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Saffier IP, Kawa H, Harling G. A scoping review of prevalence, incidence and risk factors for HIV infection amongst young people in Brazil. BMC Infect Dis 2017; 17:675. [PMID: 29020929 PMCID: PMC5637257 DOI: 10.1186/s12879-017-2795-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 10/04/2017] [Indexed: 11/12/2022] Open
Abstract
Background Despite young people being a key population for HIV prevention, the HIV epidemic amongst young Brazilians is perceived to be growing. We therefore reviewed all published literature on HIV prevalence and risk factors for HIV infection amongst 10-25 year olds in Brazil. Methods We searched Embase, LILACS, Proquest, PsycINFO, PubMed, Scopus and Web of Science for studies published up to March 2017 and analyzed reference lists of relevant studies. We included published studies from any time in the HIV epidemic which provided estimates specific to ages 10-25 (or some subset of this age range) for Brazilians on either: (a) HIV prevalence or incidence; or (b) the association between HIV and socio-demographic or behavioral risk factors. Results Forty eight publications met the inclusion criteria: 44 cross-sectional, two case-control, two cohort. Four studies analysed national data. Forty seven studies provided HIV prevalence estimates, largely for six population subgroups: Counselling and Testing Center attendees; blood donors; pregnant women; institutional individuals; men-who-have-sex-with-men (MSM) and female sex workers (FSW); four provided HIV incidence estimates. Twelve studies showed HIV status to be associated with a wide range of risk factors, including age, sexual and reproductive history, infection history, substance use, geography, marital status, mental health and socioeconomic status. Conclusions Few published studies have examined HIV amongst young people in Brazil, and those published have been largely cross-sectional and focused on traditional risk groups and the south of the country. Despite these limitations, the literature shows raised HIV prevalence amongst MSM and FSW, as well as amongst those using drugs. Time trends are harder to identify, although rates appear to be falling for pregnant women, possibly reversing an earlier de-masculinization of the epidemic. Improved surveillance of HIV incidence, prevalence and risk factors is a key component of efforts to eliminate HIV in Brazil.
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Affiliation(s)
| | - Hélia Kawa
- Department of Epidemiology, Fluminense Federal University, Niterói, Brazil
| | - Guy Harling
- Institute for Global Health, University College London, Mortimer Market Centre, London, WC1E 6JB, UK. .,Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA.
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Grinberg G, Giron LB, Knoll RK, Galinskas J, Camargo M, Arif MS, Samer S, Janini LMR, Sucupira MCA, Diaz RS. High prevalence and incidence of HIV-1 in a counseling and testing center in the city of Itajaí, Brazil. Braz J Infect Dis 2015; 19:631-5. [PMID: 26361837 PMCID: PMC9425333 DOI: 10.1016/j.bjid.2015.08.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 08/19/2015] [Accepted: 08/20/2015] [Indexed: 12/05/2022] Open
Abstract
Itajaí is a port city in southern Brazil with one of the highest incidence and mortality rates from AIDS in the country. The prevalence and incidence of HIV infection were investigated in 1085 of 3196 new HIV-1 infection cases evaluated in the counseling and testing center of Itajaí from January 2002 to August 2008. Recent infections were assessed using the BED™, and pol region sequencing was performed in 76 samples. The prevalence ranged from 3.08% to 6.17% among women and from 10.26% to 17.36% among men. A total of 17% of infections were classified as recent, with annual incidence varying from 1.6% to 4.8 per 100 patient/year among women and from 2.05% to 8.5 per 100 patient/year among men. Pol sequences were obtained from 38 randomly recent infections selected individuals: 71% were infected by subtype C, 24% B, 2% D, and 2% F1. Among 38 subjects with established infection, 76% were subtype C, and 24% B. Transmitted drug resistance was detected in 18.4% of recent infection subjects (7.8% to nucleoside analog reverse-transcriptase inhibitors, 5.2% to non-nucleoside reverse-transcriptase inhibitors, and 5.2% protease inhibitors) and 5.2% of subjects with established infection had nucleoside analog reverse-transcriptase inhibitors resistance. The high prevalence and incidence of HIV infection in this region is unprecedented in studies involving cases evaluated in the counseling and testing centers in Brazil.
