Gustavo Machado Rocha

Difficulties reported by hiv-infected patients using antiretroviral therapy in brazil

OBJECTIVE To describe the degree of difficulty that HIV-infected patients have with therapy treatment. INTRODUCTION Patients’ perceptions about their treatment are a determinant factor for improved adherence and a better quality of life. METHODS Two cross-sectional analyses were conducted in public AIDS referral centers in Brazil among patients initiating treatment. Patients interviewed at baseline, after one month, and after seven months following the beginning of treatment were asked to classify and justify the degree of difficulty with treatment. Logistic regression was used for analysis. RESULTS Among 406 patients initiating treatment, 350 (86.2%) and 209 (51.5%) returned for their first and third visits, respectively. Treatment perceptions ranged from medium to very difficult for 51.4% and 37.3% on the first and third visits, respectively. The main difficulties reported were adverse reactions to the medication and scheduling. A separate logistic regression indicated that the HIV-seropositive status disclosure, symptoms of anxiety, absence of psychotherapy, higher CD4+ cell count (> 200/mm3) and high (> 4) adverse reaction count reported were independently associated with the degree of difficulty in the first visit, while CDC clinical category A, pill burden (> 7 pills), use of other medications, high (> 4) adverse reaction count reported and low understanding of medical orientation showed independent association for the third visit. CONCLUSIONS A significant level of difficulty was observed with treatment. Our analyses suggest the need for early assessment of difficulties with treatment, highlighting the importance of modifiable factors that may contribute to better adherence to the treatment protocol.

Anal HPV prevalence and associated factors among HIV-seropositive men under antiretroviral treatment in Brazil.

Background:The incidence of anal cancer has increased in developed countries. There is evidence that high-grade anal intraepithelial neoplasia and anal cancer are both linked to some human papillomavirus (HPV) infections. There are scarce data on anal cancer or male anal HPV infection in Brazil. Objective:The purpose of this study was to assess the prevalence of anal HPV infection and associated risk factors, stratified by oncogenic and nononcogenic types, in a sample of HIV-seropositive men in Brazil. Methods:Multicenter cross-sectional study of HIV-seropositive male patients attending public AIDS clinics in urban Brazil. Participants were interviewed for sociodemographic and behavioral characteristics. Anal HPV specimens were collected with a moistened Dacron swab inserted into the anal and stored in ThinPrep solution. HPV DNA-positive samples were typed by dot-blot hybridization. The prevalences of oncogenic and nononcogenic HPV types were calculated and multinomial logistic regression was used to assess independent predictors of HPV infection. Results:Among 445 men, 65.6% were positive for HPV DNA in the anal canal. Oncogenic types were detected in 40.7%. Logistic regression indicated that lifetime history of sexual intercourse only with men or with men and women; receptive anal intercourse in the last 12 months; and CD4+ lymphocyte count below 200 cells per cubic millimeter were independently associated with the detection of anal HPV infection. Conclusions:The high prevalence of anal HPV infection in this cross-sectional study underscores the need for studying and implementing screening programs of high-risk groups in Brazil.

Prevalence and Risk Factors Associated With Anal Intraepithelial Neoplasia Among HIV-Positive Men in Brazil

Objective This study aimed to assess the prevalence of, and associated factors with, anal intraepithelial neoplasia (AIN) among HIV-positive men evaluated at public health services in Brazil. Materials and Methods This is a multicenter cross-sectional study of HIV-positive male patients attending 6 public AIDS referral clinics in urban Brazil. Participants were interviewed for sociodemographic and behavioral characteristics. Anal swab specimens were collected for anal cytology and HPV DNA testing using L1 polymerase chain reaction. Univariate and multivariate analyses were performed to evaluate risk factors associated with the presence of low-grade squamous intraepithelial lesion (LSIL) and/or high-grade squamous intraepithelial lesion (HSIL). Results Anal swabs were collected from 343 participants. Prevalence of LSIL/HSIL was 24.8%. The majority (60.1%) reported sexual intercourse with both men and women in their lifetime. At least 36.7% had 1 or more oncogenic HPV types. Four variables were independently associated with the presence of LSIL/HSIL in multivariate analysis: history of sex with both men and women (odds ratio [OR] = 4.8) or men only (OR = 6.2) compared with those having sex with women only; current cigarette smoking (OR = 2.2); current CD4+ level between 200 and 500 cells/mm3 (OR = 2.9) or below 200 cells/mm3 (OR = 3.8) compared with CD4+ level above 500 cells/mm3; and presence of oncogenic anal HPV infection (OR = 9.6). Conclusions We found a high prevalence of AIN among HIV-positive men in Brazil. This population may serve as an important bridge population to women with implications for anogenital HPV infection in both men and women. Our findings confirm the need to assess screening programs for AIN among high-risk groups, similar to those used to prevent cervical cancer.

