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Beltrán-Pavez C, Gutiérrez-López M, Rubio-Garrido M, Valadés-Alcaraz A, Prieto L, Ramos JT, Jiménez De Ory S, Navarro M, Díez-Romero C, Pulido F, Valencia E, Holguín Á. Virological outcome among HIV infected patients transferred from pediatric care to adult units in Madrid, Spain (1997-2017). Sci Rep 2020; 10:16891. [PMID: 33037235 PMCID: PMC7547007 DOI: 10.1038/s41598-020-70861-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 07/27/2020] [Indexed: 12/24/2022] Open
Abstract
The aim of this transversal study was to describe the virological and immunological features of HIV-infected youths transferred from pediatric to adult care units since 1997 vs. the non-transferred patients from the Madrid Cohort of HIV-infected children and adolescents in Spain. We included 106 non-transferred and 184 transferred patients under clinical follow-up in 17 public hospitals in Madrid by the end of December 2017. Virological and immunological outcomes were compared in transferred vs. non-transferred patients. ART drug resistance mutations and HIV-variants were analyzed in all subjects with available resistance pol genotypes and/or genotypic resistance profiles. Among the study cohort, 133 (72.3%) of 184 transferred and 75 (70.7%) of 106 non-transferred patients had available resistance genotypes. Most (88.9%) of transferred had ART experience at sampling. A third (33.3%) had had a triple-class experience. Acquired drug resistance (ADR) prevalence was significantly higher in pretreated transferred than non-transferred patients (71.8% vs. 44%; p = 0.0009), mainly to NRTI (72.8% vs. 31.1%; p < 0.0001) and PI (29.1% vs. 12%; p = 0.0262). HIV-1 non-B variants were less frequent in transferred vs. non-transferred (6.9% vs. 32%; p < 0.0001). In conclusion, the frequent resistant genotypes found in transferred youths justifies the reinforcement of HIV resistance monitoring after the transition to avoid future therapeutic failures.
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Affiliation(s)
- Carolina Beltrán-Pavez
- HIV-1 Molecular Epidemiology Laboratory, Microbiology and Parasitology Department, Hospital Ramón y Cajal-IRYCIS and CIBEREsp-RITIP-CoRISPe, Carretera de Colmenar Viejo, Km. 9,100. -2D, 28034, Madrid, Spain
| | - Miguel Gutiérrez-López
- HIV-1 Molecular Epidemiology Laboratory, Microbiology and Parasitology Department, Hospital Ramón y Cajal-IRYCIS and CIBEREsp-RITIP-CoRISPe, Carretera de Colmenar Viejo, Km. 9,100. -2D, 28034, Madrid, Spain
| | - Marina Rubio-Garrido
- HIV-1 Molecular Epidemiology Laboratory, Microbiology and Parasitology Department, Hospital Ramón y Cajal-IRYCIS and CIBEREsp-RITIP-CoRISPe, Carretera de Colmenar Viejo, Km. 9,100. -2D, 28034, Madrid, Spain
| | - Ana Valadés-Alcaraz
- HIV-1 Molecular Epidemiology Laboratory, Microbiology and Parasitology Department, Hospital Ramón y Cajal-IRYCIS and CIBEREsp-RITIP-CoRISPe, Carretera de Colmenar Viejo, Km. 9,100. -2D, 28034, Madrid, Spain
| | - Luis Prieto
- Department of Infectious Diseases, Hospital 12 de Octubre, RIS, Madrid, Spain
| | - José Tomás Ramos
- Department of Infectious Diseases, Hospital Clínico Universitario and Universidad Complutense-CoRISpe, Madrid, Spain
| | - Santiago Jiménez De Ory
- Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IisGM), CoRISpe, Madrid, Spain
| | - Marisa Navarro
- Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IisGM), CoRISpe, Madrid, Spain
| | - Cristina Díez-Romero
- Department of Infectious Diseases, Hospital Gregorio Marañón, RIS, Madrid, Spain
| | - Federico Pulido
- Hospital Universitario 12 de Octubre, imas12, UCM, Madrid, Spain
| | - Eulalia Valencia
- HIV Unit, Internal Medicine Service, Hospital Universitario La Paz-IdiPAZ, Madrid, Spain
| | - África Holguín
- HIV-1 Molecular Epidemiology Laboratory, Microbiology and Parasitology Department, Hospital Ramón y Cajal-IRYCIS and CIBEREsp-RITIP-CoRISPe, Carretera de Colmenar Viejo, Km. 9,100. -2D, 28034, Madrid, Spain.
