Hepatitis C virus infection and spontaneous clearance in HTLV-1 and HIV co-infected patients in Salvador, Bahia, Brazil

ABSTRACTBACKGROUND: While 20-40% of patients with hepatitis C virus (HCV) monoinfection will spontaneously clear the virus, less is known regarding clearance with coinfections. HCV, human immunodeficiency virus (HIV), and human T-cell lymphotrophic virus 1 and 2 (HTLV-1/2) coinfection occurs due to shared routes of transmission and is prevalent in Brazil.OBJECTIVES:To compare the proportion of patients who have spontaneously cleared HCV in patients with HCV monoinfection to patients coinfected by HCV/HIV, or HCV/HIV/HTLV-1.METHODS:Using medical records from two clinics in Salvador, Brazil, including demographic data and serological markers of HCV, HIV and HTLV-I/II, cross-sectional data was obtained from 197 patients. Patients who were anti-HCV positive and HCV RNA negative, and who did not receive HCV treatment were defined as having cleared infection.RESULTS:Nineteen patients (9.5%) showed evidence of spontaneous HCV clearance; with clearance in 9 of 108 (8.3%) patients in the HCV monoinfected group, 5 of 68 (7.4%) patients with HCV/HIV, and 5 of 21 (23.8%) patients with HCV/HIV/HTLV. Demographic data were not associated with HCV clearance status. Patients coinfected with both HIV and HTLV-1 had increased odds (5.50; 95% CI 1.00, 30.17) of spontaneous clearance of HCV compared with patients who were HIV negative or of unknown HIV status.CONCLUSION:Our study found that patients coinfected with HIV and HTLV-1 were more likely to spontaneously clear hepatitis C virus than patients with HIV/HCV or HCV alone. The effects of HTLV coinfection on the immune response of such patients may be associated with these findings.

Politicas de reducao de danos no Brasil: contribuicoes de um programa norte-americano / Harm Reduction Policies in Brazil: contributions of a north american program

Considerando a disseminação da epidemia de HIV e o controle de sua transmissão entre usuários de drogas injetáveis (UDI), estratégias de redução de danos foram incorporadas em diversos países, incluindo o Brasil. Considerando a emergência das drogas como tema central na agenda governamental, especialmente o crack, o presente artigo registra e discute as práticas observadas em um programa de pesquisa e atenção aos UDI: o UFO. Foram considerados aspectos tais como acesso e adesão do usuário, dificuldades de financiamento, sustentabilidade e avaliação de resultados. As etapas do estudo envolveram pesquisa documental, observação sistemática e entrevistas com informantes-chave. Destacamos características do UFO que poderiam contribuir para políticas de redução de danos no cenário brasileiro. O programa estudado se apresenta como um exemplo exitoso de iniciativas de redução de danos, obtendo sucesso no acesso e adesão desse grupo, favorecendo seu acesso aos serviços de saúde e prevenção de riscos associados ao uso de drogas. .

Given the rapid spread of the HIV epidemic and the need to control its transmission among intravenous drug users (IDU), harm reduction strategies have been incorporated in many countries, including Brazil. Considering these aspects and taking into account the emergence of drugs as a core concern on the government's agenda, especially crack cocaine, this article presents some of the contributions acquired from observing and recording the practices of an American model of research and care for IDUs, namely the UFO (You Find Out) Study. Issues such as participants' access and adherence, financing difficulties, sustainability and outcome evaluation were considered. The study involved documental research, systematic observation and interviews with key informants. Some of the UFO features that could contribute to the formulation of harm reduction policies in Brazil are highlighted. The UFO appears to be a successful example of harm reduction initiatives that successfully contact and guarantee the commitment of that risk group, ensuring its access to health services and reducing risks associated with drug use.

Dyslipidemia and fasting glucose impairment among HIV patients three years after the first antiretroviral regimen in a Brazilian AIDS outpatient clinic

