RESUMO
OBJECTIVE: To determine the extent of the HIV-1 epidemic in Peru. DESIGN: Part of a national serosurvey in Peru. METHODS: Between January 1986 and December 1990, 140,976 serum samples were tested for HIV-1 antibody. RESULTS: HIV-1 antibody was found in a high percentage of serum samples provided by 4300 homosexual men (26%), 2204 male sexually transmitted disease patients (10%), 145 drug users (13%), 269 hemophiliacs (10%), and 146 unlicensed female prostitutes (10%). In addition, the prevalence of HIV-1 infection increased substantially among these groups between the beginning and end of the survey period. A low but rising prevalence of HIV-1 antibody was found during this period among serum samples provided by 83,526 blood donors and 11,101 military personnel:total period prevalence, 0.25 and 0.32%, respectively. CONCLUSION: These data indicate that HIV-1 infection is epidemic in Peru among groups at high risk of sexually and parenterally transmitted diseases, and that the risk of infection appears to be low but possibly increasing among the general population.
PIP: The findings of a national seroprevalence survey conducted in Peru during 1986-90 indicate accelerating rates of human immunodeficiency virus (HIV) among population groups at high risk of sexually transmitted diseases. Two databases were maintained: 1) January 1986-December 1988 and 2) January 1989-December 1990. Of the 140,976 survey participants, 3345 (2.4%) were HIV-positive by Western blot. 2591 participants were selected because of clinical signs suggestive of acquired immunodeficiency syndrome (AIDS); 46.7% were HIV-positive, but the prevalence increased from 19% in the 1986-88 period to 60% during 1989-90. Among the 4300 men who identified themselves as homosexual or bisexual, 26% were seropositive (8% during 1986-88 and 41% during 1989-90). HIV prevalence among 2204 men attending a sexually transmitted diseases clinic was 10.3%, with an increase from 2.0% in the first period to 19.0% in the later period. 10.4% of the 269 hemophiliacs were HIV-infected, with an increase from 8% to 36%. Among the 145 intravenous drug users, the prevalence rose from 1% during 1986-88 to 27% during 1989-90. Among 5827 registered female prostitutes, the prevalence rose from 0.3% to 0.7%; however, a 1990 analysis of 146 unregistered prostitutes revealed a rate of 9.6%. The HIV rates among 285 female and 105 male heterosexual partners of known HIV-positive persons were 50.2% and 40.0%, respectively. HIV prevalence increased from 0.8% during 1986-88 to 8.0% during 1989-90 among 1532 men and 1247 women who requested anonymous HIV testing. The prevalence among 542 male and 615 female medical personnel was 2.3%. Among 78,793 volunteer and 4733 paid blood donors, HIV prevalence was 0.2% (0.3% among paid donors). The period prevalence among 11,101 male military recruits and active duty members increased from 0.009% to 0.5%. Finally, only 0.3% of 21,595 applicants for immigration visas were HIV-positive, and there were no HIV cases among 1234 pregnant women attending antenatal clinics. Although the very low HIV prevalence among military personnel and pregnant women suggests that the virus is not yet widely disseminated within the general population, the finding that 28% of HIV-positive men were married and engaged in bisexual behavior suggests potential for heterosexual transmission in the years ahead.
