RESUMO
Because HTLV-I, HTLV-2, and HIV share identical modes of transmission, simultaneous or subsequent infections with these retroviruses are to be expected. The population of Santos, the largest port in Latin America, includes large numbers of female commercial sex workers and intravenous drug users, presumably having been exposed to retroviral infection. To evaluate the seroprevalence of HTLV infection and their associated risk factors, a cross-sectional survey was carried out in 499 HIV-infected individuals from Santos, Brazil. HTLV testing consisted of enzyme immunoassays for serologic screening and confirmatory Western blot testing. Overall HTLV-I and HTLV-2 seroprevalences were 6.0% (95% confidence interval [CI], 3.9-8.1) and 7.4% (95% CI, 5.1-9.7), respectively. Multivariate logistic regression for statistical analysis revealed HTLV-I infection to be independently associated with: intravenous drug use (IDU) (odds ratio [OR]. 2.99; 95% CI, 1.09-8.20), seropositivity to hepatitis C virus (HCV) (OR, 3.03; 95% CI, 1.02-9.01) and < 3 years of education (OR, 4.73; 95% CI, 1.56-14.41). HTLV-2 infection was associated with: IDU (OR, 3.22; 95% CI, 1.33-7.84), HCV seropositivity (OR, 5.40; 95% CI, 1.86-15.66) and nonwhite race (OR, 3.32; 95% CI, 1.58-7.00). Results indicate that HIV-infected individuals living in Santos are at similarly high risk of being exposed to HTLV-1 and HTLV-2. IDU constitutes the main risk factor for HTLV acquisition in this population, and there is no significant risk associated with sexual practice.
Assuntos
Infecções por HIV/complicações , Infecções por HTLV-I/complicações , Infecções por HTLV-II/complicações , Vírus Linfotrópico T Tipo 1 Humano , Vírus Linfotrópico T Tipo 2 Humano , Adolescente , Adulto , Anticorpos Antivirais/sangue , Brasil/epidemiologia , Estudos Transversais , Feminino , Infecções por HIV/sangue , Infecções por HIV/epidemiologia , Infecções por HTLV-I/epidemiologia , Infecções por HTLV-II/epidemiologia , Hepatite C/complicações , Hepatite C/epidemiologia , Anticorpos Anti-Hepatite C/sangue , Humanos , Masculino , Razão de Chances , Análise de Regressão , Fatores de Risco , Estudos Soroepidemiológicos , Fatores Socioeconômicos , Abuso de Substâncias por Via Intravenosa/complicaçõesRESUMO
OBJECTIVE: It is an accepted fact that confinement conditions increase the risk of some infections related to sexual and/or injecting drugs practices. Mathematical techniques were applied to estimate time-dependent incidence densities of HIV infection among inmates. METHODS: A total of 631 prisoners from a Brazilian prison with 4,900 inmates at that time were interviewed and their blood drawn. Risky behavior for HIV infection was analyzed, and serological tests for HIV, hepatitis C and syphilis were performed, intended as surrogates for parenteral and sexual HIV transmission, respectively. Mathematical techniques were used to estimate the incidence density ratio, as related to the time of imprisonment. RESULTS: Prevalence were: HIV - 16%; HCV - 34%; and syphilis - 18%. The main risk behaviors related to HIV infection were HCV prevalence (OR=10.49) and the acknowledged use of injecting drugs (OR=3.36). Incidence density ratio derivation showed that the risk of acquiring HIV infection increases with the time of imprisonment, peaking around three years after incarceration. CONCLUSIONS: The correlation between HIV and HCV seroprevalence and the results of the mathematical analysis suggest that HIV transmission in this population is predominantly due to parenteral exposure by injecting drug, and that it increases with time of imprisonment.
Assuntos
Infecções por HIV/epidemiologia , Hepatite C/epidemiologia , Prisioneiros/estatística & dados numéricos , Adulto , Brasil/epidemiologia , Estudos Transversais , Infecções por HIV/sangue , Infecções por HIV/transmissão , Hepatite C/sangue , Hepatite C/transmissão , Humanos , Masculino , Análise Multivariada , Prevalência , Assunção de Riscos , Estudos Soroepidemiológicos , Abuso de Substâncias por Via Intravenosa/complicações , Abuso de Substâncias por Via Intravenosa/epidemiologia , Sífilis/sangue , Sífilis/epidemiologia , Sífilis/transmissãoRESUMO
Objetivo: É um fato correntemente aceito que as condiçöes de confinamento aumentam o risco de algumas infecçöes relacionadas às práticas sexuais e/ou ao uso de drogas injetáveis. Realizou-se estudo para estimar a densidade de incidência da infecçäo pelo HIV na populaçäo prisional com aplicaçäo de técnicas matemáticas. Método: Foram entrevistados em Säo Paulo, SP 631 prisioneiros da maior prisäo da América do Sul, que abrigava aproximadamente 4.900 presos na ocasiäo do estudo. Foi colhido sangue da populaçäo entrevistada, analisado o risco para a infecçäo pelo HIV e realizados testes sorológicos para HIV, HCV e sífilis. Técnicas matemáticas foram usadas para se estimar a densidade de incidência do HIV relacionada ao tempo de encarceramento. Resultados: As prevalências gerais encontradas foram: HIV - 16 por cento; HCV - 34 por cento; sífilis - 18 por cento. Os principais fatores associados à infecçäo pelo HIV foram a soropositividade ao HCV (OR=10,49) e a confissäo do uso de drogas injetáveis (OR=3,36). A análise matemática mostrou que o risco de adquirir a infecçäo pelo HIV aumenta com o tempo de detençäo, atingindo o máximo por volta de 3 anos de aprisionamento. Conclusöes: A correlaçäo entre a soroprevalência do HIV e do HCV e os resultados da análise matemática sugerem que a transmissäo do HIV nesta populaçäo se dá preferencialmente pela via parenteral e que seu risco aumenta com o tempo de encarceramento
Assuntos
Adulto , Humanos , Masculino , Prisioneiros , Hepatite/epidemiologia , Síndrome da Imunodeficiência Adquirida/epidemiologia , Soroprevalência de HIV , Fatores de Risco , Estudos Soroepidemiológicos , Transtornos Relacionados ao Uso de SubstânciasRESUMO
Between November 1993 and April 1994, our physicians' team interviewed and took blood samples of 631 prisoners randomly drawn from the largest prison of South America, which counted about 4700 inmates at that time. The interview consisted of questions related to risk behaviour for HIV infection, and the subjects were asked to provide blood for serological tests for HIV, hepatitis C and syphilis. Our main purpose was to investigate the relationship between HCV and injecting drug use as related to HIV seropositivity. Participation in the study was voluntary and confidentiality was guaranteed. Overall prevalences found were as follows: HIV: 16% (95% confidence interval (CI): 13-19%); HCV: 34% (95% CI: 30-38%), and syphilis: 18% (95% CI: 15-21%). Acknowledged use of ever injecting drug was 22% and no other parenteral risk was reported. Our results, as compared with other studies in the same prison, suggest that HIV prevalence has been stable in recent years, and that the major risk factor for HIV infection in this population is parenteral exposure by injecting drug use.