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da Fonseca GC, Cavalcante LTF, Brustolini OJ, Luz PM, Pires DC, Jalil EM, Peixoto EM, Grinsztejn B, Veloso VG, Nazer S, Costa CAM, Villela DAM, Goedert GT, Santos CVBD, Rodrigues NCP, do Couto Motta F, Siqueira MM, Coelho LE, Struchiner CJ, Vasconcelos ATR. Differential Type-I Interferon Response in Buffy Coat Transcriptome of Individuals Infected with SARS-CoV-2 Gamma and Delta Variants. Int J Mol Sci 2023; 24:13146. [PMID: 37685953 PMCID: PMC10487928 DOI: 10.3390/ijms241713146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/07/2023] [Accepted: 08/20/2023] [Indexed: 09/10/2023] Open
Abstract
The innate immune system is the first line of defense against pathogens such as the acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The type I-interferon (IFN) response activation during the initial steps of infection is essential to prevent viral replication and tissue damage. SARS-CoV and SARS-CoV-2 can inhibit this activation, and individuals with a dysregulated IFN-I response are more likely to develop severe disease. Several mutations in different variants of SARS-CoV-2 have shown the potential to interfere with the immune system. Here, we evaluated the buffy coat transcriptome of individuals infected with Gamma or Delta variants of SARS-CoV-2. The Delta transcriptome presents more genes enriched in the innate immune response and Gamma in the adaptive immune response. Interactome and enriched promoter analysis showed that Delta could activate the INF-I response more effectively than Gamma. Two mutations in the N protein and one in the nsp6 protein found exclusively in Gamma have already been described as inhibitors of the interferon response pathway. This indicates that the Gamma variant evolved to evade the IFN-I response. Accordingly, in this work, we showed one of the mechanisms that variants of SARS-CoV-2 can use to avoid or interfere with the host Immune system.
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Affiliation(s)
- Guilherme C. da Fonseca
- Laboratório de Bioinformática, Laboratório Nacional de Computação Científica, Petrópolis, Rio de Janeiro 25651-076, Brazil; (G.C.d.F.); (L.T.F.C.); (O.J.B.)
| | - Liliane T. F. Cavalcante
- Laboratório de Bioinformática, Laboratório Nacional de Computação Científica, Petrópolis, Rio de Janeiro 25651-076, Brazil; (G.C.d.F.); (L.T.F.C.); (O.J.B.)
| | - Otávio J. Brustolini
- Laboratório de Bioinformática, Laboratório Nacional de Computação Científica, Petrópolis, Rio de Janeiro 25651-076, Brazil; (G.C.d.F.); (L.T.F.C.); (O.J.B.)
| | - Paula M. Luz
- Instituto Nacional de Infectologia Evandro Chagas, FIOCRUZ, Rio de Janeiro 21040-360, Brazil; (P.M.L.); (D.C.P.); (E.M.J.); (E.M.P.); (B.G.); (V.G.V.); (S.N.); (L.E.C.)
| | - Debora C. Pires
- Instituto Nacional de Infectologia Evandro Chagas, FIOCRUZ, Rio de Janeiro 21040-360, Brazil; (P.M.L.); (D.C.P.); (E.M.J.); (E.M.P.); (B.G.); (V.G.V.); (S.N.); (L.E.C.)
| | - Emilia M. Jalil
- Instituto Nacional de Infectologia Evandro Chagas, FIOCRUZ, Rio de Janeiro 21040-360, Brazil; (P.M.L.); (D.C.P.); (E.M.J.); (E.M.P.); (B.G.); (V.G.V.); (S.N.); (L.E.C.)
| | - Eduardo M. Peixoto
- Instituto Nacional de Infectologia Evandro Chagas, FIOCRUZ, Rio de Janeiro 21040-360, Brazil; (P.M.L.); (D.C.P.); (E.M.J.); (E.M.P.); (B.G.); (V.G.V.); (S.N.); (L.E.C.)
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, FIOCRUZ, Rio de Janeiro 21040-360, Brazil; (P.M.L.); (D.C.P.); (E.M.J.); (E.M.P.); (B.G.); (V.G.V.); (S.N.); (L.E.C.)
| | - Valdilea G. Veloso
- Instituto Nacional de Infectologia Evandro Chagas, FIOCRUZ, Rio de Janeiro 21040-360, Brazil; (P.M.L.); (D.C.P.); (E.M.J.); (E.M.P.); (B.G.); (V.G.V.); (S.N.); (L.E.C.)
| | - Sandro Nazer
- Instituto Nacional de Infectologia Evandro Chagas, FIOCRUZ, Rio de Janeiro 21040-360, Brazil; (P.M.L.); (D.C.P.); (E.M.J.); (E.M.P.); (B.G.); (V.G.V.); (S.N.); (L.E.C.)
| | - Carlos A. M. Costa
- Escola Nacional de Saúde Pública, FIOCRUZ, Rio de Janeiro 21041-210, Brazil; (C.A.M.C.); (N.C.P.R.)
| | - Daniel A. M. Villela
- Programa de Computação Científica (PROCC), FIOCRUZ, Rio de Janeiro 21040-900, Brazil;
| | - Guilherme T. Goedert
- Escola de Matemática Aplicada (EMAp), Fundação Getúlio Vargas, Rio de Janeiro 22250-900, Brazil;
| | - Cleber V. B. D. Santos
- Instituto de Medicina Social Hesio Cordeiro (IMS), Universidade do Estado do Rio de Janeiro, Rio de Janeiro 20550-013, Brazil;
| | - Nadia C. P. Rodrigues
- Escola Nacional de Saúde Pública, FIOCRUZ, Rio de Janeiro 21041-210, Brazil; (C.A.M.C.); (N.C.P.R.)
- Instituto de Medicina Social Hesio Cordeiro (IMS), Universidade do Estado do Rio de Janeiro, Rio de Janeiro 20550-013, Brazil;
| | | | | | - Lara E. Coelho
- Instituto Nacional de Infectologia Evandro Chagas, FIOCRUZ, Rio de Janeiro 21040-360, Brazil; (P.M.L.); (D.C.P.); (E.M.J.); (E.M.P.); (B.G.); (V.G.V.); (S.N.); (L.E.C.)
| | - Claudio J. Struchiner
- Escola de Matemática Aplicada (EMAp), Fundação Getúlio Vargas, Rio de Janeiro 22250-900, Brazil;
- Instituto Oswaldo Cruz, FIOCRUZ, Rio de Janeiro 21040-360, Brazil; (F.d.C.M.); (M.M.S.)
| | - Ana Tereza R. Vasconcelos
- Laboratório de Bioinformática, Laboratório Nacional de Computação Científica, Petrópolis, Rio de Janeiro 25651-076, Brazil; (G.C.d.F.); (L.T.F.C.); (O.J.B.)
