Current Prevalence and Risk Factors Associated with Human T Lymphotropic Virus Type 1 and Human T Lymphotropic Virus Type 2 Infections Among HIV/AIDS Patients in São Paulo, Brazil

During the 1990s, high prevalences of HIV/human T lymphotropic virus type 1 (HTLV-1) and HIV/human T lymphotropic virus type 2 (HTLV-2) coinfections were detected in São Paulo, Brazil in association with intravenous drug use (IDU). The current prevalences and risk factors for HIV/HTLV-1/-2 were evaluated in 1,608 patients attending the AIDS/STD Reference and Training Center in São Paulo. Blood samples were analyzed for HTLV-1/2-specific antibodies using enzyme immunoassays (EIA Murex HTLV-I+II, Diasorin, and Gold ELISA HTLV-I+II, REM) and immunoblotting (HTLV Blot 2.4, MP Biomedicals and INNO-LIA HTLV-I/II, Innogenetics) and for the pol proviral DNA segments of HTLV-1 and HTLV-2 by “in-house” real-time PCR. These analyses revealed that 50 (3.11%) of the samples were HTLV positive, including 25 (1.55%) that were HTLV-1 positive, 21 (1.31%) that were HTLV-2 positive, and 4 (0.25%) that were HTLV positive (untypeable). The median age of the HIV/HTLV-coinfected individuals was 50 years versus 44 years in the overall population (p=0.000). The risk factors associated with HIV/HTLV-1/-2 coinfections were female gender (OR 3.26, 1.78–5.95), black/pardo color (OR 2.21, 1.21–4.03), infection with hepatitis B virus (HBV) (OR 4.27, 2.32–7.87) or hepatitis C virus (HCV) (OR 24.40, 12.51–48.11), and intravenous drug use (IDU) (OR 30.01, 15.21–59.29). The current low prevalence of HTLV-1/2 in HIV-infected patients in São Paulo could be explained in part by programs providing IDUs with sterile needles and syringes and changes in the drug usage patterns of individuals from injecting cocaine to smoking crack cocaine.

Short Communication: Current Prevalence and Risk Factors Associated with Human T Lymphotropic Virus Type 1 and Human T Lymphotropic Virus Type 2 Infections Among HIV/AIDS Patients in São Paulo, Brazil.

During the 1990s, high prevalences of HIV/human T lymphotropic virus type 1 (HTLV-1) and HIV/human T lymphotropic virus type 2 (HTLV-2) coinfections were detected in São Paulo, Brazil in association with intravenous drug use (IDU). The current prevalences and risk factors for HIV/HTLV-1/-2 were evaluated in 1,608 patients attending the AIDS/STD Reference and Training Center in São Paulo. Blood samples were analyzed for HTLV-1/2-specific antibodies using enzyme immunoassays (EIA Murex HTLV-I+II, Diasorin, and Gold ELISA HTLV-I+II, REM) and immunoblotting (HTLV Blot 2.4, MP Biomedicals and INNO-LIA HTLV-I/II, Innogenetics) and for the pol proviral DNA segments of HTLV-1 and HTLV-2 by "in-house" real-time PCR. These analyses revealed that 50 (3.11%) of the samples were HTLV positive, including 25 (1.55%) that were HTLV-1 positive, 21 (1.31%) that were HTLV-2 positive, and 4 (0.25%) that were HTLV positive (untypeable). The median age of the HIV/HTLV-coinfected individuals was 50 years versus 44 years in the overall population (p=0.000). The risk factors associated with HIV/HTLV-1/-2 coinfections were female gender (OR 3.26, 1.78-5.95), black/pardo color (OR 2.21, 1.21-4.03), infection with hepatitis B virus (HBV) (OR 4.27, 2.32-7.87) or hepatitis C virus (HCV) (OR 24.40, 12.51-48.11), and intravenous drug use (IDU) (OR 30.01, 15.21-59.29). The current low prevalence of HTLV-1/2 in HIV-infected patients in São Paulo could be explained in part by programs providing IDUs with sterile needles and syringes and changes in the drug usage patterns of individuals from injecting cocaine to smoking crack cocaine.

