Co-infection In Brazil Research Articles

Clusters of heterogeneity of tuberculosis-HIV coinfection in Brazil: a geospatial study.

To analyze the geospatialization of tuberculosis-HIV coinfection in Brazil, from 2010 to 2021, and the correlation with socioeconomic, housing, and health indicators. An ecological study of Brazilian municipalities and states, with data from HIV and tuberculosis information systems, previously reported by the Ministry of Health. The crude and smoothed coefficients were calculated by the local empirical Bayesian method of incidence of coinfection per 100,000 inhabitants in the population aged between 18 and 59 years. Univariate (identification of clusters) and bivariate (correlation with 20 indicators) Moran's indices were used. A total of 122,223 cases of coinfection were registered in Brazil from 2010 to 2021, with a mean coefficient of 8.30/100,000. The South (11.44/100,000) and North (9.93/100,000) regions concentrated the highest burden of infections. The coefficients dropped in Brazil, in all regions, in the years of covid-19 (2020 and 2021). The highest coefficients were observed in the municipalities of the states of Rio Grande do Sul, Mato Grosso do Sul, and Amazonas, with high-high clusters in the capitals, border regions, coast of the country. The municipalities belonging to the states of Minas Gerais, Bahia, Paraná, and Piauí showed low-low clusters. There was a direct correlation with human development indices and aids rates, as well as an indirect correlation with the proportion of poor or of those vulnerable to poverty and the Gini index. The spatial analysis of tuberculosis-HIV coinfection showed heterogeneity in the Brazilian territory and constant behavior throughout the period, revealing clusters with high-burden municipalities, especially in large urban centers and in states with a high occurrence of HIV and/or tuberculosis. These findings, in addition to alerting to the effects of the covid-19 pandemic, can incorporate strategic planning for the control of coinfection, aiming to eliminate these infections as public health problems by 2030.

Surveillance of TB-HIV coinfection in Brazil: a space-time approach.

To identify the epidemiological, spatial, and temporal pattern of TB-HIV coinfection in Brazil during the period from 2001 to 2020. Ecological study using space-time analysis techniques. It included cases of TB-HIV coinfection registered in Brazil from 2001 to 2020. The temporal trend analysis was performed using segmented regression by Joinpoint regression. For spatial analysis, Moran indices were calculated and choropleth maps were produced using TerraView and QGIS software. A stable temporal trend was observed in the incidence rates of TB-HIV coinfection in Brazil during the analyzed period. In addition, high-risk areas for coinfection located in states in the North, Southeast, South, and Midwest regions were identified. There was stability in the incidence of TB-HIV coinfection in Brazil over the last 20 years and heterogeneous geographic distribution of risk areas for the condition.

Temporal trend in the incidence of tuberculosis-HIV coinfection in Brazil, by macro-region, Federative Unit, sex and age group, 2010-2021.

To analyze the temporal trend in the incidence of tuberculosis-HIV coinfection in Brazil, by macro-region, Federative Unit, sex and age group, from 2010 to 2021. This was a time series study using surveillance data to estimate average annual percentage changes (AAPC), and 95% confidence intervals (95%CI) via joinpoint regression. 122,211 cases of tuberculosis-HIV coinfection were analyzed; a falling trend was identified for Brazil as a whole (AAPC = -4.3; 95%CI -5.1;-3.7), and in the country's Southern (AAPC = -6.2; 95%CI -6.9;-5.5) and Southeast (AAPC = -4.6; 95%CI -5.6;-3.8) regions, even more so during the COVID-19 pandemic (2020-2021); the greatest falling trend was seen in Santa Catarina (AAPC = -9.3; 95%CI -10.1;-8.5), while the greatest rising trend was found in Tocantins (AAPC = 4.1; 95%CI 0.1;8.6); there was a rising trend among males, especially in Sergipe (AAPC = 3.9; 95%CI 0.4;7.9), and those aged 18 to 34 years, especially in Amapá (AAPC = 7.9; 95%CI 5.1;11.5). The burden and trends of tuberculosis-HIV coinfection were geographically and demographically disparate.

