Improved strategies for HIV diagnosis among men who have sex with men (MSM) in Buenos Aires, Argentina, a population with a high prevalence and incidence of HIV infection

BACKGROUND

In Argentina, HIV diagnosis in adults is made using one or two enzyme immunoassay tests and a confirmatory test. These strategies may fail to identify infected individuals during early primary infection, which represents an important public health problem among groups with a high HIV incidence, such as men who have sex with men (MSM) (6.3% persons/year). The general objective of this study was to contribute to reducing HIV transmission among MSM through the identification of antibody-negative, nucleic acid-positive individuals.

FINDINGS

A total of 1549 MSM were recruited for an HIV seroprevalence study. A total of 161 (10.4%) MSM were HIV-positive and 14 (0.9%) were indeterminate. Among the 1374 negative individuals, 16 (1.2%) exhibited reactive results in the screening assay. Indeterminate Western blot (WB) samples and negative WB samples (with discordant results in the screening) were analysed to detect HIV nucleic acid by viral load testing. Up to 23.1% of HIV-indeterminate WB samples and 7.1% of HIV-negative WB samples with discordant results in the screening assays had detectable nucleic acid. Overall, 14.8% of the samples with discordant or indeterminate results were identified as HIV-positive using direct diagnosis. With the identification of four new cases using the nucleic acid detection test, the HIV prevalence in MSM increased by 0.3% (from 10.4 to 10.7%).

CONCLUSIONS

The results of this study suggest the importance of including nucleic acid detection in the HIV algorithm for MSM with HIV-indeterminate WB results and those with HIV-negative WB results and discordant results in screening assays, in order to decrease HIV transmission among this population with a high HIV prevalence and incidence.

Two simultaneous hepatitis B virus epidemics among injecting drug users and men who have sex with men in Buenos Aires, Argentina: characterization of the first D/A recombinant from the American continent

Previous studies have revealed that hepatitis B virus (HBV)/D and HBV/F predominate among blood donors from Buenos Aires, Argentina. In the present study, blood samples from two high-risk groups were analysed: 160 corresponding to street- and hospital-recruited injecting drug users [81.2% showing the 'anti-hepatitis B core antigen (anti-HBc) only' serological pattern] and 20 to hepatitis B surface antigen (HBsAg)(+)/anti-HBc(+) men who have sex with men. HBV genotypes were assigned by polymerase chain reaction amplification followed by restriction fragment length polymorphism and confirmed by nucleotide sequencing of two different coding regions. HBV DNA was detected in 27 injecting drug users (16.9%, occult infection prevalence: 7.7%), and 14 men who have sex with men (70%). HBV/A prevailed among injecting drug users (81.8%) while HBV/F was predominant among men who have sex with men (57.1%). The high predominance of HBV/A among injecting drug users is in sharp contrast to its low prevalence among blood donors (P = 0.0006) and men who have sex with men (P = 0.0137). Interestingly, all HBV/A S gene sequences obtained from street-recruited injecting drug users encoded the rare serotype ayw1 and failed to cluster within any of the known A subgenotypes. Moreover, one of the HBV strains from a hospital-recruited injecting drug user was fully sequenced and found to be the first completely characterized D/A recombinant genome from the American continent. Data suggest that two simultaneous and independent HBV epidemics took place in Buenos Aires: one spreading among injecting drug users and another one sexually transmitted among the homosexual and heterosexual population.

Seroprevalence of and risk factors for HIV-1 infection among female commercial sex workers in South America

OBJECTIVE

Assessment of HIV prevalence and associated risk behaviours among female commercial sex workers (FCSW) across major cities in South America.

METHODS

Seroepidemiological, cross sectional studies of 13 600 FCSW were conducted in nine countries of South America during the years 1999-2002. Participants were recruited in brothels, massage parlours, hotels, and streets where anonymous questionnaires and blood samples were collected. HIV infection was determined by enzyme linked immunosorbent assay (ELISA) screening and western blot confirmatory tests.

RESULTS

The overall HIV seroprevalence was 1.2% (range 0.0%-4.5%). The highest HIV seroprevalences were reported in Argentina (4.5%) and Paraguay (2.6%); no HIV infected FCSW were detected in Venezuela and Chile. Consistent predictors of HIV seropositivity were: (1) a previous history of sexually transmitted infections (STI, AORs = 3.8-8.3), and (2) 10 years or more in commercial sex work (AORs = 2.2-24.8). In addition, multiple (> or =3) sexual contacts (AOR = 5.0), sex with foreigners (AOR = 6.9), use of illegal drugs (AOR = 3.2), and marijuana use (AOR = 8.2) were associated with HIV seropositivity in Southern Cone countries.

