National Medical Center La Raza

Mexico City, Mexico

National Medical Center La Raza

Mexico City, Mexico
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Garcia G.H.,National Medical Center Siglo | Mata-Marin J.A.,National Medical Center La Raza | Dominguez-Hermosillo J.C.,National Medical Center La Raza | Chavez-Garcia M.,Third Level Hospital No 25 | And 7 more authors.
Journal of Infection in Developing Countries | Year: 2016

Introduction: Treatment options are limited for HIV-1-infected individuals who have received extensive previous antiretroviral therapy. ETV has shown significant clinical benefits in treatment-experienced HIV-1+ patients with antiretroviral resistance. The aim of this study was to evaluate the effectiveness of ETV plus optimized background regimen in real-life conditions in a cohort of highly HIV-1 antiretroviral-experienced patients. Methodology: Retrospective cohort of treatment-experienced HIV-1-infected adults with virological failure who started therapy with an ETV-containing regimen. The effectiveness was evaluated using HIV-1 RNA viral load and changes in CD4+ cell count after 48 weeks of treatment. Results: Forty-two patients ≥ 16 years of age were included; 74% were men, and the median age was 45 years (IQR 41–53). All participants had prior non-nucleoside reverse transcriptase inhibitor use (55% nevirapine, 83%, efavirenz, and 28% both). Baseline median HIV-1 RNA viral load was 15,598 copies/mL (IQR 2651–84,175) and CD4+ cell count was 276 cells/L (IQR 155–436). After 48 weeks of treatment, 90.5% (95% CI 78–96) of patients had HIV-1 RNA viral load < 200 copies/mL and 76% (95% CI 61–86) had < 50 copies/mL. CD4+ cell counts increased from baseline to 48 weeks of treatment to a median of 407 cells/L (IQR 242–579); p < 0.001. Virological outcome was associated with virological failure at baseline HIV-1 RNA viral load ≥ 100,000 copies/mL (OR 7.6; 95% CI 1.2–44.80; p = 0.025). Conclusions: Our study provides clinically important evidence of the effectiveness and safety of ETV in highly antiretroviral-experienced HIV-1-infected patients. © 2016 Huerta García et al.


Lopez De Leon J.I.,National Medical Center La Raza | Mata-Marin J.A.,National Medical Center La Raza | Andrade-Fuentes K.,HGR 25 | Huerta-Garcia G.,Pediatric Hospital | And 2 more authors.
AIDS Research and Therapy | Year: 2015

Background: Tubular dysfunction is common in HIV-infected people and detection of proteinuria is essential to identify this problem. In low-income countries, resources for detection of proteinuria using the Kidney Disease Improve Global Outcomes (KDIGO) gold standard urinary protein/creatinine ratio (uPCR) is rarely possible, and use of the protein reagent strip (PRS) could be an option in these places. The aims of this study were to establish the concordance between PRS and uPCR to detect tubular proteinuria in HIV-infected people, and to assess the sensitivity and specificity of PRS as a diagnostic method in this group. Methods: A cross-sectional study was conducted to evaluate the correlation between the two techniques to detect protein in urine. Participants were enrolled for a period of 6 months. The measurements were performed in participants who were on highly active antiretroviral therapy (HAART) or prior to the start of treatment. Proteinuria was defined as uPCR ≥ 150 mg/g, and/or ≥ trace on PRS. A phi coefficient was calculated to establish the degree of correlation. We assessed the sensitivity and specificity of PRS compared with uPCR using standard methods. Results: A total of 799 subjects were included. Of these, 737 (92%) were men. The mean age was 32.9 years (±10.1 years). Most (561, 70%) were on antiretroviral treatment. The mean estimated glomerular filtration rate (eGFR) calculated according to Modification of Diet in Renal Disease (MDRD)-4 was 113.0 mL/min (±22.6). Comorbidities included diabetes mellitus (10, 1.3%) and hypertension (17, 2.1%). The prevalence of proteinuria detected by PRS was 8.3% (n = 66) and by uPCR 10.6% (n = 85). The concordance assessed by phi correlation coefficient was 0.70, p < 0.001, with a sensitivity of 51.7% (95% confidence interval [CI] 41%-62%) and specificity 97% (95% CI 39%-97%). Conclusions: There is a high concordance between detection of proteinuria by PRS and uPCR. Therefore, in low-income countries PRS can be helpful for detecting tubular damage in people infected with HIV. © 2015 López De León et al.; licensee BioMed Central.


