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Merchant RC, DeLong AK, Liu T, Baird JR. Factors Influencing Uptake of Rapid HIV and Hepatitis C Screening Among Drug Misusing Adult Emergency Department Patients: Implications for Future HIV/HCV Screening Interventions. AIDS Behav 2015; 19:2025-35. [PMID: 26036465 DOI: 10.1007/s10461-015-1103-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In this randomized, controlled trial among 957 English- or Spanish-speaking drug misusing adult emergency department (ED) patients, we determined if a tailored brief intervention (BI) increased uptake of rapid HIV/HCV screening, and identified factors associated with greater screening uptake. Rapid HIV/HCV screening uptake was greater in the control than the BI arm (45 vs. 38 %; p < 0.04). Screening uptake depended on elapsed study time and which research staff member offered testing. In the control arm, uptake was lowest for those spending <30 or ≥90 min in the study. In the BI arm, screening uptake generally increased over time. Tailored BI content specifically addressing participant HIV/HCV knowledge, HIV/HCV risk behaviors, or need for HIV/HCV screening was not associated with greater screening uptake. These study findings suggested factors that should be considered when designing future ED-based screening initiatives, such as elapsed study time, who offers testing, and the content of interventions.
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Affiliation(s)
- Roland C Merchant
- Department of Emergency Medicine, Rhode Island Hospital, Alpert Medical School of Brown University, 593 Eddy Street, Claverick Building, Providence, RI, 02903, USA.
- Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA.
| | - Allison K DeLong
- Center for Statistical Sciences, School of Public Health, Brown University, Providence, RI, USA
| | - Tao Liu
- Department of Biostatistics, Center for Statistical Sciences, School of Public Health, Brown University, Providence, RI, USA
| | - Janette R Baird
- Department of Emergency Medicine, Rhode Island Hospital, Alpert Medical School of Brown University, 593 Eddy Street, Claverick Building, Providence, RI, 02903, USA
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Grotto RMT, Picelli N, de Souza LDR, Silva GF, Ferrasi AC, Silveira LVDA, Pardini MIDMC. Human Platelet Polymorphism can be a genetic marker associated with HIV/HCV coinfection. J Med Virol 2015; 87:1677-81. [PMID: 25976501 DOI: 10.1002/jmv.24233] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2015] [Indexed: 11/10/2022]
Abstract
To evaluate the associations of HPA polymorphisms -1, -3, and -5 with HIV/HCV coinfection were included in this study 60 HIV/HCV-coinfected patients from the Sao Paulo State health service centers. Data reported by Verdichio-Moraes et al. (2009: J. Med Virol 81:757-759) were used as the non-infected and HCV monoinfected groups. Human Platelet Polymorphism genotyping was performed in 60 Patients co-infected with HIV/HCV by PCR-SSP or PCR-RFLP. HIV subtyping and HCV genotyping was performed by RT-PCR followed sequencing. The data analyses were performed using the χ2 test or Fisher's Exact Test and the logistic regression model. Patients coinfected with HIV/HCV presented HCV either genotype 1 (78.3%) or non-1 (21.7%) and HIV either subtype B (85.0%) or non-B (15%). The Human Platelet Polymorphism-1a/1b genotype was more frequent (P < 0.05) in HIV/HCV coinfection than in HCV monoinfection and the allelic frequency of Human Platelet Polymorphism-5b in the Patients coinfected with HIV/HCV was higher (P < 0.05) than in HCV monoinfected cases and non-infected individuals. These data suggest that the presence of specific HPA allele on platelets could favor the existence of coinfection. On the other hand, Human Platelet Polymorphism-5a/5b was more frequent (P < 0.05) in HIV/HCV coinfected and HCV monoinfected groups than in the non-infected individuals, suggesting that this platelet genotype is related to HCV infection, regardless of HIV presence. Results suggest that the Human Platelet Polymorphism profile in HIV/HCV coinfected individuals differs from the one of both HCV monoinfected and non-infected population. So, the Human Platelet Polymorphism can be a genetic marker associated with HIV/HCV coinfection.
