Impact of coronavirus disease (COVID-19) on HIV testing and care provision across four continents.

OBJECTIVES: The coronavirus disease (COVID-19) pandemic has been associated with severe disruptions in health care services, and nonpharmacological measures such as social distancing also have an impact on access to screening tests and on the long-term care of patients with chronic conditions globally. We aimed to describe the impact of the COVID-19 pandemic on HIV testing and treatment and to describe strategies employed to mitigate the impact of COVID-19 on HIV care. METHODS: In this retrospective cohort study, we used secondary data from the AIDS Healthcare Foundation (AHF) Global Quality Program from 44 countries in four continents (Asia, Latin America and the Caribbean, Europe and Africa), and compared information on HIV testing, percentage of positive results, number of in-person appointments, and number of new enrolments in HIV care from 1 January 2020 to 31 August 2020 with the equivalent period in 2019. RESULTS: Despite marked inter-country heterogeneities, we found that COVID-19 was associated with a significant reduction in HIV testing, an increase in the percentage of positive tests, a reduction in the number of in-person consultations and a reduction in the number of new enrolments in care, despite the implementation of several mitigation strategies. The impact of COVID-19 differed across continents and key populations. CONCLUSIONS: Our findings suggest that, in the years to come, health care services must be prepared to respond to the impact of COVID-19 on HIV testing and care. Providers and facilities should build on the lessons learned so far to further improve mitigation strategies and establish care priorities for both the pandemic and the post-pandemic periods.

Antiretroviral treatment, government policy and economy of HIV/AIDS in Brazil: is it time for HIV cure in the country?

Brazil is a low-and-middle income country (LMIC) that, despite having a large population and continental dimensions, has been able to successfully fight HIV/AIDS through a number of governmental and societal measures. These included an early response to the epidemic, the development of a universal and free public health system, incisive discussions with pharmaceutical companies to reduce antiretroviral (ARV) drug prices, investments towards the development of generic drugs and compulsory licensing of ARVs. Through such measures, Brazil is among the leading LMIC towards achieving the 90-90-90 UNAIDS goals in the years to come. In this review, we analyze Brazil's progress throughout the HIV/AIDS epidemic to achieve state-of-the-art ARV treatment and to reduce AIDS mortality in the country. The top-quality HIV/AIDS research in Brazil towards HIV prophylactic and functional cure, the next step towards the economic sustainability of the battle against HIV, is also discussed.

Bone mass, fracture risk, and associated factors in postmenopausal women living with HIV.

OBJECTIVE: The aim of this study was to assess the prevalence of low bone mass (osteopenia/osteoporosis), the factors associated with low bone mass, and the risk of fractures in Brazilian postmenopausal women living with HIV (WLH) in the Amazon region. METHODS: This is a cohort study with a cross-sectional assessment at baseline conducted between March 2021 to August 2022 with 100 postmenopausal WLH undergoing antiretroviral therapy (ART) between 45 and 60 years of age and 100 age-matched HIV-negative women. Data on bone mineral density in the lumbar spine (LS) and femoral neck (FN) were collected using dual x-ray absorptiometry and the 10-year risk of hip and major osteoporotic fractures was assessed using the Fracture Risk Assessment tool (FRAX). RESULTS: The age of menopause onset occurred earlier in WLH ( P < 0.001). No differences in prevalence of osteoporosis and osteopenia in LS and FN were observed except for a lower T score in FN in WLH ( P = 0.039). The FRAX for major osteoporotic fracture and hip fracture were low in both groups, despite the mean of both FRAX scores was higher in WLH ( P < 0.001). Multivariate analysis showed that years since menopause onset, higher body mass index and higher FRAX major osteoporotic fracture were associated with the WLH group, while a higher frequency of physical activity was registered in the HIV-negative group. Multivariate analysis also showed that in WLH, a lower T score in FN was associated with years since menopause onset and body mass index and that the number of years since menopause onset was associated with a lower T score in the LS and a higher score in the FRAX hip fracture. CONCLUSIONS: Our findings show a high prevalence of low bone mass (osteopenia/osteoporosis) in Brazilian postmenopausal women from the Amazon region. Women living with HIV have higher FRAX scores than HIV-negative women and a lower T score in the FN.

Impact of COVID-19 on income, prevention attitudes, and access to healthcare among male clients in a Sexually Transmitted Infections clinic.