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Affiliation(s)
- Gorki Grinberg
- Infectious Diseases Division, Universidade Federal de São Paulo (UNIFESP), Sao Paulo, SP, Brazil
| | - Leila Bertoni Giron
- Infectious Diseases Division, Universidade Federal de São Paulo (UNIFESP), Sao Paulo, SP, Brazil
| | - Rosalie Kupka Knoll
- Centro de Ciências da Saúde, Universidade do Vale do Itajaí (UNIVALI), Itajai, SC, Brazil
| | - Juliana Galinskas
- Infectious Diseases Division, Universidade Federal de São Paulo (UNIFESP), Sao Paulo, SP, Brazil
| | - Michelle Camargo
- Infectious Diseases Division, Universidade Federal de São Paulo (UNIFESP), Sao Paulo, SP, Brazil
| | - Muhammad Shoaib Arif
- Infectious Diseases Division, Universidade Federal de São Paulo (UNIFESP), Sao Paulo, SP, Brazil
| | - Sadia Samer
- Infectious Diseases Division, Universidade Federal de São Paulo (UNIFESP), Sao Paulo, SP, Brazil
| | - Luiz Mario Ramos Janini
- Infectious Diseases Division, Universidade Federal de São Paulo (UNIFESP), Sao Paulo, SP, Brazil; Microbiology Division, Universidade Federal de São Paulo (UNIFESP), Sao Paulo, SP, Brazil
| | | | - Ricardo Sobhie Diaz
- Infectious Diseases Division, Universidade Federal de São Paulo (UNIFESP), Sao Paulo, SP, Brazil.
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Lima KOD, Salustiano DM, Cavalcanti AMS, Leal ÉDS, Lacerda HR. HIV-1 incidence among people seeking voluntary counseling and testing centers, including pregnant women, in Pernambuco State, Northeast Brazil. CAD SAUDE PUBLICA 2015. [PMID: 26200379 DOI: 10.1590/0102-311x00186813] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The HIV-1 epidemic in Brazil has displayed new characteristics over time, with an increase in heterosexual transmission and a decline in the male-to-female ratio in AIDS cases. HIV screening was offered to patients attending the Voluntary Counseling and Testing Center in Paulista, Greater Metropolitan Recife, Pernambuco State, in Northeast Brazil, to determine HIV-1 incidence. BED capture enzyme immunoassay (BED-CEIA) was used to measure HIV-1 incidence, comparing it to the AxSYM avidity index method (Ax-AI). From 2006 to 2009, 14,014 individuals were tested, and only 18 pregnant women were diagnosed with HIV infection, resulting in 0.15% annual incidence (95%CI: 0-0.33), significantly lower than in men (1.03; 95%CI: 0.45-1.61) and non-pregnant women (0.50; 95%CI: 0.11-0.89). Despite the low HIV-1 incidence in pregnant women, the high rate of recent infection detected during prenatal care emphasizes the need to increase measures to prevent vertical transmission.
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Affiliation(s)
| | | | | | - Élcio de Souza Leal
- Instituto de Ciências Biológicas, Universidade Federal do Pará, Belém, Brasil
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Drake AL, Wagner A, Richardson B, John-Stewart G. Incident HIV during pregnancy and postpartum and risk of mother-to-child HIV transmission: a systematic review and meta-analysis. PLoS Med 2014; 11:e1001608. [PMID: 24586123 PMCID: PMC3934828 DOI: 10.1371/journal.pmed.1001608] [Citation(s) in RCA: 279] [Impact Index Per Article: 27.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Accepted: 01/14/2014] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Women may have persistent risk of HIV acquisition during pregnancy and postpartum. Estimating risk of HIV during these periods is important to inform optimal prevention approaches. We performed a systematic review and meta-analysis to estimate maternal HIV incidence during pregnancy/postpartum and to compare mother-to-child HIV transmission (MTCT) risk among women with incident versus chronic infection. METHODS AND FINDINGS We searched PubMed, Embase, and AIDS-related conference abstracts between January 1, 1980, and October 31, 2013, for articles and abstracts describing HIV acquisition during pregnancy/postpartum. The inclusion criterion was studies with data on recent HIV during pregnancy/postpartum. Random effects models were constructed to pool HIV incidence rates, cumulative HIV incidence, hazard ratios (HRs), or odds ratios (ORs) summarizing the association between pregnancy/postpartum status and HIV incidence, and MTCT risk and rates. Overall, 1,176 studies met