Hepatitis C Virus among Female Sex Workers: A Cross-Sectional Study Conducted along Rivers and Highways in the Amazon Region.

Oliveira-Filho Oliveira-Filho,Lemos Lemos,Machado Machado,Cavalcante Cavalcante,Silva-Oliveira Silva-Oliveira,Kupek Kupek,Lisboa Lisboa,Raiol Raiol,Frade Frade,Martins Martins,Pinheiro Pinheiro,Pinho Pinho,Da Costa Da Costa,Aires Aires

doi:10.3390/pathogens8040236

Abstract

Background: Previous studies found a high prevalence of pathogens among female sex workers (FSWs) in the Amazon region, and established their parenteral and sexual transmission. This study estimated the prevalence of hepatitis C virus (HCV) infection and associated risk factors, and the frequency of HCV genotypes and resistance-associated substitutions (RASs) in this vulnerable group. Methods: Distinct sampling methods were used to access 412 FSWs in cities and riverside communities in the Amazon region from 2015 to 2018. Three methods for HCV diagnosis were used to determine infection status. HCV genotypes and RASs were identified by sequencing and nucleotide fragment analysis. An association between HCV infection and exposure factors was determined by bivariate and multivariate analysis. Results: In total, 44 (10.7%) FSWs were exposed to HCV, and 32 (7.8%) of them had active infection. Nine socioeconomic characteristics and risky sexual behaviors were associated with HCV exposure, particularly unprotected sex and condom exemption for the clients who paid extra money. Genotype 1 (81.3%) and 3 (18.7%) were detected. The frequency of FSWs with RASs was 23.1% (6/26) for grazoprevir related to the occurrence of substitutions Y56F and S122G. Conclusions: HCV infection among FSWs is highly prevalent and dominated by genotype I. Urgent preventive and treatment measures are required to reduce HCV infection in FSWs and the general population.

Highlights

The hepatitis C virus (HCV) infection is a major public health problem worldwide; an estimated100 million people have serological evidence of HCV exposure, which may be associated with a growing trend in deaths per year [1]
70 female sex workers (FSWs) were excluded from the sample due to being under 18 years of age, signs of the effect of alcoholic beverages during a meeting with researchers, and solicited financial resources to provide biological samples and personal information
This study sample consisted of biological samples and personal information provided by 412 FSWs (Figure 1), of which 180 women worked in the sex trade points in 7 municipalities and 18 riverine communities of the Marajó Archipelago, and the other 232 women worked in the sex trade points near highways, in 11 municipalities in the state of Pará (Supplementary Materials—Table S1)

Summary

Introduction

The hepatitis C virus (HCV) infection is a major public health problem worldwide; an estimated100 million people have serological evidence of HCV exposure, which may be associated with a growing trend in deaths per year [1]. Illicit drug use is a major risk factor for HCV infection [2,3]. Risky sexual behavior may be a risk factor for HCV infection, and has been reported as an important route of viral transmission among people who use illicit drugs (PWUDs), female sex workers (FSWs), and men who have sex with other men (MSMs) [5,6,7]. A high genetic diversity of HCV has been detected These viruses can be classified into seven genotypes (1–7) and numerous subtypes (1a, 1b, 1c, 2a, 2b, 2c, 3a, 3b, 4a, 5a, and others). This study estimated the prevalence of hepatitis C virus (HCV) infection and associated risk factors, and the frequency of HCV genotypes and resistance-associated substitutions (RASs) in this vulnerable group. Conclusions: HCV infection among FSWs is highly prevalent and dominated by genotype

Methods

Results

Conclusion