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Affiliation(s)
- Rejane Maria Tommasini Grotto
- Molecular Biology Laboratory, Blood Transfusion Center, Botucatu Medical School, Sao Paulo State University, UNESP, São Paulo, Brazil.,Department of Bioprocess and Biotechnology, School of Agricultural Sciences, Lageado Experiment Station. Sao Paulo State University, UNESP, Botucatu-SP, Brazil
| | - Natália Picelli
- Molecular Biology Laboratory, Blood Transfusion Center, Botucatu Medical School, Sao Paulo State University, UNESP, São Paulo, Brazil
| | - Lenice do Rosário de Souza
- Tropical Diseases Department, Botucatu Medical School, Sao Paulo State University UNESP, São Paulo, Brazil
| | - Giovanni Faria Silva
- Department of Internal Medicine, Botucatu Medical School, Sao Paulo State University UNESP, São Paulo, Brazil
| | - Adriana Camargo Ferrasi
- Molecular Biology Laboratory, Blood Transfusion Center, Botucatu Medical School, Sao Paulo State University, UNESP, São Paulo, Brazil.,Department of Internal Medicine, Botucatu Medical School, Sao Paulo State University UNESP, São Paulo, Brazil
| | | | - Maria Inês de Moura Campos Pardini
- Molecular Biology Laboratory, Blood Transfusion Center, Botucatu Medical School, Sao Paulo State University, UNESP, São Paulo, Brazil.,Department of Internal Medicine, Botucatu Medical School, Sao Paulo State University UNESP, São Paulo, Brazil
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Freitas SZ, Teles SA, Lorenzo PC, Puga MAM, Tanaka TSO, Thomaz DY, Martins RMB, Druzian AF, Lindenberg ASC, Torres MS, Pereira SA, Villar LM, Lampe E, Motta-Castro ARC. HIV and HCV coinfection: prevalence, associated factors and genotype characterization in the Midwest Region of Brazil. Rev Inst Med Trop Sao Paulo 2015; 56:517-24. [PMID: 25351547 PMCID: PMC4296873 DOI: 10.1590/s0036-46652014000600011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 04/29/2014] [Indexed: 12/19/2022] Open
Abstract
A cross-sectional study on prevalence, associated factors and genotype
distribution of HCV infection was conducted among 848 HIV-infected patients
recruited at reference centers in the Midwest Region of Brazil. The prevalence
rate of HIV-HCV coinfection was 6.9% (95% CI: 5.2 to 8.6).
In multivariable analysis, increasing age, use of illicit drugs (injection
and non-injection), a history of blood transfusion before 1994, and the
absence of a steady partnership were significant independent associated factors
for HIV-HCV coinfection. The phylogenetic analysis based on the NS5B region
revealed the presence of two major circulating genotypes of HCV: genotypes 1
(58.3%) and 3 (41.7%). The prevalence of HIV-HCV
coinfection was lower than those reported in studies conducted with HIV-infected
patients in different regions of Brazil, due to the fact that illicit drug use
is not a frequent mode of HIV transmission in this region of Brazil. Serologic
screening of HIV-patients for HCV before initiating antiretroviral treatment, a
comprehensive identification of associated factors, and the implementation of
effective harm reduction programs are highly recommended to provide useful
information for treatment and to prevent HCV coinfection in these patients.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Marina Sawada Torres
- Hematology and Hemotherapy Center of Mato Grosso do Sul, Campo Grande, MS, Brazil
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Raboni SM, Tuon FF, Beloto NCP, Demeneck H, Oliveira A, Largura D, Sagrado AG, Lima BP, Franzoni JP, Pedroso ML. Human immunodeficiency virus and hepatitis C virus/hepatitis B virus co-infection in Southern Brazil: clinical and epidemiological evaluation. Braz J Infect Dis 2014; 18:664-8. [PMID: 25019374 PMCID: PMC9425194 DOI: 10.1016/j.bjid.2014.05.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 05/19/2014] [Accepted: 05/20/2014] [Indexed: 12/14/2022] Open
Abstract
Hepatitis B virus, hepatitis C virus and human immunodeficiency virus share a similar transmission pathway and are often diagnosed in the same patient. These patients tend to have a faster progression of hepatic fibrosis. This cross-sectional study describes the demographic features and clinical profile of human immunodeficiency virus/hepatitis co-infected patients in Paraná, Southern Brazil. A total of 93 human immunodeficiency virus-infected patients attending a tertiary care academic hospital in Southern Brazil were included. Clinical, demographic and epidemiological data were evaluated. Hepatitis B virus and/or hepatitis C virus positive serology was found in 6.6% of patients. The anti-hepatitis C virus serum test was positive in 85% (79/93) of patients, and the infection was confirmed in 72% of the cases. Eighteen patients (19%) were human immunodeficiency virus/hepatitis B virus positive (detectable HBsAg). Among co-infected patients, there was a high frequency of drug use, and investigations for the detection of co-infection were conducted late. A low number of patients were eligible for treatment and, although the response to antiretroviral therapy was good, there was a very poor response to hepatitis therapy. Our preliminary findings indicate the need for protocols aimed at systematic investigation of hepatitis B virus and hepatitis C virus in human immunodeficiency virus-infected patients, thus allowing for early detection and treatment of co-infected patients.
