparency when facing choices about priority setting, particularly when the country plans to amplify its response through new interventions partly funded by the GFATM

Perfil etiológico del síndrome febril icterohemorrágico agudo y síndrome febril ictérico agudo en los valles del Apurimac, Quillabamba, Chanchamayo y Alto Huallaga, Perú. 1999-2000

Objetivos: Conocer el perfil etiológico del síndrome febril hemorrágico agudo (SFHA) y del síndrome febril ictérico agudo (SFIA) en los valles del Río Apurímac (Ayacucho), Quillabamba (Cusco), Chanchamayo (Junín) y Alto Huallaga (Huánuco). Materiales y métodos: Estudio longitudinal descriptivo realizado entre junio de 1999 y mayo de 2000, en 146 establecimientos de salud de los cuatro valles involucrados. Fueron incluidos pacientes que cumplieron con las definiciones de caso para la vigilancia del síndrome febril hemorrágico agudo y el síndrome febril ictérico agudo. Las muestras obtenidas se procesaron por ELISA IgM de captura para fiebre amarilla; IgM anti-HBc ELISA y HBsAg ELISA para hepatitis B; Ig anti-VHD ELISA para hepatitis D; e IgM ELISA para leptospirosis. Resultados: Fueron incluidos 63 casos: 98,4% con SFIA y 1,6% con SFHA. La letalidad fue de 16% y el tiempo entre inicio de síntomas y la obtención de la muestra de 7,2 ±5,1 días. Los casos que tuvieron confirmación diagnóstica fueron 31 (49,2%), hepatitis B (23,8%), hepatitis D (15,6%), fiebre amarilla (4,8%) y leptospirosis (4,8%). Cusco tuvo el mayor porcentaje de casos confirmados por laboratorio, siendo la mayoría hepatitis B y D. Conclusiones: El estudio de la etiología de SFIA y SFHA ha permitido identificar tres brotes de fiebre amarilla en Cusco, Junín y Huánuco, y conocer la importancia de la hepatitis B, D y leptospirosis en el diagnóstico diferencial de estos síndromes. Si bien las definiciones usadas apuntan a detectar enfermedades severas, la vigilancia de ambos síndromes es complementaria y totalmente compatible con los sistemas de enfermedad específica y por el laboratorio