BACKGROUND: Mobility restrictions and overloaded health services during the COVID-19 pandemic compromised services dedicated to the prevention and care of HIV and other sexually transmitted infections (STI). In this study, we present client's responses to standardized questionnaires applied during the COVID-19 pandemic period as part of the strategy to measure impacts on social and sexual vulnerability, access to STI prevention services, and access to STI care. METHODS: The questionnaires included variables on sociodemographics, behavior, risk perception, prevention attitudes, barriers to service-based HIV rapid test, reasons for taking an HIV self-test, and access to health services for STI diagnosis and treatment. We explored demographic variables associated with income reduction, reduced access to HIV/STI testing/treatment and increased vulnerability to HIV/STI. RESULTS: 847 participants responded to the study questionnaire between May 2020 and January 2021. Most were young, cisgender male, and 63% self-reported as men who have sex with men. Income reductions were reported by 50%, with 30% reporting a decline over 50% of total income. An increase in heavy episodic drinking (>5 doses) was reported by 18%; 7% reported more sexual partners and 6% reported using condoms less often. Difficulties in obtaining HIV tests, tests for other STI and treatment for STI were reported by 5%, 6% and 6%, respectively. Lower schooling was significantly associated with income reduction (p = 0.004) and with reduced access to HIV/STI testing or STI treatment (p = 0.024); employment status was associated with income reduction (p < 0.001) and increased vulnerability to HIV/STI (p = 0.027). Having access to an expedite test result, avoiding physical attendance in health units during the pandemic, and undertaking the test with privacy with a trusted person were reported as motivators for HIV self-test. CONCLUSIONS: Our findings are relevant to promote service improvements tailored to subgroups more likely to struggle with detrimental effects during and after the COVID-19 pandemic.

The impact of socioeconomic status on HPV infection among young Brazilians in a nationwide multicenter study.

The aim of this study is to evaluate genital human papillomavirus (HPV) infection according to socioeconomic categories in Brazil. This cross-sectional, nationwide study included 7,694 sexually active women and men aged 16-25 years. Individuals of all socioeconomic groups in all 26 Brazilian capitals and the Federal District were enrolled through public primary care units between September 2016 and November 2017. All participants answered a standardized interview administered by trained primary care health professionals. Socioeconomic class was analyzed using a pricing classification system for the Brazilian public that divides the market exclusively in terms of economic class based on the ownership of assets and the education level. Cervical samples were obtained using a Digene® HC2 DNA Collection, and penile/scrotum samples were obtained using a wet Dacron swab. HPV typing (overall and high-risk) was performed in a central lab. Of the 7,694 participants (47.85% women), 17.92% belonged to class A-B, 56.08% to class C, and 26.00% to class D-E. The prevalence of overall HPV was similar among the social classes: 51.16% for classes A-B, 53.39% for class C, and 55.47% for classes D-E (P = 0.479). Similar results were found for high-risk HPV. After adjustments, the presence of HPV in individuals with a brown skin color belonging to classes A-B was 57.00% higher [prevalence ratio 1.57 (95%: 1.23, 2.01)] than that in whites and had no impact on the other social classes. In conclusion, HPV infection affects all socioeconomic classes in Brazil, evidencing the importance of offering the HPV vaccine to the entire population.

Population attributable fractions of mortality in people living with HIV: roles of delayed antiretroviral therapy, hepatitis coinfections and social factors.

OBJECTIVES: Despite free access to antiretroviral therapy (ART) from 1996 onward, and treatment for all people living with HIV (PLWHIV) from 2013, mortality in Brazil has not homogeneously decreased. We investigated to what extent delayed ART, hepatitis coinfections and sociodemographic factors predict all-cause mortality in Brazilian PLWHIV. DESIGN: We included PLWHIV at least 18 years, with complete CD4 cell count data, followed up between 2007 and 2015 in Brazil. METHODS: After multiple imputation, an extended Cox model helped estimate the effects of fixed and time-varying covariates on mortality. RESULTS: The study population (n = 411 028) were mainly male (61%), white (55%), 40 years or less (61%), heterosexually HIV infected (71%), living in the Southeast region (48%) and had basic education (79%). Hepatitis C virus and hepatitis B virus coinfection prevalences were 2.5 and 1.4%, respectively. During a 4-year median follow-up, 61 630 deaths occurred and the mortality rate was 3.45 (95% confidence interval: 3.42-3.47) per 100 person-years. Older age, male sex, non-white ethnicity, illiteracy/basic education and living outside the Southeast and Central-West regions were independently associated with increased mortality. The main modifiable predictors of mortality were delayed ART (i.e. CD4 cell count <200 cells/µl at ART initiation) (adjusted population attributable fraction: 14.20% [95% confidence interval: 13.81-14.59]), being ART-untreated (14.06% [13.54-14.59]) and ART-treated with unrecorded CD4 at ART initiation (5.74% [5.26-6.21]). Hepatitis C virus and hepatitis B virus coinfections accounted for 2.44 [2.26-2.62] and 0.42% [0.31-0.53] of mortality, respectively. CONCLUSION: The current study demonstrates that besides early ART and coinfection control, actions targeting males, non-whites and illiterate people and those with basic education are important to reduce avoidable deaths among Brazilian PLWHIV.

