Publications by authors named "Claudia Garcia-Morales"

Article Synopsis
  • The prevalence of pretreatment drug resistance (PDR) to certain HIV medications is high in Belize, particularly among those with previous treatment exposure, posing a challenge for effective antiretroviral therapy (ART).
  • WHO recommends dolutegravir-based ART regimens for their effectiveness and low resistance risk, which is crucial for reaching UNAIDS' target of 95% viral suppression.
  • Recent surveys show that while 79.6% of adults achieved viral suppression on ART, only 50% of children and adolescents did, highlighting the need for better support and adherence to treatment.
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Article Synopsis
  • The study emphasizes the need for flexible modeling approaches, specifically random-effects regression, to better understand the dynamics of infectious diseases such as HIV in evolving host populations.
  • By analyzing plasma viral load (pVL) data from 7,325 ART-naïve HIV patients in Mexico City between 2019 and 2021, the research reveals significant functional changes over time that a fixed-effects model couldn't fully capture.
  • The findings indicate a stronger negative correlation between pVL and CpG content in the HIV pol gene, suggesting that changes in the immune environment may influence viral load dynamics, highlighting the importance of molecular factors in disease progression.
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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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The first nationally representative cross-sectional HIV drug resistance (HIVDR) survey was conducted in Uruguay in 2018-2019 among adults diagnosed with HIV and initiating or reinitiating antiretroviral therapy (ART). , , and genes of HIV-1 were sequenced. A total of 206 participants were enrolled in the survey; 63.

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Article Synopsis
  • A study in El Salvador assessed the prevalence of HIV drug resistance (HIVDR) among individuals starting antiretroviral therapy (ART) and those receiving ART for 12 and 48 months.* -
  • Findings showed that 27% of new ART users had pretreatment drug resistance, with viral load (VL) suppression rates of 88.8% at 12 months and 80.5% at 48 months.* -
  • The results indicate a need for improvements in ART delivery to address the high drug resistance to efavirenz or nevirapine and the low VL suppression rates in the population.*
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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 sequences from persons recently diagnosed at the largest HIV clinic in Mexico City (between 2016 and 2021) were annotated with demographic/geographic metadata.

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The COVID-19 pandemic interrupted routine care for individuals living with HIV, putting them at risk of virologic failure and HIV-associated illness. Often this population is at high risk for exposure to SARS-CoV-2 infection, and once infected, for severe disease. Therefore, close monitoring of HIV plasma viral load (VL) and screening for SARS-CoV-2 infection are needed.

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Human immunodeficiency virus (HIV) drug resistance increases mortality and morbidity and antiretroviral therapy (ART) costs. We describe Paraguay's first nationally representative survey on pretreatment drug resistance (PDR) conducted among persons who initiated or reinitiated ART in 2019. ​​​​We conducted a cross-sectional survey of antiretroviral (ARV) drug resistance in Paraguay in 2019.

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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.

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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.

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Introduction: Molecular surveillance systems could provide public health benefits to focus strategies to improve the HIV care continuum. Here, we infer the HIV genetic network of Mexico City in 2020, and identify actively growing clusters that could represent relevant targets for intervention.

Methods: All new diagnoses, referrals from other institutions, as well as persons returning to care, enrolling at the largest HIV clinic in Mexico City were invited to participate in the study.

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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 ( ) and screen for SARS-COV-2 infection.

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Background: Evolutionary analyses of well-annotated human immunodeficiency virus (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) and 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 Tijuana between 1996-2018.

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Article Synopsis
  • Pre-treatment HIV drug resistance (HIVDR) to NNRTIs has increased significantly over the past decade in low and middle-income countries, including Honduras.
  • A nationwide survey found that 26.9% of individuals starting antiretroviral therapy (ART) had pre-treatment HIVDR, with a notable prevalence of 25.9% specifically for NNRTIs.
  • The findings suggest a need for alternative first-line ART regimens and improved monitoring and support strategies for individuals living with HIV in Honduras.*
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Objective: Pretreatment HIV-drug resistance (PDR, HIVDR) to non-nucleoside reverse transcriptase inhibitors (NNRTIs) is increasing globally. NNRTIs continue to be used as first-line antiretroviral therapy (ART) in some communities due to the cost of dolutegravir-based ART or dolutegravir-associated adverse events. A simplified version of the oligonucleotide ligation assay (OLA) - 'OLA-Simple' - is a low-cost, near point-of-care assay that provides ready-to-use lyophilized reagents and reports HIVDR mutations as colored lines on lateral flow strips.

