Prevalence, Risk Behaviors, and Virological Characteristics of Hepatitis B Virus Infection in a Group of Men Who Have Sex with Men in Brazil: Results from a Respondent-Driven Sampling Survey.

BACKGROUND: Men who have sex with men (MSM) are at increased risk of exposure to hepatitis B virus (HBV) compared with the general population. This study aims to assess the epidemiological and virological characteristics of HBV infection in a sample of MSM in Brazil, where data are scarce. METHODS: A cross-sectional study was conducted among MSM in the City of Goiânia, Central Brazil, from March to November 2014, using Respondent-Driven Sampling (RDS). After signing the consent form, participants were interviewed and a blood sample collected. All samples were tested for HBV serological markers and HBV DNA. HBV nucleotide sequence analysis was also performed. RESULTS: A total of 522 MSM were recruited in the study. The prevalence of HBV infection (current or past [presence of anti-HBc marker]) was 15.4% (95% CI: 8.7-25.8) and the rate of HBsAg carriers was 0.6% (95% CI: 0.2-1.6). About 40% (95% CI: 32.3-48.8) of the participants had serological evidence of previous HBV vaccination (reactive for isolated anti-HBs). In addition, 44.3% (95% CI: 36.1-52.9) were seronegative for all HBV markers. Age over 25 years old, receptive anal intercourse, previous sex with women, and history of sexually transmitted infections (STIs) were factors associated with HBV infection. HBV DNA was detected only in HBsAg-positive individuals. HBV isolates were classified into genotype A (subgenotypes A1 and A2), and some mutations were identified throughout the genome. Therefore, occult HBV infection was not observed in the study population. CONCLUSIONS: Public health strategies should be improved for the MSM population in order to prevent HBV and other STIs, as well as to provide appropriate management of patients with active infections.

Prevalence, risk factors and genotypes of hepatitis C virus infection among drug users, Central-Western Brazil.

OBJECTIVE: To estimate prevalence of hepatitis C virus (HCV) infection and identify risk factors associated and circulating HCV genotypes and subtypes. METHODS: Study conducted including 691 drug users attending 26 charitable, private and public drug treatment centers in Goiânia and Campo Grande, central-western Brazil, between 2005 and 2006. Sociodemographic characteristics and risk factors for HCV infection were collected during interviews. Blood samples were tested for HCV antibodies (anti-HCV). Positive samples were submitted to HCV RNA detection by PCR with primers complementary to 5' NC and NS5B regions of viral genome and genotyped by line probe assay (LiPA) and direct nucleotide sequencing followed by phylogenetic analysis. The prevalence and odds ratio were calculated with 95% confidence intervals. Risk factors were first estimated in the univariate analysis (p<0.10) and then analyzed by hierarchical logistic regression. Statistical significance was assessed at a 5% significance level. RESULTS: The prevalence of anti-HCV was 6.9% (95% CI: 5.2-9.2). The multivariate analysis of risk factors revealed that age over 30 years and injecting drug use were associated with HCV infection. HCV RNA was detected in 85.4% (41/48) of anti-HCV-positive samples. Thirty-three samples were genotyped as genotype 1 by LiPA, subtypes 1a (63.4%) and 1b (17.1%), and 8 samples (19.5%) were genotype 3, subtype 3a. The phylogenetic analysis of the NS5B region showed that 17 (68%), 5 (20%), and 3 (12%) samples were subtypes 1a, 3a, and 1b, respectively. CONCLUSIONS: The results show a high prevalence of HCV infection and predominance of subtype 1a among drug users in Brazil. In addition, injecting drug use was a major risk factor associated with HCV infection.

Prevalência, fatores de risco e genótipos da hepatite C entre usuários de drogas / Prevalencia, factores de riesgo y genotipos de la hepatitis C entre usuarios de drogas / Prevalence, risk factors and genotypes of hepatitis C virus infection among drug users, Central-Western Brazil

