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High Prevalence of Human Papillomavirus (HPV) Infections and High Frequency of Multiple HPV Genotypes in Human Immunodeficiency Virus-Infected Women in Brazil

ABSTRACT A group of 208 human immunodeficiency virus (HIV)-infected women in Brazil were studied for the presence of human papillomavirus with the general SPF10 PCR primer set. Virtually all (98%) women were found positive for human papillomavirus (HPV) DNA. Genotyping by the reverse hybridization line probe assay (HPV-LiPA) revealed a high prevalence of multiple genotypes (78.9% of the cases), with an average of 3.1 genotypes per patient (range, 1 to 10 genotypes). HPV 6 was the most prevalent genotype and was observed in 80 (39.2%) patients, followed by types 51 (31.9%), 11 (26.0%), 18 (24.0%), and 16 (22.5%). Of the genotypes detected, 40.9% were low-risk genotypes. Twenty-two (10.5%) patients showed normal (Pap I) cytology, 149 (71.6%) patients had inflammation (Pap II), and 28 patients (13.4%) had a Pap III score. The prevalence of high-risk genotypes increased with the cytological classification. There were no significant associations between the number of HPV genotypes detected and the cytological classification, HIV viral load, and CD4 count in these patients. In conclusion, the highly sensitive SPF10 LiPA system shows that a very high proportion of HIV-infected women in Brazil are infected with HPV and often carry multiple HPV genotypes.

Vulnerability, Human Rights, and Comprehensive Health Care Needs of Young People Living With HIV/AIDS

We sought to identify and understand the health care needs of young people living with HIV/AIDS, particularly in terms of their psychosocial well-being. We conducted a qualitative analysis of HIV-positive young people and their caregivers, focusing on the implications of an HIV diagnosis for health care needs. Stigma was a recurrent issue that arose in the interviews conducted with the respondents, and it was evident that youths had been denied many rights related to health. We concluded that young people living with HIV need comprehensive care based on a human rights approach. In this regard, we offer some practical recommendations for health programs.

The right to love: the desire for parenthood among men living with HIV.

Abstract Drug regimens and procedures now exist that will prevent parents from transmitting HIV to infants, and the ethical and legal obligation to promote and protect the reproductive rights of those living with HIV should form part of training for HIV/AIDS care and prevention. This paper reports a study that investigated issues of sexuality and reproduction with 250 Brazilian men living with HIV in São Paulo. We asked whether they wished to have children and whether health professionals in HIV/AIDS treatment clinics that they attended were supportive of their wishes. Health professionals were not considered by most participants to be supportive enough or even impartial about HIV-positive people having children, and paid little attention to mens fathering role. 80% of the men had sexual relationships, and 43% of them wanted children, especially those who had no children, in spite of expectations of disapproval. Few of the men received information about treatment options that would protect infants, however. In previous studies with HIV-positive women attending the same clinics, by comparison, greater knowledge about prevention of perinatal HIV transmission was reported, but women had fewer sexual relationships, fewer desired to have children, and they expected even more disapproval of having children from health professionals. We conclude that the rights of those with HIV to found a family depend as much on curing the ills of prejudice and discrimination, including among health professionals, as on medical interventions.

Establishment and cryptic transmission of Zika virus in Brazil and the Americas

Transmission of Zika virus (ZIKV) in the Americas was first confirmed in May 2015 in northeast Brazil. Brazil has had the highest number of reported ZIKV cases worldwide (more than 200,000 by 24 December 2016) and the most cases associated with microcephaly and other birth defects (2,366 confirmed by 31 December 2016). Since the initial detection of ZIKV in Brazil, more than 45 countries in the Americas have reported local ZIKV transmission, with 24 of these reporting severe ZIKV-associated disease. However, the origin and epidemic history of ZIKV in Brazil and the Americas remain poorly understood, despite the value of this information for interpreting observed trends in reported microcephaly. Here we address this issue by generating 54 complete or partial ZIKV genomes, mostly from Brazil, and reporting data generated by a mobile genomics laboratory that travelled across northeast Brazil in 2016. One sequence represents the earliest confirmed ZIKV infection in Brazil. Analyses of viral genomes with ecological and epidemiological data yield an estimate that ZIKV was present in northeast Brazil by February 2014 and is likely to have disseminated from there, nationally and internationally, before the first detection of ZIKV in the Americas. Estimated dates for the international spread of ZIKV from Brazil indicate the duration of pre-detection cryptic transmission in recipient regions. The role of northeast Brazil in the establishment of ZIKV in the Americas is further supported by geographic analysis of ZIKV transmission potential and by estimates of the basic reproduction number of the virus.

