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Bezerra DRB, Jalil CM, Jalil EM, Coelho LE, Carvalheira E, Freitas J, Monteiro L, Santos T, Souza C, Hoagland B, Veloso VG, Grinsztejn B, Cardoso SW, Torres TS. Complementary Recruitment Strategies to Reach Men Who Have Sex with Men and Transgender Women: The Experience of a Large Brazilian HIV Prevention Service. AIDS Behav 2022; 26:2643-2652. [PMID: 35122578 DOI: 10.1007/s10461-022-03609-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2022] [Indexed: 11/29/2022]
Abstract
Different strategies have been used to reach men who have sex with men (MSM) and transgender women (TGW) for HIV prevention services. We described the characteristics of MSM and TGW attending a large HIV prevention service in Brazil according to different recruitment strategies or referrals. A total of 2713 individuals (2246[82.8%] MSM and 467[17.2%] TGW) attended the service. Among HIV-negative MSM and TGW, 74.6% and 82.8% were eligible for pre-exposure prophylaxis (PrEP), respectively. PrEP uptake among MSM and TGW was 56.4% and 39.1%, respectively. Participants were mostly referred by peers (43.6%), followed by web-based (24.1%) and venue-based recruitment (16.2%). More young and Black MSM were referred from venue-based recruitment, and web-based strategies more frequently referred MSM with higher education. TGW who were younger and had higher education were more frequently referred from venue-based recruitment. Web-based recruitment failed to reach TGW. Multiple strategies were complementary to reach diverse MSM and TGW populations.
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Affiliation(s)
- Daniel R B Bezerra
- STD/AIDS Clinical Research Lab (LapClin-AIDS), Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Cristina M Jalil
- STD/AIDS Clinical Research Lab (LapClin-AIDS), Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Emilia M Jalil
- STD/AIDS Clinical Research Lab (LapClin-AIDS), Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Lara E Coelho
- STD/AIDS Clinical Research Lab (LapClin-AIDS), Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Eduardo Carvalheira
- STD/AIDS Clinical Research Lab (LapClin-AIDS), Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Josias Freitas
- STD/AIDS Clinical Research Lab (LapClin-AIDS), Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Laylla Monteiro
- STD/AIDS Clinical Research Lab (LapClin-AIDS), Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Toni Santos
- STD/AIDS Clinical Research Lab (LapClin-AIDS), Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Cleo Souza
- STD/AIDS Clinical Research Lab (LapClin-AIDS), Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Brenda Hoagland
- STD/AIDS Clinical Research Lab (LapClin-AIDS), Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Valdilea G Veloso
- STD/AIDS Clinical Research Lab (LapClin-AIDS), Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Beatriz Grinsztejn
- STD/AIDS Clinical Research Lab (LapClin-AIDS), Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Sandra W Cardoso
- STD/AIDS Clinical Research Lab (LapClin-AIDS), Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Thiago S Torres
- STD/AIDS Clinical Research Lab (LapClin-AIDS), Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil.
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Torres TS, Jalil EM, Coelho LE, Bezerra DRB, Jalil CM, Hoagland B, Cardoso SW, Arayasirikul S, Veloso VG, Wilson EC, McFarland W, Grinsztejn B. A Technology-Based Intervention Among Young Men Who Have Sex With Men and Nonbinary People (The Conectad@s Project): Protocol for A Vanguard Mixed Methods Study. JMIR Res Protoc 2022; 11:e34885. [PMID: 35023848 PMCID: PMC8796043 DOI: 10.2196/34885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 11/15/2021] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND In many parts of the world, including Brazil, uptake for biomedical interventions has been insufficient to reverse the HIV epidemic among key populations at high risk for HIV, including men who have sex with men. Young MSM (YMSM), particularly Black YMSM, have high HIV incidence, low viral suppression, and low preexposure prophylaxis (PrEP) uptake and adherence. Therefore, novel approaches to increase the HIV biomedical interventions uptake by YMSM are urgently needed. OBJECTIVE We describe the Conectad@s Project, which aims to: (1) estimate the prevalence and incidence of HIV and other sexually transmitted infections, the onset of sexual risk behavior, and barriers to biomedical interventions among YMSM aged 18 to 24 years in Rio de Janeiro, Brazil; and (2) conduct a technology-based adherence intervention study to promote a rapid linkage of YMSM to HIV care or prevention, and support and sustain adherence. METHODS A cross-sectional survey will be conducted with 400 YMSM recruited using respondent-driven sampling (RDS) adapted for social media-based sampling, preceded by a formative phase. HIV and sexually transmitted infections testing will be conducted, including early HIV infection biomarker detection. Behavioral, partnership, network, and structural measures will be collected through structured questionnaires. All individuals recruited for the survey will have access to HIV risk assessment, antiretroviral therapy (ART), PrEP, prevention counseling, and a technology-based adherence intervention. Those who accept the adherence intervention will receive weekly text messages via a social networking app (WhatsApp) for 24 weeks, with follow-up data collected over 48 weeks. RESULTS The Conectad@s project has been approved by our local institutional review board (#CAAE 26086719.0.0000.4262) in accordance with all applicable regulations. Questionnaires for the RDS survey and intervention were developed and tested in 2020, formative interviews were conducted in January and February 2021 to guide the development of the RDS, and enrollment is planned to begin in early 2022. CONCLUSIONS The Conectad@s Project is a vanguard study that, for the first time, will apply digital RDS to sample and recruit YMSM in Brazil and rapidly connect them to ART, PrEP, or prevention counseling through a technology-based adherence intervention. RDS will allow us to estimate HIV prevalence among YMSM and measure HIV infection biomarkers in the context of the onset of risky behavior. The data will lay the groundwork to adapt and implement HIV prevention strategies, identify barriers to the earliest HIV infection diagnosis, immediate ART or PrEP initiation, and detect new clusters of HIV transmission. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/34885.
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Affiliation(s)
- Thiago Silva Torres
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Emilia Moreira Jalil
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Lara Esteves Coelho
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | | | - Cristina Moreira Jalil
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Brenda Hoagland
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Sandra Wagner Cardoso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Sean Arayasirikul
- Center for Public Health Research, San Francisco Department of Public Health, San Francisco, CA, United States
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, United States
| | | | - Erin C Wilson
- Center for Public Health Research, San Francisco Department of Public Health, San Francisco, CA, United States
| | - Willi McFarland
- Center for Public Health Research, San Francisco Department of Public Health, San Francisco, CA, United States
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
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Torres RMC, Bastos LS, Gomes MFDC, Moreira RI, Périssé ARS, Cruz MMD. Risk assessment for HIV infection in men who have sex with men and the contribution of sexual partner networks. CIENCIA & SAUDE COLETIVA 2021; 26:3543-3554. [PMID: 34468650 DOI: 10.1590/1413-81232021269.2.36912019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 01/05/2020] [Indexed: 11/22/2022] Open
Abstract
This study aimed to evaluate the risk of HIV infection in men who have sex with men (MSM) by developing an index that considers sex partner networks. The index variables were age, ethnicity/skin color, schooling, relationship type, condom use in receptive and insertive relationships, self-perception of the possibility of HIV infection, sexually transmitted infections, and rapid HIV testing results. We used data from a cross-sectional MSM egocentric network survey conducted in Rio de Janeiro between 2014 and 2015. The initial research volunteer is called ego, each partner is called alter, and each pair of people in a relationship is called the dyad. Multiple logistic regression was used to define the coefficients of the equations for the elaboration of the indices. The index ranged from 0 to 1; the closer to 1, the higher the risk of HIV infection. HIV prevalence was 13.9% among egos. The mean egos index with an HIV-reactive test was 57% higher than non-reactive, and the same profile was observed in the index values of dyads. The index allowed the incorporation of network data through the dyads and contributed to the identification of individuals with a higher likelihood of acquiring HIV.
