Hepatitis C virus prevalence among men who have sex with men: a cross-sectional study in 12 Brazilian cities.

BACKGROUND: Despite the preventive policies adopted, reduction in sexually transmitted infections (STIs) among men who have sex with men (MSM) has been limited. The risk of hepatitis C virus (HCV) infection has increased among the most vulnerable population groups, including MSM. The aim of this study was to estimate the prevalence of HCV infection and to assess risky practices among MSM from 12 Brazilian cities. METHODS: This study was carried out from June to December 2016 using respondent driven sampling (RDS). Participants completed a self-administered questionnaire to collect behavioral, socioeconomic, and demographic variables. In addition, the rapid diagnostic test (RDT) for HCV was offered. Positive results were sent to Instituto Adolfo Lutz for confirmation. RESULTS: A total of 4,176 participants were recruited and 23 samples were sent for confirmation. Of these, 16 were confirmed, resulting in a prevalence of 0.7% (95% CI: 0.3%-1.7%). The Southeast region showed a prevalence of 0.9% (95% CI: 0.3-2.6), followed by the South region, with 0.6% (95% CI: 0.2-2.1). The Northeast region had a prevalence of 0.3% (95% CI: 0.1-1.0) and the Midwest 0.1% (95% CI: 0.0-0.7). No positive cases were found in the North. Single men aged 40 years or older were the majority of participants exposed to HCV. High levels of alcohol consumption, illicit drug use, irregular condom use, in addition to infection with other STIs, were associated with exposure to HCV. CONCLUSIONS: STIs continue to be important health problems in Brazil and globally. Many STIs are inapparent for many years until they bring more serious consequences. Extra investment in HCV is also warranted, given that it can be eliminated. Relying solely on clinical data to provide information about inapparent infection, especially in stigmatized populations, will make that goal more difficult to achieve. Surveillance studies, such as the one reported here need to be repeated over time to demonstrate trends and to provide information for evaluation, program and policies. Investments in the most vulnerable populations are critical to achieve the World Health Organization global health goals including the elimination of viral hepatitis by 2030.

Hepatitis B Prevalence among Men Who Have Sex with Men in Brazil.

Hepatitis B virus (HBV) is a global public health problem and requires specific prevention actions, particularly focusing on the key populations, such as men who have sex with men (MSM). We aimed at assessing the prevalence of HBV infection, among MSM, in a multicity study in Brazil. In 2016, we conducted a survey using a respondent-driven sampling methodology in 12 Brazilian cities. Rapid tests (RT) were performed on 3178 samples from those MSM. Positive results were tested for HBV DNA and sequenced. If negative for HBV DNA, samples were tested for serological markers. The prevalence rate of HBV exposure and clearance was 10.1% (95% CI: 8.1-12.6), and 1.1% (95%; CI: 0.6-2.1) were confirmed to be HBsAg-positive. Of those samples tested for anti-HBs (n = 1033), only 74.4% presented a serological profile analogous to that elicited by hepatitis B vaccination. Among HBsAg-positive samples (n = 29), 72.4% were HBV DNA-positive, and from these, 18 were sequenced. HBV genotypes A, F, and G were found in 55.5%, 38.9%, and 5.6%, respectively. This study indicates high prevalence rates of MSM HBV exposure and a low positivity index for the serological marker of HBV vaccine immunity. These findings may contribute to the discussion of strategies to prevent hepatitis B and reinforce the importance of promoting HBV vaccination in this key population.

Accuracy of Buffy Coat in the Diagnosis of Disseminated Histoplasmosis in AIDS-Patients in an Endemic Area of Brazil.

The buffy coat is obtained routinely for disseminated histoplamosis (DH) diagnosis in Ceará, Brazil. The aim of this study is to describe the accuracy of staining smears for Histoplasma in the buffy coat of AIDS-patients with DH. From 2012-2013, all results of stained buffy coat smears and culture for fungi performed at São José Hospital were recorded. In total, 489 buffy coats of 361 patients were studied; 19/361 (5.3%; 95%CI = 2.9-7.6%) had positive direct examination stained smears for Histoplasma and 61/361 (16.9%; 95%CI = 13.0-20.8%) had growth in culture. For those with positive Histoplasma cultures, the CD4 count was significantly lower (139.3 vs. 191.7cells/µL; p = 0.014) than others, and death was 18%. The sensitivity and specificity of stained smears was 25.9% and 100%, respectively. A second test, performed up to 36 days from the first one, increased the sensitivity of stained smears to 32.2%. Stained smears of buffy coat have low accuracy; nonetheless, they are easy to perform and can give a quick diagnosis in low-resource endemic areas. Despite the decrease in mortality, it is not yet to the low levels observed in areas that have better and more efficient methods.

