RESUMEN
BACKGROUND: This study aimed to determine the prevalence and factors associated with susceptibility to hepatitis B virus (HBV) among cisgender men who have sex with men (MSM) on HIV pre-exposure prophylaxis (PrEP) in Northeastern Brazil. METHODS: This was a cross-sectional, analytical study conducted between September 2021 and June 2023. Participants underwent structured interviews to collect sociodemographic and clinical information, including hepatitis B vaccination history, HIV PrEP use and sexual health history. Blood samples were collected for hepatitis B serologic testing: HBV surface antigen (HBsAg), HBV surface antibody (anti-HBs), total and IgM HBV core antibody (anti-HBc). HBV susceptibility was defined as nonreactive results for all these serological markers. RESULTS: A total of 287 participants were enrolled into the study. The median age of the individuals was 31 years (interquartile range: 27; 36). HBV susceptibility was found in 58 out 286 individuals (20.3%; 95% CI: 15.9-25.2). Seventy-six percent of the participants reported completing the three-dose hepatitis B vaccine schedule. Susceptibility was significantly associated with a monthly income ≤ 5 minimum wages (PR: 2.02; 95% CI: 1.01-4.05), lack of complete hepatitis B vaccination schedule (PR: 4.52; 95% CI: 2.89-7.06), initiation of HIV PrEP (PR: 2.18; 95% CI: 1.21-3.94), duration of six months of HIV PrEP (PR: 2.16; 95% CI: 1.19-3.91), absence of tattoos (PR: 1.55; 95% CI: 1.00-2.40) and no history of sexually transmitted infections (PR: 1.65; 95% CI: 1.07-2.54). CONCLUSION: Our findings highlight the significant burden of HBV susceptibility among MSM on HIV PrEP in Northeastern Brazil. Socioeconomic factors, vaccination status, PrEP use and sexual health behaviors play critical roles in determining susceptibility to HBV. Integrating hepatitis B screening and vaccination into PrEP services is critical for identifying and addressing HBV susceptibility among MSM. Interventions aimed at increasing vaccination coverage and promoting safer sexual practices are essential for mitigating the burden of HBV infection in this population.
Asunto(s)
Infecciones por VIH , Hepatitis B , Homosexualidad Masculina , Profilaxis Pre-Exposición , Humanos , Masculino , Estudios Transversales , Brasil/epidemiología , Adulto , Profilaxis Pre-Exposición/estadística & datos numéricos , Infecciones por VIH/epidemiología , Infecciones por VIH/prevención & control , Hepatitis B/prevención & control , Hepatitis B/epidemiología , Homosexualidad Masculina/estadística & datos numéricos , Prevalencia , Virus de la Hepatitis B/inmunología , Susceptibilidad a Enfermedades , Adulto Joven , Factores de Riesgo , Anticuerpos contra la Hepatitis B/sangre , Antígenos de Superficie de la Hepatitis B/sangre , Antígenos de Superficie de la Hepatitis B/inmunología , Vacunas contra Hepatitis B/administración & dosificación , Vacunas contra Hepatitis B/inmunologíaRESUMEN
BACKGROUND: Cryptococcosis is a common opportunistic infection in patients infected by Human Immunodeficiency Virus (HIV) and is the second leading cause of mortality in Acquired Immunodeficiency Syndrome (AIDS) patients worldwide. The most frequent presentation of cryptococcal infection is subacute meningitis, especially in patients with a CD4+ T Lymphocytes count below 100 cells/µL. However, in severely immunosuppressed individuals Cryptococcus neoformans can infect virtually any human organ, including the bone marrow, which is a rare presentation of cryptococcosis. CASE PRESENTATION: A 45-year-old HIV-infected male patient with a CD4+ T lymphocyte count of 26 cells/µL who presented to the emergency department with fever and pancytopenia. Throughout the diagnostic evaluation, the bone marrow aspirate culture yielded encapsulated yeasts in budding, identified as Cryptococcus sp. The bone marrow biopsy revealed a hypocellularity for age and absence of fibrosis. It was observed presence of loosely formed granuloma composed of multinucleated giant cells encompassing rounded yeast like organisms stained with mucicarmine, compatible with Cryptococcus sp. Then, the patient underwent a lumbar puncture to investigate meningitis, although he had no neurological symptoms and neurological examination was normal. The cerebrospinal fluid culture yielded Cryptococcus sp. The species and genotype identification step showed the infection was caused by Cryptococcus neoformans var. grubii (genotype VNI). The patient was initially treated with amphotericin B deoxycholate plus fluconazole for disseminated cryptococcosis, according to guideline recommendations. However, the patient developed acute kidney injury and the treatment was switched for fluconazole monotherapy. The symptoms disappeared completely with recovery of white blood cells and platelets counts. Cerebrospinal fluid cultures for fungi at one and two-weeks of treatment were negative. CONCLUSIONS: Bone marrow infection caused by Cryptococcus neoformans is a rare presentation of cryptococcosis. The cryptococcal infection should be included for differential diagnosis in HIV-infected patients with fever and cytopenias, especially when CD4+ T lymphocytes count is below 100 cells/µL.