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2
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Agyemang N, Scarsi KK, Baker P, Smeaton LM, Podany AT, Olefsky M, Woolley E, Barr E, Pham M, Mawlana S, Supparatpinyo K, Gatechompol S, Jalil EM, Gadama L, Badal-Faesen S, Van Schalkwyk M, Kayama C, Belaunzaran-Zamudio PF, Godfrey C, Cohn SE, Mngqibisa R, Haas DW. Pharmacogenetic interactions of efavirenz or rifampin and isoniazid with levonorgestrel emergency contraception during treatment of HIV or tuberculosis. Pharmacogenet Genomics 2023; 33:126-135. [PMID: 37306344 PMCID: PMC10309098 DOI: 10.1097/fpc.0000000000000501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 05/16/2023] [Indexed: 06/13/2023]
Abstract
OBJECTIVE In AIDS Clinical Trials Group study A5375, a pharmacokinetic trial of levonorgestrel emergency contraception, double-dose levonorgestrel (3 mg, versus standard dose 1.5 mg) offset the induction effects of efavirenz or rifampin on plasma levonorgestrel exposure over 8 h post-dose (AUC 0-8h ). We characterized the pharmacogenetics of these interactions. METHODS Cisgender women receiving efavirenz- or dolutegravir-based HIV therapy, or on isoniazid-rifampin for tuberculosis, were followed after a single oral dose of levonorgestrel. Linear regression models, adjusted for BMI and age, characterized associations of CYP2B6 and NAT2 genotypes (which affect plasma efavirenz and isoniazid exposure, respectively) with levonorgestrel pharmacokinetic parameters. RESULTS Of 118 evaluable participants, 17 received efavirenz/levonorgestrel 1.5 mg, 35 efavirenz/levonorgestrel 3 mg, 34 isoniazid-rifampin/levonorgestrel 3 mg, and 32 (control group) dolutegravir/levonorgestrel 1.5 mg. There were 73 Black and 33 Asian participants. Regardless of genotype, women on efavirenz and isoniazid-rifampin had higher levonorgestrel clearance. In the efavirenz/levonorgestrel 3 mg group, CYP2B6 normal/intermediate metabolizers had levonorgestrel AUC 0-8h values similar to controls, while CYP2B6 poor metabolizers had AUC 0-8h values of 40% lower than controls. In the isoniazid-rifampin group, NAT2 rapid/intermediate acetylators had levonorgestrel AUC 0-8h values similar to controls, while NAT2 slow acetylators had AUC 0-8h values 36% higher than controls. CONCLUSION CYP2B6 poor metabolizer genotypes exacerbate the efavirenz-levonorgestrel interaction, likely by increased CYP3A induction with higher efavirenz exposure, making the interaction more difficult to overcome. NAT2 slow acetylator genotypes attenuate the rifampin-levonorgestrel interaction, likely by increased CYP3A inhibition with higher isoniazid exposure.
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Affiliation(s)
- Nana Agyemang
- Tufts University School of Medicine, Boston, Massachusetts
| | - Kimberly K. Scarsi
- College of Pharmacy, University of Nebraska Medical Center, Omaha, Nebraska
| | - Paxton Baker
- Vanderbilt Technologies for Advanced Genomics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Laura M. Smeaton
- Center for Biostatistics in AIDS Research, Harvard TH Chan School of Public Health; Boston, Massachusetts
| | - Anthony T. Podany
- College of Pharmacy, University of Nebraska Medical Center, Omaha, Nebraska
| | - Maxine Olefsky
- Center for Biostatistics in AIDS Research, Harvard TH Chan School of Public Health; Boston, Massachusetts
| | | | - Elizabeth Barr
- Office of Research on Women’s Health, National Institutes of Health, Bethesda, Maryland, USA
| | - Michelle Pham
- College of Pharmacy, University of Nebraska Medical Center, Omaha, Nebraska
| | - Sajeeda Mawlana
- Enhancing Care Foundation, Wentworth Hospital, Durban, South Africa
| | | | | | - Emilia M. Jalil
- Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, Brazil
| | - Luis Gadama
- Johns Hopkins Research Project, Blantyre, Malawi
| | - Sharlaa Badal-Faesen
- Clinical HIV Research Unit, Faculty of Health Sciences, University of Witwatersrand, Johannesburg
| | - Marije Van Schalkwyk
- Family Center for Research with Ubuntu, Division of Infectious Diseases, Department of Medicine, Stellenbosch University, Cape Town, South Africa
| | - Cecelia Kayama
- University of North Carolina Project-Malawi, Lilongwe, Malawi
| | | | - Catherine Godfrey
- Office of the Global AIDS Coordinator, Department of State, Washington, DC
| | - Susan E. Cohn
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Rosie Mngqibisa
- Enhancing Care Foundation, Wentworth Hospital, Durban, South Africa
| | - David W. Haas
- Department of Medicine, Vanderbilt University School of Medicine
- Department of Internal Medicine, Meharry Medical College, Nashville, Tennessee, USA
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3
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Scarsi KK, Smeaton LM, Podany AT, Olefsky M, Woolley E, Barr E, Pham M, Mawlana S, Supparatpinyo K, Gatechompol S, Jalil EM, Gadama L, Badal-Faesen S, Belaunzaran-Zamudio PF, Godfrey C, Cohn SE, Mngqibisa R. Pharmacokinetics of dose-adjusted levonorgestrel emergency contraception combined with efavirenz-based antiretroviral therapy or rifampicin-containing tuberculosis regimens. Contraception 2023; 121:109951. [PMID: 36641094 PMCID: PMC10187685 DOI: 10.1016/j.contraception.2023.109951] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 12/09/2022] [Accepted: 12/19/2022] [Indexed: 01/13/2023]
Abstract
OBJECTIVES To determine if double-dose levonorgestrel emergency contraception (EC) in combination with efavirenz or rifampicin, 2 drugs known to decrease levonorgestrel exposure, resulted in similar pharmacokinetics compared to standard-dose levonorgestrel EC without drug-drug interactions. STUDY DESIGN We conducted a phase 2, open-label, multicenter, partially randomized, 4 parallel group trial in pre-menopausal females ≥16 years old without an indication for EC and not on hormonal contraception. Participants on dolutegravir-based antiretroviral therapy (ART) received levonorgestrel 1.5 mg (control group); those on rifampicin-containing tuberculosis therapy received levonorgestrel 3 mg; those on efavirenz-based ART were randomized 1:2 to levonorgestrel 1.5 mg or 3 mg. Plasma was collected through 48 hours post-dose to assess levonorgestrel pharmacokinetics. Area under the concentration-time curve (AUC) over 8 hours was the primary outcome. Levonorgestrel pharmacokinetic parameters were compared between groups using geometric mean ratios (GMR) with 90% confidence intervals. RESULTS The median (Q1, Q3) age for all participants (n = 118) was 34 (27, 41) years and BMI was 23.2 (20, 26.3) kg/m2. Participants receiving levonorgestrel 1.5mg plus efavirenz (n = 17) had 50% lower AUC0-8h compared to the control group (n = 32) [0.50 (0.40, 0.62)]. Participants receiving levonorgestrel 3 mg had a similar AUC0-8h when receiving either efavirenz (n = 35) [0.99 (0.81, 1.20)] or rifampicin (n = 34) [1.16 (0.99, 1.36)] compared to control. Levonorgestrel 3 mg resulted in similar or higher maximum concentration with either efavirenz [1.17 (0.96, 1.41)] or rifampicin [1.27 (1.09, 1.49)] compared to the control group. CONCLUSIONS Doubling the dose of levonorgestrel EC successfully increased levonorgestrel exposure over the first 8 hours in participants receiving either efavirenz-based ART or rifampicin-containing tuberculosis therapy. IMPLICATIONS Adjusting levonorgestrel emergency contraception from 1.5 mg to 3 mg improves levonorgestrel pharmacokinetic exposure in participants receiving either efavirenz-based antiretroviral regimens or rifampicin-containing tuberculosis therapy. These data support guideline recommendations to double the dose of levonorgestrel emergency contraception in persons on medications that decrease levonorgestrel exposure by inducing levonorgestrel metabolism.