Hepatitis C Virus Coinfection in a Cohort of HIV-Infected Individuals from Santos, Brazil: Seroprevalence and Associated Factors

Although HIV/hepatitis C virus (HCV) coinfection has been recognized worldwide in individuals exposed to blood-borne and sexually transmitted diseases (STD), limited data are available on the epidemiology of this coinfection in Brazil. A cross-sectional study was carried out to estimate the prevalence of HCV seropositivity in a cohort of people living with HIV/AIDS in Santos, Brazil, and to investigate potential risk factors for HCV infection. Anti-HCV antibodies were sought by using two immunoenzymatic assays. Overall HCV seroprevalence was 36.2% (95% confidence interval [CI] 31.9-40.4%). However, it was significantly higher (84.8%, 95% CI 78.2-91.3%) among intravenous drug users (IDU) as compared to non-IDU (20.9%, 95% CI 16.8-25.1%) (p < 0.001). Multiple logistic regression analysis revealed that HCV seropositivity among IDU was independently associated with needle sharing (adjusted odds ratio [adjOR] = 4.28, p = 0.07) and with serologic evidence of exposure to other bloodborne agents: HBV (adjOR = 4.39, p = 0.01) and HTLV-I/II (adjOR = 6.43, p = 0.02). In contrast, no association with lifetime number of sexual partners, history of STD, or of sex with commercial sex workers (CSW) could be demonstrated. Among non-IDU, HCV seropositivity was independently associated with sexual partnership with IDU (adjOR = 2.15, p = 0.08) and with HBV seropositivity (adjOR = 1.71, p = 0.05), but not with engaging in oral or anal receptive intercourse or having sex with CSW. Results indicate that exposure to blood and sexual partnership with IDU constitute the main risk factors for HCV acquisition among HIV-positive patients in Santos, Brazil. Prevention of HCV spread in this population should thus include harm reduction measures and information on safer sex practices for both IDU and their sexual partners.

Prevalência de sobrepeso e obesidade abdominal em indivíduos portadores de HIV/AIDS, em uso de terapia anti-retroviral de alta potência

OBJECTIVE: To evaluate the nutritional status of HIV/AIDS patients treated with highly active antiretroviral therapy, according to gender and T CD4 + lymphocyte count. MATERIAL AND METHODS: This was a cross-sectional study, including 223 individuals (171 men and 52 women) treated with protease inhibitors, aged between 20 and 59 years. This study was developed at a HIV/AIDS reference treatment center in the city of Sao Paulo. Anthropometric data, including current weight, height, and waist circumference (WC) were collected. The body mass index (BMI) was calculated as the ratio between weight (kg) and the square of the height (m2), according to World Health Organization classification criteria. Patients were divided into three groups according to T CD4+ lymphocyte count: 350 (cel/mm3). RESULTS: The prevalence of overweight was 30.5% and of central obesity was 12.6%. Women presented a higher prevalence of overweight (36.5%) and of central obesity (32.7%) when compared to men (28.7% and 6.4% respectively). The prevalence of underweight was higher among women than in men, respectively 7.7% and 2.3%. Categories of T CD4 + lymphocyte counts were not associated with overweight and central obesity in this population. CONCLUSION: Women presented a higher prevalence of underweight, overweight and central obesity in relation to men. Obesity is the most important deviation of nutritional status, overcoming malnutrition, in these HIV/AIDS patients treated with highly active antiretroviral therapy.

