Hepatitis E Virus in People Who Use Crack-Cocaine: A Cross-Sectional Study in a Remote Region of Northern Brazil

Abstract

People who use crack-cocaine (PWUCC) have numerous vulnerabilities and pose a challenge to health and social assistance services. The exposure to pathogens and risk situations occur differently according to each individual, region and social group. This study identified the presence, genotypes and factors associated with hepatitis E virus (HEV) exposure among a community-recruited cohort of 437 PWUCC in northern Brazil. Epidemiological information was collected through community-based assessments and interviews. Thereafter, blood and fecal samples were collected and tested for HEV using an immunoenzymatic assay, and the genotype was identified by PCR. Logistic regressions were used to identify the risk factors independently associated with exposure to HEV. In total, 79 (18.1%) PWUCC were exposed to HEV: 73 (16.7%) for IgG and six for IgG + IgM. HEV RNA was detected in six fecal samples and in two blood samples from PWUCC with IgM + IgG. Subtype 3c was identified in all of the samples. The factors associated with exposure to HEV were low monthly income, unstable housing (e.g., homelessness), crack-cocaine use ≥40 months, and the shared use of crack-cocaine equipment. The current study provides unique initial insights into HEV status and risk factors among PWUCC in a remote area in Brazil, with diverse implications for urgently improved diagnosis, prevention, and treatment intervention needs.

Hepatitis E Virus Research in Brazil: Looking Back and Forwards

“…In Brazil, crack-cocaine abuse, a drug scene mostly related to vulnerability and social exclusion, has emerged as a serious public health issue. The potential risk of HEV infection associated with crack-cocaine (CCU) has been evaluated in recent cross-sectional studies, which showed high anti-HEV prevalence rates (14.2%, 18.1%, and 20%) in sampled populations from Midwest, North, and South regions [ 70 , 74 , 75 ] ( Table 1 ). Anti-HEV IgM and HEV RNA were detected in serum and fecal samples, thus providing evidence of recent exposure.…”

“…All HEV strains clustered within the subtype HEV-3c, which is frequently found among Brazilian swine herds. The main risk factors associated with exposure to HEV were homelessness, crack-cocaine use ≥40 months, and sharing crack-cocaine equipment [ 75 ].…”

Tracing the History of Hepatitis E Virus Infection in Mexico: From the Enigmatic Genotype 2 to the Current Disease Situation

“…Molecular detection of HEV-RNA in clinical and epidemiological contexts pursues two main goals: diagnosis of active infections and genome sequencing for genotyping. In Mexico, only scientific studies have been published addressing molecular HEV detection, and for most Latin American countries, short partial sequences of the HEV genome are commonly reported ( Supplementary Table S1 ) [ 25 , 27 , 28 , 29 , 40 , 89 , 93 , 94 , 95 , 96 , 97 , 98 , 99 , 100 , 101 , 102 , 103 , 104 , 105 , 106 , 107 , 108 , 109 , 110 , 111 , 112 , 113 , 114 , 115 , 116 , 117 , 118 , 119 , 120 , 121 , 122 , 123 , 124 , 125 , 126 , 127 , 128 , 129 , 130 , 131 , 132 , 133 , 134 , 135 , 136 , 137 …”

Special Issue “Viral Infections in Developing Countries”

“…This is also true for viral hepatitis. Thus, Nascimento et al [20] identified the presence, genotypes and factors associated with hepatitis E virus (HEV) exposure among a community of people who use crack cocaine (PWUCC) in northern Brazil. Blood and fecal samples were collected and tested for HEV using an immunoenzymatic assay, and the genotype was identified by PCR.…”