Comparação de testes laboratoriais para o diagnóstico de infecção por vírus linfotrópicos de células T humanas do tipo 1 (HTLV-1)e tipo 2 (HTLV-2) em pacientes infectados por HIV-1 / Comparison of laboratorial tests for the diagnosis of human T-lymphotropic virus type 1 (HTLV-1) and type 2 (HTLV-2) in HIV-1 infected patients

O presente estudo pesquisou o melhor algoritmo de testes laboratoriais para efetuar o diagnóstico de infecção por vírus linfotrópicos de células T humanas dos tipos 1 (HTLV-1) e 2 (HTLV-2) em pacientes HIV-1 positivos. Amostras de sangue de 1.608 pacientes do CRT DST/Aids-SP foram analisadas quanto à presença de anticorpos específicos usando-se dois ensaios de triagem (EIA Murex HTLV-I+II e Gold ELISA HTLV-I/II), dois confirmatórios [HTLV Blot 2.4 (Western Blot – WB) e INNO-LIA HTLV I/II (Line ImmunoAssay - LIA)] e um molecular (PCR em tempo real pol). Na triagem foram detectados 51(Murex) e 49 (Gold ELISA) soros reagentes. Pelo WB, 23 soros confirmaram infecção por HTLV-1, 12 HTLV-2, seis HTLV e nove apresentaram perfis indeterminados. O LIA detectou 24 soros HTLV-1 positivos, 20 HTLV-2 e seis HTLV. A PCR evidenciou segmento pol de HTLV-1 em 18 e HTLV-2 em 12 amostras de sangue. Pelos testes confirmatórios, em 50 pacientes foi confirmada a infecção por HTLV: 25 HTLV-1 (1,55 %), 21 HTLV-2 (1,31 %) e quatro HTLV (0,25 %). As sensibilidades do LIA, WB e PCR foram de 96 %, 76 % e 60 %, respectivamente. Considerando-se apenas o custo, o melhor algoritmo diagnóstico para população infectada pelo HIV-1 foi o uso da PCR seguida do LIA...

Prevalência de infecção por HTLV-1 e HTLV-2 em pacientes infectados pelo HIV em serviço especializado de São Paulo / Prevalence of HTLV-1 and HTLV-2 in patients infected with HIV from a Reference Center of São Paulo

Os HTLV-1, HTLV-2 e HIV compartilham as mesmas vias de transmissão e as prevalências de coinfecção HIV/HTLV-1 e HIV-HTLV-2 variam de acordo com a região geográfica, a população de estudo e a época em que foi realizada a pesquisa. Altas taxas de coinfecção foram detectadas em pacientes com Aids em São Paulo na década de 1990 e foram associadas ao uso de drogas injetáveis (UDI). Neste estudo foi determinada a prevalência e os fatores de risco para a coinfecção HIV/HTLV em pacientes do CRT-DST/Aids de São Paulo. Amostras de sangue de 1.608 pacientes que aceitaram participar do estudo foram encaminhadas ao Instituto Adolfo Lutz para pesquisa de anticorpos anti-HTLV-1/2 por ensaio imunoenzimático e Western Blot (WB) e para pesquisa de DNA proviral pela PCR em tempo real pol. Na triagem sorológica, 51 soros resultaram reagentes para HTLV. Destes, pelo WB, 23 (1,43%) confirmaram infecção HTLV-1, 12 (0,75%) HTLV-2 e 6 (0,37%) HTLV não tipado. Pela PCR houve detecção de mais um caso de HTLV-1 (total 1,49%) e cinco casos de HTLV-2 (total 1,06%). Houve associação entre infecção HTLV-1/2 e gênero feminino (p=0.0027), cor negro/pardo (p=0.0332), infecção pelo HBV (p=0.0019), HCV e UDI (p<0.0000). A PCR em tempo real foi útil para confirmar casos com resultado HTLV não tipado e Indeterminado pelo WB e pode ser usada como primeiro teste confirmatório seguido do WB. A baixa prevalência de coinfecção HIV/HTLV no presente estudo parece estar relacionada a mudanças na população exposta ao HIV e na troca de cocaína injetável por crack no momento atual...