Rapid point-of-care diagnostic test for syphilis in high-risk populations, Manaus, Brazil.

We assessed the acceptability and operational suitability of a rapid point-of-care syphilis test and identified barriers to testing among high-risk groups and healthcare professionals in a sexually transmitted infections clinic in Manaus, Brazil. Use of this test could considerably alleviate the impact of syphilis in hard-to-reach populations in the Amazon region of Brazil.

Comparison of cumulative viraemia following treatment initiation with different antiretroviral regimens: a real-life study in Brazil.

INTRODUCTION: The relative efficacy of different antiretroviral (ART) regimens has been extensively evaluated in the context of clinical trials, using HIV viral load (VL) measurements at pre-specified timepoints after ART onset. However, data from real-life studies using combined longitudinal measurements of cumulative viraemia are scarce. This study aimed to address the independent effect of different ART regimens on HIV cumulative viraemia over the first 12 months after treatment initiation, using programmatic data from the Ministry of Health of Brazil. METHODS: Retrospective cohort study analysing cumulative viraemia under the most frequently used ART regimens in Brazil (tenofovir, lamivudine and dolutegravir (regimen 1); tenofovir, lamivudine and efavirenz (regimen 2); tenofovir, lamivudine and ritonavir-boosted atazanavir (regimen 3)). RESULTS AND DISCUSSION: We included 112,243 patients >12 years old who received their first ART prescription between January 2014 and August 2017. Univariate analysis indicated that cumulative viraemia was significantly lower in patients receiving regimen 1 as compared with those receiving regimens 2 or 3 (p<0.0001 for both pairwise comparisons). In a multivariable analysis adjusted for age, sex, baseline T CD4+ counts and baseline HIV VL, ART regimen persisted with statistically significant effect on 12-month cumulative viraemia. The model predicted a 45-unit increase in log10 copy-days/mL cumulative viraemia for regimen 2 as compared with regimen 1, and a 70-unit increase in log10 copy-days/mL cumulative viraemia for regimen 3 as compared with regimen 1 (95%CI 41 to 49 and 61 to 79 respectively; p<0.001 for both comparisons). In models restricted to youths (13 to 24 years old) and female patients, ART regimen had similar effects. ART regimen with dolutegravir in association with a tenofovir-lamivudine backbone was superior to regimens containing efavirenz or boosted atazanavir in reducing HIV VL, as shown by cumulative viraemia over the first 12 months after treatment initiation. The superiority persisted even after adjusting the analysis for potential confounders. CONCLUSIONS: Our findings could bring direct benefits to patients as suggested by lower viral replication during treatment, lower risk of HIV transmission, and a potential reduction in resistance mutations in the initial 12 months under ART.

Syphilis.

Treponema pallidum subspecies pallidum (T. pallidum) causes syphilis via sexual exposure or via vertical transmission during pregnancy. T. pallidum is renowned for its invasiveness and immune-evasiveness; its clinical manifestations result from local inflammatory responses to replicating spirochaetes and often imitate those of other diseases. The spirochaete has a long latent period during which individuals have no signs or symptoms but can remain infectious. Despite the availability of simple diagnostic tests and the effectiveness of treatment with a single dose of long-acting penicillin, syphilis is re-emerging as a global public health problem, particularly among men who have sex with men (MSM) in high-income and middle-income countries. Syphilis also causes several hundred thousand stillbirths and neonatal deaths every year in developing nations. Although several low-income countries have achieved WHO targets for the elimination of congenital syphilis, an alarming increase in the prevalence of syphilis in HIV-infected MSM serves as a strong reminder of the tenacity of T. pallidum as a pathogen. Strong advocacy and community involvement are needed to ensure that syphilis is given a high priority on the global health agenda. More investment is needed in research on the interaction between HIV and syphilis in MSM as well as into improved diagnostics, a better test of cure, intensified public health measures and, ultimately, a vaccine.

