HIV behind bars: human immunodeficiency virus cluster analysis and drug resistance in a reference correctional unit from southern Brazil

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 intramu...

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Bibliographic Details
Published in:PloS one 2013-07, Vol.8 (7), p.e69033-e69033
Main Authors: Prellwitz, Isabel M, Alves, Brunna M, Ikeda, Maria Letícia R, Kuhleis, Daniele, Picon, Pedro D, Jarczewski, Carla A, Osório, Marta R, Sánchez, Alexandra, Seuánez, Héctor N, Larouzé, Bernard, Soares, Marcelo A, Soares, Esmeralda A
Format: Article
Language:English
Subjects:
Acquired immune deficiency syndrome
Adult
AIDS
Analysis
Anti-HIV Agents - pharmacology
Antiretroviral agents
Antiretroviral therapy
Bars
Biology
Brazil - epidemiology
Cluster Analysis
Comorbidity
Cross-Sectional Studies
Disease resistance
Disease transmission
Drug resistance
Drug Resistance, Viral - genetics
Epidemics
Epidemiology
Exposure
Health aspects
Health risks
Highly active antiretroviral therapy
HIV
HIV infections
HIV Infections - epidemiology
HIV-1 - classification
HIV-1 - genetics
Human immunodeficiency virus
Humans
Infection
Infections
Intravenous administration
Medicine
Molecular Sequence Data
Phylogeny
pol Gene Products, Human Immunodeficiency Virus - genetics
Prevalence
Prisoners
Prisons
Recombinants
Serology
Sexual behavior
Sexually transmitted diseases
STD
Strains (organisms)
Tuberculosis
Viruses
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Summary: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.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0069033