HIV among MSM in a large middle-income country.

OBJECTIVE: To conduct the first national biological and behavioral surveillance survey for HIV among MSM in Brazil. DESIGN: A cross-sectional surveillance study utilizing Respondent Driven Sampling (RDS) in 10 cities, following formative research. Planned sample: 350 MSM reporting sex with another man in the last 12 months, at least 18 years of age, and residing in the city of the study. METHODS: Conventional RDS recruitment. Results were calculated for each city using RDSAT 5.6. For the national estimate, a new individual weight using a novel method was calculated. The 10 cities were aggregated, treated as strata and analyzed using STATA11.0. Self-reported HIV status and logistic regression was used to impute missing values for serostatus, an important issue for RDSAT. RESULTS: A total of 3859 MSM were interviewed. Sample was diverse, most self-identified as mulatto or black, were social class C or below, and had relatively low levels of education. More than 80% reported more than one partner in the last 6 months. Only 49% had ever tested for HIV. HIV prevalence among MSM ranged from 5.2 to 23.7% in the 10 cities (3.7-16.5% without imputation) and was 14.2% for all cities combined with imputation. The overall prevalence was two and three times higher than that estimated for female sex workers and drug users, respectively, in Brazil. Half of those who tested HIV positive were not aware of their infection. CONCLUSION: The AIDS epidemic in Brazil is disproportionately concentrated among MSM, as has been found in other countries. Renewed efforts to encourage testing, prevention and treatment are required.

Travestis, an unexplored population at risk of HIV in a large metropolis of northeast Brazil: a respondent-driven sampling survey.

Travestis are highly vulnerable to HIV infection in Brazil. We conducted a survey among 304 travestis using Respondent-Driven Sampling from August to December 2008. Travestis are young (49% <24 years), poorly educated (55% just elementary school), low social class (62% Class C-E), reside with families (49%) or friends/madam (22%), are victims of homophobia (91%) and violence (61%). They report early sexual debut (75% <14), many sexual partners, drug use during sex (43%), and unprotected sex (male partner, 47%, both male and female partners, 50%). Sex work is common (82%, 59% >10 partners last six months) and relatively low cost (median=US$24). A majority report testing for HIV (69%), and report high prevalence (12% disclosed a positive result). Almost all the respondents refused to test in the study. Interventions, targeted to both travestis and to the general community about sexual discrimination, are necessary.

The phase angle and mass body cell as markers of nutritional status in hemodialysis patients.

OBJECTIVE: Bioelectrical impedance analysis (BIA) is a fast, noninvasive method for assessing body composition, and its role in the evaluation of nutritional status in haemodialysis (HD) has been studied. This study aimed to compare BIA parameters to clinical, biochemical, and anthropometric markers of nutrition in HD patients, such as subjective global assessment modified for renal disease (SGA-1), serum albumin, body mass index (BMI), percent of standard body weight (%SBW), deviation of triceps skinfold thickness (TSF), mid-arm circumference (MAC), mid-arm muscle circumference (MAMC) from the standard value (50th percentile), anthropometry-derived fat (FM-A), and fat-free mass (FFM-A). METHODS: BIA was performed 30 minutes after a HD session and the reactance (Xc), resistance (R), phase angle (PA), body cell mass (BCM), fat mass (FM-BIA), and fat-free mass (FFM-BIA) values were recorded. The prevalence of malnutrition was estimated according to PA and percent of BCM. The correlation between methods was assessed through Pearson's correlation coefficient and Bland and Altman analysis. RESULTS: A total of 58 patients were studied (30 women and 28 men; mean age of 49.2 +/- 14.8 years). The mean PA was 6.19 +/- 1.33 degrees and the mean percent of BCM was 33.75 +/- 5.91%. The prevalence of malnutrition was 17.5% and 43.9% according to the PA and percent of BCM, respectively. PA had a negative correlation with age and SGA-1 score and a positive correlation with percent SBW, MAC, MAMC, FFM-A, and albumin. Percent of BCM had a negative correlation with age, MAC, MAMC and FM-A and a positive correlation with FFM-A and albumin. A significant correlation between FFM-A and FFM-BIA was observed, as well as between FM-A and FM-BIA. CONCLUSIONS: BIA indexes reflected nutritional state. PA and BCM seem to be less influenced by changes in volume and can be used for nutritional assessments of dialysis patients.

