BackgroundTransmitted drug resistance (TDR) remains an important concern for the management of HIV infection, especially in countries that have recently scaled-up antiretroviral treatment (ART) access.Methodology/Principal FindingsWe designed a study to assess HIV diversity and transmitted drug resistance (TDR) prevalence and trends in Mexico. 1655 ART-naïve patients from 12 Mexican states were enrolled from 2005 to 2010. TDR was assessed from plasma HIV pol sequences using Stanford scores and the WHO TDR surveillance mutation list. TDR prevalence fluctuations over back-projected dates of infection were tested. HIV subtype B was highly prevalent in Mexico (99.9%). TDR prevalence (Stanford score>15) in the country for the study period was 7.4% (95% CI, 6.2∶8.8) and 6.8% (95% CI, 5.7∶8.2) based on the WHO TDR surveillance mutation list. NRTI TDR was the highest (4.2%), followed by NNRTI (2.5%) and PI (1.7%) TDR. Increasing trends for NNRTI (p = 0.0456) and PI (p = 0.0061) major TDR mutations were observed at the national level. Clustering of viruses containing minor TDR mutations was observed with some apparent transmission pairs and geographical effects.ConclusionsTDR prevalence in Mexico remains at the intermediate level and is slightly lower than that observed in industrialized countries. Whether regional variations in TDR trends are associated with differences in antiretroviral drug usage/ART efficacy or with local features of viral evolution remains to be further addressed.

An outbreak with high mortality of IMD occurred in Tijuana, Mexico. This event and evidence of endemicity should encourage health authorities to evaluate meningococcal vaccination in the region.

Background Evolutionary analyses of well-annotated 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) – 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 from Tijuana between 1996-2018. A multistep phylogenetic approach was used to characterize the dynamics of spread. The contribution of geospatial factors and HIV risk group to the local dynamics were evaluated. Results Phylogeographic analyses of the 2,034 sequences revealed an important contribution of local transmission in sustaining the epidemic, as well as a complex viral migration network across the region. Geospatial viral dispersal between San Diego communities occurred predominantly among men-who-have-sex with-men with central San Diego being the main source (34.9%) and recipient (39.5%) of migration events. HIV migration was more frequent from San Diego county towards Tijuana than vice versa. Migrations were best explained by driving time between locations. Conclusion The US-Mexico border may not be a major barrier to the spread of HIV, which may stimulate coordinated transnational intervention approaches. Whereas a focus on central San Diego has the potential to avert most spread, the substantial viral migration independent of central San Diego shows that county-wide efforts will be more effective. Combined, this work shows that epidemiological information gleaned from pathogen genomes can uncover mechanisms that underlie sustained spread and, in turn, can be a building block of public health decision making.

Our study suggests different NNRTI PDR prevalence and transmission dynamics in three geographical areas of Mexico. Even when increasing trends in efavirenz resistance were observed in the three areas, our observations support that, in a large country such as Mexico, subnational surveillance and locally tailored interventions to address drug resistance may be a reasonable option.

Tuberculous Meningitis (TBM) is the infection of the meninges by Mycobacterium tuberculosis (Mtb) [1]. First described by Green in 1836 [2], TBM is the most common form of central nervous system tuberculosis (TB), accounting for 5-6% of extrapulmonary TB cases and for 1% of the total TB cases worldwide [1,3,4]. TBM is described as a subacute illness with a duration of symptoms that ranges 5-30 days with clinical features such as a low-grade fever, headache, and signs of meningeal irritation; in advanced stages, there may be focal neurological deficits, cranial nerve paralysis, and seizures [1,5,6]. The global incidence of TBM is unknown [7]; in 2017, Mexico had an overall prevalence of 0.35 cases per 100,000 inhabitants [8]. The global HIV epidemic has increased the number of adults affected by TBM. Data from a study that included a database of 1699 adult patients from five different studies reported a mortality rate of 23% in non-HIV patients and 51.3% for HIV-infected patients [9], reaching 100% in cases of drug-resistant Mtb [3]. Despite its high incidence, to our knowledge, the clinical features and outcome of the Mexican adult population with TBM have not been described. The aim of this study is to describe the characteristics at admission and in-hospital outcome of adult Mexican patients with TBM and compare them according to the subtype of diagnosis.