CONCLUSIONS

Consistently low HIV seroprevalences were detected among FCSW in South America, particularly in the Andean region. Predictors of HIV infection across the continent were STI and length of commercial sex work; however, use of illegal drugs, especially marijuana, and sexual contacts with foreigners were also found to be associated risk factors in the Southern Cone region. Interventions for the control of HIV and other STI need to be region and country specific; drug use appears to have an ever increasing role in the spread of HIV among heterosexually active populations.

Seroprevalence of and risk factors for HIV-1 infection among South American men who have sex with men

OBJECTIVES

Sex among men constitutes an important route of transmission for HIV type 1 (HIV-1) in Latin America. Seeking better understanding of risk behaviours in this region, we determined the seroprevalence, potential risk factors, and geographic distribution of HIV-1 among groups of men who have sex with men (MSM).

METHODS

Seroepidemiological, cross sectional studies of 13,847 MSM were conducted in seven countries of South America during the years 1999-2002. Volunteers were recruited in city venues and streets where anonymous questionnaires and blood samples were obtained. HIV-1 infection was determined by enzyme linked immunosorbent assay (ELISA) screening and western blot (WB) confirmatory tests.

RESULTS

HIV-1 seroprevalence varied widely (overall 12.3%, range 11.0%-20.6%). The highest HIV-1 seroprevalence was noted in Bolivia (20.6%) and the lowest in Peru (11.0%). Predictors of HIV-1 infection varied among countries; however, a history of previous sexually transmitted disease (STD) was associated with a consistent increased risk (ORs=1.9-2.9, AORs=1.8-2.7). Multiple weekly sexual contacts was found to represent a secondary risk factor in Ecuador, Peru, and Argentina (ORs=1.6-2.9, AORs=1.6-3.1), whereas use of drugs such as cocaine was found to increase risk in Bolivia, Uruguay, and Paraguay (ORs=2.5-6.5, AORs=2.6-6.1).

CONCLUSION

The results of this study illustrate an elevated HIV-1 seroprevalence among MSM participants from Andean countries. A previous STD history and multiple partners predicted HIV-1 infection in the seven countries of South America. In Southern Cone countries, HIV-1 infection was also associated with use of illegal drugs such as cocaine.

Documentation of subtype C HIV Type 1 strains in Argentina, Paraguay, and Uruguay

HIV subtypes B, F, and BF recombinants have been previously reported in South America. This report describes the presence of HIV-1 subtype C infection in the countries of Argentina, Uruguay, and Paraguay dating back to at least 1999. Surveillance for uncommon non-B/non-F subtype viruses circulating in South America has been conducted in samples obtained from nine countries. Peripheral blood mononuclear cells (PBMC), dried filter paper (FP), and fresh blood (FB) samples were collected from HIV-positive patients from Ecuador, Colombia, Venezuela, Peru, Chile, Bolivia, Argentina, Uruguay, and Paraguay. From a total of 2962 HIV seropositive samples examined during a 9-year period (1995-2003), only 11 (0.4%) were found to be infected with non-B/non-F HIV variants. Eight of these 11 strains were determined to be subtype C by heteroduplex mobility assay (HMA). Five of these 8 strains were further characterized by sequencing and phylogenetic analysis of the protease (Pro) and reverse transcriptase (RT) region of the genome and two were sequenced full length. One of the strains was found to be a unique BC recombinant. The spread of a third subtype of HIV, subtype C, should raise the question of its potential future role in the HIV epidemic in this region.

