Kledoaldo Oliveira de Lima

Primary resistance of HIV to antiretrovirals among individuals recently diagnosed at voluntary counselling and testing centres in the metropolitan region of Recife, Pernambuco

Determining the prevalence and type of antiretroviral (ARV) resistance among ARV-naïve individuals is important to assess the potential responses of these individuals to first-line regimens. The prevalence of primary resistance and the occurrence of recent infections among individuals with human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) were identified among recently diagnosed patients at five sexually transmitted disease/AIDS testing and counselling centres in the metropolitan region of Recife (RMR), Pernambuco, Brazil, between 2007-2009. One-hundred and eight samples were analysed using the Calypte® BED assay. Males predominated (56%), as did patients aged 31-50 years. Twenty-three percent presented evidence of a recent HIV infection. The median CD4+ T lymphocyte count was 408 cells/mm³ and the median viral load was 3.683 copies/mL. The prevalence of primary resistance was 4.6% (confidence interval 95% = 1-8.2%) based on criteria that excluded common polymorphisms in accordance with the surveillance drug resistance mutation criteria. The prevalence of resistance to non-nucleoside reverse transcriptase, nucleoside/nucleotide reverse transcriptase and protease inhibitors were 3.8%, 1.5% and 0.8%, respectively. Fifty-seven percent of strains were from clade B, 37.7% were clade F and 3.1% were clade C; there were no statistically significant differences with respect to resistance between clades. Recent infection tended to be more common in men (p = 0.06) and in municipalities in the south of the RMR (Jaboatão dos Guararapes and Cabo de Santo Agostinho) (p = 0.046). The high prevalence of recent infection and the high prevalence of non-B strains in this poor Brazilian region merit further attention.

Recent HIV infection rates among HIV positive patients seeking voluntary counseling and testing centers in the metropolitan region of Recife - Pe, Brazil

UNLABELLED The BED capture enzyme immunoassay test makes it possible to determine whether individuals were recently infected with HIV. OBJECTIVE In this study, the overall HIV and recent infections prevalences were determined at five Voluntary Counseling and Testing (VCT) centers, in the Metropolitan Region of Recife, Northeastern of Brazil. MATERIAL AND METHODS A cross-sectional study was conducted among users of five VCTs in the metropolitan region of Recife between July 2007 and April 2009. Out of the individuals who tested positive for HIV, 169 were analyzed to assess the prevalence of recent infection by means of the BED-CEIA (BED-Calypte®). RESULTS Out of 46,696 individuals tested 916 (1.96%) turned out positive for HIV infection The highest prevalence was in Recife (3.9%). The prevalence was higher among males (3.93%), and men who have sex with men (MSM) (12.4%). The frequency of recent infections among the 169 subjects evaluated was 23.7%. Recent infections were more common among individuals under 25 years of age. There was slight predominance of men and higher frequency of heterosexuals in both groups, but still a significant portion of MSM (33%). Subtype B predominated, followed by a high proportion of subtype F. CONCLUSIONS Recent infection occurs mainly among young individuals and heterosexuals, despite a significant proportion of recent infection among MSM. These results suggest that preventive actions aimed at the MSM community remains a challenge and efforts focusing this group should continue to be a priority.

HIV-1 incidence among people seeking voluntary counseling and testing centers, including pregnant women, in Pernambuco State, Northeast Brazil