OBJECTIVE: To evaluate the cumulative incidence of dyslipidemia and fasting glucose impairment three years after initiating the first antiretroviral (ART) regimen and the association with the type of ART regimen in an AIDS outpatient clinic in Brazil. METHODS: Retrospective cohort of HIV-1 infected patients attending an outpatient HIV clinic in Vitoria, Brazil, between January/2010 and May/2011. Data, including blood pressure, dyslipidemia (high total cholesterol and low HDL-C), fasting glucose, and cardiovascular risk by Framingham Risk Score were abstracted from medical records from clinic visits six months prior and three years after starting ART. We assessed independent associated factors for dyslipidemia using multiple logistic regression. RESULTS: Four hundred and ninety-eight patients on ART were studied. Median age was 45 years (interquartile range (IQR): 37-52), and median time since HIV diagnosis was 7.7 years (IQR: 3.8-10.0). The proportion of patients with dyslipidemia was 22.3% (95% CI: 18.6-25.9%) 36 months after ART initiation. Triglycerides levels >150 mg/dL (55.2% vs. 25.4%, p = 0.021) and high fasting glucose (5.8% vs. 2.3%, p = 0.034) were diagnosed more frequently after ART use when compared to baseline values. Multiple logistic regression analysis has shown dyslipidemia to be associated with lopinavir/r use [OR = 1.74 (95% CI: 1.12-2.86)]. CONCLUSION: These data show high chance of dyslipidemia after initiation of ART. Long-term follow-up will help identify the impact of ART on cardiovascular risk.

Risk factors for syphilis in young women attending a family health program in Vitória, Brazil / Fatores de risco para sífilis, em mulheres jovens, atendidas pelo programa de saúde da família em Vitória (ES), Brasil

BACKGROUND: The high prevalence of STDs among women indicates the need to implement approaching techniques, case detection and prevention of new cases. OBJECTIVES: To describe the frequency of risk factors for syphilis and assess attitudes towards sexual risk in a population of young women in Vitória, ES. METHODS: Cross-sectional, population-based study, performed in Vitória. Interviews were held and VDRL and MHA-TP were investigated in blood samples. RESULTS: Among the 904 eligible women (18-29 years) sampled from the Family Health Program (FHP), 11 were diagnosed with syphilis, a prevalence of 1.2% (CI95% 0.5-1.9). Median age was 23 years (interquartile range 20-26 years); 65.7% of participants were in high school or college and 85.4% lived with their family or sexual partner. Factors associated with syphilis included: lower educational level (<8 years of schooling) [Adjusted Odds Ratio aOR=4.3 (CI 95% 1.01-17.99)]; >1 lifetime sexual partners [(aOR) =6.50 (CI95% 1.37-30.82)], and history of a previously diagnosed STD [aOR=10.3 (CI95% 2.37-44.33)]. Two thirds (67.7%) of the women surveyed agreed that it is not easy to tell their sexual partner they do not want to have sex without condoms; 52.3% thought it is difficult to use condoms in all sexual intercourses, and 36.2% said they cannot do anything if their partner refuses to use condoms. CONCLUSIONS: Using the FHP as an approach to perform routine VDRL can contribute to decreasing the vulnerability of these women and help control congenital syphilis.

FUNDAMENTOS: A prevalência elevada de DST entre as mulheres indica a necessidade de implementação de abordagem, de detecção de casos e de prevenção de novos agravos. OBJETIVO: descrever a frequência dos fatores de risco para sífilis e as percepções de risco sexual, em mulheres jovens, na cidade de Vitória, ES. MÉTODOS: Estudo populacional, em corte-transversal, por amostragem, realizado em Vitória. Foram realizadas entrevista e pesquisa de VDRL e MHA-TP em amostra de sangue. RESULTADOS: Entre as 904 mulheres elegíveis (18-29 anos) selecionadas pelo Programa de Saúde da Família (PSF), 11 foram diagnosticadas com sífilis sendo a prevalência de 1,2% (IC95% 0,5-1,9). A mediana de idade foi de 23 anos (distância interquartil de 20-26 anos); 65,7% das participantes alcançavam o ensino médio ou superior e 85,4% moravam com a família ou com o parceiro sexual. Fatores associados com a sífilis: menor nível educacional (<=oito anos de estudo) [Odds ratio ajustado (Ora) =4,3 (IC95% 1,01-17,99)]; ter tido mais de um parceiro na vida [ORa=6,50 (IC95% 1,37-30,82)] e história prévia de DST [ORa=10,3 (IC95% 2,37-44,33)]. Dois terços (67,7%) das mulheres entrevistadas relataram não achar fácil dizer ao parceiro que não fará sexo sem preservativo, 52,3% consideram difícil usar preservativo em todos os intercursos sexuais e 36,2% acham que não há o que fazer, se o parceiro recusar usar preservativo. CONCLUSÕES: A utilização do PSF como porta de entrada para a realização do VDRL, na rotina de atendimento, pode contribuir para diminuir a vulnerabilidade destas mulheres e ajudar no controle da sífilis congênita.