Nuevas estrategias para el control y la prevención de la infección por HIV

Since its first isolation in 1983, the human immunodeficiency virus (HIV) has infected over 77 million people and only one patient from whom the virus was completely removed from the body was documented. A recent second case was reported that remains to be confirmed. Antiretroviral therapy (ART) manages to control blood viral replication and, consequently, to restore −at least partially− the functions of the immune system with a notable reduction of the morbidity and mortality associated with HIV infection. However, given the difficulty in eliminating the virus from the body, treatment has to be given for life. This long-term exposure to antiretroviral drugs implies the risk of generating intolerance, toxic effects, gaps in adherence and selection of resistance mutations. Another limitation is the high cost of treating 37 million persons living with HIV, most of whom are living in resource-limited countries and relying on international aid initiatives. Having these challenges in mind, there is general agreement that new approaches for preventing and treating HIV infection are needed to control the epidemic, while efforts on vaccine development continue. In this regard, new generation broadly neutralising monoclonal antibodies (bnMAbs) against the HIV envelope protein can prevent virus acquisition, reduce viremia, enhance immunity, and induce the killing of infected cells in animal models of HIV infection. Most importantly, some clinical trials have shown that bnMAbs could effectively decrease viremia and delay viral rebound in people chronically infected with HIV.Desde su primer aislamiento en 1983, el virus de la inmunodeficiencia humana (HIV) ha infectado a más de 77 millones de personas y solo se ha documentado un caso en el cual el virus fue removido completamente del organismo; aún resta confirmar un segundo caso informado recientemente. El tratamiento antirretroviral logra controlar la replicación viral en el plasma y en consecuencia recuperar (al menos parcialmente) la actividad del sistema inmune, con una notable reducción de la morbilidad y la mortalidad asociadas a la infección por HIV. Sin embargo, ante la dificultad para eliminar completamente el virus del organismo, es necesario continuar el tratamiento de por vida. Esto implica la exposición a largo plazo a drogas antirretrovirales con riesgo de generar intolerancia, efectos tóxicos, brechas en la adherencia y selección de mutantes resistentes. Otro aspecto a considerar es la carga económica que implica tratar a 37 millones de personas infectadas con HIV, la mayoría de ellas en países que solo pueden afrontar esos costos con ayuda internacional. Por ello, hasta tanto se disponga de una vacuna capaz de prevenir la infección de todas las formas circulantes del HIV, es necesario desarrollar nuevas herramientas terapéuticas capaces de complementar y potenciar los efectos del tratamiento antirretroviral. Diversos ensayos preclínicos sugieren que la administración pasiva de anticuerpos monoclonales dirigidos contra la glicoproteína de envoltura viral podría prevenir la infección, reducir la carga viral, estimular la respuesta inmune y favorecer la eliminación de células infectadas con HIV.Fil: Jaworski, Juan Pablo. Instituto Nacional de Tecnologia Agropecuaria. Centro de Investigacion En Ciencias Veterinarias y Agronomicas. Instituto de Virologia E Innovaciones Tecnologicas. - Consejo Nacional de Investigaciones Cientificas y Tecnicas. Oficina de Coordinacion Administrativa Pque. Centenario. Instituto de Virologia E Innovaciones Tecnologicas.; ArgentinaFil: Frola, Claudia. Fundación Huésped; Argentina. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Juan A. Fernández"; ArgentinaFil: Cahn, Pedro. Fundación Huésped; Argentin

Factores contextuales, sociales e individuales como barreras y facilitadores para el acceso a la salud de mujeres trans: desde la perspectiva de la comunidad

