Characterization of HIV risks in a Brazilian sickle cell disease population
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RESEARCH ARTICLE
Open Access
Characterization of HIV risks in a Brazilian sickle cell disease population P. F. Blatyta1,2* , S. Kelly3, T. T. Goncalez3, A. B. Carneiro-Proietti4, T. Salomon4, C. Miranda4, E. Sabino5, L. Preiss6, C. Maximo7, P. Loureiro8, B. Custer3, C. de Almeida-Neto2,9 and for the NHLBI Recipient Epidemiology and Donor Evaluation Study-III (REDS-III) International Component, Brazil
Abstract Background: A low prevalence of HIV in sickle cell disease (SCD) patients has been reported in the literature though mechanisms for this are not understood. Methods: HIV risk behaviors were compared between SCD cases and non-SCD controls using a self-administered audio computer-assisted self-interview. SCD cases were recruited from a multi-center SCD cohort established in Brazil; controls were recruited from SCD social contacts. Categorical variables were analyzed using Chi-Square or Fisher exact test. Continuous variables were compared using the Mann-Whitney U test. Results: There were 152 SCD cases and 154 age/location matched controls enrolled at three participating Brazilian centers during 2016–17. No significant differences in number of sexual partners (lifetime or previous 12 months), male-to-male sex partners or intravenous drug use were observed. Cases received more transfusions, surgeries, and acupuncture treatment. Conclusions: Besides the risk of transfusion-transmitted HIV, which is now exceedingly rare, SCD and non-SCD participants demonstrated similar HIV risk behaviors. Causes other than risk behaviors such as factors inherent to SCD pathophysiology may explain the reported low prevalence of HIV in SCD. Keywords: HIV, Sickle cell disease, Transfusion transmitted infections, HIV risk factors
Background The limited literature focused on human immunodeficiency virus (HIV) in sickle cell disease (SCD) demonstrates that HIV is relatively rare in this population. Studies over the past few decades have consistently shown a lower prevalence of HIV in SCD compared to non-SCD populations [1–4], however these studies were limited by small numbers of study participants, insufficient matching of control populations and no measurement of HIV risk factors.
* Correspondence: [email protected] 1 Hospital Moysés Deutsch, São Paulo, SP, Brazil 2 Disciplina de Ciências Médicas, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil Full list of author information is available at the end of the article
Possible explanations for the reduced rates of HIV in SCD may include inhibition of human immunodeficiency virus (HIV) replication due to the pro-inflammatory status of SCD patients [5], influence of Duffy antigen on HIV-1 capability of infecting SCD host cells [6], HIV-1 transcription and replication inhibition in SCD patients’ cells due to increased ferroportin expression and reduced intracellular iron [7], or an increased expression in SCD of CCR5Δ32 [8] that promotes resistance to HIV infection. Risk of HIV in SCD may be also modulated by lower exposure to HIV, as a few prior studies h
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