Summary Background Antiretroviral therapy (ART) substantially decreases morbidity and mortality among people living with HIV. In this study, we describe population-level trends in the adult life expectancy (LE), and trends in the residual burden of HIV mortality following the rollout of a public sector ART programme in one of the populations with the most severe HIV epidemics in the world. Methods Data come from a demographic and HIV surveillance system in northern KwaZulu-Natal (South Africa), and cover the calendar years 2001 through 2014. We use non-parametric survival analysis methods to estimate gains in the population-wide LE at age 15 since the introduction of ART, and the shortfall of the population-wide adult LE compared to that of the HIV negative population (i.e., the LE deficit). LE gains and deficits are further disaggregated by age and cause of death using demographic decomposition methods. Findings The dataset contains information on 93,903 adults who jointly contribute 535,428 person-years of observation to the analyses and 9,992 deaths. Since the rollout of ART in 2004, adult LE increased by 15·2 years for men (95%-CI: 12·4-17·8), and 17·2 years for women (95%-CI: 14·5-20·2). Reductions in pulmonary TB and HIV related mortality account for 79·7% of the LE gains among men, and 90·7% among women. For men, 9·5% is the result of a decline in external injuries. By 2014, the LE deficit had contracted to 1·2 years for men (95%-CI: -2·9-5·8) and to 5·3 years for women (95%-CI: 2·6-7·8). Pulmonary TB and HIV are responsible for 84·9% of the LE deficit among men in 2011-'14, and for 80·8% among women. Interpretation The burden of HIV on adult mortality in this population is rapidly shrinking, but remains sizable for women, despite their better engagement with HIV care services. The recent gains in adult life-years lived as well as the current LE deficit are almost exclusively due to differences in mortality attributed to HIV and pulmonary TB. Funding Wellcome Trust, the Bill and Melinda Gates Foundation, and the National Institutes of Health.

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Antimicrobial resistance is an increasing worldwide concern, which poses unique challenges for the effective prevention and treatment of several infections, especially the ones triggered by organisms producing extended-spectrum β-lactamases (ESBL). Here, we present the surveillance results of the Study for Monitoring Antimicrobial Resistance Trends (SMART) of Gram-negative bacilli isolated from intra-abdominal infections (IAI, n = 1,235) and urinary-tract infections (UTI, n = 2,682), collected in Mexico from 2009 to 2015. Susceptibility and ESBL status were determined according to the Clinical and Laboratory Standards Institute (CLSI) broth microdilution method. Both E. coli (57%) and K. pneumoniae (12%) were the most frequently reported organisms, as well as the ones with the highest prevalence of ESBL-producing isolates (54% and 39%, respectively). The overall prevalence of ESBL-producing organisms was higher in nosocomial infections than in community-acquired infections (21% vs. 27%). The ESBL rates were 36% for IAI (953/2,682) and 37% for UTI (461/1,235). In addition, ertapenem, imipenem and amikacin were the antibiotics that mostly preserved bacterial susceptibility. Our results show consistency with global trends, although higher than the rates observed in Latin America.

Late diagnosis of HIV remains a public health issue in Mexico. Most national programs target high-risk groups, not including women. More data on factors associated with late diagnosis and access to care in women are needed. In 2012-2013, Mexican women recently diagnosed with HIV were interviewed. Socio-cultural background, household-dynamics and clinical data were collected. Of 301 women, 49 % had <200 CD4 cells/mm, 8 % were illiterate, 31 % had only primary school. Physical/sexual violence was reported by 47/30 %; 75 % acquired HIV from their stable partners. Prenatal HIV screening was not offered in 61 %; 40 % attended consultation for HIV-related symptoms without being tested for HIV. Seeking medical care ≥3 times before diagnosis was associated with baseline CD4 <200 cells/mm (adjusted OR 3.74, 95 % CI 1.88-7.45, p < 0.001). There were missed opportunities during prenatal screening and when symptomatic women seeked medical care. Primary care needs to be improved and new strategies implemented for early diagnosis in women.

Background Immunosupressed patients are at high risk of influenza‐related complications. Influenza AH1N1 has been hypothesized to induce worse outcomes in patients with malignancies, but after the A(H1N1)pdm09 few publications have analyzed the presentation and complications related to influenza afterward. Objectives We aimed to describe the characteristics, risk factors, and outcomes of influenza in an oncologic center after the 2009 pandemic and to compare our case distribution to the National community acquired influenza databases in Mexico and the United States. Methods We reviewed the cases of confirmed influenza in patients with cancer from an oncological center in Mexico from April 2009 to April 2017. Data on severity and influenza type, malignancy, comorbidities, and outcomes were recorded. We correlated data between the Centers for Disease Control and Prevention (CDC) in the United States and SISVEFLU (Influenza Surveillance Program) in Mexico. Results One hundred eighty‐eight patients were included; 75 (39.9%) had a solid neoplasm and 113 (60.1%) had hematologic malignancies. AH1N1 was the most frequent influenza type (54.2%). Patients with hematologic malignancies had more pneumonia (55% vs 25%, P < .001), needed more hospitalizations (75% vs 39% P < .001), had higher all‐cause mortality at 30 days (20% vs 9% P = .048) and influenza‐associated mortality (17% vs 7% P = .041). Thirty (16%) patients died within 30 days, and 24 (12.7%) were related to influenza. Influenza type was not associated with worse outcomes. Yearly occurrence of influenza reported by the CDC and SISVEFLU showed a significant correlation (ρ = 0.823, P = .006). Conclusions AH1N1 was the dominant serotype. Patients with hematologic malignancies had more severe influenza and presented worse outcomes. Annual SISVEFLU and CDC surveillance information showed a similar distribution of cases along time but influenza serotypes did not match for all seasons.