OBJETIVO: Avaliar a utilização da Escala de Depressão Pós-natal de Edimburgo como instrumento de triagem no sistema público de saúde. MÉTODOS: A Escala foi administrada entre o 40° e 90° dia do pós-parto, a 245 mulheres que tiveram parto em uma maternidade privada no município de Belo Horizonte (MG), entre 2005 e 2006. As participantes foram submetidas a uma entrevista psiquiátrica estruturada (Mini-Plus 5.0) utilizada como padrão-ouro para diagnóstico de depressão. Foram calculadas sensibilidade e especificidade da escala e utilizou-se a curva ROC para achar o melhor ponto de corte. Foi utilizado o teste t de Student para comparação das variáveis numéricas e o qui-quadrado para as variáveis categóricas. A confiabilidade foi aferida pelo coeficiente de consistência interna alfa de Cronbach. RESULTADOS: Foram diagnosticadas 66 mulheres com o quadro depressivo pós-parto (26,9 por cento da amostra). Não houve diferença entre mulheres com e sem depressão pós-parto em relação à idade, escolaridade, número de partos anteriores e estado civil. Utilizando-se o ponto de corte de 10, a sensibilidade da escala foi 86,4, a especificidade 91,1 e o valor preditivo positivo 0,78. CONCLUSÕES: As propriedades psicométricas da Escala a carcterizam como um bom instrumento de triagem da depressão pós-parto e seu uso disseminado no Sistema Único de Saúde poderia repercutir positivamente com aumento significativo na taxa de reconhecimento, diagnóstico, e tratamento da depressão pós parto.

Prevalence of hepatitis B virus and risk factors in Brazilian non-injecting drug users.

Non-injecting drug users are at high-risk for acquiring hepatitis B virus (HBV), although the factors contributing to this increased risk are not known. In the present study, the overall and occult HBV infection prevalence rates were determined in a large population of non-injecting drug users in the Central-West region of Brazil. HBV genotypes and predictors of infection were also identified. A total of 852 individuals in 34 drug treatment centers were interviewed, and their serum samples were tested for the presence of HBV markers by ELISA. HBsAg and anti-HBc-positive samples were tested for HBV DNA by PCR. Samples with HBV DNA were genotyped by restriction fragment length polymorphism (RFLP). The overall prevalence of HBV infection was 14% (95% CI: 11.7-16.5). A multivariate analysis of risk factors showed that age >30 years, non-white race/ethnicity, duration of drug use >10 years, lifetime number of sexual partners >10, non-use of condoms, and HCV and HIV status were associated significantly with HBV infection. Of the 9 (1%) HBsAg-reactive samples, HBV DNA was present in 2/2 of HBeAg-positive and in 5/7 anti-HBe-positive samples. An occult HBV infection rate of 2.7% (3/110) was found among anti-HBc-positive individuals. All HBV DNA-positive samples were genotyped: seven were genotype A, two were genotype D, and one was genotype F. Finally, few individuals (8%) had serological evidence of a previous HBV vaccination. These findings indicate that preventive interventions are needed for both sexual and drug-related high-risk behavior. Additionally, non-injecting drug users should be targeted for HBV vaccination.

Infecção pelo vírus da hepatite B em hemofílicos em Goiás: soroprevalência, fatores de risco associados e resposta vacinal / Seroprevalence, vaccination response and risk factors for hepatitis B virus infection in hemophiliacs in Goiás

Objetivando determinar a prevalência da infecção pelo vírus da hepatite B (HBV) em hemofílicos em Goiás, analisar os fatores de risco associados e avaliar a resposta vacinal contra hepatite B, 102 pacientes foram entrevistados e amostras sangüíneas coletadas para detecção dos seguintes marcadores sorológicos: HBsAg, anti-HBs e anti-HBc. Uma prevalência global de 43,7 por cento (IC 95 por cento: 33,5-54,2) para infecção pelo HBV foi encontrada. A análise multivariada dos fatores de risco mostrou que o número de episódios transfusionais e sorologia positiva para o vírus da hepatite C estiveram significantemente associados à positividade ao HBV. Foram identificados 49 (48,1 por cento) hemofílicos susceptíveis a esta infecção, sendo imunizados 30 pacientes com a vacina recombinante Euvax-B. Destes, 28 (93,3 por cento) indivíduos apresentaram títulos de anti-HBs maiores que 10 UI/L, o que mostra uma boa resposta à vacina. Os achados deste estudo ressaltam a importância das medidas de controle e prevenção da hepatite B nesta população.

In order to study the prevalence and risk factors for hepatitis Bin hemophiliacs in Goiás, 102 patients were interviewed andblood samples collected and screened for the following serologicalmarkers: HBsAg, anti-HBs and anti-HBc. An overall prevalenceof 43.7% (95% IC: 33.5-54.2) was found to hepatitis B virus(HBV) infection. Multivariate analysis of risk factors showedthat the number of transfusions and positive serology for hepatitisC virus were significantly associated with HBV positivity. Therewere 48 (48.1%) susceptible patients for this infection, of whom30 were immunized with the Euvax-B vaccine. Among them, 28(93.3%) individuals developed anti-HBs titers higher than 10IU/L. Thus, a good response was observed in the studiedpopulation. The findings of this study emphasize the importanceof strategies of control and prevention of hepatitis B in thispopulation.