Human T-Lymphotropic Virus-1/2 Infection in Central Brazil Prisons: A Multicenter Study.

Human T-lymphotropic virus (HTLV) infection is endemic in some group populations. Prisoners are at high risk of acquiring HTLV infection mainly due to the environment of closed penal institutions, socioeconomic conditions, and risk behaviors. This study aimed to investigate the prevalence, the occurrence of new cases of HTLV infection after a 1-year follow-up, and circulating subtypes of HTLV-1 among prisoners from twelve closed prisons in Mato Grosso do Sul state, Central Brazil. A total of 1,507 prisoners were randomly enrolled in the cross-sectional study. Out of the 1,507 participants, 1,000 prisoners, susceptible to HTLV infection, were included in the prospective cohort study. In the cross-sectional study, serological evidence of HTLV infection was 0.4% (CI 95%: 0.1-0.7), tested for anti-HTLV antibodies by enzyme-linked immunosorbent assay (ELISA). Three samples were positive for HTLV-1, two samples were positive for HTLV-2, and 1 sample was indeterminate by the Western blot method. The presence of HTLV proviral DNA was detected in all positive samples by amplification of the HTLV tax gene through nested-PCR. Phylogenetic analysis showed that HTLV-1 samples belonged to the Cosmopolitan subtype Transcontinental subgroup. From a cohort of 1,000 individuals, no new case of HTLV infection was detected. Although the prevalence rate of HTLV infection found in this study was similar to that observed in the Brazilian general population, the lack of access to preventive interventions and harm reduction measures all contribute to increasing the risk of HTLV transmission and acquisition among this key and vulnerable population.

Tuberculosis infection among cocaine crack users in Brazil.

BACKGROUND: WHO recommends treatment for latent tuberculosis infection (LTBI) in the homeless and people who use drugs (PWUD). The optimal test for LTBI screening is uncertain. METHODS: A cross-sectional study was conducted among the homeless and drug-rehabilitation clinic clients chronically using crack in Western Brazil. Participants were interviewed and offered HIV testing plus tuberculin skin testing (TST) and QuantiFeron®-Gold-in-Tube (QFT). We considered LTBI when either TST or QFT were positive. Factors associated with LTBI were adjusted in a multivariate model. RESULTS: Among 372 subjects with at least one valid test, 216 (58%) had LTBI. TST was not read in 18.4%; QFT was indeterminate in 2.5%. TST detected 27 (26%) extra LTBI cases among 75 QFT-negative individuals. PWUD had over three-fold odds for LTBI. TST was 4.5 times more likely to be positive in BCG-vaccinated individuals. CONCLUSION: Given the high risk of progression to disease in this population, the high rates of loss to TST reading and the possibility of false-positive TST results from BCG vaccination, we endorse current CDC recommendations to use QFT for LTBI screening among the homeless and PWUD. However, because adding TST to a negative QFT increased LTBI detection considerably, TST should be considered in QFT-negative individuals.

Treatment Outcomes of Brazilian Inmates with Treponema pallidum and Human Immunodeficiency Virus Infection: A Prospective Cohort Study.

A prospective cohort study was conducted to evaluate the incidence and treatment outcomes of syphilis and human immunodeficiency virus (HIV) in inmates from Central Brazil. In 2013, 3,363 inmates from 12 prisons in the state of Mato Grosso do Sul were recruited, and 1,614 remained incarcerated after 1 year. The inmates were interviewed, and blood samples were collected for serological testing for Treponema pallidum and HIV infections. Inmates infected with T. pallidum or HIV within the first year were assessed for treatment using prison medical record data, based on Venereal Disease Research Laboratory test results, HIV-1 viral load, and CD4 counts. Acquired syphilis was identified in 5.8% (N = 95) of the inmates and 74% (N = 70) of them demonstrated poor treatment outcomes after 1 year. Multivariate analysis revealed that not reporting a stable partner was a risk factor for failure of syphilis treatment. Twenty-five patients had HIV (1.5%) and among those, 13 (52%) had an HIV-1 viral load > 200 copies/mL after 1 year. The incidence of T. pallidum and HIV infections was 0.5% (N = 9). The poor treatment outcomes of syphilis and HIV within Brazilian prisons demonstrate the inadequacy of public health programs. Although the incidence of these infections within the prison population is low, new cases still occur. Our results reinforce the significance of screening programs during prison admission for early detection and treatment of sexually transmitted infections.