RESUMO
Hepatitis B (HBV) and delta (HDV) viruses are endemic in the Amazon region, but vaccine coverage against HBV is still limited. People who use illicit drugs (PWUDs) represent a high-risk group due to common risk behavior and socioeconomic factors that facilitate the acquisition and transmission of pathogens. The present study assessed the presence of HBV and HBV-HDV co-infection, identified viral sub-genotypes, and verified the occurrence of mutations in coding regions for HBsAg and part of the polymerase in HBV-infected PWUDs in municipalities of the Brazilian states of Amapá and Pará, in the Amazon region. In total, 1074 PWUDs provided blood samples and personal data in 30 municipalities of the Brazilian Amazon. HBV and HDV were detected by enzyme-linked immunosorbent assay and polymerase chain reaction. Viral genotypes were identified by nucleotide sequencing followed by phylogenetic analysis, whereas viral mutations were analyzed by specialized software. High rates of serological (32.2%) and molecular (7.2%) markers for HBV were detected, including cases of occult HBV infection (2.5%). Sub-genotypes A1, A2, D4, and F2a were most frequently found. Escape mutations due to vaccine and antiviral resistance were identified. Among PWUDs with HBV DNA, serological (19.5%) and molecular (11.7%) HDV markers were detected, such as HDV genotypes 1 and 3. These are worrying findings, presenting clear implications for urgent prevention and treatment needs for the carriers of these viruses.
Assuntos
Hepatite B/genética , Hepatite D/genética , Transtornos Relacionados ao Uso de Substâncias/virologia , Adulto , Brasil/epidemiologia , Coinfecção , Estudos Transversais , DNA Viral/genética , Usuários de Drogas , Ensaio de Imunoadsorção Enzimática/métodos , Feminino , Genótipo , Hepatite B/diagnóstico , Antígenos de Superfície da Hepatite B/análise , Antígenos de Superfície da Hepatite B/sangue , Vírus da Hepatite B/genética , Vírus da Hepatite B/patogenicidade , Hepatite D/diagnóstico , Vírus Delta da Hepatite/genética , Vírus Delta da Hepatite/patogenicidade , Humanos , Drogas Ilícitas , Masculino , Pessoa de Meia-Idade , Epidemiologia Molecular/métodos , Filogenia , RNA Viral/genética , Análise de Sequência de DNA/métodosRESUMO
Background: Several records of high prevalence of HBV have been made in northern Brazil. Among risk groups for viral infection, people who use illicit drugs (PWUDs) stand out, especially if they inject drugs and engage in risky sexual behavior. Objectives: In this study, the prevalence, genotype distribution and factors associated with hepatitis B virus (HBV) exposure in PWUDs were estimated. Methods: This cross-sectional study used snowball sampling from nine different sites. Socio-demographic, economic, drug use and health-related information were collected of 308 PWUDs from nine municipalities in the state of Amapá, northern Brazil. Blood samples were tested for the presence of HBV using enzyme-linked immunosorbent assay (ELISA) and real-time polymerase chain reaction (PCR). Logistic regressions were run to identify factors independently associated with HBV exposure. Results: In total, seventy (22.7%) PWUDs were exposed to HBV, and 12 (3.9%) had DNA HBV. Genotypes A (58.4%), D (33.3%) and F (8.3%) were identified. Age ≥35 years, use of injectable drug, daily use of drugs, use of drugs over 12 years, unprotected sex, exchange sex for money/drugs, and >12 sexual partners in the last 12 months were associated with exposure to HBV. Conclusions: This study identified important information on the epidemiological scenario of HBV infection in PWUDs, highlighting the high prevalence of HBV exposure and the urgent need for measures for control and prevention, especially vaccination against this hepatotropic virus.
Assuntos
Hepatite B , Drogas Ilícitas , Transtornos Relacionados ao Uso de Substâncias , Adulto , Brasil/epidemiologia , Estudos Transversais , Genótipo , Hepatite B/epidemiologia , Hepatite B/genética , Humanos , Prevalência , Fatores de Risco , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/genéticaRESUMO
BACKGROUND: People who use illicit drugs (PWUDs) have a high risk of viral infections. To date, there is a paucity of information on HIV infection among PWUDs in remote Brazilian regions. This study determined the prevalence and factors associated with HIV-1 infection among PWUDs in northern Brazil. METHODS: Sociodemographic, economic, drug use and health-related information were collected through interviews from a community-recruited, multi-site sample of 1753 PWUDs. The blood samples collected were tested for the presence of HIV-1 using chemiluminescence immunoassay and PCR or western blotting. Logistic regressions identified factors independently associated with HIV-1 infection. RESULTS: In total, 266 (15.2%) PWUDs were HIV-1 positive. Hepatitis B virus and/or hepatitis C virus nucleic acid was detected in 65 (3.7%) PWUDs infected by HIV-1. The factors associated with HIV-1 infection were male gender, older age, a lower educational level and a lower income, crack cocaine use, a longer drug use history and a history of drug injection and engagement in unsafe sex, sex work and a higher number of sexual partners. CONCLUSIONS: The current study provides unique, initial insights into HIV and co-infection status and pertinent risk factors among PWUDs in northern Brazil, with clear and diverse implications for urgently improved prevention and treatment intervention needs.