A revelação do diagnóstico na perspectiva dos adolescentes vivendo com HIV/AIDS e seus pais e cuidadores

The purpose of this study was to identify relevant issues in the disclosure of HIV-positive status in children and adolescents, aiming to improve the quality of their healthcare. A qualitative study included adolescents living with HIV/ AIDS and their parents and caregivers at AIDS reference services in Sao Paulo and Santos, Brazil. In-depth interviews and focus group were used. The main reasons for disclosure were: poor treatment adherence, sexual maturity, adolescents request, and inadequate procedures by medical staff. Disclosure was a critical moment for adolescents, with a strong impact on their life plans and horizons. Adolescents infected through sexual transmission and drug use reported the most problematic scenes involved in disclosure. Despite its initial negative impact, disclosure resulted in improved healthcare and better dialogue among the adolescents, caregivers, and healthcare providers. The adolescents also requested clear, no-nonsense, honest information. The authors conclude that health services need to actively provide an adequate approach to facilitate disclosure of HIV-positive status to children and adolescents, realizing that it is a long-term process supported by the family and a multidisciplinary team.

Validity and reliability of the Baecke questionnaire for the evaluation of habitual physical activity among people living with HIV/AIDS

This study evaluates the validity and reliability of the Baecke questionnaire on habitual physical activity when applied to a population of HIV/AIDS subjects. Validity was determined by comparing measurements for 30 subjects of peak oxygen uptake, peak workload, and energy expenditure with scores for occupational physical activity (OPA), physical exercise in leisure (PEL), leisure and locomotion activities (LLA), and total score (TS). Reliability was determined by testing and retesting 29 subjects at intervals of 15-30 days. Validity was evaluated with the Pearson correlation and reliability analyses were done using the intraclass correlation, paired Student t-test, and Bland-Altman methods. Peak VO2 and peak workload had significant correlation with PEL (r = 0.41; r = 0.43; respectively). Energy expenditure had a significant correlation with OPA (r = 0.64). The intraclass coefficients were 0.70 or more for OPA, PEL and TS. There was no difference in OPA, PEL, LLA and TS between the two evaluations. The Bland-Altman methods showed that there was good agreement between the measurements for all habitual physical activities scores. Results show that the Baecke questionnaire is valid for the evaluation of habitual physical activity among people living with HIV/AIDS.

Leisure time physical activity prevents accumulation of central fat in HIV/AIDS subjects on highly active antiretroviral therapy.

The aim of this study was to verify the relationship between habitual physical activity and body fat in HIV/AIDS subjects on highly active antiretroviral therapy. This was a cross-sectional study covering 169 men and 51 women. It was conducted at the AIDS Clinic of the School of Medicine, University of São Paulo. The dependent variables analysed were central subcutaneous fat (CSF) and waist-to-hip-ratio (WHR). The independent variable was the score for leisure time physical activity (LTPA). The control variables were sex, age, education, energy intake, body mass index, smoking, diagnosis of AIDS, T-CD4+ lymphocyte levels and duration of use of protease inhibitors. Multiple linear regressions were used for statistical analysis. After controls, there was significant negative correlation for LTPA with CSF (β=−2.849; P variable=0.013; r 2 adjusted=0.65; P model<0.001), and LTPA was in the limit of the significance with WHR (β=−0.005; P variable=0.073; r 2 adjusted=0.41; P model<0.001). Physical activity contributed towards preventing fat accumulation in HIV/AIDS subjects.

Central obesity and dietary intake in HIV/AIDS patients

OBJECTIVE To assess the association between dietary intake and central obesity among people living with HIV/AIDS and receiving highly active antiretroviral therapy. METHODS A cross-sectional study was conducted involving 223 adult individuals in the city of São Paulo city in 2002. The study population was classified according to central obesity, defined as waist-to-hip ratio >0.95 for men and >0.85 for women. The dietary variables studied were energy consumption (in calories and calories/kilo of body weight), macronutrients (in grams and % of energy intake), total fiber (grams) and fruit and vegetables intake (grams). The potential confounders examined were sex, skin color, age, schooling, income, body mass index, physical activity, smoking habits, peripheral CD4+ T lymphocyte count and length of protease inhibitor use. The multiple logistic regression model was performed in order to evaluate the association between central obesity and dietary intake. RESULTS The prevalence of central obesity was 45.7% and it was associated with greater consumption of lipids: for every increase of 10g of lipid intake the odds of central obesity increased 1.28 times. Carbohydrate consumption showed negative association (OR=0.93) with central obesity after adjustment for control variables. CONCLUSIONS The results suggest that the amount of carbohydrates and lipids in the diet, regardless of total energy intake, may modify the chance of developing central obesity in the studied population. Nutritional interventions may be beneficial for preventing central obesity among HIV/AIDS patients.