Impact of COVID-19 on income, prevention attitudes, and access to healthcare among male clients in a Sexually Transmitted Infections clinic

ABSTRACT Background Mobility restrictions and overloaded health services during the COVID-19 pandemic compromised services dedicated to the prevention and care of HIV and other sexually transmitted infections (STI). In this study, we present client's responses to standardized questionnaires applied during the COVID-19 pandemic period as part of the strategy to measure impacts on social and sexual vulnerability, access to STI prevention services, and access to STI care. Methods: The questionnaires included variables on sociodemographics, behavior, risk perception, prevention attitudes, barriers to service-based HIV rapid test, reasons for taking an HIV self-test, and access to health services for STI diagnosis and treatment. We explored demographic variables associated with income reduction, reduced access to HIV/STI testing/treatment and increased vulnerability to HIV/STI. Results: 847 participants responded to the study questionnaire between May 2020 and January 2021. Most were young, cisgender male, and 63% self-reported as men who have sex with men. Income reductions were reported by 50%, with 30% reporting a decline over 50% of total income. An increase in heavy episodic drinking (>5 doses) was reported by 18%; 7% reported more sexual partners and 6% reported using condoms less often. Difficulties in obtaining HIV tests, tests for other STI and treatment for STI were reported by 5%, 6% and 6%, respectively. Lower schooling was significantly associated with income reduction (p = 0.004) and with reduced access to HIV/STI testing or STI treatment (p = 0.024); employment status was associated with income reduction (p < 0.001) and increased vulnerability to HIV/STI (p = 0.027). Having access to an expedite test result, avoiding physical attendance in health units during the pandemic, and undertaking the test with privacy with a trusted person were reported as motivators for HIV self-test. Conclusions: Our findings are relevant to promote service improvements tailored to subgroups more likely to struggle with detrimental effects during and after the COVID-19 pandemic.

DST e suas determinantes: quatro anos de vigilância em um centro sentinela no estado do Amazonas - Brasil / Sexually transmitted diseases and its determinants: four years of sentinel surveillance in a medical center in the state of Amazonas - Brazil

Introdução: apesar da enorme magnitude e transcendência, a informação disponível sobre as DST diferentes do HIV/aids é muito limitada na maior parte dos países, por isso há necessidade de buscar informações em centros sentinelas de vigilância ou obtê-las mediante inquéritos de prevalência. Apresenta--se a experiência de 4 anos de um centro sentinela de vigilância epidemiológica. Objetivo: descrever o perfil epidemiológico das principais doenças sexualmente transmissíveis em um serviço especializado. Métodos: estudo de corte transversal com componente analítico utilizando dados secundários da base SIVADST. O estudo incluiu 14.338 pessoas que foram atendidas na Fundação Alfredo da Matta entre 2005-2008, e avaliadas utilizando-se a abordagem sindrômica e etiológica para nove das DST mais frequentes. Os diagnósticos de condiloma acuminado e herpes genital foram realizados mediante exame clínico. Todos realizaram teste de VDRL e foi oferecido o teste para HIV. Resultados: receberam diagnóstico de pelo menos uma DST, 9.346 indivíduos.Os homens predominaram (58,5%). O condiloma foi a DST mais frequente (41,2%) e as virais representaram 73%. As tendências foram descendentes paragonorreia, cancro mole e tricomoníase; estável para sífilis, condiloma e herpes e incrementou-se para HIV. Os preditores principais foram: adolescência,ser homem, pele parda e não residir em Manaus. Conclusão: destaca-se a importância de investir nestas atividades, para se dispor de informação confiável sobre a situação das DST, da carga que elas representam para os serviços de saúde e necessidades de resposta para sua prevenção e controle.