Asunto(s)
Médula Ósea/microbiología , Criptococosis/diagnóstico , Cryptococcus neoformans/aislamiento & purificación , Infecciones por VIH/patología , Lesión Renal Aguda/etiología , Anfotericina B/efectos adversos , Anfotericina B/farmacología , Anfotericina B/uso terapéutico , Antifúngicos/farmacología , Antifúngicos/uso terapéutico , Médula Ósea/patología , Linfocitos T CD4-Positivos/citología , Líquido Cefalorraquídeo/microbiología , Criptococosis/complicaciones , Criptococosis/tratamiento farmacológico , Criptococosis/microbiología , Cryptococcus neoformans/efectos de los fármacos , Cryptococcus neoformans/genética , Ácido Desoxicólico/efectos adversos , Ácido Desoxicólico/farmacología , Ácido Desoxicólico/uso terapéutico , Diagnóstico Diferencial , Combinación de Medicamentos , Fluconazol/farmacología , Fluconazol/uso terapéutico , Genotipo , Infecciones por VIH/complicaciones , Humanos , Masculino , Meningitis/complicaciones , Meningitis/diagnóstico , Persona de Mediana EdadRESUMEN
Hepatitis A virus (HAV) infection has disproportionately affected more men who have sex with men (MSM), occurring in outbreaks, despite being vaccine-preventable. We determined the prevalence and factors associated with HAV susceptibility among cisgender MSM on HIV pre-exposure prophylaxis (PrEP) in Northeastern Brazil. From September 30, 2021 to June 19, 2023, 282 cisgender MSM receiving HIV PrEP were enrolled into this cross-sectional study. Sociodemographic and clinical information were collected. Blood samples were collected for screening of sexually transmitted infections (STIs) and serum samples were tested for IgM and total anti-HAV antibodies. Non-reactive results for total anti-HAV antibodies were found in 106 of 282 (37.6%) participants. Factors associated with HAV susceptibility included age <30 years (prevalence ratio [PR]: 2.02; 95% confidence interval [95% CI]: 1.61-2.53), having health insurance (PR: 1.39; 95% CI: 1.19-1.64), sex only with cisgender men (PR: 1.52; 95% CI: 1.23-1.89), non-steady partner (PR: 1.20; 95% CI: 1.01-1.43) and no lifetime history of STIs (PR: 1.25; 95% CI: 1.03-1.53). Identifying clinical correlates of HAV susceptibility in key populations is a fundamental step towards development of public policy focused on prevention, especially following the recent hepatitis A outbreak in Brazil.
Asunto(s)
Infecciones por VIH , Virus de la Hepatitis A , Hepatitis A , Profilaxis Pre-Exposición , Minorías Sexuales y de Género , Enfermedades de Transmisión Sexual , Masculino , Humanos , Adulto , Homosexualidad Masculina , Hepatitis A/epidemiología , Hepatitis A/prevención & control , Infecciones por VIH/epidemiología , Infecciones por VIH/prevención & control , Profilaxis Pre-Exposición/métodos , Estudios Transversales , Anticuerpos de Hepatitis A , Brasil/epidemiología , Enfermedades de Transmisión Sexual/epidemiología , Enfermedades de Transmisión Sexual/prevención & controlRESUMEN
We measured fungicidal activity of continuous infusion of amphotericin B deoxycholate plus 5'flucytosine using quantitative cultures of cerebrospinal fluid (CSF) obtained from lumbar punctures of human immunodeficiency virus (HIV)-infected patients with neurocryptococcosis during 14 days of treatment. Glomerular renal function was preserved in all patients. Mycological efficacy with progressive reduction in CSF cryptococcal colony-forming units was comparable to standard 4-h infusion of amphotericin B.
Asunto(s)
Anfotericina B/administración & dosificación , Anfotericina B/uso terapéutico , Antifúngicos/administración & dosificación , Antifúngicos/uso terapéutico , Ácido Desoxicólico/administración & dosificación , Ácido Desoxicólico/uso terapéutico , Meningitis Criptocócica/tratamiento farmacológico , Adulto , Líquido Cefalorraquídeo/microbiología , Recuento de Colonia Microbiana , Cryptococcus/efectos de los fármacos , Cryptococcus/aislamiento & purificación , Combinación de Medicamentos , Femenino , Flucitosina/administración & dosificación , Flucitosina/uso terapéutico , Infecciones por VIH/complicaciones , Humanos , Infusiones Intravenosas , Masculino , Meningitis Criptocócica/microbiología , Viabilidad Microbiana/efectos de los fármacos , Persona de Mediana Edad , Resultado del Tratamiento , Adulto JovenRESUMEN
BACKGROUND: Men who have sex with men (MSM) account for the highest prevalence of HIV in Brazil. HIV testing allows to implement preventive measures, reduces transmission, morbidity, and mortality. METHODS: We conducted a cross-sectional study to evaluate HIV testing during lifetime, factors associated with the decision to test, knowledge about HIV transmission, and use of condoms between MSM from the city of Natal, northeast Brazil. RESULTS: Out of 99 participants, 62.6% had been tested for HIV during lifetime, 46.2% in the last year. The most frequent reported reason to be tested for HIV infection was curiosity (35.5%). Correct knowledge about HIV was observed in only 9.2% of participants. In multivariate analysis, age (PR 0.95; 95%CI, 0.91-0.99; p=0.041) and previous syphilis test (PR 4.21; 95%CI, 1.52-11.70; p=0.006) were associated with HIV testing. CONCLUSIONS: The frequency of HIV testing among MSM from Natal is rather low, especially in younger MSM, and knowledge about HIV transmission is inappropriate.
