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Caballé-Perez E, Hernández-Pedro N, Ramos-Ramírez M, Barrios-Bernal P, Romero-Núñez E, Lucio-Lozada J, Ávila-Ríos S, Reyes-Terán G, Cardona AF, Arrieta O. Impact of KRAS G12D subtype and concurrent pathogenic mutations on advanced non-small cell lung cancer outcomes. Clin Transl Oncol 2024; 26:836-850. [PMID: 37490263 PMCID: PMC10981588 DOI: 10.1007/s12094-023-03279-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 07/09/2023] [Indexed: 07/26/2023]
Abstract
PURPOSE Mutations in the Kirsten rat sarcoma viral (KRAS) oncogene constitute a significant driver of lung adenocarcinoma, present in 10-40% of patients, which exhibit heterogeneous clinical outcomes, mainly driven by concurrent genetic alterations. However, characterization of KRAS mutational subtypes and their impact on clinical outcomes in Latin America is limited. METHODS A cohort study was conducted at the National Cancer Institute (INCan) of Mexico. Individuals with advance-staged of adenocarcinoma and KRAS mutations, detected by next-generation sequencing, having undergone at least one line of therapy were included for analysis. Clinical and pathological characteristics were retrieved from institutional database from June 2014 to March 2023. RESULTS KRAS was identified in fifty-four (15.6%) of 346 patients, among which 50 cases were included for analysis. KRASG12D (n = 16, 32%) and KRASG12C (n = 16, 32%) represented the most prevalent subtypes. KRASG12D mutations were associated with female (p = 0.018), never smokers (p = 0.108), and concurrences with EGFR (25.0% vs. 17.6%, p = 0.124) and CDKN2A (18.8% vs. 14.7%, p = 0.157). KRASG12D patients showed a better ORR (66.6% vs. 30.0%; OR 4.66, 95% CI 1.23-17.60, p = 0.023) and on multivariate analysis was significantly associated with better PFS (HR 0.36, 95% CI 0.16-0.80; p = 0.012) and OS (HR 0.24, 95% CI 0.08-0.70; p = 0.009). CONCLUSIONS To our knowledge, this study represents the first effort to comprehensively characterize the molecular heterogeneity of KRAS-mutant NSCLC in Latin American patients. Our data reinforce the current view that KRAS-mutated NSCLC is not a single oncogene-driven disease and emphasizes the prognostic impact of diverse molecular profiles in this genomically defined subset of NSCLC. Further validation is warranted in larger multicenter Latin American cohorts to confirm our findings.
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Affiliation(s)
- Enrique Caballé-Perez
- Thoracic Oncology Unit, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
- Personalized Medicine Laboratory, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | - Norma Hernández-Pedro
- Personalized Medicine Laboratory, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | - Maritza Ramos-Ramírez
- Thoracic Oncology Unit, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | - Pedro Barrios-Bernal
- Personalized Medicine Laboratory, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | - Eunice Romero-Núñez
- Personalized Medicine Laboratory, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | - José Lucio-Lozada
- Personalized Medicine Laboratory, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | | | | | - Andrés F Cardona
- Thoracic Oncology Unit and Direction of Research, Science and Education, Luis Carlos Sarmiento Angulo, Cancer Treatment and Research Center (CTIC), Bogotá, Colombia
- Clinical and Translational Oncology Group, Clínica del Country, Bogotá, Colombia
- Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad El Bosque, Bogotá, Colombia
| | - Oscar Arrieta
- Thoracic Oncology Unit, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico.
- Personalized Medicine Laboratory, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico.
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Díaz-Basilio F, Vergara-Mendoza M, Romero-Rodríguez J, Hernández-Rizo S, Escobedo-Calvario A, Fuentes-Romero LL, Pérez-Patrigeon S, Murakami-Ogasawara A, Gomez-Palacio M, Reyes-Terán G, Jiang W, Vázquez-Pérez JA, Marín-Hernández Á, Romero-Rodríguez DP, Gutiérrez-Ruiz MC, Viveros-Rogel M, Espinosa E. The ecto-enzyme CD38 modulates CD4 T cell immunometabolic responses and participates in HIV pathogenesis. J Leukoc Biol 2024:qiae060. [PMID: 38466822 DOI: 10.1093/jleuko/qiae060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 01/31/2024] [Accepted: 02/23/2024] [Indexed: 03/13/2024] Open
Abstract
Despite abundant evidence correlating T cell CD38 expression and HIV infection pathogenesis, its role as a CD4 T cell immunometabolic regulator remains unclear. We find that CD38's extracellular glycohydrolase activity restricts metabolic reprogramming after TCR-engaging stimulation in Jurkat T CD4 cells, together with functional responses, while reducing intracellular NAD and NMN concentrations. Selective elimination of CD38's ectoenzyme function licenses them to decrease the OCR/ECAR ratio upon TCR signaling and to increase cycling, proliferation, survival, and CD40L induction. Pharmacological inhibition of ectoCD38 catalytic activity in memory CD4 T cells from chronic HIV-infected patients rescued TCR-triggered responses, including differentiation and effector functions, while reverting abnormally increased basal glycolysis, cycling, and spontaneous pro-inflammatory cytokine production. Additionally, ecto-CD38 blockage normalized basal and TCR-induced mitochondrial morpho-functionality, while increasing respiratory capacity in cells from HIV+ patients and healthy individuals. Ectoenzyme CD38's immunometabolic restriction of TCR-involving stimulation is relevant to CD4 T cell biology and to the deleterious effects of CD38 overexpression in HIV disease.
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Affiliation(s)
- Fernando Díaz-Basilio
- Laboratory of Integrative Immunology, National Institute of Respiratory Diseases "Ismael Cosío Villegas", Mexico City, Mexico
- PECEM Graduate Program, Faculty of Medicine, National Autonomous University of Mexico (UNAM), Mexico City, Mexico
| | - Moisés Vergara-Mendoza
- Department of Infectious Diseases, National Institute of Medical Sciences and Nutrition "Salvador Zubirán", Mexico City, Mexico
| | - Jessica Romero-Rodríguez
- Flow Cytometry Core Facility, National Institute of Respiratory Diseases "Ismael Cosío Villegas", Mexico City, Mexico
| | - Sharik Hernández-Rizo
- Laboratory for Cellular Physiology and Translational Medicine, Department of Health Sciences, Autonomous Metropolitan University - Iztapalapa, Mexico City, México
| | - Alejandro Escobedo-Calvario
- Laboratory for Cellular Physiology and Translational Medicine, Department of Health Sciences, Autonomous Metropolitan University - Iztapalapa, Mexico City, México
| | - Luis-León Fuentes-Romero
- Department of Infectious Diseases, National Institute of Medical Sciences and Nutrition "Salvador Zubirán", Mexico City, Mexico
| | - Santiago Pérez-Patrigeon
- Department of Infectious Diseases, National Institute of Medical Sciences and Nutrition "Salvador Zubirán", Mexico City, Mexico
| | - Akio Murakami-Ogasawara
- Center for Research in Infectious Diseases (CIENI), National Institute of Respiratory Diseases "Ismael Cosío Villegas", Mexico City, Mexico
| | - María Gomez-Palacio
- Center for Research in Infectious Diseases (CIENI), National Institute of Respiratory Diseases "Ismael Cosío Villegas", Mexico City, Mexico
| | - Gustavo Reyes-Terán
- Center for Research in Infectious Diseases (CIENI), National Institute of Respiratory Diseases "Ismael Cosío Villegas", Mexico City, Mexico
| | - Wei Jiang
- Department of Microbiology and Immunology, Medical University of South Carolina, Charleston, SC, USA
| | - Joel-Armando Vázquez-Pérez
- Laboratory for Emergent Diseases and COPD, National Institute of Respiratory Diseases "Ismael Cosío Villegas", Mexico City, Mexico
| | - Álvaro Marín-Hernández
- Department of Biochemistry, National Institute of Cardiology "Ignacio Chávez", Mexico City, Mexico
| | | | - María-Concepción Gutiérrez-Ruiz
- Laboratory for Cellular Physiology and Translational Medicine, Department of Health Sciences, Autonomous Metropolitan University - Iztapalapa, Mexico City, México
| | - Mónica Viveros-Rogel
- Department of Infectious Diseases, National Institute of Medical Sciences and Nutrition "Salvador Zubirán", Mexico City, Mexico
| | - Enrique Espinosa
- Laboratory of Integrative Immunology, National Institute of Respiratory Diseases "Ismael Cosío Villegas", Mexico City, Mexico
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Alvarado-de la Barrera C, Ávila-Ríos S, Reyes-Terán G. The gray zone between legitimate and predatory open access scientific publishing. Rev Invest Clin 2024; 76:1-5. [PMID: 37913753 DOI: 10.24875/ric.23000191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 10/10/2023] [Indexed: 11/03/2023]
Abstract
Certain open access publishers based on the article processing charges model have found it highly profitable to operate within a gray zone that encompasses both legitimate and predatory publishing practices. In this context, maximum profits can be obtained by adequate combinations of journal acceptance rates and elevated article processing charges. Considering that the gray zone can be particularly challenging to identify and that it poses risks for authors aiming to establish academic carreers, we believe it is important to provide a comprehensive description of it.
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Affiliation(s)
- Claudia Alvarado-de la Barrera
- Research Center on Infection Diseases, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - Santiago Ávila-Ríos
- Research Center on Infection Diseases, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - Gustavo Reyes-Terán
- Comisión Coordinadora de Institutos Nacionales de Salud y Hospitales de Alta Especialidad, Mexico City, Mexico
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Molina-Jaimes M, Galindo-González A, Verduzco-Aguirre HC, Bautista-Arredondo S, Reyes-Terán G, Soto-Perez-de-Celis E. Cost-effectiveness of the addition of CDK4/6 inhibitors to standard endocrine therapy in first-line treatment of women with advanced HR+/HER2- breast cancer in Mexico. Clin Transl Oncol 2024; 26:239-244. [PMID: 37329428 DOI: 10.1007/s12094-023-03247-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 06/02/2023] [Indexed: 06/19/2023]
Abstract
PURPOSE To estimate the cost-effectiveness of adding a CDK4/6 inhibitor to standard endocrine therapy in the first-line setting for advanced HR+/HER2- breast cancer in postmenopausal and premenopausal women, from the perspective of the Mexican public healthcare system. METHODS We used a partitioned survival model to simulate relevant health outcomes in a synthetic cohort of patients with breast cancer derived from the PALOMA-2, MONALEESA-2, MONARCH-3 trials for postmenopausal patients, and from the MONALEESA-7 study for premenopausal patients. Effectiveness was measured in life years gained. Cost-effectiveness is reported through incremental cost-effectiveness ratios (ICER). RESULTS In postmenopausal patients, palbociclib led to an increase of 1.51 life years, ribociclib of 1.58 years, and abemaciclib of 1.75 years, compared to letrozole alone. The ICER was 36,648 USD, 32,422 USD, and 26,888 USD, respectively. In premenopausal patients, ribociclib led to an increase of 1.82 life years when added to goserelin and endocrine therapy, with an ICER of 44,579 USD. In the cost minimization analysis, for postmenopausal patients, ribociclib was the treatment with the highest costs due to follow-up requirements. CONCLUSION Palbociclib, ribociclib, and abemaciclib demonstrated a significant increase in effectiveness in postmenopausal patients, and ribociclib in premenopausal patients, when added to standard endocrine therapy for patients with advanced HR+/HER2- breast cancer. At the national stablished willingness to pay, only the addition of abemaciclib to standard endocrine therapy in postmenopausal women would be considered cost-effective. However, differences on results between therapies for postmenopausal patients were not statistically significant.
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Affiliation(s)
| | | | | | | | - Gustavo Reyes-Terán
- Secretaría de Salud, Comisión Coordinadora de los Institutos Nacionales de Salud y Hospitales de Alta Especialidad, Mexico City, México
| | - Enrique Soto-Perez-de-Celis
- Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, México.
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Valenzuela-Ponce H, Carbajal C, Soto-Nava M, Tapia-Trejo D, García-Morales C, Murillo W, Lorenzana I, Reyes-Terán G, Ávila-Ríos S. Honduras HIV cohort: HLA class I and CCR5-Δ32 profiles and their associations with HIV disease outcome. Microbiol Spectr 2023; 11:e0161323. [PMID: 37962394 PMCID: PMC10714756 DOI: 10.1128/spectrum.01613-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 10/03/2023] [Indexed: 11/15/2023] Open
Abstract
IMPORTANCE We identify both canonical and novel human leukocyte antigen (HLA)-HIV associations, providing a first step toward improved understanding of HIV immune control among the understudied Honduras Mestizo population. Our results are relevant to understanding the protective or detrimental effects of HLA subtypes in Latin America because their unique HLA diversity poses challenges for designing vaccines against HIV and interpreting results from such vaccine trials. Likewise, the description of the HLA profile in an understudied population that shows a unique HLA immunogenetic background is not only relevant for HIV immunology but also relevant in population genetics, molecular anthropology, susceptibility to other infections, autoimmune diseases, and allograft transplantation.
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Affiliation(s)
- Humberto Valenzuela-Ponce
- CIENI Centro de Investigación en Enfermedades Respiratorias, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - Candy Carbajal
- Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras
| | - Maribel Soto-Nava
- CIENI Centro de Investigación en Enfermedades Respiratorias, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - Daniela Tapia-Trejo
- CIENI Centro de Investigación en Enfermedades Respiratorias, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - Claudia García-Morales
- CIENI Centro de Investigación en Enfermedades Respiratorias, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - Wendy Murillo
- Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras
| | - Ivette Lorenzana
- Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras
| | - Gustavo Reyes-Terán
- Comisión Coordinadora de Institutos Nacional de Salud y Hospitales de Alta Especialidad, Secretar ´ıa de Salud, Mexico City, Mexico
| | - Santiago Ávila-Ríos
- CIENI Centro de Investigación en Enfermedades Respiratorias, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
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6
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Rosel-Pech C, Pinto-Cardoso S, Chávez-Torres M, Montufar N, Osuna-Padilla I, Ávila-Ríos S, Reyes-Terán G, Aguirre-Alvarado C, Matías Juan NA, Pérez-Lorenzana H, Vázquez-Rosales JG, Bekker-Méndez VC. Distinct fecal microbial signatures are linked to sex and chronic immune activation in pediatric HIV infection. Front Immunol 2023; 14:1244473. [PMID: 37711620 PMCID: PMC10497879 DOI: 10.3389/fimmu.2023.1244473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 08/09/2023] [Indexed: 09/16/2023] Open
Abstract
Introduction Our understanding of HIV-associated gut microbial dysbiosis in children perinatally-infected with HIV (CLWH) lags behind that of adults living with HIV. Childhood represents a critical window for the gut microbiota. Any disturbances, including prolonged exposure to HIV, antiretroviral drugs, and antibiotics are likely to have a significant impact on long-term health, resulting in a less resilient gut microbiome. The objective of our study was to characterize the gut microbiota in CLWH, and compare it with HIV-unexposed and -uninfected children. Methods We enrolled 31 children aged 3 to 15 years; 15 were CLWH and 16 were HUU. We assessed dietary patterns and quality; quantified soluble and cellular markers of HIV disease progression by flow cytometry, enzyme-linked immunosorbent and multiplex-bead assays, and profiled the gut microbiota by 16S rRNA sequencing. We explored relationships between the gut microbiota, antibiotic exposure, dietary habits, soluble and cellular markers and host metadata. Results Children had a Western-type diet, their median health eating index score was 67.06 (interquartile range 58.76-74.66). We found no discernable impact of HIV on the gut microbiota. Alpha diversity metrics did not differ between CLWH and HUU. Sex impacted the gut microbiota (R-squared= 0.052, PERMANOVA p=0.024). Male children had higher microbial richness compared with female children. Two taxa were found to discriminate female from male children independently from HIV status: Firmicutes for males, and Bacteroides for females. Markers of HIV disease progression were comparable between CLWH and HUU, except for the frequency of exhausted CD4+ T cells (PD-1+) which was increased in CLWH (p=0.0024 after adjusting for confounders). Both the frequency of exhausted CD4+ and activated CD4+ T cells (CD38+ HLADR+) correlated positively with the relative abundance of Proteobacteria (rho=0.568. false discovery rate (FDR)-adjusted p= 0.029, and rho=0.62, FDR-adjusted p=0.0126, respectively). Conclusion The gut microbiota of CLWH appears similar to that of HUU, and most markers of HIV disease progression are normalized with long-term ART, suggesting a beneficial effect of the latter on the gut microbial ecology. The relationship between exhausted and activated CD4+ T cells and Proteobacteria suggests a connection between the gut microbiome, and premature aging in CLWH.
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Affiliation(s)
- Cecilia Rosel-Pech
- Posgrado en Ciencias Biológicas, Unidad de Posgrado, Universidad Nacional Autónoma de México (UNAM), Ciudad de México, Mexico
- Unidad de Investigación Médica en Inmunología e Infectología, Hospital de Infectología “Dr. Daniel Méndez Hernández”, Centro Médico Nacional “La Raza”, Instituto Mexicano del Seguro Social (IMSS), Ciudad de México, Mexico
| | - Sandra Pinto-Cardoso
- Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Ciudad de México, Mexico
| | - Monserrat Chávez-Torres
- Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Ciudad de México, Mexico
| | - Nadia Montufar
- Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Ciudad de México, Mexico
| | - Iván Osuna-Padilla
- Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Ciudad de México, Mexico
| | - Santiago Ávila-Ríos
- Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Ciudad de México, Mexico
| | - Gustavo Reyes-Terán
- Posgrado en Ciencias Biológicas, Unidad de Posgrado, Universidad Nacional Autónoma de México (UNAM), Ciudad de México, Mexico
| | - Charmina Aguirre-Alvarado
- Unidad de Investigación Médica en Inmunología e Infectología, Hospital de Infectología “Dr. Daniel Méndez Hernández”, Centro Médico Nacional “La Raza”, Instituto Mexicano del Seguro Social (IMSS), Ciudad de México, Mexico
| | - Norma Angelica Matías Juan
- Hospital de Infectología “Dr. Daniel Méndez Hernández”, Centro Médico Nacional “La Raza”, Instituto Mexicano del Seguro Social (IMSS), Ciudad de México, Mexico
| | - Héctor Pérez-Lorenzana
- UMAE Hospital General Dr. Gaudencio González Garza, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social (IMSS), Ciudad de México, Mexico
| | - José Guillermo Vázquez-Rosales
- Hospital de Pediatría “Doctor Silvestre Frenk Freund”, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, México, Mexico
| | - Vilma Carolina Bekker-Méndez
- Unidad de Investigación Médica en Inmunología e Infectología, Hospital de Infectología “Dr. Daniel Méndez Hernández”, Centro Médico Nacional “La Raza”, Instituto Mexicano del Seguro Social (IMSS), Ciudad de México, Mexico
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Bello-Chavolla OY, Antonio-Villa NE, Valdés-Ferrer SI, Fermín-Martínez CA, Fernández-Chirino L, Vargas-Vázquez A, Ramírez-García D, Mancilla-Galindo J, Kammar-García A, Ávila-Funes JA, Zúñiga-Gil CH, García-Grimshaw M, Ceballos-Liceaga SE, Carbajal-Sandoval G, Montes-González JA, Zaragoza-Jiménez CA, García-Rodríguez G, Cortés-Alcalá R, Reyes-Terán G, López-Gatell H, Gutiérrez-Robledo LM. Effectiveness of a nationwide COVID-19 vaccination program in Mexico against symptomatic COVID-19, hospitalizations, and death: a retrospective analysis of national surveillance data. Int J Infect Dis 2023; 129:188-196. [PMID: 36775188 PMCID: PMC9918316 DOI: 10.1016/j.ijid.2023.01.040] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 01/05/2023] [Accepted: 01/27/2023] [Indexed: 02/12/2023] Open
Abstract
OBJECTIVES Vaccination has been effective in ameliorating the impact of COVID-19. Here, we report vaccine effectiveness (VE) of the nationally available COVID-19 vaccines in Mexico. METHODS Retrospective analysis of a COVID-19 surveillance system to assess the VE of the BNT162b2, messenger RNA (mRNA)-12732, Gam-COVID-Vac, Ad5-nCoV, Ad26.COV2.S, ChAdOx1, and CoronaVac vaccines against SARS-CoV-2 infection, COVID-19 hospitalization, and death in Mexico. The VE was estimated using time-varying Cox proportional hazard models in vaccinated and unvaccinated adults, adjusted for age, sex, and comorbidities. VE was also estimated for adults with diabetes, aged ≥60 years, and comparing the predominance of SARS-CoV-2 variants B.1.1.519 and B.1.617.2. RESULTS We assessed 793,487 vaccinated and 4,792,338 unvaccinated adults between December 24, 2020 and September 27, 2021. The VE against SARS-CoV-2 infection was the highest for fully vaccinated individuals with mRNA-12732 (91.5%, 95% confidence interval [CI] 90.3-92.4) and Ad26.COV2.S (82.2%, 95% CI 81.4-82.9); for COVID-19 hospitalization, BNT162b2 (84.3%, 95% CI 83.6-84.9) and Gam-COVID-Vac (81.4% 95% CI 79.5-83.1), and for mortality, BNT162b2 (89.8%, 95% CI 89.2-90.2) and mRNA-12732 (93.5%, 95% CI 86.0-97.0). The VE decreased for all vaccines in adults aged ≥60 years, people with diabetes, and periods of Delta variant predominance. CONCLUSION All the vaccines implemented in Mexico were effective against SARS-CoV-2 infection, COVID-19 hospitalization, and death. Mass vaccination with multiple vaccines is useful to maximize vaccination coverage.
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Affiliation(s)
| | - Neftali Eduardo Antonio-Villa
- Dirección de Investigación, Instituto Nacional de Geriatría, Mexico City, Mexico; MD/PhD (PECEM) Program, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Sergio Iván Valdés-Ferrer
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Carlos A Fermín-Martínez
- Dirección de Investigación, Instituto Nacional de Geriatría, Mexico City, Mexico; MD/PhD (PECEM) Program, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Luisa Fernández-Chirino
- Dirección de Investigación, Instituto Nacional de Geriatría, Mexico City, Mexico; Facultad de Química, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Arsenio Vargas-Vázquez
- MD/PhD (PECEM) Program, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Daniel Ramírez-García
- Dirección de Investigación, Instituto Nacional de Geriatría, Mexico City, Mexico; Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | | | - Ashuin Kammar-García
- Dirección de Investigación, Instituto Nacional de Geriatría, Mexico City, Mexico
| | | | | | - Miguel García-Grimshaw
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | | | | | | | | | - Ricardo Cortés-Alcalá
- Dirección General de Promoción de la Salud, Secretaría de Salud, Mexico City, Mexico
| | - Gustavo Reyes-Terán
- Comisión Coordinadora de Institutos Nacionales de Salud y Hospitales de Alta Especialidad, Mexico City, Mexico
| | - Hugo López-Gatell
- Subsecretaría de Prevención y Promoción de la Salud, Secretaría de Salud Direccion General de Epidemiologia, SecretarIa de Salud, Mexico City, Mexico
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8
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Núñez I, Sierra-Madero J, Galindo-Fraga A, Ceballos-Liceaga SE, Reyes-Terán G, Valdés-Ferrer SI. Burden and severity of mpox in Mexico 6 months into the outbreak. Clin Microbiol Infect 2023:S1198-743X(23)00088-5. [PMID: 36871828 PMCID: PMC9985547 DOI: 10.1016/j.cmi.2023.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 02/24/2023] [Accepted: 02/25/2023] [Indexed: 03/07/2023]
Affiliation(s)
- Isaac Núñez
- Department of Medical Education, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; Division of Postgraduate Studies, Faculty of Medicine, Universidad Nacional Autónoma de México, Mexico City, Mexico.
| | - Juan Sierra-Madero
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, Mexico City, Mexico
| | - Arturo Galindo-Fraga
- Subdirectorate of Hospital Epidemiology and Quality Control of Medical Attention, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, Mexico City, Mexico
| | | | - Gustavo Reyes-Terán
- Coordinating Commission of the National Institutes of Health and High Specialty Hospitals, Ministry of Health, Mexico City, Mexico
| | - Sergio Iván Valdés-Ferrer
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, Mexico City, Mexico; Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, Mexico City, Mexico; Institute of Bioelectronic Medicine, Feinstein Institutes for Medical Research, Manhasset, NY, USA
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9
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Briceño O, Peralta-Prado A, Garrido-Rodríguez D, Romero-Mora K, Chávez-Torres M, Pinto Cardoso S, Alvarado de la Barrera C, Reyes-Terán G, Ávila-Ríos S. Double-Negative T Cell Number and Phenotype Alterations Before and After Effective Antiretroviral Treatment in Persons Living with HIV. AIDS Res Hum Retroviruses 2023; 39:104-113. [PMID: 36511386 DOI: 10.1089/aid.2022.0047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Double-negative (DN) T cells represent a small and phenotypically heterogeneous population that display regulatory functions. In HIV infection, DN T cells are decreased in peripheral blood and have been negatively associated with T cell activation. This study was aimed at describing the dynamics and phenotypic characteristics of DN T cells in peripheral blood of people living with HIV (PLHIV) before and after antiretroviral therapy (ART) initiation. We included 41 newly diagnosed, ART-naive individuals with advanced HIV infection, who were followed up for 6 months after ART initiation. The control group included 34 people without HIV (PWHIV), on preexposure prophylaxis for HIV infection. DN T cells in peripheral blood were characterized by flow cytometry. The absolute counts of DN T cells were lower in PLHIV than in PWHIV (p = 0.0223), and were particularly low in individuals with advanced HIV disease (p = 0.0311). Activation of DN T cells before ART initiation was directly associated with viral load (VL) (p = 0.0081, r = 0.4083) and inversely associated with CD4+ T cell counts (p = 0.0004, r = -0.4041). Compared with PWHIV, DN T cells of PLHIV expressed higher levels of CD57 (p = 0.0019), Ki67 (p = 0.0065), PD-1 (p = 0.0187), and CD38/HLA-DR (p < 0.0001). After 6 months on ART, expression of Ki67, PD-1, and CD38/HLA-DR on DN T cells returned to similar levels to those observed in PWHIV (p > 0.05 in all cases). However, expression of CD57 decreased only in individuals that start ART with high VL (p = 0.0127). DN T cell counts are decreased in HIV infection. Low DN T cell counts remained despite ART-induced immune reconstitution and viremia control. DN T cell phenotype is altered during chronic untreated infection with a high proportion of proliferating, activated, exhausted, and senescent cells. Most markers return to levels similar to those observed in PWHIV after ART. The impact of altered phenotype of DN T and their regulatory functions warrants further exploration.