Introduction: although they achieve enormous magnitude and transcendence, the information about STD other than HIV/aids available is very limited in most countries, so, one needs to seek information in sentinel surveillance centers or get them through prevalence surveys. Presents the experience of 4 years of a sentinel surveillance center. Objective: the aim of this study was to describe the epidemiological profile of the main sexually transmitted diseases in a sentinel surveillance center. Methods: cross-sectional study using a secondary analytical component of the database SIVADST. The study included 14,338 people who were seen at Fundação Alfredo da Matta between 2005-2008, and evaluated using the syndromic approach to etiology and to the nine most common STD. The diagnosis of genital warts and genital herpes were performed by clinical examination. All patients underwent testing VDRL and HIVtesting was offered. Results: 9,346 individuals were diagnosed with at least one STD. Men predominated (58.5%). Genital warts were the most commonSTD (41.2%) and viral infections accounted for 73%. The trend was downward for gonorrhea, chancroid and trichomoniasis; stable for syphilis, herpes andwarts and increased to HIV. The main predictors were: adolescence, being male, brown skin and not residing in Manaus. Conclusion: the study highlights the importance of investing these activities, to have reliable information about STD, the load they present to health services and needs in response to its prevention and control.

Prevalência da infecção por clamídia e gonococo em mulheres atendidas na clínica de DST da fundação Alfredo da Matta, Manaus, Amazonas / Prevalence of chlamydia and gonococcal infection in women assisted in the STI clinic of Alfredo da Matta foundation, Manaus, Amazon

A pouca correspondência entre a queixa de corrimento vaginal ou cervical e a positividade da infecção gonocócica ou por clamídia tem sido amplamente divulgada na literatura, por isso é necessário continuar buscando novos elementos que permitam melhorar o seu diagnóstico. Objetivo: estimara prevalência e os fatores de risco associados à infecção gonocócica e por clamídia em população feminina sintomática ou não, atendida por demanda espontânea em uma clínica especializada em DST, e avaliar a utilidade do emprego da definição, atualmente em uso no Brasil, para escore de risco emmulheres com corrimento vaginal. Métodos: foram incluídas 239 mulheres, atendidas na clínica de DST da Fundação Alfredo da Matta, na cidade deManaus, Amazonas, em 2008, e que realizaram exames para clamídia e gonorreia. Resultados: a prevalência por clamídia e gonococo foi de 18,4% e acoinfecção, de 12,9%; a prevalência da infecção por clamídia (captura híbrida) foi de 13,0% e a de cervicite gonocócica (Thayer Martin), 7,1%. As maiores prevalências foram encontradas entre adolescentes e mulheres com antecedentes de ter parceiro com corrimento uretral, porém só a última foi um preditorsignificativo na análise multivariada para a infecção gonocócica [OR = 4,8 (2,2-10,5)]. As mulheres com corrimento e escore de risco positivo (> 2) tiveram prevalência significativamente maior só para infecção gonocócica (p < 0,001). Os resultados de sensibilidade, especificidade e VPP para a definição de risco tiveram valores baixos e não conseguiram evitar uma elevada taxa de tratamentos desnecessários. Conclusão: a infecção cervical por clamídia foi a mais frequente e dentre as pacientes, 58% eram assintomáticas. Ter parceiro com corrimento uretral foi a única variável independente significativa para infecção gonocócica e para aquelas com coinfecção, porém não foi para infecção somente por clamídia. A definição atual do escore de risco tem sensibilidade eespecificidade muito baixas para o diagnóstico de infecção cervical por clamídia, gonorreia ou ambas.

The weak correspondence between the syndrome of vaginal or cervical discharge and gonococcal or chlamydial infection has been widely reported. Therefore it is necessary to find new elements permitting to improve the diagnostic. Objectives: to estimate prevalence and risk factors associated with gonococcal and chlamydial infection in symptomatic and asymptomatic women who sought care in a STI clinic and to evaluate the performance of risk assessment score for vaginal discharge, actually used in Brazil. Methodology: in 2008, 239 women, symptomatic and asymptomatic for vaginal discharge,were recruited in the STI clinic of Fundação Alfredo da Matta in Manaus, State of Amazon, and tested for Chlamydia trachomatis e Neisseria gonorrhoeae.Results: prevalence for chlamydial infection (DNA hybridization) was 13.0%, for gonococcal cervical infection 7.1% (Thayer Martin), for coinfection12.9% and 18.4% to have either one of them. Highest prevalence were found in adolescents and women who had a partner presenting urethral dischargein the past, this being the only significant predictor in multivariate analysis for gonococcal infection [OR = 4.8 (2.2-10.5)]. Symptomatic women with apositive risk score (> 2) showed only significantly higher prevalence for gonococcal infection (p < 0.001). Evaluation of sensibility, specificity and PPV for the Brazilian risk assessment score showed low values and therefore not contribute to decrease the proportion of unnecessary treatments. Conclusion:chlamydia is the most prevalent infection among the women seeking for care at the STI clinic, and 58% of them were asymptomatic cases. Having a partner with urethral discharge represents the only independent variable for gonococcal infection or for those with coinfection, but not specifically for chlamydial infection. The risk assessment score showed insufficient sensitivity and specificity to detect cervical infection with chlamydia and gonorrhea or both.