Introducción: Las mujeres transgénero (MT) son vulnerables a diversos problemas de salud, incluyendo el virus de la inmunodeficiencia humana (VIH) y otras infecciones de transmisión sexual (ITS), que reducen significativamente su expectativa de vida. Consecuentemente, existe la necesidad de entender los factores que afectan su acceso a la salud. Métodos: Se realizó una investigación cualitativa en MT que viven en alojamientos comunitarios (HT, hoteles trans) en Buenos Aires. El objetivo del estudio fue explorar las barreras y facilitadores contextuales, sociales e individuales para el acceso a la salud, particularmente los servicios de VIH, y la aceptabilidad de diferentes intervenciones. Se realizaron dos grupos focales y cinco entrevistas en tres hoteles trans. Resultados: Las barreras contextuales descriptas fueron los turnos limitados y las largas horas de espera. Los obstáculos sociales incluyeron el estigma y la discriminación por parte del personal y la culpabilización de las MT de sus problemas de salud, así como el estigma por VIH dentro de los grupos de MT. El facilitador más importante fueron los servicios inclusivos. Las barreras individuales incluyeron la auto-exclusión y el estigma anticipado, resultando en altos índices de automedicación e inyección de siliconas. Las pares juegan un rol importante acompañando a otras MT a los servicios. Aun reportando problemas similares, las MT recomendaron intervenciones diferentes según su perfil de hotel. Conclusiones: Dado que el estigma y la discriminación son la principal barrera, es imprescindible sensibilizar a todo el personal de salud. Se necesita implementar una amplia gama de estrategias en los establecimientos de salud y evaluar la aceptación de intervenciones domiciliarias para responder a las diferentes demandas de las MT

Validation of a Lateral Flow Assay for Rapid Diagnosis of Histoplasmosis in Advanced HIV Disease, Buenos Aires, Argentina

Histoplasmosis is a major cause of mortality in individuals with advanced human immunodeficiency virus (HIV) disease (AHD). We evaluated in patients with AHD a lateral flow assay (LFA) developed by MiraVista® Diagnostics (MVD LFA). Histoplasmosis was defined based on the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) case definitions. We also compared the results of this LFA with those obtained using a commercial enzyme immunoassay (EIA) developed by IMMY, Clarus Histoplasma GM EIA, IMMY (HGM EIA). A retrospective observational study was conducted at Hospital Juan A. Fernández, located in Buenos Aires, Argentina. The study included 48 urine specimens from patients aged >18 years with AHD. Urine specimens included 17 patients with disseminated histoplasmosis and 31 specimens from patients without evidence of histoplasmosis. Specimens were tested using the MVD LFA and the HGM EIA. The MVD LFA and the HGM EIA had similar analytical performance, with a sensitivity of 94%, specificity of 100%, positive predictive value of 100%, negative predictive value of 97%, and an accuracy of 98%. Comparison of the MVD LFA with the HGM EIA demonstrated a Kappa agreement index of 0.906. The LFA evaluated in this study had high analytical performance; it provided rapid diagnosis of histoplasmosis with minimal requirements for laboratory training, equipment, and laboratory infrastructure

Home-based HIV testing: Using different strategies among transgender women in Argentina.

BACKGROUND:In Argentina, HIV prevalence among transgender women (TGW) has been reported at 34%. The stigma is one of the most important factors limiting their access to healthcare services. The aims of this study were to compare different HIV testing methodologies, to determine the factors associated with HIV diagnosis and to determine the feasibility of a home-based HIV testing service for TGW. METHODS:A multidisciplinary team performed home-based HIV testing interventions in four cities of Argentina. Participants self-identified as TGW, older than 14 years and with a negative or unknown HIV status. Blood samples were screened by two rapid tests (RT), one based on antibodies (Determine™ HIV-1/2) and the other on antigen and antibodies (Determine™ HIV-1/2 Combo), and the subsequent blood processing via 4th generation ELISA (VIDAS HIV DUO). All reactive samples were confirmed with a viral load (VL). We compared the results of both RT with the ELISA. Samples were pooled in groups of 6 and a VL (Abbott Real Time) performed to identify acute HIV infections. Factors associated with HIV infection were evaluated with multivariate logistic regression analysis. RESULTS:A total of 260 TGW were tested, 51 tested positive (HIV prevalence 19.6%). There were no discordant results between both RTs nor between RTs and 4th generation ELISA, therefore the correlation was 100%. The VL identified 2 additional positive samples. The final analytic sample for positive cases consisted of 53 TGW. In the multivariate analysis, factors associated with a positive HIV result were history of other sexually transmitted infections (STIs) and not being previously tested for HIV. TGW tested for the first time were at 4 times greater risk of being HIV positive compared to those that were tested previously. CONCLUSIONS:A multidisciplinary home-based HIV testing service among TGW is feasible and effective to detect cases of HIV infection. The testing algorithm should start with an RT followed by molecular diagnosis. The history of STIs and never having been tested for HIV were the factors associated with HIV-positive results and should determine efforts to reach this population. Home-based testing reaches individuals that were not tested before and who have more risk of acquiring HIV