Berron-Ruiz L.,Mexican Center for Research and Advanced Studies | Berron-Ruiz L.,National Institute of Pediatrics SSA | Berron-Ruiz L.,Laboratory of Immunochemistry I | Lopez-Herrera G.,Mexican Center for Research and Advanced Studies | And 7 more authors.
Allergologia et Immunopathologia | Year: 2014

Background and aims: Common variable immunodeficiency (CVID) is a primary antibody deficiency characterised by decreased antibody production and low or normal B-cell numbers. To elucidate the clinical and immunological heterogeneity of CVID, we studied 16 patients diagnosed with CVID. Methods: We analysed B, T and NK cell populations. We also assessed CD27 expression to define B-cell subsets and examined the expression of molecules important in B-cell proliferation and differentiation, such as the transmembrane activator and CALM interactor (TACI), inducible costimulator (ICOS), CD154 and CD40. Results: We observed reduced B and T-cell numbers in CVID patients; this reduction was more pronounced in adults. While one group of patients (group I) showed a significant reduction in CD27+ memory B-cells, another group (group II) of patients exhibited numbers of CD27+ memory B-cells similar to the healthy donor. The frequency of B-cells and T-cells expressing CD40 and ICOS, respectively, was significantly lower in all CVID patients compared with healthy donors. Finally, a correlation between the frequency of CD27+ memory B-cells and clinical features was observed in CVID patients. Conclusion: These results suggest that in some patients, the combined defects in both T and B-cells may account for CVID. Additionally, patients in group I exhibited an increased frequency of pneumonia and chronic diarrhoea. © 2012 SEICAP.


Mata-Marin J.A.,National Medical Center La Raza | Huerta-Garcia G.,National Medical Center Siglo | Dominguez-Hermosillo J.C.,National Medical Center La Raza | Chavez-Garcia M.,Third Level Hospital No 25 | And 8 more authors.
AIDS Research and Therapy | Year: 2015

Objective: We evaluated the effectiveness of darunavir (DRV) treatment plus an optimized background regimen in 120 HIV-1 treatment-experienced patients. Design: Retrospective cohort, multicenter study. Methods: Adults >16years with virological treatment failure starting therapy with a DRV-containing regimen were included. Effectiveness was evaluated as the percentage of patients with an undetectable HIV-1 RNA viral load (<50 and <200copies/mL) after 48weeks, and changes in CD4+ cell counts. We evaluated the risk factors associated with treatment failure. Results: Of the cohort, 83% were men with a median age of 45years (interquartile range, IQR 40-51). They had experienced treatment for a median of 13years (IQR 9-17) with a median of six previous regimens (IQR 4-7), all using protease inhibitors. After treatment, 82% (95% confidence interval, CI 74-88%) of patients had an HIV-1 RNA viral load <200copies/mL and 69% (95% CI 60-76%) had <50copies/mL. The CD4+ cell count increased by 378cells/μL (IQR 252-559; P<0.001 vs. baseline). Risk factors associated with poor outcome were age >40years [odds ratio, OR 0.15 (95% CI 0.10-0.78); P=0.015], use of raltegravir in the regimen [OR 0.37 (95% CI 0.10-0.97); P=0.046], and baseline CD4+ cell count <200cells/μL [OR 2.79 (95% CI 1.11-6.97); P=0.028]. Conclusion: In this Mexican cohort Darunavir was metabolically safe, well tolerated and achieved high rates of virological suppression in highly treatment-experienced patients infected with HIV-1. © 2015 Mata-Marín et al.