Long-lasting astrocyte reaction to persistent Junin virus infection of rat cortical neurons

Immunoperoxidase labeling was performed in histological sections from rat brain harvested during acute (10-30 days), clinically inapparent (90-270 days) and late (450-540 days) stages of Junin virus-induced neurological disease. In frontoparietal cortex, count of viral antigen (+) neurons peaked during the acute period (27.7+/-6.8), dropped within the intermediate (4.8+/-4.0 to 1.4+/-1.1) and increased (7.6+/-4.3) at the onset of the late neurological syndrome. In infected vs. control rats, the number of GFAP (+) astrocytes maximized during the acute stage (19+/-4 vs. 11+/-5), and from the end of the intermediate (27+/-5 vs. 21+/-5) up to the late (37+/-7 vs. 26+/-6) periods. In turn, surface density of GFAP (+) material in infected samples peaked at 0.196+/-0.066, while it failed to exceed 0.090+/-0.043 in controls. Both astrocyte hypertrophy relapsing into chronicity, as depicted by surface density, and astrocyte hyperplasia preceding the onset of the late neurological syndrome, support their pathogenic contribution to disease expression.

[Distribution of subtypes and recombinant of HIV. Situation in Argentina]

Soon after HIV (Human Immunodeficiency Virus) was discovered, its characteristics level of diversity and variability was established. So far, within HIV-1 it is known that there exist 3 main groups, 9 subtypes and at least 12 recombinant forms. Not only does this diversity affect taxonomy, but also prophylaxis and therapy for HIV infection. Numerous studies worldwide have demonstrated the influence this variability has on both diagnosis and monitoring assays as well as on the pathogenesis of HIV infection. In Argentina, from the molecular point of view, the epidemic shows a complex pattern. HIV-1 subtypes B and F have been described as well as a recombinant B/F form. Epidemiology and molecular data suggest high percentage levels and a great diversity of these recombinant forms in the heterosexual population.

Specific IgA detection can be used for perinatal diagnosis of HIV in children under protocol ACTG 076

Detection of anti-HIV-1 IgA antibodies using a modified ELISA test for the early diagnosis of perinatally acquired HIV-1 infection in children treated with protocol ACTG 076 was evaluated. A total of 177 sera were obtained from 141 infants between 1 and 12 months of age (46 were treated and 95 were non-treated with protocol ACTG 076) and tested for HIV IgA antibodies by an ELISA test after removal of IgG with recombinant protein G. Infants were classified according to CDC's classification system after a follow-up until 20 months of age. Of the 46 treated children 22 turned out to be infected and in the group of 95 untreated children, 52 were infected. All 81 samples from uninfected children treated or untreated with protocol ACTG 076 were persistently IgA-negative. HIV IgA antibodies were detected in 14 of 25 plasma samples from infected children with treatment, and in 58 of 71 samples in infected children without treatment. Considering that the sensitivity of this test is lower in children younger than 6 months the population of children studied was divided into two groups; those under and those over 6 months of age. No significant differences were observed in the detection of IgA in treated or untreated children in both age groups. The overall specificity of the test was 100 per cent; sensitivity in children older than 6 months was 76.92 per cent in treated children and 93.10 per cent in untreated children. In spite of the small number of samples studied it could be demonstrated that treatment with zidovudine does not affect the detection of IgA antibodies. This is a simple and inexpensive method that could be used for diagnosis of treated and untreated children in developing countries.

Resistance profiles to antiretroviral drugs in HIV-1 drug-naive patients in Argentina

The drug resistance profile of treatment-naive HIV-infected individuals living in Buenos Aires, Argentina, was studied. Samples taken from 94 drug-naive individuals with established HIV infection and 13 patients with primary HIV infection were assessed by nucleotide sequencing and LIPA. The prevalence of drug-associated primary mutations in individuals with established infection was very low. In the viral protease region, 1/86 (1.2%) individuals carried the D30N mutation, whereas 1/85 (1.2%) had the M41L mutation in the reverse transcriptase (RT) region. Secondary mutations in both the protease and RT regions were found in almost 90% of the individuals. In individuals with primary infection, primary mutations were detected in 2/13 (15.4%) patients, one of them carrying M461 mutation in the protease while the other patient had a mutation at codon 184 of the RT. In accordance with current drug resistance testing guidelines, the results of this study suggest that susceptibility tests need not be performed at this time prior to initiation of antiretroviral therapy in HIV-1-infected people in Argentina. However, the public health implications of this subject warrant follow-up studies that will examine a larger number of drug-naive patients, not only in Buenos Aires but also in other major Argentinian cities and in rural areas.