Assuntos
Surtos de Doenças , Infecções por HIV/epidemiologia , HIV-1 , Feminino , Infecções por HIV/sangue , Soroprevalência de HIV , Humanos , Masculino , Peru/epidemiologia , População , Vigilância da População , Fatores de Risco , Comportamento SexualRESUMO
A Peruvian female prostitute population was evaluated over a 3-year period to determine the incidence and risk factors of retroviral and viral hepatitis transmission. At three survey periods, a questionnaire was administered and serum samples were obtained. A total of 966 subjects were studied, with 34% followed for 38 months, 22% followed for 18 months, and 44% evaluated just once. On initial evaluation, 3 (0.3%) had HIV-1 antibody, 170 (17.6%) had HTLV-I antibody, 578 (59.8%) had anti-HBc, and 7 (0.7%) had antibody to hepatitis C virus. The mean annual incidence of HTLV-I and hepatitis B infection was 1.6% and 4.7%, respectively. Univariate and logistic regression analysis of prevalence data indicated an association between sexual activity and HTLV-I and hepatitis B infection, but no independent risk factors were identified in cohort analysis. Parenteral risk factors were not associated with transmission, except for a small percentage of subjects who may have acquired hepatitis B infection from blood transfusions. These findings suggest that there is a high incidence of HTLV-I and hepatitis B infection from heterosexual contact in this female prostitute population.
Assuntos
Infecções por HTLV-I/epidemiologia , Hepatite B/epidemiologia , Hepatite C/epidemiologia , Hepatite Viral Humana/epidemiologia , Trabalho Sexual , Adulto , Feminino , Anticorpos Anti-HIV/sangue , HIV-1/imunologia , Anticorpos Anti-HTLV-I/sangue , Infecções por HTLV-I/transmissão , Hepacivirus/imunologia , Anticorpos Anti-Hepatite/sangue , Hepatite B/transmissão , Anticorpos Anti-Hepatite B/sangue , Hepatite C/transmissão , Anticorpos Anti-Hepatite C , Hepatite Viral Humana/transmissão , Humanos , Incidência , Pessoa de Meia-Idade , Peru/epidemiologia , Prevalência , Modelos de Riscos Proporcionais , Análise de Regressão , Fatores de Risco , Comportamento Sexual , Parceiros Sexuais , Reação TransfusionalRESUMO
Hepatitis D virus (HDV) is the cause of an unusually severe form of liver disease with distinct histologic features (morula cell) that occurs throughout northern South America and certain other areas of the world. Clinical studies of HDV disease worldwide indicate that there is, in fact, a wide variation in pathogenesis, and the reasons for these differences are presently unknown. One possible explanation is that factors associated with the viral genotype are determinants of HDV pathogenesis. In this study, nucleic acid sequences were determined for three different northern South American HDV isolates which were obtained from individuals with severe disease or a family history of severe disease, in areas that are hyperendemic for this disease pattern. The sequences of these three isolates are very similar to one another but only distantly related to other published HDV sequences. Comparison of the sequence of a semiconserved region from a total of 14 isolates indicates that there are at least three HDV genotypes. Most published HDV sequences, including those from North America, Europe, the Middle East, the South Pacific, and Asia, belong to a single genotype which may have some geographically based subtypes. A single Japanese isolate is the sole representative of a second HDV genotype. The South American sequences reported here constitute a third genotype. The association of a particular genotype with the severe form of type D hepatitis that occurs in northern South America supports the hypothesis that HDV genetic factors are important determinants in the pathogenesis of type D hepatitis.
Assuntos
Vírus Delta da Hepatite/classificação , Vírus Delta da Hepatite/genética , Adolescente , Sequência de Aminoácidos , Sequência de Bases , Clonagem Molecular , Primers do DNA , Genótipo , Hepatite D/microbiologia , Vírus Delta da Hepatite/isolamento & purificação , Humanos , Itália , Japão , Masculino , Dados de Sequência Molecular , Filogenia , Reação em Cadeia da Polimerase , RNA Viral/sangue , RNA Viral/isolamento & purificação , Homologia de Sequência de Aminoácidos , Homologia de Sequência do Ácido Nucleico , América do SulRESUMO
The epidemiology of HTLV-I infection in female prostitutes was studied in a survey of 395 prostitutes from Callao, Peru (the port city of Lima), 72 prostitutes from Iquitos, Peru (another port city on the Amazon River), and 510 prenatal clinic patients from Lima. Prostitutes reported a mean of 8.8 years (range, 1-39 years) of active prostitution and a mean of 205 sexual contacts during the month prior to the study. The percentage of prostitutes with HTLV-I antibody (21.8%) was significantly higher than patients attending a prenatal clinic (3.1%; P less than .0001). The prevalence of HTLV-I antibody increased steadily with age in prostitutes, but no age trend was noted in prenatal patients. By multiple logistic regression analysis, an independent association was found between HTLV-I seropositivity and a history of prostitution in Callao, age, and positive syphilis serology when all 977 study subjects were evaluated. When prostitutes alone were analyzed, the number of years of exposure as a practicing prostitute was associated with HTLV-I seropositivity after controlling for age. These data indicate a greatly increased risk of HTLV-I infection in prostitutes in Callao, Peru, and suggest an association between sexual activity and HTLV-I transmission.