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Affiliation(s)
- Sonia Mara Raboni
- Community Health Department, Universidade Federal do Paraná, Curitiba, PR, Brazil; Infectious Diseases Department, Universidade Federal do Paraná, Curitiba, PR, Brazil.
| | - Felipe Francisco Tuon
- Infectious Diseases Department, Universidade Federal do Paraná, Curitiba, PR, Brazil
| | | | - Henrique Demeneck
- Community Health Department, Universidade Federal do Paraná, Curitiba, PR, Brazil
| | - Andre Oliveira
- Community Health Department, Universidade Federal do Paraná, Curitiba, PR, Brazil
| | - Denis Largura
- Community Health Department, Universidade Federal do Paraná, Curitiba, PR, Brazil
| | | | | | - João Paulo Franzoni
- Community Health Department, Universidade Federal do Paraná, Curitiba, PR, Brazil
| | - Maria Lucia Pedroso
- Gastroenterology Department, Universidade Federal do Paraná, Curitiba, PR, Brazil
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Jaspe RC, Sulbarán YF, Loureiro CL, Martínez N, Devesa M, Rodríguez Y, Torres JR, Rangel HR, Pujol FH. Genetic diversity of hepatitis B virus and hepatitis C virus in human immunodeficiency virus type 1-co-infected patients from Venezuela. J Med Microbiol 2014; 63:1099-1104. [PMID: 24895404 DOI: 10.1099/jmm.0.067496-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
The aim of this study was to evaluate the prevalence and genetic diversity of hepatitis B virus (HBV) and hepatitis C virus (HCV) in human immunodeficiency virus type 1 (HIV-1)-co-infected Venezuelan patients. The prevalence of HBV and HCV markers of infection in HIV-1 patients was 14% for anti-hepatitis B core antigen, 3% for hepatitis B surface antigen and 0.7% for anti-HCV, respectively. HBV prevalence was higher than HCV, as expected for a country where sexual intercourse, not intravenous drug use, is the main mode of HIV-1 transmission. The HCV genotype distribution in HIV-1-co-infected patients was similar to that obtained in HCV-mono-infected patients, but genotype 1a was more frequent in HIV-1-infected patients. The HBV genotype distribution exhibited differences between mono-infected and HIV-1-co-infected individuals. HBV F3 was the most common subgenotype in both groups, followed by F1b in HIV-1 co-infection and F2 in HBV mono-infection. In addition, genotype G (single infection) was found in an HIV-1-co-infected individual. A high prevalence of occult HBV infection was detected in HIV-1-co-infected naïve patients (18%), with F2 being the most common genotype (75%). To the best of our knowledge, these results correspond to the first description of frequency and molecular characterization of HBV and HCV in HIV-1 Venezuelan patients.
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Affiliation(s)
- Rossana C Jaspe
- Laboratorio de Virología Molecular, Centro de Microbiología y Biología Celular, Instituto Venezolano de Investigaciones Científicas, Apdo 20632, Caracas 1020-A, Venezuela
| | - Yoneira F Sulbarán
- Laboratorio de Virología Molecular, Centro de Microbiología y Biología Celular, Instituto Venezolano de Investigaciones Científicas, Apdo 20632, Caracas 1020-A, Venezuela
| | - Carmen L Loureiro
- Laboratorio de Virología Molecular, Centro de Microbiología y Biología Celular, Instituto Venezolano de Investigaciones Científicas, Apdo 20632, Caracas 1020-A, Venezuela
| | - Nahir Martínez
- Sección de Infectología, Instituto de Medicina Tropical, UCV, Caracas, Venezuela
| | - Marisol Devesa
- Laboratorio de Virología Molecular, Centro de Microbiología y Biología Celular, Instituto Venezolano de Investigaciones Científicas, Apdo 20632, Caracas 1020-A, Venezuela
| | - Yesseima Rodríguez
- Laboratorio de Virología Molecular, Centro de Microbiología y Biología Celular, Instituto Venezolano de Investigaciones Científicas, Apdo 20632, Caracas 1020-A, Venezuela
| | - Jaime R Torres
- Sección de Infectología, Instituto de Medicina Tropical, UCV, Caracas, Venezuela
| | - Héctor R Rangel
- Laboratorio de Virología Molecular, Centro de Microbiología y Biología Celular, Instituto Venezolano de Investigaciones Científicas, Apdo 20632, Caracas 1020-A, Venezuela
| | - Flor H Pujol
- Laboratorio de Virología Molecular, Centro de Microbiología y Biología Celular, Instituto Venezolano de Investigaciones Científicas, Apdo 20632, Caracas 1020-A, Venezuela
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Alcohol misuse and illicit drug use are associated with HCV/HIV co-infection. Epidemiol Infect 2014; 142:2616-23. [DOI: 10.1017/s0950268814000041] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
SUMMARYWe studied hepatitis C virus (HCV) prevalence and risk factors for HCV infection in a sample of Brazilian HIV-positive patients. A cross-sectional study was conducted with 580 HIV-positive patients from a specialized HIV/AIDS diagnosis and treatment centre in southern Brazil. All patients were interviewed for socio-demographic and risk factors and tested for HCV antibodies and HCV-RNA detection. A multivariate analysis was performed to identify risk factors for HCV infection. A total of 138 (24%) patients had past or chronic hepatitis C. The following risk factors were associated with HCV infection for each gender: alcohol misuse and injecting drug use in women (P < 0·001) and low educational level, smoking drug use, and injecting drug use in men (P < 0·01). These results suggest that alcohol misuse, low educational level, smoking drug use, and injecting drug use are probable risk factors for HCV infection in HIV-positive patients. This information contributes to an understanding of the epidemiology of HIV/HCV co-infection in Brazil.
