Horacio Salomon, PhD CONICET, Principal Investigator ... - EUCO-Net

Horacio Salomon, PhD
CONICET, Principal Investigator
CNRSIDA, Director
Department of Microbiology,
School of Medicine
University of Buenos Aires

HIV cases in Argentina - 2007
First case 1982
Diagnosed cases 67,245
AIDS cases 35,570
Man/woman ratio 2.4/1
Infected children (< 14 years old) 3,857
Deaths cases 16,677
PLWHA 134,000
UNAIDS, WHO and Nat'l Program for HR, AIDS and STI, Ministry of Health, Argentina,
October 2007.

Officially reported HIV cases regarding
place of residence (2005-2007)
NW
7%
NE
5%
Entre Ríos
1%
Santa Fé
7%
Cuyo
4%
Córdoba
8%
Buenos Aires
Province
16%
Patagonia
5%
Unknown
2%
CABA
15%
GBA
30%

HIV Transmission Routes among
PLWHA (2001-2007)
HSH
31,4%
Rel hetero
41,9%
UDI
14,5%
TV
3,2%
Hemo /
Transf
0,4%
Otro
0,1%
Desconoc
ido
8,5%
Hetero
ratio
81,6%
Men Women
IDU
4.6%
Vert.
Trans
6.2%
Hemo /
Transf
0.9%
Other
0.7%
Unknow n
6.2%

5.0
4.5
4.0
3.5
3.0
2.5
2.0
1.5
1.0
0.5
0.0
3.27
2.92
3.43
Vertical Transmission Rates
per 10,000 live births
3.71
4.74
4.19
3.76
1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
3.18
4.28
3.55
3.07
2.75
2.15
1.40
0.87

Project: Supporting activities toward
HIV/AIDS prevention and control in Argentina
UBATEC SA
Funded by the Global Fund to Fight AIDS,
Tuberculosis and Malaria
Sub-project:
Seroincidence and resistance
determination of HIV in Men who
Have Sex with Men, Sex Workers,
Drug Users and Pregnant Women

Objectives
To estimate the incidence of HIV infection and primary
viral resistance in Men who Have Sex with Men (MSM),
Sex Workers (SW), Drug Users (DUs) and Pregnant
Women in Argentina.

Methodology
Recruitment coordination NGOs: NEXO
Intercambios
AMMAR
Hospital Materno Infantil Ramón
Sarda
Recruitment criteria
Individuals older than 18 years old without a positive HIV diagnosis
SW: men and women who have had sex for money for the last six
months and who have not used injecting drugs.
MSM: men who have had sex with men at least once for the last six
months and who have not used injecting drugs.
DUs: men and women who have used drugs at least once a week
for the last six months, with or without treatment for their addiction.

Populatio
n
MSM
DUs
SW
Total
Recruited Volunteers
Project period: October 2006 - March 2008
Men
1225
260
158
1643
Women
-
141
803
944
72.1% in Buenos Aires City
Total
1225
401
961
2587

City
Buenos Aires
La Plata
Santiago del Estero
Córdoba
Rosario
Paraná
Viedma
Salta
Total
Recruited Volunteers
by City and by Population
n
268
340
150
100
46
30
27
961
SW
%
27.9
35.4
15.6
10.4
4.8
3.1
2.8
n
1195
22
2
6
1225
MSM
%
97.6
1.8
0.2
0.5
n
401
401
DUs
%
100

HIV prevalence in MSM, DUs and SW
Population
MSM
DUs
SW
Population
SW
HIV-positive / Total
HIV-positive /
Total
Men
36/158
143/1219
Women
18/803
25/401
54/961
HIV prevalence
% (95% CI)
Men
22.8(15.9- 29.6)
HIV prevalence
% (95% CI)
11.7 (9.9-13.6)
6.2 (3.7-8.7)
5.6 (4.1-7.1)
Women
2.2 (1.2-3.3)
p

Population
MSM
DUs
SW
HIV annual incidence in MSM, DUs and SW
Annual incidence (%)
7.62
3.02
1.81
Population
MSM
DUs
SW
3.16
0.91
Detuned assay
Annual incidence (%)
Women
-
Men
7.62
2.61
7.35

HIV prevalence in heterosexual men and
women in relation to the use of drugs during
the last year
HIV results
Negative
Positive
Non-IDUs / Hetero 96.7 % 3.3 % 153
IDUs / Hetero 75.0 % 25.0 % 8
Non-IDUs / MSM 81.0 % 19.0 % 58
IDUs / MSM 66.6 % 33.3 % 3
Total 91.4 % 8.6 % 244
N

Determination of associated-resistance mutations
pol gene amplification
Total: 9/90 (10%)
Population
MSM
DUs
SW
Resistance (%)
7/75 (9.3)
2/11 (18.1)
0/4

Conclusion:
• The high HIV prevalence and incidence
found in this study highlight the need to
have a systematic and updated
epidemiological surveillance in order to
reinforce prevention strategies in the
Argentinean population.