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Affiliation(s)
- Raquel Maria Cardoso Torres
- Escola Nacional de Saúde Pública Sergio Arouca, Fiocruz. R. Leopoldo Bulhões, 1480, Manguinhos, Rio de Janeiro. 21041-210 Rio de Janeiro RJ Brasil.
| | - Leonardo Soares Bastos
- Programa de Computação Científica, Fiocruz. Rio de Janeiro, RJ, Brasil.,Department of Infectious Diseases Epidemiology, London School of Hygiene & Tropical Medicine. London United Kingdom
| | | | | | - André Reynaldo Santos Périssé
- Escola Nacional de Saúde Pública Sergio Arouca, Departamento de Endemias Samuel Pessoa, Fiocruz. Rio de Janeiro RJ Brasil
| | - Marly Marques da Cruz
- Escola Nacional de Saúde Pública Sergio Arouca, Departamento de Endemias Samuel Pessoa, Fiocruz. Rio de Janeiro RJ Brasil
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Teixeira SLM, Jalil CM, Jalil EM, Nazer SC, Silva SDCC, Veloso VG, Luz PM, Grinsztejn B. Evidence of an untamed HIV epidemic among MSM and TGW in Rio de Janeiro, Brazil: a 2018 to 2020 cross-sectional study using recent infection testing. J Int AIDS Soc 2021; 24:e25743. [PMID: 34132470 PMCID: PMC8207443 DOI: 10.1002/jia2.25743] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 04/28/2021] [Accepted: 04/30/2021] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Monitoring the HIV epidemic and identifying populations among whom HIV is spreading is critical. We aimed to provide an estimate of the annualized HIV incidence rate using recency testing among cisgender men who have sex with men (MSM) and transgender women (TGW) at a reference centre in Rio de Janeiro, Brazil. METHODS We evaluated MSM and TGW who sought HIV testing at the Evandro Chagas National Institute of Infectious Diseases-FIOCRUZ between March 2018 and January 2020. The Limiting Avidity assay (LAg) as part of a recent infection testing algorithm (RITA) was employed to identify recent infections (those with a normalized optical density ≤1.5 in the LAg that met all RITA criteria) among those who tested positive for HIV and the annualized HIV incidence was estimated. RESULTS AND DISCUSSION Out of 3053 individuals assessed, 2591 (84.9%) were HIV negative and 462 (15.1%) were living with HIV. Among these, 302 (65.4%) with stored samples available were evaluated and 73/302 (24.2%) were classified as recent infections. The annualized incidence rate estimate using a false recency rate of zero was 7.35% (95% CI 5.76% to 9.25%). CONCLUSIONS Our results suggest that the HIV epidemic in Rio de Janeiro, Brazil, continues to disproportionately burden vulnerable populations, including MSM and TGW despite the existence and availability of effective preventive and therapeutic interventions.
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Affiliation(s)
| | - Cristina M Jalil
- National Institute of Infectious Diseases Evandro ChagasFIOCRUZRio de JaneiroBrazil
| | - Emilia M Jalil
- National Institute of Infectious Diseases Evandro ChagasFIOCRUZRio de JaneiroBrazil
| | - Sandro C Nazer
- National Institute of Infectious Diseases Evandro ChagasFIOCRUZRio de JaneiroBrazil
| | | | - Valdilea G Veloso
- National Institute of Infectious Diseases Evandro ChagasFIOCRUZRio de JaneiroBrazil
| | - Paula M Luz
- National Institute of Infectious Diseases Evandro ChagasFIOCRUZRio de JaneiroBrazil
| | - Beatriz Grinsztejn
- National Institute of Infectious Diseases Evandro ChagasFIOCRUZRio de JaneiroBrazil
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Mangal TD, Pascom ARP, Vesga JF, Meireles MV, Benzaken AS, Hallett TB. Estimating HIV incidence from surveillance data indicates a second wave of infections in Brazil. Epidemics 2019; 27:77-85. [PMID: 30772250 PMCID: PMC6543066 DOI: 10.1016/j.epidem.2019.02.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 01/31/2019] [Accepted: 02/04/2019] [Indexed: 12/25/2022] Open
Abstract
Emerging evidence suggests that HIV incidence rates in Brazil, particularly among men, may be rising. Here we use Brazil's integrated health systems data to develop a mathematical model, reproducing the complex surveillance systems and providing estimates of HIV incidence, number of people living with HIV (PLHIV), reporting rates and ART initiation rates. An age-structured deterministic model with a flexible spline was used to describe the natural history of HIV along with reporting and treatment rates. Individual-level surveillance data for 1,077,295 cases (HIV/AIDS diagnoses, ART dispensations, CD4 counts and HIV/AIDS-related deaths) were used to calibrate the model using Bayesian inference. The results showed a second wave of infections occurring after 2001 and 56,000 (95% Credible Interval 43,000-71,000) new infections in 2015, 37,000 (95% CrI 28,000-54,000) infections in men and 16,000 (95% CrI 10,000-23,000) in women. The estimated number of PLHIV by end-2015 was 838,000 (95% CrI 675,000-1,083,000), with 80% (95% CrI 62-98%) of those individuals reported to the Ministry of Health. Women were more likely to be diagnosed and reported than men; 86.8% of infected women had been reported compared with 75.7% of men. Likewise, ART initiation rates for women were higher than those for men. The second wave contradicts previous estimates of HIV incidence trends in Brazil and there were persistent differences in the rates of accessing care between men and women. Nevertheless, the Brazilian HIV program has achieved high rates of detection and treatment, making considerable progress over the past ten years.
