Elevated Risk for HIV-1 Infection in Adolescents and Young Adults in São Paulo, Brazil

Abstract

BackgroundRecent studies have sought to describe HIV infection and transmission characteristics around the world. Identification of early HIV-1 infection is essential to proper surveillance and description of regional transmission trends. In this study we compare people recently infected (RI) with HIV-1, as defined by Serologic Testing Algorithm for Recent HIV Seroconversion (STARHS), to those with chronic infection.Methodology/Principal FindingsSubjects were identified from 2002–2004 at four testing sites in São Paulo. Of 485 HIV-1-positive subjects, 57 (12%) were defined as RI. Of the participants, 165 (34.0%) were aware of their serostatus at the time of HIV-1 testing. This proportion was statistically larger (p<0.001) among the individuals without recent infection (n = 158, 95.8%) compared to 7 individuals (4.2%) with recently acquired HIV-1 infection. In the univariate analysis, RI was more frequent in <25 and >59 years-old age strata (p<0.001). The majority of study participants were male (78.4%), 25 to 45 years-old (65.8%), white (63.2%), single (61.7%), with family income of four or more times the minimum wage (41.0%), but with an equally distributed educational level. Of those individuals infected with HIV-1, the predominant route of infection was sexual contact (89.4%), with both hetero (47.5%) and homosexual (34.5%) exposure. Regarding sexual activity in these individuals, 43.9% reported possible HIV-1 exposure through a seropositive partner, and 49.4% reported multiple partners, with 47% having 2 to 10 partners and 37.4% 11 or more; 53.4% of infected individuals reported condom use sometimes; 34.2% reported non-injecting, recreational drug use and 23.6% were reactive for syphilis by VDRL. Subjects younger than 25 years of age were most vulnerable according to the multivariate analysis.Conclusions/SignificanceIn this study, we evaluated RI individuals and discovered that HIV-1 has been spreading among younger individuals in São Paulo and preventive approaches should, therefore, target this age stratum.

A scoping review of prevalence, incidence and risk factors for HIV infection amongst young people in Brazil

“…In the earlier study, HIV seropositivity was also positively associated with early sexual initiation (<12 years old) and unprotected sexual intercourse with a male partner (whether the respondent was male or female). Second, Bassichetto et al showed that in Sao Paulo 78.9% of CTA users testing positive and aged 14-25 were single, and that sexual exposure was responsible for 98.7% of cases [21]. Although 40% of seropositive subjects were PWID, blood-to-blood transmission was not thought to be responsible for any infections in this sample.…”

“…Women attending a CTA in Rio de Janeiro in 2001 had an HIV prevalence of 6.8% amongst 14-19 year olds and 9.3% amongst 20-24 year olds [20]. Between 2002 and 2004, Bassichetto et al found that among HIV-positive adolescents and young adults, 28.6% of 14-19 year olds and 24.4% of 20-24 year olds were diagnosed as recently infected based on STARHS, and that these proportions were higher than in older age groups [21]. …”

“…Second, a large proportion of infections amongst both adolescents and young people were recent: 9.6% of HIV-positive individuals aged under 25 in Santos [15]; 17.9% of HIV-positive 20-24 year olds attending antenatal care in Sao Paulo [31]; 18.8% and 19.4% of HIV-positive 18-24 year olds Recife and Curitiba respectively in 2013 [60]; 25% of HIV-positive 15-24 year olds in Sao Paulo CTAs [21]; and 44.4% of HIV-positive adolescents seeking care in Recife CTAs [26]. While unsurprising, given the briefer sexual history of younger people and the predominantly sexual transmission route for HIV in Brazil, these data highlight the importance of developing preventive strategies focusing this age group, based on the behavioral risk factors to which they are more susceptible.…”

Expansion of a subset of CD14highCD16negCCR2low/neg monocytes functionally similar to myeloid-derived suppressor cells during SIV and HIV infection

“…Samples were selected from a cohort designed to recruit recently HIV-1infected people in 2002 in São Paulo, Brazil [26,27]. All procedures adopted in this study were performed according to the terms agreed by the Institutional Review Board from the Hospital das Clínicas, University of São Paulo (CAPPesq, Research Projects Ethics Committee, São Paulo, Brazil).…”

Rapid HIV diagnostic test in undocumented pregnant women applied at an inner-city teaching hospital

“…In Latin America, the infection remains generally stable and almost half of the people living with HIV are women. In the last decade there has been an increase in the incidence of HIV/AIDS among young women and a large proportion of infections can be attributed to the behavior of their male sexual partners 1,16,32 . This factor is even more evident where the heterosexual relationship is the dominant manner of HIV transmission 25,32 .…”