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Affiliation(s)
- Kimberly K Scarsi
- College of Pharmacy, University of Nebraska Medical Center; Omaha, NE, United States.
| | - Laura M Smeaton
- Center for Biostatistics in AIDS Research, Harvard TH Chan School of Public Health; Boston, MA, United States
| | - Anthony T Podany
- College of Pharmacy, University of Nebraska Medical Center; Omaha, NE, United States
| | - Maxine Olefsky
- Center for Biostatistics in AIDS Research, Harvard TH Chan School of Public Health; Boston, MA, United States
| | | | - Elizabeth Barr
- Office of Research on Women's Health, National Institutes of Health, Bethesda, MD, United States
| | - Michelle Pham
- College of Pharmacy, University of Nebraska Medical Center; Omaha, NE, United States
| | - Sajeeda Mawlana
- Enhancing Care Foundation, Wentworth Hospital, Durban, South Africa
| | | | | | - Emilia M Jalil
- Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, Brazil
| | - Luis Gadama
- Johns Hopkins Research Project, Blantyre, Malawi
| | - Sharlaa Badal-Faesen
- Clinical HIV Research Unit, Faculty of Health Sciences, University of Witwatersrand, South Africa
| | - Pablo F Belaunzaran-Zamudio
- Contractor, Division of AIDS, National Institute of Allergy and Infectious Diseases; Bethesda, MD, United States
| | | | - Susan E Cohn
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Rosie Mngqibisa
- Enhancing Care Foundation, Wentworth Hospital, Durban, South Africa
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4
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Coelho LE, Torres TS, Jalil EM, Cardoso SW, Moreira RI, Calvet GA, Pacheco AG, Veloso VG, Grinsztejn B, Luz PM. Mortality rates by gender and sexual orientation reveal a disproportionally high mortality among cisgender men of unknown sexual orientation and men who have sex with women in a cohort of people living with HIV in Rio de Janeiro, Brazil. Braz J Infect Dis 2023; 27:102740. [PMID: 36736374 PMCID: PMC9931919 DOI: 10.1016/j.bjid.2023.102740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 12/05/2022] [Accepted: 01/05/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Antiretroviral therapy use has led to a decline in HIV-related mortality yet disparities by gender and/or sexual orientation may exist. In this study, we estimated hazards of death in people living with HIV (PLWH) according to gender and sexual orientation. METHODS We included PLWH ≥ 18 years enrolled between 2000 and 2018 at INI/Fiocruz, Rio de Janeiro, Brazil. Participants were grouped as cisgender or transgender women, cisgender men who have sex with men (MSM) or men who have sex with women, or cisgender men with unknown sexual orientation. We assessed disparities in the hazard of death using Cox proportional hazards models. RESULTS Among 5,576 PLWH, median age at enrollment was 35 years, 39% were MSM, 28% cisgender women, 23% men who have sex with women, 5% transgender women, and 5% men with unknown sexual orientation. A total of 795 deaths occurred in 39,141 person-years of follow-up. Mortality rates per 1,000 person-years were: 82.4 for men with unknown sexual orientation, 24.5 for men who have sex with women, 18.3 for cisgender, 16.6 for transgender women, and 15.1 for MSM. Compared to MSM, men with unknown sexual orientation had the highest death hazard ratio (adjusted hazard ratio [aHR] 2.93, 95% confidence interval [CI] 2.35-3.81), followed by men who have sex with women (aHR 1.17, 95%CI 0.96, 1.43); death hazard ratios for cisgender and transgender women were not statistically different. CONCLUSION We observed disparities in the hazard of death for men with unknown sexual orientation and men who have sex with women despite universal access to antiretroviral therapy in Brazil. Future work should characterize and assist men with unknown sexual orientation with tailored policies and interventions. Increased hazard of death was not observed for transgender women, which probably results from interventions implemented in our service to reach, engage, retain, and support this population.
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Affiliation(s)
- Lara E Coelho
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brazil.
| | - Thiago S Torres
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brazil
| | - Emilia M Jalil
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brazil
| | - Sandra W Cardoso
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brazil
| | - Ronaldo I Moreira
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brazil
| | - Guilherme A Calvet
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brazil
| | - Antônio G Pacheco
- Fundação Oswaldo Cruz, Programa de Computação Científica, Rio de Janeiro, RJ, Brazil
| | - Valdiléa G Veloso
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brazil
| | - Beatriz Grinsztejn
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brazil
| | - Paula M Luz
- Fundação Oswaldo Cruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, RJ, Brazil
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5
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Coelho LE, Luz PM, Pires DC, Jalil EM, Perazzo H, Torres TS, Cardoso SW, Peixoto EM, Nazer S, Massad E, Silveira MF, Barros FC, Vasconcelos AT, Costa CA, Amancio RT, Villela DA, Pereira T, Goedert GT, Santos CV, Rodrigues NC, Grinsztejn B, Veloso VG, Struchiner CJ. Prevalence and predictors of anti-SARS-CoV-2 serology in a highly vulnerable population of Rio de Janeiro: A population-based serosurvey. The Lancet Regional Health - Americas 2022; 15:100338. [PMID: 35936224 PMCID: PMC9337985 DOI: 10.1016/j.lana.2022.100338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background COVID-19 serosurveys allow for the monitoring of the level of SARS-CoV-2 transmission and support data-driven decisions. We estimated the seroprevalence of anti-SARS-CoV-2 antibodies in a large favela complex in Rio de Janeiro, Brazil. Methods A population-based panel study was conducted in Complexo de Manguinhos (16 favelas) with a probabilistic sampling of participants aged ≥1 year who were randomly selected from a census of individuals registered in primary health care clinics that serve the area. Participants answered a structured interview and provided blood samples for serology. Multilevel regression models (with random intercepts to account for participants’ favela of residence) were used to assess factors associated with having anti-S IgG antibodies. Secondary analyses estimated seroprevalence using an additional anti-N IgG assay. Findings 4,033 participants were included (from Sep/2020 to Feb/2021, 22 epidemic weeks), the median age was 39·8 years (IQR:21·8-57·7), 61% were female, 41% were mixed-race (Pardo) and 23% Black. Overall prevalence was 49·0% (95%CI:46·8%-51·2%) which varied across favelas (from 68·3% to 31·4%). Lower prevalence estimates were found when using the anti-N IgG assay. Odds of having anti-S IgG antibodies were highest for young adults, and those reporting larger household size, poor adherence to social distancing and use of public transportation. Interpretation We found a significantly higher prevalence of anti-S IgG antibodies than initially anticipated. Disparities in estimates obtained using different serological assays highlight the need for cautious interpretation of serosurveys estimates given the heterogeneity of exposure in communities, loss of immunological biomarkers, serological antigen target, and variant-specific test affinity. Funding Fundação Oswaldo Cruz, Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Fundação de Amparo a Pesquisa do Estado do Rio de Janeiro (FAPERJ), the European Union's Horizon 2020 research and innovation programme, Royal Society, Serrapilheira Institute, and FAPESP.