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Affiliation(s)
- Tara D Mangal
- Medical Research Council Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, Norfolk Place, London, W2 1PG, United Kingdom.
| | - Ana Roberta Pati Pascom
- Ministry of Health, Department of STI, HIV/AIDS and Viral Hepatitis, SRTVN Quadra 701, Lote D, Edifício PO700, CEP: 70719-040, Brasilia, Distrito Federal, Brazil
| | - Juan F Vesga
- Medical Research Council Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, Norfolk Place, London, W2 1PG, United Kingdom
| | - Mariana Veloso Meireles
- Ministry of Health, Department of STI, HIV/AIDS and Viral Hepatitis, SRTVN Quadra 701, Lote D, Edifício PO700, CEP: 70719-040, Brasilia, Distrito Federal, Brazil
| | - Adele Schwartz Benzaken
- Ministry of Health, Department of STI, HIV/AIDS and Viral Hepatitis, SRTVN Quadra 701, Lote D, Edifício PO700, CEP: 70719-040, Brasilia, Distrito Federal, Brazil
| | - Timothy B Hallett
- Medical Research Council Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, Norfolk Place, London, W2 1PG, United Kingdom
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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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Torres RMC, Cruz MMD, Périssé ARS, Pires DRF. High HIV infection prevalence in a group of men who have sex with men. Braz J Infect Dis 2017; 21:596-605. [PMID: 28692823 PMCID: PMC9425489 DOI: 10.1016/j.bjid.2017.06.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 06/01/2017] [Accepted: 06/11/2017] [Indexed: 11/18/2022] Open
Abstract
Brazil is characterized by a concentrated AIDS epidemic, it has a prevalence of less than 1% in the general population. However, there are higher rates in specific populations, especially in men who have sex with men. The study's aim was to analyze the association between sociodemographic characteristics, sexual practices, sexual behaviors and the HIV infection in a group of men who have sex with men. Secondary data was collected between June 2014 and September 2015 in a research of cross-sectional design in the city of Rio de Janeiro, Brazil. Volunteers answered an online computerized questionnaire and took HIV test. Chi-squared distribution and multiple logistic regression was used. There were 341 participants. Most of them were racially mixed, single, average age of 30.6 years and with a higher education level. The HIV prevalence was 13.9%. Two logistic models were fit (insertive or receptive anal intercourse). Both models showed an association with HIV among those who had a HIV positive sexual partner (Odds Ratio ≈ 2.5) and a high self-perception of acquiring HIV (Model 1: Odds Ratio ≈ 7/Model 2: Odds Ratio ≈ 10). Low condom usage in receptive anal intercourse with casual partners had a direct association with HIV seropositivity, whereas insertive anal intercourse with casual partners with or without condoms were inversely related. The study identified a high prevalence of HIV infections among a group of men who sex with men with a high self-perception risk of acquiring HIV. The findings also showed a relation with sociodemographic and sexual behavior variables.
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Affiliation(s)
- Raquel Maria Cardoso Torres
- Fundação Oswaldo Cruz (Fiocruz), Escola Nacional de Saúde Pública Sergio Arouca (ENSP), Rio de Janeiro, RJ, Brazil.
| | - Marly Marques da Cruz
- Fundação Oswaldo Cruz (Fiocruz), Escola Nacional de Saúde Pública Sergio Arouca (ENSP), Departamento de Endemias Samuel Pessoa, Rio de Janeiro, RJ, Brazil
| | - André Reynaldo Santos Périssé
- Fundação Oswaldo Cruz (Fiocruz), Escola Nacional de Saúde Pública Sergio Arouca (ENSP), Departamento de Ciências Biológicas, Rio de Janeiro, RJ, Brazil
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Lima K, Leal É, Cavalcanti AMS, Salustiano DM, de Medeiros LB, da Silva SP, Lacerda HR. Increase in human immunodeficiency virus 1 diversity and detection of various subtypes and recombinants in north-eastern Brazil. J Med Microbiol 2017; 66:526-535. [PMID: 28425872 DOI: 10.1099/jmm.0.000447] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
PURPOSE Diverse human immunodeficiency virus 1 (HIV-1) subtypes and circulating recombinant forms are found in Brazil. The majority of HIV-1 molecular epidemiological studies in Brazil have been conducted in the southern and south-eastern regions of the country, although several recent studies in the north-eastern region have addressed this issue. The objective of this study was to molecularly characterize HIV-1 circulating in Pernambuco, north-eastern Brazil. METHODOLOGY A total of 64 samples were collected from 2002 to 2003, and another 103 were collected from 2007 to 2009. The protease and partial reverse transcriptase regions of the HIV-1 polymerase-encoding (pol) gene were sequenced, and subtyping, recombination and phylogenetic analyses were performed.Results/Key findings. Subtype B (60.9 %) was found to be predominant, followed by HIV-1 F (31.4 %). Several BF recombinants (4.2 %), and BC and AG recombinants were also identified. The intra-subtype genetic diversity was estimated to be 0.065 (sd±0.004) for HIV-1 B and 0.055 (sd±0.004) for HIV-1 F, reflecting a greater accumulation of mutations in subtype B (P<0.01). More codons were found to be under positive selective pressure in samples collected from 2007 to 2009, from individuals with a T-cell count≥200 cells mm-3 and from women. Coalescence data indicated that the subtype F population has been continuously expanding. CONCLUSIONS HIV-1 shows high genetic diversity in the state of Pernambuco. Thus, additional molecular evaluations of circulating strains will provide a better understanding of the epidemic and may lead to more effective preventive strategies.
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Affiliation(s)
- Kledoaldo Lima
- Tropical Medicine, Federal University of Pernambuco, Recife, PE, Brazil
| | - Élcio Leal
- Institute of Biotechnology, Federal University of Pará, Belém, PA, Brazil
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Ravasi G, Grinsztejn B, Baruch R, Guanira JV, Luque R, Cáceres CF, Ghidinelli M. Towards a fair consideration of PrEP as part of combination HIV prevention in Latin America. J Int AIDS Soc 2016; 19:21113. [PMID: 27760687 PMCID: PMC5071748 DOI: 10.7448/ias.19.7.21113] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 07/12/2016] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Despite progress in scaling up antiretroviral treatment, HIV prevention strategies have not been successful in significantly curbing HIV incidence in Latin America. HIV prevention interventions need to be expanded to target the most affected key populations with a combination approach, including new high impact technologies. Oral pre-exposure prophylaxis (PrEP) is recommended as additional prevention choice for individuals at higher risk of infection and could become a cost-effective prevention tool. We discuss the barriers and solutions for a fair consideration of PrEP as part of combination HIV prevention strategies in Latin America. DISCUSSION Although demonstration projects are ongoing or being planned in a number of countries, to date no Latin American country has implemented a public PrEP programme. The knowledge of policymakers about PrEP implementation needs to be strengthened, and programmatic guidance and cost estimate tools need to be developed to support adequate planning. Despite high levels of awareness among health providers, especially if engaged in HIV or key population care, willingness to prescribe PrEP is still low due to the lack of national policies and guidelines. Key populations, especially men who have sex with men, transgender women and sex workers, have been engaged in demonstration projects, and qualitative research shows high awareness and willingness to use PrEP, especially if accessible in the public sector for free or at affordable price. Concerns of safety, adherence, effectiveness and risk compensation need to be addressed through targeted social communication strategies to improve PrEP knowledge and stimulate demand. Alliance among policymakers, civil society and representatives from key populations, healthcare providers and researchers will be critical for the design and successful implementation of PrEP demonstration projects of locally adapted delivery models. The use of mechanisms of joint negotiation and procurement of antiretrovirals could reduce costs and significantly increase the cost-effectiveness of PrEP. CONCLUSIONS PrEP is an additional prevention tool and should be implemented in combination and synergy with other prevention interventions. PrEP programmes should target high-risk individuals from key populations for higher cost-effectiveness. Demonstration projects may generate strategic information for and lead to the implementation of full-scale PrEP programmes.