Survival analysis of acquired immune deficiency syndrome patients with and without hepatitis C virus infection at a reference center for sexually transmitted diseases/acquired immune deficiency syndrome in São Paulo, Brazil

INTRODUCTION: Survival of patients with acquired immune deficiency syndrome has improved with combination antiretroviral therapy; mortality due to liver diseases, however, has also increased in these patients. OBJECTIVES: To estimate the accumulated probability of survival in human immunodeficiency virus-hepatitis C virus coinfected and non-coinfected patients and to investigate factors related to acquired immune deficiency syndrome patients' survival. METHODS: Non-concurrent cohort study using data from surveillance information systems of acquired immune deficiency syndrome patients over 13 years of age. Hepatitis C and B, human immunodeficiency virus exposure category, CD4+ T cell count, age group, schooling, race, sex, and four acquired immune deficiency syndrome diagnosis periods were studied. Kaplan-Meier survival analysis and Cox model with estimates of the hazard ratio and 95% confidence interval were used. RESULTS: Of the total 2864 individuals included, with median age was 35 years, 219 died (7.5%), and 358 (12.5%) were human immunodeficiency virus-hepatitis C virus coinfected. The accumulated probability of survival in human immunodeficiency virus-hepatitis C virus coinfected patients, after acquired immune deficiency syndrome diagnosis, at 120 months, was 0%, 38.9%, 83.8% in 1986-1993, 1994-1996, 1997-2002, respectively, and 92.8% at 96 months in 2003-2010; survival in non-coinfected patients at 120 months was 80%, 90.2%, 94% in 1986-1993, 1994-1996, 1997-2002, respectively, and 94.1% at 96 months in 2003-2010. In the multivariate model the following variables were predictive of death: hepatitis C virus coinfection (hazard ratio=2.7; confidence interval 2.0-3.6); Hepatitis B virus coinfection (hazard ratio=2.4; confidence interval 1.7-3.6); being >50 years old (hazard ratio=2.3; confidence interval 1.3-3.8); having 8-11 years of schooling (hazard ratio=1.6; confidence interval 1.1-2.3), having 4-7 years of schooling ...

Survival analysis of acquired immune deficiency syndrome patients with and without hepatitis C virus infection at a reference center for sexually transmitted diseases/acquired immune deficiency syndrome in São Paulo, Brazil.

INTRODUCTION: Survival of patients with acquired immune deficiency syndrome has improved with combination antiretroviral therapy; mortality due to liver diseases, however, has also increased in these patients. OBJECTIVES: To estimate the accumulated probability of survival in human immunodeficiency virus-hepatitis C virus coinfected and non-coinfected patients and to investigate factors related to acquired immune deficiency syndrome patients' survival. METHODS: Non-concurrent cohort study using data from surveillance information systems of acquired immune deficiency syndrome patients over 13 years of age. Hepatitis C and B, human immunodeficiency virus exposure category, CD4+ T cell count, age group, schooling, race, sex, and four acquired immune deficiency syndrome diagnosis periods were studied. Kaplan-Meier survival analysis and Cox model with estimates of the hazard ratio and 95% confidence interval were used. RESULTS: Of the total 2864 individuals included, with median age was 35 years, 219 died (7.5%), and 358 (12.5%) were human immunodeficiency virus-hepatitis C virus coinfected. The accumulated probability of survival in human immunodeficiency virus-hepatitis C virus coinfected patients, after acquired immune deficiency syndrome diagnosis, at 120 months, was 0%, 38.9%, 83.8% in 1986-1993, 1994-1996, 1997-2002, respectively, and 92.8% at 96 months in 2003-2010; survival in non-coinfected patients at 120 months was 80%, 90.2%, 94% in 1986-1993, 1994-1996, 1997-2002, respectively, and 94.1% at 96 months in 2003-2010. In the multivariate model the following variables were predictive of death: hepatitis C virus coinfection (hazard ratio=2.7; confidence interval 2.0-3.6); Hepatitis B virus coinfection (hazard ratio=2.4; confidence interval 1.7-3.6); being ≥ 50 years old (hazard ratio=2.3; confidence interval 1.3-3.8); having 8-11 years of schooling (hazard ratio=1.6; confidence interval 1.1-2.3), having 4-7 years of schooling (hazard ratio=1.9; confidence interval 1.3-2.8) and having up to 3 years of schooling (hazard ratio=3.3; confidence interval 2.0-5.5). CONCLUSIONS: Among patients diagnosed after 1996, there was a significant increase in the cumulative probability of survival in human immunodeficiency virus-hepatitis C virus coinfected individuals; among those diagnosed with acquired immune deficiency syndrome from 2003 to 2010, this probability was similar between coinfected and non-coinfected patients.

