DSpace Repository :: Browsing by Author "Socias, Maria E."

Browsing by Author "Socias, Maria E."

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Acute HIV Seroconversion Presenting with Active Tuberculosis and Associated with High Levels of T-Regulatory Cells
(2011) Sued, Omar; Quiroga, Maria F.; Socias, Maria E.; Turk, Gabriela; Salomon, Horacio; Cahn, Pedro
A patient with well-defined acute HIV infection who developed concomitant pulmonary tuberculosis during the retroviral acute syndrome is reported here. In this patient high levels of T-regulatory cells (Tregs) and a low proliferation response to M. tuberculosis were initially detected, which normalized throughout follow-up. This case calls for the consideration of tuberculosis in patients in the early stages of HIV, and emphasizes the need for further study of the potential causal relationship between Treg cells and the risk of TB reactivation in HIV patients.
Acute retroviral syndrome and high baseline viral load are predictors of rapid HIV progression among untreated Argentinean seroconverters
(2011) Socias, Maria E.; Sued, Omar; Laufer, Natalia; Lázaro, Maria E.; Mingrone, Hugo; Remondegui, Claudio; Figueroa, Maria Ines; Cesar, Carina; Gun, Ana; Turk, Gabriela; Bouzas, Maria B.; Kavasery, Rosanna; Krolewiecki, Alejandro J.; Perez, Hector; Salomon, Horacio; Pryluka, Damian
Background Diagnosis of primary HIV infection (PHI) has important clinical and public health implications. HAART initiation at this stage remains controversial. Methods Our objective was to identify predictors of disease progression among Argentinean seroconverters during the first year of infection, within a multicentre registry of PHI-patients diagnosed between 1997 and 2008. Cox regression was used to analyze predictors of progression (LT-CD4 < 350 cells/mm3, B, C events or death) at 12 months among untreated patients. Results Among 134 subjects, 74% presented with acute retroviral syndrome (ARS). Seven opportunistic infections (one death), nine B events, and 10 non-AIDS defining serious events were observed. Among the 92 untreated patients, 24 (26%) progressed at 12 months versus three (7%) in the treated group (p = 0.01). The 12-month progression rate among untreated patients with ARS was 34% (95% CI 22.5-46.3) versus 13% (95% CI 1.1-24.7) in asymptomatic patients (p = 0.04). In univariate analysis, ARS, baseline LT-CD4 < 350 cells/mm3, and baseline and six-month viral load (VL) > 100,000 copies/mL were associated with progression. In multivariate analysis, only ARS and baseline VL > 100,000 copies/mL remained independently associated; HR: 8.44 (95% CI 0.97-73.42) and 9.44 (95% CI 1.38-64.68), respectively. Conclusions In Argentina, PHI is associated with significant morbidity. HAART should be considered in PHI patients with ARS and high baseline VL to prevent disease progression.
Distribution of Bulk and HIV-specific CD8 + T Cell Memory Phenotypes during Acute/Early HIV Infection Is Related to Reduced Antiviral Activity
(2014) Ghiglione, Yanina; Falivene, Juliana; Ruiz, Maria; Laufer, Natalia; Socias, Maria E.; Cahn, Pedro; Sued, Omar; Salomon, Horacio; Gherardi, María Magdalena; Turk, Gabriela
Background: Memory CD8+ T-cells are important components of protective immunity. Understanding their development during primary HIV infection (PHI) may contribute to optimal vaccine design. Aim: To analyze the distribution of memory subsets during PHI and their correlation with functionality and clinical parameters. Methods: 19 samples from acutely infected subjects were obtained at baseline and 12 months post-infection (mpi). Phenotypic (CD45RO, CCR7, PD-1) and functional markers (cytokines) were used to identify bulk and HIV-specific CD8+ memory populations. CD8 virus inhibitory assay (VIA) was performed. Data was compared intra-group and correlated to clinical parameters, PD-1 analysis and CD8 antiviral activity, using non-parametric statistics. Results: Bulk and HIV-specific CD8+ profile was terminal effectors (TE)>naïve>effector memory (TEM)>central memory. Spearman's correlation showed that baseline CD8+ VIA inversely correlated with the concurrent proportion of HIV-specific CD8+ TEM cells (r=-0.593, p=0.009) and directly correlated with the proportion of HIV-specific CD8+ TE cells (r=0.718, p=0.0008). Identical correlations were observed between baseline CD8+ T cell phenotype and CD8+ VIA at 12 mpi. Also, percentage of PD-1high CD8+ T cells negatively correlated with bulk and HIV-specific CD8+ TEM cells (r=−0.501, p=0.034 and r=−0.668, p=0.004, respectively). Conversely, positive correlations were observed with the proportion of bulk and HIV-specific CD8+ TE cells (r=-0.510, p=0.0308 and r=−0.564, p=0.022, respectively). Conclusions: A higher proportion of fully differentiated HIV-specific cells are related to the magnitude of CD8+ antiviral activity (rapidly able to exert effector functions) and to a higher PD-1 expression (related to T cell differentiation stage and activation status). This is the first report were a relation between CD8+ T cell memory differentiation hierarchy and antiviral function is reported during acute infection, providing information potentially useful for vaccine design.