Temporal trend in the incidence of tuberculosis-HIV coinfection in Brazil, by macro-region, Federative Unit, sex and age group, 2010-2021

RESUMO Objetivo Analisar a tendência temporal da incidência da coinfecção tuberculose-HIV no Brasil, por macrorregião, Unidade da Federação, sexo e faixa etária, 2010-2021. Métodos Estudo de séries temporais, com dados de vigilância, para a estimativa de variações percentuais anuais médias (VPAM) e intervalos de confiança de 95% (IC95%), por joinpoint regression. Resultados Foram analisados 122.211 casos de coinfecção tuberculose-HIV; identificou-se tendência decrescente no país (VPAM = -4,3; IC95% 5,1;-3,7) e em suas regiões Sul (VPAM = -6,2; IC95% -6,9;-5,5) e Sudeste (VPAM = -4,6; IC95% -5,6;-3,8), acentuada durante a pandemia de covid-19 (2020-2021); observou-se maior tendência decrescente em Santa Catarina (VPAM = -9,3; IC95% -10,1;-8,5) e maior tendência crescente no Tocantins (VPAM = 4,1; IC95% 0,1;8,6); houve tendência de incremento no sexo masculino, destacando-se Sergipe (VPAM = 3,9; IC95% 0,4;7,9), e na faixa etária de 18-34 anos, sobressaindo-se o Amapá (VPAM = 7,9; IC95% 5,1;11,5). Conclusão Verificaram-se disparidades territoriais e demográficas na carga e nas tendências da coinfecção tuberculose-HIV.

Deaths Related to Chagas Disease and COVID-19 Co-Infection, Brazil, March-December 2020.

We analyzed epidemiologic characteristics and distribution of 492 deaths related to Chagas disease and coronavirus disease (COVID-19) co-infection in Brazil during March‒December 2020. Cumulative co-infected death rates were highest among advanced age groups, persons of Afro-Brazilian ethnicity and with low education levels, and geographically distributed mainly in major Chagas disease‒endemic areas.

Visceral leishmaniasis and HIV coinfection in Brazil: epidemiological profile and spatial patterns.

Geographical overlap of human visceral leishmaniasis (HVL) and HIV infection favors occurrences of HVL/HIV coinfection. The increasing numbers of cases of HVL/HIV coinfection are a worldwide concern and knowledge of the factors involved can help in developing preventive measures. We aimed to identify spatial patterns and describe the epidemiological profile of HVL/HIV coinfection in Brazil from 2007 to 2015. This was an ecological study, in which thematic maps were created through geoprocessing tools, based on secondary data obtained from open-access platforms, to identify priority areas for interventions for controlling HLV/HIV coinfection, using the TerraView 4.2.2 software. We found spatial autocorrelations between the HVL/HIV rates of neighboring municipalities according to the global Moran index (0.10; p<0.01). The highest HVL/HIV rate was in the central-western region. Among the epidemiological characteristics according to the regions, an increasing trend in the annual variation rate was observed, with positive values over the years and statistical significance (p<0.05) in the North with 1.62 (95% CI 0.57 to 2.69; p=0.02) and Northeast with 6.41 (95% CI 2.60 to 10.37; p=0.006). Similarly, increasing trends were observed in the states of Maranhão with 21.34 (95% CI 13.99 to 9.16; p<0.001) and Sergipe with 5.44 (95% CI 0.61 to 10.50; p=0.04). Our results showed spatial overlap between occurrences of HVL and HIV with spatial patterns of HVL/HIV coinfection, thus revealing that the numbers of cases reported are increasing. Identifying areas with higher coinfection indices contributes to applying interventions and control measures among targeted populations, to prevent new cases.

Deaths related to Chagas disease and HIV/AIDS coinfection in Brazil: a nationwide population-based analysis.

Trypanosoma cruzi/HIV coinfection has been described as a relevant clinical event and an emerging public health problem. Here, we describe the epidemiological patterns of deaths related to Chagas disease and HIV/AIDS coinfection in Brazil from 2000 to 2019. We performed a nationwide population-based study using mortality data obtained from the Brazilian Mortality Information System. We included all deaths recorded in Brazil from 2000 to 2019 in which Chagas disease and HIV/AIDS were mentioned on the same death certificate, either as underlying or as associated causes of death. Chagas disease and HIV/AIDS were mentioned on 196/22 663 092 death certificates. HIV/AIDS was the underlying cause in 58.2% (114/196) of deaths and Chagas disease in 33.2% (65/196). The average annual mortality rate was 0.05 deaths/1 000 000 inhabitants (95% CI 0.03 to 0.09). The highest death rates were found among males, those aged 60-69 y, Afro-Brazilians, those with 1-3 y of schooling/study and residents in Chagas disease-endemic regions/states. Respiratory, infectious/parasitic and cardiovascular diseases/disorders were the associated causes of death most commonly mentioned. Mortality due to Chagas disease and HIV/AIDS coinfection may be largely underestimated in Brazil. Our data further reinforce the importance of screening for T. cruzi infection in HIV-infected patients from Chagas disease-endemic areas. Appropriate clinical management should be ensured for Chagas disease and HIV coinfected patients.