Assuntos
Infecções por HTLV-I/transmissão , Trabalho Sexual , Doenças Virais Sexualmente Transmissíveis/epidemiologia , Adolescente , Adulto , Fatores Etários , Feminino , Anticorpos Anti-HTLV-I/sangue , Infecções por HTLV-I/epidemiologia , Humanos , Pessoa de Meia-Idade , Peru/epidemiologia , Prevalência , Fatores de Risco , Estudos SoroepidemiológicosRESUMO
Twenty (18%) of 111 Peruvian men with sexually acquired human immunodeficiency virus infection were found also to be infected with human T-lymphotrophic virus type I or II in a retrospective study. At the time of data evaluation, 75 patients had reached Centers for Disease Control stage IV (clinical acquired immunodeficiency syndrome) and had not received antiviral medication; mortality in this group was 63.3% (38/60) among patients infected with human immunodeficiency virus alone and 80% (12/15) in the dually infected group. Of the 50 patients who had died, survival time from onset of stage IV to death was shorter in the dually infected group (5.02 +/- 3.27 months) than in those with human immunodeficiency virus infection alone (10.07 +/- 4.42 months). In Peru, sexually acquired human immunodeficiency virus infection in men is often accompanied by human T-lymphotrophic virus type I/II infection, and dual retrovirus infection is associated with a shorter survival after onset of clinical acquired immunodeficiency syndrome.
Assuntos
Síndrome da Imunodeficiência Adquirida/microbiologia , Infecções por Deltaretrovirus/complicações , Soropositividade para HIV/complicações , Síndrome da Imunodeficiência Adquirida/mortalidade , Síndrome da Imunodeficiência Adquirida/patologia , Adulto , Vírus Linfotrópico T Tipo 1 Humano , Vírus Linfotrópico T Tipo 2 Humano , Humanos , Masculino , Peru/epidemiologia , Prognóstico , Estudos Retrospectivos , Parceiros Sexuais , Taxa de SobrevidaRESUMO
The prevalence in Peru of antibody to hepatitis C virus (anti-HCV) was determined in a survey of populations living in the northern jungle region and in groups at high risk of parenterally and sexually transmitted diseases. All sera were initially screened for anti-HCV using commercial first and second generation ELISAs; repeatedly reactive sera were further verified with a second generation immunoblot assay. Serum samples were also tested by ELISA for HBsAg, anti-HBs, and anti-HBc. None of 2,111 sera obtained in the survey of jungle residents was positive for anti-HCV by immunoblot assay. Twelve of 16 HIV-1 antibody positive hemophiliacs, one of 103 HIV-1 antibody positive homosexuals, and three of 602 HIV-1 negative registered female prostitutes were positive for anti-HCV. A high prevalence of total markers of hepatitis B infection was found in all subjects, especially in older subjects and groups at high risk of parenterally and sexually transmitted diseases. The findings of this study indicate that seropositivity for hepatitis C virus antibody is uncommon in Peru except in high risk groups and suggest that the epidemiology of hepatitis C differs substantially from hepatitis B.