[HIV-1 virus transmission through maternal milk]

Human immunodeficiency virus type 1 (HIV-1) may be vertically transmitted during the pre, peri or postpartum period. Postnatal transmission as well as an increased risk of vertical transmission with breastfeeding has been shown for HIV-1 in several reports. Breastfeeding was here analyzed as a risk of HIV-1 transmission in a group of infants born to HIV-1 infected mothers. Among the 215 children studied in our population a significant difference was detected between those who were breastfed vs those who were bottle fed and finally became infected (p < 0.000000, R.R. = 4.29). We also report the case of a postnatal infection in a baby born to an HIV-1 seropositive father and a seronegative mother. Due to the risk of infection of the mother she had been thoroughly controlled when pregnant and after delivery. Mother and child were negative when retested at delivery, and at 10 months post-partum. At the age of 32 months the child attended the outpatient clinic with generalized lymphadenopathy and right parotitis. HIV-1 infection was then confirmed in both mother and child. At that time it was discovered that the baby had been breastfed up to the age of 24 months. This is the first reported child in Argentina whose infection may undoubtedly be attributed to breastfeeding.

Mother-to-child transmission of drug-resistant HIV

Mother-to-child transmission of HIV-I is responsible for the infection of hundreds of thousands of infants every year. The use of prophylactic antiretroviral treatments has brought about a dramatic decrease in the risk of transmission. Nevertheless, vertical transmission can still occur. In some cases, the presence of drug-resistant HIV-I strains in the mother has been responsible for the failure of the prophylactic scheme. Moreover, these strains have also been detected in the newborn. The aim of this review is to provide updated information on mother-to-child transmission of drug-resistant HIV strains and to help guide treatment decisions during pregnancy.

Human immunodeficiency virus bDNA assay for pediatric cases

Techniques to quantify plasma HIV-1 RNA viral load (VL) are commercially available, and they are adequate for monitoring adults infected by HIV and treated with antiretroviral drugs. Little experience on HIV VL has been reported in pediatric cases. In Argentina, the evaluation of several assays for VL in pediatrics are now being considered. To evaluate the pediatric protocol for bDNA assay in HIV-infected children, 25 samples from HIV-infected children (according to CDC criteria for pediatric AIDS) were analyzed by using Quantiplex HIV RNA 2.0 Assay (Chiron Corporation) following the manufacturer's recommendations in a protocol that uses 50 microliters of patient's plasma (sensitivity: 10,000 copies/ml). When HIV-RNA was not detected, samples were run with the 1 ml standard bDNA protocol (sensitivity: 500 HIV-RNA c/ml). Nine samples belonged to infants under 12 months of age (group A) and 16 were over 12 months (group B). All infants under one year of age had high HIV-RNA copies in plasma. VL ranged from 30,800 to 2,560,000 RNA copies/ml (median = 362,000 c/ml) for group A and < 10,000 to 554,600 c/ml (median = < 10,000) for group B. Only 25% of children in group B had detectable HIV-RNA. By using the standard test of quantification, none of the patients had non detectable HIV-RNA, ranging between 950 and 226,200 c/ml for group B (median = 23,300 RNA c/ml). The suggested pediatric protocol could be useful in children under 12 months of age, but 1 ml standard protocol must be used for older children. Samples with undetectable results from children under one year of age should be repeated using the standard protocol.

Troublesome diagnosis in two children born to HIV-1 infected mothers

In order to assess early HIV infection vertically transmitted in children it is necessary to use techniques that directly detect HIV. Positive results were found in some rare cases who later seemed to have cleared the infection. We communicate two cases of children with troublesome diagnosis. Two girls born to HIV-1 infected mothers were followed-up since birth up to 40 months old, with viral culture, polymerase chain reaction (PCR), p24 antigen detection and serologic techniques. PCRs were positive in three opportunities at 2, 8 and 30 months of age in the first child and confirmatory tests for specific antibodies remained indeterminate up to the age of 34 months. Positive viral DNAs were detected in two opportunities in the second child at 2 and 4 months of age. Western Blots were negative since 25 months. No virus was recovered nor was p24 antigen detected during the whole period of study in either child. Sequestration of the virus in lymphatic tissue, low replicative ability of the virus and/or immunological tolerance can be postulated in the first case. In patient 2, it could be hypothesized that infection, if any, had cleared up.