The HIV-1 epidemic in Brazil has displayed new characteristics over time, with an increase in heterosexual transmission and a decline in the male-to-female ratio in AIDS cases. HIV screening was offered to patients attending the Voluntary Counseling and Testing Center in Paulista, Greater Metropolitan Recife, Pernambuco State, in Northeast Brazil, to determine HIV-1 incidence. BED capture enzyme immunoassay (BED-CEIA) was used to measure HIV-1 incidence, comparing it to the AxSYM avidity index method (Ax-AI). From 2006 to 2009, 14,014 individuals were tested, and only 18 pregnant women were diagnosed with HIV infection, resulting in 0.15% annual incidence (95%CI: 0-0.33), significantly lower than in men (1.03; 95%CI: 0.45-1.61) and non-pregnant women (0.50; 95%CI: 0.11-0.89). Despite the low HIV-1 incidence in pregnant women, the high rate of recent infection detected during prenatal care emphasizes the need to increase measures to prevent vertical transmission.Abstract The HIV-1 epidemic in Brazil has displayed new characteristics over time, with an increase in het-erosexual transmission and a decline in the male-to-female ratio in AIDS cases. HIV screening was offered to patients attending the Voluntary Coun-seling and Testing Center in Paulista, Greater Metropolitan Recife, Pernambuco State, in North-east Brazil, to determine HIV-1 incidence. BED capture enzyme immunoassay (BED-CEIA) was used to measure HIV-1 incidence, comparing it to the AxSYM avidity index method (Ax-AI). From 2006 to 2009, 14,014 individuals were tested, and only 18 pregnant women were diagnosed with HIV infection, resulting in 0.15% annual inci-dence (95%CI: 0-0.33), significantly lower than in men (1.03; 95%CI: 0.45-1.61) and non-pregnant women (0.50; 95%CI: 0.11-0.89). Despite the low HIV-1 incidence in pregnant women, the high rate of recent infection detected during prenatal care emphasizes the need to increase measures to prevent vertical transmission.HIV-1; Incidence; Infectious Disease Vertical TransmissionNo Brasil, a epidemia do HIV-1 adquiriu novas caracteristicas ao longo do tempo, como o aumento da transmissao heterossexual e um declinio da razao homens:mulheres em casos de AIDS. Foi oferecida triagem para a infeccao pelo HIV a todos os pacientes atendidos no Centro de Testagem e Aconselhamento da cidade de Paulista, Regiao Metropolitana de Recife, Pernambuco, Nordeste do Brasil, com o objetivo de determinar a incidencia do HIV-1. Foi usado o enzimaimunoensaio de captura BED (BED-CEIA) para determinar a incidencia do HIV-1, comparando-o com o metodo de indice de avidez AxSYM (Ax-AI). No periodo analisado, 2006-2009, 14.014 pessoas foram testadas, e apenas 18 gestantes foram diagnosticadas para a infeccao por HIV, resultando em uma incidencia de 0,15% ao ano (IC95%: 0,00-0,33), significativamente menor do que os homens (1,03; IC95%: 0,45-1,61) e mulheres nao-gravidas (0,50; IC95%: 0,11-0,89). Apesar da baixa incidencia de HIV-1 entre as mulheres gravidas, a alta taxa de infeccao recente reforca cuidados no pre-natal para esta infeccao, para evitar a transmissao vertical.

Comparison among the BED capture enzyme immunoassay test and AxSYM avidity index assay for determining recent HIV infection and incidence in two Voluntary Counselling and Testing Centres in Northeast Brazil

The aims of this study were to compare the automated AxSYM avidity assay index with the BED capture enzyme immunoassay test and to calculate the HIV-1 incidence using the BED capture enzyme immunoassay and AxSYM avidity assay index algorithms within a population seeking the Voluntary Counselling and Testing Centres in two municipalities in the Metropolitan Region of Recife, Northeast of Brazil. An analysis was conducted in 365 samples that tested positive for HIV infection from frozen serum collected during the period 2006-2009. There was a similar proportion of males and females; most patients were heterosexual (86%) with a median age of 29 years. Of the 365 samples, 102 (28%) and 66 (18.1%) were identified as recent infections by BED capture enzyme immunoassay and AxSYM avidity assay index, respectively. The HIV-1 total incidence in the BED capture enzyme immunoassay and AxSYM avidity assay index algorithms were: 0.79 (95% CI: 0.60-0.98) and 0.34 (95% CI: -0.04 to 0.72), respectively. Incidence was higher among men. There was good agreement between the tests, with a kappa of 0.654 and a specificity of 95.8%. AxSYM avidity assay index may be helpful in improving the quality of the estimates of recent HIV infection and incidence, particularly when used in a combined algorithm with BED capture enzyme immunoassay.

