A Barrasa

Polymorphisms in the interleukin-4 receptor α chain gene influence susceptibility to HIV-1 infection and its progression to AIDS

Interleukin (IL) 4 is a key T helper-2 cytokine that downregulates and upregulates CCR5 and CXCR4, respectively, the main coreceptors for HIV. Our objective is to investigate whether single-nucleotide polymorphisms (SNPs) in the IL-4 receptor α chain gene (IL4RA) affect HIV infection and its progression to AIDS. The I50V SNP in exon 5 and the haplotypes of six SNPs in exon 12 (E375A, C406R, S411L, S478P, Q551R, and V554I) were studied by polymerase chain reaction and sequencing in 30 HIV+ long-term nonprogressors (LTNP), 36 HIV+ typical progressors (TP), 55 highly exposed but uninfected individuals (EU), 25 EU-sexuals (EU-Sex; mostly women) and 30 EU-hemophiliacs (EU-Hem; hepatitis C virus+), and 97 healthy controls (HC), all Caucasians and lacking CCR5Δ32 homozygosity. V50 homozygosity was increased in LTNP (44%) compared with the other groups [p=0.005; relative risk ratio=3.4, 95% confidence interval (CI)=1.12–10.6, p=0.03]. The most common (C) exon 12 haplotype, ECSSQV, predominated in all groups, but uncommon (U) haplotypes were increased in HIV+ individuals (n=64), especially in those (51 of 64) infected via parenteral exposure (35.3%) compared with HC (20.4%) and EU-Hem (18.4%) [p=0.01; odds ratio (OR)=2.14, 95% CI=1.25–3.67, p=0.01]. EU-Sex also had an increased frequency of U-haplotypes (34.8%) (OR=2.10, 95% CI=1.03–4.21, p=0.01) as well as an increased frequency of CU + UU genotypes (60.9%) compared with HC (38.2%) and EU-Hem (26.6%) (p=0.043). Distributions of genotypes fitted Hardy–Weinberg equilibrium. Data suggest that V50 homozygosity associates with slow progression and that exon 12 U-haplotypes might be associated with both susceptibility to infection via parenteral route and resistance to infection via sexual exposure. Further studies are required to confirm these findings.

Factors influencing HIV progression in a seroconverter cohort in Madrid from 1985 to 1999

Objective: To study HIV progression from seroconversion over a 15 year period and measure the population effectiveness of highly active antiretroviral therapy (HAART). Methods: A cohort study of people with well documented dates of seroconversion. Cumulative risk of AIDS and death were calculated by extended Kaplan-Meier allowing for late entry. Cox proportional hazards models were used to study variables associated with HIV progression. To assess the impact of HAART, calendar time was divided in three periods; before 1992, 1992–6, and 1997–9. Results: From January 1985 to May 2000, 226 seroconverters were identified. The median seroconversion interval was 11 months, median seroconversion date was March 1993. 202 (89%) were men, 76% of whom were homo/bisexual. A 66% reduction in progression to AIDS was observed in 1997–9 compared to 1992–96 (HR 0.34 95% CI: 0.16 to 0.70). People with primary education appeared to have faster progression to AIDS compared to those with university studies (HR 2.69 95%CI: 1.17 to 6.16). An 82% reduction in mortality from HIV seroconversion was observed in 1997–9 (HR 0.18 95% CI: 0.05 to 0.68) compared to 1992–6. Progression to death for people with primary education was twice as fast as for those with university education (p 0.0007). People without confirmation of an HIV negative test had faster progression (HR 4.47 95% CI: 1.18 to 16.92). Conclusions: The reduction in progression to AIDS and death from seroconversion from 1992–6 to 1997–9 in Madrid is likely to be attributable to HAART. HIV progression was faster in subjects with primary education; better educational level may be associated with better adherence to medication.

Sentinel surveillance of HIV infection in HIV test clinics, Spain 1992-2002.

HIV infection in Spain was monitored in persons undergoing voluntary HIV testing in ten sentinel clinics between 1992 and 2002. Only patients on their first visit were considered for inclusion, and their numbers rose from 4426 in 1992 to 6649 in 2002. Most of them recognised their risk exposure as heterosexual. The proportion of injecting drug users decreased from 19% to 2% of the study population, and the proportion of female sex workers increased from 6% to 26%. The number of patients diagnosed with HIV infection declined from 604 in 1992 to 153 in 2002, and HIV prevalence fell from 13.6% to 2.3% in the same period. In all risk exposure categories, a decrease in HIV prevalence was observed, more pronounced during the first few years and stabilised in the later years. In 2002, the highest HIV prevalence was found in injecting drug users (IDUs) (14.2%), homo/bisexual men (7.5%) and individuals who had an HIV infected heterosexual partner (10.2%).