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Affiliation(s)
- Olivia Briceño
- Departamento de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
| | - Amy Peralta-Prado
- Departamento de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
| | - Daniela Garrido-Rodríguez
- Departamento de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
| | - Karla Romero-Mora
- Departamento de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
| | - Monserrat Chávez-Torres
- Departamento de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
| | - Sandra Pinto Cardoso
- Departamento de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
| | - Claudia Alvarado de la Barrera
- Departamento de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
| | - Gustavo Reyes-Terán
- Institutos Nacionales de Salud y Hospitales de Alta Especialidad, Secretaría de Salud de México, Ciudad de Mexico, Mexico
| | - Santiago Ávila-Ríos
- Departamento de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
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10
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Wu VH, Nordin JML, Nguyen S, Joy J, Mampe F, Del Rio Estrada PM, Torres-Ruiz F, González-Navarro M, Luna-Villalobos YA, Ávila-Ríos S, Reyes-Terán G, Tebas P, Montaner LJ, Bar KJ, Vella LA, Betts MR. Profound phenotypic and epigenetic heterogeneity of the HIV-1-infected CD4 + T cell reservoir. Nat Immunol 2023; 24:359-370. [PMID: 36536105 PMCID: PMC9892009 DOI: 10.1038/s41590-022-01371-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 10/24/2022] [Indexed: 12/24/2022]
Abstract
Understanding the complexity of the long-lived HIV reservoir during antiretroviral therapy (ART) remains a considerable impediment in research towards a cure for HIV. To address this, we developed a single-cell strategy to precisely define the unperturbed peripheral blood HIV-infected memory CD4+ T cell reservoir from ART-treated people living with HIV (ART-PLWH) via the presence of integrated accessible proviral DNA in concert with epigenetic and cell surface protein profiling. We identified profound reservoir heterogeneity within and between ART-PLWH, characterized by new and known surface markers within total and individual memory CD4+ T cell subsets. We further uncovered new epigenetic profiles and transcription factor motifs enriched in HIV-infected cells that suggest infected cells with accessible provirus, irrespective of reservoir distribution, are poised for reactivation during ART treatment. Together, our findings reveal the extensive inter- and intrapersonal cellular heterogeneity of the HIV reservoir, and establish an initial multiomic atlas to develop targeted reservoir elimination strategies.
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Affiliation(s)
- Vincent H Wu
- Department of Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Center for AIDS Research, University of Pennsylvania, Philadelphia, PA, USA
| | - Jayme M L Nordin
- Department of Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Center for AIDS Research, University of Pennsylvania, Philadelphia, PA, USA
| | - Son Nguyen
- Department of Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Institute for Medical Engineering and Science, Department of Chemistry, and Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Jaimy Joy
- Center for AIDS Research, University of Pennsylvania, Philadelphia, PA, USA
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Felicity Mampe
- Center for AIDS Research, University of Pennsylvania, Philadelphia, PA, USA
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Perla M Del Rio Estrada
- Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
| | - Fernanda Torres-Ruiz
- Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
| | - Mauricio González-Navarro
- Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
| | - Yara Andrea Luna-Villalobos
- Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
| | - Santiago Ávila-Ríos
- Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
| | - Gustavo Reyes-Terán
- Institutos Nacionales de Salud y Hospitales de Alta Especialidad, Secretaría de Salud de México, Mexico City, Mexico
| | - Pablo Tebas
- Center for AIDS Research, University of Pennsylvania, Philadelphia, PA, USA
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Luis J Montaner
- Center for AIDS Research, University of Pennsylvania, Philadelphia, PA, USA
- The Wistar Institute, Philadelphia, PA, USA
| | - Katharine J Bar
- Center for AIDS Research, University of Pennsylvania, Philadelphia, PA, USA
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Laura A Vella
- Center for AIDS Research, University of Pennsylvania, Philadelphia, PA, USA.
- Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Michael R Betts
- Department of Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
- Center for AIDS Research, University of Pennsylvania, Philadelphia, PA, USA.
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11
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Chávez-Torres M, Gómez-Palacio-Schjetnan M, Reyes-Terán G, Briceño O, Ávila-Ríos S, Romero-Mora KA, Pinto-Cardoso S. The vaginal microbiota of women living with HIV on suppressive antiretroviral therapy and its relation to high-risk human papillomavirus infection. BMC Microbiol 2023; 23:21. [PMID: 36658503 PMCID: PMC9850673 DOI: 10.1186/s12866-023-02769-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 01/11/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Few studies have investigated the vaginal microbiota (VM) in women living with HIV (WLWH) in the context of high-risk human papillomavirus (HR-HPV) infection, even though WLWH are at an increased risk of HPV-related malignancies, including cervical cancer. To explore the impact of HIV and HPV infection on the VM in WLWH, we determined the prevalence of HR-HPV infection and cervical cytologic abnormalities in a cohort of 44 WLWH and 39 seronegative-women (SNW), characterized the vaginal microbiota by 16S sequencing, assessed genital inflammation and systemic immune activation by multiplex bead assay and flow cytometry, respectively. Finally, we explored relationships between bacterial richness and diversity, the top 20 bacterial genera, genital inflammation and systemic immune activation. RESULTS We found that HR-HPV prevalence was similar between WLWH and SNW. High-grade squamous intraepithelial lesions (HSIL) were only detected in WLWH negative for HR-HPV infection. In regression analyses, no risk factors were identified. Women co-infected with HIV and HR-HPV had the highest level of systemic immune activation, and these levels were significantly different compared with SNW without HR-HPV infection. Lactobacillus iners was the dominant Lactobacillus species in WLWH and SNW alike. CONCLUSION We found no evidence of differences in vaginal microbial richness and diversity, microbial community structure, and genital inflammation by HIV, HPV, or HIV and HPV status.
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Affiliation(s)
- Monserrat Chávez-Torres
- grid.419179.30000 0000 8515 3604Departamento de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Calzada de Tlalpan 4502, Colonia Sección XVI, Tlalpan, 14080 Ciudad de México, México
| | - Maria Gómez-Palacio-Schjetnan
- grid.419179.30000 0000 8515 3604Departamento de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Calzada de Tlalpan 4502, Colonia Sección XVI, Tlalpan, 14080 Ciudad de México, México
| | - Gustavo Reyes-Terán
- grid.415745.60000 0004 1791 0836Comisión Coordinadora de Institutos Nacionales de Salud Y Hospitales de Alta Especialidad, Secretaría de Salud, Ciudad de México, México
| | - Olivia Briceño
- grid.419179.30000 0000 8515 3604Departamento de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Calzada de Tlalpan 4502, Colonia Sección XVI, Tlalpan, 14080 Ciudad de México, México
| | - Santiago Ávila-Ríos
- grid.419179.30000 0000 8515 3604Departamento de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Calzada de Tlalpan 4502, Colonia Sección XVI, Tlalpan, 14080 Ciudad de México, México
| | - Karla Alejandra Romero-Mora
- grid.419179.30000 0000 8515 3604Departamento de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Calzada de Tlalpan 4502, Colonia Sección XVI, Tlalpan, 14080 Ciudad de México, México
| | - Sandra Pinto-Cardoso
- grid.419179.30000 0000 8515 3604Departamento de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Calzada de Tlalpan 4502, Colonia Sección XVI, Tlalpan, 14080 Ciudad de México, México
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12
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Briceño O, Gónzalez-Navarro M, Montufar N, Chávez-Torres M, Abato I, Espinosa-Sosa A, Ablanedo-Terrazas Y, Luna-Villalobos Y, Ávila-Ríos S, Reyes-Terán G, Pinto-Cardoso S. Mucosal immune cell populations and the bacteriome of adenoids and tonsils from people living with HIV on suppressive antiretroviral therapy. Front Microbiol 2022; 13:958739. [PMID: 36033845 PMCID: PMC9404693 DOI: 10.3389/fmicb.2022.958739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 07/14/2022] [Indexed: 11/13/2022] Open
Abstract
Ear, nose, and throat (ENT) conditions are prevalent in people living with HIV (PLWH) and occur at all strata of CD4 counts and despite antiretroviral therapy (ART). ENT conditions are underreported in PLWH. Also, little is known about the adenotonsillar microbiota and its relation to resident adaptive and innate immune cells. To bridge this gap, we characterized immune cell populations and the bacterial microbiota of two anatomical sites (adenoids, tonsils) and the oral cavity. Adenoids and tonsils were obtained from PLWH (n = 23) and HIV-seronegative individuals (SN, n = 16) after nasal surgery and tonsillectomy and processed for flow cytometry. Nasopharyngeal, oropharyngeal swabs, and oral rinses were collected prior to surgery for 16S sequencing. Wilcoxon rank sum test, principal coordinate analysis, permutational multivariate analysis of variance, and linear discriminant analysis (LEfSe) were used to assess differences between PLWH and SN. Spearman’s correlations were performed to explore interactions between the bacteriome and mucosal immune cells. Of the 39 individuals included, 30 (77%) were men; the median age was 32 years. All PLWH were on ART, with a median CD4 of 723 cells. ENT conditions were classified as inflammatory or obstructive, with no differences observed between PLWH and SN. PLWH had higher frequencies of activated CD4+ and CD8+ T cells, increased T helper (Th)1 and decreased Th2 cells; no differences were observed for B cells and innate immune cells. Alpha diversity was comparable between PLWH and SN at all 3 anatomical sites (adenoids, tonsils, and oral cavity). The impact of HIV infection on the bacterial community structure at each site, as determined by Permutational multivariate analysis of variance, was minor and not significant. Two discriminant genera were identified in adenoids using LEfSe: Staphylococcus for PLWH and Corynebacterium for SN. No discriminant genera were identified in the oropharynx and oral cavity. Niche-specific differences in microbial diversity and communities were observed. PLWH shared less of a core microbiota than SN. In the oropharynx, correlation analysis revealed that Th17 cells were inversely correlated with bacterial richness and diversity, Filifactor, Actinomyces and Treponema; and positively correlated with Streptococcus. Our study contributes toward understanding the role of the adenotonsillar microbiota in the pathophysiology of ENT conditions.
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Affiliation(s)
- Olivia Briceño
- Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias “Ismael Cosío Villegas”, Ciudad de México, Mexico
| | - Mauricio Gónzalez-Navarro
- Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias “Ismael Cosío Villegas”, Ciudad de México, Mexico
| | - Nadia Montufar
- Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias “Ismael Cosío Villegas”, Ciudad de México, Mexico
| | - Monserrat Chávez-Torres
- Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias “Ismael Cosío Villegas”, Ciudad de México, Mexico
| | - Indira Abato
- Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias “Ismael Cosío Villegas”, Ciudad de México, Mexico
| | - Ariana Espinosa-Sosa
- Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias “Ismael Cosío Villegas”, Ciudad de México, Mexico
| | - Yuria Ablanedo-Terrazas
- Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias “Ismael Cosío Villegas”, Ciudad de México, Mexico
| | - Yara Luna-Villalobos
- Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias “Ismael Cosío Villegas”, Ciudad de México, Mexico
| | - Santiago Ávila-Ríos
- Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias “Ismael Cosío Villegas”, Ciudad de México, Mexico
| | - Gustavo Reyes-Terán
- Comisión Coordinadora de Institutos Nacional de Salud y Hospitales de Alta Especialidad, Secretaría de Salud, Ciudad de México, Mexico
| | - Sandra Pinto-Cardoso
- Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias “Ismael Cosío Villegas”, Ciudad de México, Mexico
- *Correspondence: Sandra Pinto-Cardoso,
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13
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Núñez I, García-Grimshaw M, Castillo Valencia CY, Aguilera Callejas DE, Moya Alfaro ML, Del Mar Saniger-Alba M, Gutiérrez-Romero A, Carrillo-Mezo R, Ceballos-Liceaga SE, Baptista-Rosas RC, López-Gatell H, Reyes-Terán G, Díaz-Ortega JL, Arauz A, Valdés-Ferrer SI, Hernández-Vanegas LE. Seizures following COVID-19 vaccination in Mexico: a nationwide observational study. Epilepsia 2022; 63:e144-e149. [PMID: 35943891 PMCID: PMC9537899 DOI: 10.1111/epi.17390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 08/04/2022] [Accepted: 08/08/2022] [Indexed: 11/30/2022]
Abstract
The COVID‐19 pandemic led to the development and emergency approval of an array of effective vaccines against SARS‐CoV‐2. Given the relatively small number of patients included in vaccine trials, postapproval epidemiological surveillance is crucial to detect infrequent vaccine‐related adverse events. We conducted a nationwide retrospective descriptive study evaluating the incidence of seizures among recipients of SARS‐CoV‐2 vaccines in Mexico from December 24, 2020 (date of administration of first doses nationwide) to October 29, 2021. Among 81 916 351 doses of any vaccine that were administered, we documented seizures in 53 patients, of which 31 (60%) were new onset seizures. The incidence rate of seizures per million doses was highest for mRNA‐1273 (Moderna) with 2.73 per million, followed by BNT162b2 (Pfizer‐BioNTech) with 1.02 per million, and Ad5‐nCoV (CanSino) with 1.01 per million. Thus, we found that seizures following SARS‐CoV‐2 vaccination are exceedingly rare events.
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Affiliation(s)
- Isaac Núñez
- Department of Medical Education, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Miguel García-Grimshaw
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | | | | | - María Del Mar Saniger-Alba
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Alonso Gutiérrez-Romero
- Department of Neurology, Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico
| | - Roger Carrillo-Mezo
- Department of Neurology, Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico
| | | | - Raúl C Baptista-Rosas
- Departamento de Ciencias de la Salud-Enfermedad como Proceso Individual, Centro Universitario de Tonalá, Universidad de Guadalajara.,Unidad de Intervención de Medicina Crítica, Hospital General de Occidente, Secretaría de Salud Jalisco
| | - Hugo López-Gatell
- Subsecretaría de Prevención y Promoción de la Salud, Secretaría de Salud, Mexico City, Mexico
| | - Gustavo Reyes-Terán
- Comisión Coordinadora de Institutos Nacionales de Salud y Hospitales de Alta Especialidad, Secretaría de Salud, Mexico City, Mexico
| | - Jose Luis Díaz-Ortega
- Centro Nacional para la Salud de la Infancia y la Adolescencia, Secretaría de Salud, Mexico City, Mexico
| | - Antonio Arauz
- Department of Neurology, Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico
| | - Sergio Iván Valdés-Ferrer
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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14
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Avila-Rios S, García-Morales C, Reyes-Terán G, González-Rodríguez A, Matías-Florentino M, Mehta SR, Chaillon A. Phylodynamics of HIV in the Mexico City Metropolitan Region. J Virol 2022; 96:e0070822. [PMID: 35762759 PMCID: PMC9327710 DOI: 10.1128/jvi.00708-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 06/06/2022] [Indexed: 12/30/2022] Open
Abstract
Evolutionary analyses of viral sequences can provide insights into transmission dynamics, which in turn can optimize prevention interventions. Here, we characterized the dynamics of HIV transmission within the Mexico City metropolitan area. HIV pol sequences from persons recently diagnosed at the largest HIV clinic in Mexico City (between 2016 and 2021) were annotated with demographic/geographic metadata. A multistep phylogenetic approach was applied to identify putative transmission clades. A data set of publicly available sequences was used to assess international introductions. Clades were analyzed with a discrete phylogeographic model to evaluate the timing and intensity of HIV introductions and transmission dynamics among municipalities in the region. A total of 6,802 sequences across 96 municipalities (5,192 from Mexico City and 1,610 from the neighboring State of Mexico) were included (93.6% cisgender men, 5.0% cisgender women, and 1.3% transgender women); 3,971 of these sequences formed 1,206 clusters, involving 78 municipalities, including 89 clusters of ≥10 sequences. Discrete phylogeographic analysis revealed (i) 1,032 viral introductions into the region, over one-half of which were from the United States, and (ii) 354 migration events between municipalities with high support (adjusted Bayes factor of ≥3). The most frequent viral migrations occurred between northern municipalities within Mexico City, i.e., Cuauhtémoc to Iztapalapa (5.2% of events), Iztapalapa to Gustavo A. Madero (5.4%), and Gustavo A. Madero to Cuauhtémoc (6.5%). Our analysis illustrates the complexity of HIV transmission within the Mexico City metropolitan area but also identifies a spatially active transmission area involving a few municipalities in the north of the city, where targeted interventions could have a more pronounced effect on the entire regional epidemic. IMPORTANCE Phylogeographic investigation of the Mexico City HIV epidemic illustrates the complexity of HIV transmission in the region. An active transmission area involving a few municipalities in the north of the city, with transmission links throughout the region, is identified and could be a location where targeted interventions could have a more pronounced effect on the entire regional epidemic, compared with those dispersed in other manners.
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Affiliation(s)
- Santiago Avila-Rios
- Center for Research in Infectious Diseases, National Institute of Respiratory Diseases, Mexico City, Mexico
| | - Claudia García-Morales
- Center for Research in Infectious Diseases, National Institute of Respiratory Diseases, Mexico City, Mexico
| | - Gustavo Reyes-Terán
- Coordinating Commission of the National Institutes of Health and High Specialty Hospitals, Ministry of Health, Mexico City, Mexico
| | | | | | - Sanjay R. Mehta
- Division of Infectious Diseases and Global Public Health, University of California, San Diego, San Diego, California, USA
- Veterans Affairs Health System, San Diego, California, USA
| | - Antoine Chaillon
- Division of Infectious Diseases and Global Public Health, University of California, San Diego, San Diego, California, USA
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15
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García-Grimshaw M, Galnares-Olalde JA, Bello-Chavolla OY, Michel-Chávez A, Cadena-Fernández A, Briseño-Godínez ME, Antonio-Villa NE, Nuñez I, Gutiérrez-Romero A, Hernández-Vanegas L, Saniger-Alba MDM, Carrillo-Mezo R, Ceballos-Liceaga SE, Carbajal-Sandoval G, Flores-Silva FD, Díaz-Ortega JL, Cortes-Alcalá R, Pérez-Padilla JR, López-Gatell H, Chiquete E, Reyes-Terán G, Arauz A, Valdés-Ferrer SI. Incidence of Guillain-Barré syndrome following SARS-CoV-2 immunization: Analysis of a nationwide registry of recipients of 81 million doses of seven vaccines. Eur J Neurol 2022; 29:3368-3379. [PMID: 35841212 PMCID: PMC9349509 DOI: 10.1111/ene.15504] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 07/06/2022] [Accepted: 07/13/2022] [Indexed: 11/30/2022]
Abstract
Background and purpose Information on Guillain–Barré syndrome (GBS) as an adverse event following immunization (AEFI) against SARS‐CoV‐2 remains scarce. We aimed to report GBS incidence as an AEFI among adult (≥18 years) recipients of 81,842,426 doses of seven anti‐SARS‐CoV‐2 vaccines between December 24, 2020, and October 29, 2021, in Mexico. Methods Cases were retrospectively collected through passive epidemiological surveillance. The overall observed incidence was calculated according to the total number of administered doses. Vaccines were analyzed individually and by vector as mRNA‐based (mRNA‐1273 and BNT162b2), adenovirus‐vectored (ChAdOx1 nCov‐19, rAd26‐rAd5, Ad5‐nCoV, and Ad26.COV2‐S), and inactivated whole‐virion‐vectored (CoronaVac) vaccines. Results We identified 97 patients (52 males [53.6%]; median [interquartile range] age 44 [33–60] years), for an overall observed incidence of 1.19/1,000,000 doses (95% confidence interval [CI] 0.97–1.45), with incidence higher among Ad26.COV2‐S (3.86/1,000,000 doses, 95% CI 1.50–9.93) and BNT162b2 recipients (1.92/1,00,000 doses, 95% CI 1.36–2.71). The interval (interquartile range) from vaccination to GBS symptom onset was 10 (3–17) days. Preceding diarrhea was reported in 21 patients (21.6%) and mild COVID‐19 in four more (4.1%). Only 18 patients were tested for Campylobacter jejuni (positive in 16 [88.9%]). Electrophysiological examinations were performed in 76 patients (78.4%; axonal in 46 [60.5%] and demyelinating in 25 [32.8%]); variants were similar across the platforms. On admission, 91.8% had a GBS disability score ≥3. Seventy‐five patients (77.3%) received intravenous immunoglobulin, received seven plasma exchange (7.2%), and 15 (15.5%) were treated conservatively. Ten patients (10.3%) died, and 79.1% of survivors were unable to walk independently. Conclusions Guillain–Barré syndrome was an extremely infrequent AEFI against SARS‐CoV‐2. The protection provided by these vaccines outweighs the risk of developing GBS.
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Affiliation(s)
- Miguel García-Grimshaw
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.,Hospital General Tijuana, Tijuana, Mexico
| | | | | | - Anaclara Michel-Chávez
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Arturo Cadena-Fernández
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - María Eugenia Briseño-Godínez
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.,Department of Neurology, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico
| | - Neftali Eduardo Antonio-Villa
- Instituto Nacional de Geriatría, Mexico City, Mexico.,MD/PhD (PECEM) Program, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Isaac Nuñez
- Department of Internal Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Alonso Gutiérrez-Romero
- Department of Neurology, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico
| | - Laura Hernández-Vanegas
- Department of Neurology, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico
| | - María Del Mar Saniger-Alba
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Roger Carrillo-Mezo
- Department of Neurology, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico
| | | | | | - Fernando Daniel Flores-Silva
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - José Luis Díaz-Ortega
- Centro Nacional para la Salud de la Infancia y la Adolescencia, Secretaría de Salud, Mexico City, Mexico
| | | | | | | | - Erwin Chiquete
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Gustavo Reyes-Terán
- Comisión Coordinadora de Institutos Nacionales de Salud y Hospitales de Alta Especialidad
| | - Antonio Arauz
- Department of Neurology, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico
| | - Sergio Iván Valdés-Ferrer
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.,Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.,Feinstein Institutes for Medical Research, Manhasset, NY, USA
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López-Mena D, García-Grimshaw M, Saldivar-Dávila S, Hernandez-Vanegas LE, Saniger-Alba MDM, Gutiérrez-Romero A, Carrillo-Mezo R, Valdez-Ruvalcaba HE, Cano-Nigenda V, Flores-Silva FD, Cantú-Brito C, Santibañez-Copado AM, Diaz-Ortega JL, Ceballos-Liceaga SE, Murillo-Bonilla LM, Sepulveda-Núñez AI, García-Talavera V, Gonzalez-Guerra E, Cortes-Alcala R, Lopez-Gatell H, Carbajal-Sandoval G, Reyes-Terán G, Valdés-Ferrer SI, Arauz A. Stroke Among SARS-CoV-2 Vaccine Recipients in Mexico: A Nationwide Descriptive Study. Neurology 2022; 98:e1933-e1941. [PMID: 35277439 PMCID: PMC9141628 DOI: 10.1212/wnl.0000000000200388] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 02/01/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Information on stroke among severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines remains scarce. We report stroke incidence as an adverse event following immunization (AEFI) among recipients of 79,399,446 doses of 6 different SARS-CoV-2 vaccines (BNT162b2, ChAdOx1 nCov-19, Gam-COVID-Vac, CoronaVac, Ad5-nCoV, and Ad26.COV2-S) between December 24, 2020, and August 31, 2021, in Mexico. METHODS This retrospective descriptive study analyzed stroke incidence per million doses among hospitalized adult patients (≥18 years) during an 8-month interval. According to the World Health Organization, AEFIs were defined as clinical events occurring within 30 days after immunization and categorized as either nonserious or serious, depending on severity, treatment, and hospital admission requirements. Acute ischemic stroke (AIS), intracerebral hemorrhage (ICH), subarachnoid hemorrhage (SAH), and cerebral venous thrombosis (CVT) cases were collected through a passive epidemiologic surveillance system in which local health providers report potential AEFI to the Mexican General Board of Epidemiology. Data were captured with standardized case report formats by an ad hoc committee appointed by the Mexican Ministry of Health to evaluate potential neurologic AEFI against SARS-COV-2. RESULTS We included 56 patients (31 female patients [55.5%]) for an overall incidence of 0.71 cases per 1,000,000 administered doses (95% CI 0.54-0.92). Median age was 65 years (interquartile range [IQR] 55-76 years); median time from vaccination to stroke (of any subtype) was 2 days (IQR 1-5 days). In 27 (48.2%) patients, the event was diagnosed within the first 24 hours after immunization. The most frequent subtype was AIS in 43 patients (75%; 0.54 per 1,000,000 doses, 95% CI 0.40-0.73), followed by ICH in 9 (16.1%; 0.11 per 1,000,000 doses, 95% CI 0.06-0.22) and SAH and CVT, each with 2 cases (3.6%; 0.03 per 1,000,000 doses, 95% CI 0.01-0.09). Overall, the most common risk factors were hypertension in 33 (58.9%) patients and diabetes in 22 (39.3%). Median hospital length of stay was 6 days (IQR 4-13 days). At discharge, functional outcome was good (modified Rankin Scale score 0-2) in 41.1% of patients; in-hospital mortality rate was 21.4%. DISCUSSION Stroke is an exceedingly rare AEFI against SARS-CoV-2. Preexisting stroke risk factors were identified in most patients. Further research is needed to evaluate causal associations between SARS-COV-2 vaccines and stroke.