Arriaga-Pizano L.,Specialties Hospital | Ferat-Osorio E.,Specialties Hospital | Rodriguez-Abrego G.,Regional Hospital No | Mancilla-Herrera I.,National Institute of Perinatology | And 18 more authors.
Archives of Medical Research | Year: 2015

Background and Aims: Severe influenza A(H1N1)pdm2009 virus infection cases are characterized by sustained immune activation during influenza pandemics. Seasonal flu data suggest that immune mediators could be modified by wave-related changes. Our aim was to determine the behavior of soluble and cell-related mediators in two waves at the epicenter of the 2009 influenza pandemic. Methods: Leukocyte surface activation markers were studied in serum from peripheral blood samples, collected from the 1st (April-May, 2009) and 2nd (October 2009-February 2010) pandemic waves. Patients with confirmed influenza A(H1N1)pdm2009 virus infection (H1N1), influenza-like illness (ILI) or healthy donors (H) were analyzed. Results: Serum IL-6, IL-4 and IL-10 levels were elevated in H1N1 patients from the 2nd pandemic wave. Additionally, the frequency of helper and cytotoxic T cells was reduced during the 1st wave, whereas CD69 expression in helper T cells was increased in the 2nd wave for both H1N1 and ILI patients. In contrast, CD62L expression in granulocytes from the ILI group was increased in both waves but in monocytes only in the 2nd wave. Triggering Receptor Expressed on Myeloid cells (TREM)-1 expression was elevated only in H1N1 patients at the 1st wave. Conclusions: Our results show that during the 2009 influenza pandemic a T cell activation phenotype is observed in a wave-dependent fashion, with an expanded activation in the 2nd wave, compared to the 1st wave. Conversely, granulocyte and monocyte activation is infection-dependent. This evidence collected at the pandemic epicenter in 2009 could help us understand the differences in the underlying cellular mechanisms that drive the wave-related immune profile behaviors that occur against influenza viruses during pandemics. © 2015 IMSS.


Jimenez-Martinez M.C.,National Autonomous University of Mexico | Jimenez-Martinez M.C.,Institute Of Ophthalmology Conde Of Valenciana | Cruz F.,National Medical Center La Raza | Groman-Lupa S.,Institute Of Ophthalmology Conde Of Valenciana | And 2 more authors.
International Journal of Immunogenetics | Year: 2011

The genetic and immunophenotypic characteristics of a 3-year-old patient with Blau syndrome (BS), an early onset sarcoidosis caused by mutations in NOD2, were investigated. Molecular analysis of NOD2 gene was achieved by PCR and direct nucleotide sequencing. Immunophenotyping included cytometric analysis of memory-effector markers on T-cells, and cytokine in serum, aqueous humour and vitreous. A novel M513R mutation in NOD2 was demonstrated. Immunophenotyping revealed higher frequency of CCR4+ cells and CCR9+ cells on CD4+ cells; most CD8+ cells were CCR7- and CCR9+. IL6 and IL-8 were detected in a gradient manner: vitreous humour>aqueous humour>serum. The immunophenotype in this patient was characterized by a differential expression of chemokine receptors on T cells and by a particular ocular microenvironment enriched in IL-6 and IL-8. To our knowledge, this is the first study analysing the immunological features of BS at aqueous humour, vitreous and blood levels. Our results expand the knowledge of the genetic and immunopathological basis of BS. © 2011 Blackwell Publishing Ltd.


PubMed | National Medical Center La Raza, HGR 25 and Pediatric Hospital
Type: | Journal: AIDS research and therapy | Year: 2015

Tubular dysfunction is common in HIV-infected people and detection of proteinuria is essential to identify this problem. In low-income countries, resources for detection of proteinuria using the Kidney Disease Improve Global Outcomes (KDIGO) gold standard urinary protein/creatinine ratio (uPCR) is rarely possible, and use of the protein reagent strip (PRS) could be an option in these places. The aims of this study were to establish the concordance between PRS and uPCR to detect tubular proteinuria in HIV-infected people, and to assess the sensitivity and specificity of PRS as a diagnostic method in this group.A cross-sectional study was conducted to evaluate the correlation between the two techniques to detect protein in urine. Participants were enrolled for a period of 6months. The measurements were performed in participants who were on highly active antiretroviral therapy (HAART) or prior to the start of treatment. Proteinuria was defined as uPCR150mg/g, and/ortrace on PRS. A phi coefficient was calculated to establish the degree of correlation. We assessed the sensitivity and specificity of PRS compared with uPCR using standard methods.A total of 799 subjects were included. Of these, 737 (92%) were men. The mean age was 32.9years (10.1years). Most (561, 70%) were on antiretroviral treatment. The mean estimated glomerular filtration rate (eGFR) calculated according to Modification of Diet in Renal Disease (MDRD)-4 was 113.0mL/min (22.6). Comorbidities included diabetes mellitus (10, 1.3%) and hypertension (17, 2.1%). The prevalence of proteinuria detected by PRS was 8.3% (n=66) and by uPCR 10.6% (n=85). The concordance assessed by phi correlation coefficient was 0.70, p<0.001, with a sensitivity of 51.7% (95% confidence interval [CI] 41%-62%) and specificity 97% (95% CI 39%-97%).There is a high concordance between detection of proteinuria by PRS and uPCR. Therefore, in low-income countries PRS can be helpful for detecting tubular damage in people infected with HIV.