Investigación de una toxiinfección alimentaria en un centro penitenciario de alta ocupación

Background: On September 25 2005, more than 100 inmates (almost 5% of the 1,800 prison population) experienced sudden onset gastroenteritis. This outbreak was the largest foodborne outbreak described in a prison population in Spain. Our objective was to confirm the outbreak, identify risk factors, implement control measures, and provide recommendations. Methods: We conducted a cohort analysis of a stratified random sample of all the inmates, a cohort analysis of the one of the prison blocks, and an environmental investigation. Results: A total of 221 inmates were selected, of which 196 were interviewed. Twenty-eight percent had gastroenteritis and the main symptoms were abdominal pain (85%) and diarrhea (71%). All foods consumed caused similar attack rates. Factors associated with the risk of illness were eating the entire portion of seafood cocktail at lunch or all of the fried shrimp at dinner on September 24 (RR = 2; 95% CI, 1.1-3.8, and RR = 1.8; 95% CI, 1.1-3.1). Analysis of one of the prison blocks yielded results similar to those of the random sample. Clostridium perfringens, Bacillus cereus and Escherichia coli were isolated from a sample of the seafood cocktail. Conclusion: A gastroenteritis outbreak caused by several pathogens was confirmed. Both the reported symptoms and the calculated incubation periods corresponded to the pathogens isolated. Preparation of food in prison facilities should meet minimum safety standards, including refrigeration and training of food handlers.

Riesgo elevado de infección por el virus de la inmunodeficiencia humana en varones homosexuales incluso después del contacto con el sistema sanitario

Objetivo. Conocer la incidencia de seroconversiones al virus de la inmunodeficiencia humana (VIH) y evaluar las caracteristicas que se asocian a un mayor riesgo de seroconversion al VIH en varones homosexuales en el periodo 2000-2003. Metodo. Estudio de cohorte dinamica en todos los varones con practicas homosexuales que se analizaron para el VIH en una red de 20 centros ambulatorios de diagnostico de VIH de 19 ciudades espanolas. Se analizaron sus caracteristicas y se calculo la tasa de incidencia de seroconversiones entre los que estaban en seguimiento. Resultados. En el periodo 2000-2003 se acumularon un total de 10.189 personas-ano de seguimiento y se diagnosticaron 167 seroconversiones al VIH, lo que supuso una tasa de seroincidencia de 16,4 por 1.000 personas-ano. La mayoria de las seroconversiones (63%) ocurrieron en menores de 30 anos. Entre los varones latinoamericanos y los subsaharianos la tasa de seroconversion fue mayor que entre los espanoles. Conclusiones. En Espana el riesgo de transmision del VIH entre los varones que tienen relaciones sexuales con otros varones todavia es elevado y, por lo tanto, continua siendo una poblacion prioritaria en la prevencion de la infeccion por el VIH. Una parte de los diagnosticos de VIH entre inmigrantes son infecciones adquiridas tras su llegada a Espana, seguramente debido a condiciones de mayor vulnerabilidad social. Parece oportuno reforzar y renovar las estrategias de prevencion dirigidas a esta poblacion.

Prevalencia de vih entre las personas de ocho ciudades españolas que se realizan la serología tras exposiciones heterosexuales, 1992-2003

Fundamento: La epidemia de infecciones por el virus de la inmunodeficiencia humana (VIH) en Espana se caracterizo durante los primeros anos por el predominio de casos en personas usuarias de drogas inyectadas, pero en la actualidad todo parece apuntar a un progresivo predominio de la transmision sexual. El objetivo de este trabajo es describir la evolucion en la prevalencia de VIH en varios grupos de poblacion heterosexual y caracterizar las situaciones en las que se produjeron las infecciones. Metodos: Estudio descriptivo de las personas que se realizaron la prueba por primera vez en nueve centros de diagnostico de VIH entre 1992 y 2003 por exposiciones heterosexuales de riesgo, excluyendose a los usuarios de drogas inyectadas. Resultados: El numero de personas en las que se determino la serologia fue de 47.870. La prevalencia de VIH en la poblacion estudiada descendio del 3,2% al 1,0% (p<0,001). En las personas con pareja con diagnostico de infeccion por VIH la prevalencia se mantuvo en torno al 10%, en hombres usuarios de prostitucion descendio del 1,9% al 1,0% (p=0,049), en las mujeres que ejercen la prostitucion del 1,4% al 0,7% (p=0,008), y en el resto de heterosexuales disminuyo del 1,6% al 1,0% en hombres (p=0,014) y del 1,1% al 0,7% en mujeres (p=0,012). Conclusiones: Los resultados indican avances en el control de la transmision heterosexual del VIH, principalmente en mujeres, aunque todavia se requiere insistir en la prevencion.

[Investigation of a foodborne intoxication in a high-density penitentiary center].

BACKGROUND On September 25 2005, more than 100 inmates (almost 5% of the 1,800 prison population) experienced sudden onset gastroenteritis. This outbreak was the largest foodborne outbreak described in a prison population in Spain. Our objective was to confirm the outbreak, identify risk factors, implement control measures, and provide recommendations. METHODS We conducted a cohort analysis of a stratified random sample of all the inmates, a cohort analysis of the one of the prison blocks, and an environmental investigation. RESULTS A total of 221 inmates were selected, of which 196 were interviewed. Twenty-eight percent had gastroenteritis and the main symptoms were abdominal pain (85%) and diarrhea (71%). All foods consumed caused similar attack rates. Factors associated with the risk of illness were eating the entire portion of seafood cocktail at lunch or all of the fried shrimp at dinner on September 24 (RR = 2; 95% CI, 1.1-3.8, and RR = 1.8; 95% CI, 1.1-3.1). Analysis of one of the prison blocks yielded results similar to those of the random sample. Clostridium perfringens, Bacillus cereus and Escherichia coli were isolated from a sample of the seafood cocktail. CONCLUSION A gastroenteritis outbreak caused by several pa-thogens was confirmed. Both the reported symptoms and the calculated incubation periods corresponded to the pathogens isolated. Preparation of food in prison facilities should meet minimum safety standards, including refrigeration and training of food handlers.