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Affiliation(s)
- Giovanni Ravasi
- Pan American Health Organization (PAHO), Washington, DC, USA;
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | | | | | - Ricardo Luque
- Ministerio de Salud y Protección Social, Bogotá, Colombia
| | - Carlos F Cáceres
- Centro de Investigación Interdisciplinaria en Sexualidad, SIDA y Sociedad, Universidad Peruana Cayetano Heredia, Lima, Peru
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Global implementation of PrEP as part of combination HIV prevention - Unsolved challenges. J Int AIDS Soc 2016. [DOI: 10.7448/ias.19.7.21479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Szwarcwald CL, Ferreira ODC, Brito AMD, Luhm KR, Ribeiro CEL, Silva AM, Cavalcanti AMS, Ito TS, Raboni SM, Souza PRBD, Pereira GFM. Estimation of HIV incidence in two Brazilian municipalities, 2013. Rev Saude Publica 2016; 50:55. [PMID: 27598785 PMCID: PMC5001804 DOI: 10.1590/s1518-8787.2016050006310] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Accepted: 09/01/2015] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To estimate HIV incidence in two Brazilian municipalities, Recife and Curitiba, in the year of 2013. METHODS The method for estimating incidence was based on primary information, resulting from the Lag-Avidity laboratory test for detection of recent HIV infections, applied in a sample of the cases diagnosed in the two cities in 2013. For the estimation of the HIV incidence for the total population of the cities, the recent infections detected in the research were annualized and weighted by the inverse of the probability of HIV testing in 2013 among the infected and not diagnosed cases. After estimating HIV incidence for the total population, the incidence rates were estimated by sex, age group, and exposure category. RESULTS In Recife, 902 individuals aged 13 years and older were diagnosed with HIV infection. From these, 528 were included in the study, and the estimated proportion of recent infections was 13.1%. In Curitiba, 1,013 people aged 13 years and older were diagnosed, 497 participated in the study, and the proportion of recent infections was 10.5%. In Recife, the estimated incidence rate was 53.1/100,000 inhabitants of 13 years and older, while in Curitiba, it was 41.1/100,000, with male-to-female ratio of 3.5 and 2.4, respectively. We observed high rates of HIV incidence among men who have sex with men, of 1.47% in Recife and 0.92% in Curitiba. CONCLUSIONS The results obtained in the two cities showed that the group of men who have sex with men are disproportionately subject to a greater risk of new infections, and indicate that strategies to control the spread of the epidemic in this population subgroup are essential and urgent.
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Affiliation(s)
- Célia Landmann Szwarcwald
- Laboratório de Informações em Saúde. Instituto de Comunicação e Informação Científica e Tecnológica em Saúde. Fundação Oswaldo Cruz. Rio de Janeiro, RJ, Brasil
| | | | - Ana Maria de Brito
- Departamento de Saúde Coletiva. Centro de Pesquisas Aggeu Magalhães. Fundação Oswaldo Cruz. Recife, PE, Brasil
| | - Karin Regina Luhm
- Departamento de Saúde Comunitária. Setor de Ciências da Saúde. Universidade Federal do Paraná. Curitiba, PR, Brasil
| | | | - Ana Maria Silva
- Laboratório Municipal de Saúde Pública. Secretaria Municipal de Saúde de Recife. Recife, PE, Brasil
| | | | | | | | - Paulo Roberto Borges de Souza
- Laboratório de Informações em Saúde. Instituto de Comunicação e Informação Científica e Tecnológica em Saúde. Fundação Oswaldo Cruz. Rio de Janeiro, RJ, Brasil
| | - Gerson Fernando Mendes Pereira
- Departamento de Doenças Sexualmente Transmissíveis, Aids e Hepatites Virais. Ministério da Saúde. Distrito Federal, Brasil
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Lima YAR, Cardoso LPV, Reis MNDG, Stefani MMA. Incident and long-term HIV-1 infection among pregnant women in Brazil: Transmitted drug resistance and mother-to-child transmission. J Med Virol 2016; 88:1936-43. [PMID: 27037910 DOI: 10.1002/jmv.24540] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2016] [Indexed: 11/05/2022]
Abstract
Primary infection, seroconversion, and transmitted drug resistance (TDR) during pregnancy may influence the risk of mother-to-child-transmission (MTCT) of HIV-1 infection. This study estimated recent seroconversion, TDR rates, HIV-1 subtypes and pregnancy outcomes among 95 recently diagnosed, antiretroviral (ARV)-naïve pregnant women recruited during antenatal care in central western Brazil. Recent seroconversion was defined by BED-capture enzyme immunoassay (<155 days) and ambiguous nucleotides base calls (<1 year) in pol sequences (protease-PR and reverse transcriptase-RT regions). TDR was evaluated by the Calibrated Population Resistance tool. HIV-1 subtypes were defined by REGA and phylogenetic analyses. The median age of participants was 25 years; the median gestational age at diagnosis was 20.5 weeks. Based on serology and sequence polymorphism, recent infection was identified in 11.6% (11/95) and, 9 of them (82%), probably seroconverted during pregnancy; one MTCT case was observed among them. Three cases of stillbirth were observed among chronic infected patients (3.6%; 3/84). Moderate rate of TDR was observed (9/90, 10%, CI95% 4.7-18.1%). Subtype B was 60% (54/90), 13.3% (12/90) was subtype C, 6.7% (6/90) was subtype F1. Recombinant B(PR) /F1(RT) and F1(PR) /B(RT) viruses comprised 15.5% (14/90); B(PR) /C(RT) mosaics represented 4.4% (4/90). Seroconversion during pregnancy, late presentation to antenatal care and moderate TDR identified in this study represent significant challenges for the MTCT elimination. J. Med. Virol. 88:1936-1943, 2016. © 2016 Wiley Periodicals, Inc.
