Prevalence of Hepatitis C Virus in Brazil's Inmate Population: A Systematic Review

OBJECTIVE

To estimate the prevalence of hepatitis C virus infection in Brazil's inmate population.

METHODS

Systematic review on hepatitis C virus infection in the inmate population. Brazilian studies published from January 1, 1989 to February 20, 2014 were evaluated. The methodological quality of the studies was assessed using a scale of 0 to 8 points.

RESULTS

Eleven eligible studies were analyzed and provided data on hepatitis C virus infection among 4,375 inmates from seven states of Brazil, with a mean quality classification of 7.4. The overall hepatitis C virus prevalence among Brazilian inmates was 13.6% (ranging from 1.0% to 41.0%, depending on the study). The chances of inmates being seropositive for hepatitis C virus in the states of Minas Gerais (MG), Sergipe (SE), Mato Grosso do Sul (MS), Rio Grande do Sul (RS), Goiás (GO) and Espirito Santo (ES) were 84.0% (95%CI 0.06;0.45), 92.0% (95%CI 0.04;0.13), 88.0% (95%CI 0.09;0.18), 74.0% (95%CI 0.16;0.42), 84.0% (95%CI 0.08;0.31) and 89.0% (95%CI 0.01;0.05) respectively, lower than that observed in the Sao Paulo state (seroprevalence of 29.3%). The four studies conducted in the city of Sao Paulo revealed a lower prevalence in more recent studies compared to older ones.

CONCLUSIONS

The highest prevalence of hepatitis C virus infection in Brazil's inmate population was found in Sao Paulo, which may reflect the urban diversity of the country. Despite Brazilian studies having good methodological quality to evaluate the prevalence of the hepatitis C virus, they are scarce and lack data on risk factors associated with this infection, which could support decisions on prevention and implementation of public health policies for Brazilian prisons.

Prevalence of hepatitis C virus among inmate populations grouped into seven different states of Brazil.

State	Positive samples	Sample size	HCV sero-prevalence (%)	95%CI		OR	95%CI		p
				Lower	Upper		Lower	Upper
Sao Paulo	624	2,131	29.3	27.3	31.2	Ref.	–	–	< 0.001
Minas Gerais	4	63	6.3	0.3	12.4	0.16	0.06	0.45
Sergipe	13	422	3.1	1.4	4.7	0.08	0.04	0.13
Mato Grosso do Sul	33	686	4.8	3.2	6.4	0.12	0.09	0.18
Rio Grande do Sul	19	195	9.7	5.6	13.9	0.26	0.16	0.42
Goias	9	148	6.1	2.2	9.9	0.16	0.08	0.31
Espirito Santo	7	730	1.0	0.3	1.7	0.02	0.01	0.05
Total	709	4,375	16.2	15.1	17.3	–	–	–

Full article at:   http://goo.gl/tgGDws

By:  Magri MC1, Ibrahim KY2, Pinto WP2, França FO2, Bernardo WM3, Tengan FM2.

• 1Laboratório de Investigação Médica em Hepatologia por Vírus, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.
• 2Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil.
• 3Centro de Desenvolvimento de Educação Médica, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil. 
• Rev Saude Publica. 2015;49:36. doi: 10.1590/S0034-8910.2015049005886. Epub 2015 Jul 31.

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

High-Impact Hepatitis C Virus Testing for Injection Drug Users in an Urban ED

OBJECTIVES:

We implemented the "High-Impact Testing for Injection Drug Users", or the "HIT IDU" initiative, an emergency physician (EP)-based hepatitis C virus (HCV) testing program. The objective of this study was to evaluate the outcomes of this clinical protocol.

METHODS:

This was a prospective observational pilot study. The HIT IDU initiative encouraged EPs to integrate targeted HCV testing into care, with an emphasis on screening all people who inject drugs (PWID). Physicians selected the primary indication for HCV testing from a drop-down menu integrated into the electronic ordering process. The primary outcome was the absolute number and overall proportion of EP-based HCV antibody positive tests, further stratified by the indication for testing.

