Analysis of both the envelope sequence and the complete genome of a HIV-1 subtype f cluster of rapid expansion in Galicia: coreceptor use prediction and phylogeny

La epidemia por VIH-1 en España, al igual que en el resto de Europa occidental, está dominada por el subtipo B. Sin embargo, recientemente se ha descrito la rápida expansión de un cluster de subsubtipo F1 entre hombres que tienen relaciones sexuales con hombres en Galicia. Los objetivos de este trabajo son analizar la secuencia de la envoltura de los virus del mencionado cluster para predicción de utilización de correceptores y presencia de aminoácidos característicos, así como caracterizar secuencias de genomas completos, determinando las relaciones filogenéticas con virus de subtipo F de otros países. Los análisis filogenéticos permitieron determinar relaciones del cluster F con virus de Brasil, Suiza, Bélgica, Francia y Gran Bretaña. Por otra parte, se han encontrado posiciones características del cluster en la región V3, diferentes de otras cepas F1, así como en otras regiones de la envoltura. Aparte, se han identificado mutaciones características asociadas a tropismo X4. El cluster de VIH-1 de subtipo F recientemente expandido en Galicia procede de una variante ampliamente diseminada en Europa occidental. Los virus de dicho cluster presentan aminoácidos característicos en la envoltura, identificándose en algunos de ellos mutaciones asociadas a tropismo X4, de potencial relevancia biológicaThe HIV-1 epidemic in Spain, as in the rest of Western Europe, is dominated by subtype B. However, it has recently been reported that a subsubtype F1 cluster has rapidly expanded among men who have sex with men in Galicia. The objectives of this work are to analyze the virus envelope sequence of the aforementioned cluster to predict the use of coreceptors and to examine the presence of characteristic amino acids, as well as to characterize full-length genome sequences, determining the phylogenetic relations with subtype F viruses from other countries. The phylogenetic analyses allowed to determine the relation of the Galician F cluster with viruses from Brazil, Switzerland, Belgium, France and Great Britain. On the other hand, characteristic amino acid residues were found in the V3 loop of viruses of the cluster, differing from other F1 strains, as well as in other regions of the envelope. Additionally, characteristic mutations associated with X4 tropism were identified. The HIV-1 subtype F cluster recently expanded in Galicia derives from a variant widely disseminated in Western Europe. The viruses of the mentioned cluster show characteristic amino acids in the envelope, with mutations associated with X4 tropism having been identified in some of them, which are of potential biological relevance

EPIdemiology of Surgery-Associated Acute Kidney Injury (EPIS-AKI) : Study protocol for a multicentre, observational trial

More than 300 million surgical procedures are performed each year. Acute kidney injury (AKI) is a common complication after major surgery and is associated with adverse short-term and long-term outcomes. However, there is a large variation in the incidence of reported AKI rates. The establishment of an accurate epidemiology of surgery-associated AKI is important for healthcare policy, quality initiatives, clinical trials, as well as for improving guidelines. The objective of the Epidemiology of Surgery-associated Acute Kidney Injury (EPIS-AKI) trial is to prospectively evaluate the epidemiology of AKI after major surgery using the latest Kidney Disease: Improving Global Outcomes (KDIGO) consensus definition of AKI. EPIS-AKI is an international prospective, observational, multicentre cohort study including 10 000 patients undergoing major surgery who are subsequently admitted to the ICU or a similar high dependency unit. The primary endpoint is the incidence of AKI within 72 hours after surgery according to the KDIGO criteria. Secondary endpoints include use of renal replacement therapy (RRT), mortality during ICU and hospital stay, length of ICU and hospital stay and major adverse kidney events (combined endpoint consisting of persistent renal dysfunction, RRT and mortality) at day 90. Further, we will evaluate preoperative and intraoperative risk factors affecting the incidence of postoperative AKI. In an add-on analysis, we will assess urinary biomarkers for early detection of AKI. EPIS-AKI has been approved by the leading Ethics Committee of the Medical Council North Rhine-Westphalia, of the Westphalian Wilhelms-University Münster and the corresponding Ethics Committee at each participating site. Results will be disseminated widely and published in peer-reviewed journals, presented at conferences and used to design further AKI-related trials. Trial registration number NCT04165369

EPIdemiology of Surgery-Associated Acute Kidney Injury (EPIS-AKI): Study protocol for a multicentre, observational trial

Introduction More than 300 million surgical procedures are performed each year. Acute kidney injury (AKI) is a common complication after major surgery and is associated with adverse short-term and long-term outcomes. However, there is a large variation in the incidence of reported AKI rates. The establishment of an accurate epidemiology of surgery-associated AKI is important for healthcare policy, quality initiatives, clinical trials, as well as for improving guidelines. The objective of the Epidemiology of Surgery-associated Acute Kidney Injury (EPIS-AKI) trial is to prospectively evaluate the epidemiology of AKI after major surgery using the latest Kidney Disease: Improving Global Outcomes (KDIGO) consensus definition of AKI. Methods and analysis EPIS-AKI is an international prospective, observational, multicentre cohort study including 10 000 patients undergoing major surgery who are subsequently admitted to the ICU or a similar high dependency unit. The primary endpoint is the incidence of AKI within 72 hours after surgery according to the KDIGO criteria. Secondary endpoints include use of renal replacement therapy (RRT), mortality during ICU and hospital stay, length of ICU and hospital stay and major adverse kidney events (combined endpoint consisting of persistent renal dysfunction, RRT and mortality) at day 90. Further, we will evaluate preoperative and intraoperative risk factors affecting the incidence of postoperative AKI. In an add-on analysis, we will assess urinary biomarkers for early detection of AKI. Ethics and dissemination EPIS-AKI has been approved by the leading Ethics Committee of the Medical Council North Rhine-Westphalia, of the Westphalian Wilhelms-University Münster and the corresponding Ethics Committee at each participating site. Results will be disseminated widely and published in peer-reviewed journals, presented at conferences and used to design further AKI-related trials. Trial registration number NCT04165369.