the search criteria, of which 78 met the inclusion criterion, and 47 contributed data. Using data from 19 cohorts representing 22,803 total person-years, the pooled HIV incidence rate during pregnancy/postpartum was 3.8/100 person-years (95% CI 3.0-4.6): 4.7/100 person-years during pregnancy and 2.9/100 person-years postpartum (p = 0.18). Pooled cumulative HIV incidence was significantly higher in African than non-African countries (3.6% versus 0.3%, respectively; p<0.001). Risk of HIV was not significantly higher among pregnant (HR 1.3, 95% CI 0.5-2.1) or postpartum women (HR 1.1, 95% CI 0.6-1.6) than among non-pregnant/non-postpartum women in five studies with available data. In African cohorts, MTCT risk was significantly higher among women with incident versus chronic HIV infection in the postpartum period (OR 2.9, 95% CI 2.2-3.9) or in pregnancy/postpartum periods combined (OR 2.3, 95% CI 1.2-4.4). However, the small number of studies limited power to detect associations and sources of heterogeneity. CONCLUSIONS Pregnancy and the postpartum period are times of persistent HIV risk, at rates similar to "high risk" cohorts. MTCT risk was elevated among women with incident infections. Detection and prevention of incident HIV in pregnancy/postpartum should be prioritized, and is critical to decrease MTCT.
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Affiliation(s)
- Alison L. Drake
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Anjuli Wagner
- Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
| | - Barbra Richardson
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- Department of Biostatistics, University of Washington, Seattle, Washington, United States of America
- Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | - Grace John-Stewart
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
- Department of Pediatrics, University of Washington, Seattle, Washington, United States of America
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Costa ZB, Stefani MMDA, de Lima YAR, de Souza WV, de Siqueira Filha NT, Turchi MD, Borges WC, Filho CG, Filho JVM, Minuzzi AL, Martelli CMT. Estimated incidence and genotypes of HIV-1 among pregnant women in central Brazil. PLoS One 2013; 8:e79189. [PMID: 24223904 PMCID: PMC3817037 DOI: 10.1371/journal.pone.0079189] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Accepted: 09/24/2013] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE To estimate the incidence of HIV-1 infection among pregnant women from central-western Brazil. DESIGN Observational cross-sectional study. METHODS A total of 54,139 pregnant women received antenatal HIV screening from a network of public healthcare centers in 2011. The incidence of confirmed HIV-1 infection was estimated using the Serological Testing Algorithms for Recent HIV Seroconversion (STARHS) methodology and BED-capture enzyme immunoassay (BED-CEIA). The yearly incidence was calculated, and adjusted incidence rates were estimated. For a subgroup of patients, protease and partial reverse transcriptase regions were retrotranscribed from plasma HIV-1 RNA and sequenced after performing a nested polymerase chain reaction. RESULTS Of the participants, 20% had a pregnancy before the age of 18 and approximately 40% were experiencing their first pregnancy. Of the 54,139 pregnant women screened, 86 had a confirmed HIV-1 diagnosis, yielding an overall prevalence of 1.59 cases per 1000 women (95% CI 1.27-1.96). A higher prevalence was detected in the older age groups, reflecting cumulative exposure to the virus over time. Among the infected pregnant women, 20% were considered recently infected according to the BED-CEIA. The estimated incidence of HIV infection was 0.61 per 1000 person-years (95% CI 0.33-0.89); the corrected incidence was 0.47 per 1000 person-years (95% CI 0.26-0.68). In a subgroup of patients, HIV-1 subtype C (16.7%) was the second most prevalent form after subtype B (66.7%); BF1 recombinants (11.1%) and one case of subtype F1 (5.5%) were also detected. CONCLUSION This study highlights the potential for deriving incidence estimates from a large antenatal screening program for HIV. The rate of recent HIV-1 infection among women in their early reproductive years is a public health warning to implement preventive measures.