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Jiménez de Ory S, González-Tomé MI, Fortuny C, Mellado MJ, Soler-Palacin P, Bustillo M, Ramos JT, Muñoz-Fernández MA, Navarro ML. New diagnoses of human immunodeficiency virus infection in the Spanish pediatric HIV Cohort (CoRISpe) from 2004 to 2013. Medicine (Baltimore) 2017; 96:e7858. [PMID: 28953612 PMCID: PMC5626255 DOI: 10.1097/md.0000000000007858] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Vertical human immunodeficiency virus (HIV) infection has decreased in industrialized countries in recent decades, but there are no studies on the mechanisms of HIV transmission among infected children in Spain. Our aim was to study the characteristics and trends of diagnoses of vertically HIV-infected children in Spain from 2004 to 2013.Vertically HIV-infected children were selected if they were diagnosed from 2004 to 2013, were aged 0 to 18 years old, and were included in the Cohort of the Spanish Pediatric HIV Network (CoRISpe). Demographic, clinical, immunological, and virological data at diagnosis were obtained. The rate of diagnoses of vertically HIV-infected children was calculated as the number of cases per 100,000 inhabitants. Obstetric data of mothers of Spanish children and prophylaxis at childbirth and postpartum were obtained.A total of 218 HIV-infected children were included in the study. Of this sample, 182 children (83.5%) were perinatally HIV infected, and 125 out of those 182 children (68.7%) were born in Spain. The vertically HIV-infected Spanish children were diagnosed earlier and were in better clinical and immunological condition at diagnosis than were foreign children. The rate of vertically HIV-infected children declined from 0.09 in 2004 to 0.03 in 2013 due to the decrease in the rate of children born in Spain (0.08 in 2004 vs 0.01 in 2013). A total of 60 out of 107 mothers (56.1%) of Spanish children were diagnosed at or after childbirth. However, this number declined between 2004 and 2013.The rate of new HIV diagnoses of vertically HIV-infected children decreased significantly between 2004 and 2013 from 0.09 to 0.03 per 100,000 inhabitants.
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Affiliation(s)
- Santiago Jiménez de Ory
- Sección Inmunología, Laboratorio InmunoBiología Molecular, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón
- Spanish Human Immunodeficiency Virus Hospital Gregorio Marañón BioBank (Spanish HIV HGM BioBank)
- Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN)
- Servicio de Pediatría, Hospital Clínico San Carlos
| | - María Isabel González-Tomé
- Servicio de Infecciosas Pediátricas, Hospital Universitario Doce de Octubre, Instituto de Investigación Hospital 12 de Octubre
| | - Claudia Fortuny
- Unidad de Enfermedades Infecciosas, Servicio de Pediatría, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues del Llobregat, Barcelona
| | - Maria Jose Mellado
- Servicio de Pediatría Hospitalaria y Enfermedades Infecciosas y Tropicales Pediátricas, Hospital Universitario Infantil La Paz and Hospital Carlos III
| | - Pere Soler-Palacin
- Unitat de Patologia Infecciosa i Immunodeficiències de Pediatria, Hospital Universitari Vall d’Hebron, Institut de Recerca Vall d’Hebron, Universitat Autònoma de Barcelona, Barcelona
| | - Matilde Bustillo
- Servicio de Pediatría, Unidad Infectología, Hospital Infantil Universitario Miguel Servet, Zaragoza
| | | | - Maria Angeles Muñoz-Fernández
- Sección Inmunología, Laboratorio InmunoBiología Molecular, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón
- Spanish Human Immunodeficiency Virus Hospital Gregorio Marañón BioBank (Spanish HIV HGM BioBank)
- Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN)
| | - Maria Luisa Navarro
- Sección de Enfermedades Infecciosas, Servicio de Pediatría, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain
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Soriano-Arandes A, Noguera-Julian A, Fortuny C. Impact of immigration on HIV mother-to-child transmission in Western Europe. HIV Med 2016; 18:532-533. [PMID: 28035766 DOI: 10.1111/hiv.12482] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- A Soriano-Arandes
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Vall d'Hebron Research Institute, Barcelona, Spain
| | - A Noguera-Julian
- Infectious Diseases Unit, Pediatrics Department, Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Barcelona, Spain.,Departament de Pediatria, Universitat de Barcelona, Barcelona, Spain.,CIBER de Epidemiología y Salud Pública (Ciberesp), Spain
| | - C Fortuny
- Infectious Diseases Unit, Pediatrics Department, Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Barcelona, Spain.,Departament de Pediatria, Universitat de Barcelona, Barcelona, Spain.,CIBER de Epidemiología y Salud Pública (Ciberesp), Spain
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de Jose MI, Jiménez de Ory S, Espiau M, Fortuny C, Navarro ML, Soler-Palacín P, Muñoz-Fernandez MA. A new tool for the paediatric HIV research: general data from the Cohort of the Spanish Paediatric HIV Network (CoRISpe). BMC Infect Dis 2013; 13:2. [PMID: 23282073 PMCID: PMC3544738 DOI: 10.1186/1471-2334-13-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Accepted: 12/18/2012] [Indexed: 12/20/2022] Open
Abstract
There are approximately from 1,100 to 1,200 HIV-infected children in a follow-up in Spain. In 2008 an open, multicentral, retrospective and prospective Cohort of the Spanish Paediatric HIV Network (CoRISpe) was founded. The CoRISpe is divided into the node 1 and node 2 representing geographically almost the whole territory of Spain. Since 2008 seventy-five hospitals have been participating in the CoRISpe. All the retrospective data of the HIV-infected children have been kept in the CoRISpe since 1995 and prospective data since 2008. In this article we are going to present the notion of CoRISpe, its role, the structure, how the CoRISpe works and the process how a child is transferred from Paediatric to Adults Units. The main objective of the CoRISpe is to contribute to furthering scientific knowledge on paediatric HIV infection by providing demographic, sociopsychological, clinical and laboratory data from HIV-infected paediatric patients. Its aim is to enable high-quality research studies on HIV-infected children.
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Affiliation(s)
- Ma Isabel de Jose
- Servicio Infecciosas Infantil, Hospital Universitario “La Paz”, Paseo de la Castellana 26, Madrid, 128046, Spain
| | - Santiago Jiménez de Ory
- Laboratorio de Inmuno-Biología Molecular. Spanish HIV HGM BioBank. Hospital General Universitario “Gregorio Marañón” and Instituto de Investigación Sanitaria Gregorio Marañón, C/Dr. Esquerdo 46, Madrid, 28007, Spain
| | - Maria Espiau
- Unitat de Patologia Infecciosa i Immunodeficiències de Pediatria, Hospital Universitari Vall d` Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Claudia Fortuny
- Servicio Infecciosas Infantil, Hospital Sant Joan de Dèu, Esplugues de Llobregat, Barcelona, Spain
| | - Ma Luisa Navarro
- Sección de Enfermedades Infecciosas. Servicio de Pediatría. Hospital General Universitario “Gregorio Marañón”, Madrid, Spain
| | - Pere Soler-Palacín
- Unitat de Patologia Infecciosa i Immunodeficiències de Pediatria, Hospital Universitari Vall d` Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ma Angeles Muñoz-Fernandez
- Laboratorio de Inmuno-Biología Molecular. Spanish HIV HGM BioBank. Hospital General Universitario “Gregorio Marañón” and Instituto de Investigación Sanitaria Gregorio Marañón, C/Dr. Esquerdo 46, Madrid, 28007, Spain