Early Gag Immunodominance of the HIV-Specific T-Cell Response during Acute/Early Infection Is Associated with Higher CD8(+) T-Cell Antiviral Activity and Correlates with Preservation of the CD4(+) T-Cell Compartment
(2013) Turk, Gabriela; Ghiglione, Yanina; Falivene, Juliana; Socias, Maria E.; Laufer, Natalia; Coloccini, Romina.; Rodriguez, Ana María; Ruiz, Maria; Pando, María; Giavedoni, Luis; Cahn, Pedro; Sued, Omar; Salomon, Horacio; Gherardi, María
The important role of the CD8+ T-cell response on HIV control is well established. Moreover, the acute phase of infection represents a proper scenario to delineate the antiviral cellular functions that best correlate with control. Here, multiple functional aspects (specificity, ex vivo viral inhibitory activity [VIA] and polyfunctionality) of the HIV-specific CD8+ T-cell subset arising early after infection, and their association with disease progression markers, were examined. Blood samples from 44 subjects recruited within 6 months from infection (primary HIV infection [PHI] group), 16 chronically infected subjects, 11 elite controllers (EC), and 10 healthy donors were obtained. Results indicated that, although Nef dominated the anti-HIV response during acute/early infection, a higher proportion of early anti-Gag T cells correlated with delayed progression. Polyfunctional HIV-specific CD8+ T cells were detected at early time points but did not associate with virus control. Conversely, higher CD4+ T-cell set points were observed in PHI subjects with higher HIV-specific CD8+ T-cell VIA at baseline. Importantly, VIA levels correlated with the magnitude of the anti-Gag cellular response. The advantage of Gag-specific cells may result from their enhanced ability to mediate lysis of infected cells (evidenced by a higher capacity to degranulate and to mediate VIA) and to simultaneously produce IFN-γ. Finally, Gag immunodominance was associated with elevated plasma levels of interleukin 2 (IL-2) and macrophage inflammatory protein 1β (MIP-1β). All together, this study underscores the importance of CD8+ T-cell specificity in the improved control of disease progression, which was related to the capacity of Gag-specific cells to mediate both lytic and nonlytic antiviral mechanisms at early time points postinfection.