The Impact of Gender Identity Stigma and Mental Health on HIV Treatment among Transgender Women in Argentina

In Argentina, HIV prevalence in transgender women (TGW) is high while engagement in HIV treatment is low due to multiple factors: gender identity stigma (GIS), mental health problems (e.g., depressive symptoms) and substance use. This study examined the impact of these factors on HIV treatment uptake among TGW in Argentina. A sample of 79 TGW “on” and “off” treatment completed questionnaires to assess GIS, depressive symptoms (CES-D), alcohol (AUDIT) and drug use (DAST-10), suicidal ideation, HIV-related stigma (HIV Stigma Scale) and support from family. From them, 36.7% met criteria for “off” HIV treatment; 49.4%, for significant depressive symptoms; 53.2%, for hazardous alcohol use; and 29.7%, for problems related to drug use. GIS was positively associated with depressive symptoms and HIV-related stigma, both in TGW “on” and “off” treatment, and with alcohol and drug use, only in the last group. In the multivariable model, only experiences of GIS from the police were negatively associated with being “on” treatment, whereas GIS in workplaces (excluding sex work venues) were associated with increased odds of being “on” treatment. GIS, specifically from the police, has a far-reaching impact on the physical and emotional health of TGW living with HIV in Argentina, as it is associated with negative mental health indicators, substance use and suboptimal HIV care uptake

Prevalence of cryptococcal infection among advanced HIV patients in Argentina using lateral flow immunoassay

<div><p>Background</p><p>Globally, Latin America ranks third among regions with most cases of AIDS related cryptococcal meningitis. In 2009, a lateral flow immunoassay (LFA) for the detection of cryptococcal antigen (CrAg) was developed as a potential point-of-care test for diagnosis of cryptococcal infection. In 2011 World Health Organizations recommended on CrAg screening for HIV positive persons with CD4 below 100 cells/μL, followed by preemptive fluconazole treatment. However, in Argentina no formal recommendations for CrAg screening have been issued.</p><p>Methods</p><p>HIV positive patients > = 18 years with advanced immunosuppression (CD4 counts ≤100 cells/μL within 3 months or WHO stage III/IV), who visited the hospital between April 1, 2014 and January 31, 2015, were included. The LFA was performed according to the manufacturer’s instructions on all serum samples. When CrAg detection was positive, a lumbar puncture was performed to rule out cryptococcal meningitis. Patients without evidence of meningeal involvement were treated with preemptive oral fluconazole in ambulatory care.</p><p>Results</p><p>We included 123 patients. Prevalence of CrAg-positivity was 8.1%. Among the 10 CrAg-positive patients, 6 had meningeal involvement detected through the CSF analysis (CSF India-ink testing, CSF CrAg and culture). The remaining 4 patients with positive CrAg received targeted preemptive treatment with oral fluconazole and were free of cryptococcal disease during the follow-up period. None of the 113 patients with a negative CrAg test result developed cryptococcal disease.</p><p>Conclusions</p><p>This is the first study in Argentina, to our knowledge, describing the prevalence of cryptococcosis and usefulness of CrAg screening. LFA provided early diagnosis to determine a high prevalence of CrAg in our hospital, and that screening for subclinical infection with preemptive antifungal treatment, prevented a substantial proportion of meningeal disease.</p></div

Baseline characteristics of the cohort^a.

<p>Baseline characteristics of the cohort<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0178721#t001fn002" target="_blank">^a</a>.</p

Flow chart of the specimen testing algorithm.