Manifestações bucais em pacientes portadores de doenças sexualmente transmissíveis / Oral manifestations in subjects with sexually transmitted diseases

Introdução: a despeito dos avanços tecnológicos ocorridos na área médica nas últimas décadas, as DST persistem em nosso meio como importanteagravo de Saúde Pública, ancorado, quiçá, na falta de conhecimento dos seus mecanismos de transmissão. Particularmente a cavidade oral não tem sido objeto de muitos estudos aprofundados sobre o seu papel na transmissão e no desenvolvimento das DST. O presente estudo visa diminuir tal vácuo de informações em nosso município, assim como contribuir para o conhecimento da epidemiologia das DST em nosso meio. Objetivo: averiguar a prevalência de manifestações intraorais em pacientes portadores de doenças sexualmente transmissíveis (DST) na cidade de Manaus, Amazonas, no ano de 2008. Métodos: foram avaliados 157 portadores de doenças sexualmente transmissíveis em atendimento na Fundação Alfredo da Matta. As lesões orais foram detectadas por exame clínico oral, exames citopatológicos (raspados das lesões) e histopatológicos (biópsias). Resultados: em 24,2% dos participantesforam encontradas 46 (29,1%) lesões orais possivelmente relacionadas com as DST. Observou-se associação signifi cativa entre o nível educacional e o conhecimento acerca da relação entre lesões orais e DST, porém não se obteve associação entre a presença de lesões orais e práticas do sexo oral, nível de escolaridade ou grau de higienização bucal. As análises estatísticas foram feitas no SPSS (nível de confi ança 95%) e foram aplicados testes de qui-quadrado. Conclusão: este estudo evidenciou a existência de demanda reprimida de portadores de DST com relação ao diagnóstico de lesões em mucosa oral, assim como de tratamento e/ou encaminhamento para outros serviços especializados. A necessidade de implantação e oferta de atenção à saúde na área de estomatologia no Amazonas deve ser considerada

Introduction: despite the technological progresses that have taken place in the medical fi eld in the last decades, STD persist to be an aggravating factor in public health. This is perhaps due to the lack of knowledge of our transmission mechanisms. Particularly, the role of the oral cavity in the transmission and development of STD has not been the subject of many detailed studies. This study aims to reduce the information vacuum in our municipality, as well as contribute to the knowledge of epidemiology in STD in our . Objective: investigating the prevalence of oral manifestations of sexually transmitted diseases (STD) in infected individuals in Manaus, Amazon, in the year 2008. Methods: 157 people with confi rmed clinical and laboratorial STD diagnosis undergoing treatment at the Alfredo da Matta Foundation. The oral lesions were detected by oral clinical examination and microscopic techniques for cells and tissue studies. Results: in 24,2% participants 46 (29,1%) oral lesions were observed, which could possibly linked to STDs. Direct correlation was observed between educational level and knowledge of oral lesions and STD, but no correlation was found between oral lesions and oral sexual practice,educational level or oral hygiene. The statistical analysis was done on SPSS (95% confi dence level) and chi-square tests were applied. Conclusion: this study showed the existence of a hidden population of individuals with needs on precocious oral lesions diagnosis, treatment and referring for other specialized services, for example, the Oncology, considering the risk of malignancy of some lesions. The necessity to establish a stomatology service in the Amazon must be considered.