Early Skewed Distribution of Total and HIV-Specific CD8 T-Cell Memory Phenotypes during Primary HIV Infection Is Related to Reduced Antiviral Activity and Faster Disease Progression
(2014-8) Ghiglione, Yanina; Falivene, Juliana; Ruiz, Maria; Laufer, Natalia; Socias, Maria E.; Cahn, Pedro; Giavedoni, Luis; Sued, Omar; Gherardi, María Magdalena; Salomon, Horacio; Turk, Gabriela
The important role of the CD8+ T-cells on HIV control is well established. However, correlates of immune protection remain elusive. Although the importance of CD8+ T-cell specificity and functionality in virus control has been underscored, further unraveling the link between CD8+ T-cell differentiation and viral control is needed. Here, an immunophenotypic analysis (in terms of memory markers and Programmed cell death 1 (PD-1) expression) of the CD8+ T-cell subset found in primary HIV infection (PHI) was performed. The aim was to seek for associations with functional properties of the CD8+ T-cell subsets, viral control and subsequent disease progression. Also, results were compared with samples from Chronics and Elite Controllers. It was found that normal maturation of total and HIV-specific CD8+ T-cells into memory subsets is skewed in PHI, but not at the dramatic level observed in Chronics. Within the HIV-specific compartment, this alteration was evidenced by an accumulation of effector memory CD8+ T (TEM) cells over fully differentiated terminal effector CD8+ T (TTE) cells. Furthermore, higher proportions of total and HIV-specific CD8+ TEM cells and higher HIV-specific TEM/(TEM+TTE) ratio correlated with markers of faster progression. Analysis of PD-1 expression on total and HIV-specific CD8+ T-cells from PHI subjects revealed not only an association with disease progression but also with skewed memory CD8+ T-cell differentiation. Most notably, significant direct correlations were obtained between the functional capacity of CD8+ T-cells to inhibit viral replication in vitro with higher proportions of fully-differentiated HIV-specific CD8+ TTE cells, both at baseline and at 12 months post-infection. Thus, a relationship between preservation of CD8+ T-cell differentiation pathway and cell functionality was established. This report presents evidence concerning the link among CD8+ T-cell function, phenotype and virus control, hence supporting the instauration of early interventions to prevent irreversible immune damage.
Env-Specific IgA from Viremic HIV-Infected Subjects Compromises Antibody-Dependent Cellular Cytotoxicity
(2016) Ruiz, Maria; Ghiglione, Yanina; Falivene, Juliana; Laufer, Natalia; Holgado, Maria Pia; Socias, Maria E.; Cahn, Pedro; Sued, Omar; Giavedoni, Luis; Salomon, Horacio; Gherardi, María Magdalena; Rodriguez, Ana María; Turk, Gabriela
Elucidating the factors that modulate HIV-specific antibody-dependent cellular cytotoxicity (ADCC) will help in understanding its role in HIV immunity. The aim of this study was to determine whether IgA could modify the magnitude of ADCC in HIV infection, abrogating its protective role. Plasma samples from 20 HIV-positive (HIV(+)) subjects enrolled during primary HIV infection (PHI), 10 chronically infected subjects (chronic), and 7 elite controllers (EC) were used. ADCC was determined by using a fluorometric ADCC assay, before and after removal of plasma IgA. Data were analyzed by using nonparametric statistics. ADCC was documented in 80% of PHI enrollment samples and in 100% of PHI 12-month, chronic, and EC samples; it peaked after acute infection, reached a plateau in chronic infection, and decreased after initiation of antiretroviral treatment (ART). Significant associations between ADCC and disease progression were found only after removal of plasma IgA from 12-month PHI samples: the magnitude of ADCC not only increased after IgA removal but also correlated with CD4(+) T-cell preservation. This work provides evidence that gp120-specific IgA was capable of modifying ADCC responses during natural HIV infection for the first time and adds to similar evidence provided in other settings. Furthermore, it underscores the complexity of the ADCC phenomenon and will help in an understanding of its underlying mechanisms. Importance: Although the induction of ADCC-mediating antibodies in HIV-infected subjects has been extensively documented, the association of these antibodies with protection from disease progression is poorly understood. Here, we demonstrate that plasma IgA is a factor capable of modifying the magnitude of IgG-mediated ADCC in HIV infection, mitigating its beneficial effect. These results help in understanding why previous studies failed to demonstrate correlations between ADCC and disease progression, and they also contribute to the notion that an HIV vaccine should stimulate the production of ADCC-mediating IgG antibodies but not IgA.
High Willingness to Use HIV Pre-Exposure Prophylaxis Among Transgender Women in Argentina
(2016-12-01) Zalazar, Virginia; Aristegui, Ines; Kerr, Thomas; Marshall, Brandon D L; Romero, Marcela; Sued, Omar; Socias, Maria E.
