HIV behind Bars: Human Immunodeficiency Virus Cluster Analysis and Drug Resistance in a Reference Correctional Unit from Southern Brazil

Isabel M Prellwitz,Marta R Osório,Esmeralda A Soares,Maria Letícia R Ikeda,Alexandra Sánchez,Pedro D Picon,Carla A Jarczewski,Marcelo A Soares,Bernard Larouzé,Héctor N Seuánez,Daniele Kuhleis,Brunna M Alves

doi:10.1371/journal.pone.0069033

Abstract

People deprived of liberty in prisons are at higher risk of infection by the human immunodeficiency virus (HIV) due to their increased exposure through intravenous drug use, unprotected sexual activity, tattooing in prison and blood exposure in fights and rebellions. Yet, the contribution of intramural HIV transmission to the epidemic is scarcely known, especially in low- and middle-income settings. In this study, we surveyed 1,667 inmates incarcerated at Presídio Central de Porto Alegre, located in southern Brazil, for HIV infection and molecular characterization. The HIV seroprevalence was 6.6% (110/1,667). Further analyses were carried out on 40 HIV-seropositive inmates to assess HIV transmission clusters and drug resistance within the facility with the use of molecular and phylogenetic techniques. The molecular epidemiology of HIV-1 subtypes observed was similar to the one reported for the general population in southern Brazil, with the predominance of HIV-1 subtypes C, B, CRF31_BC and unique BC recombinants. In particular, the high rate (24%) of URF_BC found here may reflect multiple exposures of the population investigated to HIV infection. We failed to find HIV-infected inmates sharing transmission clusters with each other. Importantly, the analysis of HIV-1 pol genomic fragments evidenced high rates of HIV primary and secondary (acquired) drug resistance and an alarming proportion of virologic failure among patients under treatment, unveiling suboptimal access to antiretroviral therapy (ARV), low ARV adherence and dissemination of drug resistant HIV strains in primary infections. Our results call for immediate actions of public authority to implement preventive measures, serological screening and, for HIV-seropositive subjects, clinical and treatment follow-up in order to control HIV infection and limit the spread of drug resistance strains in Brazilian prisons.

Highlights

Despite human immunodeficiency virus (HIV)/AIDS is a pandemic with worldwide and crossstrata proportions, HIV commonly disseminates more rapidly in specific groups, such as those of men who have sex with men (MSM), commercial sex workers, intravenous drug users (IDU) and people deprived of liberty [1,2,3,4]
Inmates are at increased risk of exposure to co-infections with other viral and bacterial agents that greatly increase susceptibility to HIV infection [5]
In view of the abovementioned scenario, the present study aims to characterize the impact of intraprison HIV transmission and of HIV drug resistance to the HIV/AIDS epidemic of a large penitentiary unit in southern Brazil through the use of molecular identification techniques

Summary

Introduction

Despite HIV/AIDS is a pandemic with worldwide and crossstrata proportions, HIV commonly disseminates more rapidly in specific groups, such as those of men who have sex with men (MSM), commercial sex workers, intravenous drug users (IDU) and people deprived of liberty [1,2,3,4]. HIV prevalence rates are frequently several-fold higher when compared to the general population of the same locale, especially in low- and middle-income countries [5]. Incarcerated subjects are frequently exposed to conditions that favor HIV dissemination, such as IDU, unprotected sexual activity, promiscuity, tattooing and exposure to contaminated blood during fights and rebellions [6]. In Brazil, a middle-income country with continental dimensions, over 600,000 HIV-infected persons are estimated as of June 2011. There are estimated 514,582 incarcerated subjects in Brazil, while the South region concentrates almost 20% of this population (http://www.infopen.gov.br/). Despite such high numbers of prisoners, scarce information is known about their HIV/AIDS status and associated conditions. The contribution of HIV transmission during incarceration is largely unknown in the Brazilian penitentiary system, with few studies addressing this issue [8,9]

Methods

Results

Conclusion