Assuntos
Hepacivirus/imunologia , Anticorpos Anti-Hepatite/sangue , Hepatite C/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Coleta de Dados , Feminino , Hepatite B/epidemiologia , Anticorpos Anti-Hepatite B/sangue , Antígenos de Superfície da Hepatite B/sangue , Hepatite C/imunologia , Anticorpos Anti-Hepatite C , Humanos , Masculino , Pessoa de Meia-Idade , Peru/epidemiologia , Fatores de RiscoRESUMO
A retrospective epidemiological study was conducted in connection with an outbreak of paratyphoid fever at a Peruvian naval installation in Callao. The study sought to determine the magnitude of the outbreak, the source of infection, the attack rates, the persistence of bacilli excretion, and the clinical picture of the disease. The source of Salmonella paratyphi B infection had been a meal of chicken and rice served to around 400 members of the naval police. Over a period of three weeks, 21 persons were hospitalized and 52 received outpatient treatment at the naval hospital. In addition, through a questionnaire it was revealed that 86 unreported cases of diarrhea related to the outbreak had occurred. The most common clinical manifestations were fever, headache, weakness, anorexia, abdominal pain, and diarrhea. The general attack rate was 39.8%. In a follow-up survey carried out 37 days after exposure, fecal cultures indicated that 8.5% of the persons affected continued to excrete the microorganism. The high rates of attack and transmission of S. paratyphi B in this outbreak point up the considerable pathogenicity and virulence of some strains of the microorganism and their impact on public health. It is suggested that preventive measures be taken at naval and other similar installations, including the education of workers who handle and prepare food, in order to ensure proper hygiene.
Assuntos
Surtos de Doenças , Militares , Febre Paratifoide/epidemiologia , Intoxicação Alimentar por Salmonella/epidemiologia , Salmonella paratyphi B/isolamento & purificação , Adulto , Animais , Galinhas , Humanos , Masculino , Carne , Febre Paratifoide/etiologia , Febre Paratifoide/microbiologia , Peru , Prevalência , Estudos Retrospectivos , Intoxicação Alimentar por Salmonella/etiologiaAssuntos
Infecções por HIV/complicações , HIV-1 , Infecções por HTLV-I/complicações , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Peru , Fatores de RiscoRESUMO
OBJECTIVE: To determine the efficacy and toxicity of the World Health Organization's (WHO) recommended treatment for mucosal leishmaniasis: antimony, 20 mg/kg body weight per day for 28 days. DESIGN: Open trial with 12-month follow-up. SETTING: Inpatient unit of a regional referral hospital in a developing country. PATIENTS: Twenty-nine consecutive eligible patients with culture-confirmed infection of the mucosa with Leishmania species who were otherwise healthy. Eight patients (28%) had mild to moderate disease (confined to the nasal mucosa). Twenty-one patients (72%) had severe disease (including the oropharynx as well as the nasal mucosa). INTERVENTION: Antimony, 20 mg/kg body weight intravenously every day for 28 days. Patients received antimony in the form of sodium stibogluconate. MEASUREMENTS AND MAIN RESULTS: Initial results of therapy were as follows: 63 of 72 lesions (88%) healed or markedly improved; all lesions were culture-negative for parasites; and 18 of 29 patients (62%) showed complete clinical and parasitologic cure of all lesions. By the 12-month follow-up examinations, however, 37 lesions had recurred, 8 new lesions had appeared, and only 8 patients (30%) showed clinical cure of all lesions. Of the 8 patients with mild to moderate disease, 6 were cured compared with only 2 of the 21 patients with severe disease. Side effects of this treatment regimen included T-wave inversion on electrocardiogram (4 patients), abnormal liver function tests (10 patients), and musculoskeletal pain (24 patients). No side effects occurred during week 1 of therapy. CONCLUSIONS: The only recommended treatment for mucosal leishmaniasis is ineffective in patients with severe disease. The acceptable toxicity of the regimen suggests that longer courses of therapy with antimony, or that trials with other antileishmanial agents alone or combined with antimony be evaluated as initial therapy for this disease.