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Affiliation(s)
| | | | | | | | | | - Marilia Dalva Turchi
- Institute of Tropical Medicine and Public Health / Federal University of Goias, Goias, Brazil
| | | | | | | | - Ana Lucia Minuzzi
- Associacao de Pais e Amigos dos Excepcionais de Goiania - APAE, Goias, Brazil
| | - Celina Maria Turchi Martelli
- Institute of Tropical Medicine and Public Health / Federal University of Goias, Goias, Brazil
- Faculty of Medicine / Federal University of Pernambuco, Pernambuco, Brazil
- * E-mail:
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Morgado MG, Bastos FI. Estimates of HIV-1 incidence based on serological methods: a brief methodological review. CAD SAUDE PUBLICA 2011; 27 Suppl 1:S7-18. [PMID: 21503527 DOI: 10.1590/s0102-311x2011001300002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2009] [Accepted: 03/12/2010] [Indexed: 11/22/2022] Open
Abstract
The paper reviews the serological methods employed in the estimation of HIV incidence based on cross-sectional studies, as well as the main findings from studies carried out in Brazil that have used such methods. Each method is briefly described, as well as their advantages and limitations. The different methods are also analyzed as a set of complementary but sometimes contradictory strategies under permanent criticism and review, still far from a gold standard. Finally, an additional question--central to the accurate monitoring of the AIDS epidemic using such methods--is discussed: whether the different methods should or should not be adjusted. The debate is open and controversy should be viewed as an unavoidable consequence of a very dynamic research field, informed by the progress in sciences as diverse as epidemiology, biostatistics, mathematical modeling and different branches of basic science, such as immunology, virology, and molecular biology.
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Nair HP, Torian LV, Forgione L, Begier EM. Evaluation of HIV incidence surveillance in New York City, 2006. Public Health Rep 2011; 126:28-38. [PMID: 21337929 DOI: 10.1177/003335491112600107] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
In 2005, the New York City (NYC) Department of Health and Mental Hygiene implemented a standardized human immunodeficiency virus (HIV) incidence surveillance protocol based on the serologic testing algorithm for recent HIV seroconversion deployed nationwide by the Centers for Disease Control and Prevention (CDC). We evaluated four key attributes of NYC's HIV incidence surveillance system-simplicity, data quality, timeliness, and acceptability--using CDC's guidelines for surveillance system evaluation. The evaluation revealed that the system could potentially provide HIV incidence estimates stratified by borough and major demographic groups at about nine months after the period of interest. The system strengths include its relative simplicity and integration with routine HIV/acquired immunodeficiency syndrome surveillance. Weaknesses include lack of completeness of testing history information, a critical component of incidence estimation. Continued improvements in data completeness and timeliness will improve the currently available information to inform personnel who develop HIV-prevention programs and policy initiatives in NYC and nationally.
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Affiliation(s)
- Hemanth P Nair
- New York City Department of Health and Mental Hygiene, 233 Broadway, 26th Floor, CN-6W, New York, NY 10279, USA.
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Ferreira JLDP, Thomaz M, Rodrigues R, Harrad D, Oliveira CM, Oliveira CADF, Batista JPG, Ito TS, Brigido LFDM. Molecular characterisation of newly identified HIV-1 infections in Curitiba, Brazil: preponderance of clade C among males with recent infections. Mem Inst Oswaldo Cruz 2008; 103:800-8. [DOI: 10.1590/s0074-02762008000800010] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2008] [Accepted: 11/12/2008] [Indexed: 11/22/2022] Open
Affiliation(s)
| | | | | | - David Harrad
- Coordenação Municipal de DST/Aids de Curitiba, Brasil
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Bassichetto KC, Bergamaschi DP, Oliveira SM, Deienno MCV, Bortolato R, de Rezende HV, Arthur T, Tomiyama H, Watkins C, Mesquita F, Abbate MC, Kallas EG. Elevated risk for HIV-1 infection in adolescents and young adults in São Paulo, Brazil. PLoS One 2008; 3:e1423. [PMID: 18183303 PMCID: PMC2173939 DOI: 10.1371/journal.pone.0001423] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2007] [Accepted: 12/17/2007] [Indexed: 11/18/2022] Open
Abstract
Background Recent studies have sought to describe HIV infection and transmission characteristics around the world. Identification of early HIV-1 infection is essential to proper surveillance and description of regional transmission trends. In this study we compare people recently infected (RI) with HIV-1, as defined by Serologic Testing Algorithm for Recent HIV Seroconversion (STARHS), to those with chronic infection. Methodology/Principal Findings Subjects were identified from 2002–2004 at four testing sites in São Paulo. Of 485 HIV-1-positive subjects, 57 (12%) were defined as RI. Of the participants, 165 (34.0%) were aware of their serostatus at the time of HIV-1 testing. This proportion was statistically larger (p<0.001) among the individuals without recent infection (n = 158, 95.8%) compared to 7 individuals (4.2%) with recently acquired HIV-1 infection. In the univariate analysis, RI was more frequent in <25 and >59 years-old age strata (p<0.001). The majority of study participants were male (78.4%), 25 to 45 years-old (65.8%), white (63.2%), single (61.7%), with family income of four or more times the minimum wage (41.0%), but with an equally distributed educational level. Of those individuals infected with HIV-1, the predominant route of infection was sexual contact (89.4%), with both hetero (47.5%) and homosexual (34.5%) exposure. Regarding sexual activity in these individuals, 43.9% reported possible HIV-1 exposure through a seropositive partner, and 49.4% reported multiple partners, with 47% having 2 to 10 partners and 37.4% 11 or more; 53.4% of infected individuals reported condom use sometimes; 34.2% reported non-injecting, recreational drug use and 23.6% were reactive for syphilis by VDRL. Subjects younger than 25 years of age were most vulnerable according to the multivariate analysis. Conclusions/Significance In this study, we evaluated RI individuals and discovered that HIV-1 has been spreading among younger individuals in São Paulo and preventive approaches should, therefore, target this age stratum.
