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Abstract
The aim is to estimate HBV prevalence and the associated risks among noninjecting cocaine users (NICUs). In 2002–2003, a total of 824 NICUs from Buenos Aires (Argentina) and Montevideo (Uruguay) were interviewed using a structured questionnaire. Serologic tests were carried out for Human Immunodeficiency Virus (HIV), hepatitis B (HBV), syphilis, and others. The population was divided into two serologic groups: HBV-infected and seronegative group. Univariate and binary logistic model were developed. The results seem to indicate that, among NICUs, HBV is transmitted through sexual contact. Prevention measures, including vaccine, are needed in order to control and minimize risks. The study's limitations are noted.
RÉSUMÉ
L'objectif est d'estimer la supériorité du VHB et les facteurs à risques associés entre les usagers de cocaïne non injectable. Entre 2002 et 2003, un total de 824 usagers de cocaïne non injectable, de Buenos Aires (Argentine) et Montevideo (Uruguay) furent soumis à un questionnaire structuré. Des tests sérologiques pour le virus de l'imunodéficience acquise (VIH), VHB, Syphilis et autres furent pratiqués. La population partagée en deux groupes sérologiques: infectés par le VHB d'une part et séronégatifs d'autre part. Une analyse univariée fût alors réalisée ainsi qu'un modèle logistique binaire. Les résultats suggèrent que la transmission du VHB entre les candidats soumis au questionnaire, a lieu principalement par voie sexuelle. Des mesures de prévention incluant la vaccination sont necessaires dans le sens de controler et minimiser les risques de cette population.
Mots-clés: Hépatite B, maladie sexuellement transmissible, cocaïne non injectable.
RESUMEN
El objetivo es estimar la prevalencia del HBV y factores de riesgo asociados entre usuarios de cocaína no inyectable (UCNI). En 2002-2003, un total de 824 UCNI de Buenos Aires (Argentina) y Montevideo (Uruguay) fueron entrevistados utilizando un cuestionario estructurado. Pruebas serológicas para el virus de la inmunodeficiencia adquirida (HIV), HBV, sífilis y otros fueron realizados. La población fue dividida en dos grupos serológicos: infectados por el HBV y seronegativos. Fue realizado un análisis uni-variado y fue construido el modelo logístico binario. Los resultados sugieren que la transmisión del HBV entre UCNI parece darse, principalmente, por vía sexual. Medidas de prevención, incluyendo vacunación, son necesarias en el sentido de controlar y minimizar los riesgos en esta población.
Palabras-claves: hepatitis B, enfermedad sexualmente transmitida, cocaína no inyectable.
THE AUTHORS
K. B. F. Zocratto, D.D.S., M.S., Ph.D., is a professor of Public Health at the Newton Paiva University Center, Brazil. She has been working in the field of infectious diseases, in special, hepatitis B and C among drug users.
María Luz Osimani works in Sociology in the Medical Field and is the coordinator of the National Program of STI/AIDS for the Public Health Ministry of Uruguay. She is a university professor and investigator, and member of the Latin American Network of Harm Reduction (RELARD) and coordinator of studies and investigations on prevalence in drug users.
Martínez Peralta, M.D. and Ph.D., is an assistant professor (1997– present) at the Microbiology Department, School of Medicine, University of Buenos Aires. She is member of Clinical Research Career, CONICET. She has a total of 52 peer-reviewed publications.
Dr. Latorre is a sociologist, working in the field of health, drugs, and HIV in the Institute IDES, Uruguay. She works in PROSUL Project that study health and drugs policies. She is responsible to evaluation and monitoring drug harm reduction of the Drug National Secretary in Uruguay. She is a professor of preventive and social medicine (UDELAR) as well as methodology (UDE).
Estela Muzzio, M.D., is working at Plant, CENARESO and F. J. Muñiz Hospital in Buenos Aires. She is a medical consultant of IDIA and is an assistant director of CENARESO. She coordinates the Infectious Diseases Course for physicians at Buenos Aires University.
Marcela Segura, M.D., Ph.D., graduated by the School of Medicine, National University of Cordoba, Argentina in 2000, and has her Ph.D. from the Department of Microbiology, School of Medicine, University of Buenos Aires. Her doctoral thesis was entitled “Seroincidencia de infección por HIV, subtipos virales y coinfecciones asociadas en una cohorte de hombres que tienen sexo con hombres de la ciudad de Buenos Aires.”
Héctor Eduardo Chiparelli Pranzo is an associated professor of Medical University—UROU. He works in Department of Virology and during his scientific career he has published 20 research papers. Furthermore, he has published 4 book chapters. He has been working in the field of infectious diseases: HIV, Hepatitis A, B and C, and others. He works in projects of national agencies (ANII, CSIC, PROINBIO).