HIV-1 and hepatitis B virus infections in adolescents lodged in security institutes of Buenos Aires

The goal of this study was to determine the prevalence of human immunodeficiency virus type 1 (HIV-1) and hepatitis B virus (HBV) infections in street youth lodged in security institutes, from February 1992 to March 1995, to correlate these infections with nontherapeutic drug use, and to compare these results with a previous study done in a similar population. A total of 1460 white adolescents, 276 females and 1184 males, were enrolled (mean age 16.6 years). Prevalence of HIV-1 was 4.58% and of HBV was 6.78%. The prevalence of dual HIV-1/HBV infection was 1.91%; the prevalence of HBV infection was significantly higher in HIV-positive subjects (p < 0.0000000, chi 2 = 136.17, OR = 13.37) than in those not infected with HIV-1. Prevalences were higher in males. Intravenous drug addiction proved to be a significant risk factor for both viruses (HIV-1, p < 0.0000000, chi 2 = 171.34, OR = 16.84; HBV, p = 0.000044, chi 2 = 16.67, OR = 3.17); 6.43% of the total population were intravenous drug users. Comparison of the current results with our previous study (1989-1992) showed that the prevalence of HIV-1, HBV, and concurrent HIV/HBV as well as intravenous drug addiction has decreased significantly in our current cohort (chi 2 = 134.85, p < 0.0000000; chi 2 = 126.62, p < 0.0000000; chi 2 = 110.05, p < 0.0000000; and chi 2 = 158.3, p < 0.0000000) respectively. Progress appears to have been made in the fight against acquired immunodeficiency syndrome (AIDS), and promising results have been obtained. However, if further viral spread is to be avoided, the emphasis on prevention should be energetically maintained.

[Molecular characterization of HTLV-II from an intravenous drug addict with AIDS in Argentina]

Ten intravenous drug user AIDS patients were studied to determine the presence of HTLV-I/II infection. Sera were screened by particle agglutination test and by an in house indirect immunofluorescence assay using MT2 (HTLV-I) and C19 (HTLV-II) producing cell lines. Out of the ten sera, one was confirmed HTLV-II positive by Western blot. Peripheral blood mononuclear cells were obtained from this patient, separated through a Ficoll-Hypaque gradient and DNA was extracted and amplified by semi-nested PCR. The amplified product obtained was cloned and sequenced. Results demonstrated the presence of HTLV-II proviral DNA and comparison of the obtained sequence with different HTLV-II prototypes led to classify the virus into subtype a. This is the first molecular characterization of HTLV-II in an intravenous drug user in Argentina.

Diagnosis of perinatally acquired HIV-1 infection using an IgA ELISA test

The clinical utility of the detection of anti-HIV-1 IgA antibodies using a modified commercial ELISA (EIA) test for the early diagnosis of perinatally acquired HIV-1 infection was evaluated. One hundred and seventeen sera were obtained from 86 infants born to HIV-1-infected mothers and tested for HIV IgA antibodies by an ELISA test (third generation) after removal of IgG with recombinant protein G. Infants were classified according to the Center for Disease Control and Prevention's (CDC) classification system after 15 months of age; 46 were classified as HIV-infected children and 40 as uninfected. HIV-IgA antibodies were detected in 53 of 64 serum samples from all infected children. No significant differences were observed in IgA detection among symptomatic or asymptomatic infected children. However, when analyzed by age a significant difference was observed in IgA detection when children who were over 6 months of age were compared with the younger group (Fisher exact test, p = 0.0000053). All 53 samples from 40 noninfected children were IgA-negative. Statistical analysis was assessed comparing IgA results with HIV infection status as the gold standard. Sensitivity (95%) and specificity (100%), positive predictive value (100%), and negative predictive value (94%) of IgA antibody determination were analyzed taking into account only one sample per child and only children older than 6 months. Positive likelihood ratio was 95.9% and negative likelihood ratio was 94%. Test efficiency was 97%. The detection of IgA HIV antibodies using EIA is an effective method for early diagnosis of HIV-infected infants in comparison with conventional IgG HIV antibody tests. It is a simple and inexpensive method that could be used in both developed and developing countries.