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Pessôa R, Loureiro P, Esther Lopes M, Carneiro-Proietti ABF, Sabino EC, Busch MP, Sanabani SS. Ultra-Deep Sequencing of HIV-1 near Full-Length and Partial Proviral Genomes Reveals High Genetic Diversity among Brazilian Blood Donors. PLoS One 2016; 11:e0152499. [PMID: 27031505 PMCID: PMC4816342 DOI: 10.1371/journal.pone.0152499] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 03/15/2016] [Indexed: 11/28/2022] Open
Abstract
Background Here, we aimed to gain a comprehensive picture of the HIV-1 diversity in the northeast and southeast part of Brazil. To this end, a high-throughput sequencing-by-synthesis protocol and instrument were used to characterize the near full length (NFLG) and partial HIV-1 proviral genome in 259 HIV-1 infected blood donors at four major blood centers in Brazil: Pro-Sangue foundation (São Paulo state (SP), n 51), Hemominas foundation (Minas Gerais state (MG), n 41), Hemope foundation (Recife state (PE), n 96) and Hemorio blood bank (Rio de Janeiro (RJ), n 70). Materials and Methods A total of 259 blood samples were obtained from 195 donors with long-standing infections and 64 donors with a lack of stage information. DNA was extracted from the peripheral blood mononuclear cells (PBMCs) to amplify the HIV-1 NFLGs from five overlapping fragments. The amplicons were molecularly bar-coded, pooled, and sequenced by Illumina paired-end protocol. Results Of the 259 samples studied, 208 (80%) NFLGs and 49 (18.8%) partial fragments were de novo assembled into contiguous sequences and successfully subtyped. Of these 257 samples, 183 (71.2%) were pure subtypes consisting of clade B (n = 167, 65%), C (n = 10, 3.9%), F1 (n = 4, 1.5%), and D (n = 2, 0.7%). Recombinant viruses were detected in 74 (28.8%) samples and consist of unique BF1 (n = 41, 15.9%), BC (n = 7, 2.7%), BCF1 (n = 4, 1.5%), CF1 and CDK (n = 1, 0.4%, each), CRF70_BF1 (n = 4, 1.5%), CRF71_BF1 (n = 12, 4.7%), and CRF72_BF1 (n = 4, 1.5%). Evidence of dual infection was detected in four patients coinfected with the same subtype (n = 3) and distinct subtype (n = 1). Conclusion Based on this work, subtype B appears to be the prevalent subtype followed by a high proportion of intersubtype recombinants that appeared to be arising continually in this country. Our study represents the largest analysis of the viral NFLG ever undertaken worldwide and provides insights into the understanding the genesis of the HIV-1 epidemic in this particular area of South America and informs vaccine design and clinical trials.
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Affiliation(s)
- Rodrigo Pessôa
- Clinical Laboratory, Department of Pathology, LIM 03, Hospital das Clínicas (HC), School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Paula Loureiro
- Pernambuco State Center of Hematology and Hemotherapy—HEMOPE, Recife, Pernambuco, Brazil
| | | | | | - Ester C Sabino
- Department of Infectious Disease/Institute of Tropical Medicine, University of São Paulo, Sao Paulo, Brazil
| | - Michael P. Busch
- Blood Systems Research Institute, San Francisco, California, United States of America
| | - Sabri S Sanabani
- Clinical Laboratory, Department of Pathology, LIM 03, Hospital das Clínicas (HC), School of Medicine, University of São Paulo, São Paulo, Brazil
- * E-mail:
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Assessing the HIV-1 Epidemic in Brazilian Drug Users: A Molecular Epidemiology Approach. PLoS One 2015; 10:e0141372. [PMID: 26536040 PMCID: PMC4633026 DOI: 10.1371/journal.pone.0141372] [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: 05/28/2015] [Accepted: 10/06/2015] [Indexed: 11/24/2022] Open
Abstract
Person who inject illicit substances have an important role in HIV-1 blood and sexual transmission and together with person who uses heavy non-injecting drugs may have less than optimal adherence to anti-retroviral treatment and eventually could transmit resistant HIV variants. Unfortunately, molecular biology data on such key population remain fragmentary in most low and middle-income countries. The aim of the present study was to assess HIV infection rates, evaluate HIV-1 genetic diversity, drug resistance, and to identify HIV transmission clusters in heavy drug users (DUs). For this purpose, DUs were recruited in the context of a Respondent-Driven Sampling (RDS) study in different Brazilian cities during 2009. Overall, 2,812 individuals were tested for HIV, and 168 (6%) of them were positive, of which 19 (11.3%) were classified as recent seroconverters, corresponding to an estimated incidence rate of 1.58%/year (95% CI 0.92–2.43%). Neighbor joining phylogenetic trees from env and pol regions and bootscan analyses were employed to subtype the virus from132 HIV-1-infected individuals. HIV-1 subtype B was prevalent in most of the cities under analysis, followed by BF recombinants (9%-35%). HIV-1 subtype C was the most prevalent in Curitiba (46%) and Itajaí (86%) and was also detected in Brasília (9%) and Campo Grande (20%). Pure HIV-1F infections were detected in Rio de Janeiro (9%), Recife (6%), Salvador (6%) and Brasília (9%). Clusters of HIV transmission were assessed by Maximum likelihood analyses and were cross-compared with the RDS network structure. Drug resistance mutations were verified in 12.2% of DUs. Our findings reinforce the importance of the permanent HIV-1 surveillance in distinct Brazilian cities due to viral resistance and increasing subtype heterogeneity all over Brazil, with relevant implications in terms of treatment monitoring, prophylaxis and vaccine development.
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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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Veloso VG, Mesquita F, Grinsztejn B. Pre-exposure prophylaxis for men and transgender women who have sex with men in Brazil: opportunities and challenges. J Int AIDS Soc 2015; 18:20010. [PMID: 26198347 PMCID: PMC4509891 DOI: 10.7448/ias.18.4.20010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 05/04/2015] [Accepted: 05/18/2015] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION The World Health Organization recently released guidelines on the use of pre-exposure prophylaxis (PrEP) for prevention of HIV infection among men and transgender women (TGW) who have sex with men based on results of randomized clinical trials. The aim of this commentary is to discuss the opportunities and challenges of incorporating PrEP into the Brazilian continuum of HIV care and prevention for men who have sex with men (MSM) and TGW. DISCUSSION Key aspects of the AIDS epidemic among MSM and TGW in Brazil and the comprehensive Brazilian response to the epidemic are presented. The universal access to health care provided through the Brazilian Unified Health System (SUS) and the range of prevention and care services already available countrywide to HIV-positive individuals and at-risk MSM and TGW are identified as the main facilitators for the implementation of PrEP. Limited PrEP awareness among MSM, TGW and health care providers, low HIV testing frequency and low HIV risk perception among MSM and TGW represent the core challenges to be addressed. Data generated by demonstration projects in Brazil will provide an important contribution to PrEP rollout in Brazil. CONCLUSIONS The implementation of PrEP in Brazil is feasible. A synergistic rollout of treatment as prevention and PrEP will maximize public health and individual benefits of the country's comprehensive response to the AIDS epidemic.
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Affiliation(s)
- Valdilea G Veloso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil;
| | - Fabio Mesquita
- Departamento de Doenças Sexualmente Transmissíveis, AIDS e Hepatites Virais do Ministério da Saúde, Brasília, Brasil
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
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Cáceres CF, Mayer KH, Baggaley R, O'Reilly KR. PrEP Implementation Science: State-of-the-Art and Research Agenda. J Int AIDS Soc 2015; 18:20527. [PMID: 26198351 PMCID: PMC4581083 DOI: 10.7448/ias.18.4.20527] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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18
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Lippman SA, Koester KA, Amico KR, Lama JR, Martinez Fernandes N, Gonzales P, Grinsztejn B, Liu A, Buchbinder S, Koblin BA. Client and provider perspectives on new HIV prevention tools for MSM in the Americas. PLoS One 2015; 10:e0121044. [PMID: 25826246 PMCID: PMC4380356 DOI: 10.1371/journal.pone.0121044] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 02/10/2015] [Indexed: 01/12/2023] Open
Abstract
Men who have sex with men (MSM) in the Americas require targeted, combination HIV prevention approaches. We solicited client and provider perspectives on emerging prevention interventions including HIV pre-exposure prophylaxis (PrEP) and HIV self-tests through focus groups and in-depth interviews with 130 MSM and 41 providers across four sites: New York, San Francisco, Lima, and Rio de Janeiro. Among the MSM participants, we identified three prevention typologies: non-condom users, inconsistent condom users, and consistent condom users. Northern and Southern MSM differed in the variety of harm reduction strategies utilized: where U.S. MSM relied on condom use as well as disclosure and seroadaptive behaviors for prevention, condom use without disclosure or serostatus discussions was the norm in South America. Interest in new prevention technologies was shaped by the social context. U.S. MSM preferences differed by typology, such that non-condom users were interested in taking PrEP and using home HIV tests. MSM in Brazil, regardless of typology, were interested in exploring new prevention options. MSM in Peru demonstrated moderate interest but were less comfortable with adopting new strategies. MSM and providers' opinions differed substantially with respect to new prevention options. Across sites, most providers were reticent to engage with new prevention options, though some NGO-based providers were more supportive of exploring new prevention tools. Both clients and providers will need to be engaged in developing integrated prevention strategies for MSM.