Prevalência da infecção por Chlamydia Trachomatis e fatores associados em diferentes populações de ambos os sexos na cidade de Manaus / Prevalence of Chlamydia Trachomatis infections and associated risk factors in different populations of both gender in Manaus city

Introdução: a infecção por Chlamydia trachomatis (CT) é uma DST de alta prevalência no mundo e quando não diagnosticada pode, principalmente nas mulheres, progredir com seqüelas graves. No Brasil não se conhece com precisão o padrão de comportamento epidemiológico da infecção por CT. Objetivo: estimar prevalência e fatores associados à infecção por Chlamydia trachomatis em segmentos de população sexualmente ativa da cidade de Manaus. Métodos: durante 2004 e 2005 foi realizado estudo de corte seccional com 1732 pessoas (1007 mulheres e 755 homens) divididos em grupos de baixo risco ( 598 gestantes e 600 homens trabalhadores de indústrias) e de maior vulnerabilidade (409 mulheres e 155 homens em clínica de DST). Para o diagnóstico, empregou-se captura híbrida/DIGENE nas mulheres e PCR "Cobas Amplicor CT/NG/Roche" nos homens. Resultados: a prevalência global foi de 7,5%, em mulheres de 11,1% e nos homens de 2,8% (p = 0,000000). As taxas para gestantes e mulheres com DST foram de 11,9% e 10,0% (p = 0,36) e 3,0% e 1,9% para trabalhadores de indústrias e homens com DST (p = 0,65). Prevalências elevadas foram observadas nos adolescentes e nas gestantes (14,8%). Mulheres apresentaram risco de infecção quatro vezes maior do que os homens [ORprev. = 4,38 (IC 95% 2,66 - 7,26); p = 0,000000], a razão de prevalência (RP) foi 4 e a prevalência atribuível para mulheres foi de 8,3. Prevalência em mulheres com mais de um parceiro foi de 16,6% (42/253), superior àquelas que só tiveram um parceiro 9,3% (70/753 p = 0,001). O risco de infectar-se foi o dobro nas com mais de um parceiro [ORPrev.= 1,74 (OR 95% 1,26-2,99); p = 0,002]. Mulheres com parceiro portador de corrimento uretral representaram agravo [OR = 4,4 (IC 95% 2,15-9,21); p = 0,0000104]. A co-infecção com Neisseria gonorrhoeae ocorreu em 17,3%. Conclusão: a prevalência nas mulheres é intermediária (aproximadamente 10%) quando comparada com as taxas publicadas na literatura internacional.

Situación de la sífilis en 20 países de Latinoamérica y el Caribe: año 2006 / Syphilis situation in 20 Latin American and Caribbean countries: year 2006

Introducción: Las infecciones de transmisión sexual, en especial a sífilis, se encuentran entre las principales causas de enfermedad en el mundo y en la mayoría de los países de la América Latina. Objetivo: realizar una exploración de la situación de la sífilis y la sífilis congénita en los países de laregión y disponer de una aproximación a la situación epidemiológica actual y sus tendencias. Métodos: se realizó un estudio de corte transversal y para la obtención de los datos se diseño una encuesta que fue validada en el mes de diciembre del 2007 y enviada posteriormente a los coordinadores de programas nacionales de 20 países de la región. El periodo de ejecución y llenado de la información transcurrió entre enero y febrero del 2008 y se solicitó información de los últimos cuatro años (periodo 2003 - 2007). Resultados: todos los países poseen servicios de Vigilancia Epidemiológica y en la mayoría de ellos la sífilis total y congénita son enfermedades de notificación obligatoria. Existen, al menos, 10 países cuyas tasas de incidencia de sífilis congénita están por encima de 0,5 X 1.000 Nacidos vivos a pesar de que la subnotificación de casos en la región es grande. Latinoamérica y Caribe notifican en el 2006 un pequeño porcentaje del total de los casos de sífilis y sífilis congénita que la OMS/OPS estima ocurren en el área y según la opinión de los jefes de programas y expertos nacionales la tendencia de estas infecciones en la mitad de los países de la región es al aumento o desconocida. Conclusión: La sífilis congénita continúa siendo un serio problema de salud en la región. La información disponible sobre sífilis en términos de incidencia, prevalencia, tendencias, prioridades de intervención, coberturas de atención a grupos vulnerables, disponibilidad de recursos humanos y materiales es insuficiente en muchos países. Se observa en la región la existencia de oportunidades para el desarrollo de trabajo colaborativo conjunto entre los países miembros.