PARTICIPANTS
www.nexo.org
Sr. Miguel Zapatela
Lic. Rubén Marone www.ammar.org.ar
Sra. Elena Reynaga
Sra. Jorgelina Sosa
www.intercambios.org.ar
Dr. Marcelo Vila
Lic. Diana Rossi
www.sarda.org.ar
Dr. Oscar Torres
Dra. Miriam Maestri
www.cnrsida.org.ar
Dra. Maria A. Pando
Dr. Manuel Gómez Carrillo
Bioq. Moira Vignoles
Lic. Franco Moretti
Dra. Maria M. Avila

• Resistance

60%
50%
40%
30%
20%
10%
0%
2.3%
BUENOS AIRES,
1997-2000,
86 patients with
chronic infection
Protease inhibitors
L10I L10V K20M K20R D30N M36I L63P A71T V77I
80%
70%
60%
50%
40%
30%
20%
10%
0%
Reverse transcriptase inhibitors
M41L V179D R211K L214F
2001

BUENOS AIRES and others, 52 new infections,
2004-2005, Public Hospitals, Private Centers
K103N (3)
M41L (1)
2006
7.7%

284 nuevos diagnósticos 2003-2005
BUENOS AIRES, 284 newly diagnosed cases,
2003-2005, Public Hospital, NGO
4.2%
K103N (3)
V108I (3)
M41L (3)
2007

4.2%
7.7%
45% 55%
Know Do not know

Vertical Transmission
16%
Argentina, The Bahamas,
Brazil and Mexico cohort
118 HIV-infected pregnant
women, prophylactic
treatment, 2002-2005.

Vertical Transmission
BUENOS AIRES, 20 pregnant women,
prophylactic treatment: 3TC/ZDV/NVP
Objective: To evaluate NVP and 3TC resistance
Standard Sequencing
96% patients, sensitive virus
SPCR (selective real-time PCR)
K103N:

Resistance in infants
BUENOS AIRES, 101 children
(newly diagnosed, born to HIV-infected mothers)
2004-2008, 2 Public Children’s Hospitals
5.9%
Group (n)

Resistance Testing Criteria
Drug naïve patients•
acute or recent: RECOMMENDED
• chronic: PHYSICIAN’S CRITERIA
Therapeutic failure
Pregnancy
Children
- newly diagnosed -
• under HAART: RECOMMENDED
• discontinuation of HAART, 4 weeks:
PHYSICIAN’S CRITERIA
• before starting HAART: PHYSICIAN’S
CRITERIA
• therapeutic failure: RECOMMENDED
• < 1 year old: RECOMMENDED

There is an urgent need to
implement sustainable programs
to monitor resistance at local and
regional levels

Study of immunological parameters in response to M.
tuberculosis in HIV and TB-HIV coinfected individuals
Rationale
The pattern of cytokines produced by T lymphocytes plays a central role in
the susceptibility to TB
Several T-cell signaling molecules such as Signaling Lymphocytic
Activation Molecule (SLAM), the Inducible Costimulator (ICOS) and
Programmed Death-1 (PD-1) have been shown to modulate the level and
patterns of cytokine produced by T cells.
Objective:
To test the hypothesis that HIV infection brings about an alteration in the
host immune response to M. tuberculosis, in this study we investigated the
role of signaling molecules during HIV, TB and HIV-TB co-infection.
florenciaquiroga@gmail.com

Study of immunological parameters in response to M.
tuberculosis in HIV and TB-HIV coinfected individuals
Results and conclusions
-The higher expression of costimulatory molecules found on peripheral T
lymphocites from HIV + patients compared to healthy donors suggest that,
systemically, T cells in these individuals exist in an activated state. In
addition, since co-infected patients display a Th0 cytokine profile in
response to M. tuberculosis stimulation in vitro, our data suggest that HIV
infection might modulate the pattern of cytokines produced to an
intracellular pathogen like M. tuberculosis.
- Moreover, T lymphocytes from HIV-TB coinfected patients and HIV +
individuals were not able to increase the levels of costimulatory molecules
in response to M. tuberculosis stimulation, as healthy donors and
tuberculosis patients did.
- Furthermore, SLAM ligation, but not ICOS ligation, enhanced IFN-γ
production in co-infected patients, indicating that costimulation through
SLAM might promote CMI responses to M. tuberculosis in HIV infection.
florenciaquiroga@gmail.com

www.cnrsida.org.ar
Thank you