RESULTS:

Over the 3-month study period, 14,253 unique patients were evaluated, and EPs tested 155 patients for HCV (1.1%; 95% confidence interval [CI], 0.9%-1.2%), of which 40 (26%, 95% CI, 19%-33%) were HCV antibody positive. The proportion of HCV antibody positivity by testing indication was as follows: PWID 47% (34/73; 95% CI, 35%-59%), patient requested test 10% (4/40; 95% CI, 3%-24%), confirm patient report 67% (2/3; 95% CI, 9%-99%), liver disease of uncertain etiology 0% (0/3; 95% CI, 0%-71%), and other 0% (0/36; 95% CI, 0%-10%). There were 22 patients chronically infected, 19 had a follow-up appointment arranged, 3 attended their follow-up appointment, and 1 patient was treated at 1 year of follow-up.

CONCLUSIONS:

Although the overall number of EP-based HCV tests performed was low, high rates of infection were identified, particularly among PWID. There were significant challenges with linkage to care.

Purchase full article at:   http://goo.gl/pxvZhe

By:  Anderson ES1, Pfeil SK2, Deering LJ2, Todorovic T2, Lippert S3, White DA2.

• 1Department of Emergency Medicine, Alameda Health System, Highland Hospital, Oakland, CA; Department of Emergency Medicine, Stanford University, Palo Alto, CA. Electronic address: esoremanderson@gmail.com.
• 2Department of Emergency Medicine, Alameda Health System, Highland Hospital, Oakland, CA.
• 3Department of Emergency Medicine, Stanford University, Palo Alto, CA. 
• Am J Emerg Med. 2016 Mar 3. pii: S0735-6757(16)00186-8. doi: 10.1016/j.ajem.2016.03.004. 

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Seroprevalence of HCV Markers among HIV Infected Patients from Curitiba & Metropolitan Region, Brazil

OBJECTIVE:

to determine the prevalence and epidemiological factors associated with hepatitis (HCV) coinfection in human immunodeficiency virus (HIV) patients from Curitiba and the metropolitan region.

METHODS:

a study with 303 HIV+ patients, mean age 41.2 years (18-73); 50.5% men, followed at the Hospital de Clínicas, Universidade Federal do Paraná, between April 2008 and March 2009. Clinical and epidemiological data were obtained through questionnaires and retrospective analysis of medical records. Anti-HCV antibodies were detected by chemiluminescence immunoassay.

RESULTS:

a total of 12.9% of HIV+ patients were positive for anti-HCV antibodies, 64.1% were men and 35.9% women, with mean age of 44.5 years (24-66). The frequency of HCV among men was 16.7% and among women 9.1%. HCV prevalence was associated to HIV infection when compared to the general population. The parenteral route of transmission was the most frequent among coinfected patients (46.1%), and the sexual transmission among HIV+/HCV- (71.8%). The frequency of intravenous drug users was higher among the coinfected patients (61.5%) compared to the non coinfected (12.6%).

CONCLUSION:

the prevalence of coinfection with HCV in HIV+ patients is 12.9%, 88 times higher than in the general population in Curitiba. The most frequent route of transmission in the coinfected patients is parenteral, but the sexual route is also representative (34.6%).