Assuntos
Infecções por HIV , Drogas Ilícitas , Transtornos Relacionados ao Uso de Substâncias/complicações , Fatores Etários , Brasil/epidemiologia , Estudos Transversais , Feminino , Infecções por HIV/epidemiologia , HIV-1 , Hepatite B , Hepatite C , Humanos , Masculino , Prevalência , Fatores de Risco , Fatores Sexuais , Comportamento Sexual , Fatores Socioeconômicos , Transtornos Relacionados ao Uso de Substâncias/epidemiologiaRESUMO
BACKGROUND: Previous studies found a high prevalence of pathogens among female sex workers (FSWs) in the Amazon region, and established their parenteral and sexual transmission. This study estimated the prevalence of hepatitis C virus (HCV) infection and associated risk factors, and the frequency of HCV genotypes and resistance-associated substitutions (RASs) in this vulnerable group. METHODS: Distinct sampling methods were used to access 412 FSWs in cities and riverside communities in the Amazon region from 2015 to 2018. Three methods for HCV diagnosis were used to determine infection status. HCV genotypes and RASs were identified by sequencing and nucleotide fragment analysis. An association between HCV infection and exposure factors was determined by bivariate and multivariate analysis. RESULTS: In total, 44 (10.7%) FSWs were exposed to HCV, and 32 (7.8%) of them had active infection. Nine socioeconomic characteristics and risky sexual behaviors were associated with HCV exposure, particularly unprotected sex and condom exemption for the clients who paid extra money. Genotype 1 (81.3%) and 3 (18.7%) were detected. The frequency of FSWs with RASs was 23.1% (6/26) for grazoprevir related to the occurrence of substitutions Y56F and S122G. CONCLUSIONS: HCV infection among FSWs is highly prevalent and dominated by genotype I. Urgent preventive and treatment measures are required to reduce HCV infection in FSWs and the general population.
Assuntos
Preservativos , Hepatite B/diagnóstico , Profissionais do Sexo/psicologia , Comportamento Sexual/psicologia , Transtornos Relacionados ao Uso de Substâncias/complicações , Sexo sem Proteção , Brasil/epidemiologia , Feminino , Hepatite B/epidemiologia , Hepatite B/prevenção & controle , Vírus da Hepatite B , Humanos , Prevalência , Fatores de Risco , Assunção de Riscos , Profissionais do Sexo/estatística & dados numéricos , Fatores de TempoRESUMO
People who used illicit drugs (PWUDs) represent an important population group for acquisition and viral dispersion. In Brazil, high rates of the human T lymphotropic virus 1 (HTLV-1) and 2 (HTLV-2) have been reported in epidemiological studies. However, the epidemiological scenario of HTLV-1/2 infections in PWUDs is still poorly understood. Thus, this cross-sectional study determined the prevalence, frequency of subtypes and factors associated with HTLV-1/2 infections among PWUDs in the Brazilian state of Pará, an area considered endemic for this virus and with poor health services. Among 826 PWUDs, 53 (6.4%) presented anti-HTLV-1/2 antibodies by EIA and 44 (5.3%) presented proviral DNA by PCR. HTLV-1 and HTLV-2 were detected in 25 (3.0%) and 19 (2.3%) PWUDs, respectively. Subtypes 1a (25/44), transcontinental (23/44) and Japanese subgroups (2/44), 2b (6/44) and 2c (13/44) were identified. Involvement in illicit/criminal activity, daily use of illicit drugs, illicit drug use over 12 years, unprotected sex with other PWUDs, changes in genitalia (including ulcers and wounds), and more than 12 sexual partners were associated with HTLV-1/2 in PWUDs. This high prevalence and intense circulation of subtypes and subgroups of HTLV-1/2 is very worrying, and indicate the need for urgent actions for its control, prevention and treatment.
