AEGiS-13IAC: Increased incidence of HIV and evidence of transmission of resistant virus among anonymous test site (ATS) attendees in Santos, Brazil, 1995-1999.

13th International AIDS Conference

Durban, South Africa - July 9-July 14, 2000

Increased incidence of HIV and evidence of transmission of resistant virus among anonymous test site (ATS) attendees in Santos, Brazil, 1995-1999.

Int Conf AIDS 2000 Jul 9-14; 13:20 (abstract no.. LbOr17)

Page-Shafer K, Alves K, Graves A, Caseiro M, Rawal B, Sucupira C, Guevara H, Diaz R, Rutherford G, Coates T
University of California, San Francisco, CA 94105. Fax: 415-597-9125, E-mail: shafer@psg.ucsf.edu.

OBJECTIVES: To (1) estimate HIV incidence among ATS clients in Santos, Brazil by sensitive/less-sensitive (S/LS) EIA testing; (2) describe risk factors associated with recent infection; and (3) measure the prevalence of anti-retroviral (ARV) resistance and subtypes among recent infections.

METHODS: We collected sera from 10,725 HIV-infected ATS clients_18 years; 698 (6.5%) were HIV-1+. Recent infections were identified by a positive EIA 3A11 and a negative EIA 3A11-LS (termed HIV+SC) and incidence calculated using a standard algorithm. We also compared demographic and risk behavior in 17 HIV+SC identified in 1999 and comparison group of HIV- (N=37) and other HIV+ (N=37). We subtyped HIV-1 by synthetic peptides based on the V3 region of HIV gp120. We tested for ARV genotypic resistance by PCR amplification from proviral DNA and genomic sequencing of pol region.

RESULTS: Of 392 HIV+ clients whose samples were available, 44 (11%) were HIV+SC. Annual incidence per 100 py was 1.9%, 1.5%, 1.3%, 2.4% and 3.2%. There were no differences in age, race, marital or educational status among HIV-, HIV+SC and HIV+. 76% of HIV+SC were female; 61.5% had 1 sex partner in the past year. Risk factors for HIV+SC compared to HIV- were female sex (OR 8.0; 95%CI 1.2-52), anal sex (OR 11.5; 95%CI 2.4-55.4), and history of STD (OR 4.2; 95%CI 0.9-19.8). Almost all (97%) of the isolates were subtype B; 56% were the Brazilian variant Br; 2 were C. We found high-level genotypic resistance to AZT in 1/5 HIV+SC (M41L+T215Y). Few accessory mutations and a high level of polymorphism was found at the protease region.

CONCLUSIONS: This study documents recent increases in HIV incidence in Santos, Brazil. Recent infections are primarily among females reporting steady sexual partnerships, anal sex and history of STD. We found no non-B or C subtypes. There was evidence of transmission of ARV-resistant virus, pointing strongly to the need for further efforts to monitor this phenomenon in Brazil.

Keywords: AEGIS, Anonymous Testing, Incidence, HIV Infections, HIV-1, HIV Seropositivity, Prevalence, Risk Factors, Sex Behavior, Sexual Partners, Brazil, Human, Female, transmission, epidemiology, AIDS
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