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Affiliation(s)
- Diego López-Mena
- From the Instituto Nacional de Neurología y Neurocirugía (D.L.-M., S.S.-D., L.E.H.-V., A.G.-R., R.C.-M., H.E.V.-R., V.C.-N. A.A.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (M.G.-G., M.d.M.S.-A., F.D.F.-S., C.C.-B., S.I.V.-F.); Centro Nacional para la Salud de la Infancia y la Adolescencia, Secretaría de Salud (A.M.S.-C., J.-L.D.-O.); Dirección General de Epidemiología (S.E.C.-L., R.C.-A., G.C.-S.), Secretaría de Salud, Mexico City; Instituto Panvascular de Occidente (L.M.M.-B.), Guadalajara, Jalisco; Unidad Médica de Alta Especialidad No. 25 (A.I.S.-N., V.G.-T.), Instituto Mexicano del Seguro Social, Monterrey, Nuevo Leon; División de Vigilancia Epidemiológica (E.G.-G.), Instituto Mexicano del Seguro Social; Subsecretaría de Prevención y Promoción de la Salud (H.L.-G.), Secretaría de Salud; and Comisión Coordinadora de Institutos Nacionales de Salud y Hospitales de Alta Especialidad (G.R.-T.), Secretaría de Salud, Mexico City, México
| | - Miguel García-Grimshaw
- From the Instituto Nacional de Neurología y Neurocirugía (D.L.-M., S.S.-D., L.E.H.-V., A.G.-R., R.C.-M., H.E.V.-R., V.C.-N. A.A.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (M.G.-G., M.d.M.S.-A., F.D.F.-S., C.C.-B., S.I.V.-F.); Centro Nacional para la Salud de la Infancia y la Adolescencia, Secretaría de Salud (A.M.S.-C., J.-L.D.-O.); Dirección General de Epidemiología (S.E.C.-L., R.C.-A., G.C.-S.), Secretaría de Salud, Mexico City; Instituto Panvascular de Occidente (L.M.M.-B.), Guadalajara, Jalisco; Unidad Médica de Alta Especialidad No. 25 (A.I.S.-N., V.G.-T.), Instituto Mexicano del Seguro Social, Monterrey, Nuevo Leon; División de Vigilancia Epidemiológica (E.G.-G.), Instituto Mexicano del Seguro Social; Subsecretaría de Prevención y Promoción de la Salud (H.L.-G.), Secretaría de Salud; and Comisión Coordinadora de Institutos Nacionales de Salud y Hospitales de Alta Especialidad (G.R.-T.), Secretaría de Salud, Mexico City, México
| | - Sergio Saldivar-Dávila
- From the Instituto Nacional de Neurología y Neurocirugía (D.L.-M., S.S.-D., L.E.H.-V., A.G.-R., R.C.-M., H.E.V.-R., V.C.-N. A.A.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (M.G.-G., M.d.M.S.-A., F.D.F.-S., C.C.-B., S.I.V.-F.); Centro Nacional para la Salud de la Infancia y la Adolescencia, Secretaría de Salud (A.M.S.-C., J.-L.D.-O.); Dirección General de Epidemiología (S.E.C.-L., R.C.-A., G.C.-S.), Secretaría de Salud, Mexico City; Instituto Panvascular de Occidente (L.M.M.-B.), Guadalajara, Jalisco; Unidad Médica de Alta Especialidad No. 25 (A.I.S.-N., V.G.-T.), Instituto Mexicano del Seguro Social, Monterrey, Nuevo Leon; División de Vigilancia Epidemiológica (E.G.-G.), Instituto Mexicano del Seguro Social; Subsecretaría de Prevención y Promoción de la Salud (H.L.-G.), Secretaría de Salud; and Comisión Coordinadora de Institutos Nacionales de Salud y Hospitales de Alta Especialidad (G.R.-T.), Secretaría de Salud, Mexico City, México
| | - Laura Elena Hernandez-Vanegas
- From the Instituto Nacional de Neurología y Neurocirugía (D.L.-M., S.S.-D., L.E.H.-V., A.G.-R., R.C.-M., H.E.V.-R., V.C.-N. A.A.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (M.G.-G., M.d.M.S.-A., F.D.F.-S., C.C.-B., S.I.V.-F.); Centro Nacional para la Salud de la Infancia y la Adolescencia, Secretaría de Salud (A.M.S.-C., J.-L.D.-O.); Dirección General de Epidemiología (S.E.C.-L., R.C.-A., G.C.-S.), Secretaría de Salud, Mexico City; Instituto Panvascular de Occidente (L.M.M.-B.), Guadalajara, Jalisco; Unidad Médica de Alta Especialidad No. 25 (A.I.S.-N., V.G.-T.), Instituto Mexicano del Seguro Social, Monterrey, Nuevo Leon; División de Vigilancia Epidemiológica (E.G.-G.), Instituto Mexicano del Seguro Social; Subsecretaría de Prevención y Promoción de la Salud (H.L.-G.), Secretaría de Salud; and Comisión Coordinadora de Institutos Nacionales de Salud y Hospitales de Alta Especialidad (G.R.-T.), Secretaría de Salud, Mexico City, México
| | - María Del Mar Saniger-Alba
- From the Instituto Nacional de Neurología y Neurocirugía (D.L.-M., S.S.-D., L.E.H.-V., A.G.-R., R.C.-M., H.E.V.-R., V.C.-N. A.A.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (M.G.-G., M.d.M.S.-A., F.D.F.-S., C.C.-B., S.I.V.-F.); Centro Nacional para la Salud de la Infancia y la Adolescencia, Secretaría de Salud (A.M.S.-C., J.-L.D.-O.); Dirección General de Epidemiología (S.E.C.-L., R.C.-A., G.C.-S.), Secretaría de Salud, Mexico City; Instituto Panvascular de Occidente (L.M.M.-B.), Guadalajara, Jalisco; Unidad Médica de Alta Especialidad No. 25 (A.I.S.-N., V.G.-T.), Instituto Mexicano del Seguro Social, Monterrey, Nuevo Leon; División de Vigilancia Epidemiológica (E.G.-G.), Instituto Mexicano del Seguro Social; Subsecretaría de Prevención y Promoción de la Salud (H.L.-G.), Secretaría de Salud; and Comisión Coordinadora de Institutos Nacionales de Salud y Hospitales de Alta Especialidad (G.R.-T.), Secretaría de Salud, Mexico City, México
| | - Alonso Gutiérrez-Romero
- From the Instituto Nacional de Neurología y Neurocirugía (D.L.-M., S.S.-D., L.E.H.-V., A.G.-R., R.C.-M., H.E.V.-R., V.C.-N. A.A.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (M.G.-G., M.d.M.S.-A., F.D.F.-S., C.C.-B., S.I.V.-F.); Centro Nacional para la Salud de la Infancia y la Adolescencia, Secretaría de Salud (A.M.S.-C., J.-L.D.-O.); Dirección General de Epidemiología (S.E.C.-L., R.C.-A., G.C.-S.), Secretaría de Salud, Mexico City; Instituto Panvascular de Occidente (L.M.M.-B.), Guadalajara, Jalisco; Unidad Médica de Alta Especialidad No. 25 (A.I.S.-N., V.G.-T.), Instituto Mexicano del Seguro Social, Monterrey, Nuevo Leon; División de Vigilancia Epidemiológica (E.G.-G.), Instituto Mexicano del Seguro Social; Subsecretaría de Prevención y Promoción de la Salud (H.L.-G.), Secretaría de Salud; and Comisión Coordinadora de Institutos Nacionales de Salud y Hospitales de Alta Especialidad (G.R.-T.), Secretaría de Salud, Mexico City, México
| | - Roger Carrillo-Mezo
- From the Instituto Nacional de Neurología y Neurocirugía (D.L.-M., S.S.-D., L.E.H.-V., A.G.-R., R.C.-M., H.E.V.-R., V.C.-N. A.A.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (M.G.-G., M.d.M.S.-A., F.D.F.-S., C.C.-B., S.I.V.-F.); Centro Nacional para la Salud de la Infancia y la Adolescencia, Secretaría de Salud (A.M.S.-C., J.-L.D.-O.); Dirección General de Epidemiología (S.E.C.-L., R.C.-A., G.C.-S.), Secretaría de Salud, Mexico City; Instituto Panvascular de Occidente (L.M.M.-B.), Guadalajara, Jalisco; Unidad Médica de Alta Especialidad No. 25 (A.I.S.-N., V.G.-T.), Instituto Mexicano del Seguro Social, Monterrey, Nuevo Leon; División de Vigilancia Epidemiológica (E.G.-G.), Instituto Mexicano del Seguro Social; Subsecretaría de Prevención y Promoción de la Salud (H.L.-G.), Secretaría de Salud; and Comisión Coordinadora de Institutos Nacionales de Salud y Hospitales de Alta Especialidad (G.R.-T.), Secretaría de Salud, Mexico City, México
| | - Hector Eduardo Valdez-Ruvalcaba
- From the Instituto Nacional de Neurología y Neurocirugía (D.L.-M., S.S.-D., L.E.H.-V., A.G.-R., R.C.-M., H.E.V.-R., V.C.-N. A.A.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (M.G.-G., M.d.M.S.-A., F.D.F.-S., C.C.-B., S.I.V.-F.); Centro Nacional para la Salud de la Infancia y la Adolescencia, Secretaría de Salud (A.M.S.-C., J.-L.D.-O.); Dirección General de Epidemiología (S.E.C.-L., R.C.-A., G.C.-S.), Secretaría de Salud, Mexico City; Instituto Panvascular de Occidente (L.M.M.-B.), Guadalajara, Jalisco; Unidad Médica de Alta Especialidad No. 25 (A.I.S.-N., V.G.-T.), Instituto Mexicano del Seguro Social, Monterrey, Nuevo Leon; División de Vigilancia Epidemiológica (E.G.-G.), Instituto Mexicano del Seguro Social; Subsecretaría de Prevención y Promoción de la Salud (H.L.-G.), Secretaría de Salud; and Comisión Coordinadora de Institutos Nacionales de Salud y Hospitales de Alta Especialidad (G.R.-T.), Secretaría de Salud, Mexico City, México
| | - Vanessa Cano-Nigenda
- From the Instituto Nacional de Neurología y Neurocirugía (D.L.-M., S.S.-D., L.E.H.-V., A.G.-R., R.C.-M., H.E.V.-R., V.C.-N. A.A.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (M.G.-G., M.d.M.S.-A., F.D.F.-S., C.C.-B., S.I.V.-F.); Centro Nacional para la Salud de la Infancia y la Adolescencia, Secretaría de Salud (A.M.S.-C., J.-L.D.-O.); Dirección General de Epidemiología (S.E.C.-L., R.C.-A., G.C.-S.), Secretaría de Salud, Mexico City; Instituto Panvascular de Occidente (L.M.M.-B.), Guadalajara, Jalisco; Unidad Médica de Alta Especialidad No. 25 (A.I.S.-N., V.G.-T.), Instituto Mexicano del Seguro Social, Monterrey, Nuevo Leon; División de Vigilancia Epidemiológica (E.G.-G.), Instituto Mexicano del Seguro Social; Subsecretaría de Prevención y Promoción de la Salud (H.L.-G.), Secretaría de Salud; and Comisión Coordinadora de Institutos Nacionales de Salud y Hospitales de Alta Especialidad (G.R.-T.), Secretaría de Salud, Mexico City, México
| | - Fernando Daniel Flores-Silva
- From the Instituto Nacional de Neurología y Neurocirugía (D.L.-M., S.S.-D., L.E.H.-V., A.G.-R., R.C.-M., H.E.V.-R., V.C.-N. A.A.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (M.G.-G., M.d.M.S.-A., F.D.F.-S., C.C.-B., S.I.V.-F.); Centro Nacional para la Salud de la Infancia y la Adolescencia, Secretaría de Salud (A.M.S.-C., J.-L.D.-O.); Dirección General de Epidemiología (S.E.C.-L., R.C.-A., G.C.-S.), Secretaría de Salud, Mexico City; Instituto Panvascular de Occidente (L.M.M.-B.), Guadalajara, Jalisco; Unidad Médica de Alta Especialidad No. 25 (A.I.S.-N., V.G.-T.), Instituto Mexicano del Seguro Social, Monterrey, Nuevo Leon; División de Vigilancia Epidemiológica (E.G.-G.), Instituto Mexicano del Seguro Social; Subsecretaría de Prevención y Promoción de la Salud (H.L.-G.), Secretaría de Salud; and Comisión Coordinadora de Institutos Nacionales de Salud y Hospitales de Alta Especialidad (G.R.-T.), Secretaría de Salud, Mexico City, México
| | - Carlos Cantú-Brito
- From the Instituto Nacional de Neurología y Neurocirugía (D.L.-M., S.S.-D., L.E.H.-V., A.G.-R., R.C.-M., H.E.V.-R., V.C.-N. A.A.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (M.G.-G., M.d.M.S.-A., F.D.F.-S., C.C.-B., S.I.V.-F.); Centro Nacional para la Salud de la Infancia y la Adolescencia, Secretaría de Salud (A.M.S.-C., J.-L.D.-O.); Dirección General de Epidemiología (S.E.C.-L., R.C.-A., G.C.-S.), Secretaría de Salud, Mexico City; Instituto Panvascular de Occidente (L.M.M.-B.), Guadalajara, Jalisco; Unidad Médica de Alta Especialidad No. 25 (A.I.S.-N., V.G.-T.), Instituto Mexicano del Seguro Social, Monterrey, Nuevo Leon; División de Vigilancia Epidemiológica (E.G.-G.), Instituto Mexicano del Seguro Social; Subsecretaría de Prevención y Promoción de la Salud (H.L.-G.), Secretaría de Salud; and Comisión Coordinadora de Institutos Nacionales de Salud y Hospitales de Alta Especialidad (G.R.-T.), Secretaría de Salud, Mexico City, México
| | - Ana María Santibañez-Copado
- From the Instituto Nacional de Neurología y Neurocirugía (D.L.-M., S.S.-D., L.E.H.-V., A.G.-R., R.C.-M., H.E.V.-R., V.C.-N. A.A.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (M.G.-G., M.d.M.S.-A., F.D.F.-S., C.C.-B., S.I.V.-F.); Centro Nacional para la Salud de la Infancia y la Adolescencia, Secretaría de Salud (A.M.S.-C., J.-L.D.-O.); Dirección General de Epidemiología (S.E.C.-L., R.C.-A., G.C.-S.), Secretaría de Salud, Mexico City; Instituto Panvascular de Occidente (L.M.M.-B.), Guadalajara, Jalisco; Unidad Médica de Alta Especialidad No. 25 (A.I.S.-N., V.G.-T.), Instituto Mexicano del Seguro Social, Monterrey, Nuevo Leon; División de Vigilancia Epidemiológica (E.G.-G.), Instituto Mexicano del Seguro Social; Subsecretaría de Prevención y Promoción de la Salud (H.L.-G.), Secretaría de Salud; and Comisión Coordinadora de Institutos Nacionales de Salud y Hospitales de Alta Especialidad (G.R.-T.), Secretaría de Salud, Mexico City, México
| | - Jose-Luis Diaz-Ortega
- From the Instituto Nacional de Neurología y Neurocirugía (D.L.-M., S.S.-D., L.E.H.-V., A.G.-R., R.C.-M., H.E.V.-R., V.C.-N. A.A.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (M.G.-G., M.d.M.S.-A., F.D.F.-S., C.C.-B., S.I.V.-F.); Centro Nacional para la Salud de la Infancia y la Adolescencia, Secretaría de Salud (A.M.S.-C., J.-L.D.-O.); Dirección General de Epidemiología (S.E.C.-L., R.C.-A., G.C.-S.), Secretaría de Salud, Mexico City; Instituto Panvascular de Occidente (L.M.M.-B.), Guadalajara, Jalisco; Unidad Médica de Alta Especialidad No. 25 (A.I.S.-N., V.G.-T.), Instituto Mexicano del Seguro Social, Monterrey, Nuevo Leon; División de Vigilancia Epidemiológica (E.G.-G.), Instituto Mexicano del Seguro Social; Subsecretaría de Prevención y Promoción de la Salud (H.L.-G.), Secretaría de Salud; and Comisión Coordinadora de Institutos Nacionales de Salud y Hospitales de Alta Especialidad (G.R.-T.), Secretaría de Salud, Mexico City, México
| | - Santa Elizabeth Ceballos-Liceaga
- From the Instituto Nacional de Neurología y Neurocirugía (D.L.-M., S.S.-D., L.E.H.-V., A.G.-R., R.C.-M., H.E.V.-R., V.C.-N. A.A.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (M.G.-G., M.d.M.S.-A., F.D.F.-S., C.C.-B., S.I.V.-F.); Centro Nacional para la Salud de la Infancia y la Adolescencia, Secretaría de Salud (A.M.S.-C., J.-L.D.-O.); Dirección General de Epidemiología (S.E.C.-L., R.C.-A., G.C.-S.), Secretaría de Salud, Mexico City; Instituto Panvascular de Occidente (L.M.M.-B.), Guadalajara, Jalisco; Unidad Médica de Alta Especialidad No. 25 (A.I.S.-N., V.G.-T.), Instituto Mexicano del Seguro Social, Monterrey, Nuevo Leon; División de Vigilancia Epidemiológica (E.G.-G.), Instituto Mexicano del Seguro Social; Subsecretaría de Prevención y Promoción de la Salud (H.L.-G.), Secretaría de Salud; and Comisión Coordinadora de Institutos Nacionales de Salud y Hospitales de Alta Especialidad (G.R.-T.), Secretaría de Salud, Mexico City, México
| | - Luis Manuel Murillo-Bonilla
- From the Instituto Nacional de Neurología y Neurocirugía (D.L.-M., S.S.-D., L.E.H.-V., A.G.-R., R.C.-M., H.E.V.-R., V.C.-N. A.A.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (M.G.-G., M.d.M.S.-A., F.D.F.-S., C.C.-B., S.I.V.-F.); Centro Nacional para la Salud de la Infancia y la Adolescencia, Secretaría de Salud (A.M.S.-C., J.-L.D.-O.); Dirección General de Epidemiología (S.E.C.-L., R.C.-A., G.C.-S.), Secretaría de Salud, Mexico City; Instituto Panvascular de Occidente (L.M.M.-B.), Guadalajara, Jalisco; Unidad Médica de Alta Especialidad No. 25 (A.I.S.-N., V.G.-T.), Instituto Mexicano del Seguro Social, Monterrey, Nuevo Leon; División de Vigilancia Epidemiológica (E.G.-G.), Instituto Mexicano del Seguro Social; Subsecretaría de Prevención y Promoción de la Salud (H.L.-G.), Secretaría de Salud; and Comisión Coordinadora de Institutos Nacionales de Salud y Hospitales de Alta Especialidad (G.R.-T.), Secretaría de Salud, Mexico City, México
| | - Ana Isabel Sepulveda-Núñez
- From the Instituto Nacional de Neurología y Neurocirugía (D.L.-M., S.S.-D., L.E.H.-V., A.G.-R., R.C.-M., H.E.V.-R., V.C.-N. A.A.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (M.G.-G., M.d.M.S.-A., F.D.F.-S., C.C.-B., S.I.V.-F.); Centro Nacional para la Salud de la Infancia y la Adolescencia, Secretaría de Salud (A.M.S.-C., J.-L.D.-O.); Dirección General de Epidemiología (S.E.C.-L., R.C.-A., G.C.-S.), Secretaría de Salud, Mexico City; Instituto Panvascular de Occidente (L.M.M.-B.), Guadalajara, Jalisco; Unidad Médica de Alta Especialidad No. 25 (A.I.S.-N., V.G.-T.), Instituto Mexicano del Seguro Social, Monterrey, Nuevo Leon; División de Vigilancia Epidemiológica (E.G.-G.), Instituto Mexicano del Seguro Social; Subsecretaría de Prevención y Promoción de la Salud (H.L.-G.), Secretaría de Salud; and Comisión Coordinadora de Institutos Nacionales de Salud y Hospitales de Alta Especialidad (G.R.-T.), Secretaría de Salud, Mexico City, México
| | - Verónica García-Talavera
- From the Instituto Nacional de Neurología y Neurocirugía (D.L.-M., S.S.-D., L.E.H.-V., A.G.-R., R.C.-M., H.E.V.-R., V.C.-N. A.A.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (M.G.-G., M.d.M.S.-A., F.D.F.-S., C.C.-B., S.I.V.-F.); Centro Nacional para la Salud de la Infancia y la Adolescencia, Secretaría de Salud (A.M.S.-C., J.-L.D.-O.); Dirección General de Epidemiología (S.E.C.-L., R.C.-A., G.C.-S.), Secretaría de Salud, Mexico City; Instituto Panvascular de Occidente (L.M.M.-B.), Guadalajara, Jalisco; Unidad Médica de Alta Especialidad No. 25 (A.I.S.-N., V.G.-T.), Instituto Mexicano del Seguro Social, Monterrey, Nuevo Leon; División de Vigilancia Epidemiológica (E.G.-G.), Instituto Mexicano del Seguro Social; Subsecretaría de Prevención y Promoción de la Salud (H.L.-G.), Secretaría de Salud; and Comisión Coordinadora de Institutos Nacionales de Salud y Hospitales de Alta Especialidad (G.R.-T.), Secretaría de Salud, Mexico City, México
| | - Eduardo Gonzalez-Guerra
- From the Instituto Nacional de Neurología y Neurocirugía (D.L.-M., S.S.-D., L.E.H.-V., A.G.-R., R.C.-M., H.E.V.-R., V.C.-N. A.A.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (M.G.-G., M.d.M.S.-A., F.D.F.-S., C.C.-B., S.I.V.-F.); Centro Nacional para la Salud de la Infancia y la Adolescencia, Secretaría de Salud (A.M.S.-C., J.-L.D.-O.); Dirección General de Epidemiología (S.E.C.-L., R.C.-A., G.C.-S.), Secretaría de Salud, Mexico City; Instituto Panvascular de Occidente (L.M.M.-B.), Guadalajara, Jalisco; Unidad Médica de Alta Especialidad No. 25 (A.I.S.-N., V.G.-T.), Instituto Mexicano del Seguro Social, Monterrey, Nuevo Leon; División de Vigilancia Epidemiológica (E.G.-G.), Instituto Mexicano del Seguro Social; Subsecretaría de Prevención y Promoción de la Salud (H.L.-G.), Secretaría de Salud; and Comisión Coordinadora de Institutos Nacionales de Salud y Hospitales de Alta Especialidad (G.R.-T.), Secretaría de Salud, Mexico City, México
| | - Ricardo Cortes-Alcala
- From the Instituto Nacional de Neurología y Neurocirugía (D.L.-M., S.S.-D., L.E.H.-V., A.G.-R., R.C.-M., H.E.V.-R., V.C.-N. A.A.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (M.G.-G., M.d.M.S.-A., F.D.F.-S., C.C.-B., S.I.V.-F.); Centro Nacional para la Salud de la Infancia y la Adolescencia, Secretaría de Salud (A.M.S.-C., J.-L.D.-O.); Dirección General de Epidemiología (S.E.C.-L., R.C.-A., G.C.-S.), Secretaría de Salud, Mexico City; Instituto Panvascular de Occidente (L.M.M.-B.), Guadalajara, Jalisco; Unidad Médica de Alta Especialidad No. 25 (A.I.S.-N., V.G.-T.), Instituto Mexicano del Seguro Social, Monterrey, Nuevo Leon; División de Vigilancia Epidemiológica (E.G.-G.), Instituto Mexicano del Seguro Social; Subsecretaría de Prevención y Promoción de la Salud (H.L.-G.), Secretaría de Salud; and Comisión Coordinadora de Institutos Nacionales de Salud y Hospitales de Alta Especialidad (G.R.-T.), Secretaría de Salud, Mexico City, México
| | - Hugo Lopez-Gatell
- From the Instituto Nacional de Neurología y Neurocirugía (D.L.-M., S.S.-D., L.E.H.-V., A.G.-R., R.C.-M., H.E.V.-R., V.C.-N. A.A.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (M.G.-G., M.d.M.S.-A., F.D.F.-S., C.C.-B., S.I.V.-F.); Centro Nacional para la Salud de la Infancia y la Adolescencia, Secretaría de Salud (A.M.S.-C., J.-L.D.-O.); Dirección General de Epidemiología (S.E.C.-L., R.C.-A., G.C.-S.), Secretaría de Salud, Mexico City; Instituto Panvascular de Occidente (L.M.M.-B.), Guadalajara, Jalisco; Unidad Médica de Alta Especialidad No. 25 (A.I.S.-N., V.G.-T.), Instituto Mexicano del Seguro Social, Monterrey, Nuevo Leon; División de Vigilancia Epidemiológica (E.G.-G.), Instituto Mexicano del Seguro Social; Subsecretaría de Prevención y Promoción de la Salud (H.L.-G.), Secretaría de Salud; and Comisión Coordinadora de Institutos Nacionales de Salud y Hospitales de Alta Especialidad (G.R.-T.), Secretaría de Salud, Mexico City, México
| | - Guillermo Carbajal-Sandoval
- From the Instituto Nacional de Neurología y Neurocirugía (D.L.-M., S.S.-D., L.E.H.-V., A.G.-R., R.C.-M., H.E.V.-R., V.C.-N. A.A.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (M.G.-G., M.d.M.S.-A., F.D.F.-S., C.C.-B., S.I.V.-F.); Centro Nacional para la Salud de la Infancia y la Adolescencia, Secretaría de Salud (A.M.S.-C., J.-L.D.-O.); Dirección General de Epidemiología (S.E.C.-L., R.C.-A., G.C.-S.), Secretaría de Salud, Mexico City; Instituto Panvascular de Occidente (L.M.M.-B.), Guadalajara, Jalisco; Unidad Médica de Alta Especialidad No. 25 (A.I.S.-N., V.G.-T.), Instituto Mexicano del Seguro Social, Monterrey, Nuevo Leon; División de Vigilancia Epidemiológica (E.G.-G.), Instituto Mexicano del Seguro Social; Subsecretaría de Prevención y Promoción de la Salud (H.L.-G.), Secretaría de Salud; and Comisión Coordinadora de Institutos Nacionales de Salud y Hospitales de Alta Especialidad (G.R.-T.), Secretaría de Salud, Mexico City, México
| | - Gustavo Reyes-Terán
- From the Instituto Nacional de Neurología y Neurocirugía (D.L.-M., S.S.-D., L.E.H.-V., A.G.-R., R.C.-M., H.E.V.-R., V.C.-N. A.A.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (M.G.-G., M.d.M.S.-A., F.D.F.-S., C.C.-B., S.I.V.-F.); Centro Nacional para la Salud de la Infancia y la Adolescencia, Secretaría de Salud (A.M.S.-C., J.-L.D.-O.); Dirección General de Epidemiología (S.E.C.-L., R.C.-A., G.C.-S.), Secretaría de Salud, Mexico City; Instituto Panvascular de Occidente (L.M.M.-B.), Guadalajara, Jalisco; Unidad Médica de Alta Especialidad No. 25 (A.I.S.-N., V.G.-T.), Instituto Mexicano del Seguro Social, Monterrey, Nuevo Leon; División de Vigilancia Epidemiológica (E.G.-G.), Instituto Mexicano del Seguro Social; Subsecretaría de Prevención y Promoción de la Salud (H.L.-G.), Secretaría de Salud; and Comisión Coordinadora de Institutos Nacionales de Salud y Hospitales de Alta Especialidad (G.R.-T.), Secretaría de Salud, Mexico City, México
| | - Sergio Iván Valdés-Ferrer