COVID-19 and dengue co-infection in Brazil: optimal control and cost-effectiveness analysis.

A mathematical model for the co-interaction of COVID-19 and dengue transmission dynamics is formulated and analyzed. The sub-models are shown to be locally asymptotically stable when the respective reproduction numbers are below unity. Using available data sets, the model is fitted to the cumulative confirmed daily COVID-19 cases and deaths for Brazil (a country with high co-endemicity of both diseases) from February 1, 2021 to September 20, 2021. The fitting was done using the fmincon function in the Optimization Toolbox of MATLAB. Parameters denoting the COVID-19 contact rate, death rate and loss of infection acquired immunity to COVID-19 were estimated using the two data sets. The model is then extended to include optimal control strategies. The appropriate conditions for the existence of optimal control and the optimality system for the co-infection model are established using the Pontryagin’s Principle. Different control strategies and their cost-effectiveness analyses were considered and simulated for the model, which include: controls against incident dengue and COVID-19 infections, control against co-infection with a second disease and treatment controls for both dengue and COVID-19. Highlights of the simulation results show that: (1) dengue prevention strategy could avert as much as 870,000 new COVID-19 infections; (2) dengue only control strategy or COVID-19 only control strategy significantly reduces new co-infection cases; (3) the strategy implementing control against incident dengue infection is the most cost-effective in controlling dengue and COVID-19 co-infections.

COVID-19 and dengue coinfection in Brazil

COVID-19 and dengue coinfection in Brazil

Factors associated with directly observed treatment in tuberculosis/HIV coinfection cases in Porto Alegre, 2009-2013: A retrospective cohort.

BackgroundTB/HIV coinfection is a serious public health issue in Brazil, and patients with coinfection have difficulty adhering to treatments. Directly observed treatment (DOT) has been recommended by the World Health Organization, considering the vulnerability of those affected. The purpose is to investigate the occurrence of DOT and associated factors compared to conventional treatment in Porto Alegre, Brazil.MethodsA retrospective cohort study was carried out with all patients with coinfection from 2009 to 2013 in the city of Porto Alegre, Brazil, the state capital with the highest rate of coinfection in Brazil. The data came from national health information systems. The dependent variable was the performance of DOT. Bivariate and multivariable models were used to determine factors associated with DOT. The percentage of cure and death was verified in a period of two years, comparing patients who received and did not receive DOT.Results2,400 cases of coinfection were reported, with 1,574 males and 826 females and a mean age of 38 years ± 9.91 years. The occurrence of DOT was 16.9%. In the multivariable analysis, factors independently associated to DOT were the year (with greater chances of being received in 2012 and 2013), place of origin, non-white race (OR = 1.29, 95% CI = 1.08–1.54), cases of relapse (OR = 1.33; 95% CI = 1.03–1.73), readmission after abandonment (OR = 1.48, 95% CI = 1.20–1.83), transfer (OR = 2.04; 95% CI = 1.40–2.98), acid-fast bacilli (AFB) test with positive result in first sample (OR = 1.73, 95% CI = 1.24–2.42), alcohol abuse (OR = 1.39; 95% CI = 1.16–1.67), and mental disorders (OR = 1.83; 95% CI = 1.38–2.44.) Of the 532 cases of death, occurring in two years, 10.2% were in patients who underwent DOT and 89.8% in patients who did not undergo DOT (p<0.001). O percentual de óbitos em pessoas que receberam DOT foi de 13% e o percentual de óbitos para pessoas que receberam tratamento convencional foi de 24%.ConclusionsThere was an increase in the percentage of DOT over the years in the scenario studied, and the predictors for DOT were related to social vulnerability. In relation to death within two years, a lower proportion was found in patients who underwent DOT, suggesting a protective effect of the strategy.

Sociodemographic and health profile of TB/HIV co-infection in Brazil: a systematic review.

to ascertain the epidemiological profile of TB/HIV co-infection in Brazilian scenarios. this is a systematic review conducted via electronic search in databases PubMed, EMBASE, LILACS and SciELO, having as inclusion criterion articles based on the Brazilian scenario of TB/HIV co-infection. of the total 174 studies, 15 were selected, revealing the epidemiological profile of the co-infection in different scenarios: male, economically active age, low education level, brown/black ethnicity, low income, heterosexual, pulmonary clinical form, alcoholism and Directly Observed Therapy. the sociodemographic and epidemiological profile of people with TB/HIV co-infection has an expected occurrence pattern, which corroborates articles found in the literature, either at national level or by grouping the studies according to region or state.

