Infecção por VIH entre imigrantes na Guiana Francesa: alto risco durante os primeiros anos após a chegada

Introduction. Over 75% of HIV patients in French Guiana are foreigners most of whom are actually infected locally. Objectives. We aimed to estimate the distribution of infections in time after arrival using a retrospective cohort. Methods. CD4 erosion modelling allowed to estimate the date of infection which was compared to the date of arrival in French Guiana in the subset of foreign patients that were estimated to have acquired HIV locally. Results. Among patients estimated to have been infected in French Guiana and having arrived after 1999, over half had been infected within 4 years and that a quarter of patients had acquired HIV within the 2 first years after arrival (median 3.9 years IQR=2.1-7.8 years). Conclusions. The added value of the present results is to show the rapid infection dynamics after arrival and emphasize the necessity of increasingly proactive combined prevention in recently arrived immigrants.Introdução. Mais de 75% dos pacientes com HIV na Guiana Francesa são estrangeiros, a maioria dos quais estão realmente infectados localmente. Objetivos. O nosso objetivo era estimar a distribuição das infecções no tempo após a chegada, utilizando uma coorte retrospectiva. Métodos. A modelagem da erosão CD4 permitiu estimar a data da infecção que foi comparada à data de chegada na Guiana Francesa no subconjunto de pacientes estrangeiros que foram estimados como tendo adquirido o HIV localmente.Resultados. Entre os pacientes estimados como tendo sido infectados na Guiana Francesa e tendo chegado após 1999, mais da metade tinha sido infectada dentro de 4 anos e que um quarto dos pacientes tinha adquirido o HIV dentro dos 2 primeiros anos após a chegada (mediana de 3,9 anos IQR=2,1-7,8 anos). Conclusões. O valor agregado dos resultados atuais é mostrar a rápida dinâmica da infecção após a chegada e enfatizar a necessidade de uma prevenção combinada cada vez mais proativa nos imigrantes recém-chegados

Thirty years of HIV pregnancies in French Guiana: prevention successes and remaining obstetrical challenges

IntroductionIn a context of high HIV prevalence, poor pregnancy follow-up, frequent poverty, preeclampsia, and preterm delivery, we aimed to describe the characteristics and outcomes of pregnancies among women living with HIV in French Guiana.MethodsA retrospective cohort study was conducted on HIV-infected pregnancies enrolled between January 1st 1992 to 31st July 2022. Overall, there were 1,774 pregnancies in 881 women living with HIV.ResultsFor 75.1% of pregnancies, the HIV diagnosis was already known before pregnancy and in 67.6% of women, HIV follow-up predated pregnancy. Nearly half of women, 49.6%, only had one pregnancy since having been diagnosed with HIV. Although most women received antiretroviral therapy during pregnancy, for those with the available information we found only 48.5% had an undetectable viral load at delivery. Overall, 15.3% of pregnancies ended with an abortion. There were a total of 110 newborns infected with HIV representing an overall transmission rate of 6.2% (110/1,771). Between 1993 and 2002, the transmission rate was 34%, between 2003 and 2012 it was 1.3%, and between 2013 and 2022 it was 0.7%. Overall, in Cayenne, since 2008, 106 of 581 HIV–infected pregnancies (18.2%) with available information were premature before 37 weeks of pregnancy; of these, 33 (5.7%) were very preterm deliveries and 73 (13.3%) were late preterm deliveries. Over time, in Cayenne, preterm delivery declined significantly.ConclusionsThe present study emphasizes that, despite spectacular progress in reducing mother to child transmission, pregnancy outcomes among women living with HIV are still preoccupying with high incidence of preterm delivery and low birth weight. Teasing out what fraction is linked to HIV and what fraction is linked to social precariousness and poor follow-up was not possible in this study. Despite the high incidence of very preterm delivery recent progress suggests that coordination efforts to improve follow-up may also have improved obstetrical outcomes

Coxiella burnetii Infection in Livestock, Pets, Wildlife, and Ticks in Latin America and the Caribbean: a Comprehensive Review of the Literature

Purpose of the Review Q fever , a bacterial zoonosis caused by Coxiella burnetii, is reported very heterogeneously in humans in Latin America. The objective of this study was to review the data on Coxiella burnetii Infection in animals in Latin America and the Caribbean. Recent Findings A comprehensive literature review was carried out in the 47 countries and territories of Latin America on various search engines and grouped into four groups: livestock, pets, wildlife, and ticks. Summary Thus, 113 studies were selected between 1950 and 2022. Among the 47 countries, only 25 (53%) had at least one publication related to C. burnetii infection in animals. The most productive country was Brazil (N = 51), followed by French Guiana (N = 21), and Colombia (N = 16). Studies in livestock from 20 countries have shown widely varying country-to-country rates of seroprevalence, ranging from 0 to 67%. Some studies from seven countries, especially French Guiana and Brazil, found antibodies and sometimes positive PCR in dogs and cats, generally in the context of investigations around human clustered cases. Knowledge remained fragmented about infection in wildlife from only five countries (Chile, Colombia, Brazil, French Guiana, and Uruguay). C. burnetii infection was identified by PCR in Chiroptera (7 species), Rodentia (6 species), Suina (2 species), Xenartha (1 species), Cingulata (1 species), and Perissodactyla (1 species). Studies on Coxiella sp. in ticks have been performed in 11 countries, mostly in Brazil, and mainly found Coxiella-like endosymbionts. Thus, data on C. burnetii infection in animals are sparse and incomplete in Latin America and the Caribbean, and more research is warranted

Stochastic representations of model uncertainties at ECMWF: state of the art and future vision

Members in ensemble forecasts differ due to the representations of initial uncertainties and model uncertainties. The inclusion of stochastic schemes to represent model uncertainties has improved the probabilistic skill of the ECMWF ensemble by increasing reliability and reducing the error of the ensemble mean. Recent progress, challenges and future directions regarding stochastic representations of model uncertainties at ECMWF are described in this paper. The coming years are likely to see a further increase in the use of ensemble methods in forecasts and assimilation. This will put increasing demands on the methods used to perturb the forecast model. An area that is receiving a greater attention than 5 to 10 years ago is the physical consistency of the perturbations. Other areas where future efforts will be directed are the expansion of uncertainty representations to the dynamical core and to other components of the Earth system as well as the overall computational efficiency of representing model uncertainty