<p>Flow chart of the specimen testing algorithm.</p

Prevalence and correlates of current cigarette smoking among transgender women in Argentina

Fil: Cartujano-Barrera, F. Department of Public Health Sciences, University of Rochester Medical Center; Rochester, NY. United StatesFil: Mejia, RM. Division of Implementation Research, Fundación Huésped; Buenos Aires. ArgentinaFil: Mejia, RM. Department of Ambulatory Care, Universidad de Buenos Aires; Buenos Aires. ArgentinaFil: Mejia, RM. CEDES. Centro de Estudios de Estado y Sociedad. Área de Salud, Economía y Sociedad; Buenos Aires. ArgentinaFil: Radusky, PD. Division of Implementation Research, Fundación Huésped; Buenos Aires. ArgentinaFil: Cardozo, Nadir. Division of Implementation Research, Fundación Huésped; Buenos Aires. ArgentinaFil: Cardozo, Nadir. Asociación de Travestis, Transexuales y Transgéneros de Argentina; Buenos Aires. ArgentinaFil: Duarte, M. Division of Implementation Research, Fundación Huésped; Buenos Aires. ArgentinaFil: Duarte, M. Casa Trans; Buenos Aires. ArgentinaFil: Fabian, S. Division of Implementation Research, Fundación Huésped; Buenos Aires. ArgentinaFil: Fabian, S. Hotel Gondolín; Buenos Aires. ArgentinaFil: Caballero, R. Division of Implementation Research, Fundación Huésped; Buenos Aires. ArgentinaFil: Zalazar, V. Division of Implementation Research, Fundación Huésped; Buenos Aires. ArgentinaFil: Ramos-Pibernus, A. School of Behavioral and Brain Sciences, Ponce Health Sciences University; Ponce, PR. United StatesFil: Alpert, AB. Department of Public Health Sciences, University of Rochester Medical Center; Rochester, NY. United StatesFil: Alpert, AB. Division of Hematology, Department of Medicine, Yale School of Medicine; New Haven, CT. United StatesFil: Cupertino, AP. Department of Public Health Sciences, University of Rochester Medical Center; Rochester, NY. United StatesFil: Cupertino, AP. Department of Surgery, University of Rochester Medical Center; Rochester, NY. United StatesFil: Frola, C. Division of Implementation Research, Fundación Huésped; Buenos Aires. ArgentinaFil: Aristegui, I. Division of Implementation Research, Fundación Huésped; Buenos Aires. ArgentinaObjective: To assess the prevalence of current cigarette smoking among transgender women in Argentina, and to examine the unique associations of current cigarette smoking with demographic and psychosocial factors. Methods: This study is a secondary data analysis of the TransCITAR – a prospective cohort study of transgender individuals living in Buenos Aires, Argentina – baseline data. The baseline survey collected information on sociodemographic characteristics, perceived health status, depressive symptoms, suicide attempts, current cigarette smoking, alcohol use disorder, and substance use. Participants were also asked about lifetime experiences of physical and sexual violence perpetrated by partners, clients and/or the police, and experiences of gender identity stigma in the past year from healthcare workers and the police. Lastly, participants were asked if they had ever been arrested. Fisher’s exact test was used to compare proportions in categorical variables and student t-test was used for continuous variables. Significant associations with current cigarette smoking were tested in a logistic regression model adjusted for all significant associations. Results: A total of 41.7% of participants (n = 393) reported current cigarette smoking. Compared to their non-smoking counterparts, participants who reported current cigarette smoking (1) had completed less education, (2) were more likely to be born in Argentina, (3) more likely to had migrated to Buenos Aires from other parts of the country, (4) more likely to report a history of sex work, (5) more likely to perceive their health as excellent, (6) more likely to screen positive for hazardous alcohol drinking, (7) more likely to report any substance and cocaine use in the past year, (8) more likely to experience gender identity stigma from the police in the past year, and (9) more likely to being arrested in their lifetime (all p’s < 0.05). After controlling for all significant associations, education level of less than high school (AOR = 1.79, 95% CI 1.02–2.12), hazardous drinking (AOR = 2.65, 95% CI 1.30–5.37), and any substance use in the last year (AOR = 2.14, 95% CI 1.16–3.94) were positively and independently associated with current cigarette smoking. Conclusion: Among transgender women in Argentina, current cigarette smoking was more than double the rate for cisgender women. Current cigarette smoking was associated with education, hazardous drinking, and any drug use. These results will inform future smoking cessation interventions among transgender women in Argentina

Minimal anonymized data set.

(XLSX)</p