Resumen Antecedentes: El primer caso de COVID-19 se detectó en México el 27 de febrero de 2020. El 30 de abril, 64 días después de este primer diagnóstico, el número de pacientes aumentó exponencialmente, alcanzando un total de 19.224 casos confirmados y 1.859 (9,67%) fallecidos. En respuesta a este brote global, resumimos el estado actual del conocimiento sobre COVID-19 en México. Métodos: Los datos se obtuvieron del sitio web oficial del Ministerio de Salud en México. El período analizado fue entre el 27 de febrero y el 30 de abril de 2020. Los casos se confirmaron mediante RT-PCR en tiempo real y se analizaron los datos epidemiológicos, demográficos y clínicos. Resultados: La mayoría de los casos de COVID-19 se ubicaron en la Ciudad de México. La edad promedio de los pacientes fue de 46 años. De los 12.656 casos confirmados, el mayor número de infectados ocurre en el rango de edad entre 30 y 59 años (65,85%), y hubo una mayor incidencia en hombres (58,18%) que en mujeres (41,82%). Los pacientes fallecidos tenían una o múltiples comorbilidades, principalmente hipertensión (45,53%), diabetes (39,39%) y obesidad (30,4%). En los primeros 64 días de epidemia, China había reportado 80.304 casos con una tasa de mortalidad del 3,66%. Conclusiones: Nuestros resultados indican la transmisión temprana de COVID-19 en México. La epidemiología descriptiva muestra las similitudes entre los casos de COVID-19 de México y China. En el mismo período de la curva epidémica, observamos en México una reducción en el número de casos confirmados de COVID-19 y una mayor tasa de mortalidad en comparación con China.

Background The relationship of host immune response and viral replication with health outcomes in patients with COVID-19 remains to be defined. We aimed to characterize the medium and long-term clinical, virological, and serological outcomes after hospitalization for COVID-19, and to identify predictors of long-COVID. Methods Prospective, longitudinal study conducted in COVID-19 patients confirmed by RT-PCR. Serial blood and nasopharyngeal samples (NPS) were obtained for measuring SARS-CoV-2 RNA and S-IgG/N-IgG antibodies during hospital stay, and at 1, 2, and 6 months post-discharge. Genome sequencing was performed where appropriate. Patients filled out a COVID-19 symptom questionnaire (CSQ) at 2-month and 6-month visits, and those with highest scores were characterized. Results Of 146 patients (60% male, median age 64 years) followed-up, 20.6% required hospital readmission and 5.5% died. At 2 months and 6 months, 9.6% and 7.8% patients, respectively, reported moderate/severe persistent symptoms. SARS-CoV-2 RT-PCR was positive in NPS in 11.8% (median Ct = 38) and 3% (median Ct = 36) patients at 2 months and 6 months, respectively, but no reinfections were demonstrated. Antibody titers gradually waned, with seroreversion occurring at 6 months in 27 (27.6%) patients for N-IgG and in 6 (6%) for S-IgG. Adjusted 2-month predictors of the highest CSQ scores (OR [95%CI]) were lower peak S-IgG (0.80 [0.66-0.94]) and higher WHO severity score (2.57 [1.20-5.86]); 6-month predictors were lower peak S-IgG (0.89 [0.79-0.99]) and female sex (2.41 [1.20-4.82]); no association was found with prolonged viral RNA shedding. Conclusions Long-COVID is associated with weak anti-SARS-CoV-2 antibody response, severity of illness, and female gender. Late clinical events and persistent symptoms in the medium and long term occur in a significant proportion of patients hospitalized for COVID-19.

Seven AIDS patients who were receiving suppressive therapy for previously diagnosed cytomegalovirus (CMV) retinitis were offered treatment with protease inhibitors (PIs). Secondary prophylaxis for CMV was discontinued after 3 months of therapy with PIs if patients had ú150 CD4 cells/mm 3 and a human immunodeficiency virus (HIV) load of õ200 copies/mL and if they were negative for CMV as determined by qualitative CMV polymerase chain reaction (PCR). Ophthalmologic exams were done periodically. After a median follow-up of 9 months (range, 9 -12), no new episodes of CMV retinitis were observed. CD4 cell counts were ú150 cells/mm 3 in all cases, HIV loads were õ200 copies/mL, and results for qualitative CMV PCRs remained negative. These observations suggest that for selected patients with healed CMV retinitis who have immunologic and virologic evidence of a clinical response to potent combination antiretroviral therapy, temporary discontinuation of a chronic anti-CMV suppressive therapy may not result in further retinal necrosis. However, the long-term immunologic benefit of PIs and hence the safety of prolonged withdrawal of anti-CMV therapy is unknown.

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