Gender differences in non-adherence among Brazilian patients initiating antiretroviral therapy

OBJECTIVE: We conducted a study to identify gender differences in factors associated with the first episode of non-adherence in the 12 months following the first antiretroviral prescription. METHODS: A concurrent prospective study of patients initiating antiretroviral therapy in Brazil was conducted from 2001-2002. The self-reported measurement of adherence was defined as an intake of less than 95% of the prescribed number of doses. Only the first occurrence of non-adherence was considered in this analysis. All analyses were stratified by gender. A Cox proportional hazard model was used to estimate the risk of non-adherence, and the time to non-adherence was estimated using the Kaplan-Meier method. RESULTS: The cumulative incidence of non-adherence was 34.6% (29.7% and 43.9% among men and women, respectively; p = 0.010). Marital status (being married or in stable union; p = 0.022), alcohol use in the month prior to the baseline interview (p = 0.046), and current tobacco use (p = 0.005) increased the risk of non-adherence among female participants only, whereas a self-reported difficulty with the antiretroviral treatment was associated with non-adherence in men only. For both men and women, we found that a longer time between the HIV test and first antiretroviral therapy prescription (p = 0.028) also presented an increased risk of non-adherence. CONCLUSIONS: In this cohort study, the incidence of non-adherence was 1.5 times greater among women compared to men. Our results reinforce the need to develop interventions that account for gender differences in public referral centers. Additionally, we emphasize that, to achieve and maintain appropriate adherence levels, it is important to understand the barriers to seeking and utilizing health care services.

HIV/AIDS knowledge and associated factors among men who have sex with men in Belo Horizonte, MG

Introduction: HIV/Aids knowledge has been found low among men who have sex with men (MSM). The lack of knowledge proves detrimental to VIH prevention efforts and goes beyond individual characteristics. Objective: To analyse the social, individual and structural factors associated with low HIV/Aids knowledge in MSM sample of adults and residents of Belo Horizonte, Minas Gerais. Methods: Cross-sectional study that occurred between 2008 and 2009 with MSM recruited through Respondent Driven Sampling (RDS). HIV/Aids knowledge was ascertained through ten statements by face-to-face interview and scores were obtained using Item Response Theory (IRT).The association between the explanatory variables and low HIV/Aids knowledge was analysed using binomial logistic regression. Results: It was observed that 24.5% of MSM had low knowledge on HIV/Aids and independent associated factors were: Social, not currently working and not being encouraged by friends to use condoms; Individual, not knowing their chance of becoming infected with HIV, irregular condom use in receptive anal sex with any partner in the last six months and not feeling, or little feeling, sadness or depression; Structural, to participate in religious activity and not knowing any Aids related NGO. Conclusion: Our results indicate an important gap in knowledge regarding basic information about the modes of transmission and prevention of HIV among MSM in Belo Horizonte. An adequate level of HIV/Aids knowledge is essential for improving risk perception and the adoption of safe sexual practices among MSM. Actions directed towards social, individual and structural factors among this key population are urgently needed.

Risk behavior score: a practical approach for assessing risk among men who have sex with men in Brazil

HIV/AIDS epidemic is not well controlled, and multiple sexual behavior factors help explain high rates of HIV infection among men who have sex with men (MSM). This article proposes to exam the use of a potential risk behavior score for HIV infection, based on the type and number of sexual partners, and condom use, and their associated factors in a sample of MSM in Brazil. A cross sectional RDS (Respondent Driven Sampling) study was performed among 3738 MSM aged 18+ years old from ten Brazilian cities. The risk behavior score was composed by the number of male partners and anal condom use in the last year with steady, casual, and commercial partners. Most participants were 25+ years old (58.1%), non-white (83.1%), and single (84.9%). Final weighted ordinal logistic model showed that age≤25 years old (p=0.037), homosexual or bisexual identity (p<0.001), sexual initiation before 15-year-old (p<0.001), having sex with men only in the last 12 months (p<0.001), frequent alcohol and illicit drug use (p<0.001), and use of local sites to meet sexual partners in the last month were independently associated with higher scores of risky behavior. Specific strategies should be developed aimed at the MSM population. Additionally, pre-exposed prophylaxis (Prep) should be considered for those at higher score as a strategy for reducing risk for HIV infection in this population.

