HIV, syphilis, hepatitis B and C in key populations: results of a 10-year cross-sectional study, Southern Brazil

ABSTRACT Objective: Although the development of prevention and treatment strategies for sexually transmitted infections in key groups has improved over the years, they still remain a challenge for health systems worldwide. In this context, the objective of this study is to assess the seroprevalence in the tested population, with an emphasis on key populations, aiming at identifying the participants' profile and consequently the development of testing strategies. Methods: The present study analyzed the seroprevalence of HIV, syphilis, and hepatitis B and C, and the epidemiological profiles of key and general populations tested at a reference public health facility for sexually transmitted infections testing and counseling in the city of Curitiba, Southern Brazil. A cross-sectional study was conducted to report data from 2010 to 2019. Results: A total of 67,448 samples were analyzed, 9,086 of these tested positive, 3,633 (56%) for HIV, 4,978 (77%) for syphilis, 340 (5%) for hepatitis C virus (HCV), and 135 (2%) for hepatitis B virus (HBV). Overall, most of the participants were men (79 to 87%), and predominantly white. For HIV and syphilis, the predominant age groups were 21-30 years old (48 and 50%), HBV 21-40 years old (31%), and HCV 41-60 years old (25%). A high seroprevalence of HIV and syphilis was observed in the investigated key populations with a higher frequency in sex workers, men who have sex with men, and transgender. Conclusion: The progressive increase in syphilis cases emphasizes the need for effective interventions to enhance adherence to the use of condoms, and to expand diagnosis and treatment for these key populations.

Profile of HIV subtypes in HIV/HBV- and HIV/HCV-coinfected patients in Southern Brazil

Abstract INTRODUCTION: HIV and viral hepatitis infections are major causes of chronic disease worldwide and have some similarities with regard to routes of transmission, epidemiology, front barriers faced during access of treatment, and strategies for a global public health response. The objective was to describe the HIV-1 subtypes, viral tropism and single-nucleotide polymorphisms (SNPs) of interleukin 28B (IL28B) from a case series of HIV/viral hepatitis coinfected patients from southern Brazil. METHODS: Clinical and epidemiological data were evaluated by a review of medical records. Periodic blood draws were taken to determine the viral and host characteristics. RESULTS: This study included 38 patients with HIV/HBV or HIV/HCV coinfection; the median age was 49 years. Thirty-seven (97.4%) were on antiretroviral therapy, 32 (84.2%) had an undetectable viral load, a median CD4+ T-cell count of 452 cells/mm3. HIV-1 subtyping showed 47.4 and 31.6% of patients with subtypes C and B, respectively. Analysis of viral co-receptor usage showed a predominance of the R5 variant (64.7%), with no significant difference between the subtypes. Twenty patients with HIV/HCV coinfection were eligible to receive HCV therapy with pegylated-interferon-alpha plus ribavirin, and 10/20 (50%) of them achieved sustained virological response. SNPs of IL28B were evaluated in 93.3% of patients with HIV/HCV coinfection, and 17 (60.7%) presented the CC genotype. CONCLUSIONS: In the present case series, a higher frequency of HIV subtype C was found in coinfected patients. However such findings need to be prospectively evaluated with the inclusion of data from regional multicenter analyses.

Estimation of HIV incidence in two Brazilian municipalities, 2013 / Estimação da incidência de HIV em dois municípios brasileiros, 2013

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.

RESUMO OBJETIVO Estimar a incidência de HIV em dois municípios brasileiros, Recife e Curitiba, no ano de 2013. MÉTODOS O método de estimação da incidência foi baseado em informações primárias, resultantes do ensaio laboratorial Lag-Avidity para detecção de infecções recentes do HIV, aplicado em uma amostra dos casos diagnosticados nas duas cidades em 2013. Para a estimação da incidência de HIV para a população total das cidades, as infecções recentes detectadas na pesquisa foram anualizadas e ponderadas pelo inverso da probabilidade de teste de HIV no ano de 2013 entre os casos infectados e não diagnosticados. Após a estimação da incidência de HIV para a população total, foram estimadas as taxas de incidência por sexo, faixa de idade e categoria de exposição. RESULTADOS Em Recife, foram diagnosticados 902 indivíduos de 13 anos e mais com infecção de HIV. Desses, 528 foram incluídos no estudo, e a proporção estimada de infecções recentes foi de 13,1%. Em Curitiba, foram diagnosticadas 1.013 pessoas de 13 anos e mais, 497 participaram do estudo, e a proporção de infecções recentes foi de 10,5%. Em Recife, a taxa de incidência estimada foi de 53,1 por 100 mil habitantes de 13 anos e mais, enquanto em Curitiba, de 41,1 por 100 mil, com razão do sexo masculino para o feminino de 3,5 e 2,4, respectivamente. Foram evidenciadas elevadas taxas de incidência de HIV entre homens que fazem sexo com homens, de 1,47% em Recife e 0,92% em Curitiba. CONCLUSÕES Os resultados obtidos nas duas cidades mostraram que o grupo dos homens que fazem sexo com homens está desproporcionalmente sujeito ao maior risco de novas infecções, e indicam que estratégias para controle da disseminação da epidemia nesse subgrupo populacional são essenciais e urgentes.

