Abstract
Brazil has the largest cocaine market in South America, and crack cocaine use is closely associated with HIV-1 infection. This study investigated the prevalence, risk factors, and HIV-1 subtypes, including recombinant forms and mutations associated with drug resistance, among crack cocaine users in Central-West Brazil. We recruited 600 crack cocaine users admitted to a referral hospital in Goiânia for psychiatric disorders. The participants were interviewed; blood samples were collected for anti-HIV-1/2 serological screening. HIV-1 pol gene sequences (entire protease [PR] and partial reverse transcriptase [RT]) were obtained from plasma RNA. HIV-1 subtypes, recombinant viruses, transmitted drug resistance (TDR), and secondary drug resistance mutations were investigated. The median participant age was 30 years (range, 18–68 years); most were male, single, unemployed, and of mixed races. Among them, 2.8% (17/600) were HIV-1 positive: 2.2% of men (11/507) and 6.5% of women (6/93). The main predictors of HIV-1 seropositivity were a sexual partner with HIV infection, irregular condom use, and previous homelessness. HIV-1 pol sequences (12/17) indicated the predominance of subtype B (n = 7), followed by recombinant forms FPR/BRT (n = 1) and BPR/FRT (n = 2) and subtypes F1 (n = 1) and C (n = 1). TDR prevalence was 58.3% (7/12). Isolates from two participants showed mutations associated with resistance to nucleoside reverse transcriptase inhibitors (NRTI) only (M41L, T125C, T125F, M184V), while an isolate from one patient who had received antiretroviral therapy (ART) since 2008 had a mutation associated with resistance to non-NRTI (G190S). Five isolates had secondary mutations to protease inhibitors (K20M, L10V, L33I, A71T, A71V). In conclusion, the findings of HIV-1 circulation, TDR to NRTI, and secondary mutations to protease inhibitors in ART-naïve crack cocaine users support the importance of monitoring this population in regions far from the epicenter of the HIV epidemic.
Highlights
Unlike other regions worldwide, in South America the annual prevalence of cocaine use continues to rise, from 0.7% in 2010 (1.84 million users) to 1.2% in 2012 (3.34 million users), remaining at the same level in 2013
We investigated 600 crack cocaine users admitted to a referral hospital that attends to patients from the public health system in the city of Goiania
To the best of our knowledge, this is the first study regarding the epidemiology of HIV among crack cocaine users in Goiania, Central-West Brazil, providing insights into HIV-1 circulation and molecular characteristics and facilitating target interventions aimed at preventing HIV in this high-risk population
Summary
In South America the annual prevalence of cocaine use continues to rise, from 0.7% in 2010 (1.84 million users) to 1.2% in 2012 (3.34 million users), remaining at the same level in 2013. Brazil has been known to have the largest cocaine market in South America [1], and two large national surveys have estimated the prevalence of crack cocaine users to be 0.8%, representing 370,000 users [2, 3]. Crack cocaine use has shown a high association with sexually transmitted infections (STI) due to the increased frequency of sexual risk behaviors [7, 8]. A close relationship has been described between crack cocaine use and HIV-1 infection, and high HIV-1 prevalence rates have been observed among crack cocaine users in Western countries [9,10,11,12,13]. Crack cocaine seems to facilitate HIV disease progression [14]
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