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6
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Konda KA, Torres TS, Mariño G, Ramos A, Moreira RI, Leite IC, Cunha M, Jalil EM, Hoagland B, Guanira JV, Benedetti M, Pimenta C, Vermandere H, Bautista‐Arredondo S, Vega‐Ramirez H, Veloso VG, Caceres CF, Grinsztejn B. Factors associated with long-term HIV pre-exposure prophylaxis engagement and adherence among transgender women in Brazil, Mexico and Peru: results from the ImPrEP study. J Int AIDS Soc 2022; 25 Suppl 5:e25974. [PMID: 36225148 PMCID: PMC9557020 DOI: 10.1002/jia2.25974] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 07/19/2022] [Indexed: 11/06/2022] Open
Abstract
Introduction The HIV epidemic continues to disproportionately impact Latin‐American transgender women (TGW). We assessed factors associated with long‐term pre‐exposure prophylaxis (PrEP) engagement and adherence among TGW enrolled in the Implementation of PrEP (ImPrEP) study, the largest PrEP demonstration study in Latin America. Methods HIV‐negative TGW aged ≥18 years reporting 1+eligibility criteria in the 6 months prior to enrolment (e.g. sex partner known to be living with HIV, condomless anal sex [CAS], transactional sex or having a sexually transmitted infection [STI]) who could safely take PrEP were enrolled. Follow‐up visits were conducted at 4 weeks and then quarterly. We conducted logistic regression to identify factors associated with long‐term PrEP engagement (3+ follow‐up visits in 52 weeks) and complete self‐reported adherence (no missed pills in the past 30 days) during follow‐up. For both outcomes, we constructed multivariable models controlling for country, socio‐demographics, sexual behaviour, substance use, STIs and self‐reported adherence at 4 weeks (long‐term engagement outcome only). Results From March 2018 to June 2021, ImPrEP screened 519 TGW, enrolled 494 (Brazil: 190, Mexico: 66 and Peru: 238) and followed them for 52 weeks. At baseline, 27.5% of TGW were aged 18–24 years, 67.8% were mixed‐race and 31.6% had >secondary education. Most, 89.9% reported CAS, 61.9% had >10 sex partners and 71.9% reported transactional sex. HIV incidence was 1.82 cases per 100 person‐years (95% confidence interval [CI]: 0.76–4.38). Almost half of TGW (48.6%) had long‐term PrEP engagement, which was positively associated with reporting complete adherence at week 4 (aOR:2.94 [95%CI:1.88–4.63]) and was inversely associated with reporting CAS with unknown‐HIV partner (aOR:0.52 [95%CI:0.34–0.81]), migration (aOR:0.54 [95%CI:0.34–0.84]), and being from Mexico (aOR:0.28 [95%CI:0.14–0.53]). Self‐reported adherence was associated with TGW aged >34 (aOR:1.61 [95%CI:1.10–2.34]) compared to those aged 25–34 and those with >secondary education (aOR:1.55 [95%CI:1.10–2.19]) and was lower among TGW from Peru (aOR:0.29 [95%CI:0.21–0.41]) or reporting PrEP‐related adverse effects (aOR:0.63 [95%CI:0.42–0.92]). Conclusions Although TGW were willing to enrol in ImPrEP, long‐term PrEP engagement and complete self‐reported adherence were limited, and HIV incidence remained relatively high. A successful HIV prevention agenda should include trans‐specific interventions supporting oral PrEP and exploring long‐acting PrEP strategies for TGW.
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Affiliation(s)
- Kelika A. Konda
- Universidad Peruana Cayetano Heredia, Centro de Investigaciones Interdisciplinaria en Salud, Sexualidad, y SIDALimaPeru
| | - Thiago S. Torres
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI‐Fiocruz)Rio de JaneiroBrazil
| | - Gabriela Mariño
- Universidad Peruana Cayetano Heredia, Centro de Investigaciones Interdisciplinaria en Salud, Sexualidad, y SIDALimaPeru
| | - Alessandra Ramos
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI‐Fiocruz)Rio de JaneiroBrazil
| | - Ronaldo I. Moreira
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI‐Fiocruz)Rio de JaneiroBrazil
| | - Iuri C. Leite
- Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz (ENSP‐Fiocruz)Rio de JaneiroBrazil
| | - Marcelo Cunha
- Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz (ENSP‐Fiocruz)Rio de JaneiroBrazil
| | - Emilia M. Jalil
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI‐Fiocruz)Rio de JaneiroBrazil
| | - Brenda Hoagland
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI‐Fiocruz)Rio de JaneiroBrazil
| | - Juan V. Guanira
- Universidad Peruana Cayetano Heredia, Centro de Investigaciones Interdisciplinaria en Salud, Sexualidad, y SIDALimaPeru
| | - Marcos Benedetti
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI‐Fiocruz)Rio de JaneiroBrazil
| | | | | | | | - Hamid Vega‐Ramirez
- Instituto Nacional de Psiquiatria Ramon de la Fuente MuñizMexico CityMexico
| | - Valdilea G. Veloso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI‐Fiocruz)Rio de JaneiroBrazil
| | - Carlos F. Caceres
- Universidad Peruana Cayetano Heredia, Centro de Investigaciones Interdisciplinaria en Salud, Sexualidad, y SIDALimaPeru
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI‐Fiocruz)Rio de JaneiroBrazil
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Jalil EM, Torres TS, Luz PM, Monteiro L, Moreira RI, de Castro CRV, Leite IDC, Cunha M, de Cássia Elias Estrela R, Ramos M, Hoagland B, Wagner Cardoso S, Anderson P, Veloso VG, Wilson E, Grinsztejn B. Low PrEP adherence despite high retention among transgender women in Brazil: the PrEParadas study. J Int AIDS Soc 2022; 25:e25896. [PMID: 35255199 PMCID: PMC8901149 DOI: 10.1002/jia2.25896] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 02/08/2022] [Indexed: 01/03/2023] Open
Abstract
Introduction We aimed to evaluate daily oral pre‐exposure prophylaxis (PrEP) uptake, retention, and adherence and predictors of study non‐attendance and low PrEP adherence in a Brazilian trans‐specific 48‐week study (PrEParadas). Methods We enrolled transgender women (TGW) engaging in high‐risk sexual behaviours between August 2017 and December 2018. PrEP adherence was based on tenofovir diphosphate concentrations in dried blood spots (DBS). We used random effects logistic regression models and ordinal models to estimate the odds of having a missed visit and of low PrEP adherence, respectively. Multivariable models were adjusted for variables with p‐value<0.10 in the univariate analysis. Results From the 271 eligible, 130 participants were enrolled in the study (PrEP uptake: 48%), out of which 111 (85.4%) were retained at 48 weeks. Multivariable model for study non‐attendance included study visit, age, main sexual partner and stimulant use. The odds of missing a visit increased after the week 24. Participants aged 18–24 (adjusted odds ratio [aOR] = 8.76, 95% CI: 2.09–36.7) and 25–34 years (aOR = 6.79, 95% CI: 1.72–26.8) compared to TGW aged 35+ years had significantly higher odds of having a missed visit. The odds of a missed visit were higher among participants reporting stimulant use (aOR = 4.99, 95% CI: 1.37–18.1) compared to no stimulant use. DBS levels at week 48 showed that 42 (38.5%), 14 (12.8%) and 53 (48.6%) of 109 participants had low, moderate and high PrEP adherence. Multivariable model for low PrEP adherence included study visit, age, schooling, race/colour, housing, binge drinking, stimulant use, feminizing hormone therapy (FHT) use and received text message. Low PrEP adherence was significantly higher among participants with less years of schooling (aOR = 6.71, 95% CI: 1.30–34.5) and had a borderline association with Black colour/race (aOR = 6.72, 95% CI: 0.94–47.8). Participants using the FHT available at the site had decreased odds of low PrEP adherence (aOR = 0.38, 95% CI: 0.16–0.88). No participant seroconverted over the course of the study. Conclusions Although high PrEP retention can be achieved in a gender‐affirming setting, PrEP adherence may be an important challenge faced among TGW due to social disparities. The scale‐up of prevention tools like PrEP will have to address systemic social determinants as these stand as important barriers for TGW's access to health services.