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Kuehlkamp VM, Schuelter-Trevisol F. Prevalence of human immunodeficiency virus/hepatitis C virus co-infection in Brazil and associated factors: a review. Braz J Infect Dis 2013; 17:455-63. [PMID: 23680064 PMCID: PMC9428044 DOI: 10.1016/j.bjid.2012.10.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Revised: 10/29/2012] [Accepted: 10/29/2012] [Indexed: 11/18/2022] Open
Abstract
The hepatitis C virus and human immunodeficiency virus share the same transmission routes, which makes co-infection an unfavorable condition for the natural history of both viral diseases. In this context, it should be highlighted that the knowledge of the extent of co-infection and associated risk factors is a vital tool for prevention and control over infectious diseases. The aim of this study was to review the literature, seeking to examine the prevalence of human immunodeficiency virus/hepatitis C virus co-infection reported in studies conducted in Brazil, and identify the main risk factors associated with co-infection. The electronic search was conducted in the Medline, Lilacs and SciELO databases. The following keywords were used: human immunodeficiency virus and Hepatitis C or hepatitis C virus and Brazil. The search led to 376 articles, of which 69 were selected for data extraction. We excluded animal studies, reports or case series, review articles, letters to the editor, other types of hepatitis and those studies in which co-infected patients were intentionally selected for comparison to single infected individuals. As a result, 40 articles were reviewed. The majority of the population in these studies was male (71%) and young adults, with a mean age of 26.7 years. The prevalence of hepatitis C virus co-infection among individuals living with human immunodeficiency virus in the studies conducted in Brazil ranged from 3.3% (serum samples) to 82.4% (drug users), with an average of 20.3%. The findings reveal that the prevalence of human immunodeficiency virus/hepatitis C virus co-infection is highly variable, depending on the characteristics of the study population. Risk factors associated with human immunodeficiency virus/hepatitis C virus co-infection were injection drug use and blood transfusion.
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Wolff FH, Fuchs SC, Barcellos NNT, de Alencastro PR, Ikeda MLR, Brandão ABM, Falavigna M, Fuchs FD. Co-infection by hepatitis C virus in HIV-infected patients in southern Brazil: genotype distribution and clinical correlates. PLoS One 2010; 5:e10494. [PMID: 20463962 PMCID: PMC2864745 DOI: 10.1371/journal.pone.0010494] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2009] [Accepted: 04/13/2010] [Indexed: 11/18/2022] Open
Abstract
Background Prevalence rates of Hepatitis C Virus (HCV) co-infection, the distribution of HCV genotypes, and the frequency of spontaneous resolution of hepatitis C in patients infected with the Human Immunodeficiency Virus (HIV) have a worldwide disparity. The purpose of this study is to investigate the prevalence of HCV antibodies (anti-HCV) in patients with HIV, the proportion and correlates of infection by different HCV genotypes, and rates of spontaneous resolution of HCV infection. Methods A cross-sectional study was conducted among 1143 HIV patients under follow-up in a HIV/AIDS outpatient reference center of the Brazilian public health system. From 357 anti-HCV positive patients, a consecutive sample of 227 individuals HCV treatment-naïve was interviewed and 207 was tested for HCV-RNA and genotypes. Results Anti-HCV was detected in 357 patients (31.2%). HCV-RNA was undetectable in 16.4% of 207 anti-HCV positive individuals. Genotype 1 was diagnosed in 81.5% of the sample, genotype 2 in 1.7% and genotype 3 in 16.2%. Male gender was the unique characteristic associated with higher prevalence of genotype 1 HCV. Conclusions Co-infection by HCV is frequent among patients with HIV in our State, and it is particularly high the infection by HCV genotype 1. Further investigation is necessary to explain the important regional variation in the proportion of infection by the different HCV genotypes and to better understand rates of spontaneous HCV clearance.