Retrospective study of children born to HIV-1-infected mothers in a pediatric hospital in Argentina

The aim of this retrospective study, which included 103 children born to human immunodeficiency virus type 1 (HIV-1)- infected mothers, is to initiate a database on HIV-infected children, which has to date been unavailable in Argentina. All HIV-1 seropositive children admitted to the Pedro de Elizalde Children's Hospital in Buenos Aires from March 1, 1987, to December 31, 1992, were enrolled in this study. The number of patients enrolled dramatically increased each year during the period of study. Of the 60 infected children, 22 (36.66%) have died with a clinical diagnosis of HIV-1 infection; in 10 of those children HIV infection was also confirmed by P24 antigenemia and/or polymerase chain reaction (PCR): 20 qualified for the Centers for Disease Control and Prevention (CDC) P2D class (P2D1 = 7, P2D2 = 10, P2D3 = 3), 1 for P2C, and 1 for P2A, whose cause of death was pneumonia. The mean age of death was 14.8 months, 18 (82%) died before 18 months. When immunoglobulin G (IgG), IgM, and IgA levels were determined according to age and clinical status, significant differences (P < 0.005) were observed when both asymptomatic and symptomatic infected children (P1, P2) were compared with noninfected children (P3). A significant difference was also obtained between those children who qualified for P2 classification prior to 12 months of age who died early (at or prior to 25 months) and those who reached stage P2 after 12 months of age and have survived to date (X2 = 24.73, p < 0.0001; RR = 5.83, 2.52 < RR < 13.49).

Astrocytic reaction predominance in chronic encephalitis of Junin virus-infected rats

Junin virus antigen distribution and astrocytic reaction to prolonged infection were characterized in rat brain by the PAP technique. During the acute stage of neurologic disease following intracerebral inoculation, Junin antigen was detected in 100% of animals, strongly in most neurons but also to a much lesser degree in scattered astrocytes, dropping to 20% of rats at 540 days postinfection. Initially labeled in all brain areas, viral antigen gradually disappeared from hippocampus but persisted irregularly in cerebral cortex, basal ganglia, Purkinje cells, pons, and medulla oblongata. Such a pattern suggests that specific neuronal subpopulations, in spite of apparently unaltered cell morphology, may persistently harbor the virus, leading on occasion to a delayed neurologic syndrome. During both the acute and chronic stages of disease, a mild inflammatory exudate was observed, characterized by the presence of T and B lymphocytes, as well as macrophages and unidentified round cells. GFAP immunostaining showed increased astrocytic reaction as infection lapsed into chronicity. Corpus callosum, hippocampus, and cerebellum exhibited the sharpest reactive astrocytosis, followed by basal ganglia, pons, and medulla oblongata, whereas in cerebral cortex it was considerably less. Astrocyte activation, which failed to correlate with viral antigen presence in neurons, seems to result from a generalized condition, possibly including diffusible brain factors triggered by viral infection. Such widespread astroglial reaction may thus contribute to the outcome of the late neurologic syndrome.

Viral etiology in acute lower respiratory infections in children from a closed community

The aim of this study was to determine the viral agents associated with acute lower respiratory infections (ALRI) in young children. During a 2-yr period, 204 nasopharyngeal aspirates (NPA) from children under 4 yr of age living in an orphanage and exhibiting febrile ALRI were studied by both indirect immunofluorescence (IIF) and isolation in four cell lines. NPA cell smears as well as tissue culture cells exhibiting cytopathic effect (CPE) or hemadsorption were stained by IIF for respiratory syncytial virus (RSV), adenovirus, influenza A and B, and parainfluenza 1 and 3. Viral etiology was demonstrated in 21.2% of acute respiratory infection cases. The most frequently detected virus was RSV (53.5% of viral positive diagnoses), followed by unidentified viruses (18.6%), adenovirus (13.9%), influenza A (7%), and parainfluenza 3 (4.7%). The most common clinical entities were: bronchitis, 46.1%; pneumonia, 24%; bronchiolitis, 22%; and multifocal pneumonia, 8%. Malnourishment was found in 56% of children with ALRI, whereas 50% was found among total orphanage population. The 3 to 8-month-old age group accounted for half of all ALRI cases. Viral etiology was shown for 26.5% of patients with pneumonia, 22% with bronchitis, and 16% with bronchiolitis. RSV and adenovirus occurred in fall and winter, while parainfluenza 3 was detected in early spring. In the two fatal cases observed, histologic lesions were compatible with adenovirus infection, but this virus could be isolated from the lung in only one case.

