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Copyright of AIDS & Behavior is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

HIV Pre-exposure prophylaxis (PrEP) is an effective prevention tool, but there are still few studies about PrEP uptake among adolescents. We aimed to analyze the PrEP uptake process and factors associated with daily oral PrEP initiation among adolescent men who have sex with men (aMSM) and transgender women (aTGW) in Brazil. Baseline data from the first demonstration PrEP cohort study among aMSM and aTGW 15–19 years old (yo) ongoing in three large Brazilian cities (PrEP1519). After completing informed consent procedures, participants were enrolled in the cohort from February/2019 to February/2021. A socio-behavioral questionnaire was applied. Factors associated with PrEP initiation were assessed using a logistic regression model with adjusted prevalence ratios (aPR) and 95% confidence intervals (95%CI). Among recruited participants, 174 (19,2%) were aged 15–17 yo and 734 (80,8%) 18–19 yo. The rate of PrEP initiation was 78.2% and 77.4% for 15–17 yo and 18–19 yo, respectively. Factors associated with PrEP initiation were: black or mixed race (aPR 2.31; 95%CI: 1.10–4.84) among the younger adolescents 15–17 yo; experienced violence and/or discrimination due to their sexual orientation or gender identity (aPR 1.21; 95%CI: 1.01–1.46); transactional sex (aPR 1.32; 95%CI: 1.04–1.68); and having had between 2 to 5 sexual partners in the previous three months (aPR 1.39; 95%CI: 1.15–1.68) among those 18–19 yo. Unprotected receptive anal intercourse in the previous six months was associated with PrEP initiation in both age groups (aPR 1.98; 95%CI: 1.02–3.85 and aPR 1.45; 95%CI: 1.19–1.76 among 15–17 yo and 18–19 yo, respectively). The biggest challenge to promoting PrEP use for aMSM and aTGW was in the first steps of the PrEP uptake process. Once they were linked to the PrEP clinic, initiation rates were high. [ABSTRACT FROM AUTHOR]

Using baseline data from the PrEP1519 cohort, in this article we aimed to analyze: (i) the effectiveness of demand creation strategies (DCS) to enroll adolescent men who have sex with men (AMSM) and adolescent transgender women (ATGW) into an HIV combination prevention study in Brazil; (ii) the predictors of DCS for adolescents' enrollment; and (iii) the factors associated with DCS by comparing online and face-to-face strategies for enrollment. The DCS included peer recruitment (i.e., online and face-to-face) and referrals from health services and non-governmental organizations (NGOs). AMSM and ATGW who agreed to participate in the study could opt to enroll in either PrEP (PrEP arm) or to use other prevention methods (non-PrEP arm). Bivariate and multivariate analyses were conducted and logistic regression odds ratios were estimated. The DCS reached 4529 AMSM and ATGW, the majority of which were derived online (73.8%). Of this total, 935 (20.6%) enrolled to participate (76.6% in PrEP arm and 23.4% in non-PrEP arm). The effectiveness of enrolling adolescents into both arms was greater via direct referrals (235/382 and 84/382, respectively) and face-to-face peer recruitment (139/670 and 35/670, respectively) than online (328/3342). We found that a combination under DCS was required for successful enrollment in PrEP, with online strategies majorly tending to enroll adolescents of a higher socioeconomic status. Our findings reinforce the need for DCS that actively reaches out to all adolescents at the greatest risk for HIV infection, irrespective of their socioeconomic status. [ABSTRACT FROM AUTHOR]

Standardized treatment regimens for chronic hepatitis B (CHB) are crucial in suppressing viral replication, disease progression and the development of complications. However, information on routine compliance with such therapeutic recommendations in medical practice is rare. Aim: To evaluate the application of Brazilian therapeutic guidelines for CHB within the scope of the Unified Health System in Minas Gerais state. Four key recommendations from the national guidelines were compared with data from treated patients: (i) eligibility to start treatment; (ii) type of treatment applied; (iii) rescue antiviral therapy; and (iv) monitoring of virological response. Most physicians (69.8%) declared to adopt these guidelines, while 10 of them were unaware. However, according to the criteria established by the guidelines, only 39.5% of treated patients should have been considered "truly" eligible to start treatment and only 67.6% of these underwent the recommended pharmacological treatment. The virological response was laboratory monitored in just over a third of patients. Rescue therapy was adequately supplanted in 41.2% of patients previously treated with lamivudine. There was low compliance with national guidelines by public service physicians in Brazil, highlighting the need to raise awareness of the importance of its adherence to expand the control of CHB. Thus, increasing the adherence of health professionals to this tool is a current challenge for health institutions and managers. [ABSTRACT FROM AUTHOR]