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Article Synopsis
  • A national survey in Nicaragua assessed pretreatment and acquired HIV drug resistance among people starting antiretroviral therapy (ART) and those on ART for different durations.
  • Out of 638 participants, 23.4% had pretreatment resistance to any HIV drug, with a higher rate in those previously exposed to antiretrovirals, especially non-nucleoside reverse transcriptase inhibitors (NNRTIs).
  • The study also found viral load suppression rates of 77.8% for those on ART for around 12 months but lower at 70.3% for those on ART for over 48 months, highlighting challenges in managing HIV resistance and treatment efficacy.
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Background: HIV pretreatment drug resistance (PDR) to NNRTIs in persons initiating ART is increasing in Mexico.

Objectives: To compare HIV PDR in eight sub-regions of Mexico.

Patients And Methods: A large PDR survey was implemented in Mexico (September 2017-March 2018) across eight sub-regions.

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Different explanations exist on how HIV-1 subtype B spread in Central America, but the role of Guatemala, the Central American country with the highest number of people living with the virus, in this scenario is unknown. We investigated the evolutionary history and spatiotemporal dynamics of HIV-1 subtype B in Guatemala. A total of 1,047 HIV-1 subtype B pol sequences, from newly diagnosed ART-naïve, HIV-infected Guatemalan subjects enrolled between 2011 and 2013 were combined with published subtype B sequences from other Central American countries (n = 2,101) and with reference sequences representative of the BPANDEMIC and BCAR lineages from the United States (n = 465), France (n = 344) and the Caribbean (n = 238).

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Associations between HLA class I alleles and HIV progression in populations exhibiting Amerindian and Caucasian genetic admixture remain understudied. Using univariable and multivariable analyses we evaluated HLA associations with five HIV clinical parameters in 3,213 HIV clade B-infected, ART-naïve individuals from Mexico and Central America (MEX/CAM cohort). A Canadian cohort (HOMER, n = 1622) was used for comparison.

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HIV circumvents HLA class I-restricted CD8 T-cell responses through selection of escape mutations that leave characteristic mutational "footprints," also known as HLA-associated polymorphisms (HAPs), on HIV sequences at the population level. While many HLA footprints are universal across HIV subtypes and human populations, others can be region specific as a result of the unique immunogenetic background of each host population. Using a published probabilistic phylogenetically informed model, we compared HAPs in HIV Gag and Pol (PR-RT) in 1,612 subtype B-infected, antiretroviral treatment-naive individuals from Mexico and 1,641 individuals from Canada/United States.

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Background: Pretreatment drug resistance (PDR) levels to NNRTI approaching 10% have recently been reported in Mexico. However, subnational differences may exist in PDR prevalence and transmission dynamics.

Objectives: We longitudinally assessed HIV PDR in three geographic areas of Mexico.

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Article Synopsis
  • This study investigated the prevalence of Human Pegivirus (HPgV) in Mexico among blood donors and HIV-infected individuals, revealing that 2.98% of blood donors and 33% of HIV patients tested positive for HPgV.
  • Researchers analyzed nearly 8,000 serum samples using advanced PCR methods and found two prevalent HPgV genotypes, with viral loads showing distinct low and high patterns that affected HIV progression.
  • The study concluded that high HPgV viremia may offer a beneficial effect on HIV infection markers, indicating the need for further exploration of the underlying mechanisms driving different HPgV replication patterns.
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Background: Migration and travel are major drivers of the spread of infectious diseases. Geographic proximity and a common language facilitate travel and migration in Mesoamerica, which in turn could affect the spread of HIV in the region.

Methods: 6092 HIV-1 subtype B partial pol sequences sampled from unique antiretroviral treatment-naïve individuals from Mexico (40.

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Background: Increasing HIV pre-treatment drug resistance (PDR) levels have been observed in regions with increasing antiretroviral treatment (ART) coverage. However, data is lacking for several low/middle-income countries. We present the first PDR survey in Nicaragua since ART introduction in the country in 2003.

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Background: WHO has developed a global HIV-drug resistance surveillance strategy, including assessment of pretreatment HIV-drug resistance. We aimed to do a nationally representative survey of pretreatment HIV-drug resistance in Mexico using WHO-recommended methods.

Methods: Among 161 Ministry of Health antiretroviral therapy (ART) clinics in Mexico, the largest, including 90% of ART initiators within the Ministry of Health (66 in total), were eligible for the survey.

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