Caracterização da prevalência de HIV e risco de aquisição da doença  entre portadores de doença falciforme no Brasil

Abstract

Dedico este trabalho à minha mãe, que foi mãe e pai; e ao meu pai que partiu cedo e deixou saudades. Aos meus filhos Bernardo e Gabriel, que são o melhor presente que já ganhei; e ao meu marido Luiz, com quem compartilhei as melhores experiências da minha vida. AgradecimentosAgradeço ao meu orientador Prof. Dr. Cesar de Almeida Neto por toda a convivência e aprendizado, além de sua dedicação como mentor. Atribuo a ele grande parte do meu desenvolvimento pessoal e profissional, e sempre em meio a muitas risadas. Agradeço à Profa. Dra. Ester Sabino por tornar a pesquisa clínica acessível a todos, sem vaidades ou competições desnecessárias, promovendo o conhecimento acima de tudo.Agradeço ao grupo REDS pelas oportunidades, pelo trabalho em equipe e pela rede de suporte que criamos para o desenvolvimento e aprimoramento dos pesquisadores.Caselli PFB. Characterization of HIV prevalence and exposure to risk factors for HIV acquisition within a Brazilian sickle cell disease cohort [thesis]. Sao Paulo, "Faculdade de Medicina, Universidade de São Paulo"; 2020. INTRODUCTION:Sickle cell disease (SCD) affects mainly patients from African ancestry, especially the Sub-Saharan region, and it is also the main region affected by HIV infection in the world. There is limited literature focused on the interaction between HIV and sickle cell disease, although published reports show HIV is relatively rare in this population. It is also unknown the mechanism responsible for this possible lower HIV prevalence in SCD patients, and if it is connected to reduced exposure to risk factors for HIV or related to intrinsic mechanisms of SCD. OBJECTIVES: we described HIV prevalence and other transfusion transmitted diseases within a cohort of SCD patients treated at six blood centers in Brazil; we compared HIV risk behaviors between SCD patients (cases) from three blood centers and matched non-SCD controls. SCD participants from both studies were followed in a cohort by the Recipient Epidemiology and Donor Evaluation Study-III (REDS-III) International Component study. METHODS: we tested 2,779 patients for HIV, hepatitis C, hepatitis B, HTLV, syphilis and Chagas' disease serological markers and correlated positive tests with clinical and laboratorial results; we compared risk factors for HIV acquisition among 152 patients with SCD (cases) with 154 non-SCD participants (controls). All subjects answered an auto-administered electronic questionnaire (ACASI) with questions related to sexual behavior and other risk factors for HIV. RESULTS: the main marker found was anti-HCV (2.5%), followed by syphilis (1.2%), anti-HTLV 1/2 (0.6%), HBsAg (0.5%), anti-T. cruzi (0.5%) e anti-HIV (0.3%). The evaluation for HIV risk factors´ exposure demonstrated no difference in the main predictor (number of sexual partners in previous 12 months) in cases and controls. Cases received more blood transfusions (p<.001), had more previous surgeries (p.001) and acupuncture treatments (p<.001). CONCLUSIONS: Prevalence of serological markers for most of transfusion transmitted...