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Affiliation(s)
- Emilia M Jalil
- National Institute of Infectious Diseases Evandro Chagas, Fiocruz, Rio de Janeiro, Brazil
| | - Thiago S Torres
- National Institute of Infectious Diseases Evandro Chagas, Fiocruz, Rio de Janeiro, Brazil
| | - Paula M Luz
- National Institute of Infectious Diseases Evandro Chagas, Fiocruz, Rio de Janeiro, Brazil
| | - Laylla Monteiro
- National Institute of Infectious Diseases Evandro Chagas, Fiocruz, Rio de Janeiro, Brazil
| | - Ronaldo I Moreira
- National Institute of Infectious Diseases Evandro Chagas, Fiocruz, Rio de Janeiro, Brazil
| | | | - Iuri da C Leite
- Escola Nacional de Saude Publica, Fiocruz, Rio de Janeiro, Brazil
| | - Marcello Cunha
- Escola Nacional de Saude Publica, Fiocruz, Rio de Janeiro, Brazil
| | | | - Michelle Ramos
- National Institute of Infectious Diseases Evandro Chagas, Fiocruz, Rio de Janeiro, Brazil
| | - Brenda Hoagland
- National Institute of Infectious Diseases Evandro Chagas, Fiocruz, Rio de Janeiro, Brazil
| | - Sandra Wagner Cardoso
- National Institute of Infectious Diseases Evandro Chagas, Fiocruz, Rio de Janeiro, Brazil
| | - Peter Anderson
- Department of Pharmaceutical Sciences, University of Colorado, Aurora, Colorado, USA
| | - Valdilea G Veloso
- National Institute of Infectious Diseases Evandro Chagas, Fiocruz, Rio de Janeiro, Brazil
| | - Erin Wilson
- San Francisco Department of Public Health, San Francisco, California, USA
| | - Beatriz Grinsztejn
- National Institute of Infectious Diseases Evandro Chagas, Fiocruz, Rio de Janeiro, Brazil
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- National Institute of Infectious Diseases Evandro Chagas, Fiocruz, Rio de Janeiro, Brazil
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8
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Bezerra DRB, Jalil CM, Jalil EM, Coelho LE, Carvalheira E, Freitas J, Monteiro L, Santos T, Souza C, Hoagland B, Veloso VG, Grinsztejn B, Cardoso SW, Torres TS. Complementary Recruitment Strategies to Reach Men Who Have Sex with Men and Transgender Women: The Experience of a Large Brazilian HIV Prevention Service. AIDS Behav 2022; 26:2643-2652. [PMID: 35122578 DOI: 10.1007/s10461-022-03609-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2022] [Indexed: 11/29/2022]
Abstract
Different strategies have been used to reach men who have sex with men (MSM) and transgender women (TGW) for HIV prevention services. We described the characteristics of MSM and TGW attending a large HIV prevention service in Brazil according to different recruitment strategies or referrals. A total of 2713 individuals (2246[82.8%] MSM and 467[17.2%] TGW) attended the service. Among HIV-negative MSM and TGW, 74.6% and 82.8% were eligible for pre-exposure prophylaxis (PrEP), respectively. PrEP uptake among MSM and TGW was 56.4% and 39.1%, respectively. Participants were mostly referred by peers (43.6%), followed by web-based (24.1%) and venue-based recruitment (16.2%). More young and Black MSM were referred from venue-based recruitment, and web-based strategies more frequently referred MSM with higher education. TGW who were younger and had higher education were more frequently referred from venue-based recruitment. Web-based recruitment failed to reach TGW. Multiple strategies were complementary to reach diverse MSM and TGW populations.
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Affiliation(s)
- Daniel R B Bezerra
- STD/AIDS Clinical Research Lab (LapClin-AIDS), Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Cristina M Jalil
- STD/AIDS Clinical Research Lab (LapClin-AIDS), Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Emilia M Jalil
- STD/AIDS Clinical Research Lab (LapClin-AIDS), Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Lara E Coelho
- STD/AIDS Clinical Research Lab (LapClin-AIDS), Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Eduardo Carvalheira
- STD/AIDS Clinical Research Lab (LapClin-AIDS), Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Josias Freitas
- STD/AIDS Clinical Research Lab (LapClin-AIDS), Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Laylla Monteiro
- STD/AIDS Clinical Research Lab (LapClin-AIDS), Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Toni Santos
- STD/AIDS Clinical Research Lab (LapClin-AIDS), Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Cleo Souza
- STD/AIDS Clinical Research Lab (LapClin-AIDS), Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Brenda Hoagland
- STD/AIDS Clinical Research Lab (LapClin-AIDS), Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Valdilea G Veloso
- STD/AIDS Clinical Research Lab (LapClin-AIDS), Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Beatriz Grinsztejn
- STD/AIDS Clinical Research Lab (LapClin-AIDS), Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Sandra W Cardoso
- STD/AIDS Clinical Research Lab (LapClin-AIDS), Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Thiago S Torres
- STD/AIDS Clinical Research Lab (LapClin-AIDS), Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI-Fiocruz), Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil.
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9
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Luz PM, Jalil EM, Castilho J, Velasque L, Ramos M, Ferreira ACG, Ferreira AL, Wilson EC, Veloso VG, Thombs BD, Moodie EE, Grinsztejn B. Association of Discrimination, Violence, and Resilience with Depressive Symptoms Among Transgender Women in Rio de Janeiro, Brazil: A Cross-Sectional Analysis. Transgend Health 2022; 7:101-106. [PMID: 35224191 PMCID: PMC8867219 DOI: 10.1089/trgh.2020.0171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Transgender women experience violence and discrimination that lead to stress responses and contribute to poor mental health. In this analysis of baseline data from Transcendendo, a trans-specific open cohort in Rio de Janeiro, Brazil, we hypothesized that the experience of discrimination and violence would be associated with depressive symptoms and that resilience could mitigate this association. Results showed that prior experiences with discrimination and sexual and physical violence were associated with depressive symptoms, while resilience was inversely associated with depressive symptoms. Resilience did not moderate nor mediate the strong effects of discrimination and violence on depressive symptoms in adjusted models.
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Affiliation(s)
- Paula M. Luz
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Emilia M. Jalil
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | | | - Luciane Velasque
- Centro de Ciências Exatas e Tecnologia, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Michelle Ramos
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Ana Cristina G. Ferreira
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Ana Luisa Ferreira
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Erin C. Wilson
- San Francisco Department of Public Health, San Francisco, California, USA
| | - Valdilea G. Veloso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Brett D. Thombs
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
- Department of Psychiatry, and Biomedical Ethics Unit, McGill University, Montreal, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, and Biomedical Ethics Unit, McGill University, Montreal, Canada
- Department of Medicine, and Biomedical Ethics Unit, McGill University, Montreal, Canada
- Department of Psychology, and and Biomedical Ethics Unit, McGill University, Montreal, Canada
| | - Erica E.M. Moodie
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
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10
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Coelho LE, Torres TS, Veloso VG, Grinsztejn B, Jalil EM, Wilson EC, McFarland W. Correction to: The Prevalence of HIV Among Men Who Have Sex With Men (MSM) and Young MSM in Latin America and the Caribbean: A Systematic Review. AIDS Behav 2022; 26:296. [PMID: 34309772 DOI: 10.1007/s10461-021-03400-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Lara E Coelho
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, INI-Fiocruz. Av. Brasil, 4365 Manguinhos, Rio de Janeiro, RJ, Brazil.