- From the Instituto Nacional de Neurología y Neurocirugía (D.L.-M., S.S.-D., L.E.H.-V., A.G.-R., R.C.-M., H.E.V.-R., V.C.-N. A.A.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (M.G.-G., M.d.M.S.-A., F.D.F.-S., C.C.-B., S.I.V.-F.); Centro Nacional para la Salud de la Infancia y la Adolescencia, Secretaría de Salud (A.M.S.-C., J.-L.D.-O.); Dirección General de Epidemiología (S.E.C.-L., R.C.-A., G.C.-S.), Secretaría de Salud, Mexico City; Instituto Panvascular de Occidente (L.M.M.-B.), Guadalajara, Jalisco; Unidad Médica de Alta Especialidad No. 25 (A.I.S.-N., V.G.-T.), Instituto Mexicano del Seguro Social, Monterrey, Nuevo Leon; División de Vigilancia Epidemiológica (E.G.-G.), Instituto Mexicano del Seguro Social; Subsecretaría de Prevención y Promoción de la Salud (H.L.-G.), Secretaría de Salud; and Comisión Coordinadora de Institutos Nacionales de Salud y Hospitales de Alta Especialidad (G.R.-T.), Secretaría de Salud, Mexico City, México
| | - Antonio Arauz
- From the Instituto Nacional de Neurología y Neurocirugía (D.L.-M., S.S.-D., L.E.H.-V., A.G.-R., R.C.-M., H.E.V.-R., V.C.-N. A.A.); Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (M.G.-G., M.d.M.S.-A., F.D.F.-S., C.C.-B., S.I.V.-F.); Centro Nacional para la Salud de la Infancia y la Adolescencia, Secretaría de Salud (A.M.S.-C., J.-L.D.-O.); Dirección General de Epidemiología (S.E.C.-L., R.C.-A., G.C.-S.), Secretaría de Salud, Mexico City; Instituto Panvascular de Occidente (L.M.M.-B.), Guadalajara, Jalisco; Unidad Médica de Alta Especialidad No. 25 (A.I.S.-N., V.G.-T.), Instituto Mexicano del Seguro Social, Monterrey, Nuevo Leon; División de Vigilancia Epidemiológica (E.G.-G.), Instituto Mexicano del Seguro Social; Subsecretaría de Prevención y Promoción de la Salud (H.L.-G.), Secretaría de Salud; and Comisión Coordinadora de Institutos Nacionales de Salud y Hospitales de Alta Especialidad (G.R.-T.), Secretaría de Salud, Mexico City, México
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He C, Malone MJ, Wendel BS, Ma KY, Del Alcazar D, Weiner DB, De Jager PL, Del Río-Estrada PM, Ablanedo-Terrazas Y, Reyes-Terán G, Su LF, Jiang N. Transcriptome and TCR Repertoire Measurements of CXCR3 + T Follicular Helper Cells Within HIV-Infected Human Lymph Nodes. Front Immunol 2022; 13:859070. [PMID: 35619703 PMCID: PMC9128546 DOI: 10.3389/fimmu.2022.859070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 04/06/2022] [Indexed: 12/15/2022] Open
Abstract
Follicular-helper T cells (TFH) are an essential arm of the adaptive immune system. Although TFH were first discovered through their ability to contribute to antibody affinity maturation through co-stimulatory interactions with B cells, new light has been shed on their ability to remain a complex and functionally plastic cell type. Due to a lack sample availability, however, many studies have been limited to characterizing TFH in mice or non-canonical tissue types, such as peripheral blood. Such constraints have resulted in a limited, and sometimes contradictory, understanding of this fundamental cell type. One subset of TFH receiving attention in chronic infection are CXCR3-expressing TFH cells (CXCR3+TFH) due to their abnormal accumulation in secondary lymphoid tissues. Their function and clonal relationship with other TFH subsets in lymphoid tissues during infection, however, remains largely unclear. We thus systematically investigated this and other subsets of TFH within untreated HIV-infected human lymph nodes using Mass CyTOF and a combination of RNA and TCR repertoire sequencing. We show an inflation of the CXCR3+TFH compartment during HIV infection that correlates with a lower HIV burden. Deeper analysis into this population revealed a functional shift of CXCR3+TFH away from germinal center TFH (GC-TFH), including the altered expression of several important transcription factors and cytokines. CXCR3+TFH also upregulated cell migration transcriptional programs and were clonally related to peripheral TFH populations. In combination, these data suggest that CXCR3+TFH have a greater tendency to enter circulation than their CXCR3- counterparts, potentially functioning through distinct modalities that may lead to enhanced defense.
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Affiliation(s)
- Chenfeng He
- Department of Biomedical Engineering, Cockrell School of Engineering, University of Texas at Austin, Austin, TX, United States
| | - Michael J. Malone
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, United States,Interdisciplinary Life Sciences Graduate Program, University of Texas at Austin, Austin, TX, United States
| | - Ben S. Wendel
- Department of Biomedical Engineering, Cockrell School of Engineering, University of Texas at Austin, Austin, TX, United States,McKetta Department of Chemical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, TX, United States
| | - Ke-Yue Ma
- Interdisciplinary Life Sciences Graduate Program, University of Texas at Austin, Austin, TX, United States
| | - Daniel Del Alcazar
- Department of Medicine, Division of Rheumatology, Perelman School of Medicine, Institute for Immunology, University of Pennsylvania, Philadelphia, PA, United States,Corporal Michael J Crescenz Veterans Affairs Medical Center, Philadelphia, PA, United States
| | - David B. Weiner
- Vaccine and Immunotherapy Center, Wistar Institute, Philadelphia, PA, United States
| | - Philip L. De Jager
- Columbia University Medical Center, Center for Translational and Computational Neuroimmunology, New York, NY, United States
| | - Perla M. Del Río-Estrada
- Departamento de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias, Ciudad de México, Mexico
| | - Yuria Ablanedo-Terrazas
- Departamento de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias, Ciudad de México, Mexico
| | - Gustavo Reyes-Terán
- Comisión Coordinadora de Institutos Nacional de Salud y Hospitales de Alta Especialidad, Secretaría de Salud, Ciudad de México, Mexico
| | - Laura F. Su
- Department of Medicine, Division of Rheumatology, Perelman School of Medicine, Institute for Immunology, University of Pennsylvania, Philadelphia, PA, United States,Corporal Michael J Crescenz Veterans Affairs Medical Center, Philadelphia, PA, United States,*Correspondence: Ning Jiang, ; Laura F. Su,
| | - Ning Jiang
- Department of Biomedical Engineering, Cockrell School of Engineering, University of Texas at Austin, Austin, TX, United States,Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, United States,Interdisciplinary Life Sciences Graduate Program, University of Texas at Austin, Austin, TX, United States,Institute for Immunology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States,*Correspondence: Ning Jiang, ; Laura F. Su,
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Pérez-Padilla JR, Mora-Pavón A, Hernández-Cárdenas CM, Galindo-Fraga A, Kawa-Karasik S, Espinoza-Bautista KA, Reyes-Terán G. Efectividad de las vacunas contra SARS-CoV-2 en hospitalizados con fallas vacunales en 10 hospitales de la CCINSHAE. Salud Publica Mex 2022; 64:131-136. [DOI: 10.21149/13521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 02/10/2022] [Indexed: 11/06/2022] Open
Abstract
Objetivo. Evaluar la efectividad de las vacunas contra SARS-CoV-2 para evitar muerte e intubación en pacientes hospitalizados con Covid-19. Material y métodos. Se presentó un análisis de 3 565 hospitalizaciones por SARS-CoV-2 de personas mayores de 20 años de edad, reportadas con fines de salud pública por 10 hospitales de especialidad. Se comparó a los egresados por mejoría (2 094) con los fallecidos (1 471) en modelos mixtos de regresión logística ajustados por edad, sexo, número de comorbilidades y el hospital como variable aleatoria. Resultados. Un esquema completo de vacunación, con cinco tipos de vacunas disponibles, tuvo un efecto protector para muerte o intubación (RM: 0.67, IC95%: 0.54,0.83, 33% de protección); y para muerte (RM: 0.80, IC95%: 0.64,0.99, 20% de protección) estos datos se compararon con los que no habían sido vacunados. Todas las vacunas aplicadas mostraron un efecto protector con un RM<0.8, con intervalos de confianza variables. Conclusiones. El antecedente de vacunación reduce los riesgos de ser intubado y morir, aun en pacientes previamente vacunados y hospitalizados con Covid-19 grave.
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Dávila-Conn V, Soto-Nava M, Caro-Vega YN, Paz-Juárez HE, García-Esparza P, Tapia-Trejo D, Pérez-García M, Belaunzarán-Zamudio PF, Reyes-Terán G, Sierra-Madero JG, Galindo-Fraga A, Ávila-Ríos S. Seroepidemiology of SARS-CoV-2 in healthcare personnel working at the largest tertiary COVID-19 referral hospitals in Mexico City. PLoS One 2022; 17:e0264964. [PMID: 35298500 PMCID: PMC8929624 DOI: 10.1371/journal.pone.0264964] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 02/20/2022] [Indexed: 12/23/2022] Open
Abstract
Introduction We performed a longitudinal SARS-CoV-2 seroepidemiological study in healthcare personnel of the two largest tertiary COVID-19 referral hospitals in Mexico City. Methods All healthcare personnel, including staff physicians, physicians in training, nurses, laboratory technicians, researchers, students, housekeeping, maintenance, security, and administrative staff were invited to voluntarily participate, after written informed consent. Participants answered a computer-assisted self-administered interview and donated blood samples for antibody testing every three weeks from October 2020 to June 2021. Results A total of 883 participants (out of 3639 registered employees) contributed with at least one blood sample. The median age was 36 years (interquartile range: 28–46) and 70% were women. The most common occupations were nurse (28%), physician (24%), and administrative staff (22%). Two hundred and ninety participants (32.8%) had a positive-test result in any of the visits, yielding an overall adjusted prevalence of 33.5% for the whole study-period. Two hundred and thirty-five positive tests were identified at the baseline visit (prevalent cases), the remaining 55 positive tests were incident cases. Prevalent cases showed associations with both occupational (institution 2 vs. 1: adjusted odds ratio [aOR] = 2.24, 95% confidence interval [CI]: 1.54–3.25; laboratory technician vs. physician: aOR = 4.38, 95% CI: 1.75–10.93) and community (municipality of residence Xochimilco vs. Tlalpan: aOR = 2.03, 95% CI: 1.09–3.79) risk-factors. The incidence rate was 3.0 cases per 100 person-months. Incident cases were associated with community-acquired risk, due to contact with suspect/confirmed COVID-19 cases (HR = 2.45, 95% CI: 1.21–5.00). Conclusions We observed that between October 2020 and June 2021, healthcare workers of the two largest tertiary COVID-19 referral centers in Mexico City had similar level of exposure to SARS-CoV-2 than the general population. Most variables associated with exposure in this setting pointed toward community rather than occupational risk. Our observations are consistent with successful occupational medicine programs for SARS-CoV-2 infection control in the participating institutions but suggest the need to strengthen mitigation strategies in the community.
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Affiliation(s)
- Vanessa Dávila-Conn
- Centre for Research in Infectious Diseases, National Institute of Respiratory Diseases, Mexico City, Mexico
| | - Maribel Soto-Nava
- Centre for Research in Infectious Diseases, National Institute of Respiratory Diseases, Mexico City, Mexico
| | - Yanink N. Caro-Vega
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Héctor E. Paz-Juárez
- Centre for Research in Infectious Diseases, National Institute of Respiratory Diseases, Mexico City, Mexico
| | - Pedro García-Esparza
- Centre for Research in Infectious Diseases, National Institute of Respiratory Diseases, Mexico City, Mexico
| | - Daniela Tapia-Trejo
- Centre for Research in Infectious Diseases, National Institute of Respiratory Diseases, Mexico City, Mexico
| | - Marissa Pérez-García
- Centre for Research in Infectious Diseases, National Institute of Respiratory Diseases, Mexico City, Mexico
| | | | - Gustavo Reyes-Terán
- Institutos Nacionales de Salud y Hospitales de Alta Especialidad, Secretaría de Salud de México, Mexico City, Mexico
| | - Juan G. Sierra-Madero
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Arturo Galindo-Fraga
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Santiago Ávila-Ríos
- Centre for Research in Infectious Diseases, National Institute of Respiratory Diseases, Mexico City, Mexico
- * E-mail:
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Gulati GK, Panpradist N, Stewart SWA, Beck IA, Boyce C, Oreskovic AK, García-Morales C, Avila-Ríos S, Han PD, Reyes-Terán G, Starita LM, Frenkel LM, Lutz BR, Lai JJ. Simultaneous monitoring of HIV viral load and screening of SARS-CoV-2 employing a low-cost RT-qPCR test workflow. Analyst 2022; 147:3315-3327. [PMID: 35762367 PMCID: PMC10143869 DOI: 10.1039/d2an00405d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
This new workflow enables co-extraction of HIV and SARS-CoV2 RNAs from clinical pooled plasma/nasal secretion samples that allows sensitive detection of SARS-CoV-2 and HIV infections in the patients-living with HIV.
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Affiliation(s)
- Gaurav K. Gulati
- Department of Bioengineering, University of Washington, Seattle, Washington, USA
| | - Nuttada Panpradist
- Department of Bioengineering, University of Washington, Seattle, Washington, USA
- Global Health of Women, Adolescents, and Children (Global WACh), School of Public Health, University of Washington, Seattle, Washington, USA
| | - Samuel W. A. Stewart
- Department of Bioengineering, University of Washington, Seattle, Washington, USA
- Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Ingrid A. Beck
- Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Ceejay Boyce
- Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, Washington, USA
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Amy K. Oreskovic
- Department of Bioengineering, University of Washington, Seattle, Washington, USA
| | - Claudia García-Morales
- Centre for Research in Infectious Diseases of the National Institute of Respiratory Diseases (CIENI/INER), Mexico City, Mexico
| | - Santiago Avila-Ríos
- Centre for Research in Infectious Diseases of the National Institute of Respiratory Diseases (CIENI/INER), Mexico City, Mexico
| | - Peter D. Han
- Department of Genome Sciences, Seattle, WA, USA
- Brotman Baty Institute for Precision Medicine, Seattle, WA, USA
| | - Gustavo Reyes-Terán
- Coordination of the Mexican National Institutes of Health and High Specialty Hospitals, Mexico City, Mexico
| | - Lea M. Starita
- Department of Genome Sciences, Seattle, WA, USA
- Brotman Baty Institute for Precision Medicine, Seattle, WA, USA
| | - Lisa M. Frenkel
- Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, Washington, USA
- Departments of Medicine, Pediatrics, Laboratory Medicine and Pathology, Global Health and Medicine, University of Washington, Seattle, Washington, USA
| | - Barry R. Lutz
- Department of Bioengineering, University of Washington, Seattle, Washington, USA
- Brotman Baty Institute for Precision Medicine, Seattle, WA, USA
| | - James J. Lai
- Department of Bioengineering, University of Washington, Seattle, Washington, USA
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García-Morales C, Tapia-Trejo D, Matías-Florentino M, Quiroz-Morales VS, Dávila-Conn V, Beristain-Barreda Á, Cárdenas-Sandoval M, Becerril-Rodríguez M, Iracheta-Hernández P, Macías-González I, García-Mendiola R, Guzmán-Carmona A, Zarza-Sánchez E, Cruz RA, González-Rodríguez A, Reyes-Terán G, Ávila-Ríos S. HIV Pretreatment Drug Resistance Trends in Mexico City, 2017-2020. Pathogens 2021; 10:1587. [PMID: 34959542 PMCID: PMC8708254 DOI: 10.3390/pathogens10121587] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 11/25/2021] [Accepted: 11/30/2021] [Indexed: 11/19/2022] Open
Abstract
In response to increasing pretreatment drug resistance (PDR), Mexico changed its national antiretroviral treatment (ART) policy, recommending and procuring second-generation integrase strand-transfer inhibitor (INSTI)-based regimens as preferred first-line options since 2019. We present a four-year observational study describing PDR trends across 2017-2020 at the largest HIV diagnosis and primary care center in Mexico City. A total of 6688 baseline protease-reverse transcriptase and 6709 integrase sequences were included. PDR to any drug class was 14.4% (95% CI, 13.6-15.3%). A significant increasing trend for efavirenz/nevirapine PDR was observed (10.3 to 13.6%, p = 0.02). No increase in PDR to second-generation INSTI was observed, remaining under 0.3% across the study period. PDR was strongly associated with prior exposure to ART (aOR: 2.9, 95% CI: 1.9-4.6, p < 0.0001). MSM had higher odds of PDR to efavirenz/nevirapine (aOR: 2.0, 95% CI: 1.0-3.7, p = 0.04), reflecting ongoing transmission of mutations such as K103NS and E138A. ART restarters showed higher representation of cisgender women and injectable drug users, higher age, and lower education level. PDR to dolutegravir/bictegravir remained low in Mexico City, although further surveillance is warranted given the short time of ART optimization. Our study identifies demographic characteristics of groups with higher risk of PDR and lost to follow-up, which may be useful to design differentiated interventions locally.
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Affiliation(s)
- Claudia García-Morales
- Centre for Research in Infectious Diseases, National Institute of Respiratory Diseases, Calzada de Tlalpan 4502, Colonia Sección XVI, Mexico City 14080, Mexico; (C.G.-M.); (D.T.-T.); (M.M.-F.); (V.S.Q.-M.); (V.D.-C.); (Á.B.-B.); (M.C.-S.); (M.B.-R.); (E.Z.-S.)
| | - Daniela Tapia-Trejo
- Centre for Research in Infectious Diseases, National Institute of Respiratory Diseases, Calzada de Tlalpan 4502, Colonia Sección XVI, Mexico City 14080, Mexico; (C.G.-M.); (D.T.-T.); (M.M.-F.); (V.S.Q.-M.); (V.D.-C.); (Á.B.-B.); (M.C.-S.); (M.B.-R.); (E.Z.-S.)
| | - Margarita Matías-Florentino
- Centre for Research in Infectious Diseases, National Institute of Respiratory Diseases, Calzada de Tlalpan 4502, Colonia Sección XVI, Mexico City 14080, Mexico; (C.G.-M.); (D.T.-T.); (M.M.-F.); (V.S.Q.-M.); (V.D.-C.); (Á.B.-B.); (M.C.-S.); (M.B.-R.); (E.Z.-S.)
| | - Verónica Sonia Quiroz-Morales
- Centre for Research in Infectious Diseases, National Institute of Respiratory Diseases, Calzada de Tlalpan 4502, Colonia Sección XVI, Mexico City 14080, Mexico; (C.G.-M.); (D.T.-T.); (M.M.-F.); (V.S.Q.-M.); (V.D.-C.); (Á.B.-B.); (M.C.-S.); (M.B.-R.); (E.Z.-S.)
| | - Vanessa Dávila-Conn
- Centre for Research in Infectious Diseases, National Institute of Respiratory Diseases, Calzada de Tlalpan 4502, Colonia Sección XVI, Mexico City 14080, Mexico; (C.G.-M.); (D.T.-T.); (M.M.-F.); (V.S.Q.-M.); (V.D.-C.); (Á.B.-B.); (M.C.-S.); (M.B.-R.); (E.Z.-S.)
| | - Ángeles Beristain-Barreda
- Centre for Research in Infectious Diseases, National Institute of Respiratory Diseases, Calzada de Tlalpan 4502, Colonia Sección XVI, Mexico City 14080, Mexico; (C.G.-M.); (D.T.-T.); (M.M.-F.); (V.S.Q.-M.); (V.D.-C.); (Á.B.-B.); (M.C.-S.); (M.B.-R.); (E.Z.-S.)
| | - Miroslava Cárdenas-Sandoval
- Centre for Research in Infectious Diseases, National Institute of Respiratory Diseases, Calzada de Tlalpan 4502, Colonia Sección XVI, Mexico City 14080, Mexico; (C.G.-M.); (D.T.-T.); (M.M.-F.); (V.S.Q.-M.); (V.D.-C.); (Á.B.-B.); (M.C.-S.); (M.B.-R.); (E.Z.-S.)
| | - Manuel Becerril-Rodríguez
- Centre for Research in Infectious Diseases, National Institute of Respiratory Diseases, Calzada de Tlalpan 4502, Colonia Sección XVI, Mexico City 14080, Mexico; (C.G.-M.); (D.T.-T.); (M.M.-F.); (V.S.Q.-M.); (V.D.-C.); (Á.B.-B.); (M.C.-S.); (M.B.-R.); (E.Z.-S.)
| | - Patricia Iracheta-Hernández
- Condesa Specialised Clinic, General Benjamín Hill 24, Colonia Condesa, Mexico City 06140, Mexico; (P.I.-H.); (I.M.-G.); (A.G.-R.)
| | - Israel Macías-González
- Condesa Specialised Clinic, General Benjamín Hill 24, Colonia Condesa, Mexico City 06140, Mexico; (P.I.-H.); (I.M.-G.); (A.G.-R.)
| | - Rebecca García-Mendiola
- Condesa Iztapalapa Specialised Clinic, Combate de Celaya s/n, Colonia Unidad Habitacional Vicente Guerrero, Mexico City 09730, Mexico; (R.G.-M.); (A.G.-C.); (R.A.C.)
| | - Alejandro Guzmán-Carmona
- Condesa Iztapalapa Specialised Clinic, Combate de Celaya s/n, Colonia Unidad Habitacional Vicente Guerrero, Mexico City 09730, Mexico; (R.G.-M.); (A.G.-C.); (R.A.C.)
| | - Eduardo Zarza-Sánchez
- Centre for Research in Infectious Diseases, National Institute of Respiratory Diseases, Calzada de Tlalpan 4502, Colonia Sección XVI, Mexico City 14080, Mexico; (C.G.-M.); (D.T.-T.); (M.M.-F.); (V.S.Q.-M.); (V.D.-C.); (Á.B.-B.); (M.C.-S.); (M.B.-R.); (E.Z.-S.)
| | - Raúl Adrián Cruz
- Condesa Iztapalapa Specialised Clinic, Combate de Celaya s/n, Colonia Unidad Habitacional Vicente Guerrero, Mexico City 09730, Mexico; (R.G.-M.); (A.G.-C.); (R.A.C.)
| | - Andrea González-Rodríguez
- Condesa Specialised Clinic, General Benjamín Hill 24, Colonia Condesa, Mexico City 06140, Mexico; (P.I.-H.); (I.M.-G.); (A.G.-R.)
| | - Gustavo Reyes-Terán
- Coordinating Commission of the National Institutes of Health and High Specialty Hospitals, Periférico Sur 4809, Colonia Arenal de Tepepan, Mexico City 14610, Mexico;
| | - Santiago Ávila-Ríos
- Centre for Research in Infectious Diseases, National Institute of Respiratory Diseases, Calzada de Tlalpan 4502, Colonia Sección XVI, Mexico City 14080, Mexico; (C.G.-M.); (D.T.-T.); (M.M.-F.); (V.S.Q.-M.); (V.D.-C.); (Á.B.-B.); (M.C.-S.); (M.B.-R.); (E.Z.-S.)