Análise de sobrevida de pacientes coinfectados HIV/HCV de um centro de referência em DST/AIDS no município de São Paulo / Survival analysis of HIV/HCV co-infected patients at a STD/AIDS reference center in the city of São Paulo

Introdução: A estimativa de sobrevida de pacientes com HIV/aids aumentou após a terapia antirretroviral de alta potência: no entanto, a mortalidade por doenças hepáticas também cresceu. Objetivos: Estimar a probabilidade acumulada de sobrevida após o diagnóstico de aids entre pacientes coinfectados HIV/HCV e realizar análise exploratória para investigar fatores relacionados à sobrevida desses pacientes. Metodologia: Estudo de coorte não concorrente, utilizando sistemas de Informações: o de Agravos de Notificação, o de informação laboratorial e o de informação da vigilância epidemiológica do Centro de Referência e Treinamento DST/AIDS-SP, de pacientes com aids maiores de 13 anos, acompanhados no ambulatório geral. As variáveis estudadas foram: hepatite C, hepatite B, categoria de exposição, contagem de células T CD4+, faixa etária, escolaridade, cor, sexo e períodos de diagnóstico de aids: 1986 a 1993, 1994 a 1996, 1997 a 2002 e 2003 a 2010. Foi utilizado o estimador de Kaplan-Meier, o modelo de Cox e as estimativas das hazard ratio (HR) com os respectivos intervalos de confiança (IC 95 por cento ). Resultados: De um total de 2.864 pessoas incluídas, com idade mediana de 35 anos, 219 foram a óbito (7,5 por cento ). De 358 (12,5 por cento ) coinfectados, 159 (45,1 por cento ) eram usuários de drogas injetáveis (UDI) e de 2.506 não coinfectados, 96 (3,9 por cento ) eram UDI. A probabilidade acumulada de sobrevida entre coinfectados, a partir do diagnóstico de aids, foi 100 por cento aos 60 meses no período de 1986 a 1993; 27,8 por cento aos 168 meses no período de 1994 a 1996; 76,3 por cento aos 168 meses no período de 1997 a 2002 e 92,8 por cento aos 96 meses no período de 2003 a 2010. As curvas de sobrevida foram diferentes entre coinfectados e não coinfectados no período de 1994 a 1996 (log rank = 19,8; p < 0,001) e no período de 1997 a 2002 (log rank = 38,8; p < 0,001). No modelo de Cox multivariado, mostraram-se preditores de óbito, independentemente das outras variáveis: ter hepatite C (HR = 2,9; IC 2,1-3,9), ter hepatite B (HR = 2,5; IC 1,7-3,6), ter até 3 anos de estudo (HR = 2,3; IC 1,5-3,6), ter 50 anos ou mais de idade (HR = 2,1; IC 1,3-3,2). Ter diagnóstico de aids no período entre 1997 a 2002 mostrou-se fator de proteção ao óbito (HR = 0,4; IC 0,3-0,5). Conclusões: Coinfectados HIV/HCV apresentaram menor sobrevida quando comparado com não coinfectados nos períodos de diagnóstico de aids 1994 a 1996 e 1997 a 2002.