Assuntos
Infecções por HTLV-I/epidemiologia , Infecções por HTLV-II/epidemiologia , Vírus Linfotrópico T Tipo 1 Humano/isolamento & purificação , Vírus Linfotrópico T Tipo 2 Humano/isolamento & purificação , Adolescente , Adulto , Brasil/epidemiologia , Estudos Transversais , Usuários de Drogas , Feminino , Humanos , Drogas Ilícitas/efeitos adversos , Masculino , Prevalência , Adulto JovemRESUMO
BACKGROUND: Elevated rates of Hepatitis C Virus (HCV) infection have been reported in epidemiological studies with people who used illicit drugs (PWUIDs) in different Brazilian regions. In Brazil's Amazon region, studies have already identified the common use of illicit drugs among adolescents and the high prevalence of HCV infections among PWUIDs. However, all studies done with PWUIDs were conducted with small samples and within limited geographic coverage. This study determined the prevalence and risk factors for HCV infection in PWUIDs in the Amazon region, northern Brazil, as well as estimating the prevalence and factors associated with the HCV spontaneous clearance (HSC). METHODS: This cross-sectional study accessed 1666 PWUIDs from multiple municipalities of the Amazon region. Socio-demographic, economic, drug use and health-related information were collected through interviews. Blood samples collected were tested for the presence of anti-HCV antibodies and RNA-HCV. HCV genotypes were identified by real-time polymerase chain reaction (PCR). Logistic regressions were run to identify factors independently associated with HCV infection status and HSC. RESULTS: In total, 577 (34.6%) featured HCV antibodies, of which 384 (23.1%) had active HCV infection and 193 (11.6%) indicated HSC. Genotypes 1 (80.2%) and 3 (18.8%) were detected. HCV infection status was associated with the length of illicit drug use history, factors related to parenteral and sexual transmission, and factors of socio-economic marginalization leading to potential risk activities for HCV. HSC was associated with the ethnic (including indigenous) background of participants. CONCLUSIONS: High levels of HCV infection were detected in PWUIDs. Genotype 1 was predominant. Intense use of illicit drugs, unprotected sexual intercourse, high number of sexual partners and social marginalization were associated with all HCV infection. HSC was associated with origin (Amazonian-born) and non-white (e.g., Black or Indigenous) of PWUIDs. These findings emphasize the need for improve HCV prevention and control services and care for PWUIDs in the Brazilian Amazon region.
Assuntos
Hepacivirus/genética , Hepatite C/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adolescente , Adulto , Brasil/epidemiologia , Estudos Transversais , Feminino , Hepacivirus/patogenicidade , Hepatite C/virologia , Anticorpos Anti-Hepatite C/sangue , Humanos , Drogas Ilícitas , Masculino , Prevalência , Reação em Cadeia da Polimerase em Tempo Real , Fatores de Risco , Fatores Socioeconômicos , Transtornos Relacionados ao Uso de Substâncias/virologiaRESUMO
Hepatitis C virus (HCV) infection causes acute and chronic liver disease and may lead to cirrhosis, liver failure or hepatocellular carcinoma. The behavior of illicit drug users (DUs) typically exposes them to risks of viral infection. In the Brazilian Amazon region, a number of studies have identified high rates of drug use among adolescents, and a high prevalence of HBV infection in DUs, disseminated by sexual and parenteral activities. However, the epidemiological scenario of HCV infection in the region is still poorly understood. This study determined the prevalence, genotypes, and risk factors for HCV infection among DUs of the Marajó Archipelago. This cross-sectional study collected samples and epidemiological information from DUs in 11 municipalities. The diagnosis was established by EIA and real-time PCR, and the samples were genotyped by multiplex real time PCR. The data were analyzed by simple and multiple logistical regression. In 466 DUs, 28.3% had anti-HCV antibodies, and 25.5% had HCV-RNA. In 92 injecting drug users, 88.0% had anti-HCV antibodies, and 80.4% had HCV-RNA. Genotypes 1 and 3 were detected, with three cases of mixed infections. The multivariate analysis indicated associations of HCV infection with age (≥ 35 years), tattoos, intravenous drug use, shared use of injection equipment, and the daily and long-term (> 3 years) use of illicit drugs. These findings will contribute to the development of effective measures for the prevention of HCV infection among Brazilian DUs, as well as its general population.