Vítimas de violência sexual atendidas em um serviço de referência / Victims of sexual violence attended in a specialized service / Víctimas de violencia sexual atendidas en un servicio de referencia

Objetivou-se conhecer aspectos da violência sexual e adesão das vítimas ao seguimento ambulatorial. Estudo transversal, com coleta retrospectiva de dados em um serviço de referência no estado do Paraná. A coleta foi realizada de fevereiro a maio de 2014 mediante fichas de notificação de 2009 a 2013. Foram atendidos 1272 agredidos sexualmente, sendo 53,46% deles com idade entre 12 e 18 anos e 94,65%, mulheres. Em mais da metade dos casos, o agressor era desconhecido (53,38%), a agressão ocorreu nas residências (39,30%) e vias públicas (35%), à noite (50,33%) e, em 96,67% dos casos, houve penetração vaginal. A indicação da Profilaxia Pós-Exposição às vítimas ocorreu em 76,4% e a contracepção de emergência foi administrada em 64,77% das mulheres. Apenas 19,54% completaram o seguimento ambulatorial. As evidências indicam a necessidade de estratégias de atendimento que motivem a vítima de violência sexual a finalizar o tratamento (AU).

The aim was to investigate aspects of sexual violence and the victims' adherence to outpatient follow-up. This transversal study involved retrospective data collection in a specialized service in the Brazilian state of Paraná. The collection was undertaken between February and May 2014 from the notification files of 2009 ­ 2013. A total of 1,272 persons who had been the victims of sexual assault was attended; 53.46% of them were aged between 12 and 18 years old, and 94.65% were female. In more than half of the cases, the aggressor was unknown (53.38%), the aggression took place in homes (39.30%) and on public highways (35%), at night (50.33%) and, in 96.67% of cases, there was vaginal penetration. Indication of Post-Exposure Prophylaxis to the victims took place in 76.4% of cases and emergency contraception was administered to 64.77% of the women. Only 19.54% completed the outpatient follow-up. The evidence indicates the need for attendance strategies which motivate the victim of sexual violence to complete treatment (AU).

El objetivo del estudio fue conocer aspectos de la violencia sexual y adhesión de las víctimas al procedimiento ambulatorial. Estudio transversal cuyos datos fueron obtenidos de modo retrospectivo en un servicio de referencia en el estado de Paraná. Los datos fueron recogidos de febrero a mayo de 2014 por medio de fichas de notificación de 2009 a 2013. Fueron atendidos 1272 agredidos sexualmente, siendo la edad de 53,46% de ellos entre 12 y 18 años y 94,65%, mujeres. En más de la mitad de los casos, el agresor era desconocido (53,38%), la agresión ocurrió en las residencias (39,30%) y locales públicos (35%), por la noche (50,33%) y, en 96,67% de los casos, hubo penetración vaginal. La indicación de la Profilaxia Pos Exposicón a las víctimas ocurrió en 76,4% y la contracepción de emergencia fue administrada en 64,77% de las mujeres. Solamente 19,54% completaron el procedimiento ambulatorial. Las evidencias apuntan la necesidad de estrategias de atendimiento que ayuden la víctima de violencia sexual a finalizar el tratamiento (AU).

Cerebrospinal fluid can be used for HIV genotyping when it fails in blood / O líquido cefalorraquidiano pode ser usado para a genotipagem do HIV quando esta não é possível no plasma

Blood plasma specimens are the clinical standard for HIV-1 pol gene genotyping from viral populations; however, it is not always successful, often from low viral loads or the presence of polymerase chain reaction (PCR) inhibitors. Objective To describe the successful of HIV-1 genotyping in two samples of cerebrospinal fluid (CSF), after genotype procedures failed from blood. Method Two HIV-infected patients enrolled in a neurocognitive research study were evaluated when standard HIV-1 genotyping failed from blood plasma samples. Genotyping was performed using the commercial system TRUGENE® HIV-1 Genotyping Kit and the OpenGene® DNA Sequencing System (Siemens Healthcare Diagnostics, Tarrytown, NY, USA). Results CSF genotyping was performed via the same commercial platform and was successful in both cases. Conclusion This report demonstrates that CSF could be used as an alternate clinical specimen for HIV-1 genotyping when it fails from blood. .