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Affiliation(s)
- Fernando H Wolff
- National Institute of Science and Technology for Health Technology Assessment (IATS)-CNPq, Porto Alegre, Rio Grande do Sul, Brazil.
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Cardoso LPV, Pereira GAS, Viegas ÂA, Schmaltz LEPR, Stefani MMDA. HIV-1 primary and secondary antiretroviral drug resistance and genetic diversity among pregnant women from central Brazil. J Med Virol 2010; 82:351-7. [DOI: 10.1002/jmv.21722] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Cardoso LPV, de Araújo Stefani MM. High level of multidrug resistance mutations in HIV type 1 pol gene and resistance-associated mutations to enfuvirtide (T-20) among antiretroviral-experienced patients from central Brazil. AIDS Res Hum Retroviruses 2009; 25:943-50. [PMID: 19792869 DOI: 10.1089/aid.2009.0060] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
HIV-1 resistance mutations to antiretroviral (ARV) drugs (nucleoside reverse transcriptase inhibitors, NRTI; nonnucleoside reverse transcriptase inhibitors, NNRTI; and protease inhibitors, PI) represent a challenge for sustainable virologic and immunologic responses. HIV-1 phylogenetic diversity and ARV resistance mutations associated with protease (PR) and reverse transcriptase (RT) were assessed among 48 ARV-experienced patients from Goiania/Goias, central west Brazil. The gp41 resistance mutations to the fusion inhibitor (T-20) were analyzed among multidrug-resistant (MDR) patients. PR, partial RT, and gp41 genes were amplified and sequenced from plasma RNA. HIV-1 subtype was assigned by phylogenetic analysis. ARV mutations in PR/RT were analyzed by the Stanford Database. T-20 resistance mutations in gp41 were identified by Stanford, the Los Alamos Database, and other sources. Subtype B represented 79.2% (38/48), subtype F1 4.2% (2/48), subtype C 2.1% (1/48), F1(PR)/B(RT) 8.3% (4/48), and B(PR)/F1(RT) 6.3% (3/48). Secondary drug resistance was observed in 79% (38/48): NRTI resistance (n = 1), NNRTI resistance (n = 1), PI + NRTI or NRTI + NNRTI resistance (n = 20), and PI + NRTI +NNRTI resistance, considered MDR (n = 16). Almost half of the MDR patients had viral loads below 10,000 copies/ml. The gp41 sequences from 14 MDR revealed one F1(PR)/B(RT)/F1(ENV) recombinant and 13 subtype B(PR)/B(RT)/B(ENV) isolates. G36E, N42T, and N43S T-20 resistance mutations were observed in three MDR patients, two of them previously treated with T-20 and the other who had never used T-20. Our data among ARV-experienced patients showed a high proportion of drug-resistance mutations and MDR. T-20 resistance mutations were detected among MDR patients corroborating the importance of T-20 genotyping for clinical management and salvage therapy.