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Affiliation(s)
- Sheri A. Lippman
- Center for AIDS Prevention Studies, Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
- * E-mail:
| | - Kimberly A. Koester
- Center for AIDS Prevention Studies, Department of Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - K. Rivet Amico
- Center for Health, Intervention and Prevention, University of Connecticut, Storrs, Connecticut, United States of America
| | | | | | | | - Beatriz Grinsztejn
- HIV/AIDS Clinical Research Centre of the FIOCRUZ, Rio de Janeiro, Brazil
| | - Al Liu
- Bridge HIV, San Francisco Department of Public Health, San Francisco, California, United States of America
| | - Susan Buchbinder
- Bridge HIV, San Francisco Department of Public Health, San Francisco, California, United States of America
| | - Beryl A. Koblin
- Laboratory of Infectious Disease Prevention, New York Blood Center, New York, New York, United States of America
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Julio RS, Friedman RK, Cunha CB, De Boni RB, Cardoso SW, Torres T, Alves CA, Castro C, Fernandes NM, Veloso VG, Grinsztejn B. Unprotected sexual practices among men who have sex with women and men who have sex with men living with HIV/AIDS in Rio de Janeiro. ARCHIVES OF SEXUAL BEHAVIOR 2015; 44:357-365. [PMID: 25318623 DOI: 10.1007/s10508-014-0357-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Revised: 03/19/2014] [Accepted: 05/26/2014] [Indexed: 06/04/2023]
Abstract
Combined antiretroviral therapy is now acknowledged for preventing new HIV infections, besides decreasing mortality and morbidity. However, in many Latin America countries the epidemic is still driven by unprotected sexual intercourse. This study aims to describe sexual practices related to HIV/STD and to evaluate factors associated to unprotected sex among men who have sex with women (MSW) and men who have sex with men (MSM) under care at a reference center for HIV in Rio de Janeiro, Brazil. A cross-sectional study, nested in a Brazilian clinical cohort, evaluated the sexual practices of 404 sexually active HIV-positive MSW and men who have MSM. Approximately 30 % of them reported unprotected sexual practices during the 6 months prior to the interview. Most frequent risky practices reported were unprotected vaginal sex among MSW and unprotected receptive anal sex among MSM. Factors increasing the chance of unprotected sexual practices among MSW were the partner's desire of becoming pregnant (OR 2.81; CI 95 %: 1.36-5.95). To have received comments about excessive consumption of alcohol (OR 2.43; CI 95 %: 1.01-5.83), illicit drug use (OR 4.41; CI 95 %: 1.75-11.60) and lived in marital situation (OR 2.10; CI 95 %: 1.09-4.08) were significantly associated with unsafe sexual practices among MSM. The results highlight that health care of men living with HIV, as well as the prevention strategies, must consider the particularities of sexual behavior practiced by people who differ in sexual orientation.
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Affiliation(s)
- Renata Siqueira Julio
- Superintendência Regional de Saúde de Varginha/Centro Universitário do Sul de Minas, Varginha, Minas Gerais, Brazil
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Pessôa R, Watanabe JT, Calabria P, Alencar CS, Loureiro P, Lopes ME, Proetti AB, Félix AC, Sabino EC, Busch MP, Sanabani SS. Enhanced detection of viral diversity using partial and near full-length genomes of human immunodeficiency virus Type 1 provirus deep sequencing data from recently infected donors at four blood centers in Brazil. Transfusion 2014; 55:980-90. [PMID: 25413141 DOI: 10.1111/trf.12936] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 09/24/2014] [Accepted: 09/24/2014] [Indexed: 12/19/2022]
Abstract
BACKGROUND Here, we report application of high-throughput near full-length genome (NFLG) and partial human immunodeficiency virus Type 1 (HIV-1) proviral genome deep sequencing to characterize HIV in recently infected blood donors at four major blood centers in Brazil. STUDY DESIGN AND METHODS From 2007 to 2011, a total of 341 HIV+ blood donors from four blood centers were recruited to participate in a case-control study to identify HIV risk factors and motivations to donate. Forty-seven (17 from São Paulo, eight from Minas Gerais, 11 from Pernambuco, and 11 from Rio de Janeiro) were classified as recently infected based on testing by less-sensitive enzyme immunoassays. Five overlapping amplicons spanning the HIV genome were polymerase chain reaction amplified from peripheral blood mononuclear cells. The amplicons were molecularly barcoded, pooled, and sequenced by a paired-end protocol (Illumina). RESULTS Of the 47 recently infected donor samples studied, 39 (82.9%) NFLGs and six (12.7%) partial fragments were de novo assembled into contiguous sequences and successfully subtyped. Subtype B was the only nonrecombinant virus identified in this study and accounted for 62.2% (28/45) of samples. The remaining 37.8% (17/45) of samples showed various patterns of subtype discordance in different regions of HIV-1 genomes, indicating two to four circulating recombinant subtypes derived from Clades B, F, and C. Fourteen samples (31.1%) from this study harbored drug resistance mutations, indicating higher rate of drug resistance among Brazilian blood donors. CONCLUSION Our findings revealed a high proportion of HIV-1 recombinants among recently infected blood donors in Brazil, which has implications for future blood screening, diagnosis, therapy, and vaccine development.