Introduction: Sexually transmitted infections, especially syphilis, are found among the main causes for illnesses in the world and in the majority of Latin American countries. Objective: investigate the situation of syphilis and congenital syphilis in countries of the region and obtain an approximationof the current epidemiological situation and its tendencies. Methods: a study of transversal cut was performed and to obtain data a questionnaire was validated in the month of december of 2007 and later sent to the national program coordinators of 20 countries in the region. The implementation and information gathering period took place between January and February of 2008 and data regarding the last 4 years of the programs (from 2003 to 2007) was requested. Results: all countries have Epidemiological Surveillance services and, for the most part, total and congenital syphilis are illnesses of mandatory notification. There are at least 10 countries where congenital syphilis incidence rates are above 0,5 X 1.000 newborns, even when a high number of cases are not notified in the region. Latin America and the Caribbean notified in 2006 a percentage of total syphilis and congenital syphilis cases that is smaller than that estimated by the WHO/PAHO for the region. According to national experts and directors of national programs, the tendency of these infections in half of the countries of the region are either rising or is unknown. Conclusion: congenital syphilis continuesto be a serious health problem in the region. The available information about syphilis regarding its incidence, prevalence, tendencies, interventionpriorities, assistance to vulnerable groups, and availability of human and material resources is insufficient in many countries. There is opportunityto develop a collaborative work between member nations.

Resistência da Neisseria gonorrhoeae a antimincrobianos em Manaus: período 2005-2006 / Neisseria gonorrhoeae antimicrobial resistance in Manaus: 2005-2006 period

Introdução: em 1998, a Fundação Alfredo da Matta, de Manaus, iniciou estudos para avaliar a resistência de isolados de N. gonorrhoeae aos antibióticos recomendados para o tratamento das uretrites e cervicites gonocócicas. Objetivo: verificar a resistência de isolados de Neisseria gonorrhoeae aos antibióticos penicilina, tetraciclina, azitromicina, ceftriaxona e ciprofloxacino no Laboratório de Bacteriologia Clínica da Fundação Alfredo da Matta, Manaus - Amazonas - Brasil. Métodos: neste estudo, avaliou-se a resistência de 110 gonococos à penicilina, à tetraciclina, à azitromicina, à ceftriaxona e ao ciprofloxacino pelo método de difusão com discos. Resultados: após os testes, verificou-se que 14,5% foram betalactamase positivos (PPNG) e a resistência à penicilina foi de 21,8%. Para a tetraciclina, 80,0% foram resistentes com 12,7% TRNG. Em relação à azitromicina, 8,2% dos isolados foram resistentes e não se detectou resistência ao ciprofloxacino e à ceftriaxona, porém 6,4% apresentaram sensibilidade reduzida ao primeiro e 5,5% diâmetro inferior a 33mm ao segundo. Conclusão: ao final, conclui-se que os altos percentuais de resistência à penicilina e tetraciclina são semelhantes aos observados em outros estudos realizados com cepas da região e sugerem que ainda há elevada pressão seletiva desses antibióticos sobre os gonococos. Os índices de resistência à azitromicina inviabilizam sua utilização como opção terapêutica. Tanto o ciprofloxacino quanto a ceftriaxona foram eficazes "in vitro", mas as taxas de sensibilidade reduzida de ciprofloxacino e os valores abaixo de 35 mm de diâmetro no antibiograma para a ceftriaxona, são indicativos da necessidade do monitoramento clínico e laboratorial constante desses medicamentos.

Utilidade do escore de risco padräo do Brasil na avaliaçäo da infecçäo gonocócica em mulheres com corrimento vaginal / Usefulness the brazilian standart, risk scorn in the evaluation of gonococcal infection in women with vaginal discharge

A busca de novos elementos para aprimorar os resultados da sensibilidade e especificidade dos algoritmos para a síndrome de corrimento vaginal é uma prioridade dos programas de controle de DST. A pouca correspondência entre a queixa de corrimento vaginal e a positividade da infecçäo gonocócica e, ou clamídia tem sido amplamente reportada na literatura internacional. Avalia a utilidae do emprego das definiçöes para score de risco padronizado para a populaçäo da cidade de Manaus, Estado do Amazonas

Baixa prevalência de DST em profissionais do sexo no Município de Manacapuru - interior do Estado do Amazonas, Brasil / Low prevalence of STDS among sex professionals in Manacapuru Country, Interland of the State of Amazonas, Brazil

Um total de 147 mulheres participaram de estudo de exame ginecológico e coleta de amostras para estudos de infecçäo gonocócica, infecçäo por clamídia, sífilis, trichomonas, candida e vaginose bacteriana e foi oferecido a sorologia anti HIV a apresenta os resultados