Comparison of three techniques for detection of respiratory viruses in nasopharyngeal aspirates from children with lower acute respiratory infections

A comparison of immunofluorescence (IF), enzyme-linked immunosorbent assay (ELISA), and isolation in tissue culture (TC) for detection of respiratory viruses was performed on 496 nasopharyngeal aspirates from children under 5 years of age with lower acute respiratory infections who were receiving attention at three hospitals in Buenos Aires, Argentina. All samples were tested by the three methods for respiratory syncytial virus (RSV), influenza A and B, adenovirus, and parainfluenza 1 and 3. Viral diagnosis was made in 167 samples (33.7%); of these, 124 (74.3%) were isolated in TC, whereas 120 (71.8%) were detected by ELISA and 127 (76%) by IF. RSV was detected in 121 samples, mainly by ELISA and IF. The sensitivity and specificity of each rapid technique as compared with isolation in TC were similar, reaching 98% and 92%, respectively. When ELISA was compared with IF, the sensitivity was 95%, and the specificity was 98%. Adenovirus was detected in 18 patients by TC. For this virus, rapid techniques sensitivity as compared with TC was low (almost 22%). Parainfluenza 3 was readily detected by IF and TC; influenza A, B and parainfluenza 1 were detected in few samples; and tissue culture proved more efficient than rapid techniques. The results indicate that both rapid techniques are good tools for the detection of most respiratory viruses except for adenovirus, for which TC cannot be omitted.

[Antigenic variants of the respiratory syncytial virus in Argentina and Uruguay]

The characterization of RSV antigenic variants was carried out on 160 nasopharyngeal aspirates from children under 5 years of age, from Argentina and Uruguay, with acute respiratory infection and a previously positive etiological diagnosis for RSV. Results for Argentina were: 20.9% of samples belonged to subtype A, 76.9% to subtype B and the remaining 2.2% to new subtypes as yet uncharacterized. Results for Uruguay were: 5.6% of samples belonged to subtype A, 81% to subtype B and 13.5% to other subtypes. Subtype B was predominant in both countries. The correlation of RSV antigenic variants with the clinical picture and epidemiological profile is currently underway.

Protection of Junín virus-infected marmosets by passive administration of immune serum: association with late neurologic signs

Argentine hemorrhagic fever (Junín virus) is a human viral disease for which immune therapy proves effective, though a late neurologic syndrome is occasionally associated with the treatment. We attempted to determine in the infected marmoset Callithrix jacchus whether immune therapy leads to protection and/or CNS damage. Fifteen C jacchus were inoculated with 10(3) tissue culture infectious dose 50% (TCID50) of the XJ strain of Junín virus. On day 6 post infection (pi), 12 primates were treated with homologous immune serum. Animals were observed daily; and hematologic, serologic, virologic, and histologic studies were performed. All primates, both treated and controls, presented leukopenia, thrombocytopenia, anemia, and weight loss from day 14 pi onward. The three control animals died on days 22, 25, and 32 pi. Among the 12 treated monkeys, 3 died on days 21, 22, and 29. Hematologic values returned to normal during the second month; initial weight was recovered by the fourth month. Three out of the nine survivors showed neurologic alterations of various degrees, with hind-limb paralysis in the most severe case. Among treated monkeys, viremia and viral titers in the lungs, kidney, and lymph nodes were lower than in controls. Neutralizing antibodies were present in high titers in all treated marmosets, except in the one presenting paralysis in which values were minimal and viral persistence was detected in CNS. In conclusion, immune serum treatment of Junín virus-infected marmosets was found to reduce mortality from 100% to 25%. Viremia and viral titers in organs were lowered, and late neurologic signs appeared in 30% of treated survivors.

Chronic neurologic disease in Junín virus-infected rats

The purpose of this study was to determine whether Junín virus persistence in CNS of rats was capable of inducing late neurologic disease. Following intracerebral inoculation of newborn animals with XJ strain, three distinct stages could be discerned: an early phase of acute disease, up to 30 days pi, with 5% mortality; an intermediate one, extending to 280 days pi, without clinical signs but with evident viral persistence; and a final period of chronic illness, featuring clinical neurologic syndrome, severe perivascular inflammatory reaction, PAP-labeled viral antigen in a few cerebral and cerebellar neurons, and virus recovery only by coculture. Late neurologic disease seems associated to the lack of effective clearance of brain virus, leading to viral persistence and long lasting immunologic stimulation. The importance of animal models for pathogenic studies on CNS persistent viral infections leading to late neurologic disease is stressed.