Metabolic acidosis in AIDS patients.

BACKGROUND AND AIMS: Metabolic acidosis (MA) is a frequent and serious complication in HIV-infected patients. The aim of the study is to compare patients with and without MA associated with HIV. METHODS: Patients were retrospectively studied involving all HIV-infected patients with blood gas analysis performed during hospital stay admitted to a single hospital between April 2004 and July 2006. Statistical analysis was performed using SPSS 10.0 for Windows. RESULTS: Included in the study were 159 HIV patients, 72 cases (45.3%) with MA and 87 cases (54.7%) without. The comparison of both groups showed a mean arterial pH of 7.24 +/- 0.08 vs. 7.44 +/- 0.05, HCO(3) 12 +/- 5.7 vs. 21 +/- 5.1 mEq/L, serum urea 81 +/- 68 mg/dL vs. 39 +/- 46 mg/dL and serum creatinine 2.7 +/- 2.6 mg/dL vs. 1.2 +/- 1.9 mg/dL in MA-HIV and non-MA-HIV, respectively (p <0.05). Antiretroviral therapy (ART) was being administered to 38 subjects (52.8%) in MA-HIV group and 45 (51.7%) in non-MA-HIV group (p = 0.57). There was no association between the use of ART and MA. Mortality was higher in patients with acidosis (52.7 vs. 17.2%, p <0.0001). CONCLUSIONS: In the present study, MA was associated with acute kidney injury and increased mortality. There was no association between the use of ART and MA.

Medication noncompliance in chronic kidney disease.

BACKGROUND: Medication noncompliance has a harmful impact on reaching therapeutic goals of delaying the progression of chronic kidney disease (CKD). The aim of the present study is to calculate the prevalence of medication noncompliance and to identify medication noncompliance-associated factors in CKD. METHODS: A cross-sectional study was performed with 130 CKD patients from a university nephrology outpatient clinic, mean age 48.8 +/- 15.8 years, who were continuously self-administering an antihypertensive or immunosuppressive drug, and who were neither on dialysis nor had received a kidney transplant. Noncompliance was measured through self-report (during an interview) and physician assessment. Patients were considered noncompliers if noncompliance had been detected by any of these methods. Sociodemographic, clinical and laboratory and medication characteristics were surveyed, as well as patients' knowledge regarding prescribed medicines and opinions of the quality of the health care service provided. RESULTS: Prevalence of medication noncompliance was 36.9% (95% confidence interval [95% CI], 28.6%-45.8%). Lack of access to medicines was the most commonly reported problem with medication use (62.5%). Multiple logistic regression analysis showed that patients' insufficient knowledge regarding prescribed medicines (p=0.040) and bad opinions of the quality of the provided health care service (p=0.027) were independently associated with noncompliance. CONCLUSIONS: Medication noncompliance prevalence was high among the patients studied. Lack of access to medicines remains an important public health problem. The noncompliance-associated factors identified in CKD were the patients' poor knowledge regarding the pharmacotherapy and dissatisfaction with the health care service provided.

Desire for a child among women living with HIV/AIDS in northeast Brazil.