O plasma é a amostra clínica padrão utilizada para a genotipagem da região pol do HIV-1; entretanto, a genotipagem pode nem sempre ser bem sucedida, geralmente devido a baixas cargas virais ou à presença de inibidores da reação em cadeia da polimerase (PCR). Objetivo: Descrever o sucesso da genotipagem do HIV-1 em duas amostras de líquido cefalorraquidiano (LCR) após a falha do mesmo método em amostras de plasma dos mesmos pacientes. Método: Dois pacientes HIV+ envolvidos em um estudo neurocognitivo foram avaliados após a falha da genotipagem do HIV-1 no plasma. A genotipagem foi realizada com o sistema comercial TRUGENE® HIV-1 Genotyping e o OpenGene® DNA Sequencing (Siemens Healthcare Diagnostics, Tarrytown, NY, USA). Resultados: A genotipagem no LCR foi realizada pelo mesmo método utilizado no plasma, sendo bem sucedida para ambos os pacientes. Conclusão: Este artigo demonstra que o LCR pode ser usado como uma amostra clínica alternativa para a genotipagem do HIV-1 quando esta falha no plasma. .

Molecular epidemiology of HIV-1 clades in Southern Brazil

Human immunodeficiency virus (HIV) clades B and C account for more than 60 percent of the HIV-1 infections worldwide. In this paper, we describe the profiles of patients infected with subtypes of HIV-1 from the state of Paraná, Southern Brazil, and correlate them with demographic and epidemiological findings. A retrospective analysis of HIV cases reported from 1999-2007 was also performed. Data from 293 patients were reviewed and 245 were older than 13 (58 percent female). The distribution of clades was as follows: B 140 (57 percent), C 67 (23 percent), F 24 (10 percent) and mosaic or unique recombinant forms (URFs) 24 (10 percent). Of the 48 patients younger than 13 years of age (62.5 percent male), vertical transmission occurred in 46 and the distribution of clades was as follows: B 14 (29 percent), C 24 (50 percent), F 7 (15 percent) and URFs 6 (13 percent). There was no significant difference in mortality between HIV-1 subtypes. In both groups, patients infected with clade C tended to have higher rates of injection drug use exposure risk.

Candidemia em um hospital terciário brasileiro: incidência, freqüência das diferentes espécies, fatores de risco e suscetibilidade aos antifúngicos / Candidemia in a Brazilian tertiary care hospital: incidence, frequency of different species, risk factors and antifungal susceptibility

São apresentados os resultados de estudo transversal e observacional sobre candidemia realizado no Hospital de Clínicas da Universidade Federal do Paraná. No período de janeiro de 2001 a dezembro de 2004, foram analisados 100 episódios de candidemia. A incidência foi de 1,27 por 1.000 internações, sendo Candida spp o oitavo agente mais isolado nas infecções da corrente sanguínea. A idade variou de 5 dias a 89 anos com uma média de 32 anos, 60 por cento dos casos ocorreram em adultos (66 por cento > 50 anos) e 40 por cento em crianças (52 por cento < 1 ano). Cinqüenta e nove pacientes estavam internados em enfermarias e 41 em unidade de terapia intensiva. Candida albicans foi a espécie mais (59 por cento) freqüente, seguida por Candida tropicalis (15 por cento), Candida parapsilosis (9 por cento). As condições associadas mais (97 por cento) freqüentes foram uso de antibióticos, cateter venoso central (77 por cento), bloqueador H2 (57 por cento), nutrição parenteral total (49 por cento) internamento em unidade de terapia intensiva (41 por cento). Dos 51 isolados testados, 3 de Candida glabrata apresentaram suscetibilidade dose-dependente ao fluconazol e eram resistentes ao itraconazol. Uma amostra de Candida krusei apresentou suscetibilidade dose-dependente ao fluconazol, e uma de Candida pelliculosa suscetibilidade dose-dependente ao itraconazol. Na população de estudo, 68 por cento receberam tratamento antifúngico, no entanto a mortalidade foi de 56 por cento.

Results from a cross-sectional observational study on candidemia conducted at Hospital de Clínicas, Federal University of Paraná, are presented. From January 2001 to December 2004, one hundred candidemia cases were evaluated. The incidence was 1.27 episodes per 1,000 hospitalizations and Candida was the eighth most frequently isolated agent from bloodstream infections. The patients’ ages ranged from five days to 89 years, with a mean of 32 years. Sixty percent of the cases occurred in adults (66 percent > 50 years old) and 40 percent in children (52 percent < one year old). Fifty-nine percent had been admitted to medical wards and 41 percent to the intensive care unit. Candida albicans was the most (59 percent) frequent species followed by Candida tropicalis (15 percent) and Candida parapsilosis (9 percent). The most (97 percent) prevalent coexisting conditions were the use of antibacterial drugs, central venous catheter (77 percent), H2 blockers (57 percent), total parenteral nutrition (49 percent) and admission to the intensive care unit (41 percent). Out of the 51 isolates tested, three of Candida glabrata presented dose-dependent susceptibility to fluconazole and resistance to itraconazole. One sample of Candida krusei presented dose-dependent susceptibility to fluconazole and one of Candida pelliculosa presented dose-dependent susceptibility to itraconazole. Among the study population, 68 percent received antifungal therapy, but the mortality was 56 percent.