Fernando A Proietti, M.D., M.P.H., Sc.D., is an associate professor of Epidemiology and Collective Health at the School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil. He has been working for more than 20 years in the field of infectious diseases, with emphasis in Epidemiology. He has developed extensive experience in the design, conduct, and analysis of infectious diseases and urban health epidemiologic research, such as the cocoordination of a HTLV-1 cohort study. Dr. Proietti has been recipient of Brazilian National Council for Scientific and Technological Development (CNPq) scholarship for more than 10 years, for researching, teaching, and mentoring in the epidemiological field. He also has served on several national and international panels and committees including panels of the National Program on Sexual Transmitted Disease, Brazilian Ministry of Health and Pan-American Health Organization. Dr. Proietti is the cocoordinator of the Observatory on Urban Health in Belo Horizonte, Brazil and member of the International Society for Urban Health.
Jorge Alberto Rey, is a biochemist, and chief of the Transfusion Transmitted Diseases, Department of Hemotherapy and Immunohematology, José de San Martín Clinical Hospital, University of Buenos Aires. He is a blood bank teacher and hematology specialist course, School of Pharmacy and Biochemist, University of Buenos Aires. He is a member of the Advisory Committee in Viral Hepatitis, Ministry of Health, Argentina.
Enrique Vázquez, M.D., Ph.D., in Medicine from the University of Santiago de Compostela, Spain, and an M.P.H. from the University of Antioquia, Colombia. He was working in the Public Health Department of the Regional Autonomous Government of Galicia, Spain. His activities were focused on database information systems, mortality analysis, and epidemiological methods. Currently, he has joined the Pan-American Health Organization as an Epidemiologist in Asunción, Paraguay.
Paloma Cuchí, has recently joined the UNAIDS Epidemic and Impact Monitoring Team in the Epidemiology and Analysis Division as Senior Epidemiological Adviser in Geneva. In this current position Dr. Cuchí is working with the team to build the capacity of countries to produce estimates and projections related to HIV. Before joining UNAIDS in Geneva, Dr Cuchí was responsible the Senior Advisor in Strategic Information for the Regional Office of the Americas of the World Health Organization (PAHO/WHO) in a joint position with UNAIDS. She has extensive experience in producing strategic information for HIV and in Latin America. She has worked closely with her government counterparts to strengthen information systems at national and regional levels. Dr. Cuchí has worked for the last 17 years, focused in Latin America and the Caribbean.
Sergio Sosa-Estani, is a medical surgeon at the School of Medicine, University of Córdoba. Master in Public Health, School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil. He is a doctor in medicine, School of Medicine, University of Buenos Aires. He is the head, Service of Epidemiology, National Center for Research on Endemic Diseases (CeNDIE), ANLIS “Dr. Carlos G. Malbrán”, Ministry of Health from Argentina., adjunct researcher, National Council of Scientific and Technological Research (CONICET). He has done research projects on epidemiological and clinical research, about tropical and endemic diseases, reemerging and emerging diseases.
Diana Rossi is a coordinator researcher at Intercambios Civil Association and professor/researcher at School of Social Sciences, Buenos Aires University. She is member of the editorial board of the International Journal of Drug Policy and is an associate member of the Argentinean Consortium for the New York State/Argentina Fogarty International Project, National Institutes of Health, USA. She is representative of the School of Social Sciences in the Interdisciplinary Master Degree Program on Drug Misuse of the University of Buenos Aires.
Mercedes C. Weissenbacher, is a senior scientist and doctor in medical sciences. During her scientific career she has published 147 research papers, mainly on physiopathology, prevention, and treatment of Argentine Hemorrhagic Fever; treatment with interferon inducers in ocular viral diseases; viral etiology on Acute Respiratory Infections in childhood; and research studies on HIV/AIDS infection and risk factors in vulnerable populations of Latin America. Over the last years she has focused her research activities on HIV-AIDS in Argentina. Furthermore, she has published 13 book chapters on arenaviruses, acute respiratory viruses in children, and HIV/AIDS; obtained more than 70 grants from Argentina and abroad as principal investigator; directed 15 graduate fellows and 11 graduate's thesis; invited to attend over 100 meetings abroad; organized and coordinated numerous congresses in the country; and has presented over 200 scientific communications in national and international congresses.
W. T. Caiaffa, M.D., M.P.H., Sc.D., is an associated professor of Epidemiology at the Federal University of Minas Gerais, Brazil. She has been working in the field of infectious diseases and in the last 10 years has developed the research area on urban health studies, being a (co)founding President of the Observatory on Urban Health in Belo Horizonte, and member-at-large of the International Society for Urban Health. She is recipient of Brazilian National Council for Scientific and Technological Development (CNPq) scholarship for over than 12 years, for researching, teaching, and mentoring in epidemiology. Currently she is the PI of the project “Profiles and trends of risk behaviors for HIV/AIDS, Hepatitis B and C among Drug Users (DUs) in the context of national public health policies: exchange and integration of epidemiological data in Latin America – Brazil, Argentina, and Uruguay” (PROSUL 14/2006 – 490426/2006–9) sponsored by Brazilian National Council for Scientific and Technological Development (CNPq).
Notes
1 To reader: “at-risk” and “protective factors” are usually terms derived form empirical data obtained form epidemiological studies. For further references please see GORDIS, 1996, page 141). Also, according to LAST, 2001(Dictionary of Epidemiology). Population or group at-risk: individuals belonging to a certain group or community who have the potential to contract a certain condition.