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We monitored severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants in Haiti from 2020 to 2023. Despite Haitian coronavirus disease 2019 (COVID-19) travel restrictions and in the setting of a vaccination rate of 2.7%, the timing and lineage evolution of the Haiti epidemic mirrored what was occurring in the rest of the world. Sources for importation of lineages into Haiti were the United States, the Dominican Republic, Europe, and Brazil, with exportation of lineages to the United States, the Dominican Republic, Europe, and Asia. Viral loads in patients infected by the Delta and Omicron BA.1 variants were correlated along the phylogenies, suggesting that higher viral loads have facilitated strain transmission and evolution. [ABSTRACT FROM AUTHOR]

Background In 2018 the World Health Organization recommended a switch to an all oral bedaquiline-based second-line regimen for treatment of drug-resistant tuberculosis (DR-TB). How these new second-line regimens fare in comparison to first-line regimens for treatment of drug-sensitive tuberculosis (DS-TB) is not well known. Methods In this study, we contemporaneously enrolled subjects with DS-TB (n = 31) or DR-TB (n = 23) and assessed their response to therapy with first-line (rifampin, isoniazid, ethambutol, pyrazinamide) or second-line (bedaquiline, pyrazinamide, levofloxacin, linezolid, clofazimine) regimens, respectively. Results We found that the early bactericidal activity of first- and second-line regimens was similar during the first 2 weeks of therapy as determined by BACTEC MGIT, colony-forming units, and a liquid limiting dilution assay capable of detecting differentially detectable/culturable Mycobacterium tuberculosis. Furthermore, an identical percentage (77.8%) of subjects from the DS-TB and DR-TB cohorts converted to culture negative after 2 months of therapy. Conclusions Despite presenting with more advanced disease at time of treatment, subjects with DR-TB receiving an all oral bedaquiline-based second-line treatment regimen displayed a similar microbiological response to therapy as subjects with DS-TB receiving a first-line treatment regimen. [ABSTRACT FROM AUTHOR]

Background. Data are limited about the effectiveness of pediatric antiretroviral therapy (ART) in low-income countries. Methods. We report the outcomes of consecutively treating 236 human immunodeficiency virus type 1 (HIV - 1)—infected treatment-naive children with triple ART in Port-au-Prince, Haiti, between 1 May 2003 and 30 April 2006. Results. Kaplan-Meier survival analysis at follow-up demonstrated that 191 children (81%) remained in care, 21 (9%) were dead, and 24 (10%) were lost to follow-up. Independent baseline predictors of mortality were age !18 months, CD4+ T cell percentage ⩽5%, and weight-for-age Z score (WAZ) less than -3. Twelve months into ART, 56% of tested subjects had undetectable HIV-1 RNA loads. Median CD4+ T cell percentages at 12 months increased by 15%, 11%, and 5% in children with baseline percentages of ⩽5%, 6%-24%, and ⩾25%, respectively (P < .01). The median WAZ at 12 months increased by 1.0, 0.6, and 0.2 in children with baseline WAZ less than —2, —2 to —1.1, and —1 or more, respectively (P < .01). Conclusion. With continuous donor support, trained providers, and the availability of pediatric antiretroviral drug formulations, it proved feasible to deliver pediatric ART in Haiti. The effectiveness of this program should encourage efforts to make ART available for HIV-infected children in poor countries. [ABSTRACT FROM AUTHOR]

The mechanisms by which Cryptosporidium parvum cause persistent diarrhea and increased morbidity and mortality are poorly understood. Three groups of Haitian children <18 months old were studied: case patients, children with diarrhea not due to Cryptosporidium, and healthy control subjects. Compared with both control groups, children with acute cryptosporidiosis were more malnourished (including measures of stunting [P = .03] and general malnutrition [P = .01]), vitamin A deficient (P = .04), and less often breast-fed (P = .04). Markers of a proinflammatory immune response, interleukin (IL)-8 and tumor necrosis factor-α receptor I, were significantly elevated in the case population (P = .02 and P < .01, respectively), as was fecal lactoferrin (P = .01) and the T helper (Th)-2 cytokine IL-13 (P = .03). The counterregulatory cytokine IL-10 was exclusively elevated in the case population (P<.01). A Th1 cytokine response to infection was not detected. This triple cohort study demonstrates that malnourished children with acute cryptosporidiosis mount inflammatory, Th-2, and counterregulatory intestinal immune responses. [ABSTRACT FROM AUTHOR]