| | - Thiago S Torres
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, INI-Fiocruz. Av. Brasil, 4365 Manguinhos, Rio de Janeiro, RJ, Brazil
| | - Valdilea G Veloso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, INI-Fiocruz. Av. Brasil, 4365 Manguinhos, Rio de Janeiro, RJ, Brazil
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, INI-Fiocruz. Av. Brasil, 4365 Manguinhos, Rio de Janeiro, RJ, Brazil
| | - Emilia M Jalil
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, INI-Fiocruz. Av. Brasil, 4365 Manguinhos, Rio de Janeiro, RJ, Brazil
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11
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Wilson EC, Jalil EM, Jalil CM, Castro CRV, Ferreira ALN, Martinez NF, Martinez NF, Moura I, Oliveira C, Bezerra D, Netto EC, Monteiro L, Veloso VG, Grinsztejn B. Results from a peer-based digital systems navigation intervention to increase HIV prevention and care behaviors of young trans women in Rio de Janeiro, Brazil. Journal of Global Health Reports 2021. [DOI: 10.29392/001c.28347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Erin C. Wilson
- National Institute of Infectious Diseases, FIOCRUZ, Rio de Janeiro, Brazil
| | - Emilia M. Jalil
- San Francisco Department of Public Health, San Francisco, USA
| | | | | | | | | | | | - Isabele Moura
- San Francisco Department of Public Health, San Francisco, USA
| | - Cleo Oliveira
- San Francisco Department of Public Health, San Francisco, USA
| | - Daniel Bezerra
- San Francisco Department of Public Health, San Francisco, USA
| | | | - Laylla Monteiro
- San Francisco Department of Public Health, San Francisco, USA
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12
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Teixeira SLM, Jalil CM, Jalil EM, Nazer SC, Silva SDCC, Veloso VG, Luz PM, Grinsztejn B. Evidence of an untamed HIV epidemic among MSM and TGW in Rio de Janeiro, Brazil: a 2018 to 2020 cross-sectional study using recent infection testing. J Int AIDS Soc 2021; 24:e25743. [PMID: 34132470 PMCID: PMC8207443 DOI: 10.1002/jia2.25743] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 04/28/2021] [Accepted: 04/30/2021] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Monitoring the HIV epidemic and identifying populations among whom HIV is spreading is critical. We aimed to provide an estimate of the annualized HIV incidence rate using recency testing among cisgender men who have sex with men (MSM) and transgender women (TGW) at a reference centre in Rio de Janeiro, Brazil. METHODS We evaluated MSM and TGW who sought HIV testing at the Evandro Chagas National Institute of Infectious Diseases-FIOCRUZ between March 2018 and January 2020. The Limiting Avidity assay (LAg) as part of a recent infection testing algorithm (RITA) was employed to identify recent infections (those with a normalized optical density ≤1.5 in the LAg that met all RITA criteria) among those who tested positive for HIV and the annualized HIV incidence was estimated. RESULTS AND DISCUSSION Out of 3053 individuals assessed, 2591 (84.9%) were HIV negative and 462 (15.1%) were living with HIV. Among these, 302 (65.4%) with stored samples available were evaluated and 73/302 (24.2%) were classified as recent infections. The annualized incidence rate estimate using a false recency rate of zero was 7.35% (95% CI 5.76% to 9.25%). CONCLUSIONS Our results suggest that the HIV epidemic in Rio de Janeiro, Brazil, continues to disproportionately burden vulnerable populations, including MSM and TGW despite the existence and availability of effective preventive and therapeutic interventions.
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Affiliation(s)
| | - Cristina M Jalil
- National Institute of Infectious Diseases Evandro ChagasFIOCRUZRio de JaneiroBrazil
| | - Emilia M Jalil
- National Institute of Infectious Diseases Evandro ChagasFIOCRUZRio de JaneiroBrazil
| | - Sandro C Nazer
- National Institute of Infectious Diseases Evandro ChagasFIOCRUZRio de JaneiroBrazil
| | | | - Valdilea G Veloso
- National Institute of Infectious Diseases Evandro ChagasFIOCRUZRio de JaneiroBrazil
| | - Paula M Luz
- National Institute of Infectious Diseases Evandro ChagasFIOCRUZRio de JaneiroBrazil
| | - Beatriz Grinsztejn
- National Institute of Infectious Diseases Evandro ChagasFIOCRUZRio de JaneiroBrazil
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13
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Jalil EM, Domingues RM, Derrico M, Dias MB, Andrade ACV, Rocha VSO, Nazer S, Feitosa M, Cardoso SW, Veloso VG, Friedman RK, Grinsztejn B. Evaluating the menopausal transition with the STRAW + 10 in a Brazilian cohort of women with HIV, 2015-2016. Climacteric 2021; 24:305-312. [PMID: 33709858 DOI: 10.1080/13697137.2021.1889501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Menopausal transition is a physiological process encompassing hormonal and body changes that impact women's health and life quality. This period may be characterized by the Stages of Reproductive Aging Workshop (STRAW + 10) criteria using menstrual patterns. Use of the STRAW + 10 is uncertain in HIV infection. We aimed to characterize menopausal transition in women with HIV (WWH) using the STRAW + 10 criteria, hormonal measures and menopause symptoms. METHODS We performed a cross-sectional study, nested to the HIV-Infected Women's Cohort, in Rio de Janeiro, Brazil. Eligible women included those aged 30 years or older, without clinical or surgical menopause, hormonal contraception, replacement therapy and ovarian disorders. We conducted face-to-face interviews and collected blood samples for follicle stimulating hormone (FSH) and estradiol measures. RESULTS We enrolled 328 WWH (28.3% of women in the cohort). The distribution of age, hormonal levels and reported symptoms per each STRAW + 10 stage was consistent with the expected distribution in the menopausal transition. Age and FSH significantly increased and estradiol decreased from stage -2 (7 + days of menstrual delay) to stage +2 (8 + years of amenorrhea). CONCLUSIONS The present results support use of the STRAW + 10 to characterize the menopausal transition of WWH with good clinical and immunological control.
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Affiliation(s)
- E M Jalil
- National Institute of Infectious Diseases Evandro Chagas, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - R M Domingues
- National Institute of Infectious Diseases Evandro Chagas, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - M Derrico
- National Institute of Infectious Diseases Evandro Chagas, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - M B Dias
- National Institute of Women, Children and Adolescents Health Fernandes Figueira, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - A C V Andrade
- National Institute of Infectious Diseases Evandro Chagas, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - V S O Rocha
- National Institute of Infectious Diseases Evandro Chagas, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - S Nazer
- National Institute of Infectious Diseases Evandro Chagas, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - M Feitosa
- National Institute of Infectious Diseases Evandro Chagas, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - S W Cardoso
- National Institute of Infectious Diseases Evandro Chagas, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - V G Veloso
- National Institute of Infectious Diseases Evandro Chagas, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - R K Friedman
- National Institute of Infectious Diseases Evandro Chagas, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - B Grinsztejn
- National Institute of Infectious Diseases Evandro Chagas, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
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14
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Jalil EM, Wilson EC, Monteiro L, de Velasque LS, Ferreira ACG, Nazer SC, Friedman RK, Veloso VG, Levi JE, Grinsztejn B. High prevalence of anal high-risk HPV infection among transwomen: estimates from a Brazilian RDS study. J Int AIDS Soc 2021; 24:e25691. [PMID: 33773075 PMCID: PMC8002898 DOI: 10.1002/jia2.25691] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 02/10/2021] [Accepted: 02/23/2021] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION As the leading sexually transmitted infection worldwide, human papillomavirus (HPV) may disproportionately affect transwomen. We aimed to estimate anal HPV prevalence, especially focusing on high-risk (hr)-HPV types and evaluate their associated factors among transwomen living in Rio de Janeiro, Brazil. METHODS Transwomen enrolled in a respondent-driven sampling (RDS)-based survey conducted between August 2015 and January 2016 self-collected anal samples, which were promptly stored at minus 80°C. After DNA extraction, HPV detection and genotyping were performed using the PapilloCheck test. We estimated HPV prevalences and evaluated the correlates of anal hr-HPV infection using a regression logistic model. RESULTS Out of 345 transwomen, 272 (78.8%) were included in this analysis (122 [44.9%] HIV-positive). No participant had ever received HPV vaccination. Among participants enrolled, 212 (77.9%) were positive for any anal HPV type and 165 (60.7%) for hr-HPV. Most common hr-HPV were as follows: HPV16 (17.6%), HPV68 (14.7%), HPV39 (14.3%), HPV56 (12.5%), HPV51 (11.4%) and HPV52 (11.0%). HIV-positive transwomen had three times the odds of having an hr-HPV compared to HIV-negative transwomen. Participants who had a current rectal Neisseria gonorrhoeae infection had 3.7 times the odds of being coinfected with hr-HPV. Among HIV-positive transwomen, neither antiretroviral therapy use, undetectable viral load, current and nadir CD4 counts were associated with anal hr-HPV infection. CONCLUSIONS Brazilian transwomen in our study exhibit some of the highest population-specific rates of HPV and hr-HPV. There is an urgent need to elucidate the burden of HPV infection, prevalence of HPV-related diseases and access to and uptake of HPV vaccination among transwomen, especially from low- and middle-income settings.