Prevalence of HCV/HIV co-infection in different Brazilian geographical regions 

Geographical regions	N	HCV-HIV prevalence (Anti-HCV)	References
Florianópolis, SC	99	53.8%	Treitinger et al., 199934
São Paulo, SP	1,457	17.7%	Mendes-Corrêa et al., 200141
Rio de Janeiro, RJ	238	8.9%	Ferraz et al., 200242
Campinas, SP	232	53.8%	Pavan et al., 200335
Santos, SP	495	36.2%	Segurado et al., 200421
Londrina, PR	784	21.0%	Morimoto et al., 200522
Manaus, AM	704	5.0%	Braga et al., 200623
Porto Alegre, RS	330	38.2%	Tovo et al., 200625
Cuiabá, MT	1,008	10.9%	Mussi et al., 200726
Botucatu, SP	150	14.7%	Corvino et al., 200743
Belo Horizonte, MG	824	9.2%	Carmo et al., 200844
Belo Horizonte, MG	300	15.7%	Rodrigues et al., 200845
Londrina, PR	778	21.0%	Reiche et al., 200829
São Paulo, SP	8,019	12.9%	Farias et al., 200828
Recife, PE	343	4.1%	Carvalho et al., 200946
São Paulo, SP	2,024	16.7%	Mendes-Corrêa et al., 201040
Santa Maria, RS	250	31.2%	Santos et al., 201030
CE	1,291	25.4%	Távora et al., 201332
Curitiba, PR	303	12.9%	Present study

Full article at:   http://goo.gl/LlHsVX

By:  Tizzot MR¹, Grisbach C², Beltrame MH³, Messias-Reason IJ⁴.

¹Pharmacy Course, UNIBRASIL, Curitiba, PR, Brazil.

²Universidade Federal do paraná, Curitiba, PR, Brazil.

³Hospital das Clínicas, UFPR, Curitiba, PR, Brazil.

⁴Pathology Department, UFPR, Curitiba, PR, Brazil.

Rev Assoc Med Bras. 2016 Feb;62(1):65-71. doi: 10.1590/1806-9282.62.01.65.

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Implementation of Rapid HIV & HCV Testing Within Harm Reduction Programs for People Who Inject Drugs

Including HCV and HIV rapid tests in harm reduction programmes (HRP) for people who inject drugs (PWID) can increase detection of these infections in high-risk populations who do not seek conventional health care.

AIMS:

To assess acceptability and feasibility of rapid HIV and HCV tests in HRP; to identify HIV and HCV prevalence rates in HRP; to identify the percentage of PWID with a reactive test that attend hospital for confirmation and follow-up. Rapid oral tests for HCV and HIV were offered to users of 13 HRP from both mobile units and facility-based centres. 

A total of 172 HCV and 198 HIV tests were performed, with a refusal rate of 1.7% and 10.4%, respectively. Injectors made up 64.9% of all drug users and 35.1% did not inject drugs. Overall, 20.3% of HCV tests and 2.5% of HIV test were reactive. Only 24 of the 35 reactive HCV could be confirmed (68.6%) and one was false-negative. Of the five HIV reactive cases, only two could be confirmed (40%) with 1 false-positive case.

 Acceptability of rapid HIV and HCV tests among HRP users was high. The usefulness of oral rapid tests in HRP has been demonstrated, especially in mobile HRP.

Purchase full article at:   http://goo.gl/RwRl5R

By:  Fernàndez-López L1,2,3, Folch C1,2,3, Majó X4, Gasulla L4, Casabona J1,2,3,5.

• 1 Centre for Epidemiological Studies on HIV/STI in Catalonia (CEEISCAT) , Institut Catala d'Oncologia (ICO), Agencia de Salut Publica de Catalunya (ASPC), Generalitat de Catalunya , Badalona , Spain.
• 2 CIBER Epidemiologia y Salud Pública (CIBERESP) , Madrid , Spain.
• 3 Fundació Institut d'Investigacio Germans Trias i Pujol (IGTP) , Badalona , Spain.
• 4 Subdirecció General de Drogodependències , Agència de Salut Pública de Catalunya , Barcelona , Spain.
• 5 Departament de Pediatria, d'Obstetricia i Ginecologia i de Medicina Preventiva i de Salut Publica , Univ Autonoma Barcelona , Badalona , Spain. 
• AIDS Care. 2016 Mar 23:1-5. 

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health