Fil: Sued O. Fundación Huésped, Buenos Aires; Argentina
HIV Infection among Transgender Women: Challenges and Opportunities
(2014) Kerr, Thomas; Socias, Maria E.; Sued, Omar
Impressive gains continue to be made in the global fight against HIV disease. Notably, a new and growing body of observational and experimental evidence has revealed the powerful role that antiretroviral therapy can play in reducing not only morbidity and mortality at the individual level, but also HIV transmission at the population level [1,2]. This has led to renewed calls for the aggressive scale-up of HIV treatment, calls that have been supported by an array of cost effectiveness studies and prompted slogans referring to a potential “AIDS-free generation”. In addition, several studies demonstrated the potential efficacy of pre-exposure prophylaxis (PrEP) among HIVnegative individuals at risk, although fears regarding low adherence and implementation challenges resulted in a low uptake of this intervention. In 2013, the US Centers for Disease Control and Prevention released new evidence from the Bangkok Tenofovir Study suggesting that the benefits of PrEP interventions could likely be extended to people who inject drugs [3]. This trial built upon the results of previous studies reporting on potential benefits of PrEP for men who have sex with men and heterosexually active women and men [4-6].
Host Genetic Factors Associated with Symptomatic Primary HIV Infection and Disease Progression among Argentinean Seroconverters
(2014) Coloccini, Romina; Dilernia, Dario; Ghiglione, Yanina; Turk, Gabriela; Laufer, Natalia; Rubio, Andrea; Socias, Maria E.; Figueroa, Maria Ines; Sued, Omar; Cahn, Pedro; Salomon, Horacio; Mangano, Andrea; Pando, María Angeles
Background Variants in HIV-coreceptor C-C chemokine receptor type 5 (CCR5) and Human leukocyte antigen (HLA) genes are the most important host genetic factors associated with HIV infection and disease progression. Our aim was to analyze the association of these genetic factors in the presence of clinical symptoms during Primary HIV Infection (PHI) and disease progression within the first year. Methods Seventy subjects diagnosed during PHI were studied (55 symptomatic and 15 asymptomatic). Viral load (VL) and CD4 T-cell count were evaluated. HIV progression was defined by presence of B or C events and/or CD4 T-cell counts <350 cell/mm3. CCR5 haplotypes were characterized by polymerase chain reaction and SDM-PCR-RFLP. HLA-I characterization was performed by Sequencing. Results Symptoms during PHI were significantly associated with lower frequency of CCR5-CF1 (1.8% vs. 26.7%, p = 0.006). Rapid progression was significantly associated with higher frequency of CCR5-CF2 (16.7% vs. 0%, p = 0.024) and HLA-A*11 (16.7% vs. 1.2%, p = 0.003) and lower frequency of HLA-C*3 (2.8% vs. 17.5%, p = 0.035). Higher baseline VL was significantly associated with presence of HLA-A*11, HLA-A*24, and absence of HLA-A*31 and HLA-B*57. Higher 6-month VL was significantly associated with presence of CCR5-HHE, HLA-A*24, HLA-B*53, and absence of HLA-A*31 and CCR5-CF1. Lower baseline CD4 T-cell count was significantly associated with presence of HLA-A*24/*33, HLA-B*53, CCR5-CF2 and absence of HLA-A*01/*23 and CCR5-HHA. Lower 6-month CD4 T-cell count was associated with presence of HLA-A*24 and HLA-B*53, and absence of HLA-A*01 and HLA-B*07/*39. Moreover, lower 12-month CD4 T-cell count was significantly associated with presence of HLA-A*33, HLA-B*14, HLA-C*08, CCR5-CF2, and absence of HLA-B*07 and HLA-C*07. Conclusion Several host factors were significantly associated with disease progression in PHI subjects. Most results agree with previous studies performed in other groups. However, some genetic factor associations are being described for the first time, highlighting the importance of genetic studies at a local level.
Inclusion of trans women in pre-exposure prophylaxis trials: a review.