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de Mulder M, Yebra G, Navas A, de José MI, Gurbindo MD, González-Tomé MI, Mellado MJ, Saavedra-Lozano J, Muñoz-Fernández MÁ, de Ory SJ, Ramos JT, Holguín Á. High drug resistance prevalence among vertically HIV-infected patients transferred from pediatric care to adult units in Spain. PLoS One 2012; 7:e52155. [PMID: 23284913 PMCID: PMC3524105 DOI: 10.1371/journal.pone.0052155] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Accepted: 11/09/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Antiretroviral treatment (ART) has contributed to increased life expectancy of HIV-1 infected children. In developed countries, an increasing number of children reaching adulthood are transferred to adult units. The objectives were to describe the demographic and clinical features, ART history, antiviral drug resistance and drug susceptibility in HIV-1 perinatally infected adolescents transferred to adult care units in Spain from the Madrid Cohort of HIV-1 infected children. METHODS Clinical, virological and immunological features of HIV-1 vertically infected patients in the Madrid Cohort of HIV-infected children were analyzed at the time of transfer. Pol sequences from each patient were recovered before transfer. Resistance mutations according to the InternationaI AIDS Society 2011 list were identified and interpreted using the Stanford algorithm. Results were compared to the non-transferred HIV-1 infected pediatric cohort from Madrid. RESULTS One hundred twelve infected patients were transferred to adult units between 1997 and 2011. They were mainly perinatally infected (93.7%), with a mean nadir CD4+-T-cells count of 10% and presented moderate or severe clinical symptoms (75%). By the time of transfer, the mean age was 18.9 years, the mean CD4+T-cells count was 627.5 cells/ml, 64.2% presented more than 350 CD4+T-cells/ml and 47.3% had ≤ 200 RNA-copies/ml. Most (97.3%) were ART experienced receiving Highly Active ART (HAART) (84.8%). Resistance prevalence among pretreated was 50.9%, 76.9% and 36.5% for Protease Inhibitors (PI), Nucleoside Reverse Transcriptase Inhibitors (NRTI) and Non-NRTI (NNRTI), respectively. Resistance mutations were significantly higher among transferred patients compared to non-transferred for the PI+NRTI combination (19% vs. 8.4%). Triple resistance was similar to non-transferred pediatric patients (17.3% vs. 17.6%). CONCLUSION Despite a good immunological and virological control before transfer, we found high levels of resistance to PI, NRTI and triple drug resistance in HIV-1 infected adolescents transferred to adult units.
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Affiliation(s)
- Miguel de Mulder
- HIV-1 Molecular Epidemiology Laboratory, Microbiology and Parasitology Department, Hospital Universitario Ramón y Cajal, IRYCIS and CIBER-ESP, Madrid, Spain
| | - Gonzalo Yebra
- HIV-1 Molecular Epidemiology Laboratory, Microbiology and Parasitology Department, Hospital Universitario Ramón y Cajal, IRYCIS and CIBER-ESP, Madrid, Spain
| | - Adriana Navas
- Pediatrics Department, Hospital Universitario Infanta Leonor, Madrid, Spain
| | | | | | | | | | - Jesús Saavedra-Lozano
- Pediatrics Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Santiago Jiménez de Ory
- Molecular Immunobiology Laboratory, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - José Tomás Ramos
- Pediatrics Department, Hospital Universitario de Getafe, Madrid, Spain
| | - África Holguín
- HIV-1 Molecular Epidemiology Laboratory, Microbiology and Parasitology Department, Hospital Universitario Ramón y Cajal, IRYCIS and CIBER-ESP, Madrid, Spain
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Abstract