Increase in human immunodeficiency virus 1 diversity and detection of various subtypes and recombinants in north-eastern Brazil

Purpose. Diverse human immunodeficiency virus 1 (HIV‐1) subtypes and circulating recombinant forms are found in Brazil. The majority of HIV‐1 molecular epidemiological studies in Brazil have been conducted in the southern and south‐eastern regions of the country, although several recent studies in the north‐eastern region have addressed this issue. The objective of this study was to molecularly characterize HIV‐1 circulating in Pernambuco, north‐eastern Brazil. Methodology. A total of 64 samples were collected from 2002 to 2003, and another 103 were collected from 2007 to 2009. The protease and partial reverse transcriptase regions of the HIV‐1 polymerase‐encoding (pol) gene were sequenced, and subtyping, recombination and phylogenetic analyses were performed. Results/Key findings. Subtype B (60.9%) was found to be predominant, followed by HIV‐1 F (31.4%). Several BF recombinants (4.2%), and BC and AG recombinants were also identified. The intra‐subtype genetic diversity was estimated to be 0.065 (sd±0.004) for HIV‐1 B and 0.055 (sd±0.004) for HIV‐1 F, reflecting a greater accumulation of mutations in subtype B (P<0.01). More codons were found to be under positive selective pressure in samples collected from 2007 to 2009, from individuals with a T‐cell count≥200 cells mm−3 and from women. Coalescence data indicated that the subtype F population has been continuously expanding. Conclusions. HIV‐1 shows high genetic diversity in the state of Pernambuco. Thus, additional molecular evaluations of circulating strains will provide a better understanding of the epidemic and may lead to more effective preventive strategies.

Incidencia del VIH-1 en personas atendidas, incluidas las mujeres embarazadas, en un centro de pruebas y asesoramiento en Pernambuco, Noreste de Brasil

The HIV-1 epidemic in Brazil has displayed new characteristics over time, with an increase in heterosexual transmission and a decline in the male-to-female ratio in AIDS cases. HIV screening was offered to patients attending the Voluntary Counseling and Testing Center in Paulista, Greater Metropolitan Recife, Pernambuco State, in Northeast Brazil, to determine HIV-1 incidence. BED capture enzyme immunoassay (BED-CEIA) was used to measure HIV-1 incidence, comparing it to the AxSYM avidity index method (Ax-AI). From 2006 to 2009, 14,014 individuals were tested, and only 18 pregnant women were diagnosed with HIV infection, resulting in 0.15% annual incidence (95%CI: 0-0.33), significantly lower than in men (1.03; 95%CI: 0.45-1.61) and non-pregnant women (0.50; 95%CI: 0.11-0.89). Despite the low HIV-1 incidence in pregnant women, the high rate of recent infection detected during prenatal care emphasizes the need to increase measures to prevent vertical transmission.Abstract The HIV-1 epidemic in Brazil has displayed new characteristics over time, with an increase in het-erosexual transmission and a decline in the male-to-female ratio in AIDS cases. HIV screening was offered to patients attending the Voluntary Coun-seling and Testing Center in Paulista, Greater Metropolitan Recife, Pernambuco State, in North-east Brazil, to determine HIV-1 incidence. BED capture enzyme immunoassay (BED-CEIA) was used to measure HIV-1 incidence, comparing it to the AxSYM avidity index method (Ax-AI). From 2006 to 2009, 14,014 individuals were tested, and only 18 pregnant women were diagnosed with HIV infection, resulting in 0.15% annual inci-dence (95%CI: 0-0.33), significantly lower than in men (1.03; 95%CI: 0.45-1.61) and non-pregnant women (0.50; 95%CI: 0.11-0.89). Despite the low HIV-1 incidence in pregnant women, the high rate of recent infection detected during prenatal care emphasizes the need to increase measures to prevent vertical transmission.HIV-1; Incidence; Infectious Disease Vertical TransmissionNo Brasil, a epidemia do HIV-1 adquiriu novas caracteristicas ao longo do tempo, como o aumento da transmissao heterossexual e um declinio da razao homens:mulheres em casos de AIDS. Foi oferecida triagem para a infeccao pelo HIV a todos os pacientes atendidos no Centro de Testagem e Aconselhamento da cidade de Paulista, Regiao Metropolitana de Recife, Pernambuco, Nordeste do Brasil, com o objetivo de determinar a incidencia do HIV-1. Foi usado o enzimaimunoensaio de captura BED (BED-CEIA) para determinar a incidencia do HIV-1, comparando-o com o metodo de indice de avidez AxSYM (Ax-AI). No periodo analisado, 2006-2009, 14.014 pessoas foram testadas, e apenas 18 gestantes foram diagnosticadas para a infeccao por HIV, resultando em uma incidencia de 0,15% ao ano (IC95%: 0,00-0,33), significativamente menor do que os homens (1,03; IC95%: 0,45-1,61) e mulheres nao-gravidas (0,50; IC95%: 0,11-0,89). Apesar da baixa incidencia de HIV-1 entre as mulheres gravidas, a alta taxa de infeccao recente reforca cuidados no pre-natal para esta infeccao, para evitar a transmissao vertical.