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22
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Caro-Vega Y, Alarid-Escudero F, Enns EA, Sosa-Rubí S, Chivardi C, Piñeirúa-Menendez A, García-Morales C, Reyes-Terán G, Sierra-Madero JG, Ávila-Ríos S. Retention in Care, Mortality, Loss-to-Follow-Up, and Viral Suppression among Antiretroviral Treatment-Naïve and Experienced Persons Participating in a Nationally Representative HIV Pre-Treatment Drug Resistance Survey in Mexico. Pathogens 2021; 10:pathogens10121569. [PMID: 34959524 PMCID: PMC8706073 DOI: 10.3390/pathogens10121569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 11/25/2021] [Accepted: 11/26/2021] [Indexed: 11/20/2022] Open
Abstract
We describe associations of pretreatment drug resistance (PDR) with clinical outcomes such as remaining in care, loss to follow-up (LTFU), viral suppression, and death in Mexico, in real-life clinical settings. We analyzed clinical outcomes after a two-year follow up period in participants of a large 2017–2018 nationally representative PDR survey cross-referenced with information of the national ministry of health HIV database. Participants were stratified according to prior ART exposure and presence of efavirenz/nevirapine PDR. Using a Fine-Gray model, we evaluated virological suppression among resistant patients, in a context of competing risk with lost to follow-up and death. A total of 1823 participants were followed-up by a median of 1.88 years (Interquartile Range (IQR): 1.59–2.02): 20 (1%) were classified as experienced + resistant; 165 (9%) naïve + resistant; 211 (11%) experienced + non-resistant; and 1427 (78%) as naïve + non-resistant. Being ART-experienced was associated with a lower probability of remaining in care (adjusted Hazard Ratio(aHR) = 0.68, 0.53–0.86, for the non-resistant group and aHR = 0.37, 0.17–0.84, for the resistant group, compared to the naïve + non-resistant group). Heterosexual cisgender women compared to men who have sex with men [MSM], had a lower viral suppression (aHR = 0.84, 0.70–1.01, p = 0.06) ART-experienced persons with NNRTI-PDR showed the worst clinical outcomes. This group was enriched with women and persons with lower education and unemployed, which suggests higher levels of social vulnerability.
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Affiliation(s)
- Yanink Caro-Vega
- Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14000, Mexico; (Y.C.-V.); (J.G.S.-M.)
| | | | - Eva A. Enns
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN 55455, USA;
| | - Sandra Sosa-Rubí
- Center for Health Systems Research, Instituto Nacional de Salud Pública, Cuernavaca 62100, Mexico; (S.S.-R.); (C.C.)
| | - Carlos Chivardi
- Center for Health Systems Research, Instituto Nacional de Salud Pública, Cuernavaca 62100, Mexico; (S.S.-R.); (C.C.)
| | | | - Claudia García-Morales
- Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias, Mexico City 14080, Mexico; (C.G.-M.); (G.R.-T.)
| | - Gustavo Reyes-Terán
- Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias, Mexico City 14080, Mexico; (C.G.-M.); (G.R.-T.)
| | - Juan G. Sierra-Madero
- Departamento de Infectología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14000, Mexico; (Y.C.-V.); (J.G.S.-M.)
| | - Santiago Ávila-Ríos
- Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias, Mexico City 14080, Mexico; (C.G.-M.); (G.R.-T.)
- Correspondence: ; Tel.: +52-(55)-5666-7985 (ext. 133)
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23
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García-Grimshaw M, Ceballos-Liceaga SE, Michel-Chávez A, García-Alanis M, Cadena-Fernández A, Galnares-Olalde JA, Carbajal-Sandoval G, Carrillo-García DA, Hernández-Valdivia N, Hernández-Vanegas LE, Saniger-Alba MDM, Gutierrez-Romero A, Díaz-Ortega JL, Reyes-Terán G, López-Gatell H, Flores-Silva FD, Cantú-Brito C, Chiquete E, Arauz A, Valdés-Ferrer SI. Transient sensory symptoms among first-dose recipients of the BNT162b2 mRNA COVID-19 vaccine: A case-control study. Vaccine 2021; 39:6975-6979. [PMID: 34742595 PMCID: PMC8554108 DOI: 10.1016/j.vaccine.2021.10.058] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 09/16/2021] [Accepted: 10/25/2021] [Indexed: 12/12/2022]
Abstract
mRNA-based COVID-19 vaccines are effective; however, persistent vaccine hesitancy is partly due to a misperception of their potential adverse events. Non-specific sensory symptoms (NSSS) following immunization are thought to be mediated by stress-related responses. In this case-control study, we evaluated NSSS from a cohort of 7,812,845 BNT162b2 first-dose recipients, of whom 10,929 reported an adverse event following immunization (AEFI). We found an overall frequency of 3.4% (377 cases) or 4.8 cases per 100,000 doses administered. Anatomically, the arms (61%) and face/neck region (36.2%) were the most commonly affected sites. The control group had significantly higher rates of reactogenicity-associated symptoms, suggesting that NSSS are reactogenicity-independent; in multivariable analysis, healthcare workers reported sensory symptoms less frequently (aOR 0.54; 95% CI 0.40-0.72;p < 0.001). This is the first study describing the topography and associated factors for developing NSSS among BNT162b2 recipients. The benign nature of these symptoms may help dissipate hesitation towards this vaccine.
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Affiliation(s)
- Miguel García-Grimshaw
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
| | | | - Anaclara Michel-Chávez
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Mario García-Alanis
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Arturo Cadena-Fernández
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | | | | | | | - Laura E Hernández-Vanegas
- Department of Neurology, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico
| | - María Del Mar Saniger-Alba
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Alonso Gutierrez-Romero
- Department of Neurology, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico
| | - José Luis Díaz-Ortega
- Centro Nacional para la Salud de la Infancia y la Adolescencia, Secretaría de Salud, Mexico City, Mexico
| | - Gustavo Reyes-Terán
- Comisión Coordinadora de Institutos Nacionales de Salud y Hospitales de Alta Especialidad, Secretaría de Salud, Mexico City, Mexico
| | | | - Fernando Daniel Flores-Silva
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Carlos Cantú-Brito
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Erwin Chiquete
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Antonio Arauz
- Department of Neurology, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico
| | - Sergio Iván Valdés-Ferrer
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; Feinstein Institutes for Medical Research, Manhasset, NY, USA.
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24
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Gulati GK, Panpradist N, Stewart SWA, Beck IA, Boyce C, Oreskovic AK, García-Morales C, Avila-Ríos S, Han PD, Reyes-Terán G, Starita LM, Frenkel LM, Lutz BR, Lai JJ. Inexpensive workflow for simultaneous monitoring of HIV viral load and detection of SARS-CoV-2 infection. medRxiv 2021:2021.08.18.21256786. [PMID: 34462759 PMCID: PMC8404901 DOI: 10.1101/2021.08.18.21256786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
BACKGROUND COVID-19 pandemic interrupted routine care for individuals living with HIV, putting them at risk of becoming virologically unsuppressed and ill. Often they are at high risk for exposure to SARS-CoV-2 infection and severe disease once infected. For this population, it is urgent to closely monitor HIV plasma viral load ( VL ) and screen for SARS-COV-2 infection. METHOD We have developed a non-proprietary method to isolate RNA from plasma, nasal secretions ( NS ), or both. HIV, SARS-CoV-2, and human RP targets in extracted RNA are then RT-qPCR to estimate the VL and classify HIV/SARS-CoV-2 status ( i . e ., HIV as VL failure or suppressed; SARS-CoV-2 as positive, presumptive positive, negative, or indeterminate). We evaluated this workflow on 133 clinical specimens: 40 plasma specimens (30 HIV-seropositive), 67 NS specimens (31 SARS-CoV-2-positive), and 26 pooled plasma/NS specimens (26 HIV-positive with 10 SARS-CoV-2-positive), and compared the results obtained using the in-house extraction to those using a commercial extraction kit. RESULTS In-house extraction had a detection limit of 200-copies/mL for HIV and 100-copies/mL for SARS-CoV-2. In-house and commercial methods yielded positively correlated HIV VL (R 2 : 0.98 for contrived samples; 0.81 for seropositive plasma). SARS-CoV-2 detection had 100% concordant classifications in contrived samples, and in clinical NS extracted by in-house method, excluding indeterminate results, was 95% concordant (25 positives, 6 presumptive positives, and 31 negatives) to those using the commercial method. Analysis of pooled plasma/NS showed R 2 of 0.91 (contrived samples) and 0.71 (clinical specimens) for HIV VL correlations obtained by both extraction methods, while SARS-CoV-2 detection showed 100% concordance in contrived and clinical specimens. INTERPRETATION Our low-cost workflow for molecular testing of HIV and SARS-CoV-2 could serve as an alternative to current standard assays for laboratories in low-resource settings.
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Piña-Reyna Y, García-Rincón A, Ortiz-Fernández PH, Alcocer-Gamba MA, Gutiérrez-Fajardo P, Merino-Rajme JA, Reyes-Terán G. Atención de la cardiopatía isquémica en salas de cateterismo durante la contingencia sanitaria por pandemia de COVID-19. Recomendaciones de la Sociedad de Cardiología Intervencionista de México (SOCIME). RECIC 2021. [DOI: 10.24875/recic.m20000123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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26
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García-Grimshaw M, Michel-Chávez A, Vera-Zertuche JM, Galnares-Olalde JA, Hernández-Vanegas LE, Figueroa-Cucurachi M, Paredes-Ceballos O, Reyes-Terán G, Carbajal-Sandoval G, Ceballos-Liceaga SE, Arauz A, Valdés-Ferrer SI. Guillain-Barré syndrome is infrequent among recipients of the BNT162b2 mRNA COVID-19 vaccine. Clin Immunol 2021; 230:108818. [PMID: 34358692 PMCID: PMC8332675 DOI: 10.1016/j.clim.2021.108818] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/19/2021] [Accepted: 07/31/2021] [Indexed: 02/07/2023]
Abstract
Vaccines are the most effective strategy to mitigate the global impact of COVID-19. However, vaccine hesitancy is common, particularly among minorities. Guillain-Barré syndrome (GBS) is the most common autoimmune illness of the peripheral nervous system, occurring at an incidence of 1.1/100,000 worldwide. A causal link between mRNA vaccines and GBS has not been previously evaluated. We analyzed a cohort of 3,890,250 Hispanic/Latinx recipients of the BNT162b2 mRNA vaccine (613,780 of whom had already received both doses) for incident GBS occurring within 30 days from vaccine administration. Seven cases of GBS were detected among first-dose recipients, for an observed incidence of 0.18/100,000 administered doses during the prespecified timeframe of 30 days. No cases were reported after second-dose administration. Our data suggest that, among recipients of the BNT162b2 mRNA vaccine, GBS may occur at the expected community-based rate; however, this should be taken with caution as the current incidence of GBS among the unvaccinated population against COVID-19 is still undetermined. We hope that this preliminary data will increase the public perception of safety toward mRNA-based vaccines and reduce vaccine hesitancy.
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Affiliation(s)
- Miguel García-Grimshaw
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Anaclara Michel-Chávez
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Juan Mauricio Vera-Zertuche
- Department of Endocrinology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | - Laura E Hernández-Vanegas
- Department of Neurology, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico
| | | | | | | | | | | | - Antonio Arauz
- Department of Neurology, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico
| | - Sergio Iván Valdés-Ferrer
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; Feinstein Institutes for Medical Research, Manhasset, NY, USA.
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27
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García-Grimshaw M, Ceballos-Liceaga SE, Hernández-Vanegas LE, Núñez I, Hernández-Valdivia N, Carrillo-García DA, Michel-Chávez A, Galnares-Olalde JA, Carbajal-Sandoval G, Del Mar Saniger-Alba M, Carrillo-Mezo RA, Fragoso-Saavedra S, Espino-Ojeda A, Blaisdell-Vidal C, Mosqueda-Gómez JL, Sierra-Madero J, Pérez-Padilla R, Alomía-Zegarra JL, López-Gatell H, Díaz-Ortega JL, Reyes-Terán G, Arauz A, Valdés-Ferrer SI. Neurologic adverse events among 704,003 first-dose recipients of the BNT162b2 mRNA COVID-19 vaccine in Mexico: A nationwide descriptive study. Clin Immunol 2021; 229:108786. [PMID: 34147649 PMCID: PMC8213977 DOI: 10.1016/j.clim.2021.108786] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 06/10/2021] [Accepted: 06/15/2021] [Indexed: 12/29/2022]
Abstract
mRNA vaccines against SARS-CoV-2 are remarkably effective. Limited information exists about the incidence of adverse events following immunization (AEFI) with their use. We conducted a prospective observational study including data from 704,003 first-doses recipients; 6536 AEFI were reported, of whom 65.1% had at least one neurologic AEFI (non-serious 99.6%). Thirty-three serious events were reported; 17 (51.5%) were neurologic (observed frequency, 2.4/100,000 doses). At the time of writing this report, 16/17 cases had been discharged without deaths. Our data suggest that the BNT162b2 mRNA COVID-19 vaccine is safe; its individual and societal benefits outweigh the low percentage of serious neurologic AEFI. This information should help to dissipate hesitancy towards this new vaccine platform.
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Affiliation(s)
- Miguel García-Grimshaw
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | - Laura E Hernández-Vanegas
- Department of Neurology, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico
| | - Isaac Núñez
- Department of Internal Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | | | - Anaclara Michel-Chávez
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | | | - María Del Mar Saniger-Alba
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Roger A Carrillo-Mezo
- Department of Neuroradiology, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico
| | - Sergio Fragoso-Saavedra
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; Programa de Estudios Combinados en Medicina (MD/PhD program), Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | | | | | | | - Juan Sierra-Madero
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Rogelio Pérez-Padilla
- Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | | | | | | | - Gustavo Reyes-Terán
- Comisión Coordinadora de Institutos Nacionales de Salud y Hospitales de Alta Especialidad, Mexico City, Mexico
| | | | - Sergio Iván Valdés-Ferrer
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; Secretaría de Salud, Gobierno de México, Mexico; Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico; Feinstein Institutes for Medical Research, Manhasset, NY, USA.
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Girón-Callejas A, García-Morales C, Mendizabal-Burastero R, Meza RI, Sierra T, Tapia-Trejo D, Pérez-García M, Quiroz-Morales VS, Paredes M, Rodríguez A, Juárez SI, Farach N, Videa G, Lara B, Rodríguez E, Ardón E, Sajquim E, Lorenzana R, Ravasi G, Northbrook S, Reyes-Terán G, Ávila-Ríos S. High level of pre-treatment and acquired HIV drug resistance in Honduras: a nationally representative survey, 2016-17. J Antimicrob Chemother 2021; 75:1932-1942. [PMID: 32303063 DOI: 10.1093/jac/dkaa100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 02/11/2020] [Accepted: 02/20/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Pre-treatment HIV drug resistance (HIVDR) to NNRTIs has consistently increased in low-/middle-income countries during the last decade. OBJECTIVES To estimate the prevalence of pre-treatment HIVDR and acquired HIVDR among persons living with HIV (PLHIV) on ART for 12 ± 3 months (ADR12) and ≥48 months (ADR48) in Honduras. PATIENTS AND METHODS A nationwide cross-sectional survey with a two-stage cluster sampling was conducted from October 2016 to November 2017. Twenty-two of 54 total ART clinics representing >90% of the national cohort of adults on ART were included. HIVDR was assessed for protease and reverse transcriptase Sanger sequences using the Stanford HIVdb tool. RESULTS A total of 729 PLHIV were enrolled; 26.3% (95% CI 20.1%-33.5%) ART initiators reported prior exposure to antiretrovirals. Pre-treatment HIVDR prevalence was 26.9% (95% CI 20.2%-34.9%) to any antiretroviral and 25.9% (19.2%-33.9%) to NNRTIs. NNRTI pre-treatment HIVDR was higher in ART initiators with prior exposure to antiretrovirals (P = 0.001). Viral load (VL) suppression rate was 89.7% (85.1%-93.0%) in ADR12 and 67.9% (61.7%-73.6%) in ADR48. ADR12 to any drug among PLHIV with VL ≥1000 copies/mL was 86.1% (48.9%-97.6%); 67.1% (37.4%-87.5%) had HIVDR to both NNRTIs and NRTIs, and 3.8% (0.5%-25.2%) to PIs. ADR48 was 92.0% (86.8%-95.3%) to any drug; 78.1% (66.6%-86.5%) to both NNRTIs and NRTIs, and 7.3% (1.8%-25.1%) to PIs. CONCLUSIONS The high prevalence of NNRTI pre-treatment HIVDR observed in Honduras warrants consideration of non-NNRTI-based first-line regimens for ART initiation. Programmatic improvements in HIVDR monitoring and adherence support may also be considered.
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Affiliation(s)
| | - Claudia García-Morales
- Centre for Research in Infectious Diseases, National Institute of Respiratory Diseases, Mexico City, Mexico
| | | | - Rita I Meza
- Secretaría de Salud de Honduras, Tegucigalpa City, Honduras
| | - Tomasa Sierra
- Secretaría de Salud de Honduras, Tegucigalpa City, Honduras
| | - Daniela Tapia-Trejo
- Centre for Research in Infectious Diseases, National Institute of Respiratory Diseases, Mexico City, Mexico
| | - Marissa Pérez-García
- Centre for Research in Infectious Diseases, National Institute of Respiratory Diseases, Mexico City, Mexico
| | - Verónica S Quiroz-Morales
- Centre for Research in Infectious Diseases, National Institute of Respiratory Diseases, Mexico City, Mexico
| | - Mayte Paredes
- Universidad del Valle de Guatemala, Tegucigalpa City, Honduras
| | | | - Sandra I Juárez
- US Centers for Disease Control and Prevention, Central American Region, Guatemala City, Guatemala
| | - Nasim Farach
- US Centers for Disease Control and Prevention, Central American Region, Guatemala City, Guatemala
| | | | - Bredy Lara
- Secretaría de Salud de Honduras, Tegucigalpa City, Honduras
| | | | - Elvia Ardón
- Secretaría de Salud de Honduras, Tegucigalpa City, Honduras
| | - Edgar Sajquim
- Universidad del Valle de Guatemala, Guatemala City, Guatemala
| | | | | | - Sanny Northbrook
- US Centers for Disease Control and Prevention, Central American Region, Guatemala City, Guatemala
| | - Gustavo Reyes-Terán
- Centre for Research in Infectious Diseases, National Institute of Respiratory Diseases, Mexico City, Mexico
| | - Santiago Ávila-Ríos
- Centre for Research in Infectious Diseases, National Institute of Respiratory Diseases, Mexico City, Mexico
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Moysi E, Del Rio Estrada PM, Torres-Ruiz F, Reyes-Terán G, Koup RA, Petrovas C. In Situ Characterization of Human Lymphoid Tissue Immune Cells by Multispectral Confocal Imaging and Quantitative Image Analysis; Implications for HIV Reservoir Characterization. Front Immunol 2021; 12:683396. [PMID: 34177929 PMCID: PMC8221112 DOI: 10.3389/fimmu.2021.683396] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 05/13/2021] [Indexed: 11/13/2022] Open
Abstract
CD4 T cells are key mediators of adaptive immune responses during infection and vaccination. Within secondary lymphoid organs, helper CD4 T cells, particularly those residing in germinal centers known as follicular helper T cells (Tfh), provide critical help to B-cells to promote their survival, isotype switching and selection of high affinity memory B-cells. On the other hand, the important role of Tfh cells for the maintenance of HIV reservoir is well documented. Thus, interrogating and better understanding the tissue specific micro-environment and immune subsets that contribute to optimal Tfh cell differentiation and function is important for designing successful prevention and cure strategies. Here, we describe the development and optimization of eight multispectral confocal microscopy immunofluorescence panels designed for in depth characterization and immune-profiling of relevant immune cells in formalin-fixed paraffin-embedded human lymphoid tissue samples. We provide a comprehensive library of antibodies to use for the characterization of CD4+ T-cells -including Tfh and regulatory T-cells- as well as CD8 T-cells, B-cells, macrophages and dendritic cells and discuss how the resulting multispectral confocal datasets can be quantitatively dissected using the HistoCytometry pipeline to collect information about relative frequencies and immune cell spatial distributions. Cells harboring actively transcribed virus are analyzed using an in-situ hybridization assay for the characterization of HIV mRNA positive cells in combination with additional protein markers (multispectral RNAscope). The application of this methodology to lymphoid tissues offers a means to interrogate multiple relevant immune cell targets simultaneously at increased resolution in a reproducible manner to guide CD4 T-cell studies in infection and vaccination.
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Affiliation(s)
- Eirini Moysi
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Perla M Del Rio Estrada
- Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
| | - Fernanda Torres-Ruiz
- Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
| | - Gustavo Reyes-Terán
- Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico.,Comisión Coordinadora de Institutos Nacionales de Salud y Hospitales de Alta Especialidad, Secretaría de Salud, Mexico City, Mexico
| | - Richard A Koup
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Constantinos Petrovas
- Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States.,Institute of Pathology, Department of Laboratory Medicine and Pathology, Lausanne University Hospital, Lausanne, Switzerland
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30
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Borrayo-Sánchez G, Alcocer-Gamba MA, Araiza-Garaygordobil D, Arias-Mendoza A, Aubanel-Riedel P, Cortés-Lawrenz J, González-Juanatey JR, Gutiérrez-Fajardo P, Martín-Hernández P, Martínez-Ramírez L, Merino-Rajme JA, Muñoz-Carrillo JM, López-Pais J, Parra-Michel R, Piña-Reyna Y, Ortiz-Fernández P, Ramírez-Arias E, Robles-Rangel MA, Rosas-Peralta M, Rangel-Velázquez R, Palami-Antúnez D, López-Ridaura R, Reyes-Terán G. Interinstitutional clinical practice guidelines for the treatment of acute myocardial infarction. GAC MED MEX 2021; 156:559-569. [PMID: 33877123 DOI: 10.24875/gmm.m21000455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Mexico has the highest 30-day mortality due to acute myocardial infarction (AMI), which constitutes one of the main causes of mortality in the country: 28 % versus 7.5 % on average for the Organization for Economic Co-operation and Development member countries. OBJECTIVE To establish critical pathways and essential interinstitutional pharmacological strategies for the care of patients with AMI in Mexico, regardless of their socioeconomic status. METHOD A group of experts in AMI diagnosis and treatment, representatives of the main public health institutions in Mexico, as well as the Mexican cardiology societies, the Mexican Red Cross and representatives of the Spanish Society of Cardiology, were brought together in order to optimize strategies based on the best existing evidence. RESULTS An interinstitutional clinical practice guideline was designed for early diagnosis and timely treatment of AMI with ST-segment elevation, following the clinical horizon of the disease, with the proposal of algorithms that improve the prognosis of patients who attend the emergency services due to an AMI. CONCLUSION With these clinical practice guidelines, the group of experts proposes to universalize AMI diagnosis and treatment, regardless of patient socioeconomic status. INTRODUCCIÓN México tiene la mortalidad más alta a 30 días por infarto agudo de miocardio (IAM), el cual constituye una de las principales causas de mortalidad en el país: 28 % versus 7.5 % del promedio de los países de la Organización para la Cooperación y el Desarrollo Económicos. OBJETIVO Establecer las rutas críticas y las estrategias farmacológicas esenciales interinstitucionales para la atención de los pacientes con IAM en México, independientemente de su condición socioeconómica. MÉTODO Se reunió a un grupo de expertos en diagnóstico y tratamiento de IAM, representantes de las principales instituciones públicas de salud de México, así como las sociedades cardiológicas mexicanas, Cruz Roja Mexicana y representantes de la Sociedad Española de Cardiología con la finalidad de optimizar las estrategias con base en la mejor evidencia existente. RESULTADOS Se diseñó una guía de práctica clínica interinstitucional para el diagnóstico temprano y tratamiento oportuno del IAM con elevación del segmento ST, siguiendo el horizonte clínico de la enfermedad, con la propuesta de algoritmos que mejoren el pronóstico de los pacientes que acuden por IAM a los servicios de urgencias. CONCLUSIÓN Con la presente guía práctica, el grupo de expertos propone universalizar el diagnóstico y tratamiento en el IAM, independientemente de la condición socioeconómica del paciente.