Participation of men who have sex with men in non-governmental organizations in Belo Horizonte, 2007-2009

The aim of this study was to describe and analyze the participation of men who have sex with men (MSM) in NGOs. This is a cross-sectional study with 265 MSM in Belo Horizonte in 2007-2009. The sampling technique RDS (Respondent Driven Sampling) was used to contact populations considered difficult to be reached. The results indicate that among the participants, 72.7% have sufficient knowledge about the transmission of sexually transmitted diseases (STDs) and HIV. High proportions of alcohol drinking for more than twice a week (62.6%) and of irregular condom use in receptive or insertive anal intercourse (40.5% and 43.9%, respectively) were found. It was also observed that 40.6% felt they were discriminated against due to sexual orientation and the proportion of those who suffered sexual, verbal or physical violence due to sexual orientation was high (67.2%). The participation of MSM in NGOs in Belo Horizonte can be considered low (17.3%). The following variables were statistically associated with higher participation in NGOs: non-white skin color, being in a common-law union, feeling discriminated against because of sexual orientation, a history of sexual, physical or verbal violence, receiving free condoms in the last 12 months, having been tested for syphilis, perceiving to be under risk of becoming infected with HIV, and having a history of STD in the last 12 months. NGOs should strive for specific awareness to encourage greater participation, regular condom use, and prevention of transmission of HIV and other STDs.

Vulnerability and factors associated with HIV and syphilis among men who have sex with men, Belo Horizonte, MG

Introduction: The HIV epidemic in Brazil is characterized as concentrated on key populations, incluiding men Who have sex with men (MSM). However, monitoring and evaluation indicators are not well known at Municipal or State levels. Objective: To describe risk behaviors and HIV and syphilis prevalences among MSM in Belo Horizonte, MG. Methods: Cross-sectional study part of a national multicenter study among adult MSM in Brazil. The sample was recruited using Respondent Driven Sampling (RDS) technique. Semistructure interviews and serological exams for HIV and syphilis were conducted. Resultads: A total of 274 MSM were recruited in Belo Horizonte. Participants were mostly young, with high education, social classes A/B, self-reported as gay or homosexual and with high proportion of irregular use of condoms. Weighted prevalence of HIV infection and syphilis were, respectively, 10.3% and 13.9%. Age, color, sharing with their mother or father their sexual orientation, prior HIV and syphilis testing, and previous diagnosis of syphilis or other STDs were statistically associated with both infections (p<0.05). Marital status, family disapproval or indifference of their sexual orientation, better HIV/Aids knowledge, not knowing their chances of acquiring HIV were statistically associated only with HIV and social class only with syphilis. Conclusion: These results indicate the severity of the HIV epidemic amongthe MSM population in Belo Horizonte. Public poli

Unprotected receptive anal sex among men who have sex with men, Belo Horizonte, MG

Introduction: The Brazilian HIV epidemic is considered concentrated among vulnerable populations, particularly men who have sex with men (MSM). Objective: This paper analyzes the characteristics of sexual behavior and its associated factors among MSM in the city of Belo Horizonte, MG. Methods: Cross-sectional study conducted in 2008-2009, among 274 MSM recruited by Respondent Driven Sampling (RDS). Odds Ratios were estimated by logistic regression.Results: Among 274 subjects, 35.7% reported inconsistent condom use in receptive anal intercourse in the 6 months preceding the interview, with a high proportion of multiple sexual partnerships (average of 4.3 partners). Final logistic regression model showed that being married or living in a stable relationship, selfreported sexual identity as ‘gay’, feeling tense or worried some or many times in the past 12 months, history of sexual intercourse under influence of alcohol in the last six months, low knowledge about HIV transmission and history of previous testing for syphilis were Unprotected receptive anal sex among men who have sex with men, Belo Horizonte, MG Gustavo Machado Rocha1, Raquel Regina de Freitas Magalhaes Gomes2, Lidyane do Valle Camelo3, Maria das Gracas Braga Ceccato4, Mark Drew Crosland Guimaraes5 1 Medico Infectologista. Mestre em Saude Publica. Professor Assistente da Universidade Federal de Sao Joao Del-Rei, Divinopolis, MG. Doutorando em Saude Publica no Departamento de Medicina Preventiva e Social da Faculdade de Medicina da Universidade Federal de Minas Gerais – UFMG. Belo Horizonte, MG – Brasil. 2 Cirurgia-dentista. Epidemiologista. Mestre em Saude Publica. Secretaria Municipal de Saude de Belo Horizonte. Doutoranda em Saude Publica no Departamento de Medicina Preventiva e Social da Faculdade de Medicina da UFMG. Belo Horizonte, MG – Brasil. 3 Enfermeira. Mestre em Saude Publica. Doutoranda do Programa de Pos-Graduacao em Saude Publica da Faculdade de Medicina da UFMG, membro do Grupo de Pesquisas em Epidemiologia e Avaliacao em Saude (GPEAS). Belo Horizonte, MG – Brasil. 4 Farmaceutica bioquimica. Doutora em Saude Publica. Professora Adjunta do Departamento de Farmacia Social da Faculdade de Farmacia da UFMG. Belo Horizonte, MG – Brasil. 5 Medico. Doutor em Epidemiologia. Professor Associado do Departamento de Medicina Preventiva e Social da Faculdade de Medicina da UFMG. Belo Horizonte, MG – Brasil. Sexo anal receptivo desprotegido entre homens que fazem sexo com homens, Belo Horizonte, MG DOI: 10.5935/2238-3182.20130069