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HIV-1 pol phylogenetic diversity and antiretroviral resistance mutations in treatment naïve patients from Central West Brazil. J Clin Virol 2009; 46:134-9. [DOI: 10.1016/j.jcv.2009.07.009] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2009] [Revised: 07/03/2009] [Accepted: 07/15/2009] [Indexed: 11/23/2022]
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Costa ZB, Machado GC, Avelino MM, Filho CG, Filho JVM, Minuzzi AL, Turchi MD, Stefani MMA, de Souza WV, Martelli CMT. Prevalence and risk factors for Hepatitis C and HIV-1 infections among pregnant women in Central Brazil. BMC Infect Dis 2009; 9:116. [PMID: 19635135 PMCID: PMC2726149 DOI: 10.1186/1471-2334-9-116] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2008] [Accepted: 07/27/2009] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Hepatitis C (HCV) and human immunodeficiency virus (HIV) infections are a major burden to public health worldwide. Routine antenatal HIV-1 screening to prevent maternal-infant transmission is universally recommended. Our objectives were to evaluate the prevalence of and potential risk factors for HCV and HIV infection among pregnant women who attended prenatal care under the coverage of public health in Central Brazil. METHODS Screening and counselling for HIV and HCV infections was offered free of charge to all pregnant women attending antenatal clinic (ANC) in the public health system, in Goiania city (~1.1 million inhabitants) during 2004-2005. Initial screening was performed on a dried blood spot collected onto standard filter paper; positive or indeterminate results were confirmed by a second blood sample. HCV infection was defined as a positive or indeterminate sample (EIA test) and confirmed HCV-RNA technique. HIV infection was defined according to standard criteria. Factors associated with HIV and HCV infections were identified with logistic regression. The number needed to screen (NNS) to prevent one case of infant HIV infection was calculated using the Monte Carlo simulation method. RESULTS A total of 28,561 pregnant women were screened for HCV and HIV-1 in ANC. Mean maternal age was 23.9 years (SD = 5.6), with 45% of the women experiencing their first pregnancy. Prevalence of HCV infection was 0.15% (95% CI 0.11%-0.20%), and the risk increased with age (p < 0.01). The prevalence of anti-HIV infection was 0.09% (95% CI 0.06%-0.14%). Black women had a 4.9-fold (95% CI 1.42-16.95) greater risk of HIV-1 infection compared to non-black women. NNS to prevent one case of infant HIV infection ranged from 4,141 to 13,928. CONCLUSION The prevalence of HIV and HCV infections were low among pregnant women, with high acceptability rates in the opt-in strategy in primary care. Older maternal age was a risk factor for HCV and antenatal HCV testing does not fulfill the requirements for screening recommendation. The finding of higher risk of HIV-1 infection among black women despite being in consonance with the HIV-1 ethnic pattern in some American regions cannot be ruled out to be a surrogate marker of socio-economic condition.
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Affiliation(s)
- Zelma B Costa
- Faculty of Medicine, Federal University of Goiás, Goiás, Brazil
| | | | | | - Clidenor Gomes Filho
- Health State Secretariat, Goiás, Brazil, Associação de Pais e Amigos dos Excepcionais de Goiania – APAE, Goiás, Brazil
| | - Jose V Macedo Filho
- Health State Secretariat, Goiás, Brazil, Associação de Pais e Amigos dos Excepcionais de Goiania – APAE, Goiás, Brazil
| | - Ana L Minuzzi
- Health State Secretariat, Goiás, Brazil, Associação de Pais e Amigos dos Excepcionais de Goiania – APAE, Goiás, Brazil
| | - Marilia D Turchi
- Institute of Tropical Medicine and Public Health, Federal University of Goiás, Goiás, Brazil
| | - Mariane MA Stefani
- Institute of Tropical Medicine and Public Health, Federal University of Goiás, Goiás, Brazil
| | | | - Celina MT Martelli
- Institute of Tropical Medicine and Public Health, Federal University of Goiás, Goiás, Brazil
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Alcântara KC, Pereira GA, Albuquerque M, Stefani MM. Seroreversion in children born to HIV-positive and AIDS mothers from Central West Brazil. Trans R Soc Trop Med Hyg 2009; 103:620-6. [DOI: 10.1016/j.trstmh.2009.03.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2007] [Revised: 09/11/2007] [Accepted: 03/16/2009] [Indexed: 11/15/2022] Open
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Mendes-Correa MC, Cavalheiro NP, Mello C, Barone AA, Gianini RJ. Genotypic distribution of hepatitis C among hepatitis C and HIV co-infected patients in Brazil. Int J STD AIDS 2008; 19:595-9. [DOI: 10.1258/ijsa.2007.007183] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Summary: Information on hepatitis C virus (HCV) genotypic distribution among HIV-HCV co-infected patients is lacking in Brazil as well as other Latin American countries. The objective of this study was to evaluate the level of exposure to different risk factors associated with HCV transmission among a group of co-infected patients and to characterize the genotypic distribution of HCV in this cluster. A series of 100 HIV-HCV co-infected patients was analysed. The data to be analysed were collected from specific laboratory tests. Information was collected through a questionnaire. HCV genotyping was carried out by sequencing the 5′ non-coding region of HCV. Chi-square and Fischer association tests or Kruskal-Wallis test were used to study the association between HCV transmission-related variables and the established genotypes. In conclusion, exposure to multiple risk factors associated with HCV transmission was common among HIV co-infected patients and an association between HCV genotype 3 and intravenous drug user was observed.