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Affiliation(s)
- Emilia M Jalil
- National Institute of Infectious DiseasesFIOCRUZRio de JaneiroBrazil
| | - Erin C Wilson
- San Francisco Department of Public HealthSan FranciscoCAUSA
| | - Laylla Monteiro
- National Institute of Infectious DiseasesFIOCRUZRio de JaneiroBrazil
| | - Luciane S de Velasque
- National Institute of Infectious DiseasesFIOCRUZRio de JaneiroBrazil
- Mathematics and Statistics DepartmentUNIRIORio de JaneiroBrazil
| | | | - Sandro C Nazer
- National Institute of Infectious DiseasesFIOCRUZRio de JaneiroBrazil
| | - Ruth K Friedman
- National Institute of Infectious DiseasesFIOCRUZRio de JaneiroBrazil
| | - Valdilea G Veloso
- National Institute of Infectious DiseasesFIOCRUZRio de JaneiroBrazil
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15
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Pereira GFM, Kim A, Jalil EM, Fernandes Fonseca F, Shepherd BE, Veloso VG, Rick F, Ribeiro R, Pimenta MC, Beber A, Corrêa RG, Lima R, Maruri F, McGowan CC, Schwartz Benzaken A, Grinsztejn B, Castilho JL. Dolutegravir and pregnancy outcomes in women on antiretroviral therapy in Brazil: a retrospective national cohort study. Lancet HIV 2021; 8:e33-e41. [PMID: 33387477 PMCID: PMC7869891 DOI: 10.1016/s2352-3018(20)30268-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 08/24/2020] [Accepted: 09/17/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Dolutegravir has been widely available in Brazil since 2017. Following the signal that infants born to women with dolutegravir exposure at conception in Botswana had a higher risk of neural tube defects (NTDs), public health leaders initiated a national investigation to evaluate periconception dolutegravir exposure among all pregnant Brazilian women with HIV and its potential association with risk of NTDs, stillbirth, or miscarriage before 22 weeks (also called spontaneous abortion). METHODS In this retrospective, observational, national, cohort study, we identified all women with pregnancies and possible dolutegravir exposure within 8 weeks of estimated date of conception between Jan 1, 2017, and May 31, 2018, and approximately 3:1 matched pregnant women exposed to efavirenz between Jan 1, 2015, and May 31, 2018, using the Brazilian antiretroviral therapy database. We did detailed chart reviews for identified women. The primary outcomes were NTD and a composite measure of NTD, stillbirth, or miscarriage. NTD incidences were calculated with 95% CI. The composite outcome was examined with logistic regression using propensity score matching weights to balance confounders. FINDINGS Of 1427 included women, 382 were exposed to dolutegravir within 8 weeks of estimated date of conception. During pregnancy, 183 (48%) of 382 dolutegravir-exposed and 465 (44%) of 1045 efavirenz-exposed women received folic acid supplementation. There were 1452 birth outcomes. There were no NTDs in either dolutegravir-exposed (0, 95% CI 0-0·0010) or efavirenz-exposed groups (0, 95% CI 0-0·0036). There were 23 (6%) stillbirths or miscarriages in 384 dolutegravir-exposed fetuses and 28 (3%) in the 1068 efavirenz-exposed fetuses (p=0·0037). Logistic regression models did not consistently indicate an association between dolutegravir exposure and risk of stillbirths or miscarriages. After study closure, two confirmed NTD outcomes in fetuses with periconception dolutegravir exposure were reported to public health officials. An updated estimate of NTD incidence incorporating these cases and the estimated number of additional dolutegravir-exposed pregnancies between Jan 1, 2015 and Feb 28, 2019, is 0·0018 (95% CI 0·0005-0·0067). INTERPRETATION Neither dolutegravir nor efavirenz exposure was associated with NTDs in our national cohort; incidence of NTDs is probably well under 1% in dolutegravir-exposed HIV-positive women but still slightly above HIV-uninfected women (0·06%) in Brazil. FUNDING The Brazilian Ministry of Health and the United States' National Institutes of Health.
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Affiliation(s)
- Gerson Fernando Mendes Pereira
- Department of Surveillance, Prevention, and Control of STIs, AIDS, and Viral Hepatitis, Ministry of Health, Brasília, Brazil
| | - Ahra Kim
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Emilia M Jalil
- Fiocruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, Brazil
| | | | - Bryan E Shepherd
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Valdilea G Veloso
- Fiocruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, Brazil
| | - Fernanda Rick
- Department of Surveillance, Prevention, and Control of STIs, AIDS, and Viral Hepatitis, Ministry of Health, Brasília, Brazil
| | - Rachel Ribeiro
- Department of Surveillance, Prevention, and Control of STIs, AIDS, and Viral Hepatitis, Ministry of Health, Brasília, Brazil
| | - Maria Cristina Pimenta
- Department of Surveillance, Prevention, and Control of STIs, AIDS, and Viral Hepatitis, Ministry of Health, Brasília, Brazil
| | - Andrea Beber
- Department of Surveillance, Prevention, and Control of STIs, AIDS, and Viral Hepatitis, Ministry of Health, Brasília, Brazil
| | - Renato Girade Corrêa
- Department of Surveillance, Prevention, and Control of STIs, AIDS, and Viral Hepatitis, Ministry of Health, Brasília, Brazil
| | - Renato Lima
- Department of Surveillance, Prevention, and Control of STIs, AIDS, and Viral Hepatitis, Ministry of Health, Brasília, Brazil
| | - Fernanda Maruri
- Department of Medicine, Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Catherine C McGowan
- Department of Medicine, Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Adele Schwartz Benzaken
- Department of Surveillance, Prevention, and Control of STIs, AIDS, and Viral Hepatitis, Ministry of Health, Brasília, Brazil; AIDS Health Care Foundation, Global Program, São Paulo, Brazil
| | - Beatriz Grinsztejn
- Fiocruz, Instituto Nacional de Infectologia Evandro Chagas, Rio de Janeiro, Brazil
| | - Jessica L Castilho
- Department of Medicine, Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, USA
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16
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Wilson EC, Jalil EM, Moreira RI, Velasque L, Castro CV, Monteiro L, Veloso VG, Grinsztejn B. High risk and low HIV prevention behaviours in a new generation of young trans women in Brazil. AIDS Care 2020; 33:997-1001. [PMID: 33191759 DOI: 10.1080/09540121.2020.1844859] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Adult trans women in Brazil are highly impacted by HIV, but little is known about risk for young trans women. Our study was conducted to compare the HIV prevalence and correlates of risk for young trans women ages 18-24 years old to adult trans women in Brazil. Trans women were recruited from Rio de Janeiro and Baixada (the metropolitan area of Rio de Janeiro), Brazil (N = 345). Youth ages 18-24 years of age had significantly greater odds of being HIV negative than adults (OR 0.4, 95% CI 0.2-0.6, p = 0.0002), but significantly lower odds of having post-exposure prophylaxis (PEP) knowledge (OR 0.5, 95% CI:0.3-0.9, p = 0.02) and PrEP awareness (OR 0.5, 95% CI: 0.3-0.8, p = 0.01). Young trans women also had significantly higher odds of using substances (OR 1.8, 95% CI 1.1-2.9, p = 0.02) and condomless anal intercourse with their last three sexual partners (OR 1.8, 95% CI: 1.1-3.0, p = 0.03) compared to adults. Already by age 24, one in four trans women in Brazil were infected with HIV pointing to a new generation at high risk of acquiring HIV. HIV prevention interventions are needed to change the healthcare system to reach and engage young trans women.