PubMed | National Medical Center Siglo, General Hospital No 24, National Medical Center La Raza, Third Level Hospital No 25 and 3 more.
Type: | Journal: AIDS research and therapy | Year: 2015

We evaluated the effectiveness of darunavir (DRV) treatment plus an optimized background regimen in 120 HIV-1 treatment-experienced patients.Retrospective cohort, multicenter study.Adults >16years with virological treatment failure starting therapy with a DRV-containing regimen were included. Effectiveness was evaluated as the percentage of patients with an undetectable HIV-1 RNA viral load (<50 and <200copies/mL) after 48weeks, and changes in CD4+ cell counts. We evaluated the risk factors associated with treatment failure.Of the cohort, 83% were men with a median age of 45years (interquartile range, IQR 40-51). They had experienced treatment for a median of 13years (IQR 9-17) with a median of six previous regimens (IQR 4-7), all using protease inhibitors. After treatment, 82% (95% confidence interval, CI 74-88%) of patients had an HIV-1 RNA viral load <200copies/mL and 69% (95% CI 60-76%) had <50copies/mL. The CD4+ cell count increased by 378cells/L (IQR 252-559; P<0.001 vs. baseline). Risk factors associated with poor outcome were age >40years [odds ratio, OR 0.15 (95% CI 0.10-0.78); P=0.015], use of raltegravir in the regimen [OR 0.37 (95% CI 0.10-0.97); P=0.046], and baseline CD4+ cell count <200cells/L [OR 2.79 (95% CI 1.11-6.97); P=0.028].In this Mexican cohort Darunavir was metabolically safe, well tolerated and achieved high rates of virological suppression in highly treatment-experienced patients infected with HIV-1.


PubMed | National Institute of Perinatology, Womans Hospital, Regional Hospital No, Specialties Hospital of the National Medical Center Siglo and 4 more.
Type: Journal Article | Journal: Archives of medical research | Year: 2016

Severe influenza A(H1N1)pdm2009 virus infection cases are characterized by sustained immune activation during influenza pandemics. Seasonal flu data suggest that immune mediators could be modified by wave-related changes. Our aim was to determine the behavior of soluble and cell-related mediators in two waves at the epicenter of the 2009 influenza pandemic.Leukocyte surface activation markers were studied in serum from peripheral blood samples, collected from the 1(st) (April-May, 2009) and 2(nd) (October 2009-February 2010) pandemic waves. Patients with confirmed influenza A(H1N1)pdm2009 virus infection (H1N1), influenza-like illness (ILI) or healthy donors (H) were analyzed.Serum IL-6, IL-4 and IL-10 levels were elevated in H1N1 patients from the 2(nd) pandemic wave. Additionally, the frequency of helper and cytotoxic Tcells was reduced during the 1(st) wave, whereas CD69 expression in helper Tcells was increased in the 2(nd) wave for both H1N1 and ILI patients. In contrast, CD62L expression in granulocytes from the ILI group was increased in both waves but in monocytes only in the 2(nd) wave. Triggering Receptor Expressed on Myeloid cells (TREM)-1 expression was elevated only in H1N1 patients at the 1(st) wave.Our results show that during the 2009 influenza pandemic a Tcell activation phenotype is observed in a wave-dependent fashion, with an expanded activation in the 2(nd) wave, compared to the 1(st) wave. Conversely, granulocyte and monocyte activation is infection-dependent. This evidence collected at the pandemic epicenter in 2009 could help us understand the differences in the underlying cellular mechanisms that drive the wave-related immune profile behaviors that occur against influenza viruses during pandemics.

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