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Xiao Y, Jiang Y, Feng J, Xu W, Wang M, Funkhouser E, Vermund SH, Jia Y. Seroincidence of recent human immunodeficiency virus type 1 infections in China. CLINICAL AND VACCINE IMMUNOLOGY : CVI 2007; 14:1384-6. [PMID: 17671229 PMCID: PMC2168114 DOI: 10.1128/cvi.00356-06] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A subtype B, E, and D immunoglobulin G capture immunoassay shows promise as a tool for estimating human immunodeficiency virus type 1 seroincidence from cross-sectional surveys, but the test-specific limitations suggest that an adjustment is necessary, and further validation of the assay with populations with divergent subtypes is needed.
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Affiliation(s)
- Yao Xiao
- National AIDS Reference Laboratory, National Center for AIDS & STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100050, People's Republic of China
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Abstract
In 1996, Brazil became the first developing country to provide universal access to antiretroviral therapy (ART), based on a strategy that utilizes an individualized approach to treatment and an open formulary. At the time, the number of patients in need of treatment was less than 15% of what it is today, there were six approved drugs for the treatment of HIV infection (compared with 25 today), and the life expectancy of patients was measured in months and years, not in decades. In recent years, preventable and treatable conditions such as cardiovascular diseases increased significantly faster as causes of death among HIV-infected individuals than in the general population. In the near future there will be a substantial increase in the number of patients in need of therapy and in the number of patients using more complex regimens who also have co-morbidities that impact prognosis. Brazil will thus need to expand its network of treatment facilities, increase its capacity to manage more complex clinical conditions, and decide on the proper balance of sophistication that will be required. As the Brazilian scientific output is not commensurate with its successes in the treatment and prevention of HIV infection, there is little empirical basis to inform decisions on how best to allocate finite resources. The Brazilian response to the HIV/AIDS epidemic, universal access to ART in particular, is an example to other developing countries. The Brazilian experience also shows that operational research should be an integral part of programmes of access to treatment, if their long-term sustainability is to be ensured.
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Affiliation(s)
- Mauro Schechter
- Hospital Universitario Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rua Professor Rodolpho Paulo Rocco no, 255, Ilha do Fundão, CEP 21941.590 Rio de Janeiro, SP, Brazil.