(2015) Escudero, Daniel; Kerr, Thomas; Operario, Don; Socias, Maria E.; Sued, Omar; Marshall, Brandon
Trans women are at high-risk of HIV infection. We conducted a review to determine the extent to which trans women were eligible for inclusion in and enrolled into pre-exposure prophylaxis (PrEP) efficacy trials. Out of seven trials analyzing PrEP efficacy, we found that trans women comprised only 1.2% of one trial, and 0.2% of total trial enrollments. Although an additional PrEP trial to determine efficacy among trans women may not be warranted, further research is needed to determine the effectiveness of PrEP in this marginalized population, through observational and feasibility studies. These studies should focus on unique barriers that trans women may experience while obtaining access to PrEP, such as gender discrimination, transphobia, and violence.
Prevalence and correlates of suicidal behavior among transgender women in Argentina.
(2016-2) Marshall, Brandon; Socias, Maria E.; Kerr, Thomas; Zalazar, Virginia; Sued, Omar; Aristegui, Ines
This study examined the lifetime prevalence and correlates of attempted suicide among transgender persons in Argentina. Data were derived from a nation-wide, cross-sectional survey conducted in 2013. We assessed individual, social, and structural correlates of reporting a history of attempting suicide using logistic regression. Among 482 participants, the median age was 30, 91% identified as transwomen, and 32% resided in the Buenos Aires metropolitan area. A lifetime suicide attempt was reported by 159 (33%), among whom the median age at first attempt was 17. In a multivariate model, internalized stigma was positively associated with a history of suicidal behavior, while participants with stable housing had reduced odds of prior suicide attempt(s). These findings suggest that reducing stigma and mitigating structural vulnerabilities (through, for example, the enactment and enforcement of laws that prohibit discrimination based on gender identity to ensure equitable access to housing) could be effective targets for intervention to reduce suicide attempts among transgender individuals in Argentina.
Prueba piloto de validación del método portátil PIMA para el recuento de células CD4 en comparación con la citometría de flujo.
(2015-04) Sued, Omar; Salgado, Pablo; Picchio, Camila; Figueroa, Maria Ines; Socias, Maria E.; Cando, Osvaldo; Díaz, Liliana; Hermes, Ricardo; Pérez, Héctor; Cahn, Pedro
Objetivo: comparar la metodología PIMA con la citometría de flujo convencional para el recuento de linfocitos CD4 en pacientes con infección por HIV. Métodos: se realizaron determinaciones pareadas en sangre venosa de pacientes con HIV y se comparó la correlación entre ambos resultados. Resultados: se realizaron 223 determinaciones en forma pareadas. La concordancia fue muy buena, con una correlación lineal de Pearson de 0,974, correlación por rangos de Spearman de 0,971 y con un coeficiente de determinación lineal (R cuadrado) de 0,949 (p < 0,01). El coeficiente de correlación intraclases para las medidas individuales fue de 0,965 (IC 95 % 0,926-0,980) y para medidas promedio 0,982 (IC95 % 0,961-0,990). El coeficiente de variación para medidas duplicadas fue bajo siendo 11,4 %. Discusión: este estudio demuestra una buena correlación entre la determinación de células CD4 con el sistema PIMA frente a la citometría de flujo y apoya el uso de estas metodologías donde no hay acceso a citometría convencional.
Routine HIV Testing among Hospitalized Patients in Argentina. Is It Time for a Policy Change?
(2013) Socias, Maria E.; Hermida, L.; Singman, M.; Kulgis, G.; Díaz Armas, A.; Cando, O.; Sued, Omar; Perez, Hector; Ricardo, Hermes; José Luis Presas; Cahn, Pedro
Introduction The Argentinean AIDS Program estimates that 110,000 persons are living with HIV/AIDS in Argentina. Of those, approximately 40% are unaware of their status, and 30% are diagnosed in advanced stages of immunosuppression. Though studies show that universal HIV screening is cost-effective in settings with HIV prevalence greater than 0.1%, in Argentina, with the exception of antenatal care, HIV testing is always client-initiated. Objective We performed a pilot study to assess the acceptability of a universal HIV screening program among inpatients of an urban public hospital in Buenos Aires. Methods Over a six-month period, all eligible adult patients admitted to the internal medicine ward were offered HIV testing. Demographics, uptake rates, reasons for refusal and new HIV diagnoses were analyzed. Results Of the 350 admissions during this period, 249 were eligible and subsequently enrolled. The enrolled population was relatively old compared to the general population, was balanced on gender, and did not report traditional high risk factors for HIV infection. Only 88 (39%) reported prior HIV testing. One hundred and ninety (76%) patients accepted HIV testing. In multivariable analysis only younger age (OR 1.02; 95%CI 1.003-1.05) was independently associated with test uptake. Three new HIV diagnoses were made (undiagnosed HIV prevalence: 1.58%); none belonged to a most-at-risk population. Conclusions Our findings suggest that universal HIV screening in this setting is acceptable and potentially effective in identifying undiagnosed HIV-infected individuals. If confirmed in a larger study, our findings may inform changes in the Argentinean HIV testing policy.
