HIV-1 infection among crack cocaine users in a region far from the epicenter of the HIV epidemic in Brazil: Prevalence and molecular characteristics

Abstract

Brazil has the largest cocaine market in South America, and crack cocaine use is closely associated with HIV-1 infection. This study investigated the prevalence, risk factors, and HIV-1 subtypes, including recombinant forms and mutations associated with drug resistance, among crack cocaine users in Central-West Brazil. We recruited 600 crack cocaine users admitted to a referral hospital in Goiânia for psychiatric disorders. The participants were interviewed; blood samples were collected for anti-HIV-1/2 serological screening. HIV-1 pol gene sequences (entire protease [PR] and partial reverse transcriptase [RT]) were obtained from plasma RNA. HIV-1 subtypes, recombinant viruses, transmitted drug resistance (TDR), and secondary drug resistance mutations were investigated. The median participant age was 30 years (range, 18–68 years); most were male, single, unemployed, and of mixed races. Among them, 2.8% (17/600) were HIV-1 positive: 2.2% of men (11/507) and 6.5% of women (6/93). The main predictors of HIV-1 seropositivity were a sexual partner with HIV infection, irregular condom use, and previous homelessness. HIV-1 pol sequences (12/17) indicated the predominance of subtype B (n = 7), followed by recombinant forms FPR/BRT (n = 1) and BPR/FRT (n = 2) and subtypes F1 (n = 1) and C (n = 1). TDR prevalence was 58.3% (7/12). Isolates from two participants showed mutations associated with resistance to nucleoside reverse transcriptase inhibitors (NRTI) only (M41L, T125C, T125F, M184V), while an isolate from one patient who had received antiretroviral therapy (ART) since 2008 had a mutation associated with resistance to non-NRTI (G190S). Five isolates had secondary mutations to protease inhibitors (K20M, L10V, L33I, A71T, A71V). In conclusion, the findings of HIV-1 circulation, TDR to NRTI, and secondary mutations to protease inhibitors in ART-naïve crack cocaine users support the importance of monitoring this population in regions far from the epicenter of the HIV epidemic.

HIV-1 Molecular Epidemiology, Transmission Clusters and Transmitted Drug Resistance Mutations in Central Brazil

“…Recently, among crack cocaine users in Central Brazil, a high prevalence of TDRM was found (58.3%). It is worth noting that only 12 HIV-positive individuals were investigated (Da Silva França et al, 2018).…”

Near Full-length Genomic Sequencing and Molecular Analysis of HIVInfected Individuals in a Network-based Intervention (TRIP) in Athens, Greece: Evidence that Transmissions Occur More Frequently from those with High HIV-RNA

“…Miller et al also highlighted the important role of acute and early HIV infection (due to high levels of HIV-RNA during these stages), as opposed to chronic infection, in sexual transmission [66]. Similarly, several studies reported that during HIV outbreaks among PWID, a high number of individuals have been infected with genetically similar viruses [62, 64, 67-80] - a finding that supports the hypothesis of the involvement of recently HIV-infected people in HIV transmissions. The crucial role of the natural history of HIV-1 (high HIV-RNA) has also been investigated by simulation studies and was found to play a significant role (along with injection risk networks) during periods of high HIV prevalence among PWID [5].…”

HIV and Substance Use in Latin America: A Scoping Review

“…Being female has been associated with higher risk of HIV among PWUS in Brazil, Mexico, and Colombia [ 45 , 46 , 47 , 51 , 52 ]. A study in Tijuana found that sex work mediated 84.3% of the association between female gender and HIV incidence [ 48 ].…”