In Brazil, an increasing proportion of new HIV infections and AIDS cases involve women of reproductive age. To describe the reproductive desire of women with HIV/AIDS and to identify factors associated with the desire for motherhood, a cross-sectional study was carried out in the referral hospital for infectious diseases in Ceará State, northeast Brazil. In total, 229 women were included in data analysis. Median age was 32 years (interquartile range, 26-37), and 63% had a monthly family income of less than 210 USD. Forty-nine percent were using a contraceptive method, and 37% wished to undergo tubal ligation. Sixty-four percent of the latter women were motivated by the fear of having an HIV-positive child. Forty percent of the participants wanted to have a child. In the multivariate regression analysis, variables independently associated with women's desire to have a child were: younger age (in years, odds ration [OR] = 0.94; 95% confidence interval [CI]: 0.90-0.98), number of children (OR = 0.73; 95% CI: 0.57-0.96), and partner's desire for a child (OR = 3.35; 95%CI: 1.75-6.39). Having a partner who did not know about the woman's positive serostatus was negatively associated with the woman's desire for a child (OR = 0.17; 95% CI: 0.04-0.69). No variable related to clinical status was significantly associated with the outcome variable. Our data showed that many unsterilized HIV-positive women in northeast Brazil, at whatever stage of illness, have a desire for children. We recommend that nondirective counseling, consisting of helping women evaluate their own feelings, goals and needs with respect to reproductive options be provided.

Survival of adult AIDS patients in a reference hospital of a metropolitan area in Brazil.

OBJECTIVE: To evaluate the influence of sociodemographic, clinical, and epidemiological factors in AIDS patients survival in a reference hospital. METHODS: A sample of 502 adult AIDS patients out of 1,494 AIDS cases registered in a hospital in Fortaleza, Brazil, was investigated between 1986 and 1998. Sixteen cases were excluded due to death at the moment of the AIDS diagnosis and 486 were analyzed in the study. Socioeconomic and clinical epidemiological were the variables studied. Statistical analysis was conducted using the Kaplan-Meier survival analysis and the Cox proportional hazards model. RESULTS: Three hundred and sixty two out of the 486 patients studied took at least one antiretroviral drug and their survival was ten times longer than those who did not take any drug (746 and 79 days, respectively, p <0.001). Patients who took two nucleoside reverse transcriptase inhibitors (NRTI) plus protease inhibitor were found to have higher survival rates (p <0.001). The risk of dying in the first year was significantly lower for patients who took NRTI and a protease inhibitor compared to those who took only NRTI. In addition, this risk was much lower from the second year on (0.10; 95%CI: 0.42-0.23). The risk of dying in the first year was significantly higher for less educated patients (15.58; 95%CI: 6.64-36.58) and those who had two or more systemic diseases (3.03; 95%CI: 1.74-5.25). After the first year post-diagnosis, there was no risk difference for these factors. CONCLUSIONS: Higher education revealed to exert a significant influence in the first-year survival. Antiretroviral drugs had a greater impact in the survival from the second year on. A more aggressive antiretroviral therapy started earlier could benefit those patients.

Survival of adult AIDS patients in a reference hospital of a metropolitan area in Brazil

Objetivo: Avaliar, em um hospital de referência, a influência de fatores sociodemográficos e clínico-epidemiológicos na sobrevivência de pacientes com Aids. Métodos: Foi estudada uma amostra de 486 adultos com Aids atendidos em hospitais de referência no Ceará, entre 1986 e 1998. Foram avaliadas as variáveis socioeconômicas e clínico-epidemiológicas. A análise foi realizada pelo método Kaplan-Meier e por regressäo de Cox. Resultados: Dos 486 pacientes estudados, 362 utilizaram pelo menos uma droga anti-retroviral e tiveram sobrevida dez vezes maior que os que näo a utilizaram (746 e 79 dias, respectivamente; p<0,001). O risco de morrer, no primeiro ano, foi significativamente menor (0,25; IC95 por cento: 0,12-0,50) para os que fizeram uso de dois inibidores de transcriptase reversa ou HAART e menor a partir do segundo ano (0,10; IC95 por cento:0,42-0,23) em relaçäo aos que näo os usaram. Indivíduos sem nível universitário (15,58; IC95 por cento:6,64-36,58) e que apresentaram duas ou mais doenças sistêmicas (3,03; IC95 por cento:1,74-5,25) tiveram risco significativamente maior de morrer no primeiro ano. Após o primeiro ano, näo se observou diferença. Conclusäo: O melhor nível socioeconômico, medido indiretamente pela escolaridade, demonstrou grande influência na sobrevivência no primeiro ano. As drogas anti-retrovirais tiveram mais impacto na sobrevivência a partir do segundo ano, assim igualaram o risco de morrer de pacientes com duas ou mais doenças sistêmicas àqueles que näo tiveram nenhuma no mesmo período. Concluiu-se que uma introduçäo mais precoce e mais agressiva dos anti-retrovirais poderia beneficiar os pacientes