BACKGROUND Drug resistance mutations compromise antiretroviral treatment (ART) effectiveness in HIV-1-infected children. Trends in drug resistance prevalence have not been previously evaluated in HIV-infected children in Spain. METHODS HIV-1 variants, drug resistance prevalence dynamics and drug susceptibility were analyzed from 1993 to 2010 in HIV-infected children with available pol sequence, sample or drug resistance profile. HIV-1 variants were characterized by phylogenetic analysis. Resistance mutations in pretreated and naive patients were identified according to International AIDS Society-2010 and the World Health Organization list, respectively. RESULTS In 232 patients, genotypic resistance profiles (n = 11) or pol sequences (n = 128) were recovered or newly generated from infected samples (n = 93). Patients were mainly in care at pediatric units (63%), were mostly Europeans (84%), with moderate AIDS symptoms (65%), on ART (91%) and infected by HIV-1 subtype B (89%). Transmitted major drug resistance mutations were selected in 6 (13.6%) of the 44 ART-naive children: 4.8%, 9.3% and 11.6%, for protease inhibitors, nucleoside reverse transcriptase inhibitors and nonnucleoside reverse transcriptase inhibitors, respectively. Overall resistance prevalence was higher (71.8%) among ART-exposed children: 39.9%, 66.5% and 35.3% for protease inhibitors, nucleoside reverse transcriptase inhibitors and nonnucleoside reverse transcriptase inhibitors, respectively. Resistance prevalence among ART-exposed children was higher in 2009 to 2010 relative to 1993 to 1999 for nonnucleoside reverse transcriptase inhibitors (42% versus 6%; P = 0.006), protease inhibitors (39% versus 13%; P = 0.004) and nucleoside reverse transcriptase inhibitors (63% versus 44%; P = NS). Susceptibility to each drug in resistant viruses was predicted. The rate of non-B infections increased in the last years, mainly caused by recombinant viruses. CONCLUSIONS The increasing resistance prevalence among the HIV-infected pediatric population in Spain highlights the importance of specific drug resistance and drug susceptibility surveillance in long-term pretreated children to optimize treatment regimens.
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de Mulder M, Yebra G, Martín L, Prieto L, Mellado MJ, Rojo P, Muñoz-Fernández MÁ, Jiménez de Ory S, Ramos JT, Holguín A. Drug resistance prevalence and HIV-1 variant characterization in the naive and pretreated HIV-1-infected paediatric population in Madrid, Spain. J Antimicrob Chemother 2011; 66:2362-71. [PMID: 21810838 DOI: 10.1093/jac/dkr305] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Drug resistance mutations affect antiretroviral therapy (ART) effectiveness in HIV-1-infected children, compromising long-term therapy. HIV-1 variants and drug resistance mutations were identified in HIV-infected children from Madrid, Spain. METHODS Patients from the Madrid cohort of HIV-infected children (1993-2009) with available pol sequences or infected samples stored at the Spanish HIV-1 BioBank were selected. Specimens were used to perform new pol sequences when not available. HIV-1 variants were characterized by phylogenetic analysis. Resistance mutations were identified according to the International AIDS Society-USA list (2009). RESULTS In 198 patients, pol sequences were recovered from routine resistance testing (n = 98) or newly performed using stored plasma, lymphocytes or DNA (n = 100). Patients were mostly Europeans (90%), with moderate to severe AIDS symptoms (65%), on ART (85%) when the specimen was sequenced and infected by subtype B (90%). Among the 19 HIV-1 non-B variants found, 58% were recombinants (8CRF02_AG, 1CRF08_BC, 1CRF12_BF and 1CRF13_cpx) and the rest were 'pure' non-B subtypes (1A2, 2C, 2D, 1F1, 1G and 1H). Transmitted drug resistance (TDR) mutations were detected in 13% of naive children; 4%, 7% and 10% for protease inhibitors (PIs), nucleoside reverse transcriptase inhibitors (NRTIs) and non-nucleoside reverse transcriptase inhibitors (NNRTIs), respectively. Global resistance prevalence was higher (66%) among ART-exposed children; 37% for PIs, 54% for NRTIs and 35% for NNRTIs. CONCLUSIONS HIV-1 non-B variants infected 10% of the cohort during 1993-2009. Resistant viruses were present in 26.5% and 66% of naive and pretreated children, respectively. Our data suggest that TDR prevalence in children could be higher than that reported in adults in Spain. The provided data will help to improve clinical management of HIV-infected children in Spain.