Frequent contact with hazardous materials makes waste collection a potentially unhealthy activity. This article assesses the perception of waste management workers regarding work-related accidents in domestic and health service contexts in Brazil. Six focus groups were performed between June 2014 and August 2015. The aims of this study were to apprehend different aspects of the participants' health, workers' experiences of work-related accidents and perception of risks. Cuts and puncture injuries were reported most frequently in the line of work and were often considered as irrelevant. Immunization against hepatitis B was not common among all workers, which increases the risk of infection for those individuals. Finally, it is considered urgent to consolidate an inclusive space in which workers can have discussions on their health. [ABSTRACT FROM AUTHOR]

Copyright of Revista Bioetica is the property of Conselho Federal de Medicina and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

As more urban solid waste is generated, managing it becomes ever more challenging and the potential impacts on the environment and human health also become greater. Handling waste - including collection, treatment and final disposal - entails risks of work accidents. This article assesses the perception of waste management workers regarding work-related accidents in domestic and health service contexts in Belo Horizonte, Brazil. These perceptions are compared with national data from the Ministry of Social Security on accidents involving workers in solid waste management. A high proportion of accidents involves cuts and puncture injuries; 53.9% among workers exposed to domestic waste and 75% among those exposed to health service waste. Muscular lesions and fractures accounted for 25.7% and 12.5% of accidents, respectively. Data from the Ministry of Social Security diverge from the local survey results, presumably owing to under-reporting, which is frequent in this sector. Greater commitment is needed from managers and supervisory entities to ensure that effective measures are taken to protect workers' health and quality of life. Moreover, workers should defend their right to demand an accurate registry of accidents to complement monitoring performed by health professionals trained in risk identification. This would contribute to the improved recovery of injured workers and would require managers in waste management to prepare effective preventive action. [ABSTRACT FROM AUTHOR]

Copyright of Revista Bioetica is the property of Conselho Federal de Medicina and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Infection with the hepatitis B and C viruses may occur through contact with infected body fluids, including injury with infected sharps. Collectors of domestic or healthcare wastes are potentially exposed to these infections. The aim of this article is to investigate the risk factors associated with the prevalence of hepatitis B and C viruses (HBV and HCV) infection among domestic and healthcare waste workers in Belo Horizonte, Brazil. A cross-sectional study of hepatitis B and C infection was conducted from November 2014 to January 2015, through blood sample collection and interviews about socio-demographic factors with 61 workers exposed to healthcare waste (‘exposed’) and 461 exposed only to domestic wastes (‘unexposed’). The prevalence of antibodies to HCV (Anti-HCV) antibodies was 3.3% in ‘exposed’ workers and 0.9% in ‘unexposed’, and of antibody to hepatitis B core antigen (Anti-HBc) was 9.8% and 5.6% in ‘exposed’ and ‘unexposed’ workers, respectively. Only 207 (44.9%) of those exposed to domestic waste and 45 (73.8%) of those handling healthcare waste were effectively immunised against hepatitis B virus (HBV). Exposures to domestic waste and to healthcare wastes were associated with similar risks of infection with HBV. The risk of hepatitis C virus (HCV) infection was marginally higher among healthcare waste workers compared with domestic waste workers, probably because of needlestick accidents owing to deficient sharps management systems. Immunisation against hepatitis B and screening tests to ensure the success of vaccination should be a condition for recruitment for both groups of waste workers. [ABSTRACT FROM AUTHOR]

Copyright of Revista Bioetica is the property of Conselho Federal de Medicina and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Bioetica is the property of Conselho Federal de Medicina and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: There has recently been an increase in HIV infection rates among men who have sex with men (MSM). This study aimed at investigating risk factors associated with incident HIV infection in a MSM cohort–Project Horizonte, Belo Horizonte, Minas Gerais, Brazil. Methodology: This is a nested case-control study in an ongoing open cohort of homosexual and bisexual men, carried out in 1994–2010, during which 1,085 volunteers were enrolled. Each HIV seroconverted volunteer (case) was compared with three randomly selected HIV negative controls, matched by admission date and age (±3 years). During follow-up, 93 volunteers seroconverted and were compared with 279 controls. Principal Findings: The risk factors associated with HIV seroconversion were: contact with partner’s blood during sexual relations (OR 3.7; 95% CI 1.2–11.6), attendance at gay saunas in search for sexual partners (OR 2.6; 95% CI 1.3–5.4), occasional intake of alcohol when flirting and engaging in sexual activity (OR 2.5; 95% CI 1.3–5.1), inconsistent use of condoms in receptive anal sex (OR 2.4; 95% CI 1.1–5.4), little interest to look up information about AIDS (OR 2.6; 95% CI 1.0–6.7) particularly in newspapers (OR 3.4; 95% CI 1.4–8.1). Conclusions: This study shows that MSM are still engaging in risk behavior, such as unprotected anal intercourse, despite taking part in a cohort study on various preventive measures. New preventive strategies in touch with the epidemic’s development and the specificities of this particular population are needed. [ABSTRACT FROM AUTHOR]