Attenuated Junin virus infection in Callithrix jacchus

Twenty marmosets, male Callithrix jacchus, were used during this study. Fifteen of the marmosets were inoculated with 5,000 TCID50 of the attenuated XJC13 strain of Junin virus by intramuscular route and five were left as uninoculated controls. Animals were observed for a 420-day period. In order to carry out virologic, hematologic, serologic, and histologic studies the animals were bled and/or killed at different days post infection(pi). Results obtained showed that the attenuated strain produced an infection with no mortality or signs of illness. There was only a slight loss of weight at 18-40 days pi, which was soon recovered. Viremia was present from day 6 to 22, titers peaking at 4.0 log. Viral spread was limited to the lungs, spleen, lymph nodes, and bone marrow in the animal killed on day 14. No virus was found in the organs of the animal killed on day 23, and neither hematologic alterations nor pathologic lesions were seen in these monkeys except for ganglionar hypertrophy with immunoblast proliferation. Antigen was detected by immunofluorescence (IF) in lymph nodes, spleen, adrenals, lungs and brain. Neutralizing antibodies were detected from the third week onward. Protection conferred by the XJC13 strain proved effective when XJC13-inoculated monkeys were challenged with 1,000 TCID50 of the pathogenic XJ strain at days 60 or 380 pi, while normal controls died. When viral persistence was searched for on days 370, 390, and 420 pi, no infectious virus was detected, but viral antigen was seen in certain organs, which, however, lacked tissue damage.(ABSTRACT TRUNCATED AT 250 WORDS)

Pathogenicity of an attenuated strain (XJCl3) of Junin virus. Morphological and virological studies in experimentally infected guinea pigs

Infection of guinea pigs with an attenuated strain of Junin virus (JV) produced 16% mortality between days 17 and 27 postinfection (p.i.). The morphological study showed a marked pancreatitis between days 6 and 23 p.i. and meningoencephalitis between days 17 and 20 p.i. in a large proportion of the animals. These lesions were coincident with the presence of JV antigenic determinants in the pancreatic acinar cells, neurons and blood vessels of the brain. Infectious virus could be isolated from lymph nodes, spleen, bone marrow, lungs, adrenal glands, and brain. The lesions appeared to be reversible, as they were absent in animals studied after day 64 p.i. Meningoencephalitis, present in all animals dying spontaneously, appeared to be the most important cause of death. Our observations indicate that more accurate markers of virulence must be investigated in the search for attenuated strains of JV as potential vaccine candidates for Argentine hemorrhagic fever.

Junin virus activity in two rural populations of the Argentine hemorrhagic fever (AHF) endemic area

To determine the prevalence of inapparent infection with Junin virus among the rural population and its relation to the clinical disease, a serological study was carried out in two zones of the endemic area of Argentine hemorrhagic fever (AHF). From the first appearance of AHF in the zones (1963) and the moment of the survey (1977), 14 years had passed. A total of 695 serum samples were obtained, 540 from Córdoba and 155 from Buenos Aires. Of the 695 serum samples, 83 were positive for neutralizing antibodies against Junin virus. Total infection (clinical and inapparent cases) reached 11.6% and 12.03% in the Buenos Aires and Córdoba zones, respectively, showing that the total prevalence of infection in two zones separated by 320 miles, are very much alike. In Córdoba province, the prevalence of clinical infection was 7.59%, while that for inapparent infection was 4.44%. Values for the Province of Buenos Aires were 9.67% and 1.93%, respectively. In addition to a low prevalence of inapparent infections, the results of this survey show that roughly 90% of the population is susceptible to contract the disease; this stresses the need to immunize susceptible individuals in the endemic area.

Argentine hemorrhagic fever: a biologic marker

Mortality rates and viral replication in blood and brains of Wistar rats between 6 h and 26 days of age inoculated with two strains of Junin virus of different virulence were compared. Viral growth curves in brains showed no differences between strains. However, differences in mortality rates were significant among rats between 1 and 3 days of age. When the intracerebral (i.c.) route was used, high mortality rates were induced by the attenuated XJC13 strain and low mortality rates were induced by the pathogenic XJ strain. On the other hand, when the intraperitoneal or subcutaneous route was used, mortality rates were reversed: low for the attenuated strain and high for the pathogenic one. The use of different doses of each virus and the application of various routes of inoculation in 2-day-old rats showed that 10(3) TCID50 by the i.c. route resulted in the greatest difference in mortality rates.