Incidência do HIV-1 em pessoas atendidas, incluindo gestantes, em um Centro de Testagem e Aconselhamento em Pernambuco, Nordeste do Brasil

The HIV-1 epidemic in Brazil has displayed new characteristics over time, with an increase in heterosexual transmission and a decline in the male-to-female ratio in AIDS cases. HIV screening was offered to patients attending the Voluntary Counseling and Testing Center in Paulista, Greater Metropolitan Recife, Pernambuco State, in Northeast Brazil, to determine HIV-1 incidence. BED capture enzyme immunoassay (BED-CEIA) was used to measure HIV-1 incidence, comparing it to the AxSYM avidity index method (Ax-AI). From 2006 to 2009, 14,014 individuals were tested, and only 18 pregnant women were diagnosed with HIV infection, resulting in 0.15% annual incidence (95%CI: 0-0.33), significantly lower than in men (1.03; 95%CI: 0.45-1.61) and non-pregnant women (0.50; 95%CI: 0.11-0.89). Despite the low HIV-1 incidence in pregnant women, the high rate of recent infection detected during prenatal care emphasizes the need to increase measures to prevent vertical transmission.Abstract The HIV-1 epidemic in Brazil has displayed new characteristics over time, with an increase in het-erosexual transmission and a decline in the male-to-female ratio in AIDS cases. HIV screening was offered to patients attending the Voluntary Coun-seling and Testing Center in Paulista, Greater Metropolitan Recife, Pernambuco State, in North-east Brazil, to determine HIV-1 incidence. BED capture enzyme immunoassay (BED-CEIA) was used to measure HIV-1 incidence, comparing it to the AxSYM avidity index method (Ax-AI). From 2006 to 2009, 14,014 individuals were tested, and only 18 pregnant women were diagnosed with HIV infection, resulting in 0.15% annual inci-dence (95%CI: 0-0.33), significantly lower than in men (1.03; 95%CI: 0.45-1.61) and non-pregnant women (0.50; 95%CI: 0.11-0.89). Despite the low HIV-1 incidence in pregnant women, the high rate of recent infection detected during prenatal care emphasizes the need to increase measures to prevent vertical transmission.HIV-1; Incidence; Infectious Disease Vertical TransmissionNo Brasil, a epidemia do HIV-1 adquiriu novas caracteristicas ao longo do tempo, como o aumento da transmissao heterossexual e um declinio da razao homens:mulheres em casos de AIDS. Foi oferecida triagem para a infeccao pelo HIV a todos os pacientes atendidos no Centro de Testagem e Aconselhamento da cidade de Paulista, Regiao Metropolitana de Recife, Pernambuco, Nordeste do Brasil, com o objetivo de determinar a incidencia do HIV-1. Foi usado o enzimaimunoensaio de captura BED (BED-CEIA) para determinar a incidencia do HIV-1, comparando-o com o metodo de indice de avidez AxSYM (Ax-AI). No periodo analisado, 2006-2009, 14.014 pessoas foram testadas, e apenas 18 gestantes foram diagnosticadas para a infeccao por HIV, resultando em uma incidencia de 0,15% ao ano (IC95%: 0,00-0,33), significativamente menor do que os homens (1,03; IC95%: 0,45-1,61) e mulheres nao-gravidas (0,50; IC95%: 0,11-0,89). Apesar da baixa incidencia de HIV-1 entre as mulheres gravidas, a alta taxa de infeccao recente reforca cuidados no pre-natal para esta infeccao, para evitar a transmissao vertical.