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Affiliation(s)
- Gabriela Borrayo-Sánchez
- A Todo Corazón, Código Infarto Program, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | | | - Diego Araiza-Garaygordobil
- Coronary and Hemodynamics Unit, Instituto Nacional de Cardiología "Juan Badiano", Secretaría de Salud, Mexico City, Mexico
| | - Alexandra Arias-Mendoza
- Coronary and Hemodynamics Unit, Instituto Nacional de Cardiología "Juan Badiano", Secretaría de Salud, Mexico City, Mexico
| | - Patricia Aubanel-Riedel
- Cardiology Department, Institute of Cardiovascular Sciences, Hospital del Prado, Baja California, Mexico
| | | | | | | | - Patricia Martín-Hernández
- Cardiology Department, Hospital Central Militar, Secretaría de la Defensa Nacional, Mexico City, Mexico
| | - Leonel Martínez-Ramírez
- Emergency Department and Coronary Unit, Hospital de Cardiología Siglo XXI, Instituo Mexicano del Seguro Social, Mexico City, México
| | - José A Merino-Rajme
- Cardiology Department, Hospital 20 de Noviembre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Mexico City, Mexico
| | | | - Javier López-Pais
- Cardiology Department, Hospital Universitario Santiago de Compostela, Coruña, Spain
| | - Rodolfo Parra-Michel
- Coronary Unit, Hospital de Especialidades, Centro Médico de Especialidades de Occidente, Instituto Mexicano del Seguro Social, Jalisco, Mexico
| | - Yigal Piña-Reyna
- Coronary and Hemodynamics Unit, Instituto Nacional de Cardiología "Juan Badiano", Secretaría de Salud, Mexico City, Mexico
| | - Patricio Ortiz-Fernández
- Coronary and Hemodynamics Unit, Instituto Nacional de Cardiología "Juan Badiano", Secretaría de Salud, Mexico City, Mexico
| | - Erick Ramírez-Arias
- Emergency Department and Coronary Unit, Hospital de Cardiología Siglo XXI, Instituo Mexicano del Seguro Social, Mexico City, México
| | - Marco A Robles-Rangel
- Emergency Department and Coronary Unit, Hospital de Cardiología Siglo XXI, Instituo Mexicano del Seguro Social, Mexico City, México
| | - Martín Rosas-Peralta
- Department of Medical Benefits, Delegación México Poniente, Instituto Mexicano del Seguro Social, State of Mexico, Mexico
| | - Raúl Rangel-Velázquez
- Comisión Coordinadora de los Institutos Nacionales de Salud y Hospitales de Alta Especialidad, Secretaría de Salud, Mexico City, Mexico
| | - Diana Palami-Antúnez
- Comisión Coordinadora de los Institutos Nacionales de Salud y Hospitales de Alta Especialidad, Secretaría de Salud, Mexico City, Mexico
| | - Ruy López-Ridaura
- Strategic Programs, Centro Nacional de Programas Preventivos y Control de Enfermedades, Secretaría de Salud, Mexico City, Mexico
| | - Gustavo Reyes-Terán
- Comisión Coordinadora de los Institutos Nacionales de Salud y Hospitales de Alta Especialidad, Secretaría de Salud, Mexico City, Mexico
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Briceño O, Peralta-Prado A, Garrido-Rodríguez D, Romero-Mora K, Chávez-Torres M, de la Barrera CA, Reyes-Terán G, Ávila-Ríos S. Characterization of CD31 expression in CD4+ and CD8+T cell subpopulations in chronic untreated HIV infection. Immunol Lett 2021; 235:22-31. [PMID: 33852965 DOI: 10.1016/j.imlet.2021.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 03/09/2021] [Accepted: 04/07/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND The platelet endothelial cell adhesion molecule-1 (PECAM-1) or CD31 has been involved in regulation of T-cell tolerance, activation, survival and homing in mice cells. However, there is limited knowledge about the expression pattern and role of this molecule in human T cells, particularly in conditions of chronic immune activation. OBJECTIVES We explored CD31 expression in T cell differentiation subsets of individuals with untreated HIV infection and in non-HIV-infected controls. We also assessed phenotypic differences between CD31+ and CD31- subsets in memory and terminally differentiated (TEMRA) CD4+ and CD8 + T cells. METHODS Forty-one individuals with untreated HIV infection and 34 non-HIV-infected controls were included in the study. We compared the expression of CD31 in CD4+ and CD8 + T cells across stages of differentiation in the two study groups by flow cytometry. We also analyzed the expression of CD57 (a marker of senescence), Ki67 (a marker of cycling cells), PD-1 (a marker of exhaustion), and CD38/HLA-DR (a marker of immune activation) on memory and TEMRA CD31+ and CD31- T cells. RESULTS CD31 expression was significantly higher in CD8 + T cells than in CD4 + T cells, measured as frequency, absolute numbers and median fluorescence intensity (MFI), in both study groups (p < 0.0001 in all cases). Intermediate differentiation subsets of CD4+ and CD8 + T cells expressed higher levels of CD31 in the context of HIV infection (p < 0.001 in all cases). CD31 expression frequency decreased with cellular differentiation of CD4+ and CD8 + T cells in both groups, but this decrease was steeper in individuals without HIV infection (CD4+: p < 0.001 and CD8+: p < 0.0001). As expected, memory and TEMRA CD4+ and CD8 + T cells expressed significantly higher levels of CD57, PD-1, Ki67 and CD38/HLA-DR in HIV-infected compared to non-HIV-infected individuals (p < 0.01 in all cases). CD31 expression was associated with lower activation of memory (but not TEMRA) CD4 + T cells in non-HIV-infected persons, an effect not observed in the HIV-infected group. CD31 expression on memory CD8 + T cells of HIV-infected individuals was associated higher levels of PD-1 (p = 0.0019) and CD38/HLADR (p = 0.0345), and higher PD-1 expression on CD8 + TEMRA (p = 0.0024), an effect not observed in non-HIV-infected individuals. CONCLUSION In the context of HIV-associated chronic immune activation, specifically on memory CD8 + T cells, CD31 expression was associated with higher PD-1 and CD38/HLA-DR co-expression, suggesting that CD31 expression may result from an insufficient attempt to contain T cell exhaustion and activation. CD31-targeted therapies may contribute to modulate these cellular responses.
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Affiliation(s)
- Olivia Briceño
- Instituto Nacional de Enfermedades Respiratorias, Centro de Investigación en Enfermedades Infecciosas, México City, Mexico.
| | - Amy Peralta-Prado
- Instituto Nacional de Enfermedades Respiratorias, Centro de Investigación en Enfermedades Infecciosas, México City, Mexico
| | - Daniela Garrido-Rodríguez
- Instituto Nacional de Enfermedades Respiratorias, Centro de Investigación en Enfermedades Infecciosas, México City, Mexico
| | - Karla Romero-Mora
- Instituto Nacional de Enfermedades Respiratorias, Centro de Investigación en Enfermedades Infecciosas, México City, Mexico
| | - Monserrat Chávez-Torres
- Instituto Nacional de Enfermedades Respiratorias, Centro de Investigación en Enfermedades Infecciosas, México City, Mexico
| | - Claudia-Alvarado de la Barrera
- Instituto Nacional de Enfermedades Respiratorias, Centro de Investigación en Enfermedades Infecciosas, México City, Mexico
| | - Gustavo Reyes-Terán
- Coordinating Commission of the Mexican National Institutes of Health, Mexico City, Mexico
| | - Santiago Ávila-Ríos
- Instituto Nacional de Enfermedades Respiratorias, Centro de Investigación en Enfermedades Infecciosas, México City, Mexico
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Martínez-Gamboa A, Niembro-Ortega MD, Torres-González P, Santiago-Cruz J, Velázquez-Zavala NG, Rangel-Cordero A, Crabtree-Ramírez B, Gamboa-Domínguez A, Reyes-Gutiérrez E, Reyes-Terán G, Lozano-Fernandez VH, Ahumada-Topete VH, Martínez-Ayala P, Manríquez-Reyes M, Ramírez-Hinojosa JP, Rodríguez-Zulueta P, Hernández-León C, Ruíz-Quiñones J, Rivera-Martínez NE, Chaparro-Sánchez A, Andrade-Villanueva J, González-Hernández LA, Cruz-Martínez S, Flores-Barrientos O, Gaytán-Martínez JE, Magaña-Aquino M, Cervantes-Sánchez A, Olivas-Martínez A, Araujo-Meléndez J, del Rocío Reyes-Montes M, Duarte-Escalante E, Frías-De León MG, Ramírez JA, Taylor ML, de León-Garduño AP, Sifuentes-Osornio J. Diagnostic accuracy of antigen detection in urine and molecular assays testing in different clinical samples for the diagnosis of progressive disseminated histoplasmosis in patients living with HIV/AIDS: A prospective multicenter study in Mexico. PLoS Negl Trop Dis 2021; 15:e0009215. [PMID: 33684128 PMCID: PMC7971897 DOI: 10.1371/journal.pntd.0009215] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 03/18/2021] [Accepted: 02/06/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The progressive disseminated histoplasmosis (PDH) has been associated with severe disease and high risk of death among people living with HIV (PLWHIV). Therefore, the purpose of this multicenter, prospective, double-blinded study done in ten Mexican hospitals was to determine the diagnostic accuracy of detecting Histoplasma capsulatum antigen in urine using the IMMY ALPHA Histoplasma EIA kit (IAHE), clarus Histoplasma GM Enzyme Immunoassay (cHGEI IMMY) and MiraVista Histoplasma Urine Antigen LFA (MVHUALFA); as well as the Hcp100 and 1281-1283220SCAR nested PCRs in blood, bone-marrow, tissue biopsies and urine. METHODOLOGY/PRINCIPAL FINDINGS We included 415 PLWHIV older than 18 years of age with suspicion of PDH. Using as diagnostic standard recovery of H. capsulatum in blood, bone marrow or tissue cultures, or histopathological exam compatible, detected 108 patients (26%, [95%CI, 21.78-30.22]) with proven-PDH. We analyzed 391 urine samples by the IAHE, cHGEI IMMY and MVHUALFA; the sensitivity/specificity values obtained were 67.3% (95% CI, 57.4-76.2) / 96.2% (95% CI, 93.2-98.0) for IAHE, 91.3% (95% CI, 84.2-96.0) / 90.9% (95% CI, 87.0-94.0) for cHGEI IMMY and 90.4% (95% CI, 83.0-95.3) / 92.3% (95% CI, 88.6-95.1) for MVHUALFA. The Hcp100 nested PCR was performed on 393, 343, 75 and 297, blood, bone marrow, tissue and urine samples respectively; the sensitivity/specificity values obtained were 62.9% (95%CI, 53.3-72.5)/ 89.5% (95%CI, 86.0-93.0), 65.9% (95%CI, 56.0-75.8)/ 89.0% (95%CI, 85.2-92.9), 62.1% (95%CI, 44.4-79.7)/ 82.6% (95%CI, 71.7-93.6) and 34.9% (95%CI, 24.8-46.2)/ 67.3% (95%CI, 60.6-73.5) respectively; and 1281-1283220SCAR nested PCR was performed on 392, 344, 75 and 291, respectively; the sensitivity/specificity values obtained were 65.3% (95% CI, 55.9-74.7)/ 58.8% (95%CI, 53.2-64.5), 70.8% (95%CI, 61.3-80.2)/ 52.9% (95%CI, 46.8-59.1), 71.4% (95%CI, 54.7-88.2)/ 40.4% (95%CI, 26.4-54.5) and 18.1% (95%CI, 10.5-28.1)/ 90.4% (95%CI, 85.5-94.0), respectively. CONCLUSIONS/SIGNIFICANCE The cHGEI IMMY and MVHUALFA tests showed excellent performance for the diagnosis of PDH in PLWHIV. The integration of these tests in clinical laboratories will certainly impact on early diagnosis and treatment.
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Affiliation(s)
- Areli Martínez-Gamboa
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; Tlalpan, Mexico City, Mexico
| | - María Dolores Niembro-Ortega
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; Tlalpan, Mexico City, Mexico
| | - Pedro Torres-González
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; Tlalpan, Mexico City, Mexico
| | - Janeth Santiago-Cruz
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; Tlalpan, Mexico City, Mexico
| | - Nancy Guadalupe Velázquez-Zavala
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; Tlalpan, Mexico City, Mexico
| | - Andrea Rangel-Cordero
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; Tlalpan, Mexico City, Mexico
| | - Brenda Crabtree-Ramírez
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; Tlalpan, Mexico City, Mexico
| | - Armando Gamboa-Domínguez
- Department of Pathology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico City, Mexico
| | - Edgardo Reyes-Gutiérrez
- Department of Pathology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Tlalpan, Mexico City, Mexico
| | - Gustavo Reyes-Terán
- Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas; Tlalpan, Mexico City, Mexico
| | - Víctor Hugo Lozano-Fernandez
- Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas; Tlalpan, Mexico City, Mexico
| | - Víctor Hugo Ahumada-Topete
- Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas; Tlalpan, Mexico City, Mexico
| | - Pedro Martínez-Ayala
- HIV Unit, Hospital Civil de Guadalajara “Fray Antonio Alcalde”; Guadalajara, Jalisco, Mexico
| | - Marisol Manríquez-Reyes
- Department of Internal Medicine, Hospital de Alta Especialidad de Veracruz; Veracruz, Veracruz, Mexico
| | | | - Patricia Rodríguez-Zulueta
- Department of Infectious Diseases, Hospital General Dr. Manuel Gea González; Tlalpan, Mexico City, Mexico
| | - Christian Hernández-León
- Area of Infectious Diseases, Department of Internal Medicine, Hospital General de Puebla “Dr. Eduardo Vázquez Navarro”; Puebla, Puebla, Mexico
| | - Jesús Ruíz-Quiñones
- Intensive Care Unit, Department of Internal Medicine, Hospital “Dr. Juan Graham Casasus”; Villahermosa, Tabasco, Mexico
| | - Norma Eréndira Rivera-Martínez
- Adult Infectious Diseases Department, Hospital Regional de Alta Especialidad de Oaxaca, HRAEO; San Bartolo Coyotepec, Oaxaca, Mexico
| | - Alberto Chaparro-Sánchez
- Department of Infectious Diseases, Hospital de Infectología del Centro Médico Nacional “La Raza”, Instituto Mexicano del Seguro Social; Azcapotzalco, Mexico City, Mexico
| | | | | | - Sofia Cruz-Martínez
- Adult Infectious Diseases Department, Hospital Regional de Alta Especialidad de Oaxaca, HRAEO; San Bartolo Coyotepec, Oaxaca, Mexico
| | - Oscar Flores-Barrientos
- Intensive Care Unit, Department of Internal Medicine, Hospital “Dr. Juan Graham Casasus”; Villahermosa, Tabasco, Mexico
| | - Jesús Enrique Gaytán-Martínez
- Department of Infectious Diseases, Hospital de Infectología del Centro Médico Nacional “La Raza”, Instituto Mexicano del Seguro Social; Azcapotzalco, Mexico City, Mexico
| | - Martín Magaña-Aquino
- Department of Internal Medicine, Hospital Central Dr. Ignacio Morones Prieto; San Luis Potosí, San Luis Potosí, Mexico
| | - Axel Cervantes-Sánchez
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; Tlalpan, Mexico City, Mexico
| | - Antonio Olivas-Martínez
- Department of Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; Tlalpan, Mexico City, Mexico
| | - Javier Araujo-Meléndez
- Department of Internal Medicine, Hospital Central Dr. Ignacio Morones Prieto; San Luis Potosí, San Luis Potosí, Mexico
| | - María del Rocío Reyes-Montes
- Mycology Unit, Department of Microbiology and Parasitology, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Esperanza Duarte-Escalante
- Mycology Unit, Department of Microbiology and Parasitology, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | | | - José Antonio Ramírez
- Mycology Unit, Department of Microbiology and Parasitology, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - María Lucia Taylor
- Mycology Unit, Department of Microbiology and Parasitology, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Alfredo Ponce de León-Garduño
- Department of Infectious Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; Tlalpan, Mexico City, Mexico
| | - José Sifuentes-Osornio
- Department of Medicine, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán; Tlalpan, Mexico City, Mexico
- * E-mail:
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Robles R, Rodríguez E, Vega-Ramírez H, Álvarez-Icaza D, Madrigal E, Durand S, Morales-Chainé S, Astudillo C, Real-Ramírez J, Medina-Mora ME, Becerra C, Escamilla R, Alcocer-Castillejos N, Ascencio L, Díaz D, González H, Barrón-Velázquez E, Fresán A, Rodríguez-Bores L, Quijada-Gaytán JM, Zabicky G, Tejadilla-Orozco D, González-Olvera JJ, Reyes-Terán G. Mental health problems among healthcare workers involved with the COVID-19 outbreak. ACTA ACUST UNITED AC 2020; 43:494-503. [PMID: 33331498 PMCID: PMC8555639 DOI: 10.1590/1516-4446-2020-1346] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 10/16/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The mental health problems and perceived needs of healthcare workers involved with coronavirus disease (COVID-19) may vary due to individual and contextual characteristics. The objective of this study was to evaluate healthcare workers' mental health problems during the common COVID-19 exposure scenario in Mexico, comparing those on the frontline with other healthcare workers according to gender and profession, determining the main risk factors for the most frequent mental health problems. METHODS A cross-sectional online study was conducted with a non-probabilistic sample of 5,938 Mexican healthcare workers who completed brief screening measures of mental health problems and ad hoc questions about sociodemographic professional characteristics, conditions related to increased risk of COVID-19 infection, life stressors during the COVID-19 emergency, and perceived need to cope with COVID-19. RESULTS The identified mental health problems were insomnia, depression, and posttraumatic stress disorder (PTSD), all of which were more frequent in frontline healthcare workers (52.1, 37.7, and 37.5%, respectively) and women (47.1, 33.0 %, and 16.3%, respectively). A lack of rest time was the main risk factor for insomnia (OR = 3.1, 95%CI 2.6-3.7, p ≤ 0.0001). Mourning the death of friends or loved ones due to COVID-19 was the main risk factor for depression (OR = 2.2, 95%CI 1.8-2.7, p ≤ 0.0001), and personal COVID-19 status was the main risk factor for PTSD (OR = 2.2, 95%CI 1.7-2.9, p ≤ 0.0001). CONCLUSION The most frequent mental health problems during the common exposure scenario for COVID-19 in Mexico included the short-term psychological consequences of intense adversity. A comprehensive strategy for preventing mental health problems should focus on individuals with cumulative vulnerability and specific risk factors.
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Affiliation(s)
- Rebeca Robles
- Centro de Investigación en Salud Mental Global, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, Mexico
| | - Evelyn Rodríguez
- Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias, Ciudad de México, Mexico
| | - Hamid Vega-Ramírez
- Centro de Investigación en Salud Mental Global, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, Mexico
| | - Dení Álvarez-Icaza
- Dirección de Servicios Clínicos, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, Mexico
| | - Eduardo Madrigal
- Dirección General, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, Mexico
| | - Sol Durand
- Dirección General, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, Mexico
| | - Silvia Morales-Chainé
- Facultad de Psicología Universidad Nacional Autónoma de México, Ciudad de México, Mexico
| | - Claudia Astudillo
- Servicios de Atención Psiquiátrica, Secretaría de Salud, Ciudad de México, Mexico
| | - Janet Real-Ramírez
- Cetro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Ciudad de México, México
| | - María-Elena Medina-Mora
- Centro de Investigación en Salud Mental Global, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, Mexico.,Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, Mexico
| | - Claudia Becerra
- Dirección de Servicios Clínicos, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, Mexico
| | - Raúl Escamilla
- Dirección de Servicios Clínicos, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, Mexico
| | - Natasha Alcocer-Castillejos
- Departamento de Neurología y Psiquiatría, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, Mexico
| | - Leticia Ascencio
- Unidad de Cuidados Paliativos, Instituto Nacional de Cancerología, Ciudad de México, Mexico
| | - Dulce Díaz
- Centro de Investigación en Salud Mental Global, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, Mexico
| | - Hugo González
- Clínica de Trastornos Adictivos, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, Mexico
| | | | - Ana Fresán
- Subdirección de Investigación Clínica, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, Mexico
| | | | | | - Gady Zabicky
- Dirección General, Comisión Nacional contra las Adicciones, Ciudad de México, Mexico
| | | | | | - Gustavo Reyes-Terán
- Comisión Coordinadora de Institutos Nacional de Salud y Hospitales de Alta Especialidad, Secretaría de Salud, Ciudad de México, Mexico
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34
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Borrayo-Sánchez G, Alcocer-Gamba MA, Araiza-Garaygordobil D, Arias-Mendoza A, Aubanel-Riedel P, Cortés-Lawrenz J, González-Juanatey JR, Gutiérrez-Fajardo P, Martín-Hernández P, Martínez-Ramírez L, Merino-Rajme JA, Muñoz-Carrillo JM, López-Pais J, Robles-Rangel MA, Rosas-Peralta M, Rangel-Velázquez R, Palami-Antúnez D, López-Ridaura R, Reyes-Terán G. Guía práctica interinstitucional para el tratamiento del infarto agudo de miocardio. GAC MED MEX 2020. [DOI: 10.24875/gmm.20000372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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35
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Osuna-Padilla I, Aguilar-Vargas A, Rodríguez-Moguel NC, Villazón-De la Rosa A, Osuna-Ramírez I, Ormsby CE, Reyes-Terán G. Resting energy expenditure in HIV/AIDS patients: Development and validation of a predictive equation. Clin Nutr ESPEN 2020; 40:288-292. [PMID: 33183552 DOI: 10.1016/j.clnesp.2020.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 08/23/2020] [Accepted: 09/02/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Accurate measurements of resting energy expenditure (REE) are important for determining nutritional needs in HIV patients. Indirect calorimetry (IC) is a noninvasive method that reflects REE but can be costly and is frequently calculated with predictive equations. Research suggests that REE obtained by predictive equations in people living with HIV/AIDS (PLWH) is inaccurate. The aim of the study is to develop and validate a new predictive equation of REE based on a population of PLWH. METHODS Cross-sectional study including 164 PLWH (82 to develop and 82 to validate the equation). Multiple linear regression was used to determine the relationship between variables and to develop the new predictive equation. Intraclass correlation coefficient (ICC) and Bland-Altman methods were used to evaluate agreement between the new predictive equation and indirect calorimetry. RESULTS A new predictive equation with an accuracy of 67% when compared with IC was developed. This equation included as covariates: fat free mass, antiretroviral therapy status and age. CONCLUSION A new equation to predict energy expenditure in PLWH was developed and validated. This formula can be used to estimate REE if IC is not available.
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Affiliation(s)
- Iván Osuna-Padilla
- Centro de Investigaciones en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - Adriana Aguilar-Vargas
- Centro de Investigaciones en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico.
| | - Nadia C Rodríguez-Moguel
- Centro de Investigaciones en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - Andrea Villazón-De la Rosa
- Centro de Investigaciones en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - Ignacio Osuna-Ramírez
- Facultad de Ciencias Químico Biológicas, Universidad Autónoma de Sinaloa, Culiacán, Sinaloa, Mexico
| | - Christopher E Ormsby
- Centro de Investigaciones en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - Gustavo Reyes-Terán
- Centro de Investigaciones en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
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36
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Diéguez-Campa CE, Pérez-Neri I, Reyes-Terán G, Flores-Apodaca IA, Castillo-Ledón-Pretelini J, Mercado-Bautista O, Álvarez-Santana R, Zenteno MA, Bowles B, Lee Á. The 2020 research pandemic: A bibliometric analysis of publications on COVID-19 and their scientific impact during the first months. Arch Cardiol Mex 2020; 91:001-011. [PMID: 33147597 PMCID: PMC10161849 DOI: 10.24875/acm.20000370] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The outbreak of COVID-19 has created a landslide of publications, from different sources and unequal impact. We considered that the first 3 months are crucial to understand how knowledge has been generated by performing a bibliometric analysis, including the citations to these articles to guide researchers in exploring this field, and to evaluate the relationship between confirmed COVID-19 cases and deaths with the number of papers per country. METHODS Scientific publications were obtained from PubMed (January-March 2020) and their citations during the first 6 months retrieved from the Scopus database. An analysis of the number of papers by country, approach (type and category of publication), and impact was made. A multiple linear regression model was implemented to analyze the correlation between the number of publications and confirmed cases and deaths. RESULTS A total of 2,530 publications were analyzed with 59,104 citations (23.4 citations/article), written by authors from 67 countries. China was the country with more publications (988, 39%) and more citations (36,416, 63%) followed by the United States with 423 articles (16.7%) and 7,458 citations (12.6%). The coauthorship network identified 10,756 authors. According to the multivariate analysis, both confirmed cases and deaths were significantly correlated with the number of publications per country (corrected by population size and gross domestic product). CONCLUSION The correlation with the number of publications suggests that cases and deaths had some impact on the medical literature, reflecting how rapidly the scientific community has been on the frontline in the fight against COVID-19.