Introduction: Published data addressing the effectiveness of darunavir-ritonavir (DRV/r)-based therapy for multiexperienced patients in developing countries are scarce. This study evaluated the 48-week virologic and immunologic effectiveness of salvage therapy based on DRV/r for the treatment of multidrug-experienced HIV-1-infected adults in Brazil.Materials and Methods: A multicenter retrospective cohort study was carried out with multidrug-experienced adults who were on a failing antiretroviral therapy and started a DRV/r-based salvage therapy between 2008 and 2010. The primary effectiveness end point was the proportion of patients with virologic success (plasma HIV-1 RNA <50 copies/mL at week 48).Results: At 48 weeks, 73% of the patients had HIV-RNA <50 copies/mL and a mean increase of 108 CD4 cells/mm(3). Higher baseline viral load, lower baseline CD4 count, younger age, and 3 or more DRV/r-associated resistance mutations were significantly predictive of virologic failure. Concomitant use of raltegravir was strongly associated with virologic success.Conclusion: The use of DRV/r-based regimens for salvage therapy is an effective strategy in the clinical care setting of a developing country. [ABSTRACT FROM AUTHOR]

Abstract: This study aims at estimating the prevalence of Leishmania infection among HIV-infected patients through the use of non-invasive tests. The study was conducted in three Infectious Diseases Services in two large Brazilian cities, both endemic areas for visceral leishmaniasis. Three hundred and eighty-one asymptomatic patients were enrolled whose ages ranged from 19 to 58 years old; 63.5% were men; mean TCD4+ was 380 cells/μl; and mean viral load was 153800 copies/ml. All individuals were tested for Leishmania infection through: ELISA using crude Leishmania infantum (ELISA), ELISA using the recombinant K39 antigen (rK39), indirect fluorescent antibody test (IFAT) and PCR targeted to kDNA region. The tests’ positivity were: 10.8% (ELISA), 3.9% (IFAT), 0.8% (rK39), 6.3% PCR and 20.2% (overall, at least one positive test), with no statistical correlation between positivity and clinical and laboratorial variables. Concordance among tests was low (Kappa <0.20). Prevalence of Leishmania asymptomatic infection was high in this population, reinforcing the need for attention in the evaluation of HIV patients from endemic areas. New efforts are needed to develop more specific and sensitive tests to diagnose Leishmania asymptomatic infection. Highly active antiretroviral therapy (HAART) seems to have a protective role against disease progression in co-infected individuals. [Copyright &y& Elsevier]

Background: In the central nervous system, HIV replication can occur relatively independent of systemic infection, and intrathecal replication of HIV-1 has been observed in patients with HIV-related and opportunistic neurological diseases. The clinical usefulness of HIV-1 RNA detection in the cerebrospinal fluid (CSF) of patients with opportunistic neurological diseases, or the effect of opportunistic diseases on CSF HIV levels in patients under HAART has not been well defined. We quantified CSF and plasma viral load in HIV-infected patients with and without different active opportunistic neurological diseases, determined the characteristics that led to a higher detection rate of HIV RNA in CSF, and compared these two compartments. Methods: A prospective study was conducted on 90 HIV-infected patients submitted to lumbar puncture as part of a work-up for suspected neurological disease. Seventy-one patients had active neurological diseases while the remaining 19 did not. Results: HIV-1 RNA was quantified in 90 CSF and 70 plasma samples. The HIV-1 RNA detection rate in CSF was higher in patients with neurological diseases, in those with a CD4 count lower than 200 cells/mm3, and in those not receiving antiretroviral therapy, as well as in patients with detectable plasma HIV-1 RNA. Median viral load was lower in CSF than in plasma in the total population, in patients without neurological diseases, and in patients with toxoplasmic encephalitis, while no significant difference between the two compartments was observed for patients with cryptococcal meningitis and HIV-associated dementia. CSF viral load was lower in patients with cryptococcal meningitis and neurotoxoplasmosis under HAART than in those not receiving HAART. Conclusion: Detection of HIV-1 RNA in CSF was more frequent in patients with neurological disease, a CD4 count lower than 200 cells/mm³ and detectable plasma HIV-1. Median HIV-1 RNA levels were generally lower in CSF than in plasma but some patients showed higher CSF levels, and no difference between these two compartments was observed in patients with cryptococcal meningitis and HIV-associated dementia, suggesting the presence of intrathecal viral replication in these patients. HAART played a role in the control of CSF HIV levels even in patients with cryptococcal meningitis and neurotoxoplasmosis in whom viral replication is potentially higher. [ABSTRACT FROM AUTHOR]