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Affiliation(s)
- M C Mendes-Correa
- Division of Infectious and Parasitic Diseases, Hospital das Clinicas, Medical School
- Laboratory of Medical Investigation in Hepatitis
| | | | - C Mello
- Laboratory of Medical Investigation in Hepatitis
| | - A A Barone
- Division of Infectious and Parasitic Diseases, Hospital das Clinicas, Medical School
- Laboratory of Medical Investigation in Hepatitis
| | - R J Gianini
- Laboratory of Medical Investigation in Epidemiology and Statistics, Medical School, University of São Paulo, São Paulo, Brazil
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Wolff FH, Fuchs SC, Barcellos NT, Falavigna M, Cohen M, Brandão ABM, Fuchs FD. Risk factors for hepatitis C virus infection in individuals infected with the HIV. Dig Liver Dis 2008; 40:460-7. [PMID: 18096448 DOI: 10.1016/j.dld.2007.11.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2007] [Revised: 11/05/2007] [Accepted: 11/07/2007] [Indexed: 12/11/2022]
Abstract
BACKGROUND Except for injecting drug use, other routes of transmission for hepatitis C virus among HIV-AIDS patients have not been consistently described, and risk estimates are often not adjusted for confounding factors. AIMS To evaluate characteristics associated with hepatitis C virus infection in individuals infected with the HIV. PATIENTS Cases were patients co-infected by HIV and hepatitis C virus, and controls were infected only by HIV. METHODS Cases and controls were consecutively enrolled at a public health care outpatient HIV-AIDS reference centre in Porto Alegre, Southern Brazil. RESULTS A total of 227 cases (63% men; 40.3+/-8.7 years) and 370 controls (44.6% men; 38.9+/-9.8 years) were enrolled in the study. In a multiple logistic regression model, male gender (odds ratio 1.9; 95% confidence interval 1.3-2.7), age between 30 and 49 years (odds ratio 2.1; 95% confidence interval 1.2-3.7), elementary school education (odds ratio 4.2; 95% confidence interval 1.9-9.6), lower family income (odds ratio 1.7; 95% confidence interval 1.1-2.7), sharing personal hygiene objects (odds ratio 2.0; 95% confidence interval 1.3-3.3), using injected drugs (odds ratio 21.6; 95% confidence interval 10.8-43.0) and crack cocaine (odds ratio 2.8; 95% confidence interval 1.1-6.9) were independently associated with co-infection by hepatitis C virus. CONCLUSION These results confirm the risk profile for hepatitis C virus-HIV infection and suggest that sharing personal hygiene objects might explain the transmission of virus C to those not infected by the usual routes, which may be of relevance for developing preventive strategies.
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Affiliation(s)
- F H Wolff
- Post-Graduate Program in Medical Sciences, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil.
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Brígido LF, Nunes CC, Oliveira CM, Knoll RK, Ferreira JLP, Freitas CA, Alves MA, Dias C, Rodrigues R. HIV type 1 subtype C and CB Pol recombinants prevail at the cities with the highest AIDS prevalence rate in Brazil. AIDS Res Hum Retroviruses 2007; 23:1579-86. [PMID: 18160017 DOI: 10.1089/aid.2007.0102] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
HIV-1 B is predominant in Brazil, but HIV-1 C has increasingly been reported in the south of the country. However, many samples clustering with clade C are actually a recombinant, with a small B segment at RT (CRF31). Samples (209) from the three cities with the highest aids prevalence rate are analyzed. Partial polymerase sequences from HIV RNA made it possible to determine HIV clades and recombination patterns and to identify primary drug resistance mutations (DRMs). The incidence was estimated with a BED assay. HIV-1 C and CRF31 patterns were twice as frequent as clade B at all sites, but the proportion of C and CRF31 patterns was significantly different among sites. The incidence estimate for SC was 2.6 persons-years. Infection in recent or younger cases showed no association with clade C. Surveillance DRM was observed in 8.3% (95% CI 5-13), mostly to NNRTIs. Clade F pol genomes had significantly more primary DRM.