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Affiliation(s)
- Carlos E Diéguez-Campa
- Department of Neurochemistry, National Institute of Neurology and Neurosurgery, Mexico City; Institute of Biomedical Sciences, Autonomous University of Ciudad Juárez, Chihuahua, Ciudad Juárez; Mexico
| | - Ivan Pérez-Neri
- Department of Neurochemistry, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Gustavo Reyes-Terán
- Coordination of National Institutes of Health and High Specialty Hospitals, Mexico City, Mexico
| | - Iliana A Flores-Apodaca
- Institute of Biomedical Sciences, Autonomous University of Ciudad Juárez, Chihuahua, Ciudad Juárez, Department of Human Genetics, National Institute of Pediatrics, Mexico City, Mexico
| | - Jorge Castillo-Ledón-Pretelini
- Unit of Research in Metabolic Diseases (UIEM), National Institute of Medical Sciences and Nutrition, Mexico City; Autonomous Metropolitan University, Xochimilco Unit, Mexico City, Mexico
| | - Omar Mercado-Bautista
- Unit of Health Sciences. Veracruzana University, Poza Rica de Hidalgo, Veracruz; Sleep Medicine Unit. National Institute of Respiratory Diseases, Mexico City, Mexico
| | - Ricardo Álvarez-Santana
- Institute of Biomedical Sciences, Autonomous University of Ciudad Juárez, Chihuahua, Ciudad Juárez; Department of Nuclear Cardiology. National Institute of Cardiology, Mexico City, Mexico
| | - Marco A Zenteno
- Department of Endovascular Neurological Therapy. National Institute of Neurology and Neurosurgery, Mexico City
| | - Brigham Bowles
- Department of Endovascular Neurological Therapy. National Institute of Neurology and Neurosurgery, Mexico City; Westhill University, Mexico City, Cuajimalpa. Mexico
| | - Ángel Lee
- Coordination of National Institutes of Health and High Specialty Hospitals, Mexico City, Mexico
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37
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Curty G, Beckerle GA, Iñiguez LP, Furler RL, de Carvalho PS, Marston JL, Champiat S, Heymann JJ, Ormsby CE, Reyes-Terán G, Soares MA, Nixon DF, Bendall ML, Leal FE, de Mulder Rougvie M. Human Endogenous Retrovirus Expression Is Upregulated in the Breast Cancer Microenvironment of HIV Infected Women: A Pilot Study. Front Oncol 2020; 10:553983. [PMID: 33194615 PMCID: PMC7649802 DOI: 10.3389/fonc.2020.553983] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 09/17/2020] [Indexed: 12/21/2022] Open
Abstract
In people living with HIV (PLWH), chronic inflammation can lead to cancer initiation and progression, besides driving a dysregulated and diminished immune responsiveness. HIV infection also leads to increased transcription of Human Endogenous Retroviruses (HERVs), which could increase an inflammatory environment and create a tumor growth suppressive environment with high expression of pro-inflammatory cytokines. In order to determine the impact of HIV infection to HERV expression on the breast cancer microenvironment, we sequenced total RNA from formalin-fixed paraffin-embedded (FFPE) breast cancer samples of women HIV-negative and HIV-positive for transcriptome and retrotranscriptome analyses. We performed RNA extraction from FFPE samples, library preparation and total RNA sequencing (RNA-seq). The RNA-seq analysis shows 185 differentially expressed genes: 181 host genes (178 upregulated and three downregulated) and four upregulated HERV transcripts in HIV-positive samples. We also explored the impact of HERV expression in its neighboring breast cancer development genes (BRCA1, CCND1, NBS1/NBN, RAD50, KRAS, PI3K/PIK3CA) and in long non-coding RNA expression (AC060780.1, also known as RP11-242D8.1). We found a significant positive association of HERV expression with RAD50 and with AC060780.1, which suggest a possible role of HERV in regulating breast cancer genes from PLWH with breast cancer. In addition, we found immune system, extracellular matrix organization and metabolic signaling genes upregulated in HIV-positive breast cancer. In conclusion, our findings provide evidence of transcriptional and retrotranscriptional changes in breast cancer from PLWH compared to non-HIV breast cancer, including dysregulation of HERVs, suggesting an indirect effect of the virus on the breast cancer microenvironment.
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Affiliation(s)
- Gislaine Curty
- Oncovirology Program, Instituto Nacional de Câncer, Rio de Janeiro, Brazil
| | - Greta A Beckerle
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, NY, United States
| | - Luis P Iñiguez
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, NY, United States
| | - Robert L Furler
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, NY, United States
| | | | - Jez L Marston
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, NY, United States
| | - Stephane Champiat
- Drug Development Department (DITEP), Gustave Roussy, Paris-Saclay University, Villejuif, France
| | - Jonas J Heymann
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, United States
| | - Christopher E Ormsby
- Center for Research in Infectious Diseases (CIENI), National Institute of Respiratory Diseases (INER), Mexico City, Mexico
| | - Gustavo Reyes-Terán
- Center for Research in Infectious Diseases (CIENI), National Institute of Respiratory Diseases (INER), Mexico City, Mexico
| | - Marcelo A Soares
- Oncovirology Program, Instituto Nacional de Câncer, Rio de Janeiro, Brazil
| | - Douglas F Nixon
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, NY, United States
| | - Matthew L Bendall
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, NY, United States
| | - Fabio E Leal
- Oncovirology Program, Instituto Nacional de Câncer, Rio de Janeiro, Brazil
| | - Miguel de Mulder Rougvie
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, NY, United States
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38
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Vrancken B, Mehta SR, Ávila-Ríos S, García-Morales C, Tapia-Trejo D, Reyes-Terán G, Navarro-Álvarez S, Little SJ, Hoenigl M, Pines HA, Patterson T, Strathdee SA, Smith DM, Dellicour S, Chaillon A. Dynamics and Dispersal of Local HIV Epidemics Within San Diego and Across The San Diego-Tijuana Border. Clin Infect Dis 2020; 73:e2018-e2025. [PMID: 33079188 DOI: 10.1093/cid/ciaa1588] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Evolutionary analyses of well-annotated HIV sequence data can provide insights into viral transmission patterns and associated factors. Here, we explored the transmission dynamics of the HIV-1 subtype B epidemic across the San Diego (US) - Tijuana (Mexico) border region to identify factors that could help guide public health policy. METHODS HIV pol sequences were collected from people with HIV in San Diego County and from Tijuana between 1996-2018. A multistep phylogenetic approach was used to characterize the dynamics of spread. The contribution of geospatial factors and HIV risk group to the local dynamics were evaluated. RESULTS Phylogeographic analyses of the 2,034 sequences revealed an important contribution of local transmission in sustaining the epidemic, as well as a complex viral migration network across the region. Geospatial viral dispersal between San Diego communities occurred predominantly among men-who-have-sex with-men with central San Diego being the main source (34.9%) and recipient (39.5%) of migration events. HIV migration was more frequent from San Diego county towards Tijuana than vice versa. Migrations were best explained by driving time between locations. CONCLUSION The US-Mexico border may not be a major barrier to the spread of HIV, which may stimulate coordinated transnational intervention approaches. Whereas a focus on central San Diego has the potential to avert most spread, the substantial viral migration independent of central San Diego shows that county-wide efforts will be more effective. Combined, this work shows that epidemiological information gleaned from pathogen genomes can uncover mechanisms that underlie sustained spread and, in turn, can be a building block of public health decision making.
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Affiliation(s)
- Bram Vrancken
- Department of Microbiology, Immunology and Transplantation, Rega Institute, Laboratory for Computational and Evolutionary Virology, KU Leuven, Herestraat, Leuven, Belgium
| | - Sanjay R Mehta
- Division of Infectious Diseases and Global Public Health, University of California San Diego, CA
| | - Santiago Ávila-Ríos
- Centre for Research in Infectious Diseases, National Institute of Respiratory Diseases, Calzada de Tlalpan, Colonia Sección XVI, CP, Mexico City, Mexico
| | - Claudia García-Morales
- Centre for Research in Infectious Diseases, National Institute of Respiratory Diseases, Calzada de Tlalpan, Colonia Sección XVI, CP, Mexico City, Mexico
| | - Daniela Tapia-Trejo
- Centre for Research in Infectious Diseases, National Institute of Respiratory Diseases, Calzada de Tlalpan, Colonia Sección XVI, CP, Mexico City, Mexico
| | - Gustavo Reyes-Terán
- Coordinating Commission of the Mexican National Institutes of Health, Periférico Sur, Arenal Tepepan, Mexico City, Mexico
| | | | - Susan J Little
- Division of Infectious Diseases and Global Public Health, University of California San Diego, CA
| | - Martin Hoenigl
- Division of Infectious Diseases and Global Public Health, University of California San Diego, CA
| | - Heather A Pines
- Division of Infectious Diseases and Global Public Health, University of California San Diego, CA
| | - Thomas Patterson
- Division of Infectious Diseases and Global Public Health, University of California San Diego, CA
| | - Steffanie A Strathdee
- Division of Infectious Diseases and Global Public Health, University of California San Diego, CA
| | - Davey M Smith
- Division of Infectious Diseases and Global Public Health, University of California San Diego, CA
| | - Simon Dellicour
- Department of Microbiology, Immunology and Transplantation, Rega Institute, Laboratory for Computational and Evolutionary Virology, KU Leuven, Herestraat, Leuven, Belgium.,Spatial Epidemiology Lab (SpELL), Université Libre de Bruxelles, av. FD Roosevelt, Bruxelles, Belgium
| | - Antoine Chaillon
- Division of Infectious Diseases and Global Public Health, University of California San Diego, CA
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39
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Wu VH, Nobles CL, Kuri-Cervantes L, McCormick K, Everett JK, Nguyen S, Del Rio Estrada PM, González-Navarro M, Torres-Ruiz F, Ávila-Ríos S, Reyes-Terán G, Bushman FD, Betts MR. Assessment of HIV-1 integration in tissues and subsets across infection stages. JCI Insight 2020; 5:139783. [PMID: 32970634 PMCID: PMC7605534 DOI: 10.1172/jci.insight.139783] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 09/17/2020] [Indexed: 12/19/2022] Open
Abstract
The integration of HIV DNA into the host genome contributes to lifelong infection in most individuals. Few studies have examined integration in lymphoid tissue, where HIV predominantly persists before and after antiretroviral treatment (ART). Of particular interest is whether integration site distributions differ between infection stages with paired blood and tissue comparisons. Here, we profiled HIV integration site distributions in sorted memory, tissue-resident, and/or follicular helper CD4+ T cell subsets from paired blood and lymphoid tissue samples from acute, chronic, and ART-treated individuals. We observed minor differences in the frequency of nonintronic and nondistal intergenic sites, varying with tissue and residency phenotypes during ART. Genomic and epigenetic annotations were generally similar. Clonal expansion of cells marked by identical integration sites was detected, with increased detection in chronic and ART-treated individuals. However, overlap between or within CD4+ T cell subsets or tissue compartments was only observed in 8 unique sites of the 3540 sites studied. Together, these findings suggest that shared integration sites between blood and tissue may, depending on the tissue site, be the exception rather than the rule and indicate that additional studies are necessary to fully understand the heterogeneity of tissue-sequestered HIV reservoirs.
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Affiliation(s)
- Vincent H Wu
- Department of Microbiology and.,Institute for Immunology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Leticia Kuri-Cervantes
- Department of Microbiology and.,Institute for Immunology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | | | - Son Nguyen
- Department of Microbiology and.,Institute for Immunology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Perla M Del Rio Estrada
- Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
| | - Mauricio González-Navarro
- Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
| | - Fernanda Torres-Ruiz
- Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
| | - Santiago Ávila-Ríos
- Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
| | - Gustavo Reyes-Terán
- Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
| | | | - Michael R Betts
- Department of Microbiology and.,Institute for Immunology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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40
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Nguyen S, Deleage C, Darko S, Ransier A, Truong DP, Agarwal D, Japp AS, Wu VH, Kuri-Cervantes L, Abdel-Mohsen M, Del Rio Estrada PM, Ablanedo-Terrazas Y, Gostick E, Hoxie JA, Zhang NR, Naji A, Reyes-Terán G, Estes JD, Price DA, Douek DC, Deeks SG, Buggert M, Betts MR. Elite control of HIV is associated with distinct functional and transcriptional signatures in lymphoid tissue CD8 + T cells. Sci Transl Med 2020; 11:11/523/eaax4077. [PMID: 31852798 DOI: 10.1126/scitranslmed.aax4077] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 09/03/2019] [Accepted: 11/11/2019] [Indexed: 12/21/2022]
Abstract
The functional properties of circulating CD8+ T cells have been associated with immune control of HIV. However, viral replication occurs predominantly in secondary lymphoid tissues, such as lymph nodes (LNs). We used an integrated single-cell approach to characterize effective HIV-specific CD8+ T cell responses in the LNs of elite controllers (ECs), defined as individuals who suppress viral replication in the absence of antiretroviral therapy (ART). Higher frequencies of total memory and follicle-homing HIV-specific CD8+ T cells were detected in the LNs of ECs compared with the LNs of chronic progressors (CPs) who were not receiving ART. Moreover, HIV-specific CD8+ T cells potently suppressed viral replication without demonstrable cytolytic activity in the LNs of ECs, which harbored substantially lower amounts of CD4+ T cell-associated HIV DNA and RNA compared with the LNs of CPs. Single-cell RNA sequencing analyses further revealed a distinct transcriptional signature among HIV-specific CD8+ T cells from the LNs of ECs, typified by the down-regulation of inhibitory receptors and cytolytic molecules and the up-regulation of multiple cytokines, predicted secreted factors, and components of the protein translation machinery. Collectively, these results provide a mechanistic framework to expedite the identification of novel antiviral factors, highlighting a potential role for the localized deployment of noncytolytic functions as a determinant of immune efficacy against HIV.
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Affiliation(s)
- Son Nguyen
- Department of Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Claire Deleage
- AIDS and Cancer Virus Program, Frederick National Laboratory for Cancer Research, Leidos Biomedical Research Inc., Frederick, MD 21702, USA
| | - Samuel Darko
- Human Immunology Section, Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Amy Ransier
- Human Immunology Section, Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Duc P Truong
- Department of Mathematics, Southern Methodist University, Dallas, TX 75205, USA
| | - Divyansh Agarwal
- Department of Statistics, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Alberto Sada Japp
- Department of Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Vincent H Wu
- Department of Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Leticia Kuri-Cervantes
- Department of Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | | | - Perla M Del Rio Estrada
- Departamento de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias, Mexico City 14080, Mexico
| | - Yuria Ablanedo-Terrazas
- Departamento de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias, Mexico City 14080, Mexico
| | - Emma Gostick
- Division of Infection and Immunity, Cardiff University School of Medicine, Cardiff CF14 4XN, UK
| | - James A Hoxie
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Nancy R Zhang
- Department of Statistics, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Ali Naji
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Gustavo Reyes-Terán
- Departamento de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias, Mexico City 14080, Mexico
| | - Jacob D Estes
- Vaccine and Gene Therapy Institute, Oregon Health and Science University, Portland, OR 97239, USA.,Division of Pathobiology and Immunology, Oregon National Primate Research Center, Oregon Health and Science University, Portland, OR 97239, USA
| | - David A Price
- Division of Infection and Immunity, Cardiff University School of Medicine, Cardiff CF14 4XN, UK
| | - Daniel C Douek
- Human Immunology Section, Vaccine Research Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
| | - Steven G Deeks
- Department of Medicine, University of California, San Francisco General Hospital, San Francisco, CA 94110, USA
| | - Marcus Buggert
- Department of Medicine Huddinge, Karolinska Institutet, Karolinska University Hospital Huddinge, 14186 Stockholm, Sweden
| | - Michael R Betts
- Department of Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.
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Del Alcazar D, Wang Y, He C, Wendel BS, Del Río-Estrada PM, Lin J, Ablanedo-Terrazas Y, Malone MJ, Hernandez SM, Frank I, Naji A, Reyes-Terán G, Jiang N, Su LF. Mapping the Lineage Relationship between CXCR5 + and CXCR5 - CD4 + T Cells in HIV-Infected Human Lymph Nodes. Cell Rep 2020; 28:3047-3060.e7. [PMID: 31533030 PMCID: PMC6878759 DOI: 10.1016/j.celrep.2019.08.037] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 05/27/2019] [Accepted: 08/09/2019] [Indexed: 12/29/2022] Open
Abstract
CXCR5 is a key marker of follicular helper T (TFH) cells. Using primary lymph nodes (LNs) from HIV-infected patients, we identified a population of CXCR5− CD4+ T cells with TFH-cell-like features. This CXCR5− subset becomes expanded in severe HIV infection and is characterized by the upregulation of activation markers and high PD-1 and ICOS surface expression. Integrated analyses on the phenotypic heterogeneity, functional capacity, T cell receptor (TCR) repertoire, transcriptional profile, and epigenetic state of CXCR5−PD-1+ICOS+ T cells revealed a shared clonal relationship with TFH cells. CXCR5−PD-1+ICOS+ T cells retained a poised state for CXCR5 expression and exhibited a migratory transcriptional program. TCR sequence overlap revealed a contribution of LN-derived CXCR5−PD-1+ICOS+ T cells to circulating CXCR5− CD4+ T cells with B cell help function. These data link LN pathology to circulating T cells and expand the current understanding on the diversity of T cells that regulate B cell responses during chronic inflammation. Follicular helper T (TFH) cells are critical for antibody production. Del Alcazar et al. showed that TFH cells can lose their characteristic chemokine receptor, giving rise to migratory populations of CXCR5− T cells that retain B cell help function and are poised for CXCR5 expression.
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Affiliation(s)
- Daniel Del Alcazar
- Department of Medicine, Division of Rheumatology, Philadelphia VA Medical Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA; Institute for Immunology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
| | - Yifeng Wang
- Department of Medicine, Division of Rheumatology, Philadelphia VA Medical Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA; Institute for Immunology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
| | - Chenfeng He
- Laboratory of Systems Immunology, Department of Biomedical Engineering, Cockrell School of Engineering, University of Texas at Austin, Austin, TX 78712, USA
| | - Ben S Wendel
- Laboratory of Systems Immunology, Department of Biomedical Engineering, Cockrell School of Engineering, University of Texas at Austin, Austin, TX 78712, USA; McKetta Department of Chemical Engineering, Cockrell School of Engineering, University of Texas at Austin, Austin, TX 78712, USA
| | - Perla M Del Río-Estrada
- Departamento de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias, Ciudad de México, México
| | - Jerome Lin
- Institute for Biomedical Informatics, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Yuria Ablanedo-Terrazas
- Departamento de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias, Ciudad de México, México
| | - Michael J Malone
- Laboratory of Systems Immunology, Department of Biomedical Engineering, Cockrell School of Engineering, University of Texas at Austin, Austin, TX 78712, USA; Institute for Cellular and Molecular Biology, College of Natural Sciences, University of Texas at Austin, Austin, TX 78712, USA
| | - Stefany M Hernandez
- Laboratory of Systems Immunology, Department of Biomedical Engineering, Cockrell School of Engineering, University of Texas at Austin, Austin, TX 78712, USA; McKetta Department of Chemical Engineering, Cockrell School of Engineering, University of Texas at Austin, Austin, TX 78712, USA
| | - Ian Frank
- Department of Medicine, Division of Infectious Disease, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
| | - Ali Naji
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA
| | - Gustavo Reyes-Terán
- Departamento de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias, Ciudad de México, México
| | - Ning Jiang
- Laboratory of Systems Immunology, Department of Biomedical Engineering, Cockrell School of Engineering, University of Texas at Austin, Austin, TX 78712, USA; Institute for Cellular and Molecular Biology, College of Natural Sciences, University of Texas at Austin, Austin, TX 78712, USA
| | - Laura F Su
- Department of Medicine, Division of Rheumatology, Philadelphia VA Medical Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA; Institute for Immunology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA.
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Alcocer-Gamba MA, Gutiérrez-Fajardo P, Cabrera-Rayo A, Sosa-Caballero A, Piña-Reyna Y, Merino-Rajme JA, Heredia-Delgado JA, Cruz-Alvarado JE, Galindo-Uribe J, Rogel-Martínez U, González-Hermosillo JA, Ávila-Vanzzini N, Sánchez-Carranza JA, Jímenez-Orozco JH, Sahagún-Sánchez G, Fanghänel-Salmón G, Albores-Figueroa R, Carrillo-Esper R, Reyes-Terán G, Cossio-Aranda JE, Borrayo-Sánchez G, de Los Ríos MO, Berni-Betancourt AC, Cortés-Lawrenz J, Leiva-Pons JL, Ortiz-Fernández PH, López-Cuellar J, Araiza-Garaygordobil D, Madrid-Miller A, Saturno-Chiu G, Beltrán-Nevárez O, Enciso-Muñoz JM, García-Rincón A, Pérez-Soriano P, Herrera-Gomar M, Rosal JJLD, Fajardo-Juárez AI, Olmos-Temois SG, Rodríguez-Reyes H, Ortiz-Galván F, Márquez-Murillo MF, Celaya-Cota MDJ, Cigarroa-López JA, Magaña-Serrano JA, Álvarez-Sangabriel A, Ruíz-Ruíz V, Chávez-Mendoza A, Méndez-Ortíz A, León-González S, Guízar-Sánchez C, Izaguirre-Ávila R, Grimaldo-Gómez FA, Preciado-Anaya A, Ruiz-Gastélum E, Fernández-Barros CL, Gordillo A, Alonso-Sánchez J, Cerón-Enríquez N, Núñez-Urquiza JP, Silva-Torres J, Pacheco-Beltrán N, García-Saldivia MA, Pérez-Gámez JC, Lezama-Urtecho C, López-Uribe C, López-Mora GE, Rivera-Reyes R. Excerpts from the documents of Mexican positions and recommendations in cardiovascular diseases and COVID-19. Arch Cardiol Mex 2020; 90:100-110. [PMID: 32523138 DOI: 10.24875/acm.m20000057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The recommendations in which the Mexican Society of Cardiology (SMC) in conjunction with the National Association of Cardiologists of Mexico (ANCAM) as well as different Mexican medical associations linked to cardiology are presented, after a comprehensive and consensual review and analysis of the topics related to cardiovascular diseases in the COVID-19 pandemic. Scientific positions are analyzed and responsible recommendations on general measures are given to patients, with personal care, healthy eating, regular physical activity, actions in case of cardio-respiratory arrest, protection of the patient and health personnel as well as precise indications in the use of non-invasive cardiovascular imaging, prescription of medications, care in specific topics such as systemic arterial hypertension, heart failure, arrhythmias and acute coronary syndromes, in addition to emphasizing electrophysiology, interventionism, cardiac surgery and in cardiac rehabilitation. The main interest is to provide the medical community with a general orientation on what to do in daily practice and patients with cardiovascular diseases in the setting of this unprecedented epidemiological crisis of COVID-19.
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Affiliation(s)
| | | | | | | | | | - José A Merino-Rajme
- Asociación Nacional de Cardiólogos al Servicio de los Trabajadores del Estado
| | | | | | | | | | | | | | | | | | | | | | | | | | - Gustavo Reyes-Terán
- Comisión Coordinadora de Institutos Nacionales de Salud y Hospales de Alta Especialidad
| | | | | | | | | | - Jorge Cortés-Lawrenz
- Sociedad Mexicana de Cardiología.,Sociedad de Cardiología Intervencionista de México
| | - José L Leiva-Pons
- Sociedad Mexicana de Cardiología.,Sociedad de Cardiología Intervencionista de México
| | | | - Julio López-Cuellar
- Sociedad Mexicana de Cardiología.,Sociedad de Cardiología Intervencionista de México
| | | | | | | | | | - José M Enciso-Muñoz
- Asociación Mexicana para la Prevención de la Ateroesclerosis y sus Complicaciones
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Andrés Preciado-Anaya
- Sociedad Mexicana de Cardiología.,Sociedad de Cardiología Intervencionista de México
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Piña-Reyna Y, García-Rincón A, Ortiz-Fernández P PH, Alcocer-Gamba MA, Gutiérrez-Fajardo P, Merino-Rajme JA, Reyes-Terán G. Care of acute coronary syndromes during the health contingency due to a SARS-CoV-2 outbreak. Arch Cardiol Mex 2020; 90:33-35. [PMID: 32523135 DOI: 10.24875/acm.m20000062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The communications accumulated in the last weeks make it clear that there is no agreement to define the best treatment strategy in patients with acute coronary syndrome (SICA). In patients presenting with an acute myocardial infarction with ST-segment elevation (IAMCESST), it has been suggested to favor fibrinolysis (FL) over primary percutaneous coronary intervention (PCI), reserving ICP for cases of failed FL1,2; however, some societies have maintained the indication of the ICPp as the repercussion method of choice3. In SICAs without ST segment elevation (SICASESST) the recommendations are very similar, favoring medical treatment over percutaneous coronary intervention in this subgroup of patients1. Several companies consider the contagion status, particularly in the SICASESST, to decide which repercussion follow3. Anticipating that the epidemiological curve in Mexico will be similar to that observed in most countries, we recommend continuing the care of patients with SICA, the catheterization rooms must maintain their operation.