First description of Theiler's disease-associated virus infection and epidemiological investigation of equine pegivirus and equine hepacivirus coinfection in Brazil.

Recent advances in the study of equine pegivirus (EPgV), Theiler's disease-associated virus (TDAV) and equine hepacivirus (EqHV) highlight their importance to veterinary and human health. To gain some insight into virus distribution, possible risk factors, presence of liver damage and genetic variability of these viruses in Brazil, we performed a cross-sectional study of EPgV and TDAV infections using a simultaneous detection assay, and assessed EqHV coinfection in different horse cohorts. Of the 500 serum samples screened, TDAV, EPgV and EPgV-EqHV were present in 1.6%, 14.2% and 18.3%, respectively. EPgV-positive horses were present in four Brazilian states: Espírito Santo, Mato Grosso do Sul, Minas Gerais and Rio de Janeiro. Serum biochemical alterations were present in 40.4% of EPgV-infected horses, two of them presenting current liver injury. Chance of infection was 2.7 times higher in horses ≤5years old (p=0.0008) and 4.9 times higher in horses raised under intensive production systems (p=0.0009). EPgV-EqHV coinfection was 75% less likely in horses older than 5years comparatively to those with ≤5years old (p=0.047). TDAV-positive animals were detected in different horse categories without biochemical alteration. Nucleotide sequences were highly conserved among isolates from this study and previous field and commercial product isolates (≥88% identity). Tree topology revealed the formation of two clades (pp=1) for both EPgV and TDAV NS3 partial sequences. In conclusion, the widespread presence of EPgV-RNA suggests an enzootic infection with subclinical viremia in Brazil. Horse management can influence virus spread. This first report of TDAV-infected horses outside the USA reveals the existence of subclinical viremic horses in distant geographical regions. EPgV and TDAV have similar circulating isolates worldwide. These findings contribute to global efforts to understand the epidemiology and pathogenesis of these equine viruses.

Detection and quantification of hepatitis E virus in the absence of IgG and IgM anti-HEV in HIV-positive patients.

To improve RT-qPCR with an internal control and a synthetic standard curve to detect HEV in HIV co-infected patients. A single-stranded RNA (ssRNA) and a double-stranded DNA (dsDNA) synthetic curve were designed, compared to the international reference panel for HEV genotypes, and tested to quantify and detect a reference panel for HEV genotypes. The detection limit of the RNA synthetic curve (50 copies per ml) was better than the DNA synthetic curve (100 copies per ml) and the WHO standard curve (250 copies per ml). Then, 280 serum samples from HIV-positive patients were tested for HEV RNA, which was detected in 3·6% of serum samples. The viral load ranged from 2×102 copies per ml to 4·78×108 copies per ml. HEV IgM/IgG antibodies were not detected in the RNA-positive patients. Sequencing analysis of HEV showed that the virus belongs to genotype 3 (HEV GT3). Real-time PCR was a useful tool to estimate co-infection with HEV/HIV, even in patients with low viral loads and undetectable anti-HEV IgG and IgM antibodies. Hepatitis E virus genotype 3 (HEV GT3) has been associated with silent chronic hepatitis and cirrhosis in HIV-positive subjects worldwide, but there is a lack of data on this co-infection in Brazil.

Visceral leishmaniasis and HIV/AIDS in Brazil: Are we aware enough?

BackgroundThe urbanization of visceral leishmaniasis (VL) and the concurrent movement of the HIV infection to rural areas in Brazil are possible mechanisms associated with an increased number of Leishmania/HIV coinfected people. This study aimed to describe the clinical and epidemiological profile of VL/HIV coinfected patients and compare this profile to non-coinfected VL patients.MethodsCases of VL/HIV coinfection were obtained through a probabilistic record linkage of databases of VL and AIDS cases from the Brazilian Ministry of Health.ResultsWe retrieved 760 cases of VL/HIV coinfection, most prevalent in adult males, with incidence ranging from 0.01 to 0.07 cases, per 100.000 population, in 2001 and 2010, respectively. Case-fatality rates were 27.3% in 2001 and 23.2% in 2010. Weakness, weight loss, cough, other associated infections and haemorrhagic phenomena were more commonly found among coinfected patients, which had a fatality rate three times higher as compared to the non-coinfected group. The relapse proportion was two times greater among coinfected (6.3%) than non-coinfected (3.1%).ConclusionsThe results found herein contribute to the increase of knowledge of the epidemiological situation of VL/HIV coinfection in Brazil and reinforce the necessity of implementing specific strategies to improve early case detection and efficacious and less toxic treatment in order to achieve lower case-fatality rates.