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Affiliation(s)
- Rodrigo Pessôa
- Department of Virology, São Paulo Institute of Tropical Medicine, University of São Paulo, São Paulo, Brazil
| | - Jaqueline Tomoko Watanabe
- Department of Virology, São Paulo Institute of Tropical Medicine, University of São Paulo, São Paulo, Brazil
| | - Paula Calabria
- Department of Virology, São Paulo Institute of Tropical Medicine, University of São Paulo, São Paulo, Brazil
| | - Cecilia Salete Alencar
- Clinical Laboratory, Department of Pathology, LIM 03, Hospital das Clínicas (HC), School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Paula Loureiro
- Pernambuco State Center of Hematology and Hemotherapy-HEMOPE, Recife, Pernambuco, Brazil
| | | | - Anna Barbara Proetti
- Minas Gerais State Center of Hematology and Hemotherapy-HEMOMINAS, Belo Horizonte, Minas Gerais, Brazil
| | - Alvina Clara Félix
- Department of Virology, São Paulo Institute of Tropical Medicine, University of São Paulo, São Paulo, Brazil
| | - Ester C Sabino
- Department of Infectious Disease/Institute of Tropical Medicine, University of São Paulo, São Paulo, Brazil
| | | | - Sabri S Sanabani
- Clinical Laboratory, Department of Pathology, LIM 03, Hospital das Clínicas (HC), School of Medicine, University of São Paulo, São Paulo, Brazil
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Velasco-de-Castro CA, Grinsztejn B, Veloso VG, Bastos FI, Pilotto JH, Fernandes N, Morgado MG. HIV-1 diversity and drug resistance mutations among people seeking HIV diagnosis in voluntary counseling and testing sites in Rio de Janeiro, Brazil. PLoS One 2014; 9:e87622. [PMID: 24498155 PMCID: PMC3907471 DOI: 10.1371/journal.pone.0087622] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 12/27/2013] [Indexed: 11/19/2022] Open
Abstract
The remarkable viral diversity remains a big challenge to the development of HIV vaccines and optimal therapy worldwide. In the latest years, as a consequence of the large expansion of highly active antiretroviral therapy (HAART) availability worldwide, an increase in transmitted drug resistance mutations (TDRM) has been observed, varying according the region. This study assessed HIV-1 diversity and TDRM profile over time among newly HIV-1 diagnosed individuals from Rio de Janeiro, Brazil. Blood samples were collected from individuals seeking HIV diagnosis in four voluntary counseling and testing (VCTs) sites located in the Rio de Janeiro Metropolitan Area, in 2005-2007. Recent (RS) and long-term (LTS) HIV-1 seroconverters were distinguished using BED-CEIA. Pol viral sequences were obtained for 102 LTS identified in 2005 and 144 RS from 2005-2007. HIV-1 subtype and pol recombinant genomes were determined using Rega HIV-1 Subtyping Tool and by phylogenetic inferences and bootscanning analyses. Surveillance of HIV-1 TDRM to protease and reverse transcriptase inhibitors were performed according to the Calibrated Population Resistance (CPR) Tool 6.0. Overall, subtype B remains the most prevalent in Rio de Janeiro in both LTS and RS HIV-1 infected individuals. An increased proportion of recombinant samples was detected over time, especially in RS heterosexual men, due to the emergence of CRF02_AG and URF samples bearing a subtype K fragment. The prevalence of HIV-1 samples carrying TDRM was high and similar between LTS and RS (15.7% vs 14.6%) or age (<25yo 17.9% vs >25yo 16.6%) along the study period. The high resistance levels detected in both populations are of concern, especially considering the dynamics of HIV-1 diversity over time. Our results suggest that the incorporation of resistance testing prior to HAART initiation should be highly considered, as well as permanent surveillance, aiming to carefully monitoring HIV-1 diversity, with focus on CRF/URF emergence and putative transmission.
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Affiliation(s)
- Carlos A. Velasco-de-Castro
- Laboratório de AIDS & Imunologia Molecular, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil
- Instituto de Pesquisa Clínica Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil
- Laboratório de Virologia, Departamento de Patologia Clínica, Instituto Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil
- * E-mail: (MGM); (CAVdC)
| | - Beatriz Grinsztejn
- Instituto de Pesquisa Clínica Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil
| | - Valdiléa G. Veloso
- Instituto de Pesquisa Clínica Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil
| | - Francisco I. Bastos
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil
- Laboratório de Informação em Saúde, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil, and Imperial College London (CAPES visiting researcher # 17551-12-8), London, United Kingdom
| | - José H. Pilotto
- Laboratório de AIDS & Imunologia Molecular, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil
- Hospital Geral de Nova Iguaçu, Nova Iguaçu, RJ, Brasil
| | - Nilo Fernandes
- Instituto de Pesquisa Clínica Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil
| | - Mariza G. Morgado
- Laboratório de AIDS & Imunologia Molecular, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil
- * E-mail: (MGM); (CAVdC)
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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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23
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Tracing the origin and northward dissemination dynamics of HIV-1 subtype C in Brazil. PLoS One 2013; 8:e74072. [PMID: 24069269 PMCID: PMC3771961 DOI: 10.1371/journal.pone.0074072] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Accepted: 07/26/2013] [Indexed: 11/19/2022] Open
Abstract
Previous studies indicate that the HIV-1 subtype C epidemic in southern Brazil was initiated by the introduction of a single founder strain probably originating from east Africa. However, the exact country of origin of such a founder strain as well as the origin of the subtype C viruses detected outside the Brazilian southern region remains unknown. HIV-1 subtype C pol sequences isolated in the southern, southeastern and central-western Brazilian regions (n = 209) were compared with a large number (n ~ 2,000) of subtype C pol sequences of African origin. Maximum-likelihood analyses revealed that most HIV-1 subtype C Brazilian sequences branched in a single monophyletic clade (CBR-I), nested within a larger monophyletic lineage characteristic of east Africa. Bayesian analyses indicate that the CBR-I clade most probably originated in Burundi and was introduced into the Paraná state (southern region) around the middle 1970s, after which it rapidly disseminated to neighboring regions. The states of Paraná and Santa Catarina have been the most important hubs of subtype C dissemination, and routine travel and spatial accessibility seems to have been the major driving forces of this process. Five additional introductions of HIV-1 subtype C strains probably originated in eastern (n = 2), southern (n = 2) and central (n = 1) African countries were detected in the Rio de Janeiro state (southeastern region). These results indicate a continuous influx of HIV-1 subtype C strains of African origin into Brazil and also unveil the existence of unrecognized transmission networks linking this country to east Africa.
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Cavalcanti AMS, Brito AMD, Salustiano DM, Lima KOD, Silva SPD, Lacerda HR. Recent HIV infection rates among HIV positive patients seeking voluntary counseling and testing centers in the metropolitan region of Recife - PE, Brazil. Braz J Infect Dis 2013; 16:157-63. [PMID: 22552458 DOI: 10.1016/s1413-8670(12)70298-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Accepted: 12/11/2011] [Indexed: 12/15/2022] Open
Abstract
UNLABELLED The BED capture enzyme immunoassay test makes it possible to determine whether individuals were recently infected with HIV. OBJECTIVE In this study, the overall HIV and recent infections prevalences were determined at five Voluntary Counseling and Testing (VCT) centers, in the Metropolitan Region of Recife, Northeastern of Brazil. MATERIAL AND METHODS A cross-sectional study was conducted among users of five VCTs in the metropolitan region of Recife between July 2007 and April 2009. Out of the individuals who tested positive for HIV, 169 were analyzed to assess the prevalence of recent infection by means of the BED-CEIA (BED-Calypte®). RESULTS Out of 46,696 individuals tested 916 (1.96%) turned out positive for HIV infection The highest prevalence was in Recife (3.9%). The prevalence was higher among males (3.93%), and men who have sex with men (MSM) (12.4%). The frequency of recent infections among the 169 subjects evaluated was 23.7%. Recent infections were more common among individuals under 25 years of age. There was slight predominance of men and higher frequency of heterosexuals in both groups, but still a significant portion of MSM (33%). Subtype B predominated, followed by a high proportion of subtype F. CONCLUSIONS Recent infection occurs mainly among young individuals and heterosexuals, despite a significant proportion of recent infection among MSM. These results suggest that preventive actions aimed at the MSM community remains a challenge and efforts focusing this group should continue to be a priority.