Aims: To compare the intra-abdominal fat thickness measured by ultrasound between HIV-infected patients treated or not with antiretroviral drugs and to correlate these visceral adiposity measurements to other parameters of cardiovascular risks. Methods: In a transversal observational study, 160 HIV-infected patients were recruited and divided in two groups, i.e., 123 antiretroviral (ARV)-treated and 37 ARV-naïve patients. These patients were submitted to anthropometric determinations, laboratorial analysis, ultrasonographic measurements of subcutaneous and intra- abdominal fat thickness and to tetrapolar bioelectrical impedance analysis in order to measure the body composition. Results: In the patients treated with highly active antiretroviral therapy (HAART) the intra-abdominal fat pad was significantly thicker than that of the untreated group (69 ± 21 mm, n = 123 vs. 60 ± 18 mm, n = 37; p = 0.03 Student’s t test). The intra-abdominal fat thickness correlated significantly with plasma triglyceride, total cholesterol, fasting glucose, glucose measurements 2 h after dextrose load, fasting insulin, HOMA-IR index, systolic and diastolic blood pressures, weight, BMI, WHR and caliper-measured total fat percentage. Conclusion: The results showed that antiretroviral therapy is associated with increased ultrasonographic measurements of visceral adiposity. Our data demonstrated a strong correlation between intra-abdominal fat thickness and independent risk factors of cardiovascular disease: atherogenic lipid profile and insulin resistance. Copyright © 2007 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

The article discusses a study to assess HIV-related knowledge, sources of information, risk behaviors, and prevention beliefs and strategies among street youths in Belo Horizonte, Brazil. Individual interviews were conducted with 379 youth who work and live on the streets of Belo Horizonte. Respondents demonstrated high levels of factual knowledge about HIV transmission coupled with high levels of misconceptions about casual transmission and intermediate levels of knowledge about prevention. Only 54% of the respondents had heard about AIDS, and 37.5% said they talked to someone about AIDS. the proportion of youth taking effective precautions was low. Among the 247 youth who had initiated sexual activity, lifetime condom use was reported by 18%, and condom use at last intercourse by 10%. Youth with higher levels of knowledge were more likely to report behavior changes to avoid HIV infection. These findings underscore the urgent need for prevention programs tailored to street youth in developing countries. The findings reported in this paper demonstrate that Brazilian street youth are at risk of HIV infection. Prevention programs are needed to increase understanding of transmission mechanisms, decrease beliefs in casual contagion, and promote effective risk-reduction strategies.

de Lima e Costa M F F (Grupo de Pesquisas em Epidemiologia, Universidade Federal de Minas Gerais, Av Alfredo Balena 190, 30. 130, Belo Horizonte, Minas Gerais, Brazil), Oliveira M R, Oliveira E I, Paulino U H M, Greco D B, Chiari C A, Guimaraes M D C, Proietti F A, Antunes C M F and Munoz A. Factors associated with AIDS and AIDS-like syndrome among homosexual and bisexual men in Minas Gerais, Brazil, 1990, : 429–434. A case-control study to determine factors associated with AIDS and AIDS-like syndrome among homosexual/bisexual men was conducted in the State of Minas Gerais (Brazil). Eighty-three per cent (45 patients) of all AIDS/AIDS-like syndrome cases in homosexual/bisexual men reported in Minas Gerais between February, 1986 and June, 1987 were compared to 133 seronegative controls seen at the same clinic. Blood samples were tested by ELISA and confirmed by Western blot. Sex with men from the USA, sex with someone who developed AIDS, number of male partners (≥ 100 lifetime), age (≥30 years old) and ethnicity (white) were independently associated with AIDS/AIDS-like syndrome (Odds Ratios = 5.5, 4.3, 3.9, 3.5 and 2.7, respectively). Thirty-nine per cent of cases and 44% of controls reported bisexual activity during the previous two years. From these, a high proportion reported anal intercourse with women in the same period (53% of bisexual cases and 33% of bisexual controls). Bisexual men had more male partners than female partners in the previous two years (median male partners = 20 for cases and five for controls; median female partners = three for both cases and controls). This explains in part why the epidemic has increased more rapidly among men then among women in Minas Gerais, despite the large proportion of bisexuals with the disease. [ABSTRACT FROM PUBLISHER]

The Sociedade Brasileira de Alergia e Immunopatologia (SBAI), or Brazilian Society for Allergy and Imnunopathology, was established in 1962 to improve the practice of and the research on allergology and clinical immunology in Brazil. The SBAI will hold its main regional scientific meeting in Salvador, Bahia, from November 6-9, 1997, and the Brazilian Congress of Allergy and Immunopathology will he held in Belo Horizonte, Minas Gerais, in November 1998.