EPIDEMIOLOGIA MOLECULAR DO HIV-1 E INFECÇÃO PELO VÍRUS DA HEPATITE E EM POPULAÇÃO PRIVADA DE LIBERDADE DE MATO GROSSO DO SUL

Abstract

The prison population (PP) faces difficulties in obtaining an early diagnosis, timely treatment, and adherence to treatment for various communicable diseases. Therefore, in this population subgroup, alarming prevalences of communicable diseases, such as infections caused by human immunodeficiency virus (HIV) and coinfection with hepatitis E virus (HEV), are still observed. Therefore, the present study aimed to identify the genetic variability of circulating HIV-1, verify the occurrence of HIV-1 transmission networks, and describe the mutations associated with antiretroviral resistance present in the polymerase gene (protease and reverse transcriptase) and possible socio-behavioral factors associated with these in HIV-1-infected PP (article 1). In article 2, we aimed to estimate the prevalence of hepatitis E virus (HEV) coinfection, as well as to identify the factors associated with this coinfection in this population. The target population of the study consisted of prisoners from Mato Grosso do Sul (MS), previously diagnosed as HIV-1 infected in previous studies and active searches in prisons. For article 1, 103 subjects were recruited and proviral DNA was extracted from whole blood samples of 100 individuals for whom we had biological material stored, and partial polymerase fragment was amplified by nested-PCR in 93 of them. The purified products of the viral isolates were subjected to nucleotide sequencing by Sanger for identification of resistance mutations, classification of HIV-1 subtypes, and verification of the occurrence of transmission clusters by phylogenetic analysis combined with genetic distance calculation. Seven samples were excluded for being double sampled and two due to poor sequencing quality. Thus, molecular results from 84 individuals allowed the characterization of 49 (58.3%) as belonging to HIV-1 subtype B, 12 (14.3%) to C, 1 to D (1.2%),1 (1.2%) to F1 and recombinant forms were detected in 21 (25.0%). Of the 84 individuals, 50 (59.5%) were using antiretrovirals, while 34 (40.5%) were antiretroviral-naive. Among those previously treated, antiretroviral resistance mutations were found in 32.0% (16/50), and 6.0% of the individuals had multiple mutations mainly to non-nucleoside reverse transcriptase inhibitors (NNRTI) and nucleoside transcriptase inhibitors (NRTI). Among those antiretroviral-naïve prisoners, 5.9% (2/34) had resistance-related mutations. Fourteen clusters were detected between sequences obtained from PPL and/or sequences obtained from the Los Alamos database, with an average of 3.5 sequences/cluster. Being a man who has sex with men (MSM) increases the chance of forming a cluster by 9.38 times (95% CI: 1.59-55.25) and being infected by non-B subtype is protective for cluster formation. The phylogenetic networks indicate that PPL may be influencing transmission not only within prisons, but also in the community outside of prisons. Paper 2 aimed to estimate the prevalence of HEV-HIV coinfection, using commercial kits for the qualitative detection of anti-HEV IgG and IgM by enzyme immunoassay. Of 104 individuals screened for HEV-HIV coinfection, 14 (13.5%; 95% CI: 8.1-21.6) prisoners had anti-HEV IgG and 5 (4.8%; 95% CI: 2.0-11.2) anti-HEV IgM, these high prevalences being similar to those found in people living with HIV in other Brazilian cities. Taken together, improving knowledge of PPL, with early diagnosis of viral infections and followed by early initiation of treatment may limit the transmission dynamics of these viruses, and help to delineate public health interventions more specific to these settings.