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Affiliation(s)
- Miguel de Mulder
- HIV-1 Molecular Epidemiology Laboratory, FiBIO-IRYCIS, Hospital Ramón y Cajal, Madrid, Spain
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Palladino C, Bellón JM, Jarrín I, Gurbindo MD, De José MI, Ramos JT, González-Iome MI, Mellado MJ, Beceiro J, Amo JD, Muñoz-Fernández MÁ. Impact of highly active antiretroviral therapy (HAART) on AIDS and death in a cohort of vertically HIV type 1-infected children: 1980-2006. AIDS Res Hum Retroviruses 2009; 25:1091-7. [PMID: 19895191 DOI: 10.1089/aid.2009.0070] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We evaluated the population effectiveness of highly active antiretroviral therapy (HAART) on the risk of AIDS and death in a multicenter cohort of 346 HIV-1 vertically infected children born between 1980 and 2006 in the Comunidad Autónoma de Madrid (CAM), Spain. Risks of AIDS and death in patients with the same duration of HIV infection were compared in different calendar periods [CP1: 1980-1989, CP2: 1990-1993 (reference), CP3: 1994-1996, CP4: 1997-1998, CP5: 1999-2006] through cumulative incidence curves and Cox proportional hazards models, allowing for late entry, that included the calendar period as the time-dependent covariate and adjusting for gender and mother's transmission category. The median follow-up was 11.8 years [interquartile range (IQR), 6.3-15.9]. Median CD4+ T cell percentage increased up to 26.5 in CP5 (IQR, 19.5-36.7) while the viral load decreased (median log(10) copies/ml in CP5, 3.66; IQR, 3.07-4.22). Multivariate analysis showed significant reduction in the risk of death since 1997 onward [CP4: adjusted hazard ratios (AHR), 0.29; 95% confidence interval (CI), 0.12-0.69; CP5: AHR, 0.06; 95% CI, 0.03-0.15]. Reduction in progression to AIDS reached borderline significance in CP4 (AHR, 0.49; 95% CI, 0.23-1.05) and was more marked in the last period (CP5: AHR, 0.30; 95% CI, 0.16-0.59). The reductions in the incidence of AIDS and death observed since 1996 were largely attributable to HAART.
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Affiliation(s)
- Claudia Palladino
- Laboratorio de Inmuno-Biología Molecular, Hospital General Universitario “Gregorio Marañón,” Madrid, Spain
- Istituto Pasteur, Fondazione Cenci-Bolognetti, Università degli Studi di Roma “La Sapienza,” 00185 Rome, Italy
- Università degli Studi di Roma “La Sapienza,” 00185 Rome, Italy
| | - Jose M. Bellón
- Laboratorio de Inmuno-Biología Molecular, Hospital General Universitario “Gregorio Marañón,” Madrid, Spain
| | - Inmaculada Jarrín
- Centro Nacional de Epidemiología, Instituto de Salud “Carlos III,” Madrid, Spain
| | - Maria Dolores Gurbindo
- Sección Inmuno-Pediatría, Hospital Materno Infantil “Gregorio Marañón,” Madrid, Spain
- Unidad Asociada de Retrovirología Humana, HGUGM-CSIC, Madrid, Spain
| | - M. Isabel De José
- Servicio Infecciosas Infantil, Hospital Universitario “La Paz,” Madrid, Spain
| | - José T. Ramos
- Servicio de Pediatría, Hospital Universitario de Getafe, Madrid, Spain
| | - M. Isabel González-Iome
- Servicio de Infecciosas Pediátricas, Hospital Universitario “Doce de Octubre,” Madrid, Spain
| | - Maria José Mellado
- Servicio de Pediatría, Hospital Universitario “Carlos III,”, Madrid, Spain
| | - José Beceiro
- Servicio de Pediatría, Hospital Universitario “Príncipe de Asturias,” Madrid, Spain
| | - Julia Del Amo
- Centro Nacional de Epidemiología, Instituto de Salud “Carlos III,” Madrid, Spain
| | - M. Ángeles Muñoz-Fernández
- Laboratorio de Inmuno-Biología Molecular, Hospital General Universitario “Gregorio Marañón,” Madrid, Spain
- Unidad Asociada de Retrovirología Humana, HGUGM-CSIC, Madrid, Spain
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