Identification of the Genotypes Circulating in the Ecuadorian Population Infected with the Hepatitis C Virus (HCV)

Miguel Moncayo,1,2 Enrique Teran,1,3 Jorge Reyes,4,5 Gabriela Yerovi,6 Marcia Robalino,6 Ana Cristina Aguilar,1,3 Daniel Garzon-Chavez1,3 1Instituto de Microbiología, Universidad San Francisco de Quito USFQ, Quito, Ecuador; 2Laboratorio Clinico Pasteur Dr. Alberto Moncayo Calero, Quito, Ecuador; 3Colegio de Ciencias de la Salud, Universidad San Francisco de Quito USFQ, Quito, Ecuador; 4Facultad de Ciencias Químicas, Universidad Central del Ecuador, Quito, Ecuador; 5Departamento de Microbiologı´a, Hospital del IESS Quito Sur, Quito, Ecuador; 6Ministerio de Salud Pública del Ecuador, Quito, EcuadorCorrespondence: Daniel Garzon-Chavez, Email [email protected]: The hepatitis C virus (HCV) is responsible for 1.5 million new infections, and around 290 thousand deaths worldwide. 15 to 30% of the patients that go into a chronic phase of the disease will develop cirrhosis or hepatocellular carcinoma within 20 years and is the leading etiology for liver transplantation. HCV genetic characteristics display a remarkable genetic diversity, which divides HCV into 8 genotypes and 67 subgenotypes; the treatment and probability of chronic HCV depend on these genotypes and subgenotypes. In Ecuador, there is no available information regarding HCV genotypes and subgenotypes; therefore, this study aims to provide an overview of the main genotypes circulating in Ecuador.Methods: In a cross-sectional and descriptive study using the Ecuadorian Ministry of Health (MSP) registry of patients already diagnosed with Hepatitis C (HCV) between 2017 and 2019. From 51 patients identified by health ministry, blood samples from a total of 15 subjects (named HCV1 to HCV15) were collected using an appropriate venipuncture technique. Pandemic-related circumstances avoid reaching all patients identified by health ministry.Results: After the amplification of 11 samples from patients living in the Ecuadorian territory, the genotypes of HCV obtained were distributed as follows: 6 samples corresponding to subgenotype 2b (54.5%), 2 samples corresponding to subgenotype 1a (18.2%), 2 samples corresponding to subgenotype 4d (18.2%) and 1 corresponding to sample 1b (9.1%).Conclusion: These results represent the first epidemiological approach to genotype distribution in Ecuador, and it contributes to better management of patients. We emphasize the importance of the development of better strategies from the Healthcare Ministry of Ecuador (MSP) for the identification, treatment and tracking of HCV patients.Keywords: hepatitis C virus, hepatitis C genotype, hepatitis C subgenotype, hepatitis C prevalence, cirrhosis, hepatocellular carcinom

Increased incidences of noninfectious comorbidities among aging populations living with human immunodeficiency virus in Ecuador: a multicenter retrospective analysis

Isabel Hernández,1,2 Julio Barzallo,3 Simón Beltrán,4 Alberto Castillo,5 Nelson Cevallos,6 Patricio Hernández,7 Camilo López,8 Rita Vera,9 Gabriela Yerovi,10 Alejandra Mendoza,1 Santiago Terán,1 Andres Izurieta,11 Enrique Teran11Colegio de Ciencias de la Salud, Universidad San Francisco de Quito, Quito, Ecuador; 2Facultad de Enfermería, Pontificia Universidad Católica del Ecuador, Quito, Ecuador; 3Hospital Teofilo Dávila, Ministerio de Salud Pública, Machala, Ecuador; 4Hospital Carlos Andrade Marín, Instituto Ecuatoriano de Seguridad Social, Quito, Ecuador; 5Hospital Eugenio Espejo, Ministerio de Salud Pública, Quito, Ecuador; 6Hospital Enrique Garcés, Ministerio de Salud Pública, Quito, Ecuador; 7Hospital de Infectología Dr. José Daniel Rodríguez Maridueña, Ministerio de Salud Pública, Guayaquil, Ecuador; 8Hospital Teodoro Maldonado Carbo, Instituto Ecuatoriano de Seguridad Social, Guayaquil, Ecuador; 9Hospital Abel Gilbert Pontón, Ministerio de Salud Pública, Guayaquil, Ecuador; 10Programa Nacional para Control del VIH, Ministerio de Salud Pública, Quito, Ecuador; 11Department of Computer Engineering, College of Engineering, University of South Florida, Tampa, FL, USAIntroduction: Besides the well-known increased risk of developing HIV-related infectious comorbidities; compared with the general population, people living with HIV (PLHIV) may also have an increased risk of developing noninfectious comorbidities (NICMs). This is the first study intended to determine the NICMs rates affecting PLHIV who were under cART regimen in Ecuador.Methods: A total of 503 HIV-positive patients were evaluated during the period June 2015-November 2016 and included in a multicenter retrospective, cross-sectional study conducted in seven main government and nongovernment community-based hospitals in Ecuador.Results: The average age of the participants was 39.2±11.9 years old and the majority of them were male (67.2%). The average age at HIV diagnosis was 34.1 years old and cART in average was started 15.9 months after HIV-diagnosis. Recruited patients were receiving cART for an average of 59.2±40.2 months. Only 9.9% (n=50) of the patients did not show any NICMs. Diabetes and pre-diabetes was found in 6% (n=30) and 16.3% (n=82) patients, respectively; however, dyslipidemia and overweight/obesity was frequent, as they affected 41.4% (n=208) and 36.4% (n=183) patients, respectively. Sixty patients (11.9%) were diagnosed with depression and 28.2% (n=142) of the studied subjects were found to have other NICMs.Conclusion: Prevalence of NICMs among subjects under cART was greater than that reported among the Ecuadorian general population, therefore specific public health actions are required to make patients aware of and prevent NICMs among PLHIV in Ecuador.Keywords: HIV noninfectious comorbidities, people living with HIV, HIV combined antiretroviral therapy, HIV diagnosis, HIV treatment, HIV in developing countries, HIV in Ecuado

Expression of Tumor Antigens within an Oncolytic Virus enhances the Anti-Tumor T Cell Response

Although patients benefit from immune checkpoint inhibition (ICI) therapy in a broad variety of tumors, resistance may arise from immune suppressive tumor microenvironments (TME), which is particularly true of hepatocellular carcinoma (HCC). Since oncolytic viruses (OV) can generate a highly immune-infiltrated, inflammatory TME, OVs could potentially restore ICI responsiveness via recruitment, priming, and activation of anti-tumor T cells. Here we find that on the contrary, an oncolytic vesicular stomatitis virus, expressing interferon-ß (VSV-IFNß), antagonizes the effect of anti-PD-L1 therapy in a partially anti-PD-L1-responsive model of HCC. Cytometry by Time of Flight shows that VSV-IFNß expands dominant anti-viral effector CD8 T cells with concomitant relative disappearance of anti-tumor T cell populations, which are the target of anti-PD-L1. However, by expressing a range of HCC tumor antigens within VSV, combination OV and anti-PD-L1 therapeutic benefit could be restored. Our data provide a cautionary message for the use of highly immunogenic viruses as tumor-specific immune-therapeutics by showing that dominant anti-viral T cell responses can inhibit sub-dominant anti-tumor T cell responses. However, through encoding tumor antigens within the virus, oncolytic virotherapy can generate anti-tumor T cell populations upon which immune checkpoint blockade can effectively work.</p