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Affiliation(s)
- Yigal Piña-Reyna
- Instituto Nacional de Cardiología "Ignacio Chávez", Secretaria de Salud, Ciudad de México, México.,Sociedad de Cardiología Intervencionista de México
| | - Andrés García-Rincón
- Sociedad de Cardiología Intervencionista de México.,Hospital de Especialidades Dr. Antonio Fraga Mouret del Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Ciudad de México, México, Sociedad de Cardiología Intervencionista de México
| | - Patricio H Ortiz-Fernández P
- Instituto Nacional de Cardiología "Ignacio Chávez", Secretaria de Salud, Ciudad de México, México.,Sociedad de Cardiología Intervencionista de México
| | - Marco A Alcocer-Gamba
- Sociedad de Cardiología Intervencionista de México.,Instituto de Corazón de Querétaro, Facultad de Medicina, UAQ, Querétaro.,Sociedad Mexicana de Cardiología
| | - Pedro Gutiérrez-Fajardo
- Hospitales Mac Bernardette y Sanatorio San Francisco de Asis, Guadalajara, Jalisco, México.,Asociación Nacional de Cardiólogos de México
| | - José A Merino-Rajme
- Sociedad de Cardiología Intervencionista de México.,Sociedad Mexicana de Cardiología.,Servicio de Hemodinamia, Centro Médico Nacional 20 de Noviembre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Ciudad de México, México. Asociación Nacional de Cardiólogos al Servicio de los Trabajadores del Estado (ANCISSSTE)
| | - Gustavo Reyes-Terán
- Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias Ismael Cosió Villegas, Secretaría de Salud. Ciudad de México, México, Comisión Coordinadora de Institutos Nacionales de Salud y Hospitales de Alta Especialidad (CCINSHAE)
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Alvarado-de-la-Barrera C, Reyes-Terán G. How to Avoid Predatory Publishing. Rev Invest Clin 2020; 73:006-007. [PMID: 33053564 DOI: 10.24875/ric.20000221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 05/18/2020] [Indexed: 06/11/2023]
Abstract
The open access (OA) publishing, where a reader- pays economy has been replaced by an author-pays model, began at the end of the 20th century. This movement arose as an attempt to avoid excessive costs and copyright transfer agreements inherent to the subscription model.
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Affiliation(s)
- Claudia Alvarado-de-la-Barrera
- Centro de Investigación en Enfermedades Infecciosas (CIENI), Instituto Nacional de Enfermedades Respiratorias Ismael Cosío Villegas, Mexico City, Mexico
| | - Gustavo Reyes-Terán
- Comisión Coordinadora de Institutos Nacionales de Salud y Hospitales de Alta Especialidad, Mexico City, Mexico
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Salgado G, Del Río - Estrada PM, Avila-Ríos S, Reyes-Terán G. CCR4 and CCR6 Expression Characterizes Memory Tregs Subsets During HIV Infection and Correlates with Disease Progression. The Journal of Immunology 2020. [DOI: 10.4049/jimmunol.204.supp.94.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Abstract
Chemokine receptor expression on Tregs has been associated with pathogenesis of several diseases such as cancer, as CCR4 promotes Treg recruitment into tumors. During HIV infection, continuous Treg stimulation due to chronic inflammation has negative effects such as tissue fibrosis and limited antiviral response. We studied CCR4, CCR6, CXCR3 and CXCR5 on Treg subsets to identify homing patterns during HIV disease.
CD4+ T cells (Tc) from 33 chronic untreated (CHR) and 52 antiretroviral treated (ART) HIV donors were characterized by FACS using memory markers. Tregs were defined as CD127lowCD25hi. Analysis was performed on Cytobank and Prism 6 using non-parametric tests.
Tregs represented 7.0% and 8.0% of total CD4+ Tc in CHR and ART, respectively. Average Treg memory subsets distribution in CHR vs. ART was: Tscm=17.2% vs. 15.3%, Tcm=30.7% vs. 36.3% (p=0.0008), Ttm=27.4% vs. 25.7%. Chemokine receptor expression on total Tregs was (CHR vs. ART): R4=46.9% vs. 55.2% (p=0.0261), R6=31.6% vs. 40.1% (p=0.0043), X3=20.8% vs. 20.9% and X5=7.6% vs. 10.3%. In CHR, R4 (p=0.0007 r=0.3161) and R6 (p=0.0054 r=0.2241) frequencies correlated with CD4+ Tc count. Both markers were preferentially found on memory Treg (Tcm: R4=70.5%, R6=51.2%; Ttm: R4=93.4%, R6=65.7%) and had a significantly lower expression on non-Treg subsets (Tcm: R4=43.2%, R6=46.9%; Ttm: R4=37.0%, R6=29.9%). A similar pattern was also observed in people on ART.
We showed that Tregs are characterized by R4 and R6 expression during treated and untreated HIV infection. Both molecules are markedly found on memory phenotypes, suggesting a role in controlling homing of effector Tregs. Accumulation of R4+R6+ Tregs may reflect a response to control chronic activation that persists after ART.
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Valdespino-Vázquez MY, Sevilla-Reyes EE, Lira R, Yocupicio-Monroy M, Piten-Isidro E, Boukadida C, Hernández-Pando R, Soriano-Jimenez JD, Herrera-Salazar A, Figueroa-Damián R, Reyes-Terán G, Zamora-Escudero R, Cardona-Pérez JA, Maldonado-Rodríguez A, Moreno-Verduzco ER, Torres-Flores JM. Congenital Zika Syndrome and Extra-Central Nervous System Detection of Zika Virus in a Pre-term Newborn in Mexico. Clin Infect Dis 2020; 68:903-912. [PMID: 30188990 PMCID: PMC6399440 DOI: 10.1093/cid/ciy616] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 07/30/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND During pregnancy, the Zika virus (ZIKV) replicates in the placenta and central nervous system (CNS) of infected fetuses; nevertheless, the ability of ZIKV to replicate in other fetal tissues has not been extensively characterized. METHODS We researched whether dissemination of congenitally-acquired ZIKV outside the CNS exists by searching for the accumulation of the viral envelope protein, ZIKV ribonucleic acid (RNA), and infectious viral particles in different organs of a deceased newborn with Congenital Zika Syndrome. A real-time qualitative polymerase chain reaction (qPCR) was used to detect ZIKV RNA in the brain, thymus, lungs, kidneys, adrenal glands, spleen, liver, and small intestine. The same tissues were analyzed by indirect immunofluorescence and immunoperoxidase assays using the monoclonal antibody 4G2 to detect ZIKV envelope antigens. Isolation of infectious ZIKV in a cell culture was carried out using brain and kidney samples. RESULTS A postmortem, virological analysis of multiple organs, such as the kidneys (epithelial cells in the renal tubules), lungs (bronchial epithelia), thymus (epithelial cells inside the Hassall's corpuscles), and brain (neurons, ependymal cells, and macrophages) revealed the presence of ZIKV RNA and envelope antigens. Other tissues of the deceased newborn tested positive by qPCR for Epstein-Barr virus and human herpesvirus 6, including the brain cortex (Epstein-Barr) and the thymus, kidneys, and adrenal glands (human herpesvirus 6). The kidneys were identified as a significant niche for viral replication, given that infectious particles were successfully isolated from renal tissues. CONCLUSIONS Our findings demonstrate the ability of congenitally-acquired ZIKV to produce disseminated infections and the viral tropism towards epithelial cells.
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Affiliation(s)
| | - Edgar E Sevilla-Reyes
- Departamento de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias, Ciudad de Mexico, México
| | - Rosalia Lira
- Unidad de Investigación Médica en Enfermedades Infecciosas y Parasitarias, Unidad Médica de Alta Especialidad Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de Mexico, México
| | - Martha Yocupicio-Monroy
- Universidad Autónoma de la Ciudad de México, Posgrado en Ciencias Genómicas, Ciudad de Mexico, México
| | - Elvira Piten-Isidro
- Departamento de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias, Ciudad de Mexico, México
| | - Celia Boukadida
- Departamento de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias, Ciudad de Mexico, México
| | - Rogelio Hernández-Pando
- Sección de Patología Experimental, Departamento de Patología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de Mexico, México
| | | | | | | | - Gustavo Reyes-Terán
- Departamento de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias, Ciudad de Mexico, México
| | | | | | - Angélica Maldonado-Rodríguez
- Unidad de Investigación Médica en Enfermedades Infecciosas y Parasitarias, Unidad Médica de Alta Especialidad Hospital de Pediatría, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Ciudad de Mexico, México
| | - Elsa Romelia Moreno-Verduzco
- Subdirección de Servicios Auxiliares de Diagnóstico, Instituto Nacional de Perinatología, Ciudad de Mexico, México
| | - Jesús Miguel Torres-Flores
- Laboratorio de Virología, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Ciudad de Mexico, México
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Matías-Florentino M, Chaillon A, Ávila-Ríos S, Mehta SR, Paz-Juárez HE, Becerril-Rodríguez MA, del Arenal-Sánchez SJ, Piñeirúa-Menéndez A, Ruiz V, Iracheta-Hernández P, Macías-González I, Tena-Sánchez J, Badial-Hernández F, González-Rodríguez A, Reyes-Terán G. Pretreatment HIV drug resistance spread within transmission clusters in Mexico City. J Antimicrob Chemother 2020; 75:656-667. [PMID: 31819984 PMCID: PMC7021100 DOI: 10.1093/jac/dkz502] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 10/28/2019] [Accepted: 11/05/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Pretreatment HIV drug resistance (HIVDR) to NNRTIs has consistently increased in Mexico City during the last decade. OBJECTIVES To infer the HIV genetic transmission network in Mexico City to describe the dynamics of the local HIV epidemic and spread of HIVDR. PATIENTS AND METHODS HIV pol sequences were obtained by next-generation sequencing from 2447 individuals before initiation of ART at the largest HIV clinic in Mexico City (April 2016 to June 2018). Pretreatment HIVDR was estimated using the Stanford algorithm at a Sanger-like threshold (≥20%). Genetic networks were inferred with HIV-TRACE, establishing putative transmission links with genetic distances <1.5%. We examined demographic associations among linked individuals with shared drug resistance mutations (DRMs) using a ≥ 2% threshold to include low-frequency variants. RESULTS Pretreatment HIVDR reached 14.8% (95% CI 13.4%-16.2%) in the cohort overall and 9.6% (8.5%-10.8%) to NNRTIs. Putative links with at least one other sequence were found for 963/2447 (39%) sequences, forming 326 clusters (2-20 individuals). The inferred network was assortative by age and municipality (P < 0.001). Clustering individuals were younger [adjusted OR (aOR) per year = 0.96, 95% CI 0.95-0.97, P < 0.001] and less likely to include women (aOR = 0.46, 95% CI 0.28-0.75, P = 0.002). Among clustering individuals, 175/963 (18%) shared DRMs (involving 66 clusters), of which 66/175 (38%) shared K103N/S (24 clusters). Eight municipalities (out of 75) harboured 65% of persons sharing DRMs. Among all persons sharing DRMs, those sharing K103N were younger (aOR = 0.93, 95% CI 0.88-0.98, P = 0.003). CONCLUSIONS Our analyses suggest age- and geographically associated transmission of DRMs within the HIV genetic network in Mexico City, warranting continuous monitoring and focused interventions.
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Affiliation(s)
- Margarita Matías-Florentino
- Centre for Research in Infectious Diseases, National Institute of Respiratory Diseases, Calzada de Tlalpan 4502, Colonia Sección XVI, CP 14080 Mexico City, Mexico
| | - Antoine Chaillon
- University of California San Diego, 9500 Gilman Drive 0679, La Jolla, CA 92093, USA
| | - Santiago Ávila-Ríos
- Centre for Research in Infectious Diseases, National Institute of Respiratory Diseases, Calzada de Tlalpan 4502, Colonia Sección XVI, CP 14080 Mexico City, Mexico
| | - Sanjay R Mehta
- University of California San Diego, 9500 Gilman Drive 0679, La Jolla, CA 92093, USA
| | - Héctor E Paz-Juárez
- Centre for Research in Infectious Diseases, National Institute of Respiratory Diseases, Calzada de Tlalpan 4502, Colonia Sección XVI, CP 14080 Mexico City, Mexico
| | - Manuel A Becerril-Rodríguez
- Centre for Research in Infectious Diseases, National Institute of Respiratory Diseases, Calzada de Tlalpan 4502, Colonia Sección XVI, CP 14080 Mexico City, Mexico
- Clínica Especializada Condesa, Gral, Benjamín Hill 24, Hipódromo Condesa, CP 06170 Mexico City, Mexico
| | - Silvia J del Arenal-Sánchez
- Centre for Research in Infectious Diseases, National Institute of Respiratory Diseases, Calzada de Tlalpan 4502, Colonia Sección XVI, CP 14080 Mexico City, Mexico
| | - Alicia Piñeirúa-Menéndez
- Clínica Especializada Condesa Iztapalapa, Av. Combate de Celaya S/N, Colonia Unidad Habitacional Vicente Guerrero, CP 09730 Mexico City, Mexico
| | - Verónica Ruiz
- Clínica Especializada Condesa, Gral, Benjamín Hill 24, Hipódromo Condesa, CP 06170 Mexico City, Mexico
| | - Patricia Iracheta-Hernández
- Clínica Especializada Condesa Iztapalapa, Av. Combate de Celaya S/N, Colonia Unidad Habitacional Vicente Guerrero, CP 09730 Mexico City, Mexico
| | - Israel Macías-González
- Clínica Especializada Condesa, Gral, Benjamín Hill 24, Hipódromo Condesa, CP 06170 Mexico City, Mexico
| | - Jehovani Tena-Sánchez
- Clínica Especializada Condesa, Gral, Benjamín Hill 24, Hipódromo Condesa, CP 06170 Mexico City, Mexico
| | - Florentino Badial-Hernández
- Clínica Especializada Condesa Iztapalapa, Av. Combate de Celaya S/N, Colonia Unidad Habitacional Vicente Guerrero, CP 09730 Mexico City, Mexico
| | - Andrea González-Rodríguez
- Clínica Especializada Condesa, Gral, Benjamín Hill 24, Hipódromo Condesa, CP 06170 Mexico City, Mexico
| | - Gustavo Reyes-Terán
- Centre for Research in Infectious Diseases, National Institute of Respiratory Diseases, Calzada de Tlalpan 4502, Colonia Sección XVI, CP 14080 Mexico City, Mexico
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48
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Furler RL, Newcombe KL, Del Rio Estrada PM, Reyes-Terán G, Uittenbogaart CH, Nixon DF. Histoarchitectural Deterioration of Lymphoid Tissues in HIV-1 Infection and in Aging. AIDS Res Hum Retroviruses 2019; 35:1148-1159. [PMID: 31474115 DOI: 10.1089/aid.2019.0156] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Impaired immunity is a common symptom of aging and advanced Human Immunodeficiency Virus type 1 (HIV-1) disease. In both diseases, a decline in lymphocytic function and cellularity leads to ineffective adaptive immune responses to opportunistic infections and vaccinations. Furthermore, despite sustained myeloid cellularity there is a background of chronic immune activation and a decrease in innate immune function in aging. In HIV-1 disease, myeloid cellularity is often more skewed than in normal aging, but similar chronic activation and innate immune dysfunction typically arise. Similarities between aging and HIV-1 infection have led to several investigations into HIV-1-mediated aging of the immune system. In this article, we review various studies that report alterations of leukocyte number and function during aging, and compare those alterations with those observed during progressive HIV-1 disease. We pay particular attention to changes within lymphoid tissue microenvironments and how histoarchitectural changes seen in these two diseases affect immunity. As we review various immune compartments including peripheral blood as well as primary and secondary lymphoid organs, common themes arise that help explain the decline of immunity in the elderly and in HIV-1-infected individuals with advanced disease. In both conditions, lymphoid tissues often show signs of histoarchitectural deterioration through fat accumulation and/or fibrosis. These structural changes can be attributed to a loss of communication between leukocytes and the surrounding stromal cells that produce the extracellular matrix components and growth factors necessary for cell migration, cell proliferation, and lymphoid tissue function. Despite the common general impairment of immunity in aging and HIV-1 progression, deterioration of immunity is caused by distinct mechanisms at the cellular and tissue levels in these two diseases.
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Affiliation(s)
- Robert L. Furler
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Kevin L. Newcombe
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Perla M. Del Rio Estrada
- Departmento de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias “Ismael Cosío Villegas,” CDMX, Mexico DF, Mexico
| | - Gustavo Reyes-Terán
- Departmento de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias “Ismael Cosío Villegas,” CDMX, Mexico DF, Mexico
| | - Christel H. Uittenbogaart
- Department of Microbiology, Immunology and Molecular Genetics, Medicine-Pediatrics, UCLA AIDS Institute and the Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, California
| | - Douglas F. Nixon
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, New York
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Bendall ML, de Mulder M, Iñiguez LP, Lecanda-Sánchez A, Pérez-Losada M, Ostrowski MA, Jones RB, Mulder LCF, Reyes-Terán G, Crandall KA, Ormsby CE, Nixon DF. Telescope: Characterization of the retrotranscriptome by accurate estimation of transposable element expression. PLoS Comput Biol 2019; 15:e1006453. [PMID: 31568525 PMCID: PMC6786656 DOI: 10.1371/journal.pcbi.1006453] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 10/10/2019] [Accepted: 09/17/2019] [Indexed: 12/20/2022] Open
Abstract
Characterization of Human Endogenous Retrovirus (HERV) expression within the transcriptomic landscape using RNA-seq is complicated by uncertainty in fragment assignment because of sequence similarity. We present Telescope, a computational software tool that provides accurate estimation of transposable element expression (retrotranscriptome) resolved to specific genomic locations. Telescope directly addresses uncertainty in fragment assignment by reassigning ambiguously mapped fragments to the most probable source transcript as determined within a Bayesian statistical model. We demonstrate the utility of our approach through single locus analysis of HERV expression in 13 ENCODE cell types. When examined at this resolution, we find that the magnitude and breadth of the retrotranscriptome can be vastly different among cell types. Furthermore, our approach is robust to differences in sequencing technology and demonstrates that the retrotranscriptome has potential to be used for cell type identification. We compared our tool with other approaches for quantifying transposable element (TE) expression, and found that Telescope has the greatest resolution, as it estimates expression at specific TE insertions rather than at the TE subfamily level. Telescope performs highly accurate quantification of the retrotranscriptomic landscape in RNA-seq experiments, revealing a differential complexity in the transposable element biology of complex systems not previously observed. Telescope is available at https://github.com/mlbendall/telescope. Almost half of the human genome is composed of transposable elements (TEs), but their contribution to the transcriptome, their cell-type specific expression patterns, and their role in disease remains poorly understood. Recent studies have found many elements to be actively expressed and involved in key cellular processes. For example, human endogenous retroviruses (HERVs) are reported to be involved in human embryonic stem cell differentiation. Discovering which exact HERVs are differentially expressed in RNA-seq data would be a major advance in understanding such processes. However, because HERVs have a high level of sequence similarity it is hard to identify which exact HERV is differentially expressed. To solve this problem, we developed a computer program which addressed uncertainty in fragment assignment by reassigning ambiguously mapped fragments to the most probable source transcript as determined within a Bayesian statistical model. We call this program, “Telescope”. We then used Telescope to identify HERV expression in 13 well-studied cell types from the ENCODE consortium and found that different cell types could be characterized by enrichment for different HERV families, and for locus specific expression. We also showed that Telescope performed better than other methods currently used to determine TE expression. The use of this computational tool to examine new and existing RNA-seq data sets may lead to new understanding of the roles of TEs in health and disease.
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Affiliation(s)
- Matthew L. Bendall
- Computational Biology Institute, Milken Institute School of Public Health, George Washington University, Washington, D.C., United States of America
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, N.Y., United States of America
- * E-mail:
| | - Miguel de Mulder
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, N.Y., United States of America
| | - Luis Pedro Iñiguez
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, N.Y., United States of America
- Center for Research in Infectious Diseases (CIENI), Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
| | - Aarón Lecanda-Sánchez
- Center for Research in Infectious Diseases (CIENI), Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
| | - Marcos Pérez-Losada
- Computational Biology Institute, Milken Institute School of Public Health, George Washington University, Washington, D.C., United States of America
- Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, George Washington University, Washington, D.C., United States of America
- CIBIO-InBIO, Centro de Investigação em Biodiversidade e Recursos Genéticos, Universidade do Porto, Campus Agrário de Vairão, Vairão, Portugal
| | - Mario A. Ostrowski
- Department of Immunology, University of Toronto, Toronto, Ontario, Canada
- Keenan Research Centre for Biomedical Science of St. Michael's Hospital, Toronto, Ontario, Canada
| | - R. Brad Jones
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, N.Y., United States of America
| | - Lubbertus C. F. Mulder
- Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
- The Global Health and Emerging Pathogens Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Gustavo Reyes-Terán
- Center for Research in Infectious Diseases (CIENI), Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
| | - Keith A. Crandall
- Computational Biology Institute, Milken Institute School of Public Health, George Washington University, Washington, D.C., United States of America
- Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health, George Washington University, Washington, D.C., United States of America
| | - Christopher E. Ormsby
- Center for Research in Infectious Diseases (CIENI), Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
| | - Douglas F. Nixon
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, N.Y., United States of America
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Cortés-Rubio CN, Salgado-Montes de Oca G, Prado-Galbarro FJ, Matías-Florentino M, Murakami-Ogasawara A, Kuri-Cervantes L, Carranco-Arenas AP, Ormsby CE, Cortés-Rubio IK, Reyes-Terán G, Ávila-Ríos S. Longitudinal variation in human immunodeficiency virus long terminal repeat methylation in individuals on suppressive antiretroviral therapy. Clin Epigenetics 2019; 11:134. [PMID: 31519219 PMCID: PMC6743183 DOI: 10.1186/s13148-019-0735-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 08/30/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Persistence of latent, replication-competent provirus in CD4+ T cells of human immunodeficiency virus (HIV)-infected individuals on antiretroviral treatment (ART) is the main obstacle for virus eradication. Methylation of the proviral 5' long terminal repeat (LTR) promoter region has been proposed as a possible mechanism contributing to HIV latency; however, conflicting observations exist regarding its relevance. We assessed 5'-LTR methylation profiles in total CD4+ T cells from blood of 12 participants on short-term ART (30 months) followed up for 2 years, and a cross-sectional group of participants with long-term ART (6-15 years), using next generation sequencing. We then looked for associations between specific 5'-LTR methylation patterns and baseline and follow-up clinical characteristics. RESULTS 5'-LTR methylation was observed in all participants and behaved dynamically. The number of 5'-LTR variants found per sample ranged from 1 to 13, with median sequencing depth of 16270× (IQR 4107×-46760×). An overall significant 5'-LTR methylation increase was observed at month 42 compared to month 30 (median CpG Methylation Index: 74.7% vs. 0%, p = 0.025). This methylation increase was evident in a subset of participants (methylation increase group), while the rest maintained fairly high and constant methylation (constant methylation group). Persons in the methylation increase group were younger, had higher CD4+ T cell gain, larger CD8% decrease, and larger CD4/CD8 ratio change after 48 months on ART (all p < 0.001). Using principal component analysis, the constant methylation and methylation increase groups showed low evidence of separation along time (factor 2: p = 0.04). Variance was largely explained (21%) by age, CD4+/CD8+ T cell change, and CD4+ T cell subpopulation proportions. Persons with long-term ART showed overall high methylation (median CpG Methylation Index: 78%; IQR 71-87%). No differences were observed in residual plasma viral load or proviral load comparing individuals on short-term (both at 30 or 42 months) and long-term ART. CONCLUSIONS Our study shows evidence that HIV 5'-LTR methylation in total CD4+ T cells is dynamic along time and that it can follow different temporal patterns that are associated with a combination of baseline and follow-up clinical characteristics. These observations may account for differences observed between previous contrasting studies.
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Affiliation(s)
- César N. Cortés-Rubio
- Centre for Research in Infectious Diseases, National Institute of Respiratory Diseases, Tlalpan 4502, 14080 Mexico City, Mexico
| | - Gonzalo Salgado-Montes de Oca
- Centre for Research in Infectious Diseases, National Institute of Respiratory Diseases, Tlalpan 4502, 14080 Mexico City, Mexico
| | | | - Margarita Matías-Florentino
- Centre for Research in Infectious Diseases, National Institute of Respiratory Diseases, Tlalpan 4502, 14080 Mexico City, Mexico
| | - Akio Murakami-Ogasawara
- Centre for Research in Infectious Diseases, National Institute of Respiratory Diseases, Tlalpan 4502, 14080 Mexico City, Mexico
| | - Leticia Kuri-Cervantes
- Department of Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
| | - Ana P. Carranco-Arenas
- Centre for Research in Infectious Diseases, National Institute of Respiratory Diseases, Tlalpan 4502, 14080 Mexico City, Mexico
| | - Christopher E. Ormsby
- Centre for Research in Infectious Diseases, National Institute of Respiratory Diseases, Tlalpan 4502, 14080 Mexico City, Mexico
| | | | - Gustavo Reyes-Terán
- Centre for Research in Infectious Diseases, National Institute of Respiratory Diseases, Tlalpan 4502, 14080 Mexico City, Mexico
| | - Santiago Ávila-Ríos
- Centre for Research in Infectious Diseases, National Institute of Respiratory Diseases, Tlalpan 4502, 14080 Mexico City, Mexico
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