Introduction Midwestern Brazil is a significant route and market for cocaine in South America. The consumption of illicit drugs has contributed to HIV dissemination worldwide. Despite this scenario there is little information on the epidemiology of HIV among crack cocaine users in this region. The aims of this study were to estimate the prevalence, risk factors and HIV-1 subtypes among crack users in Goiania, a city in Midwestern Brazil.
Methods A total of 600 crack users were interviewed and blood samples were collected for detection of anti-HIV-1. HIV-RNA was detected in positive samples, the HIV-1 protease (PR) and reverse transcriptase (RT) regions were sequenced; subtypes were assigned by REGA/phylogenetic analysis. HIV-subtypes were assigned by REGA. Univariate and multivariate analysis were carried out to identify predictors of HIV infection. This study was analysed and approved by the Committee on Ethics in Human Research of Hospital das Clínicas, Universidade Federal de Goiás.
Results The median age of participants was 30 years old, and the majority were male, mixed race, single, and unemployed. Of the total, 2.8% were HIV-positive. Having sex with an HIV carrier, irregular condom use during sexual intercourse, and experience of living on the streets were predictors of HIV positivity (p<0.05). In 12 out of 17 crack users RNA HIV-1 were amplified and sequenced. Seven isolates were subtype B, one subtype F1 and one subtype C.
Conclusion A high HIV prevalence was observed among crack users in Midwestern Brazil, a region far from the epicentre of HIV epidemiology. The predictors of HIV infection identified are concerning, and necessitate preventive strategies for HIV infection specifically directed toward this population. HIV-1 subtype C seems to have emerged over the last few years in this population at the centre of the country.
Support: This work was supported by Conselho Nacional de Desenvolvimento Cientifico e Tecnologico – CNPq, and Fundação de Amparo a Pesquisa do Estado de Goiás – FAPEG
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