Asunto(s)
Serodiagnóstico del SIDA/estadística & datos numéricos , Infecciones por VIH/epidemiología , Conocimientos, Actitudes y Práctica en Salud , Homosexualidad Masculina/estadística & datos numéricos , Adulto , Brasil/epidemiología , Estudios Transversales , Infecciones por VIH/diagnóstico , Infecciones por VIH/transmisión , Humanos , Masculino , Análisis Multivariante , Análisis de Regresión , Factores de Riesgo , Factores Socioeconómicos , Encuestas y Cuestionarios , Adulto JovenRESUMEN
BACKGROUND: Histoplasmosis is a neglected disease that affects mainly immunocompromised patients, presenting a progressive dissemination pattern and a high mortality rate, mainly due to delayed diagnosis, caused by slow fungal growth in culture. Therefore, a fast, suitable and cost-effective assay is required for the diagnosis of histoplasmosis in resource-limited laboratories. This study aimed to develop and evaluate two new molecular approaches for a more cost-effective diagnosis of histoplasmosis. METHODOLOGY: Seeking a fast, suitable, sensitive, specific and low-cost molecular detection technique, we developed a new Loop-mediated Isothermal Amplification (LAMP) assay and nested PCR, both targeting the Internal Transcribed Spacer (ITS) multicopy region of Histoplasma capsulatum. The sensitivity was evaluated using 26 bone marrow and 1 whole blood specimens from patients suspected to have histoplasmosis and 5 whole blood samples from healthy subjects. All specimens were evaluated in culture, as a reference standard test, and Hcp100 nPCR, as a molecular reference test. A heparin-containing whole blood sample from a heathy subject was spiked with H. capsulatum cells and directly assayed with no previous DNA extraction. RESULTS: Both assays were able to detect down to 1 fg/µL of H. capsulatum DNA, and ITS LAMP results could also be revealed to the naked-eye by adding SYBR green to the reaction tube. In addition, both assays were able to detect all clades of Histoplasma capsulatum cryptic species complex. No cross-reaction with other fungal pathogens was presented. In comparison with Hcp100 nPCR, both assays reached 83% sensitivity and 92% specificity. Furthermore, ITS LAMP assay showed no need for DNA extraction, since it could be directly applied to crude whole blood specimens, with a limit of detection of 10 yeasts/µL. CONCLUSION: ITS LAMP and nPCR assays have the potential to be used in conjunction with culture for early diagnosis of progressive disseminated histoplasmosis, allowing earlier, appropriate treatment of the patient. The possibility of applying ITS LAMP, as a direct assay, with no DNA extraction and purification steps, makes it suitable for resource-limited laboratories. However, more studies are necessary to validate ITS LAMP and nPCR as direct assay in other types of clinical specimens.
Asunto(s)
ADN Espaciador Ribosómico/genética , Histoplasma/aislamiento & purificación , Histoplasmosis/diagnóstico , Técnicas de Diagnóstico Molecular/métodos , Técnicas de Amplificación de Ácido Nucleico/métodos , Sangre/microbiología , Médula Ósea/microbiología , Histoplasma/genética , Humanos , Estudios Prospectivos , Sensibilidad y EspecificidadRESUMEN
ABSTRACT Background: Men who have sex with men (MSM) account for the highest prevalence of HIV in Brazil. HIV testing allows to implement preventive measures, reduces transmission, morbidity, and mortality. Methods: We conducted a cross-sectional study to evaluate HIV testing during lifetime, factors associated with the decision to test, knowledge about HIV transmission, and use of condoms between MSM from the city of Natal, northeast Brazil. Results: Out of 99 participants, 62.6% had been tested for HIV during lifetime, 46.2% in the last year. The most frequent reported reason to be tested for HIV infection was curiosity (35.5%). Correct knowledge about HIV was observed in only 9.2% of participants. In multivariate analysis, age (PR 0.95; 95%CI, 0.91-0.99; p = 0.041) and previous syphilis test (PR 4.21; 95%CI, 1.52-11.70; p = 0.006) were associated with HIV testing. Conclusions: The frequency of HIV testing among MSM from Natal is rather low, especially in younger MSM, and knowledge about HIV transmission is inappropriate.