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Vignoles M, Avila MM, Osimani ML, de Los Angeles Pando M, Rossi D, Sheppard H, Sosa-Estani S, Benetucci J, Maulen S, Chiparelli H, Russi J, Sánchez JL, Montano SM, Martínez-Peralta L, Weissenbacher M. HIV seroincidence estimates among at-risk populations in Buenos Aires and Montevideo: use of the serologic testing algorithm for recent HIV seroconversion. J Acquir Immune Defic Syndr 2006; 42:494-500. [PMID: 16810116 DOI: 10.1097/01.qai.0000221678.06822.8b] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Using the serological testing algorithm for recent HIV seroconversion, we estimated annualized incidences (per 100 person-years) of HIV-1 infection in different at-risk groups in Buenos Aires and Montevideo, during a 5-year period between 1998 and 2003. HIV-positive serum samples from 9 serosurveys conducted among men who have sex with men, patients attending clinics for a sexually transmitted infections consult (STIs), female commercial sex workers, injecting drug users (IDUs), noninjecting cocaine users (NICUs), asymptomatic women screened for HIV infection, and patients with tuberculosis were used. HIV incidences were as follows: 6.7 for men who have sex with men, 2.0 for STIs, 1.3 for female commercial sex workers, 0.0 for Argentinean IDUs, 10.3 for Uruguayan IDUs, 3.1 for Argentinean NICUs, 4.4 for Uruguayan NICUs, and 2.4 for patients with tuberculosis. Among asymptomatic women screened for HIV infection, incidence rose from 0.4 in 1998 to 4.6 in 1999 and to a high of 10.2 in the year 2000. Unexpectedly, high HIV incidences were detected among at-risk groups in Buenos Aires and Montevideo. This pattern shows an emerging HIV epidemic among heterosexuals stemming from core HIV-infected at-risk groups. There is an urgent need for development and implementation of specific prevention strategies to address this burgeoning epidemic.
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Affiliation(s)
- Moira Vignoles
- Centro Nacional de Referencia para el SIDA (CNRS), Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
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Abstract
PURPOSE OF REVIEW For the first time, Africa is poised to test the efficacy of two candidate vaccines. This raises many scientific, logistic, regulatory and ethical challenges for the continent. This review outlines recent developments relating to the epidemiologic, scientific, site development, and standard of care issues relevant to the conduct of these trials in developing countries. RECENT FINDINGS The AIDS epidemic in Africa has reached crisis proportions. Despite more than 20 years having passed since the discovery of HIV, there are no effective biomedical interventions. The testing of two adenovirus type 5-vectored HIV vaccine candidates for efficacy is crucial. These vaccines, which seek to elicit cytotoxic T lymphocyte responses, may not prevent infection, but may ameliorate infection and potentially prevent secondary HIV transmission. Efficacy of these vaccines may be impacted by the presence of pre-existing immunity to the vectors and the genetic diversity of HIV. Trials will be conducted in areas of the world with high HIV incidence, and special efforts should be made to enroll young women and adolescents. The development of clinical trial site capacity, technology transfer of immunogenicity assays to in-country laboratories, and expediting high-quality regulatory and ethical review and executing efficacy trials of the highest standard should be seen as paramount by donors, vaccine developers, clinical trial networks and developing world governments. SUMMARY HIV vaccine efficacy trials will soon be conducted in Africa.
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Bastos FI, Hacker MA. [Brazilian psychosocial and operational research vis-à-vis the UNGASS targets]. Rev Saude Publica 2006; 40 Suppl:42-51. [PMID: 16729158 DOI: 10.1590/s0034-89102006000800007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Items from the UNGASS Draft Declaration of Commitment on HIV/AIDS (2001) are analyzed. The Brazilian experience of new methods for testing and counseling among vulnerable populations, preventive methods controlled by women, prevention, psychosocial support for people living with HIV/AIDS, and mother-child transmission, is discussed. These items were put into operation in the form of keywords, in systematic searches within the standard biomedicine databases, also including the subdivisions of the Web of Science relating to natural and social sciences. The Brazilian experience relating to testing and counseling strategies has been consolidated through the utilization of algorithms aimed at estimating incidence rates and identifying recently infected individuals, testing and counseling for pregnant women, and application of quick tests. The introduction of alternative methods and new technologies for collecting data from vulnerable populations has been allowing speedy monitoring of the epidemic. Psychosocial support assessments for people living with HIV/AIDS have gained impetus in Brazil, probably as a result of increased survival and quality of life among these individuals. Substantial advances in controlling mother-child transmission have been observed. This is one of the most important victories within the field of HIV/AIDS in Brazil, but deficiencies in prenatal care still constitute a challenge. With regard to prevention methods for women, Brazil has only shown a halting response. Widespread implementation of new technologies for data gathering and management depends on investments in infrastructure and professional skills acquisition.
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Affiliation(s)
- Francisco Inácio Bastos
- Departamento de Informações em Saúde, Centro de Informação Científica e Tecnológica, Fundação Oswaldo Cruz, 21040-900 Rio de Janeiro, RJ, Brazil.
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