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Affiliation(s)
- Erin C Wilson
- San Francisco Department of Public Health, San Francisco, CA, USA
| | - Emilia M Jalil
- Instituto Nacional de Infectologia Evandro Chagas (INI), Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Ronaldo I Moreira
- Instituto Nacional de Infectologia Evandro Chagas (INI), Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Luciane Velasque
- Instituto Nacional de Infectologia Evandro Chagas (INI), Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Cristiane V Castro
- Instituto Nacional de Infectologia Evandro Chagas (INI), Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Laylla Monteiro
- Instituto Nacional de Infectologia Evandro Chagas (INI), Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Valdilea G Veloso
- Instituto Nacional de Infectologia Evandro Chagas (INI), Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas (INI), Fundacao Oswaldo Cruz, Rio de Janeiro, Brazil
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17
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Abstract
Pre-exposure prophylaxis (PrEP) is an important biomedical intervention that may help reduce the risk of HIV transmission among transwomen. To date, little research is available to inform interventions to increase uptake and adherence to PrEP among transwomen, especially in places outside the U.S. We conducted a qualitative study in 2015 with 34 adult transwomen in Rio de Janeiro, Brazil and assessed awareness, interest, barriers and facilitators to PrEP uptake and adherence for transwomen. Almost one third of participants had heard of PrEP, and most were interested and thought it would be beneficial for transwomen in their community. Barriers to PrEP included fear of being HIV positive resulting in low HIV testing and concerns about the ability to adhere to a daily PrEP regimen. The most prominent barrier to uptake was past experiences of transgender-identity related discrimination in the universal health care system that reduced willingness to seek PrEP or health care in general. Participants recommended technological solutions to PrEP health education information that could address uptake and adherence. This study informs efforts to increase PrEP use among transwomen in Brazil.
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Affiliation(s)
- Erin C Wilson
- San Francisco Department of Public Health, San Francisco, CA, USA
| | - Emilia M Jalil
- Instituto Nacional de Infectologia (INI) Evandro Chagas, Fundacao Oswaldo Cruz, Fiocruz, Brazil
| | - Cristiane Castro
- Instituto Nacional de Infectologia (INI) Evandro Chagas, Fundacao Oswaldo Cruz, Fiocruz, Brazil
| | - Nilo Martinez Fernandez
- Instituto Nacional de Infectologia (INI) Evandro Chagas, Fundacao Oswaldo Cruz, Fiocruz, Brazil
| | - Luciana Kamel
- Instituto Nacional de Infectologia (INI) Evandro Chagas, Fundacao Oswaldo Cruz, Fiocruz, Brazil
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia (INI) Evandro Chagas, Fundacao Oswaldo Cruz, Fiocruz, Brazil
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18
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Grinsztejn B, Jalil EM, Monteiro L, Velasque L, Moreira RI, Garcia ACF, Castro CV, Krüger A, Luz PM, Liu AY, McFarland W, Buchbinder S, Veloso VG, Wilson EC. Unveiling of HIV dynamics among transgender women: a respondent-driven sampling study in Rio de Janeiro, Brazil. Lancet HIV 2017; 4:e169-e176. [PMID: 28188030 DOI: 10.1016/s2352-3018(17)30015-2] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 11/28/2016] [Accepted: 11/29/2016] [Indexed: 01/15/2023]
Abstract
BACKGROUND The burden of HIV in transgender women (transwomen) in Brazil remains unknown. We aimed to estimate HIV prevalence among transwomen in Rio de Janeiro and to identify predictors of newly diagnosed HIV infections. METHODS We recruited transwomen from Rio de Janeiro, Brazil, by respondent-driven sampling. Eligibility criteria were self-identification as transwomen, being 18 years of age or older, living in Rio de Janeiro or its metropolitan area, and having a valid peer recruitment coupon. We recruited 12 seed participants from social movements and formative focus groups who then used peer recruitment coupons to refer subsequent peers to the study. We categorised participants as HIV negative, known HIV infected, or newly diagnosed as HIV infected. We assessed predictors of newly diagnosed HIV infections by comparing newly diagnosed with HIV-negative participants. We derived population estimates with the Respondent-Driven Sampling II estimator. FINDINGS Between Aug 1, 2015, and Jan 29, 2016, we enrolled 345 eligible transwomen. 29·1% (95% CI 23·2-35·4) of participants had no previous HIV testing (adjusted from 60 participants), 31·2% (18·8-43·6) had HIV infections (adjusted from 141 participants), and 7·0% (0·0-15·9) were newly diagnosed as HIV infected (adjusted from 40 participants). We diagnosed syphilis in 28·9% (18·0-39·8) of participants, rectal chlamydia in 14·6% (5·4-23·8), and gonorrhoea in 13·5% (3·2-23·8). Newly diagnosed HIV infections were associated with black race (odds ratio 22·8 [95% CI 2·9-178·9]; p=0·003), travesti (34·1 [5·8-200·2]; p=0·0001) or transsexual woman (41·3 [6·3-271·2]; p=0·0001) gender identity, history of sex work (30·7 [3·5-267·3]; p=0·002), and history of sniffing cocaine (4·4 [1·4-14·1]; p=0·01). INTERPRETATION Our results suggest that transwomen bear the largest burden of HIV among any population at risk in Brazil. The high proportion of HIV diagnosis among young participants points to the need for tailored long-term health-care and prevention services to curb the HIV epidemic and improve the quality of life of transwomen in Brazil. FUNDING Brazilian Research Council, National Institute of Allergy and Infectious Diseases, Brazilian Sexually Transmitted Disease/AIDS, and Viral Hepatitis Department of the Brazilian Ministry of Health.
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Affiliation(s)
- Beatriz Grinsztejn
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.
| | - Emilia M Jalil
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Laylla Monteiro
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Luciane Velasque
- Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ronaldo I Moreira
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Ana Cristina F Garcia
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Cristiane V Castro
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Alícia Krüger
- Department of Surveillance, Prevention and Control of Sexually Transmitted Diseases, Aids and Viral Hepatitis, Brazilian Ministry of Health, Brazil
| | - Paula M Luz
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Albert Y Liu
- Bridge HIV, San Francisco Department of Public Health, San Francisco, CA, USA
| | - Willi McFarland
- Departments of Medicine, Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Susan Buchbinder
- Bridge HIV, San Francisco Department of Public Health, San Francisco, CA, USA; Departments of Medicine, Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Valdilea G Veloso
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Erin C Wilson
- Bridge HIV, San Francisco Department of Public Health, San Francisco, CA, USA
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