Temporal analysis of reported cases of tuberculosis and of tuberculosis-HIV co-infection in Brazil between 2002 and 2012.

ABSTRACTObjective:To investigate the reported cases of tuberculosis and of tuberculosis-HIV co-infection in Brazil between 2002 and 2012. Methods:This was an observational study based on secondary time series data collected from the Brazilian Case Registry Database for the 2002-2012 period. The incidence of tuberculosis was stratified by gender, age group, geographical region, and outcome, as was that of tuberculosis-HIV co-infection. Results:Nationally, the incidence of tuberculosis declined by 18%, whereas that of tuberculosis-HIV co-infection increased by 3.8%. There was an overall decrease in the incidence of tuberculosis, despite a significant increase in that of tuberculosis-HIV co-infection in women. The incidence of tuberculosis decreased only in the 0- to 9-year age bracket, remaining stable or increasing in the other age groups. The incidence of tuberculosis-HIV co-infection increased by 209% in the ≥ 60-year age bracket. The incidence of tuberculosis decreased in all geographical regions except the south, whereas that of tuberculosis-HIV co-infection increased by over 150% in the north and northeast. Regarding the outcomes, patients with tuberculosis-HIV co-infection, in comparison with patients infected with tuberculosis only, had a 48% lower chance of cure, a 50% greater risk of treatment nonadherence, and a 94% greater risk of death from tuberculosis. Conclusions:Our study shows that tuberculosis continues to be a relevant public health issue in Brazil, because the goals for the control and cure of the disease have yet to be achieved. In addition, the sharp increase in the incidence of tuberculosis-HIV co-infection in women, in the elderly, and in the northern/northeastern region reveals that the population of HIV-infected individuals is rapidly becoming more female, older, and more impoverished.

Mortality related to tuberculosis-HIV/AIDS co-infection in Brazil, 2000-2011: epidemiological patterns and time trends.

Co-infection of tuberculosis (TB)-HIV/AIDS is a persistent public health problem in Brazil. This study describes epidemiological patterns and time trends of mortality related to TB-HIV/AIDS co-infection. Based on mortality data from 2000-2011 (almost 12.5 million deaths), 19,815 deaths related to co-infection were analyzed. The average age-adjusted mortality rate was 0.97 deaths/100,000 inhabitants. The highest mortality rates were found among males, those in economically productive age groups, black race/color and residents of the South region. There was a significant reduction in the mortality coefficient at the national level (annual average percent change: -1.7%; 95%CI: -2.4; -1.0), with different patterns among regions: increases in the North, Northeast and Central regions, a reduction in the Southeast and a stabilization in the South. The strategic integration of TB-HIV/AIDS control programmes is fundamental to reduce the burden of mortality related to co-infection in Brazil.

HCV/HTLV coinfection: Does HTLV-1 interfere in the natural history of HCV-related diseases?

Hepatitis C virus (HCV) and human T-lymphotropic virus type 1 (HTLV-1) coinfection occurs in many regions. However, few studies have focused on the natural history of HCV-induced liver disease in coinfected patients. To describe the clinical, epidemiological, and histopathological aspects of HTLV-1/HCV coinfection in Brazil. A cross-sectional study with 23 patients coinfected with HCV/HTLV. The control groups consisted of 21 patients monoinfected with HCV and 20 patients monoinfected with HTLV-1. The cytokine profiles (Th1 and Th2 cell responses), clinical, laboratory features, and histopathological aspects were examined. The control group for cytokine analysis validation consisted of patients monoinfected with HTLV, and a fourth group consisted of healthy blood donors. No anthropometric differences present between the three infected groups. We observed higher serum concentrations of IFN-γ in patients coinfected with HCV/HTLV-1 than those in HCV monoinfected patients. The HCV/HTLV-1 coinfected group also exhibited a higher degree of liver steatosis than the HCV monoinfected patients. Results suggest that HCV/HTLV-1 coinfection may result in a different pattern of HCV infection due to the immunologic disorders likely associated with HTLV-1, but there is no clear evidence of the HTLV role in the natural history of HCV infection. J. Med. Virol. 88:1967-1972, 2016. © 2016 Wiley Periodicals, Inc.

