Prevalence and factors associated with coinfections among women living with HIV/AIDS in a state in northeastern Brazil

Introduction: the impact of the biological interaction between Human Immunodeficiency Virus (HIV) and coinfections is widely discussed in the world context. Objective: to verify the prevalence of coinfections in women living with HIV/AIDS in a state in northeastern Brazil. Methods: A cross-sectional study was conducted at reference outpatient clinic for people living with HIV/AIDS in Sergipe state between August 2014 and November 2017. A total of 435 HIV-positive women were followed-up at the clinic. After interview, clinical reports and laboratory tests of syphilis, hepatitis B and C, toxoplasmosis, rubella and cytomegalovirus were verified. HIV-Tuberculosis coinfection was analysed by record linkage with the SINAN/Sergipe database with reported tuberculosis cases in women between 2001 and 2017. For the molecular diagnosis of human papillomavirus (HPV), samples of the endocervical canal were collected of 270 women participating in the study. DNA was extracted and amplified by the Polymerase Chain Reaction technique and genotyping was performed by sequencing the positive samples. Descriptive statistics and bivariate analyses were performed to measure associations between independent variables and occurrence of coinfections. Results: Among 435 HIV-positive women, the median (interquartile range) age was 38 (30-46) years old; 209 (48.5%) had 0-4 years of schooling; 280 (67.6%) were in marital union; and 191 (45.4%) had their first sexual intercourse under 15 years old. Being black (Prevalence Ratio (PR) 1.58, 95% CI= 0.75-3.33), acquiring HIV through sexual intercourse (PR=1.58, 95% CI= 0.80-2.73), having first sexual intercourse under the age of 15 (PR=1.51, 95% CI= 0.93-2.45), and having sex for money (PR=1.76, 95% CI=0.88-3.50) were predictors of coinfection. The prevalences of coinfections identified in this study were: 9.1% for syphilis (38/419), 3.9% for tuberculosis (17/435), 3.8% for toxoplasmosis (13/340), 2.5% for hepatitis C (10/401), 2.3% for hepatitis B (9/394) and 1.8% for rubella (5/280). In addition, seropositivity for IgG antibody against cytomegalovirus (96.2%), rubella (90%) and toxoplasmosis (71.2%) were detected. Among the 270 women who underwent the HPV-DNA detection test, 150 (5.6%) were positive. Twenty- four viral types were identified, 113 (72%) had high risk of oncogenicity HPV and the most prevalent was HPV 16 (53/35.3%), followed by: HPV 6, 31, 33 and 35 (9/6%, each). Positive 12 HPV status was statistically associated with having 4-8 years of schooling (Odds Ratio (OR)= 3.03; 95%CI=1.45-6.53; P=0.002) and having been diagnosed less than five years ago (OR=1.90; 95%CI=1.06-3.40; P=0.027). Among 231 women, 31 (13.4%) had cytological abnormalities, most of them with high-grade squamous intraepithelial lesions (16/51.6%). Of the 200 (86.6%) who were negative for lesions and malignancy on cytology, 99 (49.5%) were HPV DNA positive. Conclusions: syphilis and HPV were the most prevalent coinfections, which shows a higher vulnerability to sexually transmitted infections. In addition, a large diversity of HPV genotypes was detected, of which HPV 16 was the most prevalent. Thus, the information obtained in this study can help strengthen public policies for prevention and diagnosis of coinfections directed at the female population living with HIV/AIDS in Sergipe.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPESIntrodução: o impacto da interação biológica entre o Vírus da Imunodeficiência Humana (HIV) e as coinfecções é bastante discutido mundialmente. Objetivo: verificar a prevalência de coinfecções em mulheres com HIV/AIDS de Sergipe. Métodos: estudo transversal realizado com 435 mulheres HIV-positivas acompanhadas no ambulatório de referência em HIV/AIDS de Sergipe, entre agosto de 2014 e novembro de 2017. Após entrevista, verificou-se relatórios clínicos e testes laboratoriais de sífilis, hepatites B e C, toxoplasmose, rubéola e citomegalovírus. A coinfecção HIV-tuberculose foi analisada através do pareamento determinístico com a base de dados do SINAN/Sergipe. Para realização do diagnóstico molecular do papilomavírus humano (HPV), foram coletadas amostras do canal endocervical de 270 participantes. O DNA foi extraído e amplificado através da técnica de Reação em Cadeia da Polimerase. Realizou-se estatística descritiva e análises bivariadas para mensurar associações entre variáveis independentes e ocorrência de coinfecções. Resultados: entre as 435 mulheres HIV-positivas, a mediana (intervalo interquartil) de idade foi de 38 (30-46) anos; 209 (48,5%) tinham de zero a quatro anos de estudo; 280 (67,6%) estavam em união conjugal; e 191 (45,4%) tiveram a primeira relação sexual com menos de 15 anos. Ser de raça negra (Razão de Prevalência (RP)= 1.58, IC 95%= 0.75-3.33), contrair o HIV por via sexual (RP= 1.58, IC 95%= 0.80-2.73), ter a primeira relação sexual com menos de 15 anos (RP= 1.51, IC 95%= 0.93-2.45) e fazer sexo por dinheiro (RP= 1.76, IC 95%= 0.88-3.50) foram fatores preditores da ocorrência de coinfecção. As prevalências das coinfecções identificadas nesse estudo foram: 9,1% para sífilis (38/419), 3,9% para tuberculose (17/435), 3,8% para toxoplasmose (13/340), 2,5% para hepatite C (10/401), 2,3% para hepatite B (9/394) e 1,8% para rubéola (5/280). Além disso, foram detectadas soropositividades para o anticorpo IgG contra o citomegalovírus (96.2%), rubéola (90%) e toxoplasmose (71,2%). Entre as 270 mulheres que fizeram o teste molecular de detecção do HPV, 150 (5,6%) apresentaram positividade. Foram identificados 24 tipos virais, 113 (72%) de HPV de alto risco de oncogenicidade e o mais prevalente foi o HPV 16 (53/35.3%), seguido por: HPV 6, 31, 33 e 35 (9/6%, cada). O status positivo para HPV apresentou associação com ter de 4 a 8 anos de 10 estudo (Odds Ratio (OR)= 3.03; IC 95%=1.45-6.53; P= 0.002) e ter sido diagnosticada com HIV a menos de cinco anos (OR= 1.90; IC 95%= 1.06-3.40; P= 0.027). Entre 231 mulheres, 31 (13,4%) apresentavam anormalidades citológicas, sendo a maior parte de lesões escamosas de alto grau (16/51,6%). Das 200 (86,6%) que foram negativas para lesões e malignidade na citologia, 99 (49,5%) apresentavam positividade para HPV. Conclusões: a sífilis e o HPV foram as coinfecções mais prevalentes, o que evidencia uma maior vulnerabilidade a infecções sexualmente transmissíveis. Além disso, foi detectada uma ampla diversidade de genótipos de HPV de alto risco, sendo o HPV 16 o mais prevalente. Assim, as informações obtidas nesse estudo podem ajudar no fortalecimento de políticas públicas de prevenção e diagnóstico de coinfecções direcionadas a população feminina vivendo com HIV/AIDS de Sergipe. .São Cristóvã