Th17 and Th17/Treg ratio at early HIV infection associate with protective HIV-specific CD8+ T-cell responses and disease progression
(2015) Falivene, Juliana; Ghiglione, Yanina; Laufer, Natalia; Socias, Maria E.; Holgado, Maria Pia; Ruiz, Maria; Maeto, Cynthia; Figueroa, Maria Ines; Giavedoni, Luis D.; Cahn, Pedro; Salomon, Horacio; Sued, Omar; Turk, Gabriela; Gherardi, María Magdalena
The aim of this study was to analyze Th17 and Treg subsets and their correlation with anti-HIV T-cell responses and clinical parameters during (acute/early) primary HIV infection (PHI) and up to one year post-infection (p.i). Samples from 14 healthy donors (HDs), 40 PHI patients, 17 Chronics and 13 Elite controllers (ECs) were studied. The percentages of Th17 and Treg subsets were severely altered in Chronics, whereas all HIV-infected individuals (including ECs) showed Th17/Treg imbalance compared to HDs, in concordance with higher frequencies of activated CD8+ T-cells (HLA-DR+/CD38+). Better clinical status (higher CD4 counts, lower viral loads and activation) was associated with higher Th17 and lower Treg levels. We found positive correlations between Th17 at baseline and anti-HIV CD8+ T-cell functionality: viral inhibitory activity (VIA) and key polyfunctions (IFN-γ+/CD107A/B+) at both early and later times p.i, highlighting the prognostic value of Th17 cells to preserve an effective HIV T-cell immunity. Th17/Treg ratio and the IL-17 relative mean fluorescence intensity (rMFI of IL-17) were also positively correlated with VIA. Taken together, our results suggested a potential link between Th17 and Th17/Treg ratio with key HIV-specific CD8+ T-cell responses against the infection.
The coughing patient: TB or not TB; That is the question
(2010) Laufer, Natalia; Sued, Omar; Abusamra, Lorena; Cabrini, Mercedes; Socias, Maria E.; Sisto, Alicia; Perez, Hector; Cahn, Pedro
Tuberculosis (TB) has been declared a global emergency, increasing approximately 1% each year. There are evidences that TB is being underdiagnosed worldwide1,2. One of the reasons is the failure of healthcare workers to consider TB in the differential diagnosis of patients with respiratory symptoms. Delay in the diagnosis of TB in HIV-infected people in an important contributor to the excess morbidity and mortality 2,3. The main purpose of this prospective study was to define clinical and epidemiological characteristics that can guide physician to the rapid diagnosis of pulmonary TB in HIV patients. During 18 month (10/2004 to 04/2006), all patients attending for unscheduled visits to an Infectious Diseases Division of a public Hospital in Argentina, were asked if they present cough among their symptoms and if so they were invited to participate in the study. Patients, who signed informed consent, filled a questionnaire and their clinical records were evaluated prospectively. Chest X-Rays were classified according to the classification described by Tattevin, et al.4. Epidemiological and clinical data were compared between HIV patients with TB coinfection and those with HIV and other diagnosis. X2 and t-test were used to compare data. During the period studied, 9245 unscheduled visits were recorded, with 286 patients presenting cough. Among the patients with cough, 40 did not sign the consent. Of the remaining who agreed to participated, 35 (13%) presented a TB diagnosis (positive sputum smear and/or positive sputum or blood culture for M. tuberculosis), 211 have a non-TB diagnosis (most of them with PCP –n=51, 24%-, community acquired pneumonia –n=70, 33%-). Twenty three of the TB patients were HIV co-infected. When TB-HIV-coinfected patients were evaluated (Table 1) and compared with HIV-infected patients who have cough but non-TB diagnosis, statistical association with TB was found with: hepatomegaly (p=0.005); splenomegaly (p=0.003); night-sweats (p=0.001); weight-loss of more than 5 kg (p=0.003; duration of symptoms between 15 and 30 days (p=0.03) but not with longer time; elevate alkaline phosphatase (p=0.03); chest X-ray pattern of typical (p=0.0003) or compatible (p=0.013) with TB and previous contact with a patient with TB. We could not find association (p >0.05) with hemoptysis, pulmonary physical examination, previous TB or incarceration, lower educational level, LT CD4 count, HIV-1 viral load, number of previous opportunistic infections or white cell count.