Short communication: Prevalence and risk factors for human T cell lymphotropic virus infection in Southern Brazilian HIV-positive patients.

HIV/human T cell lymphotropic virus (HTLV) coinfection has a large range of prevalence in the different risk groups and geographic regions of the world. Most of the HTLV-infected people live in geographic areas where the virus is endemic, as it happens in Brazil. The aim of this study was to identify HTLV prevalence and risk factors in HIV-positive patients. A cross-sectional study was conducted with 580 HIV-positive patients (mean age of 40.6 years and 45.0% men) from a specialized HIV/AIDS diagnosis and treatment center in Southern Brazil. Sociodemographic data, HIV risk factors, and HTLV-1/2 antibodies were collected. HTLV proviral DNA was detected by polymerase chain reaction (PCR). A multivariate analysis was performed to identify risk factors for HTLV infection. HTLV antibodies were detected in 29 (5.0%) and HTLV provirus in 17 (2.9%) patients. HTLV-1 was identified in 11 (64.7%) patients and HTLV-2 in 6 (35.3%) patients. No significant differences were observed between mono and coinfected patients in clinical characteristics regarding HIV/AIDS (time since HIV diagnosis, HIV viral load, lymphocytes CD4(+) count, and use of highly active antiretroviral therapy). Blood transfusion history was significantly associated with HIV/HTLV coinfection (p=0.039). Alcohol abuse was more prevalent in HTLV-positive (47.1%) than in HIV mono-infected patients (20.4%; p=0.008). Tattooing was the only risk factor independently associated with HIV/HTLV coinfection (p=0.035). This information contributes to an understanding of the epidemiology of HIV/HTLV coinfection in Brazil.

Epidemiological patterns of mortality due to visceral leishmaniasis and HIV/AIDS co-infection in Brazil, 2000–2011

Visceral leishmaniasis (VL)-HIV/AIDS co-infection is an emerging health problem with high case fatality. This study presents the epidemiological and clinical aspects of deaths related to VL-HIV/AIDS co-infection in Brazil. This was a nationwide population-based study based on mortality data obtained from the Brazilian Mortality Information System. We included all deaths between 2000 and 2011 (about 12.5 million), and analyzed those in which VL and HIV/AIDS were mentioned in the same death certificate. VL and HIV/AIDS were mentioned in 272 deaths. HIV/AIDS was the underlying cause in 59.6% (162/272) of deaths by VL-HIV/AIDS co-infection, and VL the underlying cause in 39.3% (107/272). Predominating characteristics were: male gender (79.0%, 215/272), age 30-39 years (41.0%, 111/271), brown race/color (61.6%, 159/258) and residence in the Northeast region (47.4%, 129/272). Average annual age-adjusted mortality rate was 0.13 deaths/1 000 000 inhabitants. Deaths were distributed in 20 of 27 Brazilian states. There was an increasing trend of mortality (annual percent change: 16.4%). Infectious/parasitic (58.8%) and respiratory (51.1%) diseases/disorders, particularly sepsis, respiratory failure and pneumonia, were most commonly associated with deaths related to this co-infection. VL-HIV/AIDS co-infection is an increasing public health problem in Brazil. The systematic description of the epidemiological characteristics and magnitude of mortality related to VL-HIV/AIDS co-infection reflects the need to intensify control measures and disease surveillance.

Alcohol misuse and illicit drug use are associated with HCV/HIV co-infection

We studied hepatitis C virus (HCV) prevalence and risk factors for HCV infection in a sample of Brazilian HIV-positive patients. A cross-sectional study was conducted with 580 HIV-positive patients from a specialized HIV/AIDS diagnosis and treatment centre in southern Brazil. All patients were interviewed for socio-demographic and risk factors and tested for HCV antibodies and HCV-RNA detection. A multivariate analysis was performed to identify risk factors for HCV infection. A total of 138 (24%) patients had past or chronic hepatitis C. The following risk factors were associated with HCV infection for each gender: alcohol misuse and injecting drug use in women (P < 0·001) and low educational level, smoking drug use, and injecting drug use in men (P < 0·01). These results suggest that alcohol misuse, low educational level, smoking drug use, and injecting drug use are probable risk factors for HCV infection in HIV-positive patients. This information contributes to an understanding of the epidemiology of HIV/HCV co-infection in Brazil.