P3.256 Transmitted Resistance Among Individuals Recently Diagnosed with HIV/AIDS in the Metropolitan Region of Recife, Northeast of Brazil

Background The highly active anti-retroviral therapy (HAART) has increased survival of patients with HIV/AIDS. However, some individuals may present therapeutic failure due to a variety of factors, including transmitted antiretroviral resistance. Thus, the objective of the study was investigate frequency of primary resistance and recent infection among HIV-1 seropositive individuals at five Voluntary Counseling and Testing Centers (VCT) at Metropolitan Region of Recife in Northeast of Brazil. Methods For RNA transcription to cDNA and PCR amplification with genetic sequencing of the product was carried out using the TRUGENE® HIV-1 Genotyping Assay. The sequences were analysed using the software OpenGene® DNA Sequencing System and ARV resistance mutations and subtypes were submitted to the Stanford HIV Drug Resistance Database and further confirmed by SIMPLOT v.2. The BED Calypte® assay was carried out for detection of recent HIV infection. Results A total of 130 samples were analysed. Most participants were males (56%) and aged 31–50 years. Median T CD4+ lymphocyte was 408 cells/mm3 and viral load was 3,683 copies/ml. Primary resistance rate was 4.6%. Recent infection rate was 23%. Mutations associated with resistance to NNRTI, NRTI and PIs occurred in 3.84%, 1.53% and 0.77%, respectively. Conclusions The present study showed that 4.6% of the strains had transmitted antiretroviral resistance mutations, which coincides with the low resistance rates that have been found in Brazil. Despite a high prevalence of recent infection, there were no significant differences in the prevalence of mutations between the recent and chronic infection groups (p = 0.327).

P3.234 Prevalence and Estimated HIV-1 Incidence at Two Voluntary Counseling and Testing Centers in Northeast of Brazil

Background Estimates of incidence and prevalence are important tools for the investigation of regional trends of the HIV epidemic. Currently, the use of immunoassays for epidemiology investigation is referred by RITA (Recent Infection Testing Algorithm). This study aimed to determine the prevalence HIV-1 incidence in two Voluntary and Counseling Testing (VCT) Centers, in the Metropolitan Region of Recife - Northeast of Brazil, in the period from 2008 to 2009 Methods Demographics and behavioural data were obtained from 245 individuals diagnosed as HIV-positive among 19,451 volunteers screened from January 2008 to December 2009. The BED - CEIA was used for the determination of recent infection and estimate HIV-1 incidence. Results HIV-1 prevalence was 1.3% (95% CI: 1:14 to 1:46) and the corresponding HIV-1 estimated incidence was 0.71%/year (95% CI: 0.53–0.89). The males obtained a higher prevalence (2.6%, 95% CI: 2:13 to 3:07) and incidence (1.29%/year, 95% CI: 0.79–1.79) than females, whose prevalence was 0.8% (95% CI: 0.62 –0.98) and the incidence rate was 0.52%/year (95% CI: 0.34–0.70). A high rate of recent infection was observed in both genders (male: 25% female: 29.9%). Conclusions Our study shows a high rate of recent infection for HIV-1 in genders, as well as a high prevalence and incidence among males, indicating that prevention strategies in this population should be intensified.