Assuntos
Genótipo , Hepacivirus/genética , Anticorpos Anti-Hepatite/sangue , Hepatite C/epidemiologia , RNA Viral/genética , Abuso de Substâncias por Via Intravenosa/epidemiologia , Adolescente , Adulto , Brasil , Estudos Transversais , Usuários de Drogas , Feminino , Hepacivirus/classificação , Hepacivirus/crescimento & desenvolvimento , Hepatite C/complicações , Hepatite C/diagnóstico , Hepatite C/virologia , Humanos , Drogas Ilícitas , Técnicas Imunoenzimáticas , Masculino , Tipagem Molecular , Análise Multivariada , Reação em Cadeia da Polimerase , Prevalência , Abuso de Substâncias por Via Intravenosa/complicações , Abuso de Substâncias por Via Intravenosa/diagnóstico , Abuso de Substâncias por Via Intravenosa/virologiaRESUMO
South America is considered to have a low prevalence of hepatitis B virus (HBV) infection, although areas with a relatively high prevalence have been identified in northern Brazil. Few epidemiological studies of populations at risk of HBV infection are available for this region. Given this, in the present study, we investigated the prevalence of HBV and the factors associated with infection among illicit drug users (DUs) in the Marajó Archipelago, northern Brazil. In this cross-sectional study, we collected samples and epidemiological information from DUs in 11 municipalities of the Marajó Archipelago. The diagnosis was established by ELISA and real-time PCR; and genotyping was done by multiplex real-time PCR. Statistical modeling was based on simple and multiple logistical regressions with the Hosmer-Lemeshow test. The mean age of the 466 DUs was 28.4 years, and most were male. The most-consumed illicit drugs were crack cocaine and marijuana. In all, 171 DUs were exposed to HBV, with genotypes A, D and F being identified. The factors associated with higher frequencies of HBV infection were (i) male gender, (ii) age above 35 years, (iii) anti-HIV positivity, (iv) tattoos, (v) the use of injected drugs, (vi) the use of illicit drugs for more than 3 years, (vii) sexual relations without protection, (viii) sexual relations with another DU, and (ix) more than 10 sexual partners in the past 24 months. In summary, this study provides important insights into the dynamics of HBV infection among DUs in the Marajó Archipelago. We hope that these findings will contribute to the development of strategies, actions and public health policies aimed at preventing and controlling this viral infection more effectively.
Assuntos
Usuários de Drogas , Vírus da Hepatite B/classificação , Vírus da Hepatite B/genética , Hepatite B/epidemiologia , Hepatite B/virologia , Transtornos Relacionados ao Uso de Substâncias/complicações , Adulto , Distribuição por Idade , Brasil/epidemiologia , Ensaio de Imunoadsorção Enzimática , Feminino , Técnicas de Genotipagem , Vírus da Hepatite B/isolamento & purificação , Humanos , Drogas Ilícitas , Masculino , Reação em Cadeia da Polimerase , Fatores de Risco , Distribuição por SexoRESUMO
BACKGROUND: Currently, sharing of drug paraphernalia is the main form of HCV transmission worldwide. In South America, consistent findings indicate that shared sniffing equipment is an important factor in the spread of HCV among non-injecting drug users. Epidemiological data on the status of HCV infection in illicit drug users in the Amazon region are scarce, although reports of clinical cases of hepatitis or pathologies associated with HCV infection in other population groups are numerous. Thereby, this study investigated the prevalence, genotype frequency, and epidemiological factors associated with HCV infection in non-injecting drug users in the state of Pará, eastern Amazon. RESULTS: During 2008-2011, 300 non-injecting drug users attending drug-treatment centers participated in this study. Most non-injecting drug users were male (63.7%). The mean age was 32.5 years. The non-injecting drugs most consumed were: cannabis (15.6%), cocaine paste (21.3%), and oxi cocaine (25.7%). Tobacco (60.9%) and alcohol (79.4%) were also commonly consumed. One hundred six (35.1%; CI 95%: 29.8 - 41.1) non-injecting drug users presented anti-HCV antibodies by EIA. The HCV-RNA prevalence was 28.0% (95% CI: 20.6 - 35.8). Genotypes 1 (76.9%) and 3 (23.1%) of HCV have been identified. A multivariate analysis demonstrated that HCV infection was independently associated with the following factors: "age (≥ 35 years)", "tattoos", "use of a needle or syringe sterilized at home", "shared use of drug paraphernalia", "uses drugs for more than 5 years", and "use of drugs everyday". CONCLUSIONS: This study revealed a high prevalence of HCV infection in non-injecting drug users, and most infections are occasioned by genotype 1. Likely, HCV transmission is associated with the tattoos, the use of needle or syringe sterilized at home by people over the age of 35 years, and sharing, time and frequency of use of non-injecting drugs. These findings should serve as an incentive for the establishment of a program of Hepatitis C prevention and control by the local public-health authorities in order to develop effective policies and strategies for contain the spread of HCV infection.