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Gräf T, Pinto AR. The increasing prevalence of HIV-1 subtype C in Southern Brazil and its dispersion through the continent. Virology 2012; 435:170-8. [PMID: 22999094 DOI: 10.1016/j.virol.2012.08.048] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Revised: 08/29/2012] [Accepted: 08/30/2012] [Indexed: 01/15/2023]
Abstract
The HIV-1 has evolved swiftly and the scenario of HIV-1 genetic diversity is constantly changing. In South America, recombinant forms of subtypes B, F1, and BF1 have historically driven the HIV-1 epidemic. In recent years, however, infection with subtype C has gained prominence as its prevalence increased in Southern Brazil as well as neighboring countries. Current studies point to a single introduction of closely related strains as the beginning of the Brazilian subtype C epidemic. However, the place of origin of these strains, date, and route of introduction are under continuous debate as well as the clinical outcomes of the emergence of subtype C. Therefore, this paper reviews the history of the HIV-1 subtype C in Brazil, particularly in the Southern region, covering its demographic and evolutionary history and the possible implications to the Brazilian AIDS epidemic as well as to neighboring countries.
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Affiliation(s)
- Tiago Gräf
- Laboratório de Imunologia Aplicada, Departamento de Microbiologia, Imunologia e Parasitologia, Centro de Ciências Biológicas, Universidade Federal de Santa Catarina, 88040-900 Florianópolis, SC, Brazil
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Celik DG, Yuksel P, Aslan M, Saribas S, Baltali ND, Abdelkareem A, Ziver T, Nazlican O, Gencer S, Celikkol E, Bahar H, Kocazeybek B. The importance of transmission time in HIV infections and an epidemiological prospective follow-up study for 1 year in the Marmara Region of Turkey. Transfus Apher Sci 2012; 47:3-7. [PMID: 22483628 DOI: 10.1016/j.transci.2012.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Accepted: 03/13/2012] [Indexed: 11/16/2022]
Abstract
It is important to detect recent and new HIV/1 infections and to take preventative measures in order to prevent rapid disease progression in AIDS and to decrease the incidence of infection. We aimed to detect long standing or recent HIV infections by determining transmission times for the cases in which first-time HIV/1 seropositivity were detected. The serum samples of 323 cases which were found to be seropositive by ELISA and Western-blotting were included in this study. The discrimination between long-term and recent HIV/1 infection was made by determining transmission-time with the Aware BED-EIA, HIV-1 incidence test (IgG capture HIV-EIA) tests. Ninety-six healthy blood donors who did not have a positive anti-HIV test and a chronic infectious disease for at least 1 year were included in this study as a negative healthy control group. In the discrimination of long-term and recent HIV/1 infections, only in vitro ODn values were used. The cases with normalized optical density (OD) (OD(specimen)/OD(calibrator))<0.8 by commercial kit were accepted as recent HIV infection (155 days history or seroconversion less than 6 months). The cases with ODn >1.2 were accepted as long-term HIV/1 infections (more than 155 days history or more than 6 months). The cases with ODn between 0.8 and 1.2 were accepted as "additional tests needed" cases. We detected recent HIV/1 infections (<6 months) in 60 (18.5%) out of 323 cases and long-term HIV/1 infections (>6 months) in 263 (81.5%) out of 323 cases. The most frequently encountered transmission route in long-term and recent HIV/1 infections was heterosexual sexual intercourse as 54 (50%) and 257 (97%), respectively. 63.3% of newly infected patients were married females and 65.3% of recently infected patients were males. In conclusion, the detection of the high ratio of long-term HIV/1 infection cases (81.5%) compared to recent infections (18.5%) suggested to us, that the long standing cases may have some activities related with transmission of HIV/1 in the past. The detection of higher HIV/1-infections in individuals which had heterosexual sex and also in married males suggested that this situation poses a very great threat for the health of society.
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Affiliation(s)
- Deniz Gozde Celik
- The University of Istanbul, Cerrahpasa Faculty of Medicine, Microbiology and Clinical Microbiology Department, Istanbul, Turkey
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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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Sanabani SS, Pastena ÉRDS, da Costa AC, Martinez VP, Kleine-Neto W, de Oliveira ACS, Sauer MM, Bassichetto KC, Oliveira SMS, Tomiyama HTI, Sabino EC, Kallas EG. Characterization of partial and near full-length genomes of HIV-1 strains sampled from recently infected individuals in São Paulo, Brazil. PLoS One 2011; 6:e25869. [PMID: 22022460 PMCID: PMC3193532 DOI: 10.1371/journal.pone.0025869] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2011] [Accepted: 09/13/2011] [Indexed: 12/03/2022] Open
Abstract
Background Genetic variability is a major feature of human immunodeficiency virus type 1 (HIV-1) and is considered the key factor frustrating efforts to halt the HIV epidemic. A proper understanding of HIV-1 genomic diversity is a fundamental prerequisite for proper epidemiology, genetic diagnosis, and successful drugs and vaccines design. Here, we report on the partial and near full-length genomic (NFLG) variability of HIV-1 isolates from a well-characterized cohort of recently infected patients in São Paul, Brazil. Methodology HIV-1 proviral DNA was extracted from the peripheral blood mononuclear cells of 113 participants. The NFLG and partial fragments were determined by overlapping nested PCR and direct sequencing. The data were phylogenetically analyzed. Results Of the 113 samples (90.3% male; median age 31 years; 79.6% homosexual men) studied, 77 (68.1%) NFLGs and 32 (29.3%) partial fragments were successfully subtyped. Of the successfully subtyped sequences, 88 (80.7%) were subtype B sequences, 12 (11%) BF1 recombinants, 3 (2.8%) subtype C sequences, 2 (1.8%) BC recombinants and subclade F1 each, 1 (0.9%) CRF02 AG, and 1 (0.9%) CRF31 BC. Primary drug resistance mutations were observed in 14/101 (13.9%) of samples, with 5.9% being resistant to protease inhibitors and nucleoside reverse transcriptase inhibitors (NRTI) and 4.9% resistant to non-NRTIs. Predictions of viral tropism were determined for 86 individuals. X4 or X4 dual or mixed-tropic viruses (X4/DM) were seen in 26 (30.2%) of subjects. The proportion of X4 viruses in homosexuals was detected in 19/69 (27.5%). Conclusions Our results confirm the existence of various HIV-1 subtypes circulating in São Paulo, and indicate that subtype B account for the majority of infections. Antiretroviral (ARV) drug resistance is relatively common among recently infected patients. The proportion of X4 viruses in homosexuals was significantly higher than the proportion seen in other study populations.
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Affiliation(s)
- Sabri Saeed Sanabani
- Division of Clinical Immunology and Allergy, Faculty of Medicine, University of São Paulo, São Paulo, Brazil.
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