Towards Full Citizenship: Correlates of Engagement with the Gender Identity Law among Transwomen in Argentina
(2014-8) Socias, Maria E.; Marshall, Brandon; Aristegui, Ines; Zalazar, Virginia; Romero, Marcela; Sued, Omar; Kerr, Thomas
Introduction In May 2012, Argentina passed its “Gender Identity” Law, which aimed to address the legal invisibility, discrimination and marginalization that transgender individuals have historically faced. The aim of this study was to explore factors associated with engagement with the Gender Identity Law among transwomen living in Argentina. Methods Data were derived from a 2013 nationwide, cross-sectional study involving transwomen in Argentina. Using multivariate logistic regression, we assessed the prevalence and factors associated with acquiring a gender-congruent identity card within the first 18 months of enactment of the Gender Identity Law. Results Among 452 transwomen, 260 (57.5%) reported that they had obtained a new gender-congruent identity card. In multivariate analysis, factors positively associated with acquiring a new ID were: previously experiencing discrimination by healthcare workers (adjusted odd ratio [aOR] = 2.01, 95% CI: 1.27–3.20); having engaged in transition procedures (aOR = 3.06, 95% CI: 1.58–5.93); and having a job other than sex work (aOR = 1.81, 95% CI: 1.06–3.10). Foreign born transwomen were less likely to have obtained a new ID (aOR = 0.14, 95% CI: 0.06–0.33). Conclusions More than half of transwomen in our sample acquired a new gender-congruent ID within the first 18 months of enactment of the Gender Identity Law. However, access to and uptake of this right has been heterogeneous. In particular, our findings suggest that the most empowered transwomen may have been among the first to take advantage of this right. Although educational level, housing conditions, HIV status and sex work were not associated with the outcome, foreign-born status was a strong negative correlate of new ID acquisition. Therefore, additional efforts should be made in order to ensure that benefits of this founding policy reach all transwomen in Argentina.
Treatment as prevention: Are Argentinean HIV care providers willing to adopt earlier antiretroviral therapy?
(2014-5) Socias, Maria E.; Sued, Omar; Pryluka, Daniel; Patterson, Patricia; Fink, Valeria; Cesar, Carina; Cahn, Pedro
HIV guidelines increasingly recommend antiretroviral therapy (ART) initiation at a higher CD4 levels. The extent to which these evolving standards are translated into routine clinical care has not been evaluated in Argentina. During October 2012, we conducted an online survey among Argentinean HIV clinicians to assess their attitudes and practices toward ART initiation and its potential use for HIV prevention. Of the 280 physicians included, 61% would prescribe ART at CD4 ≤500 cells/µL for asymptomatic patients. Although, only 11% would recommend ART irrespective of CD4 cell count, 72% would do it for serodiscordant couples, and 75% for sex workers. Most participants agreed that they would consider earlier initiation of ART if transmission risk exists, and that expansion of ART could help decrease HIV incidence. These results suggest that a large proportion of Argentinean HIV care providers are willing to adopt the recently updated Argentinean guidelines recommending earlier ART, especially when high HIV transmission risk exists.

Browsing by Author "Socias, Maria E."

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