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Affiliation(s)
- Luis F.M. Brígido
- Laboratório de Retrovírus, Instituto Adolfo Lutz, São Paulo, SP, Brazil
| | - Cynara C. Nunes
- Serviço de Assistência Especializada em DST/AIDS, Porto Alegre, RS, Brazil
| | | | | | | | - Carmem A. Freitas
- Laboratório de Sorologia, Instituto Adolfo Lutz, São Paulo, SP, Brazil
| | | | - Claudia Dias
- Serviço de Assistência Especializada em DST/AIDS, Porto Alegre, RS, Brazil
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Sampaio J, Brites C, Araujo I, Bacchi CE, Dittmer DP, Tanaka PY, Harrington W, Netto EM. AIDS related malignancies in Brazil. Curr Opin Oncol 2007; 19:476-8. [PMID: 17762574 PMCID: PMC2855639 DOI: 10.1097/cco.0b013e3282c8c8eb] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW There have been relatively few studies of HIV-related malignancies in Brazil. Universal access to antiretroviral drugs in Brazil has changed both the mortality and morbidity rates of AIDS. Nevertheless, there is also extreme poverty in both urban and rural areas and complications of prolonged immune suppression such as mycobacterial and malignant diseases have put a significant strain on the country's healthcare system. This brief review outlines the existing data regarding AIDS related malignancies in the largest Latin American country. RECENT FINDINGS Currently, there are almost 600 000 people infected with HIV in Brazil and 170,000 patients are receiving highly active antiretroviral therapy. In the studies done of HIV malignancies in Brazil, it appears that these tumors are histologically similar to those that occur in other equatorial countries and differ somewhat from those seen in Europe and the US. Another unique distinction is the high association with oncogenic herpes viruses. SUMMARY The existence of federally sponsored highly active antiretroviral therapy, clinicians and healthcare providers experienced in the care of HIV patients and high incidence of malignancies associated with oncogenic viruses make Brazil an important site for clinical and basic research in AIDS and immunodeficiency related malignancies.
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Affiliation(s)
- Julio Sampaio
- University of Miami Miller School of Medicine, Fogarty International Center (AIDS and Tuberculosis Program), Miami, Florida, USA
- Prof. Edgard Santos University Hospital, Federal University of Bahia, Salvador, Brazil
| | - Carlos Brites
- Prof. Edgard Santos University Hospital, Federal University of Bahia, Salvador, Brazil
| | - Iguaracyra Araujo
- Prof. Edgard Santos University Hospital, Federal University of Bahia, Salvador, Brazil
| | | | - Dirk P. Dittmer
- University of North Carolina, Chapel Hill, North Carolina, USA
| | - Paula Y. Tanaka
- Section of Hematology, Emílio Ribas Infectology Institute, São Paulo, Brazil
| | - William Harrington
- University of Miami Miller School of Medicine, Fogarty International Center (AIDS and Tuberculosis Program), Miami, Florida, USA
| | - Eduardo M. Netto
- Prof. Edgard Santos University Hospital, Federal University of Bahia, Salvador, Brazil
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Stefani MMA, Pereira GAS, Lins JAB, Alcantara KC, Silveira AA, Viegas AA, Maya NC, Mussi AH. Molecular screening shows extensive HIV-1 genetic diversity in Central West Brazil. J Clin Virol 2007; 39:205-9. [PMID: 17537671 DOI: 10.1016/j.jcv.2007.04.012] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2006] [Revised: 04/11/2007] [Accepted: 04/14/2007] [Indexed: 12/01/2022]
Abstract
BACKGROUND Information is limited about HIV-1 subtypes circulating in less populated Brazilian areas where the AIDS epidemic is expanding, such as in the Central West region. OBJECTIVE To describe HIV-1 subtypes in patients from the States of Goias, Mato Grosso do Sul and Mato Grosso in Central West Brazil. STUDY DESIGN Heteroduplex mobility analysis of nested-PCR products from env (primers: ED5/ED12, ES7/ES8) and gag regions (primers: H1P202/H1G777, H1Gag1584/g17) of 406 HIV-1 isolates from Goias (n=271), Mato Grosso do Sul (n=85) and Mato Grosso (n=50) collected from 2001 to 2004. RESULTS Median age of patients was 26 years (1-79 range), 68.7% (279/406) females, 69.9% (269/385) sexual exposure, 14.3% parenteral risk, 15.8% vertical cases. Overall 69.9% (284/406) of HIV-1 subtypes were concordant B(env)/B(gag), 1.7% F(env)/F(gag) and 1% C(env)/C(gag). Discordant HIV-1 isolates were 14.5% (59/406), mainly B(env)/F(gag) and F(env)/B(gag) (49/59); five were B(env)/D(gag), four B(env)/C(gag) and one C(env)/D(gag). B/B and discordant B/F isolates were detected among all risk categories and among children and adults. CONCLUSION Extensive genetic diversity of HIV-1 was observed in Central West Brazil. Continued molecular studies should monitor the changing dynamics of HIV-1 over time especially in areas where the epidemic is growing.
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Affiliation(s)
- Mariane M A Stefani
- Tropical Pathology and Public Health Institute, Federal University of Goias, Rua Delenda Rezende de Melo s/n, Setor Universitario, 74.605-050 Goiania, Goias, Brazil.
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